Cystoid macular edema secondary to intraocular lens sub-luxation and iris perforation by iol haptic / Edema macular cistóide secundário a subluxação de lente intraocular e perfuração da íris por haptico da lente

Abstract We present a case of 50-years-old, man with vision loss, dysmorphopsia and micropsy in the right eye with for 6 months. Ocular history included uncomplicated cataract surgery 10 years before. Best corrected visual acuity was 20/100 in the right eye and 20/20 in the left eye. Anterior segment OD demonstrated intra-ocular lens (IOL) haptic in the anterior chamber with iris perforation. Fundus examination revealed cystoid macular edema in right eye. Surgical approach with reposition of the IOL and triamcinolone acetonide intravitreal injection were performed with visual and tomographical improvement.

Resumo Apresentamos o caso de um homem de 50 anos, com queixa de perda de visão, dismorfopsia e micropsia em olho direito (OD) há 6 meses. A história ocular incluiu cirurgia de catarata sem complicações 10 anos antes. A melhor acuidade visual corrigida foi 20/100 em OD e 20/20 em olho esquerdo. O segment anterior do OD demonstrou háptica da lente intraocular (LIO) na câmara anterior com perfuração da íris. A fundoscopia revelou edema macular cistoide em OD. A abordagem cirúrgica com reposição da LIO e injeção intravítrea de triancinolona acetonida foi realizada com melhora visual e tomográfica.

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)

Análisis de impacto presupuestal de ranibizumab comparado con aflibercept, triamcinolona y bevacizumab para tratamiento de pacientes con edema macular secundario a oclusión de la vena central de retina en Colombia / Ranibizumab budget impact analysis compared to aflibercept, triamcinolone and bevacizumab for treatment of patients with macular edema secondary to central retinal vein occlusion in Colombia

Tecnologías evaluadas: Intervención: Ranibizumab; Comparadores: Aflibercept, triamcinolona y bevacizumab. Población: Pacientes con edema macular secundario a oclusión de la vena central de la retina en Colombia. \r\nPerspectiva: Tercer pagado - Sistema General de Seguridad Social en Salud (SGSSS). Horizonte temporal: \r\nEl horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente, se reportan las\r\nestimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Costo de medicamentos; Costos de procedimientos e insumos. Fuente de costos: SISMED; Manual tarifario ISS 2001. Escenarios: Escenario 1: El costo de los medicamentos permanece igual al actual. El uso de bevacizumab sería de 85%, aflibercept sería del 10%, triamcinolona podría ocupar el 15 % restante Escenario 2: tanto el costo de ranibizumab como el de aflibercept se ajustan al valor de bevacizumab. Ante esta situación, la utilización de aflibercept sería del 50%, ranibizumab y bevacizumab tomarían un 22.5% de participación cada uno y triamcinolona el restante 5%. Resultados: El impacto presupuestal total e incremental al que el sistema de salud colombiano estaría incurriendo al incluir los\r\nmedicamentos ranibizumab, aflibercept, bevacizumab y triamcinolona dentro del plan de beneficios para el tratamiento de edema macular secundario a OVCR bajo las condiciones de caso base este valor sería de 25.716 millones de pesos para el primer año de adopción. Para el segundo y tercer año el impacto incremental sería superior a los 6 y 8 mil millones de pesos respectivamente. (AU)

Non leaking cystoid macular edema

The current study was conducted to report the discrepancy in findings between Spectral Domain-Optical Coherence Tomography [SD-OCT] and Fundus Fluorescein Angiography [FFA] examinations of the macular area regarding Cystoid Macular Edema [CME] in patients with diabetic retinopathy [DR] or retinal vein occlusion [RVO]. This was a retrospective observational case study, involved 205 eyes of 179 patients. Eyes with diabetic retinopathy or retinal vein occlusion those underwent SD-OCT and FFAwere included in the study. All eyes had SD-OCT detected CME. In the current study, SD-OCT detected CME was associated with diabetic retinopathy in 56.1% of eyes and with retinal vein occlusion in 43.9% of eyes. CME associated with DR or RVO was undetected on FFA examination in 12.2% and 7.3% of eyes, respectively. Both SD-OCT and FFA were complementary to each other in the detection of CME in eyes with DR or RVO. The use of both SD-OCT and FFA aided in the diagnosis, the choice of the treatment option and the final visual outcome

