Results of Peripheral Vitrectomy Under Air in Rhegmatogenous Retinal Detachment.

BACKGROUND AND OBJECTIVE: To evaluate the safety and efficacy of peripheral vitrectomy under air in rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS: Consecutive patients who underwent 23-gauge pars plana vitrectomy for RRD were included. After removal of core vitreous and drainage of subretinal fluid, peripheral vitreous was removed under air infusion without scleral indentation. Silicone oil or C3F8 gas was used as tamponade. RESULTS: Forty-five eyes of 45 patients were evaluated retrospectively. Mean LogMAR, which was 1.65 LogMAR ± 1.44 LogMAR preoperatively, decreased to 0.26 LogMAR ± 0.28 LogMAR (P < .001; paired t-test). Initial and final reattachment rates were 91% and 98%, respectively. Scleral indentation was not necessary in any case. Iatrogenic retinal breaks occurred in three initial cases. Macular hole developed in one case after reoperation. CONCLUSIONS: Peripheral vitrectomy under air is safe and effective in cases with RRD. Air eliminates the need for scleral indentation, stabilizes the retina, and allows sufficient clarity for vitrectomy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:51-54.].

Intraocular intrusion of suture material that was used as scleral buckling material.

PURPOSE: To report intrusion of encircling suture used for scleral buckling 20 years ago. METHODS: Observational case report of a patient who admitted with the complaint of floaters. The patient had surgery for retinal detachment 20 years ago. Fundus examination revealed an encircling suture material. In some locations, the encircling suture had eroded all the way through the sclera to the vitreous cavity. In these locations, it was passing through the vitreous cavity. There was no retinal detachment, inflammation, or hemorrhage. RESULTS: Prophylactic argon laser photocoagulation was performed. No complication occurred during 1-year follow-up. CONCLUSION: A conservative approach with close follow-up may be suitable in case of an intrusion of suture material if there are no accompanying complications.

Outcome of photodynamic therapy in choroidal neovascularization due to pathologic myopia and related factors.

To evaluate the outcome of photodynamic therapy (PDT) and the factors influencing its outcome in patients with subfoveal choroidal neovascularization (CNV) due to pathologic myopia. Twenty-three eyes of 21 consecutive patients who received PDT for subfoveal CNV due to pathologic myopia and who were followed for >12 months were included in the study. The relationship between the factors that might affect the treatment outcome were evaluated. Mean age was 48.7 ± 16.0 years (23-74 years). Mean follow-up was 23.2 ± 7.7 months (15-41 months). Mean logMAR visual acuity was 0.85 ± 0.24 before treatment, 0.89 ± 0.37 at 12 months, and 0.92 ± 0.46 at the final visit. Mean logMAR visual acuity did not change significantly at 12 months or at the final visit (P = 0.47 and 0.36, respectively). The baseline visual acuity strongly correlated with the final visual acuity (P = 0.001). Age showed an inverse correlation with change in logMAR visual acuity at 12 months (P = 0.01). PDT prevented significant visual loss in eyes with subfoveal CNV due to pathologic myopia. Better initial visual acuity resulted in better final visual acuity. Younger age was correlated with better treatment outcome at 12 months.

Pars plana vitrectomy with and without triamcinolone acetonide assistance in pseudophakic retinal detachment complicated with proliferative vitreoretinopathy.

PURPOSE: To evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) in pseudophakic retinal detachment (RD) complicated with proliferative vitreoretinopathy (PVR) without previous scleral buckling (SB) or vitrectomy, both with and without triamcinolone acetonide (TA) assistance. METHODS: In this retrospective, interventional, comparative case series, 72 pseudophakic eyes with RD with PVR grade C1 or greater underwent PPV either with (group 1, n = 40) or without (group 2, n = 32) TA assistance. Eyes with a minimum of 6 months of follow-up were evaluated. Main outcome measures were reattachment, redetachment, complication rate, and changes in visual acuity (VA). RESULTS: The mean follow-up period was 14.57 +/- 8.55 months. Single-surgery and final reattachment rates were 87.50% and 95% in group 1, and 78.12 % and 96.87% in group 2, (P = 0.349, P = 1.000). Redetachment rates were 12.50% in group 1 and 21.87% group 2 (P = 0.349). In both groups the mean VA increased significantly in postoperative week 1 and in all control visits (P< 0.001) with no difference in complication rate (P > 0.05). CONCLUSIONS: In this study PPV with TA assistance resulted in a lower, albeit statistically insignificant, redetachment rate in the treatment of RD complicated with PVR compared to PPV without TA assistance in eyes without previous SB or PPV. Visual acuity improved in 72% of eyes in both groups. Intraoperative and postoperative complication rates were also similar.

