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®).

Estrategias de tratamiento para el edema macular diabético / Treatment strategies for diabetic macular edema

RESUMEN Se hace una revisión bibliográfica acerca del tratamiento que se utiliza en el edema macular clínicamente significativo. Esta es la primera causa de mala visión en los pacientes con diabetes mellitus. Entre las líneas de tratamiento tenemos los antiangiogénicos con sus variantes, los esteroides y la cirugía por medio de la vitrectomía pars plana con pelado de la membrana limitante interna. No existe hasta el momento el tratamiento ideal. La tomografía de coherencia óptica ayuda a predecir la visión final(AU)

ABSTRACT Treatment of clinically significant diabetic macular edema is the topic of our review. This condition is the first cause of vision loss in diabetic patients. Treatment options include anti-VEFG drugs, steroids and surgery (vitrectomy with internal limiting membrane peeling). There is no an ideal treatment at present. Optic coherence tomography is a useful tool to predict final vision in these patients(AU)

The usefulness of systemic inflammatory markers as diagnostic indicators of the pathogenesis of diabetic macular edema / A utilidade de marcadores inflamatórios sistêmicos como indicadores diagnósticos da patogênese do edema macular diabético

ABSTRACT Purpose: To investigate the usefulness of systemic inflammatory markers [i.e., white blood cell and platelet counts, mean platelet volume, and their ratios] as diagnostic markers of the pathogenesis of diabetic macular edema. Methods: The study cohort included 80 diabetic macular edema patients (40 with diabetic retinopathy and 40 without) and 40 healthy age- and sex-matched controls. Neutrophil, lymphocyte, monocyte, and platelet counts, and the mean platelet volume were determined from peripheral blood samples, and the monocyte/lymphocyte, platelet/lymphocyte, and mean platelet volume/lymphocyte, and neutrophil/lymphocyte ratios were calculated and compared among groups. Results: The mean neutrophil/lymphocyte ratio of the diabetic macular edema and non-diabetic macular edema groups was higher than that of the control group, and the value of the diabetic macular edema group was higher than that of the non-diabetic macular edema group (p<0.001 in diabetic macular edema vs. control, p=0.04 in non-diabetic macular edema vs. control, and p=0.03 in diabetic macular edema vs. non-diabetic macular edema). A neutrophil/lymphocyte cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with a sensitivity of 85% and specificity of 74%. The mean platelet volume of the diabetic macular edema group was higher than those of the non-diabetic macular edema and control groups, while those of the non-diabetic macular edema and control groups were similar (diabetic macular edema vs. non-diabetic macular edema, p=0.08; diabetic macular edema vs. control, p=0.02; and non- diabetic macular edema vs. control, p=0.78). All other parameters were similar between groups (all p>0.05). Conclusion: The neutrophil/lymphocyte ratio and mean platelet volume of the diabetic macular edema group were higher than those of the non-diabetic macular edema and control groups. A neutrophil/lymphocyte ratio cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with high sensitivity and specificity. Moreover, the neutrophil/ lymphocyte ratio of the non-diabetic macular edema group was higher than that of the control group.

