Posterior sub-Tenon triamcinolone injection in the treatment of postoperative cystoid macular edema secondary to pars plana vitrectomy

Purpose: To evaluate the efficacy and safety of posterior sub?Tenon triamcinolone (PSTA) in chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy (PPV). Methods: Consecutive 22 patients who developed chronic PCME after PPV and underwent PSTA treatment were included in this retrospective study. Best?corrected visual acuity (BCVA) and central macular thickness (CMT) were measured pre injection and post injection at one month, three months, six months, and at last visit. The patients were divided into three groups according to the injection response status: complete, partial, and resistant. Results: The mean follow?up period was 26.4 ± 16.2 months after PSTA. According to pre?injection values, there was a significant improvement in the values of BCVA and CMT at the first, third, and sixth months and at the last examination (P < 0.05). In the final examination, PCME recovered completely in 12 patients, partially in 8 patients, and resistance was observed in 2 patients. Conclusion: Posterior sub?Tenon triamcinolone seems to be effective in chronic PCME following PPV.

Central macular thickness change after uneventful small-incision cataract surgery - An observational study

Purpose: The purpose of this study was to diagnose CME with the help of optical coherence tomography (OCT) after uneventful cataract surgery to prevent visual deterioration. Methods: This study was conducted on 120 patients, who underwent manual small-incision cataract surgery with posterior chamber intra-ocular lens implantation. Follow-up was performed after the first week, sixth week, and 12th week post-operatively. Detailed examination was performed at each visit along with measurements of central macular thickness using OCT. Statistical analysis was performed using SPSS 22.0. Result: The mean age of the patients was 61.85 � 11.41 years having female preponderance. The pre-operative mean best corrected visual acuity (BCVA) was found to be 0.05 � 0.04, whereas the mean post-operative BCVA was found to be 0.65 � 0.17 at the first week, 0.66 � 0.17 at the sixth week, and 0.67 � 0.17 at the 12th week follow?up. The post-operative mean macular thicknesses at the first week, sixth week, and 12th week post?operatively were documented to be 221.66 � 8.49 ?m, 224.60 � 8.75 ?m, and 219.17 � 8.22 ?m, respectively. Conclusion: A sub-clinical increase in macular thickness occurs even after uncomplicated cataract surgery. The maximum increase was observed after 6 weeks of surgery, which returns to near normal values within 3 months. Comparison of central macular thicknesses pre-operatively and post-operatively at the first week, sixth week, and 12th week suggests a significant correlation

Secondary glaucoma after intravitreal dexamethasone implant (Ozurdex) injection in patients with retinal disorder: A retrospective study

Purpose: To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center. Methods: Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow?up. The post?T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre?existing glaucoma and lost to follow?up were excluded. Results: A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post?injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post?T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22–25 mmHg; 8 in the range 26–30 mmHg; and 1 eye had 34 mmHg and required multiple AGM—no surgical intervention was needed. Conclusion: A secondary IOP spike post?IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field

Unilateral intravitreal dexamethasone implant for the treatment of cystoid macular edema in intermediate uveitis / Implante unilateral de dexametasona intravítrea para tratamento de edema macular cistoide na uveíte intermediária

ABSTRACT This report aims to describe the effectiveness of a unilateral intravitreal dexamethasone implant (Ozurdex®) used for the treatment of cystoid macular edema in a patient with recurrent intermediate uveitis. Bearing in mind the adverse effects of the prolonged use of systemic corticosteroids, the objective here was to provide a less damaging form of intervention, and also to demonstrate the safety of the dexamethasone implant for patients who fail to respond to conventional treatment. In the present case, there was bilateral improvement in retinal anatomy and function with use of the unilateral intravitreal dexamethasone implant (Ozurdex®).