Secondary iris claw intraocular lens implantation for the correction of aphakia after pars plana vitrectomy.

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of aphakia in vitrectomized eyes without capsular support. METHODS: This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications. RESULTS: Mean follow-up was 15.58 +/- 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P < 0.05). Mean best-corrected visual acuity increased 10 letters/2 lines at the final follow-up visit (P = 0.023). Mean postoperative spheric equivalent at the last visit was -1.68 +/- 063 D, and the spheric equivalent was within +/-2.00 D of emmetropia in 9 (75%) eyes. Mean central macular thickness increased only at postoperative Month 3 (P = 0.043). Mean endothelial cell density loss was 23.87% at the last visit. Mean corneal thickness did not change during follow-up (P > 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes. CONCLUSION: Secondary iris claw intraocular lens implantation is clinically safe and effective to correct aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.

Comparative outcomes of pars plana vitrectomy in acute postoperative endophthalmitis with 25-gauge and 20-gauge techniques.

PURPOSE: To evaluate the safety and outcomes of 25-gauge pars plana vitrectomy (PPV) in the treatment of postoperative endophthalmitis and compare it with 20-gauge PPV. METHODS: The medical records of all patients diagnosed with acute endophthalmitis following cataract surgery who underwent PPV between December 2000 and December 2007 were reviewed. Main outcome measures included final visual acuity (VA), additional interventions, and both intraoperative and postoperative complications. RESULTS: Records of 70 eyes of 70 patients with a condition diagnosed as postoperative endophthalmitis were evaluated. Fifty-eight eyes underwent 20-gauge PPV (group 1), and 12 eyes underwent 25-gauge PPV (group 2). Mean follow-up time for group 1 was 9.6 +/- 8.8 months, and for group 2, 7.9 +/- 12.7 months (P = 0.57). Median VA at presentation was hand motion in both groups. The differences between the two groups in frequencies of visual outcome levels of 20/800 and 20/100 were significant in favor of group 2 (20/800, P = 0.006; 20/100, P = 0.01). In group 2, fewer additional interventions were required, and postoperative complications tended to be less frequent. CONCLUSIONS: Twenty-five-gauge PPV seems to be safe and effective in the management of postoperative endophthalmitis. This sutureless technique may have some advantages over 20-gauge surgery, but controlled studies are needed to confirm the results.

25-Gauge sutureless vitrectomy with oblique sclerotomies for the management of retinal detachment in pseudophakic and phakic eyes.

PURPOSE: To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex retinal detachments (RD) in pseudophakic and phakic eyes. METHODS: In this interventional clinical case series, 23 pseudophakic and 13 phakic eyes with total RDs with proliferative vitreoretinopathy grade A/B underwent primary 25-gauge sutureless vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were single surgery and final reattachment rates, complications, and changes in visual acuity (VA). RESULTS: Mean duration of visual loss was 14.65+/-12.57 and 22.46+/-18.95 days in pseudophakic and phakic eyes, respectively. Eighteen (78.26%) pseudophakic eyes and 12 (92.30%) phakic eyes had macular detachment. In all eyes, 25-gauge sutureless vitrectomy was completed without complication. Mean follow-up period was 11.00+/-6.63 months. Single surgery and final retinal attachment rates were 91.30% and 95.65% in pseudophakic eyes and 61.53% and 84.61% in phakic eyes, respectively (p=0.073, p=0.539). In both groups, mean VA increased significantly at postoperative month 1 (p<0.05) and at the last visit (p<0.001). Transient hypotony was detected in 2 pseudophakic and 3 phakic eyes with spontaneous resolution. Two (15.38%) phakic eyes had cataractous changes. CONCLUSIONS: In this study, 25-gauge sutureless vitrectomy resulted in higher single surgery and final anatomic success rates in primary treatment of noncomplex RDs in pseudophakic versus phakic eyes, with commensurate increase in VA.

