Comparison between multi-spot laser and conventional laser in treatment of diabetic clinically significant macular edema / Comparação entre laser multi-spot e laser convencional no tratamento de edema macular diabético

Abstract Objectives: The purpose of this work is to assess the safety and the efficacy of multi-spot laser in comparison with the conventional laser in the treatment of non-proliferative diabetic retinopathy with CSME in relation to the visual outcome, central macular thickness by (OCT) and the presence of adverse events. Methods: prospective randomized study on total number of 50 eyes divided in two groups each one 25 patients . group A patients underwent focal, grid laser or modified grid macular laser photocoagulation using green laser 532nm GYC-1000. Group B underwent focal ,grid laser or modified grid macular laser photocoagulation multispot laser photocoagulation (VALON TT inclusion criteria was diabetes mellitus type II patients , clinically significant macular edema . patients were monitored by BCVA, OCT, IOP, adverse events pre and 1 week , one month , three months postoperative. Results: The mean preoperative BCVA in group A with conventional laser was 0.294 ± 0.1715 decimal and in group B with multispot laser (valon ) was 0.3040 ± 0.2140 . The mean BCVA 3 months post-laser in group A was 0.4820 ±0.244 decimal and in Group B was 0.5080 ± 0.1977. Central macular thickness of the patients was measured pre-laser and in the follow up periods of 1week, one month, three months. The mean preoperative CMT in Group A was 375.92 ± 65.69 um and in Group B was 361.0± 50.400 um. The mean CMT 3 months post-laser in Group A was 314.44 ±85.938 um and in Group B was 0322.668 ± 57.500 um. The multisport system parameters used higher power of mean 155 mW ± 90.1 more than the conventional laser 100 mW ± 19.4 to produce the same therapeutic visible effect. Conclusion: We found that multisport system is safe, rapid, effective in treatment of clinically significant macular edema in short term follow up periods and had short exposure time. Although the shorter pulse duration of the multisport system necessitates the use of a higher power, it is not associated with adverse effects.

Resumo Objetivos: O objetivo deste trabalho é avaliar a segurança e a eficácia do laser multi-spot em comparação com o laser convencional no tratamento da retinopatia diabética não proliferativa com CSME em relação ao resultado visual, à espessura macular central por (OCT) e à presença de eventos adversos. Métodos: estudo prospectivo randomizado sobre o número total de 50 olhos divididos em dois grupos, cada um de 25 pacientes. Os pacientes do grupo A foram submetidos a fotocoagulação focal, a laser de grade, ou de laser macular de grade modificada com a utilização do laser verde de 532nm GYC-1000. O grupo B foi submetido a fotocoagulação fotocoagulação focal, a laser de grade, ou de laser macular de grade modificada (os critérios de inclusão VALON TT foram pacientes com diabetes mellitus tipo II, edema macular clinicamente significativo). Os pacientes foram monitoradoss para BCVA, OCT, IOP, eventos adversos pré e uma semana, um mês, e três meses de pós-operatório. Resultados: O BCVA preoperatório médio no grupo A com laser convencional foi 0,294 ± 0,1715 decimal, e no grupo B com laser multispot (valon) foi 0,3040 ± 0,2140. O BCVA médio 3 meses após o laser no grupo A foi 0.4820 ± 0.244 decimal, e no grupo B foi 0.5080 ± 0.1977. A espessura macular central dos pacientes foi medida antes do laser e nos períodos de acompanhamento de 1 semana, um mês e três meses. O CMT médio pré-operatório no grupo A foi 375,92 ± 65,69 um, e no grupo B foi 361,0 ± 50,400 um. O CMT médio 3 meses após o laser no grupo A foi 314,44 ±85,938 um, e no grupo B foi 0322,668 ± 57,500 um. Os parâmetros do sistema multisport utilizaram uma potência media 155 mW ± 90,1 superior a do laser convencional de 100 mW ± 19,4 para produzir o mesmo efeito terapêutico visível. Conclusão: Descobrimos que o sistema multisport é seguro, rápido e eficaz no tratamento de edema macular clinicamente significativo em períodos de acompanhamento de curto prazo, e ele teve um curto tempo de exposição. Embora uma duração de pulso mais curta do sistema multisport necessite utilizar uma potência maior, ela não está associada aos efeitos adversos.