RESUMO Neste estudo, o objetivo foi descrever, a partir de um relato de caso, a eficácia do uso de implante de dexametasona intravítrea (Ozurdex®) unilateral, para o tratamento de edema macular cistoide, em um paciente com quadro de uveíte intermediária recorrente, visando uma terapêutica menos lesiva, diante dos efeitos colaterais do uso prolongado de corticoesteroides sistêmicos, demonstrando também a segurança desse tratamento alternativo para aqueles pacientes que se apresentam refratários a terapêutica tradicional. No caso relatado, vale ressaltar a melhora bilateral da anatomia e função retiniana com o implante unilateral de dexametasona intravítrea (Ozurdex®).

Efectividad de la dorzolamida en el tratamiento del edema quístico macular poscirugía de catarata / Effectiveness of dorzolamide in the treatment of cystoid macular edema after cataract surgery

Objetivo: Evaluar la efectividad del tratamiento combinado con dorzolamida tópica en pacientes con edema quístico macular poscirugía de catarata. Métodos: Se realizó un estudio experimental en pacientes atendidos en el Servicio de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el año 2018. Se definió el grupo de casos (dorzolamida y tratamiento convencional) y el grupo control (tratamiento convencional), los cuales se evaluaron en la consulta inicial y al mes de tratamiento. Resultados: La edad media fue de 60,73 ± 11,25 años. Predominó el sexo femenino (53,33 por ciento), el ojo afectado derecho (60,00 por ciento), el tiempo posquirúrgico ≤ 3 meses (63,33 por ciento), sin factores de riesgo asociados (56,67 por ciento). El edema sin alteraciones asociadas fue más frecuente (80,00 por ciento). La media del grosor macular disminuyó en ambos grupos (de 529,27 ± 183,58 a 349,93 ± 221,35 en los casos y de 498,87 ± 213,26 a 373,53 ± 215,51 en los controles). Resultó mayor la variación en el grupo de casos (179,33 p= 0,008). La agudeza visual aumentó en ambos grupos. Se observó un porcentaje mayor de ojos que mejoraron la visión en el grupo de casos (52,38 por ciento). La mejoría de la agudeza visual se relacionó con la recuperación del grosor macular. Conclusiones: En los casos con edema quístico macular poscirugía de catarata, en los que está indicado el tratamiento tópico con antinflamatorios, la combinación con dorzolamida resulta efectiva para la reducción del grosor macular y la mejoría de la agudeza visual corregida(AU)

ABSTRACT Objective: Evaluate the effectiveness of a treatment combined with topical dorzolamide in patients with cystoid macular edema after cataract surgery. Methods: An experimental study was conducted of patients attending the Vitreous-Retina Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology in the year 2018. The sample was divided into a case group (dorzolamide and conventional treatment) and a control group (conventional treatment), and evaluated at the initial consultation and after one month of treatment. Results: Mean age was 60.73 ± 11.25 years. A predominance was found of the female sex (53.33 percent), affected right eye (60.00 percent), postsurgical time ≤ 3 months (63.33 percent), and no associated risk factors (56.67 percent). Edema without associated alterations was more common (80.00 percent). Mean macular thickness decreased in both groups (from 529.27 ± 183.58 to 349.93 ± 221.35 in cases and from 498.87 ± 213.26 to 373.53 ± 215.51 in controls). Variation was greater in the case group (179.33 p= 0.008). Visual acuity increased in both groups. A higher percentage of eyes with improved vision was found in the case group (52.38 percent). Visual acuity improvement was related to macular thickness recovery. Conclusions: In cases of cystoid macular edema after cataract surgery with indication of topical treatment with anti-inflammatories, the combination with dorzolamide is effective to reduce macular thickness and improve corrected visual acuity(AU)

Incidence of clinical and subclinical macular edema in patients submitted to phacoemulsification in a university health service

INTRODUCTION: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. OBJECTIVE: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). METHODS: The incidence of subclinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. RESULTS: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. CONCLUSION: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Incidence of cystoid macular edema following routine cataract surgery using NSAIDs alone or with corticosteroids / Incidência de edema macular cistóide após cirurgia de catarata de rotina com a utilização de AINEs isoladamente ou com corticosteroides

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste­roidal anti-inflammatory drugs with corticosteroids.

RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas interme­diárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.

Research progress of pseudophakic cystoid macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#Cataract is the most common blinding eye disease in our country. Cataract phacoemulsification combined with intraocular lens implantation is the first choice for cataract surgery, with advantages of a small incision, mild anterior chamber reaction, repaid recovery and small astigmatism of corneal. However, there are still some patients failed to achieve ideal visual quality after surgery due to various reasons even if the surgery is successful. Cystoid macular edema(CME)is one of the common complications in pseudophakic eyes affecting postoperative visual quality after cataract surgery. Recent studies on pseudophakic cystoid macular edema(PCME)are reviewed in this paper.

Acute bilateral Irvine-Gass Syndrome following uneventful cataract surgery in a patient without systemic risk factors / Síndrome de Irvine-Gass aguda bilateral após cirurgia de catarata sem complicações em paciente sem fatores de risco sistêmicos

Abstract We herein report a patient without risk factors who presented acute bilateral Irvine-Gass syndrome after uneventful phacoemulsification. The novelty of our case lies on the fact that the patient presented acute bilateral Irvine-Gass syndrome without a predisposing systemic disease. Even though Cystoid Macular Edema (CME) was somehow expected in the first eye because of the ocular history of trauma, prophylactic measures were not strong enough to avoid its development. Furthermore, those measures could not avoid developing CME in the second eye. A 44-years-old male who underwent cataract surgery in both eyes presented bilateral Irvine-Gass syndrome. Despite prophylactic measures, both eyes developed CME after uneventful cataract surgery. Regular treatment options could not solve the situation and intravitreal Anti-VEGF injections were needed. Bilateral cases of Irvine-Gass Syndrome are rare and generally associated with systemic risk factors. Patients who developed CME following their first cataract surgery should be counseled about the risks of developing the condition following surgery on the contralateral eye. On top of that, aggressive prophylactic measures should be encouraged to prevent CME in these cases.

Resumo Relatamos aqui um paciente sem fatores de risco que apresentou síndrome de Irvine-Gass bilateral aguda após facoemulsificação sem intercorrências. A novidade do nosso caso reside no fato de o paciente apresentar síndrome de Irvine-Gass bilateral aguda sem doença sistêmica predisponente. Embora o Edema Macular Cistoide (EMC) fosse de alguma forma esperado no primeiro olho por causa do histórico ocular de trauma, as medidas profiláticas não foram suficientemente fortes para evitar seu desenvolvimento. Além disso, essas medidas não puderam evitar o desenvolvimento de EMC no segundo olho. Homem de 44 anos submetido a cirurgia de catarata em ambos os olhos apresentou síndrome de Irvine-Gass bilateral. Apesar das medidas profiláticas, ambos os olhos desenvolveram EMC após a cirurgia de catarata sem intercorrências. As opções de tratamento regular não conseguiram resolver a situação e foram necessárias injeções intravítreas de Anti-VEGF. Casos de Síndrome de Irvine-Gass bilateral são raros e geralmente associados a fatores de risco sistêmicos. Os pacientes que desenvolveram EMC após a primeira cirurgia de catarata devem ser avisados sobre os riscos de desenvolver a doença após a cirurgia no olho contralateral. Além disso, medidas profiláticas agressivas devem ser incentivadas para evitar a EMC nesses casos.

