RESUMEN
To evaluate the effect of intravitreal triamcinolone acetonide [IVT] on clinical, angiographic, and optical coherence tomographic parameters in refractory diabetic macular edema [DME]. In a double-masked placebo-controlled randomized clinical trial, 88 eyes of 61 patients with DME refractory to previous laser therapy or not suitable for such treatment were included in the study. Eligible eyes were randomly assigned into two groups. The treatment group [45 eyes] received 4 mg IVT and the placebo group [43 eyes] received subconjunctival injection of placebo. Complete ophthalmologic examination, fluorescein angiography, and optical coherence tomography [OCT] were performed before intervention and repeated after 2 and 4 months. Quantitative measurement of variables on angiograms including hard exudates [HE], size of foveal avascular zone, and leakage severity was performed using Photoshop software. Two months after intervention, visual acuity [VA] improved in the treatment group [-0.13 Log MAR, P=0.01] but slightly deteriorated in the placebo group [0.02 Log MAR, P=0.63]. The difference of the above changes [0.15 Log MAR] was statistically significant at 2 months [P=0.02] but reduced to 0.11 Log MAR [P=0.08] after 4 months. Mean [standard deviation] of central macular thickness [CMT] by OCT before and 2 and 4 months after injection was 393 [15 I], 293 [109], and 362 [119] microns in the treatment group and 393 [166], 404 [134], and 405 [160] microns in the placebo group, respectively. The second month difference was statistically significant [P=0.01]. Reduction of the amount of HE [51%, P=0.004] and petaloid pattern [P=0.012] was significant in the treatment group as compared with the placebo group. There were no significant IVT-related side effects except for transient ocular hypertension in 32.6% of patients after 2 months. The greatest therapeutic effect of IVT on DME according to CMT and VA occurs at 2 months and decreases up to the fourth month. However, concerning cyctoid macular edema and hard exudates, the effect is maintained up to 4 months
RESUMEN
To evaluate the agreement between a new method for quantitative analysis of fundus or angiographic images using Photoshop software and clinical judgment. Four hundred evaluated by three retina variables were selected for eighteen fundus and angiographic images of diabetic patients were specialists and then by computer using Photoshop 7.0 software. Four amount of hard exudates [HE] on color pictures, amount of HE on red-free pictures, severity of leakage, and size of foveal avascular zone. Available programs in the software such as color selection, luminosity channel, and histogram and tools such as magnetic lasso and magic wand were used for measurement. Coefficients of agreement and kappa measurements were calculated. Agreement [kappa] between the two methods in the amount of HE on color and red-free photographs were 85% [0.69] and 79% [0.59], respectively. This agreement for severity of leakage was 72% [0.46]. In the evaluation of the foveal avascular zone size with two methods of quantification using the magic and lasso software tools the agreement was 54% [0.09] and 89% [0.77], respectively. Quantitative measurement of fundus and angiographic image variables such as HE, leakage, and foveal avascular zone can be performed precisely using Photoshop software
RESUMEN
Purpose: to evaluate the effect of transpupillary thermotherapy on visual improvement and regression of occult choroidal neovascularization [CNV] in patients with age-related macular degeneration
Methods: thirty eyes of 30 patients with CNV who underwent thermotherapy by means of diode laser [lamda= 810 nm] were studied. Visual acuity, regression of neovascularization, funduscopy, and angiography were evaluated after 6 weeks, 3 months and 6 months
Results: out of 30 patients, 8 cases were female and 22 cases were male. Mean age was 67.3 years. After a mean follow up of 5.3 months, mean visual acuity improved from 1.25 log MAR [20/320] preoperatively to 1.06 log MAR [20/200] postoperatively which is equivalent to 2 lines of improvement in visual acuity [P< 0.004]. Anatomic success [choroidal atrophy or flat scar] was achieved in [73.3%] and failure [disciform scar or recurrent CNV] occurred in 26.7% [P= 0.0001]. Twelve cases of pigmented epithelial detachment [PED] including 2 cases of very large PED, responded to safe treatment perfectly
Conclusion: transpupillary thermotherapy may cause regression of choroidal neovascularization in age-related macular degeneration
RESUMEN
Purpose: to report a case of exudative retinal detachment [ERD] secondary to bilateral choroidal metastasis of bilateral adenocarcinoma the breast
Patient and findings: a 50-year-old woman with history of decreased visual acuity [OD] since for 3 months had multiple visits and history of subtenon Depomedrol injection. Visual acuity was counting fingers at 2 meters and 6/10 in the right and left eyes, respectively. Relative afferent pupillary defect was 3+ [OD]. On slit lamp, 2+ anterior chamber and vitreous reaction was detected. On funduscopy, advanced ERD of the right eye and multiple subretinal masses in the left eye were noted. On systemic work up, bilateral multiple breast masses were found on mammography. Her breast biopsy showed advanced invasive intraductal adenocarcinoma
Conclusion: any patient with exudative retinal detachment of undetermined cause should undergo a thorough systemic work up. Prompt intervention is imperative and may be life saving
RESUMEN
Purpose: to evaluate the effects of posterior subtenon triamcinolone acetonide [TA] injection on clinical, angiographic, and optical coherence tomographic [OCT] features in refractory diabetic macular edema [DME]
Method: in a randomized double-masked placebo-controlled clinical trial, 38 consecutive patients [64 eyes] with DME refractory to previous laser therapy or not suitable for such treatment were studied. An equal number of eyes [32] were allocated in the treatment and control groups. Posterior subtenon injection of 40 mg TA in the treatment group and subconjnctival injection of 0.1 ml of lidocaine 2% in the control group was performed and repeated after two months. Clinical, angiographic, and OCT features were evaluated before intervention and after 4 months. Quantitative measurement of hard exudates [HE], size of foveal avascular zone [FAZ], and leakage was done using Photoshop 7-0 software
Results: before injection, best corrected visual acuity [BCVA] was 0.93 +/- 0.39 LogMAR in the control group and 0.75 +/- 0.38 LogMAR in the treatment group [P= 0.078]. At the last follow up, BCVA was 0.88 +/- 0.48 LogMAR in the control group and 0.71 +/- 0.42 LogMAR in the treatment group [P= 0.136]. Before injection, central macular thickness [CMT] was 388.2 +/- 119.1 [micro]m in controls and 392.2 +/- 153.6 [micro]m in cases [P= 0.9]. At the end of the study, CMT was 375.4 +/- 154.66 [micro]m and 377.37 +/- 180.04 [micro]m in cases and controls, respectively [P= 0.5]. There was also no significant difference in HE, FAZ, and leakage changes in the angiograms. In 2 eyes of the treatment group, intraocular pressure exceeded 20 mmHg which was controlled by medication
Conclusion: posterior subtenon injection of TA in the eyes with severe DME seems to have no effect on visual acuity and macular thickness