Effect of intravitreal dexamethasone implant in treatment-naive and previously-treated patients with diabetic macular edema.

PURPOSE: To document the effects of intravitreal dexamethasone implant on retinal microvasculature in patients with diabetic retinopathy complicated by center-involving macular edema. METHODS: 35 eyes of 35 patients affected by retinopathy due to type 2 diabetes (15 treatment-naïve and 20 previously treated) were included in this retrospective study with a follow-up of 4 months. Foveal avascular zone (FAZ) area and superficial capillary plexus (SCP) and deep capillary plexus (DCP) densities in the foveal and parafoveal areas were measured by optical coherence tomography angiography (OCTA) at baseline and 2 and 4 months post-injection. Intraocular pressure, morphological and functional parameters were evaluated. RESULTS: a significant difference was found in both groups at 2 months after injection in terms of functional (BCVA, p < 0.05) and morphological (CMT, p < 0.05) parameters. During follow-up, FAZ area, SCP, and DCP in the foveal and parafoveal areas did not change significantly. CONCLUSIONS: intravitreal dexamethasone implant is effective in the treatment of diabetic center-involving macular edema and was associated with significant improvements in BCVA and CMT at 2 months after injection. After a single dexamethasone implant injection, FAZ area and retinal vascular density does not show significant variations in both naive and non-naive DME patients subgroups.

Panretinal Photocoagulation Does Not Change Macular Perfusion in Eyes With Proliferative Diabetic Retinopathy.

BACKGROUND AND OBJECTIVE: To quantify and compare the vessel density (VD) in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP), as well as the size of the foveal avascular zone (FAZ) in patients with proliferative diabetic retinopathy (PDR) before and after panretinal photocoagulation (PRP). PATIENTS AND METHODS: This prospective clinical study was conducted in the Department of Ophthalmology, Miulli Hospital Acquaviva delle Fonti, Italy. Each patient underwent measurement of best-corrected visual acuity (BCVA), fluorescein angiography, spectral-domain optical coherence tomography (OCT), and OCT angiography (OCTA) at baseline. Patients received PRP within 7 days from baseline, using frequency-doubled Nd:YAG pattern scan laser. BCVA and OCTA were repeated at 1 month and at 6 months. Repeated measure one-way analysis of variance was used to investigate differences between OCTA parameters before and after PRP. RESULTS: Eighteen eyes of 14 patients with diabetes (11 males, 78.6%) were enrolled. Patients underwent a mean of four laser treatments. BCVA was slightly worse at baseline (0.30 ± 0.20) compared to the visual function after 6 months (0.25 ± 0.24; P = .3). FAZ (0.33 ± 0.19 mm2 vs. 0.33 ± 0.16 mm2; P = .6), foveal SCP (16.4 ± 8.0 vs. 16.5 ± 6.5; P = .4), foveal DCP (28.5 ± 8.6 vs. 28.2 ± 8.1; P = .8), parafoveal SCP (38.4 ± 5.7 vs. 38.6 ± 4.5; P = .9), and parafoveal DCP (46.1 ± 5.2 vs. 43.8 ± 5.1; P = .3) did not change 6 months after PRP. CONCLUSIONS: OCTA parameters were not significantly affected by peripheral laser treatment at both short- (1-month) and medium- / long-term (6-month) follow-up. Further analysis with larger samples and longer duration is warranted to confirm these results. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:174-178.].

COMPARATIVE ANALYSIS OF RETINAL REATTACHMENT SURGERY WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING TO PREVENT POSTOPERATIVE MACULAR PUCKER.

PURPOSE: To determine whether internal limiting membrane (ILM) peeling during pars plana vitrectomy for rhegmatogenous retinal detachment reduces the incidence of epiretinal membrane (ERM) formation. METHODS: In this retrospective study, preoperative, intraoperative, and postoperative data from all eyes undergoing pars plana vitrectomy for rhegmatogenous retinal detachment between January 2007 and December 2013 was analyzed. All cases with at least 1-year of follow-up were included. Data collection included vision, intraoperative complications, occurrence of ERM, and spectral domain optical coherence tomography characteristics. The OCTs were retrieved for all eyes and were graded by a single masked grader. RESULTS: Out of 159 eyes recruited, ILM peeling was done in 78 eyes (49%). Overall occurrence of ERM was 20%. Seven eyes (9%) in ILM peeling group and 25 eyes in the non-ILM peeling group (31%) showed ERM (P = 0.001). Postoperative vision was significantly better in eyes that had ILM peeling (0.48 ± 0.4 logarithm of the minimum angle of resolution [20/63] vs. 0.77 ± 0.6 logarithm of the minimum angle of resolution [20/125], P = 0.003). In multivariable models adjusting for type of tamponade, ILM peeling reduced the likelihood of ERM formation by 75% (P = 0.01). CONCLUSION: Internal limiting membrane peeling during pars plana vitrectomy for rhegmatogenous retinal detachment significantly reduces ERM formation in the postoperative period and is associated with better visual and anatomical outcomes.

