Prediction of Anti-VEGF Response in Diabetic Macular Edema After 1 Injection.

PURPOSE: With multiple anti-vascular endothelial growth factor and steroid therapies available for diabetic macular edema (DME), there is a need for early determination of the best treatment for a particular patient to prevent irreversible vision loss from chronic DME. In this study, we classify patients as responders or non-responders to anti-vascular endothelial growth factor (VEGF) monotherapy in the treatment of DME after a single anti-VEGF injection. METHODS: The study was designed as a single center, retrospective, interventional case series. We included patients who received 3 consecutive monthly injections with the same anti-VEGF agent. We excluded patients who were treated for DME in the preceding 3 months with any form of anti-VEGF therapy. Visual acuity and central retinal thickness (CRT) data were followed for one year. Receiver operating characteristic (ROC) curve analysis was performed in order to identify cutoff values for identifying responders. RESULTS: 107 eyes were reviewed, with 40 eyes of 34 patients meeting all inclusion criteria. Based on ROC curve analysis, a reduction in CRT by > 15% at 1-month, identified eyes that responded to treatment and had a >25% reduction in CRT at 3-months (sensitivity 0.75, specificity 0.92). CONCLUSION: DME eyes that have early response to anti-VEGF treatment by reduction in CRT will have significant response to treatment by 3 months.

Stalagmite-like preretinal inflammatory deposits in vitrectomized eyes with posterior uveitis.

We report a new clinical sign of vitreous inflammation in patients with posterior uveitis: spectral-domain optical coherence tomography identified stalagmite-like, discrete, diffusely distributed, hyperreflective, preretinal deposits in previously vitrectomized eyes of 2 patients during flares of posterior uveitis. The extent of the deposits correlated with disease activity. The underlying primary diseases encountered were necrotizing retinochoroiditis secondary to toxoplasmosis and primary central nervous system lymphoma.

RECURRENT MACULAR HOLES IN THE ERA OF SMALL-GAUGE VITRECTOMY: A Review of Incidence, Risk Factors, and Outcomes.

PURPOSE: To evaluate the preoperative features, intraoperative management, and postoperative outcomes of recurrent macular holes that developed after initial successful repair with small-gauge vitrectomy techniques. METHODS: We retrospectively reviewed 392 eyes with idiopathic macular holes successfully treated with small-gauge vitrectomy. Thirteen of these eyes underwent reoperation after macular hole reopening. We assessed patient demographics, visual acuity, postoperative anatomical success, potential precipitating clinical factors of hole reopening, and details of the surgical repairs of these eyes. RESULTS: Macular hole reopening occurred in 13 (3.3%) of 392 eyes in a mean of 28 months (range, 1-120 months) after initial repair. All 13 recurrent holes closed after a second vitrectomy, but 4 (31%) holes reopened again and had vitrectomy. Of these, 2 reopened a third time. Ultimately, 11 (85%) holes were closed at the most recent follow-up. The mean best-corrected visual acuity was 20/81 before initial repair, 20/148 after the first reopening, 20/115 after repair of the first reopening, and 20/55 after repair of >1 reopening. Ten of 13 (77%) patients had, or later developed, macular holes in the other eye during follow-up. CONCLUSION: Reoperation successfully achieved hole closure and ultimate visual improvement in most eyes with recurrent macular holes. Most patients with recurrent holes previously had, or later developed, full-thickness macular holes in the other eye.