Esclerite posterior associada à oclusão da veia central da retina e edema macular cistoide: relato de caso / Posterior scleritis associated with central retinal vein occlusion and cystoid macular edema: case report

Apresentamos um caso de esclerite posterior associada à oclusão da veia central da retina e edema macular cistoide. Com esse caso, observamos como a doença pode ser agressiva e como a acuidade visual pode ser comprometida. No entanto, o tratamento correto pode melhorar as alterações oculares com melhora visual. Alertamos também para os cuidados que devem ser tomados em relação ao uso de altas doses de corticosteroides.

A case of posterior scleritis associated with central retinal vein occlusion and cystoid macular edema is reported. With this case, we noticed how the disease can be aggressive and how the visual acuity can be compromised. However, the correct treatment can improve the ocular changes with visual improvement. We also alert to the care with the use of high doses of corticosteroids.

Intraocular Pressure and Its Determinants in Subjects With Type 2 Diabetes Mellitus in India / 예방의학회지

OBJECTIVES: This study was conducted to show the intraocular pressure (IOP) distribution and the factors affecting IOP in subjects with type 2 diabetes mellitus (DM) in India. METHODS: We measured the anthropometric and biochemical parameters for confirmed type 2 DM patients. A comprehensive ocular examination was performed for 1377 subjects aged > 40 years and residing in Chennai. RESULTS: A significant difference in IOP (mean +/- standard deviation) was found between men and women (14.6+/-2.9 and 15.0+/-2.8 mmHg, p = 0.005). A significantly elevated IOP was observed among smokers, subjects with systemic hypertension and women with clinically significant macular edema (CSME). After a univariate analysis, factors associated significantly with higher IOP were elevated systolic blood pressure, elevated resting pulse rate and thicker central corneal thickness (CCT). In women, elevated glycosylated hemoglobin was associated with a higher IOP. After adjusting for all variables, the elevated resting pulse rate and CCT were found to be associated with a higher IOP. CONCLUSIONS: Systemic hypertension, smoking, pulse rate and CCT were associated with elevated intraocular pressure in type 2 DM. Women with type 2 DM, especially those with CSME, were more prone to have an elevated IOP.

Comparison of serum glycosylated hemoglobin levels in patients with diabetic cystoid macular edema with and without serous macular detachment.

Aim: A clinical comparative trial was conducted to compare the levels of glycosylated hemoglobin (HbA1c) in patients with diabetic cystoid macular edema (CME) with and without serous macula detachment (SMD). Materials and Methods: Thirty patients (group 1) with diabetic CME in both eyes, but without SMD, and 30 patients (group 2) with diabetic CME and SMD in both eyes documented by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA), were included in the study. In addition to the measurement of central macular thickness by OCT and visual acuity (VA) (as logMAR) using the the early treatment diabetic retinopathy study (ETDRS) chart, the concentrations of HbA1c were measured by high performance liquid chromatography (HPLC). Statistical analysis was done by independent samples t test. Results: The mean logMAR VA was 0.8 ± 0.22 (1.0–0.5) in group 1and 0.7 ± 0.16 (1.0–0.6) in group 2. The mean central macular thickness, as determined by OCT, was 468.70 ± 70.44 μm (344–602 μm) in group 1 and 477.80 ± 73.34 μm (354–612 μm) in group 2. The difference between the groups was not statistically significant (P = 0.626). The mean HbA1c levels were 8.16 ± 0.99% in group 1 and 10.05 ± 1.66% in group 2. The difference between the groups was statistically significant (P < 0.001). Conclusions: The presence of SMD and high HbA1c levels in the patients with diabetic CME may be indirectly suggestive of retinal pigment epithelium dysfunction.