Prognostic factors in severely traumatized eyes with posterior segment involvement.

BACKGROUND: To determine the prognostic indicators of functional outcome in eyes with severe posterior segment trauma managed with pars plana vitrectomy. METHODS: One hundred and six eyes of 101 patients were retrospectively reviewed to determine the accuracy of a number of factors in predicting functional outcome after surgery. These potential prognostic indicators included initial visual acuity (VA), retinal detachment (RD), type of trauma, presence of intraocular foreign body (IOFB), type of IOFB, posttraumatic endophthalmitis, hyphema, choroidal detachment, initial hypotonia, accompanying lens subluxation/dislocation, and severe vitreous hemorrhage. In our study, functional success was defined as VA > or =5/200. Fisher's exact and chi-square tests were used for statistical analysis. RESULTS: The mean follow-up time was 12.8+/-0.52 (8-18) months. Thirty-three eyes (31.13%) had functional success. Forty-four (68.7%) of 64 eyes with preoperative RD had anatomical success (total retinal reattachment). Predictors of poor visual outcome (VA < or =5/200) were found to be poor initial VA (p<0.0001), presence of RD (p<0.001), and presence of endophthalmitis (p<0.05). No statistically significant correlation was found between the other predictors surveyed and visual outcome (p>0.05). CONCLUSION: Vitreoretinal surgery can improve anatomical and functional success in eyes with severe posterior segment trauma. Poor initial VA, RD, and posttraumatic endophthalmitis are poor predictors of visual outcome.

Ocular trauma score in open-globe injuries.

BACKGROUND: To determine the value of calculating an ocular trauma score (OTS) for patients with open-globe injuries. OTS evaluating system can provide valuable prognostic information, and its use may be an asset in counseling patients with open-globe injuries. METHODS: This study was conducted as a retrospective review of 114 eyes of 114 patients who presented with open-globe injuries between January 2001 and July 2006. OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defect) were determined and OTS was calculated in 114 eyes of 114 patients at the time of initial examination. In this study, presenting and final visual acuity were grouped (1 through 5) as > or = 20/40, 20/200 to 20/50, 1/200 to 19/200, light perception (LP)/hand motion (HM), and no light perception (NLP), similar to the OTS study group. Numerical values to the OTS variables were converted into OTS categories. Similarity of final visual acuities by groups was compared with those in the OTS study. Patients under the age of two and the ones with incomplete data for OTS variables were excluded. RESULTS: When comparing the distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.35) between the results of our study and the OTS study group. NLP ratio in category 1 and > or = 20/40 ratio in category 5 were statistically higher than in our study (p = 0.01). However, in our study, category 2 of LP/HM ratio (p < 0.0001) was statistically higher than in the OTS study. The likelihood of the final visual acuities (NLP, LP/HM, 1/200 to 19/200, 20/200 to 20/50, and > or = 20/40) in the other OTS categories in this group was similar to those in the OTS study group. The OTS showed positive correlation with final visual acuity (p < 0.001). CONCLUSION: In open-globe injuries, a commonly accepted system for calculating ocular trauma score (OTS) can provide reliable prognostic information.

Acute-onset endophthalmitis after cataract surgery: success of initial therapy, visual outcomes, and related factors.

PURPOSE: To evaluate the success of initial treatment and the factors influencing the outcome in acute-onset endophthalmitis after cataract surgery. METHODS: We retrospectively reviewed the medical records of all patients with acute postoperative endophthalmitis between 2000 and 2007. We performed pars plana vitrectomy (PPV) to all eyes with initial visual acuity of light perception. Eyes with visual acuity of hand motions or better underwent either intraocular antibiotic injection (IOAI) or PPV. Eyes that did not give a good clinical response to initial therapy within 60 hours underwent a second procedure. The main outcome measure was the rate of early reintervention after PPV and IOAI. RESULTS: We evaluated 88 eyes of 88 patients. Thirty-seven patients underwent PPV and 51 patients underwent IOAI alone. Six of 37 (16.2%) patients required 1 or more procedures within 60 hours of the initial procedure in the PPV group. Twenty-eight of 51 eyes (54.9%) in the IOAI group underwent PPV within 60 hours. The rate of response to primary PPV was significantly higher than to primary IOAI (P < 0.001). Gram-negative organisms composed 35.1% of the isolates. CONCLUSION: Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

25-gauge sutureless vitrectomy in osteogenesis imperfecta type I.