Early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema

To get optimal visualization of fundus by early phacoemulsification in diabetic cataract for early recognition and management of diabetic macular oedema. Interventional study. Ophthalmology Unit III, Sindh Government Lyari General Hospital and Dow University of Health Sciences and Al-Noor Eye Hospital, Karachi, from July 2008 to June 2009. Patients with uncontrolled type-II diabetes mellitus of more than 10 years of duration were selected. Patients with clinical significant macular oedema [CSME], non-proliferative diabetic retinopathy [NPDR] and proliferative diabetic retinopathy [PDR] were excluded. Follow-up was done on day 1, 1 week, 1 month, 3 months and 6 months. The male to female ratio was 1:1.44. Out of 218 patients; 129 [59.2%] were males and 89 [40.8%] were females. CSME was found in 82 patients [37.6%] at first postoperative week which declined to 29 cases [13.3%] at first month follow-up. Three subjects developed mild to moderate NPDR. In majority of the subjects, best corrected visual acuity [BCVA] gradually improved in each subsequent follow-up visit. Early phacoemulsification in diabetic cataract offers optimal posterior pole visualization and clears the ambiguity of decreased vision either caused by cataract or macular oedema. Uncomplicated phacoemulsification does not accelerate diabetic macular oedema or retinopathy provided glycemic control and co-morbids are well addressed

Surgical management of diabetic retinopathy

Surgery for late complications of proliferative diabetic retinopathy remains the cornerstone of management even in patients who have received optimal laser photocoagulation and medical therapy. With improvisation in the surgical techniques and development of micro-incision surgical techniques for vitrectomy, the indications for surgical intervention are expanding to include diabetic macular edema with a greater number of patients undergoing early intervention. This review describes the current indications, surgical techniques, adjunctive anti-vascular endothelial growth factor therapy, surgical outcomes, and postoperative complications of pars plana vitrectomy for proliferative diabetic retinopathy and macular edema

A preliminary study of Heavy Brilliant Blue G for internal limiting membrane staining in macular hole surgery.

Context: Surgical outcomes of vitrectomy for idiopathic macular hole using a “heavy” Brilliant Blue G (HBBG) solution for staining and removal of the internal limiting membrane (ILM). Settings and Design: Prospective interventional case series conducted in a tertiary eye care hospital. Materials and Methods: Nineteen patients (20 eyes) with idiopathic macular hole were enrolled to undergo vitrectomy with ILM peeling using HBBG. BBG dye was made heavy by mixing with 10% dextrose normal saline (DNS) solution in 2:1 ratio. The adequacy of ILM staining was noted intraoperatively. The closure rates of macular hole and visual improvement were recorded. Patients were followed up postoperatively on day 1, week 1, and subsequently at 1, 3, and 6 months, and every 6th month thereafter. Statistical Analysis: Wilcoxon signed-rank test was used; P < 0.05 was considered significant. Results: Preoperative best-corrected visual acuity (BCVA) ranged from 20/1000 to 20/63 (median: 20/100). Intraoperatively, the ILM stained very well in all eyes, and was easily removed. All macular holes closed postoperatively. The mean follow-up was 6.15 ± 2 months (range: 4-10; median: 6 months). Final BCVA ranged from 20/20 to 20/80 (median: 20/40), amounting to a significant visual improvement (P = 0.0001). BCVA improved by 1-8 Snellen lines in 19 eyes (95%); 16 eyes (80%) improved by ≥2 lines; 13 eyes (65%) achieved a final BCVA of 20/40 or better. Conclusions: Addition of 10% DNS to BBG dye allowed good ILM staining with less dye during macular hole surgery, and provided excellent anatomic and visual outcomes.