Resolution of macular edema in Coats' disease with intravitreal bevacizumab.

A 13-year-old boy was referred because of visual deterioration in his right eye. The visual acuity was two meters of counting fingers. Indirect ophthalmoscopy and biomicroscopy revealed exudative macular edema as well as tumor-like telangiectatic vessels and exudation in temporal periphery. With diagnosis of Coats' disease (stage II) confirmed by fluorescein angiography, three intravitreal injections of bevacizumab were performed at 6-week intervals. One year after the last injection, there was a significant resolution of macular edema as well as visual acuity improvement to 20/20. This is the first case report in which a distinct improvement in macular edema was observed with intravitreal bevacizumab in Coats' disease.

The response pattern of intravitreal triamcinolone injection for non-AMD macular edema.

OBJECTIVE: To determine the pattern of functional and anatomical responses after intravitreal triamcinolone (IVTA) for macular edema in diabetic retinopathy, retinal vein occlusion, uveitis, and macular telangiectasia. MATERIAL AND METHOD: A Retrospective interventional study was carried out between January 2004 and July 2006. Thirty-eight eyes from 36 patients who had undergone an IVTA injection for macular edema from etiologies other than age-related macular degeneration (non-AMD macular edema) were included in the present study. Visual improvement and retinal thickness were the main outcomes. Potential complications, including increased intraocular pressure (IOP), intraocular bleeding, and postoperative endophthalmitis were also recorded. RESULTS: The mean pre-operative logarithm of Minimum Angle of Resolution (logMAR) visual acuity (VA) was 1.0 with an average macular thickness of 463.2 +/- 141.4 microns and mean IOP of 12.9 +/- 2.7 mmHg. The macular thickness rapidly decreased in the first week after an injection with a trough at two months (p < 0.001) and began to rise thereafter. The overall VA started to improve significantly at one month and lasted for two months. The IOP significantly increased from the mean baseline during the first two months in 31.6%, which could be controlled only by the medication. No other serious complications were observed. CONCLUSION: IVTA has the potential to improve both functional and anatomical outcomes in non-AMD macular edema. The decrease in macular thickness occurs from one week after an injection but the visual function improves more slowly and has a short-time effect.

Comparison of Combination Posterior Sub-Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema

PURPOSE: To compare the efficacy of posterior sub-Tenon's capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). MATERIALS AND METHODS: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. RESULTS: The ETDRS scores at baseline were 25.2 +/- 13.6 (mean +/- SD) letters in the PSTI + MP group, whereas 21.7 +/- 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 +/- 15.9, 34.7 +/- 16.6 and 30.9 +/- 19.0 letters in the PSTI + MP group whereas by 30.9 +/- 15.4, 30.1 +/- 17.9 and 31.5 +/- 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p 0.05, Student's t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 +/- 148.3, 309.1 +/- 131.3, 319.3 +/- 93.3, 340.4 +/- 123.5micrometer (mean +/- SD) in the PSTI + MP group vs. 369.1 +/- 123.1, 241.4 +/- 52.3, 277.5 +/- 137.4, 290.2 +/- 127.9micrometer in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the PSTI + MP group, and at both 1 month (p 0.05, Student's t-test). In contrast to the PSTI + MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group. CONCLUSION: PSTI + MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.

Central retinal vein occlusion associated with thrombotic thrombocytopenic purpura/ hemolytic uremic syndrome: complete resolution is possible.

We aim to describe a case of central retinal vein occlusion associated with this is a case report of a 45-year-old patient who was admitted for management of thrombotic thrombocytopenic purpura (TTP). He developed left central retinal vein occlusion three months later. The retinal vein occlusion resolved gradually as his TTP started to respond to medical treatment but significant macular edema persisted. Focal argon laser treatment resulted in complete resolution of the macular edema.

