Intravitreal Ranibizumab As Adjuvant Treatment For Neovascular

The purpose of this study was to describe a prospective case series of 5 eyes treated with intravitreal ranibizumab injection for neovascular glaucoma (NVG). Five patients with clinically uncontrolled NVG secondary to proliferative diabetic retinopathy (4 patients) and central retinal vein occlusion (1 patient), non-responsive to maximal tolerable medication and panretinal photocoagulation, received intravitreal ranibizumab injection (0.5 mg). Patients were seen at 1st, 3rd and 7th day after the ranibizumab injection and when it was necessary. Success was defined as intraocular pressure (IOP) 21, despite maximal tolerable medication, underwent trabeculectomy with 0.5mg/ml mitomycin C (MMC) for 1 minute. Failure was defined as IOP > 21 mmHg, phthisis bulbi, loss of light perception or additional glaucoma surgery. The primary outcome was 6-month IOP control. Mean IOP before the ranibizumab injection was 37 mmHg (7 mmHg SD). Two out of five eyes underwent only ranibizumab injection, having an IOP control after the procedure. Three patients were submitted to trabeculectomy with MMC on the 7th day after the injection. At 6-month follow-up, the mean IOP was 12mmHg (3 mmHg SD). All eyes showed regression of rubeosis iridis and IOP control. Visual acuity improved in 2 eyes worsened in 1 eye, and remained stable in 2 eyes. These data suggest that intravitreal ranibizumab injection may be a useful tool in the treatment of NVG.722119121Allingham, R.R., Damji, K.F., Freedman, S., Moroi, S.E., Shafranov, G., (2005), pp. 328-46. , Shields textbook of glaucoma. 5th ed. Philadelphia, PA: Lippincott Williams & WilkinsParrish, R., Hershler, J., Eyes with end-stage neovascular glaucoma.Natural history following successful modified filtering operation (1983) Arch Ophthalmol, 101 (5), pp. 745-6Beutel, J., Peters, S., Lüke, M., Aisenbrey, S., Szurman, P., Spitzer, M.S., Yoeruek, E., Bevacizumab Study Group, Grisanti S. Bevacizumab as adjuvant for neovascular glaucoma (2010) Acta Ophthalmol, 88 (1), pp. 103-9. , Comment in Acta Ophthalmol. 2010;88(4):e133Douat, J., Auriol, S., Mahieu-Durringer, L., Ancèle, E., Pagot-Mathis, V., Mathis, A., [Intravitreal bevacizumab for treatment of neovascular glaucoma. Report of 20 cases] (2009) J Fr Ophtalmol, 32 (9), pp. 652-63Saito, Y., Higashide, T., Takeda, H., Ohkubo, S., Sugiyama, K., Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucoma (2010) Acta Ophthalmol, 88 (1), pp. 96-10

Prophylactic Use Of Ketorolac Tromethamine In Cataract Surgery: A Randomized Trial

