Comparison of the Effects of Phacoemulsification and Dexamethasone Implantation in the Same Session with Other Phakic Conditions.

Objectives: The objective of the study is to evaluate anatomical and functional results such as best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) in patients who received intravitreal dexamethasone (DEX) implant for diabetic macular edema (DME), and to compare the efficacy according to patients' lens status and concurrent phacoemulsification surgery. Methods: A total of 70 eyes of 55 patients with DME who received intravitreal DEX implantation were included in this retrospective study. Patients who received intravitreal DEX implantation were divided into three groups phaco-DEX (group 1), pseudophakic (group 2), and phakic (group 3). The BCVA, CMT, and IOP changes were compared between the three groups. Results: One month after the intravitreal DEX implant, BCVA improved in all three groups. (p=0.001, p=0.01, and p=0.009, respectively). There was a decrease in CMT at the end of 1st and 4th months in all three groups compared to the preoperative measurements (p=0.005, p<0.001, p<0.001 respectively). While IOP was increased in group 2 and group 3, no IOP increase was observed in group 1. (p=0.41, p=0.01, and p=0.01, respectively). Conclusion: Combining intravitreal DEX implantation with phacoemulsification surgery seems to be an effective and reliable method in patients with DME accompanied by cataract. The IOP elevation in follow-up visits of phakic and pseudophakic patients after intravitreal DEX implantation was not observed in the Phaco-DEX group.

Comparison of Ranibizumab Treatment Response of Superior and Inferior Temporal Branch Retinal Vein Occlusion: A Year Follow-Up.

Objectives: The aim of the study was to compare ranibizumab treatment response of macular edema secondary to superior and inferior temporal branch retinal vein occlusion. Methods: Sixty-four eyes of 64 patients treated with 0.5 mg/0.05 mL ranibizumab due to macular edema secondary to branch retinal vein occlusion were enrolled in this retrospective study. Thirty-eight eyes with superior temporal branch retinal vein occlusion were classified as Group 1 and 26 eyes with inferior temporal branch retinal vein occlusion as Group 2. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of intravitreal injections were evaluated and compared between the groups. Results: The mean baseline, 3rd, 6th, 9th, and 12th month BCVA values in Group 1 were 0.77±0.47, 0.37±0.20, 0.37±0.22, 0.38±0.24, and 0.35±0.18 logarithm of the minimum angle of resolution (logMAR) and in Group 2 were 0.75±0.45, 0.37±0.18, 0.35±0.19, 0.32±0.17, and 0.28±0.20 logMAR, respectively. The mean baseline, 3rd, 6th, 9th, and 12th month CMT values in Group 1 were 522.92±136.01, 318.03±66.65, 287.53±48.27, 271.95±32.47, and 280.47±91.66 µm and in Group 2 were 524.08±145.51, 289.85±53.08, 268.96±31.57, 260.77±30.22, and 244.04±44.78 µm, respectively. BCVA and CMT improved significantly within both groups after the treatment (p<0.05) and there was no statistically significant difference between the groups (p>0.05). However, a significantly higher number of injections was needed for Group 1. Conclusion: Ranibizumab improved the visual and anatomical outcomes similarly in both superior and inferior temporal branch retinal vein occlusion with macular edema. However, more frequent injections were needed to achieve the same efficacy in superior temporal branch retinal vein occlusion.

Change in Accommodation and Ocular Aberrations in Keratoconus Patients Fitted With Scleral Lenses.

