Retro-mode imaging of fibrovascular membrane in proliferative diabetic retinopathy after intravitreal bevacizumab injection

The F10 is a new commercially available scanning laser confocal ophthalmoscope (SLO) that can perform multiple functions. We determined the usefulness of noninvasive evaluation of proliferative diabetic retinopathy (PDR) pathologies before and after intravitreal injection of bevacizumab (IVB) using the new indirect viewing system of the retro-mode function of the F10 SLO, and compared the images histologically with surgically excised fibrovascular membrane from two cases. In PDR, neovascular vessels in fibrovascular membrane were clearly seen with the retro-mode, even after IVB and without blood flow. The F10 SLO may be useful in evaluating neovascular vessels in fibrovascular membrane in PDR and for determining the precise retinal changes in diabetic retinopathy

Geometric Morphometrics Can Predict Postoperative Visual Acuity Changes in Patients With Epiretinal Membrane: A Retrospective Study

Purpose: To investigate the efficacy of the geometric morphometrics method for the evaluation of retinal deformation in patients with epiretinal membrane (ERM) and determine whether the degree of deformation can serve as a predictive factor for postoperative visual outcome.Methods: We retrospectively evaluated data from 29 eyes of 29 patients with primary ERM. Preoperative optical coherence tomography images were compared with images of their normal fellow eyes using the geometric morphometrics thin-plate spline technique. Conventional parameters such as retinal layer thickness and previously reported indices were also measured. The correlation between the preoperative parameters and visual acuity was evaluated. Statistical comparisons were performed using a paired t-test, and associations between the optical coherence tomography image parameters and visual acuity were determined using Spearman\u27s rank correlation coefficient.Results: Bending energy, which was calculated using geometric morphometrics, was significantly associated with visual acuity as well as conventional optical coherence tomography parameters and previously reported indices. Multiple regression analysis showed that bending energy was an independent predictive factor for postoperative visual acuity changes.Conclusions: The geometric morphometrics method is an effective approach for evaluating the severity of ERM and predicting the efficacy of surgery.Translational Relevance: Geometric morphometrics can effectively evaluate retinal deformation in eyes with epiretinal membrane

Transcorneal three-port vitrectomy without conjunctival incision.

Background: Although widely accepted, pars plana vitrectomy is difficult to perform when patients have a large filtering bleb. We describe technical details of 25-gauge transcorneal vitrectomy and the clinical outcomes. Methods: We performed 25-gauge transcorneal vitrectomy on seven eyes of seven patients (female: male, 4:3; age, 39 to 77 years; mean, 66.1 years) between January 2005 and February 2007. Phacoemulsification via a corneal incision was followed by continuous curvilinear capsulorrhexis (CCC) of the posterior capsule. We used a notched contact lens to perform 25-gauge transcorneal vitrectomy. Results: Four patients with idiopathic ERM and three with secondary ERM were treated by 25-gauge vitrectomy. Postoperative visual acuity was good in most of them and the cell density of the corneal endothelium was maintained. Conclusion: These advantages of this procedure are that the conjunctiva and ocular surface can be completely maintained and vitreous incarceration can be avoided. Thus, 25-gauge vitrectomy might be particularly suitable for treating glaucoma with a filtering bleb. (158 words/200 words

Effect of inverted internal limiting membrane flap technique on small-medium size macular holes

Inverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for small-medium size MH. We recruited patients who underwent vitrectomy for small-medium size (< 400 μm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score, 21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. We compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for small-medium size MHs and may delay recovery of retinal integrity

Recurrence of neovascular age-related macular degeneration after cessation of treat and extend regimen

The appropriate timing of treatment cessation after treat and extend (TAE) regimen for age-related macular degeneration has not been established. This study aimed to investigate the incidence and risk factors of recurrence after cessation of the TAE regimen. We included patients who received and discontinued the TAE regimen, after extension of the treatment interval to ≥ 12 weeks. Forty-nine patients were included in the study. The estimated recurrence rates were 33% at 1 year and 48% at 2 years after treatment cessation, respectively. Good visual acuity at cessation and a large number of injections in the 6 months before cessation were significant risk factors. Higher chances of recurrence were associated with < 0.1 logarithm of the minimum angle of resolution (logMAR) at cessation (P < 0.002). Meanwhile, five patients with visual acuity ≥ 1.0 logMAR at cessation did not show recurrence. Among the 25 recurrences, two lines of vision loss were noted in only two cases after resumed treatment. This study confirmed the importance of the number of injections in reducing recurrence and the association between visual acuity and recurrence. Recurrence is generally well-controlled with resumed treatment

RETINAL BLOOD FLOW LEVELS MEASURED BY LASER SPECKLE FLOWGRAPHY IN PATIENTS WHO RECEIVED INTRAVITREAL BEVACIZUMAB INJECTION FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION

Purpose: To report retinal blood flow levels measured by Laser speckle flowgraphy in three patients after they received an intravitreal bevacizumab injection (IVB) for macular edema secondary to central retinal vein occlusion (CRVO). Methods: Three patients (3 eyes) being treated with IVB (1.25 mg/0.05 mL) for secondary macular edema of CRVO were examined. Laser speckle flowgraphy analyses of the blood flow were based on the examinations of mean blur rate (MBR) at the major vessels of the optic disk. Central retinal thickness (CRT) was measured by optical coherence tomography using Macular Cube 512 128 scanning protocol. Results: After the first IVB, Case 1 exhibited an increase in MBR and decrease in CRT. After 4months, an additional injectionwas required because of a subsequentMBR decrease and CRT increase, which led to an increase inMBR and decrease in CRT similar to that observed after the first treatment. Subsequently, blood flow has continued to improve without additional IVB. Macular edema recurrence in Case 2 led to 3 further IVBs over a 6-month period. Although increases inMBRanddecreases inCRTwerenoted,MBRvalues tendedtodeclineafter eachIVB. In Case 3, macular edema recurrence led to 5 additional IVBs being carried out within a 1-year period. Continuous MBR increases and CRT decreases were observed in the patient after each IVB. By measuringMBR using laser speckle flowgraphy,wemay predict the prognosis of CRVO. Conclusion: Mean blur rate increases after IVB were confirmed by laser speckle flowgraphy in three patients. Even though CRVO pathology backgrounds can vary, laser speckle flowgraphy may be useful in both determining the CRVO prognosis and in evaluating treatment efficacy