RESUMO Objetivo: Investigar a utilidade de marcadores inflamatórios sistêmicos (ou seja, contagem de glóbulos brancos e plaquetas, volume médio de plaquetas e suas proporções) como marcadores de diagnóstico da patogênese do edema macular diabético. Métodos: A coorte do estudo incluiu 80 pacientes com edema macular diabético (40 com retinopatia diabética e 40 sem) e 40 controles saudáveis de acordo com a idade e sexo. As contagens de neutrófilos, linfócitos, monócitos, plaquetas e valores do volume plaquetário médio foram determinados a partir de amostras de sangue periféricdo, e as proporções de monócitos/linfócitos, plaquetas/linfócitos, volume plaquetário médio/linfócitos e neutrófilos/linfócitos foram calculadas e comparadas entre os grupos. Resultados: A proporção média de neutrófilos/linfócitos dos grupos com edema macular diabético e não-diabético foi maior que a do grupo controle, e o valor do grupo com edema macular diabético foi maior que o do grupo com edema macular não diabético (p<0,001 no com edema macular diabético vs. controle, p=0,04 no com edema macular não diabético vs. controle e p=0,03 no com edema macular diabético vs. o com edema macular não-diabético). Um valor de corte de neutrófilos/linfócitos ≥2,26 foi identificado como um indicador da patogênese do edema macular diabético com sensibilidade de 85% e especificidade de 74%. O volume plaquetário médio do grupo com edema macular diabético foi maior que o dos grupos com edema macular não-diabético e controle, enquanto os do grupo de edema macular não-diabético e controle foram semelhantes (edema macilar diabético vs. Edema macular não-diabético, p=0,08; com edema macular diabético vs. controle, p=0,02; e com edema macular não-diabético vs. controle, p=0,78). Todos os outros parâmetros foram semelhantes entre os grupos (todos p>0,05). Conclusão: A proporção de neutrófilos/linfócitos e o volume plaquetário médio do grupo com edema macular diabético foram superiores aos do grupo com edema macular não-diabético e controle. Um valor de corte da razão neutrófilos/linfócitos ≥2,26 foi identificado como um indicador da patogênese do edema macular diabético com alta sensibilidade e especificidade. Além disso, a proporção de neutrófilos/linfócitos do grupo com edema macular não-diabético foi superior à do grupo controle.

Comparative study between intravitreal ranibizumab and triamcinolone treatment of diabetic macular edema as regard to optical coherence tomography changes and visual acuity / Estudo comparativo entre o tratamento intravítreo com ranibizumabe e triancinolona do edema macular diabético quanto às alterações na tomografia de coerência óptica e na acuidade visual

Abstract Objectives: To compare the effect of intravitreal Ranibizumab (0.3mg) and Triamicinolone (4mg) on different parameters in spectral domain OCT and their relation to visual acuity of patients with diabetic macular edema. Methods: This study is designed as a prospective randomized study. Patients were randomly divided into 2 groups receiving either Pro re nata intravitreal Ranibizumab (0.3mg) or Triamicinolone acetonide (4mg), to whom Spectral Domain OCT was done as well as best corrected Log MAR visual acuity. Results: 40 patients were included in this study. Comparison and correlation of mean BCVA and mean CMT among and within treatment groups of our study revealed strong and significant relationship between both parameters and showing equal effect of both treatment types regarding them with the consideration that Triamicinolone acetonide treated group (Group B) showed statistically significant lower CMT compared to Ranibizumab treated group (Group A) at three and six months. Also both showed equal effectivity regarding improvement of the photoreceptors integrity and in turn the improvement of the BCVA. Meanwhile the association of CMT and IS/OS integrity was found to be significant only at six months in both groups (p =0.009 in Group A; p =0.031 in Group B). The fading initial effect of a single ranibizumab injection on macular edema can be augmented by following that one injection with two injections of the loading dose. Triamicinolone effect after single injection began to fade at 3 months. Conclusion: Both treatment types had good effect on reduction of CMT and improvement of BCVA and the IS/OS junction with difference in sustainability of their effects due to difference in their pharmacokinetics and need for repeated injections.

Resumo Objetivos: Comparar o efeito do ranibizumabe intravítreo (0,3mg) e triacmicinolona (4mg) em diferentes parâmetros do domínio espectral da OCT e sua relação com a acuidade visual de pacientes com edema macular diabético. Métodos: Este estudo foi concebido como um estudo prospectivo randomizado. Os pacientes foram divididos aleatoriamente em 2 grupos que receberam Ranibizumab Pro rata intravitreal (0,3mg) ou acetonido de Triamicinolona (4mg), a quem foi realizada a Spectral Domain OCT, bem como a melhor acuidade visual de Log MAR corrigida. Resultados: Quarenta pacientes foram incluídos neste estudo. A comparação e a correlação da acuidade visual média e CMT média entre e dentro de grupos de tratamento do nosso estudo revelaram uma relação forte e significativa entre ambos os parâmetros e mostrando um efeito igual de ambos os tipos de tratamento, considerando que o grupo tratado com acetonido Triamicinolona (Grupo B) apresentou significância estatística. menor CMT comparado ao grupo tratado com Ranibizumab (Grupo A) aos três e seis meses. Também ambos mostraram igual efetividade em relação à melhoria da integridade dos fotorreceptores e, por sua vez, a melhora do BCVA. Enquanto isso, a associação de CMT e IS / OS integridade foi significativa apenas aos seis meses em ambos os grupos (p = 0,009 no Grupo A; p = 0,031 no Grupo B). O efeito inicial enfraquecido de uma única injeção de ranibizumabe no edema macular pode ser aumentado seguindo-se aquela injeção com duas injeções da dose de ataque. O efeito triamicinolona após injeção única começou a diminuir aos 3 meses. Conclusão: Ambos os tipos de tratamento tiveram bom efeito na redução da CMT e melhora do BCVA e da junção IS / OS com a diferença na sustentabilidade de seus efeitos devido à diferença em sua farmacocinética e necessidade de injeções repetidas.

