Tolerating subretinal fluid in the treatment of neovascular age-related macular degeneration with intravitreal aflibercept.

OBJECTIVE: To compare the anatomical and functional outcomes of intensive and relaxed intravitreal aflibercept regimen in the management of neovascular age-related macular degeneration. METHODS: The medical records of 50 eyes of 50 patients with treatment-naive neovascular age-related macular degeneration, who underwent intravitreal aflibercept therapy in the Retinal Department of University of Health Sciences Okmeydani Training and Research Hospital (Istanbul, Turkey), were retrospectively reviewed. The demographic features and best-corrected visual acuities at baseline and at 1st-, 2nd-, 3rd-, 4th-, 6th-, 10th- and 12th- months, optical coherence tomography measurements, presence of intraretinal fluid, subretinal fluid and intraocular pressure values were studied. The patients were divided into two groups: intensive (subretinal fluid intolerant) and relaxed (<200 microns subretinal fluid tolerated) intravitreal aflibercept regimens. RESULTS: The change in the mean best-corrected visual acuities from baseline to 12th month was 13.72 ± 33.97 letters in the intensive treatment group and 8.68 ± 27.22 in the relaxed group. There was no statistically significant difference between the groups (p = 0.566). Similar proportions of both groups achieved ⩾10 letters gain (%48 vs. %40, respectively; p = 0.755) and ⩾10 letters loss (%20 vs. %24, respectively; p = 0.755). The mean central subfield thickness values decreased statistically significantly in both groups (p < 0.001). There was no statistically significant difference between the groups (442.40 ± 161.32 to 318.0 ± 63.10 vs. 431.64 ± 151.52 to 303.08 ± 140.91, respectively; p = 0.724). The mean total injection numbers were significantly lower in the relaxed group (6.4 ± 1.65 vs. 4.8 ± 1.45, respectively; p = 0.01). CONCLUSION: Relaxed intravitreal aflibercept regimen has comparable efficiency and safety outcomes at 12 months with intensive intravitreal aflibercept regimen with fewer injections in the management of neovascular age-related macular degeneration.

Possible antiapoptotic and neuroprotective effects of magnesium sulphate on retina in a preterm hypoxic-ischemic rat model

Background/aim: The effects of systemic magnesium sulfate (MgSO4) on retina in preterm hypoxic-ischemic (HI) rat model are not known. Our aim was to investigate the effects of MgSO4 on retinal ganglion cell (RGC) count, retinal ganglion cell (RGC) apoptotic index, retinal vascular endothelial growth factor receptor-2 (VEGFR-2), and glial fibrillary acidic protein (GFAP) expressions in preterm HI rat model. Materials and methods: Fifteen, postnatal day (PND) 7 rat pups were divided into 3 groups: 1. Sham-operated group, 2. HI group, and 3. MgSO4-treated HI group. The second and third groups underwent ischemia followed by exposure to hypoxia for 2 h (Vannucci model). The first and second groups received intraperitoneal saline and the third group received intraperitoneal MgSO4. On PND 10, eyes of the pups were evaluated for RGC count, apoptotic index, VEGFR-2, and GFAP expressions. Results: In both HI and MgSO4-treated HI group, the mean total RGC counts were found to be significantly decreased. However, the mean total RGC count in the MgSO4-treated HI group was significantly higher than that of the HI group. The mean apoptotic index was found to be significantly increased in the HI group. Retinal VEGFR-2 and GFAP expressions were found to be significantly higher in the HI group. Conclusions: Magnesium sulfate preconditioning and treatment in preterm HI rat model might diminish apoptosis, relatively preserve RGCs, and reduce retinal VEGFR-2 and GFAP expressions.

Intravitreal Ranibizumab Versus Intravitreal Ranibizumab Combined with Posterior Subtenon Triamcinolone Acetonide in Diabetic Macular Edema.

OBJECTIVES: This is a retrospective, comparative evaluation of the short-term efficacy and safety of intravitreal ranibizumab (IVR) and IVR combined with posterior subtenon triamcinolone acetonide (STA) in the treatment of diabetic macular oedema (DME). METHODS: A total of 79 pseudophakic eyes of 57 patients with DME who underwent IVR injection treatment were examined retrospectively. All of the patients were treatment-naive. In the study group (STA+IVR), consisting of 30 eyes of 39 patients, the STA and IVR were administered in the first treatment session simultaneously, followed by 2 consecutive monthly IVR injections. In the control group (IVR only) comprised 40 eyes of 27 patients, 3 consecutive monthly IVR injections were administered. Patients with serous retinal detachment (SRD) according to optical coherence tomography images were identified in both groups for subgroup analyses. The primary outcome measures were changes in central macular thickness (CMT), best corrected visual acuity (BCVA), and the intraocular pressure (IOP) at 1, 2, and 3 months post-injection. RESULTS: There was no statistically significant difference between the demographic characteristics of the patients' baseline BCVA and CMT measurements (p>0.05). For the IVR group, the mean pre-treatment CMT and BCVA was 421.20±89.10 µm and 0.42±0.24 logMAR, respectively. After the third injection, the mean was 308.12±59.07 µm and 0.20±0.12 logMAR, respectively. The combined treatment group baseline measurements were 454.50±122.52 µm and 0.54±0.29 logMAR, respectively. After the third injection, the mean was 294.22±50.33 µm and 0.27±0.21 logMAR, respectively. The decrease was statistically significant for both groups (p=0.001). Comparison of the CMT within groups revealed a statistically significant difference in favor of the combined group after the second injection (p=0.017). There was no statistically significant difference in the BCVA gains between groups (p>0.05). Patients with SRD were evaluated as a subgroup, and at the first month, the mean gain in CMT was -71.63±57.98 µm in the control group and -123.61±93.46 µm in the study group (p=0.048). The required anti-glaucomatous treatment was statistically significant in the combined group (p=0.008). CONCLUSION: Both treatments provided improvement in BCVA and CMT and can be considered functional and anatomically effective treatment options for DME.