PURPOSE: To report a case with type I osteogenesis imperfecta (OI) with intravitreal opacities who underwent 25-gauge sutureless vitrectomy. METHODS: A 2.5-year-old girl with OI type I who presented with intravitreal opacities underwent 25-gauge sutureless vitrectomy. RESULTS: The 25-gauge sutureless vitrectomy system, which is less traumatic, was performed in a patient with OI type I. Nine months postoperatively, funduscopic examination under general anesthesia showed a healthy optic nerve and retina without detachment. Intraocular pressure by Tonopen was 10 mmHg. CONCLUSION: The use of 25-gauge sutureless vitrectomy to avoid scleral suturing and minimize surgical trauma is an option in pediatric patients with associated thin sclera.

Removal of large subretinal foreign bodies with bimanual vitrectomy and use of a suture loop.

PURPOSE: To describe removal of large subretinal foreign bodies with bimanual pars plana vitrectomy and use of a suture loop. METHODS: In a retrospective interventional case series, 2 eyes of 2 patients referred 1 month after primary wound suturation, both with posttraumatic retinal detachment and 1 with endophthalmitis, underwent pars plana vitrectomy. Intraocular foreign bodies (IOFBs) were grasped using a 6-0 polypropylene suture loop. The loop was placed around the IOFBs using an intraocular forceps, and the foreign bodies were extracted from the eyes. RESULTS: A suture loop was placed around the IOFB bimanually, and removal was performed as described. Two large subretinal IOFBs, one metallic and one nonmetallic, were removed successfully without slippage, the first through a limbal incision and the second through an enlarged sclerotomy. The patients were observed for 3 months. One eye had retinal attachment, but the other eye had redetachment that was considered inoperable. CONCLUSION: Large metallic and nonmetallic subretinal IOFBs of different shapes and sizes can be removed with a suture loop, but in complicated cases, bimanual placement of the loop may provide better control for IOFB removal and the ability to surround the IOFB at its desired axis, thereby decreasing the size of the incision for extraction.

Mitomycin protection of peridural fibrosis in lumbar disc surgery.

OBJECT: In this prospective, randomized clinical study the authors sought to evaluate the effects of locally applied mitomycin C on peridural fibrosis during lumbar microdiscectomy. METHODS: Patients undergoing lumbar disc surgery were randomly divided into 2 groups. Thirty patients had 1 mg/ml mitomycin C applied at the site of discectomy for 5 minutes, and 30 age- and sex-matched patients underwent lumbar microdiscectomy without mitomycin C application as the control group. The groups were compared for degree of postoperative neurological function, radicular/back pain, and degree of peridural fibrosis on MR imaging 6 months after the operation. RESULTS: The median follow-up was 18 months. No serious drug adverse effects and no clinically significant laboratory adverse effects were reported in patients in the mitomycin C group. Patients in both groups showed similar clinical recoveries postoperatively. On postoperative evaluation of the MR images, pain scores, and neurological function, patients given mitomycin C have shown no reduction of peridural fibrosis either clinically or radiographically. CONCLUSIONS: Mitomycin C is easy to use and safe in patients undergoing lumbar microdiscectomy. However, no benefit was observed either clinically or radiographically in this study.

Primary 25-gauge sutureless vitrectomy with oblique sclerotomies in pseudophakic retinal detachment.