Ranibizumab as an adjunct to laser for macular edema secondary to branch retinal vein occlusion.

To compare the safety, efficacy, and dosing regimen of intravitreal ranibizumab as an adjunct to laser therapy for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). Materials and Methods: Thirty eyes of 30 patients of BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received grid laser treatment alone, Group 2 received a single dose of intravitreal injection of ranibizumab (0.5 mg / 0.05 ml) followed by grid laser treatment on 7th day following injection, while Group 3 received three loading doses of intravitreal ranibizumab at monthly interval (i.e. 0, 1, & 2 months) + standard laser treatment 7 days after the 1st injection. Outcome measure noted at 6 months follow-up were the improvement in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: At 6 months follow-up, there was an average gain of 12 letters (P=0.05), 17.5 letters (P=0.05) and 19 letters (P=0.05) in groups 1, 2, and 3, respectively, with the decrease in CMT being 208.7 μm (P=0.05), 312.9 μm (P= 0.05) and 326.8 μm (P=0.05), respectively, in these groups. Gain in BCVA of more than 3 lines was noted in 1/10 patients in Group 1(10%) as compared to 3/10 (30%) and 4/10 (40%) patients in groups 2 and 3, respectively. Conclusion: The gain in BCVA and reduction in CMT were better with combination therapy (single- and triple- dose regimen) compared to grid laser alone. Single dose of intravitreal ranibizumab with grid laser seems to be an effective therapy.

Fasciite necrotisante após vacina influenza: relato de caso / Necrotizing fasciitis after influenza vaccine: case report

Paciente de 30 anos, do sexo masculino, apresentou, após vacinação contra influenza comum, dor intensa, edema e eritema em membro superior esquerdo no local da aplicação e febre contínua não aferida. Foi hospitalizado, porém houve agravamento progressivo do quadro e resistência ao tratamento com anti-inflamatórios e antibióticos, culminando em queda do estado geral, formação de coleção no local e convulsão febril. Optou-se por tratamento cirúrgico, submetendo-se o paciente a procedimentos para fasciotomia, desbridamento, drenagem de coleção e sutura de extenso ferimento em membro superior esquerdo.

A 30-year-old male patient, after being vaccinated against the common influenza, presented severe pain, swelling and erythema at the site of injection on the left upper limb and had continuous fever that was not checked. He was admitted to the hospital,, but his clinical condition got worse, with no response to treatment with anti-inflammatory drugs and antibiotics. He developed an abscess at the site of vaccine injection, and high fever with febrile seizures. Surgical treatment was chosen, and the patient underwent debridement and drainage of the abscess, upper arm fasciotomy and repair of the extensive surgical wounds of the left arm.

Experience with the Pascal® photocoagulator: An analysis of over 1200 laser procedures with regard to parameter refinement.

Aim: To systematically refine and recommend parameter settings of spot size, power, and treatment duration using the Pascal® photocoagulator, a multi-spot, semi-automated, short-duration laser system. Materials and Methods: A retrospective consecutive series with 752 Caucasian eyes and 1242 laser procedures over two years were grouped into, (1) 374 macular focal / grid photocoagulation (FP), (2), 666 panretinal photocoagulation (PRP), and (3) 202 barrage photocoagulation (BP). Parameters for power, duration, spot number, and spot size were recorded for every group. Results: Power parameters for all groups showed a non-gaussian distribution; FP group, median 190 mW, range 100 – 950 mW, and PRP group, median 800 mW, range 100 – 2000 mW. On subgroup comparison, for similar spot size, as treatment duration decreased, the power required increased, albeit in a much lesser proportion than that given by energy = power × time. Most frequently used patterns were single spot (89% of cases) in FP, 5 × 5 box (72%) in PRP, and 2 × 2 box (78%) in BP. Spot diameters as high as ≈ 700 μm on retina were given in the PRP group. Single session PRP was attempted in six eyes with a median spot count of 3500. Conclusion: Overall, due to the small duration of its pulse, the Pascal® photocoagulator tends to use higher powers, although much lower cumulative energies, than those used in a conventional laser. The consequent lesser heat dissipation, especially lateral, can allow one to use relatively larger spot sizes and give more closely spaced burns, without incurring significant side effects.