Purpose: To determine the efficacy of topical ketorolac tromethamine in preventing cystoid macular edema (CME) after uncomplicated cataract surgery. Methods: This single-center, prospective, double-masked, randomized clinical trial consisted of 81 patients who were scheduled for cataract surgery. Patients were randomized to receive hypromellose/dextran 70 as a placebo (n=44) or ketorolac tromethamine 0.4% (n=37) as an adjuvant therapy. These eye drops were administered 4 times daily (QID) for 3 days before surgery and 5 weeks postoperatively. All patients received prednisolone acetate 1% QID during the same period as basal/standard anti-inflammatory therapy. The primary outcome was the incidence of angiographic CME 5 weeks after surgery. The secondary outcomes were mean change in best-corrected visual acuity (BCVA) [Early Treatment Diabetic Retinopathy study (ETDRS)], clinical CME incidence, intraocular pressure, and retinal thickness measured using optical coherence tomography (OCT). Results: In the placebo group, 2/44 (4.5%) patients and in the ketorolac group, 2/37 (5.4%) patients presented with angiographic CME (P=0.624). The mean change in postoperative BCVA was 32±15 letters in the placebo group and 26±16 letters in the ketorolac group (P=0.07). There were no statistically significant between-group differences in the mean central subfield thickness (P=0.679), minimal central thickness (P=0.352), or central macular volume (P=0.729). Conclusion: There was no difference between ketorolac tromethamine and a placebo with regard to BCVA results or prevention of CME after uncomplicated cataract surgery. © 2014 Mary Ann Liebert, Inc.306495501Wittpenn, J.R., Silverstein, S., Heier, J., A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients (2008) Am. J. 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Ophthalmol., 40, pp. 781-785Gass, J.D., Norton, E.W., Cystoid macular edema and papilledema following cataract extraction A fluorescein fundoscopic and angiographic study (1966) Arch. Ophthalmol., 76, pp. 646-661Miyake, K., Prevention of cystoid macular edema after lens extraction by topical indomethacin (I) A preliminary report (1977) Albrecht von Graefes Arch. Klin. Exp. Ophthalmol., 203, pp. 81-88Miyake, K., Sugiyama, S., Norimatsu, I., Ozawa, T., Prevention of cystoid macular edema after lens extraction by topical indomethacin (III) radioimmunoassay measurement of prostaglandins in the aqueous during and after lens extraction procedures (1978) Albrecht von Graefes Arch. Klin. Exp. Ophthalmol., 209, pp. 83-88Donnenfeld, E.D., Perry, H.D., Wittpenn, J.R., Pre-operative ketorolac tromethamine 0.4% in phacoemulsifi-cation outcomes: Pharmacokinetic-response curve (2006) J. Cataract Refract. Surg., 32, pp. 1474-1482McColgin, A.Z., Heier, J.S., Control of intraocular inflammation associated with cataract surgery (2000) Curr. Opin. Ophthalmol., 11, pp. 3-6Wolf, E.J., Braunstein, A., Shih, C., Braunstein, R.E., Incidence of visually significant pseudophakic macular edema after uneventful phacoemulsification in patients treated with nepafenac (2007) J. Cataract Refract. Surg., 33, pp. 1546-1549Almeida, D.R.P., Johnson, D., Hollands, H., Effect of prophylactic nonsteroidal antiinflammatory drugs on cystoid macular edema assessed using optical coherence tomography quantification of total macular volume after cataract surgery (2008) J. Cataract Refract. Surg., 34, pp. 64-69Almeida, D.R.P., Khan, Z., Xing, L., Prophylactic nepafenac and ketorolac versus placebo in preventing postoperative macular edema after uneventful phacoe-mulsification (2012) J. Cataract Refract. Surg., 38, pp. 1537-1543Brar, M., Yuson, R., Kozak, I., Correlation between morphologic features on spectral-domain optical coherence tomography and angiographic leakage patterns in macular edema (2010) Retina (Philadelphia, Pa.)., 30, pp. 383-389Horii, T., Murakami, T., Nishijima, K., Relationship between fluorescein pooling and optical coherence tomo-graphic reflectivity of cystoid spaces in diabetic macular edema (2012) Ophthalmology., 119, pp. 1047-1055Gharbiya, M., Cruciani, F., Cuozzo, G., Macular thickness changes evaluated with spectral domain optical coherence tomography after uncomplicated phacoemulsifi-cation (2013) Eye (Lond)., 27, pp. 605-611Mathys, K.C., Cohen, K.L., Impact of nepafenac 0.1% on macular thickness and postoperative visual acuity after cataract surgery in patients at low risk for cystoid macular oedema (2010) Eye (Lond)., 24, pp. 90-96Moschos, M.M., Chatziralli, I.P., Pantazis, P., Rouvas, A.A., Sergentanis, T.N., Is topical diclofenac essential before and after uneventful phacoemulsification cataract surgery? (2012) J. Ocul. Pharmacol. Ther., 28, pp. 335-339Grover, S., Murthy, R.K., Brar, V.S., Chalam, K.V., Normative data for macular thickness by high-definition spectral-domain optical coherence tomography (spectralis) (2009) Am. J. Ophthalmol., 148, pp. 266-271Mentes, J., Erakgun, T., Afrashi, F., Kerci, G., Incidence of cystoid macular edema after uncomplicated phacoe-mulsification (2003) Ophthalmologica., 217, pp. 408-412Lobo, C.L., Faria, P.M., Soares, M.A., Bernardes, R.C., Cunha-Vaz, J.G., Macular alterations after small-incision cataract surgery (2004) J. Cataract Refract. Surg., 30, pp. 752-760Gulkilik, G., Kocabora, S., Taskapili, M., Engin, G., Cystoid macular edema after phacoemulsification: Risk factors and effect on visual acuity (2006) Can. J. Ophthalmol., 41, pp. 699-703Asano, S., Miyake, K., Ota, I., Reducing angiographic cystoid macular edema and blood-aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation: Multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethasone 0.1% (2008) J. Cataract Refract. Surg., 34, pp. 57-63Miyake, K., Masuda, K., Shirato, S., Comparison of diclofenac and fluorometholone in preventing cystoid macular edema after small incision cataract surgery: A multicentered prospective trial (2000) Jpn. J. Ophthalmol., 44, pp. 58-67Chatziralli, I.P., Papazisis, L., Sergentanis, T.N., Ke-torolac plus tobramycin/dexamethasone versus tobramycin/dexamethasone after uneventful phacoemulsification surgery: A randomized controlled trial (2011) Ophthalmologica., 225, pp. 89-94Berkow, J.W., Flower, R.W., Orth, D.H., Kelley, J.S., (1997) Fluorescein and Indocyanine Green Angiography: Technique and Interpretation (Ophthalmology Monographs), , San Francisco: American Academy of Ophthalmology;Yilmaz, T., Cordero-Coma, M., Gallagher, M.J., Ke-torolac therapy for the prevention of acute pseudophakic cystoid macular edema: A systematic review (2012) Eye (Lond)., 26, pp. 252-258Solomon, L.D., Efficacy of topical flurbiprofen and indo-methacin in preventing pseudophakic cystoid macular edema Flurbiprofen-CME Study Group i (1995) J. Cataract Refract. Surg., 21, pp. 73-8