ABSTRACT
@#AIM: To investigate for any detectable change in sub-foveal choroidal thickness following intravitreal injections of Ranibizumab or Aflibercept in patients with central involving diabetic macula edema(DME), evidenced by optical coherence tomography(OCT).<p>METHODS: Totally 17 patients with central involving DME who required and agreed to intravitreal anti-VEGF injection were invited to be the subject of this study. These injection-naive subjects were undergone three loading doses of monthly intravitreal anti-VEGF(Ranibizumab 0.5 mg/0.05 mL for 9 patients or Aflibercept 2 mg/0.05 mL for 8 patients)injection, and a clinic review appointment 1mo after the third injection. The changes of foveal choroidal thickness, visual acuity and central retinal thickness at 1mo were observed before and after treatment in 2 groups by enhanced depth image-optical coherence tomography(EDI-OCT). <p>RESULTS: We recorded a significant sub-foveal choroidal thinning and vision improvement after three loading doses of anti-VEGF(all <i>P</i><0.05). The thinning effect between Ranibizumab and Aflibercept group was insignificant(all <i>P</i>>0.05). There was no significant correlation between pre-treatment sub-foveal choroidal thickness and vision improvement(<i>r<sub>s</sub></i>=-0.269, <i>P</i>=0.296). There was also no significant correlation between choroidal thickness changes with vision improvement, central retinal thickness change and age of subjects(all <i>P</i> >0.05).<p>CONCLUSION: Intravitreal Ranibizumab and Aflibercept injections both leads to significant sub-foveal choroidal thinning in DME subjects. It was accompanied with significant vision improvement with no evidence of immediate detrimental effect of choroidal thinning. Future research with a longer study duration would help in establishing the duration and long term effect of choroidal thinning.
ABSTRACT
@#AIM: To observe the intraocular pressure(IOP)control and bleb function after phacoemulsification in patients with previous history of successful/qualified success mitomycin-C augmented trabeculectomy.<p>METHODS: This was a retrospective cohort study. Data of patients who had undergone trabeculectomy between 1st January 2013 to 31st Dec 2015 with subsequent cataract surgery were extracted from server. All patients had previous either success/qualified success trabeculectomy done. They went through uncomplicated phacoemulsification <i>via</i> clear corneal incision. Postoperative follow-up, review of bleb and IOP readings using Goldmann tonometer were taken. Details that were investigated include postoperative IOP control, visual improvement, number of anti-glaucoma medications, as well as the timing from trabeculectomy to phacoemulsification. Comparison with control group was made.<p>RESULTS: Fifteen eyes from thirteen patients fulfilled the criteria for study and had undergone uncomplicated phacoemulsification on a post-trabeculectomy eye. Two of the eyes had secondary glaucoma while the other thirteen had primary glaucoma. All phacoemulsifications were done at least 6mo after trabeculectomy(mean 14.7±4.3mo). There was only 1 eye(6.7%)requiring anti-glaucoma medications before the cataract surgery. This number increased to 4(26.7%)at 1-year post-phacoemulsification. The number further increased to eight(53.3%)at 2y post-phacoemulsification. The number of anti-glaucoma drops needed after surgery at 2y ranged from 2-4. In all the 15 eyes, there was no statistically significant change in IOP control between pre-cataract surgery(mean 13.4±2.9 mmHg)compared to 1y(mean 14.1±3.2 mmHg, <i>P</i>=0.357)and 2y(mean 15.1±3.3 mmHg, <i>P</i>=0.212)post-phacoemulsification. Visual improvement after phacoemulsification however is significant, from a preoperative average visual acuity of LogMAR 1.52±1.00 to a postoperative average visual acuity of 0.53±0.54(<i>P</i>=0.000, paired <i>t</i>-test). <p>CONCLUSION: This analysis shows significant visual improvement following cataract surgery in post-trabeculectomy patients without compromising IOP control. However, a reduced bleb function is noted following the surgery evidenced by the increase in number of anti-glaucoma drops used after surgery especially two years after the cataract surgery. Patients should be counselled regarding the possibility of restarting on anti-glaucoma medications post-phacoemulsification. The timing and sequence of cataract and glaucoma surgery should be optimized for best outcome.
ABSTRACT
@#AIM: To observe the intraocular pressure(IOP)control and bleb function after phacoemulsification in patients with previous history of successful/qualified success mitomycin-C augmented trabeculectomy.<p>METHODS: This was a retrospective cohort study. Data of patients who had undergone trabeculectomy between 1st January 2013 to 31st Dec 2015 with subsequent cataract surgery were extracted from server. All patients had previous either success/qualified success trabeculectomy done. They went through uncomplicated phacoemulsification <i>via</i> clear corneal incision. Postoperative follow-up, review of bleb and IOP readings using Goldmann tonometer were taken. Details that were investigated include postoperative IOP control, visual improvement, number of anti-glaucoma medications, as well as the timing from trabeculectomy to phacoemulsification. Comparison with control group was made.<p>RESULTS: Fifteen eyes from thirteen patients fulfilled the criteria for study and had undergone uncomplicated phacoemulsification on a post-trabeculectomy eye. Two of the eyes had secondary glaucoma while the other thirteen had primary glaucoma. All phacoemulsifications were done at least 6mo after trabeculectomy(mean 14.7±4.3mo). There was only 1 eye(6.7%)requiring anti-glaucoma medications before the cataract surgery. This number increased to 4(26.7%)at 1-year post-phacoemulsification. The number further increased to eight(53.3%)at 2y post-phacoemulsification. The number of anti-glaucoma drops needed after surgery at 2y ranged from 2-4. In all the 15 eyes, there was no statistically significant change in IOP control between pre-cataract surgery(mean 13.4±2.9 mmHg)compared to 1y(mean 14.1±3.2 mmHg, <i>P</i>=0.357)and 2y(mean 15.1±3.3 mmHg, <i>P</i>=0.212)post-phacoemulsification. Visual improvement after phacoemulsification however is significant, from a preoperative average visual acuity of LogMAR 1.52±1.00 to a postoperative average visual acuity of 0.53±0.54(<i>P</i>=0.000, paired <i>t</i>-test). <p>CONCLUSION: This analysis shows significant visual improvement following cataract surgery in post-trabeculectomy patients without compromising IOP control. However, a reduced bleb function is noted following the surgery evidenced by the increase in number of anti-glaucoma drops used after surgery especially two years after the cataract surgery. Patients should be counselled regarding the possibility of restarting on anti-glaucoma medications post-phacoemulsification. The timing and sequence of cataract and glaucoma surgery should be optimized for best outcome.