Intravitreal sustained-release dexamethasone implant for the treatment of persistent cystoid macular edema in ocular syphilis

With a resurgence of syphilis with human immunodeficiency virus (HIV) infection in last few years, various ocular manifestations of syphilis have been described in literature. This case report described an HIV-positive patient on anti-retroviral therapy who was diagnosed and treated for posterior uveitis secondary to ocular syphilis in the recent past presented to our clinic with cystoid macular edema (CME). CME, which did not respond to periocular corticosteroid, resolved with intravitreal sustained release dexamethasone implant. There was a recurrence CME 9 months later and repeat injection of intravitreal implant showed complete resolution. A long-term follow-up did not reveal reactivation of the infection with intravitreal corticosteroid. Intravitreal sustained release dexamethasone implant can be an effective treatment for refractory CME in patients with regressed syphilitic uveitis.

Intravenous tocilizumab in idiopathic pediatric uveitis with refractory cystoid macular edema – A case report

A 13-year-old boy with a 4-year history of idiopathic pediatric uveitis and recurrent uveitic macular edema had failed conventional immunomodulatory therapy and presented to us with a vision of 6/24 [right eye (OD)] and 6/9 [left eye (OS)]. Fluorescein angiography showed diffuse vascular leakage along with cystoid macular edema (CME). Intravenous tocilizumab (10 mg/kg body) was given as 14 injections over 12 months. Repeat fluorescein angiography every 3 months showed a dramatic improvement in the vascular leakage and resolution of CME. At 13 months OF follow-up, vision had improved to 6/9p (OD) and 6/6(OS) with no recurrence of inflammation or CME.

Modified low-dose triamcinolone acetonide intravitreal injection for macular cystoid edema after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the efficacy of intravitreal injection of modified low-dose of triamcinolone acetonide(TA)in the treatment of pseudophakic cystoid macular edema(PCME).<p>METHODS: Retrospective study. Totally 12 eyes of 12 patients with PCME in our hospital were received intravitreal injection with modified low doses of TA from 2015-01 to 2018-12. The TA suspension was firstly resuspended by intraocular irrigating solution through 0.22um pore filter, then the new TA suspension(2mg/0.05mL)was injected intravitreally. The best-corrected visual acuity(BCVA), central macular thickness(CMT), intraocular pressure(IOP), and other side effects were recorded at 2wk, 1mo, 3mo and 6mo after injection, then compared the data with pre-injection(baseline)information.<p>RESULTS: After intravitreal injection of modified low dose TA, all patients got improved BCVA and alleviated CMT, as compare to the baseline data, and the difference was statistically significant(<i>P</i><0.05), but the difference of IOP was not significant(<i>P</i>>0.05). All patients had no recorded ocular or systemic complication.<p>CONCLUSION: Intravitreal injection of modified low-dose TA is effective and safe for PCME, without significant increase in IOP. It's an affordable substitution to anti-vascular endothelial growth factor(anti-VEGF)agents. This still needs to be confirmed by the long-term follow-up study with large samples.

Intravitreal Dexamethasone Implantation in Intravitreal Bevacizumab Treatment-resistant Pseudophakic Cystoid Macular Edema

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.

New progress of diagnosis and treatment in pseudophakic cystoid macular edema / 中华实验眼科杂志

Pseudophakic cystoid macular edema (PCME) is one of the most common complications of cataract surgery.It is the main cause of postoperative visual loss.PCME pathogenesis is unclear yet,inflammation is supposed to be an important cause.Systemic or local diseases,and complicated surgical operations may increase the risk of PCME.Diabetes is the most common independent risk factor,and the risk of PCME is closely related to severity of preoperative diabetes.Typical clinical symptoms of PCME include acute vision loss after surgery.In PCME eyes,fundus fluorescein angiography (FFA) can show the petal-like spots characteristically,and visual disc dot staining can be seen later.Cystoid macular edema (CME) first appears in the inner nuclear layer (INL) and gradually develops in the outer plexiform layer (OPL).Finally,fluid accumulates in the subretinal space.Besides,optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have new advances in differential diagnosis between PCME and diabetic macular edema (DME).In practice,topical non-steroid anti-inflammatory drugs (NSAIDs) or glucocorticoids are generally used as first-line treatment medicines.Anti-vascular endothelial growth factor (anti-VEGF) also attracts attention as a new treatment.Individualized prevention and treatment is required for specific types of PCME.It still lacks a common recognized treatment of PCME,and long-term efficacy of the current treatment remains to be observed more rigorous and comprehensive experimental programs are required.