A integridade da cápsula posterior na fisiopatologia do EMC da pseudofacia / Cystoid macular edema and the integrity of the posterior capsule in pseudophakia eye

Objetivo:O objetivo dos autores é mostrar a relaçäo entre a ruptura da cápsula posterior (RCP), primária ou secundária à capsulotomia com Nd Yag laser, e o desenvolvimento do edema macular cistóide (EMC). Material e método: Foram analisados 928 olhos submetidos à facoemulsificaçäo com implante de lente intra-ocular nos anos de 1997 a 1998. Resultados: Dos 928 olhos submetidos à facectomia, houve ruptura da cápsula posterior no per-cirúrgico de 40 olhos (40/928 = 4.31 por cento); nenhum destes olhos desenvolveu EMC. Dos 888 olhos em que näo houve ruptura de cápsula, 20 desenvolveram EMC (20/888 = 2.15 por cento). Destes 20 olhos, 2 eram portadores de retinopatia diabética. Dos olhos que näo ocorreu RCP no per-cirúrgico, 141 olhos (141/888 = 15.87 por cento) foram submetidos à capsulotomia secundária (com Nd Yag laser), e destes, 6 evoluíram com EMC (6/141 = 4.25 por cento). Conclusäo: Concluímos que as causas do EMC dos olhos submetidos à cirurgia de catarata sem intercorrências permanecem obscuras, porém, fica evidente que a RCP bem conduzida näo é fator determinante ao EMC. Há fortes evidências de correlaçäo entre capsulotomia posterior com Nd Yag laser e EMC.

Retinopatía diabética en la población piurana: prevalencia y asociación con otras complicaciones de la diabetes mellitus / Diabetic retinopathy in the population piurana: prevalence and asociation with complications of the diabetes mellitus

Se evaluaron 849 pacientes del Programa de Diabetes Mellitus del IPSS - Piura estudiándose la presencia de Retinopatía Diabética (RD) y Edema Macular (EM), así como su asociación con otras complicaciones de la enfermedad. La prevalencia de RD fue 30 por ciento, de ellos el 81 por ciento tuvo RD no proliferativa, 19 por ciento RD Proliferativa; y 35 por ciento EM. El tiempo de enfermedad, hipertensión arterial y tipo de tratamiento fueron factores relacionados con su aparición. La realización del fondo de ojo durante las sesiones educativas del Programa de Diabetes Mellitus incrementó marcadamente la precosidad del diagnóstico, participación y cumplimiento del tratamiento.

The rationale of argon green laser photocoagulation for diabetic maculopathy.

Eighty-four patients of bilateral diabetic retinopathy were divided into 2 groups: Group I comprised of 60 patients (mean age 46 yrs) having non-proliferative diabetic retinopathy with maculopathy (total no. of eyes = 120). Group II consisted of 24 patients (mean age 49.1 yrs) with proliferative diabetic retinopathy with maculopathy (total no. of eyes under study = 48). One eye of each patient in group I was treated as a control and the other was subjected to focal laser therapy. While 48/60 control Group I eyes (80%) had 6/24 vision at the outset, at one year follow-up only 39/60 cases (65%) had 6/24 vision. Diabetic maculopathy persisted in all the 60 control eyes at one year. In contrast, 44/60 eyes (73%) subjected to focal laser therapy in Group I, had 6/24 vision at outset but one year later, 49/60 eyes (81%) had 6/24 vision. Maculopathy completely regressed in 48/60 eyes (80%). The 48 eyes of Group II patients were subjected to focal and scatter laser therapy. 20/48 eyes (41.6%) had 6/24 vision prior to treatment but one year after treatment, 25/48 eyes (52%) had 6/24 vision. Neovascularization and macular edema regressed after one year in 42/48 eyes (87.1%) and only 4/48 eyes (8.3%) developed localized vitreous hemorrhage. Laser therapy in Group I improved visual acuity by reducing macular edema. In Group II, it improved the vision and reduced the risk of vitreous hemorrhage, detachment and glaucoma.