Direct transretinal removal of subfoveal perfluorocarbon liquid combined with internal limiting membrane peeling.

A 65-year-old woman was referred to our institution with a 5-day history of visual impairment in her right eye and macula-off retinal detachment. A successful 23 G pars plana vitrectomy was performed with a 1000 cs silicone oil injection, and the silicone oil tamponade was extracted 2 months later. During the fundoscopic and optical coherence tomography examinations, three subfoveal perfluorocarbon liquid bubbles were detected, and her best corrected visual acuity was limited to 20/400. Brilliant blue staining was used for the internal limiting membrane peeling, and the direct transretinal aspiration of the perfluorocarbon liquid bubbles was performed with a 23 G silicone-tip Flute cannula. This patient's best corrected visual acuity increased to 20/200 at the 1 month follow-up and then to 20/100 at the 1-year follow-up.

An immunohistochemical analysis of the neuroprotective effects of memantine, hyperbaric oxygen therapy, and brimonidine after acute ischemia reperfusion injury.

PURPOSE: This study applies treatment methods to rat retinas subjected to acute ischemia reperfusion injury and compares the efficacy of memantine, hyperbaric oxygen (HBO) therapy, and brimonidine by histopathological examination. METHODS: Thirty adult Wistar albino rats were divided into five groups after retinal ischemia was induced by elevating the intraocular pressure to 120 mmHg. The groups were as follows: group 1: control; group 2: acute retinal ischemia (ARI) model but without treatment group; group 3: memantine (MEM) treatment group; group 4: HBO therapy group; and group 5: brimonidine treatment (BRI) group. In the control group, right eyes were cannulated with a 30-gauge needle and removed without causing any intraocular pressure change. The ARI group was an acute retinal ischemia model, but without treatment. In the MEM group, animals were given a unique dose of intravenous 25 mg/kg memantine by the tail vein route after inducing ARI. In the HBO group, at 2 h following ARI, HBO treatment was applied for nine days. In the BRI group, a 0.15% brimonidine tartrate eye drop treatment was applied twice a day (BID) for seven days before ARI. Twenty-one days after establishing ischemia reperfusion, the right eyes were enucleated after the cardiac gluteraldehyde perfusion method, and then submitted to histological evaluation. RESULTS: On average, the total retinal ganglion cell number was 239.93 ± 8.60 in the control group, 125.14 ± 7.18 in the ARI group, 215.89 ± 8.36 in the MEM group, 208.69 ± 2.05 in the HBO group, and 172.27 ± 8.16 in the BRI group. Mean apoptotic indexes in the groups were 1.1 ± 0.35%, 57.71 ± 0.58%, 23.57 ± 1.73%, 15.63 ± 0.58%, and 29.37 ± 2.55%, respectively. CONCLUSIONS: The present study shows that memantine, HBO, and brimonidine therapies were effective in reducing the damage induced by acute ischemia reperfusion in the rat retina. Our study suggests that these treatments had beneficial effects due to neuroprotection, and therefore may be applied in clinical practice.

[Traumatic orbital emphysema: a case report]. / Bir olgu nedeniyle, travmatik orbital amfizemlere yaklasim.

A 30-year-old male presented with sudden diminution of vision, orbital pain, diplopia, and swelling of the eyelid of the right eye after blowing his nose within three days after a blunt ocular trauma. His best-corrected visual acuities were 6/10 in the right eye and 10/10 in the left eye. Anterior segment and fundus examination were normal bilaterally. Limitation of upward ocular motility was noticed in the right eye. Diplopia was detected in both upward and downward motilities. Intraocular pressures were 21 mmHg in OD and 16 mmHg in OS. Hertel exophthalmometry measurements were 21 mm for the right eye and 19 mm for the left eye. The direct computerized tomography image displayed the inferior orbital wall fracture and orbital emphysema in the right orbit. Prophylactic antibiotherapy was applied. The patient was advised not to blow his nose. He had no complaints on the third day after the trauma. Follow-up examinations showed no ophthalmological complications.

A case of Joubert syndrome with features of ocular neovascularization.

A 12-year-old boy with a diagnosis of Joubert syndrome with bilateral horizontal nystagmus was evaluated. Neovascularization over the iris and the pupillary border was observed on biomicroscopy. There was pigmentary retinal dystrophy in both eyes. Fundus fluorescein angiography revealed ischemic areas and fluorescein leakage due to retinal neovascularization in both eyes.