Utilidad de la tomografía de coherencia óptica para la caracterización y clasificación del edema macular diabético / Utility of the optical coherence tomography for characterization and classification of diabetic macular edema

Introducción: El edema macular es la causa más frecuente de deterioro visual en pacientes con retinopatía diabética no proliferativa, la separación de los fotorreceptores, inducida por permeabilidad vascular anormal, reduce el poder de resolución del ojo y la capacidad visual, lo que lleva al paciente a la baja visión. Objetivo: Caracterizar el comportamiento del edema macular diabético y su clasificación según la tomografía de coherencia óptica. Material y métodos: Se realizó un estudio descriptivo, prospectivo, de corte transversal no controlado, en 40 diabéticos (80 ojos) con diagnóstico clínico de edema macular diabético, quienes acudieron a la consulta de Retina del Hospital Docente Dr. Salvador Allende y el Centro de Atención al Diabético entre enero 2014 y diciembre 2016. La evaluación única fue realizada mediante la biomicroscopía posterior y la tomografía de coherencia óptica (OCT Stratus 3000), basada en la clasificación propuesta por Panozzo y colaboradores. Resultados: Se constataron variaciones del grosor macular por encima de las 250 micras, predominó el engrosamiento cistoide y según la clasificación aplicada y el grado de tracción epirretiniana, se incluyeron más pacientes en los grupos T1 y T2. Finalmente, se clasificó el edema en no traccional (T0 y T1, 69 por ciento) y en traccional (T2yT3, 31 por ciento). Conclusiones: La tomografía de coherencia óptica y la clasificación de Panozzo son de gran utilidad para caracterizar el tipo de edema macular traccional o no traccional y orienta sobre el adecuado tratamiento a seguir en cada paciente. El edema macular diabético no traccional sobresalió en la muestra estudiada(AU)

Introduction: Macular edema is the most frequent cause of visual loss in patients suffering from non-proliferative diabetic retinopathy. In this condition, the detachment of photoreceptors induced by an abnormal vascular permeability reduces the resolving power of the eye and visual capacity, causing low vision in the patient. Objective: To characterize the behavior of diabetic macular edema and its classification according to the main changes in the optical coherence tomography. Material and methods: A descriptive, prospective, cross-sectional and non-controlled study was carried out in 40 diabetic patients, (80 eyes), with the clinical diagnosis of diabetic macular edema in the Department of Retina of Salvador Allende University Hospital and the Diabetes Care Center from January 2014 to December 2016. A single evaluation was carried out with a subsequent biomicroscopy and optical coherence tomography (Stratus OCT; model 3000), based on the classification suggested by Panozzo and collaborators. Results: Variations in retinal volume over 250 microns were found in the tomography. The cystoid thickening predominated; and according to the classification used and the degree of epiretinal traction, more patients were included in T1 and T2 groups. Finally, edema was classified as non-tractional (T0 and T1, 69 percent), and tractional (T2 and T3, 31 percent). Conclusions: Optical coherence tomography and the classification suggested by Panozzo are highly useful to characterize the type of the macular edema into tractional or non-tractional, and allows to follow the adequate treatment in each patient. Non-tractional diabetic macular edema was highly noticeable in the sample studied(AU)

An unexpected complication in bilateral acute iris transillumination: Cystoid macular edema

A 47-year-old male presented with bilateral 4 + circulating pigment in the anterior chamber, diffuse iris transillumination, dilated pupils unresponsive to light, and high intraocular pressure (IOP) levels in both eyes. Visual acuity and IOP improved bilaterally with topical steroid and antiglaucomatous therapy. In the 10th month, bilateral cystoid macular edema (CME) was developed and resolved after subtenon triamcinolone injections. CME recurred after cataract surgery in the right eye which was treated with intravitreal dexamethasone implant injection. CME was recurred in the left eye and treated with intravitreal dexamethasone implant at the same setting with cataract surgery. CME can be seen in the course of bilateral acute iris transillumination (BAIT). This is the first BAIT case presenting with bilateral CME.