Intravítrea de bevacizumab vs. bevacizumab y triamcinolona para el edema macular diabético / Intravitreal bevacizumab versus bevacizumab and triamcinolone for the diabetic macular edema

Objetivos: evaluar el uso de la inyección IV de bevacizumab, sola o combinada con triamcinolona, así como sus efectos adversos y la correlación entre la mejor agudeza visual corregida y el grosor macular central. Métodos: se realizó un estudio observacional, longitudinal, prospectivo de caso y control a doble ciegas a 90 pacientes en la consulta de Vítreo­Retina del Instituto Cubano de Oftalmología Ramón Pando Ferrer, con edema macular diabético no tratados previamente y sin tracción vítrea. Se dividieron al azar en 3 grupos de tratamientos: un grupo control tratado con láser, otro con intravítrea de bevacizumab (1,25 mg en 0,05 mL) y otro con bevacizumab y triamcinolona (1,25 mg en 0,05 mL más 4 mg en 0,1 mL respectivamente). Cada grupo estuvo formado por 30 pacientes, con evolución a las 6, 12, 18, 24, 30 semanas y al año. Resultados: la mejor agudeza visual corregida al año de tratamiento entre los tres grupos no tuvo significación estadística (p= 0,099). En el grupo de láser el 40 por ciento mejoró 2 o más líneas, seguido del grupo de bevacizumab (20 por ciento) y el de bevacizumab y triamcinolona (10 por ciento). Hubo diferencia significativa (p= 0,001), en la disminución del grosor macular central entre los grupos al año; el grupo del láser fue el de mayor disminución (60 por ciento). El grupo de intravítrea de bevacizumab y triamcinolona logró los mejores resultados en la disminución del grosor macular central, pero no se mantuvo al año; sin embargo, el efecto del láser logró una disminución del grosor macular más estable. Conclusión: el tratamiento con fotocoagulación macular para el edema macular diabético es más eficaz al año en la disminución de grosor macular y en la mejor agudeza visual corregida(AU)

Objective: to evaluate the use of intravitreal bevacizumab injection alone or combined with triamcinolone as well as the adverse effects and the correlation between the best corrected visual acuity and the central macular thickness. Methods: prospective, longitudinal and observational double-blinded case control study performed in 90 patients with untreated diabetic macular edema and no vitreous traction in the vitreous-retina service of Ramón Pando Ferrer Institute of Ophthalmology of Cuba. They were randomly divided into 3 groups for treatment: a control group treated with laser, another one with intravitreal bevacizumab (1,25 mg in 0,05 mL) and the other with bevacizumab plus triamcinolone (1,25 mg in 0,05 mL plus 4 mg in 0,1 mL, respectively). Each group had 30 patients, with progress evaluated at 6, 12, 16, 24, 30 weeks and one year. Results: the best corrected visual acuity after a year of treatment did not have statistical significant in any of the three groups (p= 0,099). In the laser-treated group, 40 percent improved two or more lines in the Snellen chart, followed by bevacizumab group (20 percent) and that of bevacizumab plus triamcinolone (10 percent). There was significant difference (p= 0,001) in the central macular thickness decrease after one year in the three groups, being the laser group the one with highest decrease rate (60 percent). The group treated with intravitreal bevacizumab plus triamcinolone achieved the best results in reducing the central macular thickness but this result did not remain after a year. However, the laser treatment showed a more stable reduction of the macular thickness. Conclusions: macular photocoagulation for the diabetic macular edema is more effective one year after treatment in reducing the macular thickness and achieving the best corrected visual acuity(AU)

