Retcam fluorescein gonioangiography: a new modality for early detection of angle neovascularization in diabetic retinopathy.

PURPOSE: To evaluate the role of Retcam fluorescein gonioangiography in detecting neovascularization of the angle and correlate the same with gonioscopy in diabetic retinopathy. METHODS: One hundred and fifty eyes of 150 patients (25 each of mild, moderate, severe, very severe nonproliferative diabetic retinopathy (NPDR) proliferative diabetic retinopathy (PDR); and PDR with high-risk characteristics) were recruited. They underwent complete ocular examination including applanation tonometry, gonioscopy, Retcam fluorescein gonioangiography, and fundus fluorescein angiography. RESULTS: Using Retcam fluorescein gonioangiography, of 150 eyes neovascularization of the angle was detected in 37 eyes (24.66%) compared with 22 eyes (14.66%) on gonioscopy (P = 0.04). Small newly formed vessels were evident only with Retcam fluorescein gonioangiography. In 10 of 50 patients (20%) with severe/very severe NPDR, angle neovascularization was appreciable on Retcam fluorescein angiography compared with 5 patients (10%) on gonioscopy. Similarly, 25 of 50 patients (50%) with PDR/PDR with high-risk characteristics had neovascularization of the angle on Retcam gonioangiography compared with 17 (34%) on gonioscopy. CONCLUSION: Retcam fluorescein gonioangiography is a novel technique for early detection of angle neovascularization in diabetic retinopathy and hence preventing progression to neovascular glaucoma. The objective nature of this test helps in precise decision making compared with gonioscopy for early intervention especially in cases of pre-PDR.

Comparison of topical anesthesia and peribulbar anesthesia for 23-gauge vitrectomy without sedation.

PURPOSE: To compare the safety and efficacy of topical anesthesia versus peribulbar anesthesia for 23-gauge vitrectomy without sedation. METHODS: Selected group of 60 patients with vitreous hemorrhage were divided into 2 groups and underwent 23-gauge vitrectomy. Group 1 used topical anesthesia, whereas Group 2 used peribulbar anesthesia. A 5-point Visual Analogue Scale was used to assess patients' pain score and surgeon's ease while operating. Any complications thereof were made note of. RESULTS: Mean overall patients' pain scores were 1.77 ± 0.50 in Group 1 and 1.77 ± 0.43 in Group 2. Surgeon's comfort score was recorded as 0.3 ± 0.53 and 0.17 ± 0.38 in Groups 1 and 2, respectively. Mean surgical time was 33.7 ± 7.1 minutes and 30.1 ± 6.2 minutes in Groups 1 and 2, respectively. These means were not statistically significant (P > 0.05). No patient required sedation or anesthesia supplementation. Group 1 patients reported maximum pain during trocar entry, whereas Group 2 reported maximum pain during block. Group 2 patients also reported significant conjunctival chemosis and lid edema postblock. CONCLUSION: Topical anesthesia without any sedation is a viable option, comparable to peribulbar block, for performing vitrectomy in selected group of patients requiring vitrectomy and thus avoiding complication of injection anesthesia and quicker postoperative recovery.

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

PURPOSE: 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 7 th 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 1 st 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.

Comparison of intravitreal bevacizumab, intravitreal triamcinolone acetonide, and macular grid augmentation in refractory diffuse diabetic macular edema: A prospective, randomized study.

BACKGROUND: In spite of laser being the gold standard treatment for Diabetic Macular edema (DME), some patients do not respond to laser. Various treatment modalities are being tried in the management of refractory diffuse DME (DDME). PURPOSE: To compare the efficacy of intravitreal bevacizumab (IVB), intravitreal triamcinolone acetonide (IVTA), and macular grid augmentation in the management of refractory DDME. SETTINGS AND DESIGN: Prospective randomized study in a tertiary eye care center. MATERIALS AND METHODS: SIXTY PATIENTS WITH REFRACTORY DDME WERE RANDOMLY ASSIGNED TO THREE GROUPS: Group 1 received IVB (1.25 mg/0.05 ml), Group 2 received IVTA (4 mg/0.1ml), and Group 3 underwent laser augmentation. Primary outcome measures were best corrected visual acuity (BCVA) and central macular thickness (CMT) at the end of 6 months. STATISTICS: Analysis was performed using SPSS 14.0 RESULTS: Group 1 and 2 showed significant improvement in mean BCVA from 20/160 at baseline to 20/80 and from 20/125 to 20/63, respectively, at 6 months (P < 0.05). These groups also showed a significant reduction in the mean CMT from 457 ± 151 µ at baseline to 316 ± 136 µ and from 394 ± 61 µ to 261 ± 85 µ, respectively, at 6 months (P < 0.05). Group 3 showed only small improvement in mean BCVA from 20/100 to 20/80 (P = 1.0) while mean CMT increased from 358 ± 89 µ at baseline to 395 ± 127 µ at 6 months (P = 0.191). Eight (40%) eyes in Group 2 had intraocular pressure (IOP) rise and 10 (50%) eyes developed cataract. CONCLUSIONS: Both IVB and IVTA may be effective in the treatment of refractory DDME compared with macular grid augmentation. IVTA may be associated with side effects such as IOP rise and cataract formation.