One year outcomes of treat and extend and pro re nata (PRN) treatment regimens with aflibercept for polypoidal choroidal vasculopathy.

PURPOSE: To compare the 1-year outcomes of treat-and-extend and pro re nata (PRN) treatment regimens with aflibercept for polypoidal choroidal vasculopathy (PCV), by the means of visual acuity (VA), frequency of recurrence of polypoidal lesions and developed fibrosis, and the number of intravitreal injections, and thus to determine which one is preferable in the maintenance phase in PCV. METHODS: In our prospective study, only naive and previously untreated PCV patients were included. Initially one session of photodynamic therapy (PDT) and three monthly intravitreal injections of 2.0 mg aflibercept (IAIs) were applied in 38 eyes. After this loading phase, they were re-examined and 30 PCV eyes with no exudative phenomena were included in the study. They were divided in two groups; in the first one (16 patients) the PRN treatment modality of IAIs was applied, while in the second one (14 patients) the treat-and-extend regimen was applied. RESULTS: Over a 12-month period, VA significantly improved in treat-and-extend group (logMAR BCVA 0.41 ± 0.15 vs 0.57 ± 0.24 at baseline, p = 0.044), while in the PRN group VA remained stable (logMAR BCVA 0.70 ± 0.36 vs 0.65 ± 0.18 at baseline, p = 0.61). During the maintenance phase, the patients of treat-and-extend group did not encounter development/progression of fibrosis or any recurrent episodes, whereas the patients of PRN group had significantly more recurrent episodes (0 vs 1.37 ± 0.5, p < 0.001) and the frequency of development/progression of fibrosis was significantly higher (0% vs 44%, p = 0.02). However, the treat-and-extend treatment regimen was accompanied by significantly more administered IAIs (6 ± 0 vs 5.13 ± 1.08, p = 0.006). CONCLUSION: We highlighted the superiority of treat-and-extend regime with IAIs, which seems to yield better functional outcomes by preventing recurrence and subfoveal fibrosis, although a greater number of injections is required.

Comparison of Subthreshold 532 nm Diode Micropulse Laser with Conventional Laser Photocoagulation in the Treatment of Non-Centre Involved Clinically Significant Diabetic Macular Edema.

BACKGROUND: The aim of the study was to investigate the effect of the 532 nm (green) diode subthreshold micropulse laser (SML) in the treatment of non-centre involved clinically significant macular edema (CSME) in comparison to the conventional laser photocoagulation (CLP). METHODS: A total of 60 eyes of patients diagnosed with non-centre involved CSME were randomly divided into two groups. SML photocoagulation was performed in the first group (G1), while CLP in the second one (G2). Central macular thickness (CMT) and best corrected visual acuity (BCVA) were measured prior to treatment and at 3 and 6 months after intervention. RESULTS: G1 participants had significantly better CMT at 6 months after laser application (p = 0.04) compared to G2. Additionally, CMT in both groups was significantly lower 6 months after laser application in comparison to baseline values (G1: p < 0.001, G2: p = 0.002). Moreover, significant improvement was detected 6 months after SML in G1 regarding BCVA compared to values before laser treatment (p = 0.001). CONCLUSION: SML was more effective than CLP in reducing CMT and improving BCVA in patients with non-centre involved CSME. Therefore, it seems that SML can be a good substitute for CLP in DME treatment if confirmed in future studies.

Variability of different reference bodies in normal, keratoconus, and collagen crosslinked corneas.

PURPOSE: To evaluate the reproducibility of different Scheimpflug imaging-derived reference bodies in normal, keratoconus (KC), and crosslinked (CXL) eyes. METHODS: In this prospective, observational study, 40 participants populated the control group (CG), while 33 and 34 patients formed the KC group and the CXL group, respectively. One eye was randomly selected when both were eligible. Elevation measurements were obtained using Scheimpflug camera, by applying the following reference bodies: the best fit sphere (BFS), the best fit toric ellipsoid (BFTE), the best fit toric ellipsoid with fixed eccentricity of 0.4 (BFTEF), the best fit ellipsoid (BFE), and the best fit torus, by 2 operators in 2 sessions. The variability of different reference bodies' parameters was assessed using intraclass correlation coefficient (ICC). RESULTS: Differences between operators were nonsignificant for all reference bodies' parameters in all study groups (p>0.1). Regarding CG, BFS for both operators and BFTE for operator 1 presented the best intrasession repeatability (majority of ICCs >0.90), while average interobserver reliability was recorded for the majority of reference bodies' parameters. Regarding KC and CXL groups, BFS, BFTEF, and BFE reference bodies demonstrated the best intrasession and interobserver reproducibility (majority of ICCs >0.90) for both groups. Steep and flat radius parameters presented the best overall reproducibility, with the majority of ICCs for all reference bodies ranging above 0.90, in all study groups. CONCLUSIONS: High variability was encountered for most reference surfaces. Ellipsotoric surfaces presented acceptable repeatability in KC and post-CXL corneas.

Variability in Scheimpflug image-derived posterior elevation measurements in keratoconus and collagen-crosslinked corneas.

PURPOSE: To determine the variability in Scheimpflug image-derived posterior elevation measurements in eyes with keratoconus or corneal collagen crosslinking (CXL). SETTING: Eye Institute of Thrace, Alexandroupolis, Greece. DESIGN: Prospective observational study. METHODS: Two operators in 2 sessions obtained posterior elevation measurements using the Pentacam Scheimpflug system. Variability in measurements was assessed using Bland-Altman analysis and intraclass correlation coefficients (ICCs). Measurements were associated with a series of Scheimpflug-derived keratoconus indices using the Pearson correlation and multivariate linear-regression analysis. RESULTS: Mean interobserver differences for the central elevation point (e1) and the highest elevation point (HEP) in the keratoconus group were -0.9 µm (95% limits of agreement [LoA], 5.7 to -7.5 µm) and 1.7 µm (95% LoA, 26 to -22.6 µm), respectively. In the CXL group, the mean differences were 0.2 µm (95% LoA, 6.0 to -5.5 µm) and -6.1 µm (95% LoA, 16.8 to -29 µm), respectively. The ICC values in the keratoconus group were satisfactory for most elevation points; the ICC values were unsatisfactory for a series of points in the lower corneal hemisphere. The ICC values for points in both hemispheres were unsatisfactory in the CXL group; HEP had adequate reproducibility. The e1 and HEP parameters correlated significantly with most Scheimpflug-derived indices (P<.05) in the keratoconus group but not in the CXL group. Regression analysis indicated that the central keratoconus index was the primary determinant of the variability in keratoconus eyes. CONCLUSIONS: Scheimpflug-derived posterior elevation measurements had acceptable reproducibility in keratoconus eyes and post-CXL eyes. Less consistent measurements were obtained in the lower hemisphere.