Baseline predictors for visual acuity loss during observation in diabetic macular oedema with good baseline visual acuity

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Posterior Segment Intraocular Foreign Body: Extraction Surgical Techniques, Timing, and Indications for Vitrectomy

Ocular penetrating injury with Intraocular Foreign Body (IOFB) is a common form of ocular injury. Several techniques to remove IOFB have been reported by different authors. The aim of this publication is to review different timing and surgical techniques related to the extraction of IOFB. Material and Methods. A PubMed search on “Extraction of Intraocular Foreign Body,” “Timing for Surgery Intraocular Foreign Body,” and “Surgical Technique Intraocular Foreign Body” was made. Results. Potential advantages of immediate and delayed IOFB removal have been reported with different results. Several techniques to remove IOFB have been reported by different authors with good results. Conclusion. The most important factor at the time to perform IOFB extraction is the experience of the surgeon

Observation versus Treatment in Diabetic Macular Edema with Very Good Visual Acuity – The OBTAIN study

Purpose : To describe and compare the functional and anatomical 12-month outcomes of untreated and treated diabetic macular edema (DME) in eyes with very good baseline visual acuity (VA) in a real-world setting. Methods : To be included in this retrospective, multicenter, observational cohort study, eyes were required to have DME with baseline visual acuity (VA) ≤ 0.1 logMAR (≥ 20/25 Snellen) and central subfield thickness (CST) > 250 µm with intra- and/or subretinal fluid seen on optical coherence tomography. Patients charts were reviewed for demographic data and baseline characteristics, prior DME treatment, VA and CST at baseline, month 3, 6, 9, 12, and DME treatment during the 12-month follow-up. Main outcome measures were change in VA and CST at 12 months in treaed vs. observed eyes. Statistical analyses were performed by generalized estimating equations procedure. Results : A total of 249 eyes from 211 patients were included, of which 155 eyes were treated during follow up and 94 eyes were observed. The majority of eyes maintained vision (VA loss < 5 letters or VA gain) at 12 months (treated: 58.1%; observed: 73.4%). In the vast majority of observed eyes (63/73 eyes, 86.3%) with stable VA within the first 6 months, VA was maintained throughout the follow-up (-0.1 ± 3.8 letters, p=0.889). In 54 of 147 eyes (36.7%), that were initially observed, a VA loss ≥ 5 letters within 6 months was experienced. Within those eyes, further observation (n=21) led to worse visual outcome than treatment (n=33) (-4.2 vs. -7.8 letters, p=0.013). In eyes in which treatment was initiated at baseline (n=102), intensive treatment (8-12 anti-VEGF injections during the 12 months follow up) led to CST improvement (-85.9 vs.+11.3 µm, p=0.003), but there was no significant difference in visual acuity (-0.3 vs. -1.8 letters, p=0.137) compared with observation. Conclusions : In a real-world setting, the majority of DME patients with very good VA maintained vision at 12 months, regardless of whether the DME was treated or not. This study supports close observation of eyes with DME and very good VA with consideration of treatment when a one line drop in vision is observed

Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema

International audienceTo compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting. To be included in this retrospective multicenter, case-control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain ae 5 letters or reduction in central subfield thickness (CST) ae> 20%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12 months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group. A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12 months was - 0.4 +/- 10.8 letters (anti-VEGF group), and + 6.1 +/- 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 +/- 145.9 A mu m (anti-VEGF group) and - 92.8 +/- 173.6 A mu m (DEX group) (P 10 letters (OR 3.71, 95% CI 1.19-11.61, P = 0.024) at month 12. In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12 months than those that continued treatment with anti-VEGF therapy

Real-world outcomes of observation and treatment in diabetic macular edema with very good visual acuity: the OBTAIN study

International audienceTo describe and compare the functional and anatomical outcomes of untreated and treated diabetic macular edema (DME) in eyes with very good baseline visual acuity (VA) in a real-world setting

Polypoidal Choroidal Vasculopathy Based on Non-ICGA Criteria in White Patients With Neovascular Age-Related Macular Degeneration

PURPOSE: To determine prevalence of probable poly-poidal choroidal vasculopathy (PCV) among White patients with neovascular age-related macular degeneration (nAMD) using non-indocyanine green angiography (ICGA) criteria & BULL; DESIGN: Multicenter, multinational, retrospective, cross-sectional study. METHODS: A total of 208 treatmentnaive eyes from Hispanic and non-Hispanic White individuals diagnosed with nAMD were included. All underwent color fundus photography (CFP), optical coherence tomography (OCT), and fluorescein angiography (FFA). De-identified images of study eyes were sent to 2 groups of graders. Group 1 reviewed CFP, OCT, and FFA to confirm nAMD diagnosis. Group 2 reviewed CFP and OCT to determine highly suggestive features for PCV. Probable PCV diagnosis defined as the presence of > 2 of 4 highly suggestive features for PCV: notched or fibrovascular pigment epithelial detachment (PED) on CFP, sharply-peaked PED, notched PED, and hyperreflective ring on OCT. RESULTS: Eleven eyes were excluded because of poor image quality (6) or non-nAMD diagnosis (5). Of 197 eligible eyes (197 patients), the mean age (SD) was 78.8 years (8.9), 44.2% were men, 26.4% were Hispanic, and 73.6% were non-Hispanic White individuals; 41.1%, 23.4%, 9.1%, and 2.5% had > 1, > 2, > 3, and 4 highly suggestive features. Results showed that 23.4% (95% CI, 17.6%-29.9%) had probable PCV diagnosis. Pre-dominantly occult CNV was more frequently found in probable PCV than nAMD subgroup (84.8% vs 64.9%, P = .01). Hispanic White individuals had a lower prevalence of probable PCV than non-Hispanic White individuals (9.6% vs 28.2%, P = .006) CONCLUSIONS: These findings suggest that probable PCV occurs between 17.6% and 29.9% in White individuals with nAMD, and more commonly in non-Hispanic than in Hispanic White individuals. (C) 2022 Elsevier Inc. All rights reserved.