PURPOSE: To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex pseudophakic rhegmatogenous retinal detachments (RRD). METHODS: Prospective interventional institutional case series. Twenty-two eyes with pseudophakic RRD with proliferative vitreoretinopathy grade A or B underwent primary 25-gauge vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were reattachment rate with single surgery, reoperation, complication rates, and changes in visual acuity (VA). RESULTS: Mean duration of visual loss was 14.68 +/- 12.87 days. Seventeen (77.27%) eyes had macular detachment. In all eyes 25-gauge sutureless vitrectomy was completed without complications. The mean follow-up period was 10.40 +/- 5.77 months. Retinal attachment was achieved in 21 (95.45%) eyes with single surgery and in all (100%) eyes with second vitrectomy. Mean preoperative VA of 1.61 +/- 1.18 improved to 0.50 +/- 0.53 at the last visit (P < 0.001). Transient hypotony was detected in 2 (9.09%) eyes with spontaneous resolution. No other postoperative complication was observed. CONCLUSIONS: Twenty-five-gauge sutureless vitrectomy with oblique sclerotomies in primary treatment of noncomplex pseudophakic RRDs resulted in reattachment in 95.45% with single surgery, and in 100% with reoperation in one eye, accompanied by an increase in visual acuity in 86% of eyes.

Transconjunctival 25-gauge sutureless vitrectomy and silicone oil injection in diabetic tractional retinal detachment.

PURPOSE: The purpose of this article was to evaluate the outcomes and complications of transconjunctival sutureless 25-gauge vitrectomy using silicone oil tamponade in diabetic tractional retinal detachment. MATERIALS AND METHODS: Patients were retrospectively evaluated. Main outcome measure was the feasibility of pars plana vitrectomy and silicone oil injection with 25-gauge system in eyes with diabetic tractional retinal detachment. RESULTS: Fourteen eyes of 14 patients were included in the study. Tractional retinal detachment was accompanied by vitreous hemorrhage in 9 eyes and combined traction/rhegmatogenous retinal detachment was present in 1 eye. All patients underwent transconjunctival sutureless 25-gauge vitrectomy and 1,000 centistokes silicone oil injection. Angled insertion of the trocars was made in all eyes. Bimanual surgery was performed in 6 (42.8%) eyes. The median preoperative best-corrected visual acuities were 3.00 logarithm of the minimum angle of resolution; it increased to 1.60 logarithm of the minimum angle of resolution at last visit. Retinal tear formation occurred in 4 (28.5%) eyes. Retinal detachment developed in 2 (14.2%) eyes. Intraocular pressure of 5 mmHg or less was detected in 3 (21.4%) eyes. One patient lost light perception due to anterior hyaloidal fibrovascular proliferation. CONCLUSION: Pars plana vitrectomy and 1,000 centistokes silicone oil injection with 25-gauge system is feasible in diabetic tractional retinal detachment even in complex cases. Indications of 25-gauge surgery may be expanded toward this area.

Isolates and antibiotic sensitivity of eighty culture-proven endophthalmitis cases from Istanbul.

PURPOSE: To investigate the spectrum of organisms causing endophthalmitis and their sensitivity to commonly used antimicrobial agents. METHODS: Medical records of 80 consecutive patients treated at Beyoglu Eye Hospital for endophthalmitis from January 2001 to April 2006 were reviewed. Specimens were obtained from either the vitreous (93%, 81/87) or anterior chamber (7%, 6/87) during pars plana vitrectomy or vitreous tap, and were inoculated into blood culture bottles. A Kirby-Bauer disk diffusion test was performed to determine antibiotic susceptibility. The outcome measures included isolates identified and antibiotic sensitivity of the specimens. RESULTS: Fifty-six of 87 (64.4%) isolates were Gram-positive organisms, 29 (33.3%) were Gram-negative organisms, and 2 (2.3%) were fungi. The most common organism group identified was coagulase-negative staphylococci in 26.4% (23/87). While vancomycin was active against all Gram-positive isolates tested (100%), ceftazidime had the highest susceptibility rate (100%) for Gram-negative organisms isolated. CONCLUSIONS: Although coagulase-negative micrococci predominated in this series, a high isolation rate for Gram-negative organisms was obtained. High susceptibility rates for ofloxacin make it an alternative to ceftazidime and vancomycin in both Gram-negative- and Gram-positive-derived endophthalmitis, respectively. Studies with larger series and additional antibiotics are needed to confirm these findings.

Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions.