Early diagnosis of diabetic retinopathy in primary care / Diagnóstico temprano de retinopatía diabética en el primer nivel de atención

Objective: To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, México. Methods: Study transversal, observational, prospective, analytical, eight primary care units from Mexican Social Security Institute in the northern delegation of the State of Quintana Roo, Mexico were included. A program for early detection of diabetic retinopathy (DR) in adult 376,169 was designed. Were diagnosed 683 cases of type 2 diabetes, in 105 patients randomized was conducted to direct ophthalmoscopy were subjected to a secondary hospital were assigned. Will determine the degree of diabetic retinopathy and macular edema was performed. Results: In population were 55.2% female, mean age 48+11.1 years, 23.8 % had some degree of DR, 28.0% with mild non- proliferative diabetic retinopathy 48.0 % moderate 16.0% and severe and 8.0% showed proliferative diabetic retinopathy. Those over age 30 are 2.8 times more risk of developing DR, OR= 2.8; 95%CI: 0.42-18.0, and OR= 1.7; 95%CI: 1.02-2.95 women. Conclusions: The implementation of programs aimed at the early detection of debilitating conditions such as diabetic retinopathy health impact beneficiaries, effective links between primary care systems and provide second level positive health outcomes for patient diseases.

Objetivo: Evaluar el impacto de una estrategia para la detección temprana de Retinopatía Diabética en pacientes con Diabetes Mellitus tipo 2 (DM2) en Quintana Roo. Métodos: Estudio Transversal, observacional, prospectivo, analítico. En Ocho unidades de primer nivel de atención de la delegación Norte del Estado de Quintana Roo, México del Instituto Mexicano del Seguro Social. Se diseñó un programa de detección oportuna de retinopatía diabética en 376,169 adultos, se realizó el diagnóstico de 683 casos de DM2, de forma aleatoria se asignaron 105 pacientes a quienes se les practicó oftalmoscopia directa en un hospital de segundo nivel. Se realizó la determinación del grado de retinopatía diabética y edema macular. Resultados: En la muestra predominaron las mujeres: 55.2%, edad promedio de 48+11.1 años, el 23.8% presentó algún grado de DR, 28.0% con retinopatía diabética no proliferativa leve (DRnPL), 48.0% moderada (DRnPM), 16.0% Severa (DRnPS) y el 8.0% presento Retinopatía diabética proliferativa (DRP). Los mayores de 30 años tuvieron 2.8 veces más riesgo de desarrollar DR, OR 2.8; IC95%: 0.42-18.0 al igual que las mujeres OR= 1.7; IC95%: 1.02-2.95. Conclusiones: La realización de programas dirigidos a la detección oportuna de enfermedades incapacitantes como la retinopatía diabética tienen impacto en la salud de los derechohabientes, la vinculación efectiva entre los sistemas de atención primaria y segundo nivel ofrecen resultados favorables para la salud de los pacientes.

Association between Microperimetric Parameters and Optical Coherent Tomographic Findings in Various Macular Diseases

PURPOSE: To analyze the correlation between microperimetric parameters and optical coherent tomographic findings in the eyes of patients with macular diseases. METHODS: A total of 64 eyes were included in this retrospective cross-sectional study. Differences in the macular integrity index and microperimetric parameters were analyzed according to types of outer retinal band defects. Correlations between average threshold values and retinal thickness in the corresponding areas were analyzed. Finally, microperimetric parameters were compared between inner and outer retinal lesions. RESULTS: Measures of best-corrected visual acuity, macular integrity index, and average threshold values were significantly worse in eyes with defects in the ellipsoid portion of the photoreceptor inner segment (ISe), the cone outer segment tip (COST), and the external limiting membrane (ELM) than in eyes without ISe, COST, and ELM defects. Also, visual functionality is more significantly impacted by ELM defects than by other hyper-reflective band defects. There was a significant negative correlation between retinal thickness and the average threshold of the corresponding area in the Early Treatment Diabetic Retinopathy Study grid. Microperimetric parameters in the eyes of patients with inner retinal lesions were better than in the eyes of patients with outer retinal lesions. CONCLUSIONS: The macular integrity index may be a useful factor for reflecting the functional aspects of macular diseases. Specifically, ELM, ISe, and COST defects are significantly associated with poor retinal sensitivity and macular integrity index values that suggest abnormalities. Among eyes with these particular defects, the visual functionality of patients is most sensitively impacted by ELM defects. This finding suggests that microperimetric parameters are sensitive and useful for evaluating functional abnormalities in the eyes of patients with macular disease, particularly in patients with outer retinal pathology.

Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery

PURPOSE: To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS: A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS: Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS: Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.

Edema cistoide de mácula pós-LASIK tratado com ranibizumabe / Macular edema post-LASIK treated with ranibizumab

Os autores relatam o caso de uma paciente que desenvolveu edema cistóide de mácula pós-cirurgia para correção de miopia pelo método LASIK. Foi submetida a tratamento com injeções intravítrea de ranibizumabe e apresentou resultado visual satisfatório.

The authors report the case of a patient who developed cystoid macular edema after surgery for myopia by LASIK method. She was treated with intravitreal injections of ranibizumab and presented satisfactory visual result.

Patient's Self-recognition of Reduced Visual Acuity Due to Recurrence of Macular Edema and Prompt Visitation to the Hospital in Retinal Vein Occlusion

PURPOSE: To evaluate patients' self-recognition of reduced visual acuity due to recurring macular edema in retinal vein occlusion. METHODS: A retrospective review of medical records of patients who were diagnosed with recurring macular edema secondary to retinal vein occlusion was performed. The proportion of patients who recognized reduced visual acuity due to the recurrence of macular edema and who visited the hospital before the scheduled follow-up date was determined. Parameters including age, sex, diagnosis, visual acuity before recurrence of macular edema, and extent of visual acuity reduction due to recurrence of macular edema were compared in patients who recognized a reduction in visual acuity and those who did not. The proportion of patients who visited the hospital promptly was also determined. RESULTS: Forty eyes of 40 patients were included in the analysis. Sixteen and 24 patients were diagnosed with central retinal vein occlusion and branch retinal vein occlusion, respectively. Twenty-one patients (52.5%) recognized reduced visual acuity due to recurring macular edema. These patients were younger (59.2 +/- 7.6 vs. 64.8 +/- 9.4 years, p = 0.046), had better visual acuity before recurrence of macular edema (0.52 +/- 0.48 vs. 1.02 +/- 0.46, p = 0.002), and exhibited a greater reduction in visual acuity after recurrence of macular edema (0.34 +/- 0.24 vs. 0.14 +/- 0.13, p = 0.003). Only four patients visited the hospital before the scheduled follow-up date, and all of these patients lived relatively close to the hospital. CONCLUSIONS: For prompt treatment of recurring macular edema, more intensive education about the self-estimation of visual acuity is necessary, particularly for elderly patients who have relatively poor visual acuity. In addition, a simple and easy way to identify the recurrence of macular edema at the local clinic should be established for patients who live relatively far from the hospital.

The Short-term Efficacy of Subthreshold Micropulse Yellow (577-nm) Laser Photocoagulation for Diabetic Macular Edema

PURPOSE: This pilot study aimed to evaluate the efficacy and safety of subthreshold micropulse yellow (577-nm) laser photocoagulation (SMYLP) in the treatment of diabetic macular edema (DME). METHODS: We reviewed 14 eyes of 12 patients with DME who underwent SMYLP with a 15% duty cycle at an energy level immediately below that of the test burn. The laser exposure time was 20 ms and the spot diameter was 100 microm. Laser pulses were administered in a confluent, repetitive manner with a 3 x 3 pattern mode. RESULTS: The mean follow-up time was 7.9 ± 1.6 months. The baseline-corrected visual acuity was 0.51 ± 0.42 logarithm of the minimum angle of resolution (logMAR), which was improved to 0.40 ± 0.35 logMAR (p = 0.025) at the final follow-up. The central macular thickness at baseline was 385.0 ± 111.0 microm; this value changed to 327.0 ± 87.7 microm (p = 0.055) at the final follow-up. CONCLUSIONS: SMYLP showed short-term efficacy in the treatment of DME and did not result in retinal damage. However, prospective, comparative studies are needed to better evaluate the efficacy and safety of this treatment.