Succinate Increases in the Vitreous Fluid of Patients With Active Proliferative Diabetic Retinopathy

Purpose: To examine vitreous succinate levels from proliferative diabetic retinopathy (PDR) patients and ascertain their association with PDR activity. Design: Comparative case series. Methods: A total of 81 eyes of 72 PDR patients were divided into active PDR (22 eyes), quiescent PDR (21 eyes), and active PDR with intravitreal bevacizumab injection (38 eyes). Twenty epiretinal membrane (ERM) patients (21 eyes) served as controls. Results: Mean vitreous succinate levels were 1.27 μM in ERM and 2.20 μM in PDR, with the differences statistically significant (P = .03). When comparing mean vitreous succinate levels (active PDR: 3.32 μM; quiescent PDR: 1.02 μM; active PDR with intravitreal bevacizumab injection: 1.20 μM), significant differences were found between active and quiescent PDR (P < .01) and between active PDR and active PDR with intravitreal bevacizumab injection (P < .01). Even though succinate levels were low, retinopathy activities were very high in patients with active PDR with intravitreal bevacizumab injection. Mean vitreous vascular endothelial growth factor (VEGF) levels (active PDR: 1696 pg/mL; quiescent PDR: 110 pg/mL; active PDR with intravitreal bevacizumab injection: n.d.) were similar to previous reports. Mean vitreous erythropoietin levels (active PDR: 703 mIU/mL; quiescent PDR: 305 mIU/mL; active PDR with intravitreal bevacizumab injection: 1562 mIU/mL) suggested very high retinopathy activities in patients with active PDR with intravitreal bevacizumab injection. Conclusions: Succinate, like VEGF, may be an angiogenic factor that is induced by ischemia in PDR. Although succinate is reported to promote VEGF expression, VEGF inhibition decreases succinate. Thus, VEGF, via a positive feedback mechanism, may regulate succinate

Oral kallidinogenase improved visual acuity and maintained chorioretinal blood flow levels after treatment for diabetic macular edema

Purpose: This study was designed to investigate the therapeutic effects of oral kallidinogenase medication as an adjuvant therapy in treating patients with diabetic macular edema (DME). Study design: This was a prospective, open-labeled, randomized study. Methods: All patients were given posterior sub-Tenon triamcinolone acetonide (STTA) injection and focal laser treatment session for DME. The patients were subdivided into two groups: 1) those treated with oral kallidinogenase for at least 6 months after local treatment(treated group) and 2) those treated without oral kallidinogenase (untreated group). In this study, best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SCT), and chorioretinal blood flow level were measured in 17 patients (19 eyes). Chorioretinal blood flow levels at the disc and macula were measured by laser speckle flowgraphy and evaluated using the mean blur rate (MBR). These data were measured at baseline and at 1, 3, and 6 months after treatment initiation. Results: BCVA at 6 months after treatment significantly improved in treated group (P,0.05).But the mean CRT after treatment significantly decreased in both groups. There was no significant difference in the mean SCT at baseline between the two groups. The mean SCT after treatment in treated group was significantly thinner than that before treatment(P,0.05). Compared to baseline (100%), MBR at the disc and the macula at 6 months after treatment significantly decreased to 84.8% and 86.2%, respectively, in untreated group (P,0.05), though it remained unchanged at 98.7% and 99.7% in treated group.Conclusion: Oral kallidinogenase medication is useful as an adjuvant therapy to enhance the therapeutic effect of STTA in DME patients

Comparison between post-operative anterior chamber depth after cataract alone and combined with vitrectomy

Purpose: To evaluate the refractive power and changes in the depth of the anterior chamber after cataract surgery with or without simultaneous vitreous surgery. Methods: 28 eyes of 22 cases who received cataract surgery (PEA group) and 30 eyes of 30 cases who received cataract surgery simultaneously with vitreous surgery (Vit group) were enrolled prospectively. A vitrectomy was performed for a macular hole or epiretinal membrane. Refractive outcomes, axial length, and the anterior chamber depth were measured before, immediately after, as well as 1, 3, 6, and 12 months after the surgery using an Auto Ref/keratometer, the ultrasound biometry, the Pentacam, and IOL Master. Results: The mean postoperative difference in refractive power immediately after surgery was -0.01±0.66 D and -0.19±0.62 D in the PEA and Vit groups, respectively. Postoperatively, the Vit group showed a significant increase in myopia compared to the PEA group in ultrasound results at all time points (p <0.05), whereas no difference was observed between the groups in IOL Master. For both measures, the postoperative refractive error in the Vit group was more myopic than predicted. Furthermore, there was a significant increase in anterior chamber depth in both groups after surgery, as observed with Pentacam and IOL Master (p <0.0001). Conclusions: A significant myopic shift occurred in the Vit group compared to the PEA group after surgery, as indicated by the ultrasound results. Both groups showed a significant increase in anterior chamber depth after surgery in both measurements.Acta medica Nagasakiensia, 67(2), pp.61-67; 202