Three versus five intravitreal aflibercept injections as the initial loading phase in the treatment of diabetic macular edema: one-year results

Purpose: To compare the efficacy of three initial monthly intravitreal aflibercept injections followed by pro re nata (3+PRN) dosing versus five initial monthly intravitreal aflibercept injections followed by pro re nata (5+ PRN) dosing in patients with diabetic macular edema. Methods: A total of 60 treatment-naive patients with macular edema who underwent intravitreal aflibercept injections (2 mg/0.05 mL) with at least one year of follow-up were analyzed in this retrospective and comparative study. The patients were divided into two groups according to the number of intravitreal aflibercept injections administered in the loading phase. The 3+PRN group comprised 27 patients, whereas the 5+PRN group comprised 33 patients. The visual and anatomical outcomes were compared between the two groups at baseline and at 3, 6, 9, and 12 months. Results: Both 3+ PRN and 5+ PRN, showed statistically significant improvements in the best-corrected visual acuity and central macular thicknesse throughout the study period (p<0.001 and, p < 0.001, respectively). There were no significant differences between the two groups in terms of changes in the best-corrected visual acuity and central macular thickness (p=0.453 and, p=0.784, respectively). The mean number of intravitreal aflibercept injections was significantly greater in the 5+PRN group (6.1 +/- 0.8) than in the 3+PRN group (3.9 +/- 0.8) (p<0.001). Conclusion: The 3+PRN and 5+PRN regimens showed similar 12-month visual and anatomical outcomes following treatment with intravitreal aflibercept injections in patients with macular edema

Farklı cam iyonomer simanların kompozit ve kompomere olan makaslama bağlanma dayanım kuvvetlerinin karşılaştırılması

Amaç: Bu çalışmanın amacı dört farklı cam iyonomer simanın kompozit ve kompomere olan makaslama bağlanma dayanımlarını karşılaştırmaktır. Gereç ve Yöntemler: Çalışma için 80 adet silindirik şekilli akrilik blok hazırlandı. Blokların düz yüzeylerinin ortasına 2 mm derinliğinde ve 3 mm çapında olan çukurcuklar açıldı. Bloklar dört gruba ayrılarak açılan çukurcuklar Ionoseal (Ionoseal, Cuxhaven, Almanya), Ketac Molar (3M EPSE, Seefeld, Almanya), Equia (GC Avrupa, Tokyo, Japonya) ve İmicryl (Imicryl SC, Imicryl Diş Malz San. Tic. AŞ, Konya, Türkiye) marka cam iyonomer materyalleri ile dolduruldu. Standart yüzeyler elde etmek için sertleşmeden önce cam iyonomerlerin üzeri şeffaf bant ile kapatıldı. Sertleşme tamamlandıktan sonra cam iyonomer siman yüzeylerine tek aşamalı adeziv (Futurabond M, VOCO GmbH, Cuxhaven, Almanya) uygulandı ve polimerize edildi. Her bir grup 2 alt gruba ayrıldı. Hazırlanan yüzeylerin üzerine yerleştirilen 2 mm yüksekliğinde ve 2 mm çapındaki aparatın içerisine taşmayacak şekilde doldurulan kompomer (Imicryl SC, Imicryl Diş Malz San. Tic. AŞ, Konya, Türkiye) ve kompozit (VOCO, Cuxhaven, Almanya) materyalleri üretici firmaların tavsiyeleri doğrultusunda LED ışık cihazı ile polimerize edildi. Universal test makinesi ile her bir örnekte kırılma meydana gelinceye kadar kuvvet uygulandı. Veriler iki yönlü varyans analizi ve Tukey çoklu karşılaştırma testleri ile istatistiksel olarak değerlendirildi (p=0.05). Bulgular: Ionoseal’ in kompozit ve kompomere olan makaslama bağlanma değeri diğer cam iyonomerlerden istatistiksel olarak daha yüksek bulundu (p &lt; 0,05). Ketac Molar, Equia ve İmicryl’ in kompozit ve kompomere olan makaslama bağlanma değerleri arasında istatistiksel olarak fark gözlenmedi (p &gt; 0,05). Sonuç: Rezin esaslı cam iyonomer siman olan Ionoseal kimyasal sertleşen Ketac Molar, Equia ve İmicryl cam iyonomer simanlara göre daha yüksek makaslama bağlanma değeri göstermektedir

Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion

AIM: To compare three initial monthly intravitreal ranibizumab (IVR) injections followed by pro re nata (PRN) dosing with one initial monthly IVR injections followed by PRN dosing for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection (1+PRN group) and 24 eyes received 3 monthly IVR injections (3+PRN). At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography (SD-OCT) was performed. Central macular thickness (CMT), the integrity of the external limiting membrane (ELM), the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment (IS/OS) defect were determined. RESULTS: At baseline the mean CMT was 521.3±153.2 µm in the 3+PRN group while it was 438.1±162.4 µm in 1+PRN group. At the final visit, mean CMT was 278.3±87.8 µm in the 3+PRN group and 285.2±74.2 µm in the 1+PRN group (P=0.079). The changes in CMT over the entire study period were also comparable in both groups (243±160 µm in the 3+PRN group, and 152.9±175.3 µm in the 1+PRN group; P=0.090). At baseline, best-corrected visual acuity (BCVA) was 0.92±0.60 logarithm of the minimal angle of resolution (logMAR) in the 3+PRN group, while it was 0.72±0.46 logMAR in the 1+PRN group. Final BCVA was 0.42±0.55 logMAR in the 3+PRN group and 0.38±0.50 logMAR in the 1+PRN group (P=0.979). Additionally, the BCVA changes from baseline to final visit were not significantly different (-0.50±0.45 logMAR in the 3+PRN group, and -0.33±0.39 logMAR in the 1+PRN group; P=0.255). CONCLUSION: No significant differences in the anatomical or functional results are found between 3+PRN and 1+PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1

Objectives: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. Materials and Methods: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. Results: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively. Conclusion: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen

Direct transretinal removal of subfoveal perfluorocarbon liquid combined with internal limiting membrane peeling

A 65-year-old woman was referred to our institution with a 5-day history of visual impairment in her right eye and macula-off retinal detachment. A successful 23 G pars plana vitrectomy was performed with a 1000 cs silicone oil injection, and the silicone oil tamponade was extracted 2 months later. During the fundoscopic and optical coherence tomography examinations, three subfoveal perfluorocarbon liquid bubbles were detected, and her best corrected visual acuity was limited to 20/400. Brilliant blue staining was used for the internal limiting membrane peeling, and the direct transretinal aspiration of the perfluorocarbon liquid bubbles was performed with a 23 G silicone-tip Flute cannula. This patient’s best corrected visual acuity increased to 20/200 at the 1 month follow-up and then to 20/100 at the 1-year follow-up

Comparative Results of Viscotrabeculotomy and Classical Trabeculotomy in Congenital Glaucoma in a Longer-Term Follow-Up

Purpose: To evaluate the results of previously described viscotrabeculotomy technique and to compare them with those of conventional trabeculotomy in longer-term follow-up. Material and Method: This retrospective study included the eyes of 64 patients who underwent either viscotrabeculotomy (group 1) or conventional trabeculotomy (group 2) between February 1992 and April 2011. Group 1 consisted of 58 eyes of 34 patients who underwent viscotrabeculotomy surgery and group 2 consisted of 51 eyes of 30 patients who underwent conventional trabeculotomy. 3 patients (5 eyes) in group 1 and 2 patients (3 eyes) in group 2 left the follow-up for some reasons. At the last visit, group 1 comprised 53 eyes of 31 patients and group 2 comprised 48 eyes of 28 patients. Outcome measures were intraocular pressure (IOP), antiglaucomatous medications, horizontal corneal diameter, and success rate. Results: Success rates in group 1 at 12, 36, 60, 72, 96, 120 months, and at the last visit were 93.10%, 91.30% 89.30%, 87.00%, 84.90%, 83.00%, and 83.00%, respectively. The success rates in group 2 at the above-mentioned follow-up visits were 72.50%, 68.60%, 68.60%, 66.10%, 66.00%, 64.50%, and 62.50%, respectively. The success rate in group 1 was statistically significantly higher than in group 2 at the last visit (p=0.027). IOP and anti-glaucomatous medications at each follow-up examination were lower in group 1 compared to group 2, and these differences were with statistical significance (for each, p<0.05). Horizontal corneal diameters did not differ between the two groups in the postoperative follow-up. Discussion: Viscotrabeculotomy has been found safer and more effective than classical trabeculotomy in longer-term evaluation. Viscodissection of the trabecular meshwork, viscodilation of the Schlemm’s canal, keeping away the lips of trabeculotomy incision, and possibly prevention of postoperative hemorrhage and fibroblastic proliferation by means of high-viscosity sodium hyaluronate are the possible factors that play an important role in the overall success of this procedure. (Turk J Ophthalmol 2013; 43: 380-