ABSTRACT
PURPOSE: To evaluate the changes in visual acuity (VA) and central macular thickness (CMT) after intravitreal dexamethasone (IVD) implantation in intravitreal bevacizumab (IVB) treatment-resistant cases with pseudophakic cystoid macular edema (PCME). METHODS: This study included 10 PCME cases who underwent uneventful phacoemulsification and intraocular lens implantation with similar methods and six PCME cases referred to our hospital for treatment of low VA after cataract surgery. Due to the persistence of PCME, both topical steroid and anti-inflammatory medication were administered first, followed by IVB injection. IVD implantation was performed for all IVB treatment-resistant cases. VA and CMT values were compared before and at three months after the first IVD implantation. RESULTS: The mean VA values before and at 3 months after the first IVD implantation were 0.69 ± 0.19 logarithm of the minimum angle of resolution (logMAR) (1.50 to 0.10 logMAR) and 0.26 ± 0.07 logMAR (1.00 to 0.00 logMAR), respectively (p < 0.001). The mean CMT was 476.13 ± 135.13 mm (314 to 750 mm) and 294.06 ± 15.26 mm (222 to 480 mm), respectively (p < 0.001). The mean number of implanted IVD was 1.44 ± 0.89 (1 to 4) and the mean follow-up time was 7.4 ± 4.6 months (6 to 24 months). After IVD implantation therapy, the mean VA and CMT values were 0.19 ± 0.05 logMAR (0.70 to 0.00 logMAR) and 268.38 ± 31.35 mm (217 to 351 mm), respectively. CONCLUSIONS: To the best of our knowledge, this is the first report to show the efficacy of IVD implantation even after repeated IVB injections in treatment-resistant PCME. IVD implantation is both a safe and effective method for decreasing PCME after both uneventful and complicated cataract surgery.
Subject(s)
Bevacizumab , Cataract , Dexamethasone , Follow-Up Studies , Lens Implantation, Intraocular , Macular Edema , Methods , Phacoemulsification , Visual AcuityABSTRACT
Brown's syndrome is characterized by absence or severe limitation of elevation in adduction with a positive forced duction test and minimal elevation deficit in abduction and primary position. Nanophthalmos is an uncommon congenital ocular malformation characterized by an extremely small eye. In this report,a case with bilateral Brown's syndrome and nanophthalmos combined with generalized joint stiffness was presented.
ABSTRACT
· AIM: To investigate risk factors for the development of membrane formation in the anterior chamber after pha coemulsification.· METHODS: A total of 1356 patients who underwent phacoemulsification with implantation of single piece polymethyl methacrylate (PMMA) IOL were prospectively evaluated. Presence of pseudoexfoliation syndrome, nuclear hardness, pupil size, phaco time, effective phaco time, systemic diseases, perioperative complications (capsulorhexis rupture, zonular dialysis, posterior capsule rupture with vitreous loss), location of IOL placement and postoperative complications (intraocular pressure changes, synechia formation) were analyzed as risk factors for development of membrane formation.· RESULTS: In 111 (8.1%) patients postoperative fibrinous anterior uveitis with membrane formation was observed. The mean time for membrane formation was postoperative second day (range postoperative 1st and 7th day). Mean duration of the presence of membrane was 5.2 days (range 1 to 48 days). Among the patients who had membrane formation, +4 hardness of the nucleus was present in 45%, while it was present in only 13.5% of patients who did not have membrane formation. The difference was statistically significant (P＜0.05). In the membrane-forming group, mean phaco time was 2.4minute and mean effective phaco time was 32.8 seconds,compared to 1.8 minute and 22.1 seconds in the membrane-free group. Both parameters were significantly longer in the membrane-forming group (P＜0.05). Posterior capsule rupture with vitreous loss and sulcus implantation of IOL was seen in 33% of membrane-forming patients and in 11% of membrane-free patients (P＜0.05). Other risk factors were not statistically different between membrane-forming and membrane-free patients. On postoperative first and 7th day, the mean best corrected visual acuity in the membrane-forming group was 0.2 and 0.4 respectively, versus 0.4 and 0.6 in the membrane-free group on Snellen chard (P＜0.05). But three months after surgery, the best corrected visual acuity was similar between the membrane-forming and membrane- free patients (0.8 and 0.9 respectively).· CONCLUSION: Higher nucleus hardness, longer phaco time and effective phaco time, and posterior capsule rupture during surgery were risk factors which significantly assocaiated with postoperative fibrinous membrane formation in the anterior chamber.