Early treatment with dexamethasone intravitreal implants in diabetic macular edema: Naïve versus refractory patients.

PURPOSE: To assess the efficacy and safety of dexamethasone 0.7 mg implants (DEX-I) in patients with diabetic macular edema (DME) either naïve to therapy or refractory to anti-VEGF treatment, in a single-center, real-world setting. METHODS: Patients diagnosed with DME and treated with DEX-I were retrospectively enrolled in the study and split in two groups: naïve (Group 1, n = 64) and refractory (Group 2, n = 64) to treatment. Patients were evaluated at baseline, at 1 month, and every 3 months after each DEX-I implant. Main outcome measures were change in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to follow-up visits. RESULTS: Significant improvements in BCVA were observed in treatment-naïve patients at 6 months following the first and second DEX-I injection (p = 0.0023 and p = 0.0063, respectively), with significant reductions in mean CMT at 6 months after all DEX implants. In treatment-refractory patients, mean CMT was significantly reduced from baseline to 6 months (p < 0.05) after all DEX-I injections, although no changes were observed in BCVA. CONCLUSIONS: DEX-I improved visual acuity and macular edema mostly in treatment-naïve patients, suggesting DEX-I may be a viable first-line treatment option in DME.

Lamellar macular hole following intravitreal pegaptanib sodium (Macugen) injection for diabetic macular edema.

To report on a patient who developed a lamellar macular hole 1 month after an intravitreal pegaptanib sodium injection. Interventional case report. A 66 year old patient developed a lamellar macular hole 1 month after an intravitreal pegaptanib sodium injection for diabetic macular edema (DME). The pathogenesis of the lamellar macular hole in our case can be attributed to the intravitreal injection that may have induced vitreous incarceration, causing vitreoretinal traction at the macula and development of a lamellar macular hole. Alternatively or in association, pegaptanib itself may have caused the lamellar macular hole by inducing sudden reduction of the DME and exacerbation of tangential traction of the posterior vitreous on the overlying macular retina. Lamellar macular hole seems to be a potential complication of pegaptanib injection even in patients without pretreatment clinically detectable vitreomacular traction.

Intravitreal avastin for choroidal neovascularization associated with stargardt-like retinal abnormalities in pseudoxanthoma elasticum.

The aim of the study was to describe a patient with pseudoxanthoma elasticum (PXE), showing Stargardt-like retinal abnormalities, who underwent treatment with intravitreal bevacizumab for subfoveal choroidal neovascularization (CNV) of the right eye (RE). A 57-year-old woman with diagnosis of angioid streaks, retinal flecks, and chorioretinal Stargardt-like atrophy due to PXE was referred to our department for sudden decreased vision in her RE (20/160). Upon a complete ophthalmologic examination, including fluorescein angiography (FA), and optical coherence tomography (OCT), the patient was diagnosed with subfoveal CNV of the RE. Owing to the subfoveal localization of the CNV, the patient was submitted to intravitreal bevacizumab injection. At the 1-month follow-up, visual acuity (VA) improved (20/40), and FA and OCT revealed the CNV closure. Twelve months after the treatment, the patient's VA remained stable with no recurrence of active CNV. On the basis of our findings, a single intravitreal bevacizumab injection seems to induce total regression of CNV complicating PXE, in a patient showing Stargardt-like retinal abnormalities. Further investigations are required to confirm our results.

Very Large Bilateral Lesions Obscuring Diagnosis of Adult-Onset Foveomacular Vitelliform Dystrophy.

Adult-onset foveomacular vitelliform dystrophy (AFVD) is a clinically heterogeneous and pleomorphic disease originally described by Gass as bilateral with symmetrical, solitary, round or oval, slightly elevated, yellowish subretinal lesions, one third to one disc diameter in size, often with a central pigmented spot. A possible AFVD patient showing very large bilateral macular lesions was reported.

Local resection versus combined local resection and plaque radiotherapy in the treatment of choroidal melanoma.

