Postoperative macular hole formation after vitrectomy with internal limiting membrane peeling for the treatment of epiretinal membrane

PURPOSE:: To evaluate the incidence, clinical features, and outcomes of macular hole formation after pars plana vitrectomy with internal limiting membrane peeling for the management of epiretinal membrane. METHODS:: Retrospective consecutive chart review of 423 cases. RESULTS:: Eleven subjects developed postoperative macular holes (incidence 2.6%; 95% confidence interval, 1.5-4.6%). Two of the 11 subjects developed central macular holes (incidence 0.5%; 95% confidence interval, 0.1-1.7%) while 9 had eccentric (nonfoveal) macular holes (incidence 2.1%; 95% confidence interval, 1.1-4.0%). Seven of the 9 eccentric macular holes were <115 μm in diameter, 7 were determined to be along the margin of the internal limiting membrane peel, and 8 were either in the superior or temporal macula. The two central macular holes were closed with subsequent pars plana vitrectomy and gas tamponade. There was no association between macular hole formation and age, gender, preoperative visual acuity, axial length, and preoperative central macular thickness. Overall, a 0.2 or more improvement in logMAR was associated with pseudophakia and poorer preoperative acuity on univariate and multivariate analysis, whereas increased preoperative central macular thickness was associated with improved outcomes on univariate but not multivariate analysis. CONCLUSION:: Postoperative macular hole formation is an infrequent sequela to pars plana vitrectomy with internal limiting membrane peeling for epiretinal membrane. In our cohort, eccentric macular holes tended to be small, located along the edge of the internal limiting membrane peel, and were not visually significant. © by Opthamic Communication Society, Inc. Unauthorized reproduction of this article is prohibited

Postoperative macular hole formation after vitrectomy with internal limiting membrane peeling for the treatment of epiretinal membrane

PURPOSE:: To evaluate the incidence, clinical features, and outcomes of macular hole formation after pars plana vitrectomy with internal limiting membrane peeling for the management of epiretinal membrane. METHODS:: Retrospective consecutive chart review of 423 cases. RESULTS:: Eleven subjects developed postoperative macular holes (incidence 2.6%; 95% confidence interval, 1.5-4.6%). Two of the 11 subjects developed central macular holes (incidence 0.5%; 95% confidence interval, 0.1-1.7%) while 9 had eccentric (nonfoveal) macular holes (incidence 2.1%; 95% confidence interval, 1.1-4.0%). Seven of the 9 eccentric macular holes were &lt;115 μm in diameter, 7 were determined to be along the margin of the internal limiting membrane peel, and 8 were either in the superior or temporal macula. The two central macular holes were closed with subsequent pars plana vitrectomy and gas tamponade. There was no association between macular hole formation and age, gender, preoperative visual acuity, axial length, and preoperative central macular thickness. Overall, a 0.2 or more improvement in logMAR was associated with pseudophakia and poorer preoperative acuity on univariate and multivariate analysis, whereas increased preoperative central macular thickness was associated with improved outcomes on univariate but not multivariate analysis. CONCLUSION:: Postoperative macular hole formation is an infrequent sequela to pars plana vitrectomy with internal limiting membrane peeling for epiretinal membrane. In our cohort, eccentric macular holes tended to be small, located along the edge of the internal limiting membrane peel, and were not visually significant. © by Opthamic Communication Society, Inc. Unauthorized reproduction of this article is prohibited

Treat-and-extend intravitreal bevacizumab for branch retinal vein occlusion

BACKGROUND AND OBJECTIVE: To determine the effectiveness and direct medical costs of treat-and-extend (TAE) intravitreal bevacizumab (IVB) for the treatment of branch retinal vein occlusion (BRVO) - associated macular edema (ME). PATIENTS AND METHODS: Retrospective chart review of 52 consecutive patients diagnosed with BRVO-associated ME treated with IVB using a TAE protocol. RESULTS: Mean change in logMAR vision was -0.30 (P &lt; .001), and mean change in central macular thickness was -244.0 μm (P &lt; .001). The mean number of injections was 8.2 (95% CI; 7.8 to 8.6). The yearly average direct cost of the TAE regimen was calculated to be $2,580.26 per patient. CONCLUSION: Treatment of BRVO-associated ME with IVB using a TAE regimen resulted in similar visual outcomes and number of intravitreal injections as did as-needed treatment with 0.5 mg ranibizumab conducted in phase 3 trials but with fewer visits and lower annual medical costs

Treat-And-extend bevacizumab for neovascular age-related macular degeneration: The importance of baseline characteristics