In vivo evidence of hypotrophic ciliary body in ocular ischemic syndrome by ultrasound biomicroscopy.

In ocular ischemic syndrome, the ischemic condition is due to markedly reduced blood flow and increased vascular resistance of retrobulbar circulation, as in the central retina and posterior ciliary arteries. Chronic hypoxia affects even the iris and ciliary body. The hypoperfusion of the ciliary body leads to a relative hypotony, presumably related to decreased aqueous humor production. Histopathologic study has demonstrated ciliary body atrophy on an ischemic basis. The authors used ultrasound biomicroscopy to demonstrate in vivo the hypotrophic condition of the ciliary body in ocular ischemic syndrome.

Tubulointerstitial nephritis and uveitis syndrome.

Tubulointerstitial nephritis and uveitis syndrome is likely underdiagnosed. A 13-year-old girl with no significant medical history had photophobia, ocular pain, and decreased visual acuity. Bilateral papilledema was present. Renal biopsy revealed interstitial nephritis. Immunosuppressive therapy was added (3 mg/kg/d of cyclosporine). One year later, visual acuity was 20/20 and findings were normal on ocular examination and laboratory tests.

Combined radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide for central retinal vein occlusion.

To evaluate the efficacy of radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide for central retinal vein occlusion. Eight consecutive eyes with central retinal vein occlusion with a duration of less than 6 months, cystoid macular edema, and best-corrected visual acuity (BCVA) of less than 20/200 were enrolled. BCVA, intraocular pressure, fluorescein angiography, and optical coherence tomography were evaluated. After 4.75 +/- 0.7 months, BCVA significantly improved, intraocular pressure was well controlled, and fluorescein angiography showed perfused state and reduction of the number of retinal hemorrhages in all eyes. Optical coherence tomography revealed significant reduction of macular thickness. Bleeding in the neurotomy site occurred in 3 cases. Radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide may be useful in the management of central retinal vein occlusion with macular edema.

Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia.

PURPOSE: To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months). RESULTS: Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation. CONCLUSIONS: Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.

Evaluation of corneal damage by combined phacoemulsification and passive efflux of silicone oil in vitrectomized eyes.

PURPOSE: To evaluate the effect on the corneal endothelium of phacoemulsification combined with passive silicone oil removal and intraocular lens (IOL) implantation under topical anesthesia after pars plana vitrectomy. SETTING: Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy. METHODS: This retrospective study evaluated the corneal endothelium in 17 consecutive patients (17 eyes) who had phacoemulsification with transpupillary passive silicone oil washout (1300 centistokes) through a posterior capsulorhexis and single clear corneal incision and foldable acrylic IOL implantation. The findings were compared with those in a control group of 17 patients (17 eyes) who had phacoemulsification with acrylic IOL implantation through a single clear corneal incision. All procedures were performed by the same surgeon using topical anesthesia. The preoperative and postoperative endothelial cell densities, coefficient of variation (CV), and percentage of hexagonal cells at the corneal center and peripheral temporal position, evaluated by noncontact specular microscopy, were compared between the 2 groups. The central corneal thickness and occurrence of keratopathy were also noted. RESULTS: The mean phacoemulsification and total ultrasound times did not differ significantly between the 2 groups. At 6 months, the mean endothelial cell loss was 284.50 cell/mm(2) +/- 462.3 (SD) (11.2%) in the study group and 200.15 +/- 117.9 cell/mm(2) (8.3%) in the control group (P=.87, unpaired t test). There were no significant between-group differences in the increase in the mean CV and the percentage of hexagonal cells. The mean pachymetry remained at preoperative values, with no difference between groups. Keratopathy was not observed in any patient. CONCLUSIONS: Passive silicone oil efflux caused significant endothelial cell loss and changes in endothelial morphology. Nevertheless, these modifications were well tolerated and minimally different from the results of trauma caused by standard phacoemulsification with posterior chamber IOL implantation.