PURPOSE: To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-gauge sutureless vitrectomy. METHODS: In a retrospective, interventional, institutional case series, 25-gauge sutureless vitrectomy with straight incisions was performed on 111 eyes. Postoperative intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and 1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications associated with low IOP were assessed to determine outcome. RESULTS: Mean follow-up +/- SD was 5.45 +/- 3.44 months. Mean IOP decreased significantly by 2 hours and on postoperative day 1 (P < 0.001) and increased to preoperative levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%, and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was 2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas endotamponade that remained hypotonic for the first postoperative week underwent reoperation due to unsealed MHs. CONCLUSIONS: Twenty-five-gauge sutureless vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2 hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not increase the incidence of postoperative complications.

Passive removal of silicone oil with a 25-gauge sutureless system.

PURPOSE: To report the outcome of a new sutureless technique for passive removal of silicone oil with a 25-gauge system. METHODS: Between January 2005 and February 2006, 32 patients (32 eyes) underwent passive silicone oil removal with a 25-gauge system in a prospective, interventional case series in our hospital. Main data recorded were visual acuity, intraocular pressure (IOP), silicone oil removal time, complications, and number of sutured sites. RESULTS: Mean follow-up was 11.46 +/- 3.98 months. Mean silicone oil removal time was 8.93 +/- 0.85 (range, 7.0-11.5) min. A suture was placed in only one eye because of leakage. Visual acuity improved in 27 eyes (86.4%), and stabilized in five eyes (15.6%). IOP decreased significantly at all visits during follow-up. On day one, four eyes (12.5%) were hypotonous. Choroidal folds were observed in two eyes (6.25%). No other complications were noted. CONCLUSIONS: Passive removal of silicone oil with a 25-gauge sutureless technique was effective for 1000 centistokes of oil. Transient hypotony in the early postoperative period did not adversely affect the visual outcomes.

Efficacy of intravitreal triamcinolone for the treatment of macular edema secondary to branch retinal vein occlusion in eyes with or without grid laser photocoagulation.

PURPOSE: To evaluate the efficacy of primary and secondary (following grid laser photocoagulation) intravitreal triamcinolone acetonide (IVTA) injection for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Eyes with macular edema secondary to BRVO and best-corrected visual acuity (BCVA) worse than 20/40 were included. Eyes eligible for Branch Retinal Vein Occlusion Study (BVOS) guidelines received grid laser treatment first. Those that were not improved at least two lines following grid laser or that did not meet those guidelines received 4 mg IVTA injection. The efficacy of IVTA treatment was assessed by analyzing the change in BCVA and reduction in central macular thickness (CMT) measured by optical coherence tomography. Intraocular pressure (IOP) spikes and other complications were recorded. RESULTS: The data from 37 eyes were included; in 12 of them IVTA injection was given after grid laser while 25 of them received IVTA as a primary treatment. Mean follow-up was 9.6 +/- 4.5 months. BCVA was 0.06 +/- 0.30 and 0.17 +/- 0.50 in the primary and secondary IVTA injection groups, respectively. In the primary injection group, there was a statistically significant gain in BCVA throughout the follow-up (P < 0.05), while a small increase in BCVA was noted only at the third month visit in the secondary IVTA injection group (P = 0.04). Average CMT were 434.8 +/- 122.1microm and 389.0 +/- 171.9 microm before IVTA injection in the two groups, respectively. In the primary IVTA injection group, CMT decreased at 1 month following IVTA injection and remained statistically significant until the sixth month visit (P < 0.05). In the secondary IVTA injection group, a slight reduction in CMT was noted only in the first month visit (P = 0.02). Pre-IVTA BCVA was found to be the single statistically significant predictor of BCVA gain following IVTA injection. In 8 patients (21.6%), the IOP increased above 25 mmHg postoperatively, and was successfully managed by medical treatment. Endophthalmitis did not develop in any of the patients. CONCLUSION: IVTA injection produced a significant reduction of macular edema in eyes with BRVO either with or without prior grid laser treatment. Reduction of CMT increased the BCVA in most of the eyes receiving IVTA primarily, while only a slight improvement of BCVA was found in eyes with prior grid laser. The IVTA effect was transient. Larger studies are necessary to find the best approach (either grid laser or IVTA) to patients with macular edema associated with BRVO.