Comparison of Injection of Intravitreal Drugs with Standard Care in Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: We reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase. RESULTS: Totals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups. CONCLUSIONS: Although IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.

Comparison of Injection of Intravitreal Drugs with Standard Care in Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: We reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase. RESULTS: Totals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups. CONCLUSIONS: Although IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.

Communications between intraretinal and subretinal space on optical coherence tomography of neurosensory retinal detachment in diabetic macular edema

The pathogenesis of development and progression of neurosensory retinal detachment [NSD] in diabetic macular edema [DME] is not yet fully understood. The purpose of this study is to describe the spectral domain optical coherence tomography [SD-OCT] morphological characteristics of NSD associated with DME in the form of outer retinal communications and to assess the correlation between the size of communications and various factors. This was an observational retrospective nonconsecutive case series in a tertiary care eye institute. We imaged NSD and outer retinal communications in 17 eyes of 16 patients having NSD associated with DME using SD-OCT. We measured manually the size of the outer openings of these communications and studied its correlation with various factors. Statistical analysis [correlation test] was performed using the Statistical Package for Social Sciences [SPSS] software [version 14.0]. The main outcome measures were correlation of the size of communications with dimensions of NSD, presence of subretinal hyper-reflective dots, and best-corrected visual acuity [BCVA]. The communications were seen as focal defects of the outer layers of elevated retina. With increasing size of communication, there was increase in height of NSD [r = 0.701, P = 0.002], horizontal diameter of NSD [r = 0.695, P = 0.002], and the number of hyper-reflective dots in the subretinal space [r = 0.729, P = 0.002]. The minimum angle of resolution [logMAR] BCVA increased with the increasing size of communications [r = 0.827, P< 0.0001]. Outer retinal communications between intra and subretinal space were noted in eyes having NSD associated with DME. The size of communications correlated positively with the size of NSD and subretinal detachment space hyper-reflective dots, and inversely with BCVA

Cytomegalovirus Retinitis after Intravitreal Bevacizumab Injection in an Immunocompetent Patient

We report a case of cytomegalovirus (CMV) retinitis after intravitreal bevacizumab injection. A 61-year-old woman with diabetic macular edema developed dense vitritis and necrotizing retinitis 3 weeks after intravitreal bevacizumab injection. A diagnostic vitrectomy was performed. The undiluted vitreous sample acquired by vitrectomy was analyzed by polymerase chain reaction and culture. Polymerase chain reaction of the vitreous was positive for CMV DNA. Other laboratory results did not show evidence of other infectious retinitis and systemic immune dysfunction. Human immunodeficiency virus antibodies were also negative. After systemic administration of ganciclovir, retinitis has resolved and there has been no recurrence of retinitis during the follow-up period of 12 months. Ophthalmologists should be aware of potential risk for CMV retinitis after intravitreal bevacizumab injection.

Resultados de la implantación de la cámara no midriática sobre la población diabética / Results of non-mydriatic fundus camera screening in a diabetic population

Objetivo: Determinar el impacto de la implantación de sistemas de cribado de retinopatía diabética (RD) mediante cámara no midriática (CNM) en una población con diabetes mellitus (DBT). Métodos: Estudio prospectivo de 6 años de duración, sobre el cribado oportunístico de una población de 12 801 pacientes con DBT. Resultados: Se revisaron 10 047 pacientes con DBT, un 78.48% de los individuos con DBT censados. En 86 (0.86%) pacientes no se pudo interpretar la imagen y debieron ser referidos a las consultas de oftalmología. Un total de 1 908 pacientes (19%) requirió dilatación pupilar. A los 6 años se detectó RD en 1 410 pacientes, con una incidencia anual del 6.15%; la forma leve fue la más frecuente, con un 77.94% de casos. La incidencia de edema macular diabético fue del 4.84% anual. Se verificó la presencia de otras enfermedades en 995 pacientes (9.91%). Conclusiones: Podemos extraer que el cribado mediante CNM es altamente útil para poder acceder a una gran parte de la población diabética, en especial aquella que acude con escasa frecuencia al oftalmólogo, lo que nos permite diagnosticar un número importante de individuos susceptibles de tratamiento láser para evitar que presenten ceguera.