Estudo do tratamento do edema macular difuso do diabético com triancinolona intravítrea e fotocoagulação / Use of intravitreal triamcinolone and laser photocoagulation for the treatment of diffuse diabetic macular edema

OBJETIVO: Avaliar a eficácia do uso intravítreo da triancinolona acetonida associada a fotocoagulação com laser no tratamento do edema macular difuso diabético. Comparar esta associação terapêutica com o uso isolado de cada tratamento. MÉTODOS: Após controle clínico sistêmico, trinta pacientes portadores de edema macular difuso diabético foram divididos em 3 grupos de tratamento: (1) fotocoagulação macular em grade com laser de argônio; (2) aplicação intravítrea de 4 mg de triancinolona acetonida; (3) associação dos itens anteriores. O seguimento foi realizado em intervalos predeterminados de um dia, uma semana e mensalmente, até completar 6 meses. Foram analisados os parâmetros: acuidade visual corrigida LogMAR, espessura macular central, volume macular total e pressão intra-ocular. RESULTADOS: A fotocoagulação com laser não reduziu de forma estatisticamente significativa a espessura macular central e o volume macular total. Esta redução foi significativa e estatisticamente semelhante nos outros dois grupos. Todos os grupos apresentaram melhora da acuidade visual, entretanto, o grupo que recebeu a associação do laser com a triancinolona intravítrea obteve maior porcentagem de pacientes com ganho de 10 ou mais letras de visão. CONCLUSÃO: O uso simultâneo da fotocoagulação com a triancinolona intravítrea pode ser considerado uma opção terapêutica para o edema macular difuso diabético.

PURPOSE: To assess the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and to compare it with the separate use of each treatment. METHODS: After systemic clinical control, thirty patients with diffuse diabetic macular edema were divided into 3 treatment groups: (1) macular grid photocoagulation; (2) intravitreal injection of 4 mg of triamcinolone acetonide; (3) combination of the two previous therapies. Follow-up was scheduled at predetermined intervals of one day, one week and monthly until completion of six months. The following parameters were analyzed: LogMAR best corrected visual acuity, central macular thickness, total macular volume and intraocular pressure. RESULTS: Grid photocoagulation did not significantly reduce the central macular thickness or the total macular volume. On the other hand, this reduction was statistically significant in the other two groups. All groups improved their mean visual acuity, however, the group that received both treatments had a higher percentage of patients that gained 10 or more letters. CONCLUSION: The simultaneous administration of grid photocoagulation with intravitreal triamcinolone can be considered an option for the treatment of diffuse diabetic macular edema.

Espessura macular e acuidade visual na retinopatia diabética tratada por panfotocoagulação / Visual acuity and macular thickness in diabetic retinopathy treated with panphotocoagulation