PURPOSE: To evaluate the outcome of local resection versus combined local resection and plaque radiotherapy in the treatment of choroidal melanoma. METHODS: We retrospectively analyzed the records of 60 patients (60 eyes) managed by local resection (group 1, 30 patients, external or internal local resection) or combined local resection and plaque radiotherapy (group 2, 30 patients, both Ruthenium-106 or Cobalt-60), among the 364 melanomas treated at our Department of Ophthalmology, between January 1980 and December 2006. Main outcomes measures were postsurgical complications, visual acuity, local recurrence, reasons for enucleation, and development of metastasis. RESULTS: The 2 groups of patients were considered sufficiently homogeneous as regards location, cell type, and age. Mean follow-up was 7 years. The median largest basal tumor diameter was 9.8 mm and 10.1, and the median tumor thickness was 7.9 mm and 8, respectively, in groups 1 and 2. No statistically significant differences resulted between group 1 and group 2 as regards postsurgical complications (vitreous hemorrhage, retinal detachment, maculopathy, cataract, and optic neuropathy) (p>0.05), visual acuity (p>0.05), local recurrence (p>0.05), reasons for enucleation (p>0.05), or development of metastasis (p>0.05). CONCLUSIONS: No adjunctive benefits from the combined local resection and plaque radiotherapy can be ruled out from our study.

High-Definition OCT Findings in Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

The authors report a case of acute posterior multifocal placoid pigment epitheliopathy evaluated by autofluorescence, fluorescein angiography, indocyanine green angiography, high-definition optical coherence tomography, and microperimetry in both the acute and the post-acute phase. Based on the integrated findings, the authors believe that acute posterior multifocal placoid pigment epitheliopathy is an inflammatory disease that primarily affects the choroid and that the retinal pigment epithelium is secondarily involved in the course of the disease.

Foveal geographic atrophy following intravitreal pegaptanib sodium (Macugen) for drusenoid pigment epithelium detachment.

PURPOSE: To describe a patient with nonexudative age-related macular degeneration (AMD) who underwent intravitreal pegaptanib sodium injection for drusenoid pigment epithelium detachment (PED). METHODS: A 66-year-old woman, who underwent intravitreal pegaptanib sodium injection in her right eye (RE) for chronic serous drusenoid PED, was submitted to a complete ophthalmologic examination, including fundus biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT-3, Humphrey-Zeiss, San Leandro, CA), 3 days and 1 month after the treatment. RESULTS: Three days after the intravitreal pegaptanib sodium injection, best-corrected visual acuity (BCVA) was 20/32 in the RE. One month later, the patient's BCVA dropped to 20/200 in the RE. Interestingly, fundus biomicroscopy, FA, OCT, and ICGA revealed the development of foveal geographic atrophy. Fundus-related perimetry (MP-1 Micro Perimeter, Nidek Technologies, Padova, Italy) revealed an eccentric and unstable fixation within 2 degrees with central absolute scotoma and pericentral diffuse reduction of sensitivity. CONCLUSIONS: The rapid development of foveal geographic atrophy in our patient may be related to the antivascular endothelial growth factor treatment, in part because of the reduced neuroprotective effect, and in part because of the adjunctive decreased blood flow in an already imbalanced foveal choroidal circulation due to AMD complicated by chronic serous drusenoid PED.

Short-term fluctuation of diabetic macular edema after intravitreal ranibizumab injection.

PURPOSE: To examine the short-term fluctuation of diabetic macular edema (DME) after one intravitreal ranibizumab injection. METHODS: Twenty consecutive patients with DME received an intravitreal injection of ranibizumab (0.05 mL/0.5 mg). Assessment of best-corrected visual acuity (BCVA), fundus biomicroscopy, MP-1 fundus-related perimetry using follow-up strategy (pattern macula 8 degrees 0 dB with threshold strategy 4-2), and optical coherence tomography central macular thickness (CMT),were performed at baseline and 1 hour, 24 hours, 14 days, 28 days, and 56 days after intravitreal injection of ranibizumab. RESULTS: A total of 18 eyes of 18 patients (9 male, 9 female; mean age, 62.28 +/- 8.08 years; range, 48-75 years) who completed the 56-day follow-up were included for analysis. Intravitreal ranibizumab was found to produce significant improvements in mean BCVA and MP-1 sensitivity, as well as reduction in mean CMT, after one injection. This anatomical and functional improvement, which compared with baseline was evident as soon as the 1-hour follow-up (mean CMT reduction: t= 1.7899, P = 0.045; mean MP-1 sensitivity improvement: t = -1.9891, P 0.0315), and lasted until the 56-day follow-up (mean BCVA improvement: t= 2.26, P < 0.05; mean CMT reduction: t = 3.61, P < 0.05; MP-1 sensitivity improvement: t = -5.21, P < 0.05). CONCLUSION: These short-term observations give insights into the physiopathology of DME treated with a intravitreal ranibizumab injection.