Factors predicting response of pseudophakic cystoid macular edema to topical steroids and nepafenac

Purpose: The purpose of this study is to determine factors predicting resolution of acute pseudophakic cystoid macular edema (PCME) after 6 weeks of topical prednisolone and nepafenac application. Methods: Case records of patients with a clinical and optical coherence tomography (OCT)-based diagnosis of acute PCME were retrospectively reviewed for best-corrected visual acuity and OCT-based parameters at the time of presentation with PCME. In addition, demographic variables, intraoperative and early postoperative factors, and type of treatment prescribed (tapering vs. nontapering prednisolone, generic vs. branded prednisolone and nepafenac) were recorded from case records for analysis. Complete and any successes were defined and baseline factors predicting complete success at 6 weeks were analyzed. Results: We analyzed 69 eyes of 69 patients out of which complete success with topical medications was seen in 37 eyes (54%) and any success was seen in 55 eyes (80%) at 6 weeks. Multivariable logistic regression showed that eyes with lower vision at presentation had a significantly lower likelihood of experiencing both, complete (odds ratio [OR] = 0.83 with one-line decrement in baseline vision, 95% confidence interval [CI] = 0.61�89, P = 0.003) and any success (OR = 0.61, 95% CI = 0.4�9, P = 0.007). Baseline OCT thickness did not influence success rates. Conclusion: Topical prednisolone and nepafenac lead to resolution in PCME in half of the eyes at 6 weeks. Baseline vision is the only factor predicting rates of success and PCME resolution with topical medications.

Choroidal osteoma in a preterm infant

Choroidal osteoma (CO) is a rare, benign, and usually unilateral intraocular tumor composed of mature bone affecting the choroid. It appears as slightly elevated, yellowish-white, or orange choroidal mass with well-defined borders. It is commonly encountered in young female adults. Here, we report findings of a 4-week-old premature baby with CO in her left eye which was detected during a routine examination for “retinopathy of prematurity.” We believe that this case is the youngest patient reported with CO which showing that this pathology can be encountered even in a newborn.

Pars Plana Vitrectomy for Cystoid Macular Edema in a Retinitis Pigmentosa Patient

PURPOSE: To report the first case of cystoid macular edema in a retinitis pigmentosa patient with pars plana vitrectomy. CASE SUMMARY: A 43-year-old female visited our hospital with visual disturbances of both eyes. Corrected visual acuity was 20/22 in the right eye and 20/25 in the left eye. Peripheral depigmentation and atrophy of the retinal pigment epithelium, pigmentary retinal degeneration, and attenuated arterioles were observed in both eyes. Cystoid macular edema was observed on optical coherence tomography which showed that the central macular thickness was 308 µm in the right eye and 422 µm in left eye. Intravitreal aflibercept was injected into the left eye. One month after injection, the central macular thickness showed no response with a thickness of 449 µm. An intravitreal dexamethasone implant was then injected, 1 month after injection, the central macular thickness was 367 µm. Six months after injection, the patient again complained of visual disturbance of the left eye with a corrected visual acuity of 20/70. Vitreous opacity was observed and the central macular thickness was 501 µm. The patient underwent pars plana vitrectomy. Three days after surgery, the central macular thickness was 320 µm. One year after surgery, the corrected visual acuity was 20/33 and the central macular thickness was 311 µm. CONCLUSIONS: Pars plana vitrectomy due to cystoid macular edema in a retinitis pigmentosa patient has not been previously reported in the Republic of Korea. Pars plana vitrectomy can therefore be an effective treatment for cystoid macular edema in retinitis pigmentosa patients.