OBJETIVO: Comparar espessura macular e acuidade visual em pacientes portadores de retinopatia diabética, com e sem edema de mácula, submetidos à panfotocoagulação retiniana com laser de argônio. MÉTODOS: Os pacientes foram classificados em dois grupos antes do tratamento, sendo submetidos a exame oftalmológico e tomografia de coerência óptica. Todos os pacientes foram tratados com panfotocoagulação. O resultado foi avaliado por meio da acuidade visual no 3º mês e pela tomografia de coerência óptica na 1ª semana, nos 1º e 3º meses do tratamento. RESULTADOS: A amostra foi composta por 37 pacientes (37 olhos). Grupo 1 foi constituído por 29 portadores de retinopatia diabética sem edema macular e Grupo 2, por 8, com edema. Os grupos não apresentaram diferenças na idade, sexo e nas médias de disparos da panfotocoagulação. Os grupos apresentaram diferença na acuidade visual (p<0,001), sendo que o Grupo 2 teve piora da visão após tratamento (p<0,001). Quanto à espessura macular na tomografia de coerência óptica, o Grupo 2 apresentou médias de espessuras maculares maiores (p<0,001) e maior variabilidade entre os momentos avaliados. CONCLUSÃO: Evidenciou-se que portadores de retinopatia diabética com edema macular evoluíram com variação acentuada na espessura macular e perda visual após a panfotocoagulação. Naqueles sem edema, observou-se aumento na espessura macular ao longo do seguimento, porém sem repercussões funcionais.

PURPOSE: To compare the visual acuity and macular thickness in patients with diabetic retinopathy presenting and not presenting macular edema before treatment and submitted to argon laser retinal panphotocoagulation. Methods: Patients were included and classified into two groups before the treatment. All patients were submitted to ophthalmological examination and optical coherence tomography, following panphotocoagulation. The results were evaluated by measuring visual acuity at the end and by optical coherence tomography after one week, one and three months following the treatment. RESULTS: The sample was composed of 37 patients (37 eyes). Group 1 included 29 patients with diabetic retinopathy without macular edema; Group 2 included 8 patients with macular edema. The two groups were similar regarding gender, age, and the mean of argon laser spots treatment. The groups showed differences in visual acuity (p<0.001) and Group 2 patients presented decrease of visual acuity three months after the treatment (p<0.001). Group 2 patients showed a greater mean of macular thickness measurements on optical coherence tomography evaluation. CONCLUSION: Variation of the macular thickness as well as decrease in visual acuity was present in the patients with macular edema previously to panphotocoagulation. Only minimal increase in macular thickness was observed in the absence of macular edema.

Análise da espessura macular pela tomografia de coerência óptica no edema macular refratário de origem diabética após aplicação de triancinolona intravítrea / Macular thickness analysis by optic coherence tomography in refractory diabetic macular edema treated with intravitreous triamcinolone

OBJETIVO: Avaliar o efeito da aplicação intravítrea de triancinolona na espessura macular medida pela tomografia de coerência óptica (Stratus-OCT), pressão intra-ocular e acuidade visual no tratamento do edema macular diabético não responsivo ao tratamento prévio com fotocogulação a laser, no período de 6 meses. MÉTODOS: Foram estudados 21 indivíduos (22 olhos) submetidos a exame oftalmológico completo, medida da acuidade visual, pressão intra-ocular e análise pela tomografia de coerência óptica, tratados previamente com no mínimo 2 sessões de laser. Os indivíduos participantes do estudo foram tratados com aplicação intravítrea de acetato triancinolona na dose de 4 mg / 0,1 ml. As visitas de acompanhamento foram agendadas no 1º dia pós-aplicação, 1º, 3º e 6º meses. Foram estudados o resultado visual e anatômico assim como as possíveis complicações relacionadas com o procedimento da aplicação intravítrea. RESULTADOS: O estudo demonstrou redução significativa da espessura macular média analisada pelo OCT nos 1º, 3º e 6º meses pós-aplicação (p=0,001), acompanhado de melhora da acuidade visual média (p<0,001). A espessura macular central média ± DP na primeira visita foi de 399 ± 121 µm e diminuiu em 39,9 por cento (239 ± 53 µm) no primeiro mês (p<0,001), 35,5 por cento (255 ± 93 µm) no terceiro mês (p<0,001) e 18,1 por cento (326 ± 135 µm) no sexto mês (p=0,001). A melhora da acuidade visual média foi de 18 e 16 letras na tabela ETDRS nos 3º e 6º meses respectivamente. As complicações relatadas foram o aumento da pressão intra-ocular em 7 olhos (33,3 por cento casos). CONCLUSÕES: Foi observada redução da média das espessuras da retina ao longo de todo o tempo de acompanhamento, com aumento significante da espessura macular entre o 3º e 6º mês. Foi observado melhora estatisticamente significante da média da acuidade visual ao final do acompanhamento, porém não houve melhora entre o 3º e 6º mês.