Intravitreal pegaptanib sodium (Macugen) for diabetic macular oedema.

PURPOSE: To report the functional and anatomical outcomes resulting from the use of intravitreal pegaptanib sodium (Macugen) in patients with diabetic macular oedema (DMO). METHODS: We conducted a retrospective outcome analysis, by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), of eyes with DMO treated with intravitreal pegaptanib sodium. Moreover, we evaluated the foveal transverse photoreceptor (PR) band integrity in the OCT images at the time of the last follow-up visit. RESULTS: Sixty-three eyes of 48 patients with a minimum of 6 months of follow-up were included for analysis. Intravitreal pegaptanib was found to produce significant improvements in mean BCVA (p = 0.019) and reductions in mean central macular thickness (CMT) (p < 0.001) as soon as the 6-week follow-up. Most eyes (60/63) required a mean of 3.03 +/- 0.9 repeated treatments, over a mean follow-up period of 6.7 +/- 1.2 months, to achieve significant improvements in mean BCVA (p < 0.001) and mean CMT (p < 0.001). In our series, the lower visual acuities tended to congregate in the group with the less-defined PR band (p < 0.001) and the lower CMT tended to congregate in the group with the best-defined PR band (p = 0.04), even though the higher CMT did not tend to congregate in the group with the less-defined PR band. CONCLUSION: Our findings demonstrate that selective inhibition by intravitreal pegaptanib sodium of vascular endothelial growth factor (VEGF)-165 may produce a clinically meaningful and statistically significant benefit in the treatment of DMO.

Leber miliary aneurysms and multiple sclerosis.

PURPOSE: To describe a patient with Leber miliary aneurysms who fulfilled the criteria for clinically definite multiple sclerosis (MS) in remission. METHODS: Case report. RESULTS: We performed a complete ophthalmologic examination in a 45-year-old woman who was referred to our department for retinal vascular abnormalities in her left eye. Twenty-eight years previously,the patient had been diagnosed with MS. Following a complete ophthalmologic examination,the patient was diagnosed with Leber miliary aneurysms and coincident MS in remission. To our knowledge, there are no previous reports describing association between Leber miliary aneurysms and MS. CONCLUSIONS: Leber miliary aneurysms have been found in association with multiple ocular and systemic syndromes. In this report, we suggest another possible systemic association (MS) with Leber miliary aneurysms.

Correlation of visual function impairment and optical coherence tomography findings in patients with adult-onset foveomacular vitelliform macular dystrophy.

PURPOSE: To investigate the relationship between morphologic and functional abnormalities in patients affected with adult-onset foveomacular vitelliform macular dystrophy (AFVD). DESIGN: Prospective, noncomparative observational study. METHODS: A complete ophthalmologic examination, including best-corrected visual acuity (BCVA), fundus examination, fundus-related perimetry, and optical coherence tomography (OCT), was performed in 20 consecutive AFVD patients. The stage of the disease and the thickness of the neuroepithelium at the foveola (neurosensory retina) were compared with the BCVA as well as with the type of scotoma, the average retinal sensitivity, and the location and stability of fixation. RESULTS: Thirty-five eyes of 20 consecutive patients (10 men and 10 women; mean age, 58.2 years) were graded as follows: 10 had vitelliform stage (stage 1), nine had pseudohypopyon stage (stage 2), 10 had vitelliruptive (stage 3), and six had atrophic stage (stage 4) disease. Reduced thickness of the neuroepithelium at the foveola and BCVA were statistically correlated to an advanced stage of the disease (P = .001 and P = .0062, respectively). Moreover, worse BCVA was correlated statistically to reduced thickness of the neuroepithelium at the foveola (r = 0.14; P = .02). Reduced thickness of the neuroepithelium at the foveola was correlated statistically to the development of absolute scotoma (P = .03), eccentric fixation (P = .01), and unstable fixation (P = .03). CONCLUSIONS: OCT and fundus-related perimetry allow a correlation to be defined between foveal thickness and visual function and are useful tools to define better the degree of anatomic and functional impairment in AFVD patients.