Resolution of Macular Edema after Systemic Treatment with Furosemide

We report two cases of macular edema treated with the oral administration of furosemide. The first case presented here was a 78-year-old male patient with visual disturbance of the left eye. He had been taking an oral agent for diabetes and had chronic renal failure for 7 years. From 10 days prior to the visit, he had visual disturbance of the left eye accompanied by systemic edema. There were no specific findings in the anterior segment, but sub-retinal fluid was observed in the left fundus. Macular edema was observed on fluorescein angiography and optical coherence tomography; therefore, the oral administration of furosemide was initiated. After seven days, the sub-retinal fluid disappeared. The second case was a 43-year-old female patient with visual disturbance of the left eye who had been taking hypoglycemic agents for diabetes for 13 years. There were no specific findings in the anterior segment, but flame-shaped retinal hemorrhages were scattered over both posterior poles, neovascularization was observed in the left eye, and, of particular note, sub-retinal fluid was detected in the macula of the left eye. Macular edema was also observed on fluorescein angiography and optical coherence tomography, and oral administration of furosemide was initiated. After 3 weeks, the macular edema had significantly decreased.

Intravitreal Bevacizumab Alone versus Combined with Macular Photocoagulation in Diabetic Macular Edema

PURPOSE: To compare the efficacy between intravitreal bevacizumab and combination treatment (bevacizumab and macular photocoagulation) for the treatment of diabetic macular edema (DME). In addtion, changes of DME type were researched using optical coherence tomography. METHODS: The present study included 90 eyes with bevacizumab injection and 38 eyes with combination treatment. Using chart records, patients were reviewed until 6 months after treatment. The present study compared changes of visual acuity (VA) and macular thickness at each follow up. DME was classified into 4 types and the morphologic pattern was compared. RESULTS: In patients with the bevacizumab injection only, VA improved from 0.29 +/- 0.18 to 0.48 +/- 0.26 at 1 month and returned to 0.32 +/- 0.20 at 6 months after treatment. In the combination treatment, VA improved from 0.32 +/- 0.22 to 0.52 +/- 0.26 at 1 month and returned to 0.36 +/- 0.18 at 6 months after treatment. There was no significant improvement of VA at the final follow-up with either treatment. There was significant decrease of macular thickness except in the mixed DME type. CONCLUSIONS: The combination treatment did not yield better VA or macular thickness reduction at 6 months than bevacizumab injection alone. By classifying and observing the change of DME type, determining the treatment objectively and predicting the effectiveness of treatment can be helpful.

Intravitreal Bevacizumab Alone versus Combined with Macular Photocoagulation in Diabetic Macular Edema

PURPOSE: To compare the efficacy between intravitreal bevacizumab and combination treatment (bevacizumab and macular photocoagulation) for the treatment of diabetic macular edema (DME). In addtion, changes of DME type were researched using optical coherence tomography. METHODS: The present study included 90 eyes with bevacizumab injection and 38 eyes with combination treatment. Using chart records, patients were reviewed until 6 months after treatment. The present study compared changes of visual acuity (VA) and macular thickness at each follow up. DME was classified into 4 types and the morphologic pattern was compared. RESULTS: In patients with the bevacizumab injection only, VA improved from 0.29 +/- 0.18 to 0.48 +/- 0.26 at 1 month and returned to 0.32 +/- 0.20 at 6 months after treatment. In the combination treatment, VA improved from 0.32 +/- 0.22 to 0.52 +/- 0.26 at 1 month and returned to 0.36 +/- 0.18 at 6 months after treatment. There was no significant improvement of VA at the final follow-up with either treatment. There was significant decrease of macular thickness except in the mixed DME type. CONCLUSIONS: The combination treatment did not yield better VA or macular thickness reduction at 6 months than bevacizumab injection alone. By classifying and observing the change of DME type, determining the treatment objectively and predicting the effectiveness of treatment can be helpful.