PURPOSE:: To evaluate the factors affecting visual and anatomical outcomes and the number of intravitreal bevacizumab injections required in the treatment of neovascular age-related macular degeneration using a treat-And-extend regimen. METHODS:: Retrospective consecutive case series. The charts of subjects treated with intravitreal bevacizumab for neovascular age-related macular degeneration using a treat-And-extend regimen over a 12-month period were reviewed. The key variables explored were patient age, phakic status, posterior vitreous detachment status, baseline best-corrected visual acuity (BCVA), baseline central macular thickness (CMT), and type of chorodial neovascularization. The primary outcome measures were improvement in BCVA of 3 logMAR lines or more, maintenance of BCVA within 3 logMAR lines of baseline, number of intravitreal injections delivered over a 12-month period, and final CMT on optical coherence tomography. RESULTS:: A total of 230 eyes met the criteria. Mean presenting BCVA was Snellen 20/55 (0.44 logMAR) and mean final BCVA was Snellen 20/44 (0.35 logMAR) (P < 0.001). A total of 23.5% (95% confidence interval [CI], 18.5-29.4%) of the subjects demonstrated an improvement in BCVA of 3 or more logMAR lines, whereas 96.5% (95% CI, 93.3-98.2%) of the subjects lost fewer than 3 logMAR lines. Mean CMT on optical coherence tomography changed from a baseline average of 373.1 μm (95%CI, 360.3-386.1 μm) to a final average of 305.5 μm (95% CI, 290.0-316.0 μm). The average number of injections during the 12-month period was 9.2 (95% CI, 9.0-9.4). Posterior vitreous detachment was associated with fewer injections on univariate and multivariate analysis (8.7 injections in the posterior vitreous detachment group versus 9.8 in the non-posterior vitreous detachment group, P < 0.001). Patients with poorer presenting BCVA and greater baseline CMTs were more likely to demonstrate a 3 or more logMAR line improvement in BCVA. Thinner final CMTs were independently associated with thinner presenting CMTs and fewer injections. CONCLUSION:: Favorable visual and anatomical outcomes may be achieved with intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration using a treat-And-extend regimen. Our study suggests that posterior vitreous detachment may play a role in the efficacy of intravitreal bevacizumab during the treatment of neovascular age-related macular degeneration. © by Opthamic Communication Society, Inc. Unauthorized reproduction of this article is prohibited

Treat-and-extend intravitreal bevacizumab for branch retinal vein occlusion

BACKGROUND AND OBJECTIVE: To determine the effectiveness and direct medical costs of treat-and-extend (TAE) intravitreal bevacizumab (IVB) for the treatment of branch retinal vein occlusion (BRVO) - associated macular edema (ME). PATIENTS AND METHODS: Retrospective chart review of 52 consecutive patients diagnosed with BRVO-associated ME treated with IVB using a TAE protocol. RESULTS: Mean change in logMAR vision was -0.30 (P < .001), and mean change in central macular thickness was -244.0 μm (P < .001). The mean number of injections was 8.2 (95% CI; 7.8 to 8.6). The yearly average direct cost of the TAE regimen was calculated to be $2,580.26 per patient. CONCLUSION: Treatment of BRVO-associated ME with IVB using a TAE regimen resulted in similar visual outcomes and number of intravitreal injections as did as-needed treatment with 0.5 mg ranibizumab conducted in phase 3 trials but with fewer visits and lower annual medical costs

Treat-And-extend bevacizumab for neovascular age-related macular degeneration: The importance of baseline characteristics

PURPOSE:: To evaluate the factors affecting visual and anatomical outcomes and the number of intravitreal bevacizumab injections required in the treatment of neovascular age-related macular degeneration using a treat-And-extend regimen. METHODS:: Retrospective consecutive case series. The charts of subjects treated with intravitreal bevacizumab for neovascular age-related macular degeneration using a treat-And-extend regimen over a 12-month period were reviewed. The key variables explored were patient age, phakic status, posterior vitreous detachment status, baseline best-corrected visual acuity (BCVA), baseline central macular thickness (CMT), and type of chorodial neovascularization. The primary outcome measures were improvement in BCVA of 3 logMAR lines or more, maintenance of BCVA within 3 logMAR lines of baseline, number of intravitreal injections delivered over a 12-month period, and final CMT on optical coherence tomography. RESULTS:: A total of 230 eyes met the criteria. Mean presenting BCVA was Snellen 20/55 (0.44 logMAR) and mean final BCVA was Snellen 20/44 (0.35 logMAR) (P &lt; 0.001). A total of 23.5% (95% confidence interval [CI], 18.5-29.4%) of the subjects demonstrated an improvement in BCVA of 3 or more logMAR lines, whereas 96.5% (95% CI, 93.3-98.2%) of the subjects lost fewer than 3 logMAR lines. Mean CMT on optical coherence tomography changed from a baseline average of 373.1 μm (95%CI, 360.3-386.1 μm) to a final average of 305.5 μm (95% CI, 290.0-316.0 μm). The average number of injections during the 12-month period was 9.2 (95% CI, 9.0-9.4). Posterior vitreous detachment was associated with fewer injections on univariate and multivariate analysis (8.7 injections in the posterior vitreous detachment group versus 9.8 in the non-posterior vitreous detachment group, P &lt; 0.001). Patients with poorer presenting BCVA and greater baseline CMTs were more likely to demonstrate a 3 or more logMAR line improvement in BCVA. Thinner final CMTs were independently associated with thinner presenting CMTs and fewer injections. CONCLUSION:: Favorable visual and anatomical outcomes may be achieved with intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration using a treat-And-extend regimen. Our study suggests that posterior vitreous detachment may play a role in the efficacy of intravitreal bevacizumab during the treatment of neovascular age-related macular degeneration. © by Opthamic Communication Society, Inc. Unauthorized reproduction of this article is prohibited