PURPOSE: To assess the effect of intravitreal injections of triamcinolone on macular thickness (Stratus-OCT), intra-ocular pressure and visual acuity, in the treatment of diabetic macular edema non-responsive to previous laser photocoagulation, over a 6-month period. METHODS:The study included 21 subjects (22 eyes) who underwent complete ophthalmologic examination, measurements of visual acuity and intraocular pressure, and OCT, previously treated with at least 2 laser applications. The study participants were treated with 4 mg / 0.1 ml intravitreal triamcinolone. Follow-up visits were scheduled for the 1st day after treatment, and after 1, 3 and 6 months. Visual and anatomical results, as well as possible complications associated with the intravitreal injection procedure were studied. RESULTS: The study showed a significant reduction in mean macular thickness, assessed by OCT at 1, 3 and 6 months post-treatment (p=0.001), combined with an improvement of the mean visual acuity (p<0.001). Central macular thickness mean ± SD value on the first visit was 399 (±121 µm); it was reduced by 39.9 percent (239 ± 53 µm) at the first month (p<0.001), 35.5 percent (255 ± 93 µm) at the third month (p<0.001), and 18.1 percent (326 ± 135 µm) at the sixth month (p=0.001). The improvement in mean visual acuity was of 18 and 16 letters on the ETDRS table, on the 3rd and 6th month, respectively. Reported complications were an increase in intraocular pressure in seven eyes (33.3 percent of the cases). CONCLUSIONS: A reduction in mean retinal thickness was observed throughout the entire follow-up period, with significant increase in macular thickness between the 3rd and 6th month. The mean visual acuity showed statistically significant improvement at the end of the follow-up period, but no change was noticed between the 3rd and 6th month.

Evaluation of the Efficacy of Vitrectomy for Persistent Diabetic Macular Edema and Associated Factors Predicting Outcome

PURPOSE: To evaluate the efficacy of vitrectomy for persistent diabetic macular edema after laser photocoagulation or intravitreal triamcinolone injections and to determine the demographic and ocular factors that influence functional and anatomical outcomes. METHODS: We retrospectively evaluated 55 eyes (51 patients) that had persistent diffuse macular edema after laser photocoagulation or intravitreal triamcinolone injections. We compared preoperative and postoperative best corrected visual acuity and macular thickness by Optical Coherence Tomography and investigated factors including patient's age, presence of vitreomacular traction, grade of diabetic retinopathy, and intraoperative internal limiting membrane removal that may influence the surgical results. RESULTS: The mean preoperative BCVA (log MAR) was 0.91+/-0.40 (0.8-1.2). The BCVA improved to 0.72+/-0.39 (0.3-1.2). The mean preoperative macular thickness was 440+/-130 (202-805) micrometer and the mean macular thickness decreased to 306+/-97 (136-580) micrometer postoperatively. The eyes showed statistically significant improvement in BCVA and central macular thickness (p<0.001). Preoperative better BCVA was associated with an improved postoperative visual acuity. (p=0.04). No other covariates were found to be statistically significant factors for prognosis of postoperative BCVA. CONCLUSIONS: In eyes with persistent diabetic macular edema after laser or IVTA injections, vitrectomy was effective for decreasing macular thickness and improvement of vision. The visual improvement after vitrectomy was associated with the preoperative better BCVA.

Vitrectomy for diffuse refractory diabetic macular edema associated with a taut premacular posterior hyaloid

To evaluate the anatomic and visual results and complications of vitrectomy in eyes with diffuse refractory diabetic macular edema associated with a taut posterior hyaloid. This prospective interventional case series was conducted in 25 eyes of 22 patients with diffuse clinically significant diabetic macular edema, macular thickness greater than 250 microns on optic coherence tomography [OCT] and thickened posterior hyaloid. Best-corrected visual acuity [BCVA] and macular thickness measured by OCT were evaluated preoperatively and 3 and 6 months postoperatively. Macular perfusion was evaluated by fluorescein angiography, preoperatively. Mean BCVA was 1.14 +/- 0.51 LogMAR, preoperatively and 0.89 +/- 0.53 LogMAR 6 months postoperatively [P=0.005]. Mean preoperative macular thickness was 506 +/- 121.9 micro m which decreased to 318 +/- 90.5 micro m, postoperatively [P=0.001]. Vitrectomy with removal of the posterior hyaloid membrane appears to be beneficial in some cases of diffuse persistent diabetic macular edema with a taut premacular posterior hyaloid unresponsive to laser therapy. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes

Tratamiento del edema macular diabético difuso con vitrectomía y remoción de membrana limitante interna / diffuse diabetic macular edema treatment with vitrectomy and internal limiting membrane

Objetivo: Evaluar el resultado quirúrgico de 20 pacientes portadores de edema difuso tratados con vitrectomía pars plana, separación de la hialoides posterior y remoción de membranas limitantes internas (MNI). Métodos: Estudios retrospectivos de 20 pacientes con edema macular difuso, agudeza visual de 0,1 o inferior, fotocoagulados, sin capacidad de medios, tratados con vitrectomía Standard y remoción de MLI asistida por tinción Indocianina G.. Medición de resultados anatómicos, funcionales, y grosor foveal con OCT. Resultados: Agudeza visual mejor o igual en 75 por ciento. Promedio de 3,5 líneas ganadas ETDRS Disminución de grosor foveal a OCT en 80 por ciento. Alguna complicación en 2 casos (un paciente con catarata en evolución, un caso de desprendimiento retinal) Seguimiento promedio de 6,9 meses. Conclusión: La vitrectomía con separación de hialoides posterior y remoción de MLI mejoró significativamente agudeza visual y grosor foveal demostrado por OCT. Es una alternativa terapéutica a considerar en el tratamiento del edema macular diabético difuso.

Argon laser photocoagulation for chronic clinically significant cystoid macular edema

We report the therapeutic outcome of 14 eyes of 11 patients with chronic clinically significant pseudophakic cystoid macular edema refractory to medical management who underwent argon laser photocoagulation of the perifoveal area. Inclusion criteria included chronic cystoid macular edema of more than six months duration of decreased visual acuity (20/100 or less), positive fluorescein angiogram and contact lens examination, pseudophakos with posterior chamber intraocular lens and intact posterior capsule, normal fasting blood sugar, failed medical treatment and minimal follow up of six months. Fifty per cent of the eyes improved after laser treatment (p = .0345, relative to unchanged plus worsened cases). Further prospective, randomized, clinical trials are recommended to define the effectiveness of this treatment protocol

O laser no trtamento do edema macular diabético / The laser in the treatment of diabetic macular edema

O edema macular diabético pode se apresentar sob duas formas na maioria dos casos: A forma focal em que existem microaneurismas e exsudatos duros em torno da mácula e a forma difusa com näo perfusäo capilar e edema com características cistóides. O tratamento com o laser para os casos focais é dirigido aos micro aneurismas de onde ocorre o vazamento e nos casos difusos o tratamento é feito sob a forma de "grid" macular

Edema cistóide de mácula após cirurgia de catarata / Macular cistoid edema post cataract extraction

The author, studied 15 cases underwent to intracapsular fecectomy, and found the incidency of 6 cases of macular cistoid edema, that corrspondes to 40%. This percentage, is included in the normal parameters founded in others ophtalmological centers. He has concluded that the pre and post operatives cases as the cirurgical thecnics used are under satisfatory aules