PURPOSE: To evaluate the accommodative response to different accommodative stimulus and to determine the changes in ocular higher-order aberrations with accommodation in keratoconus patients fitted with mini scleral lenses. MATERIAL AND METHODS: The study included 15 keratoconus patients wearing mini scleral lenses (Misa Scleral Lens-Microlens, Arnhem, the Netherlands) and 15 keratoconus patients wearing rigid gas permeable lenses. Hartmannn Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France) was used for the evaluation of accommodation. Accommodative responses to the accommodative stimulus ranging from 0.5 to 5.0 diopters (D) with intervals of 0.5 D were recorded. Spherical, coma, trefoil aberration, and root mean square (RMS) of total higher-order aberrations (HOAs, third to sixth orders) at baseline, at 2.5 D stimulus, and at 5 D stimulus were also recorded. RESULTS: Although accommodative response to accommodative stimulus of 0.5 to 2.5 D (with 0.5 D intervals) was similar in both groups, accommodative response to accommodative stimulus of 3.0 to 5.0 D was significantly lower in keratoconus group wearing mini scleral lenses. The coma, spherical, trefoil aberrations, and the RMS of total HOAs at baseline, at 2.5 D stimulus, and at 5 D stimulus were not significantly different between the groups. However, changes in the coma and trefoil aberrations and RMS of total HOA with 2.5 D and 5.0 D stimulus were significant only in the RGP group. CONCLUSIONS: Accommodative response to increasing accommodative stimulus was found to be impaired in keratoconus patients wearing mini scleral lenses.

Comparison of intra- and postoperative complications of phaco between sequential and combined procedures of 23-gauge vitrectomy and phaco.

PURPOSE: To evaluate the intra- and postoperative complications of phacoemulsification in sequential and combined procedures of 23-gauge vitrectomy and cataract surgery. METHODS: The medical records of 376 patients who underwent phacoemulsification in a vitrectomized eye (sequential group) and 458 patients who underwent combined vitrectomy and phacoemulsification (combined group) were retrospectively reviewed. Main outcome measures were intra- and postoperative complications of phacoemulsification surgery. Surgical indications were a progressed cataract with various retinal conditions. RESULTS: The most common intraoperative complication during phacoemulsification was posterior capsule rupture in both groups. The rate of this complication was higher in the sequential group (18 eyes, 4.8%) than in the combined group (7 eyes, 1.5%) (p = 0.006). The most common early postoperative complication was transient high intraocular pressure (68 eyes, 14.8%) and late postoperative complication was pupillary in the synechia combined group (82 eyes, 17.9%). The most common early postoperative complication was transient high intraocular pressure (29 eyes, 7.7%) and late postoperative complication was posterior capsule opacification (27 eyes, 7.2%) in the sequential group. Fibrinous exudation occurred more in the combined group (57 eyes, 12.4%) than in the sequential group (19 eyes, 5.1%) (p = 0.000). CONCLUSION: Both sequential and combined cataract surgeries seemed to be safe. Combined surgery could be preferred in harder cataracts and zonular dehiscence.

Influence of the epiretinal membrane on ranibizumab therapy outcomes in patients with diabetic macular edema / Influência da membrana epirretiniana sobre os resultados da terapia de ranibizumab em edema macular diabético

ABSTRACT Purpose: To investigate the influence of the epiretinal membrane (ERM) on intravitreal ranibizumab (IVR) therapy for diabetic macular edema (DME). Methods: This retrospective study included 56 eyes of 48 patients with DME divided into two groups: the DME with ERM (study) and only DME (control) groups. Changes in the central macular thickness (CMT) and best-corrected visual acuity (BCVA) were evaluated. Results: In the study group, although the CMT was significantly reduced following the first injection (p<0.001), BCVA did not improve significantly (p=0.296). However, after the first injection, the control group exhibited both a significant decrease in CMT (p<0.001) and improvement in BCVA (p<0.001). However, the improvement in BCVA in the control group was not significantly different from the outcome of the study group. Conclusions: We observed a negative short-term influence of the ERM on IVR treatment for DME.

RESUMO Objetivo: Investigar a influência da membrana epirretiniana (ERM) na terapia intravítrea com ranibizumab (IVR) para o edema macular diabético (DME). Métodos: Este estudo retrospectivo consistiu de 56 olhos de 48 pacientes com DME que foram divididos em dois grupos: o grupo DME com ERM (estudo) e o grupo só DME (controle). Foram avaliadas alterações na espessura central de macular (CMT) e melhor acuidade visual corrigida (BCVA). Resultados: No grupo de estudo, embora a CMT tenha sido significativamente reduzida após a 1ª injeção (p<0,001), a acuidade visual não melhorou significativamente (p=0,296). Após a 1ª injeção, o grupo controle apresentou diminuição significativa no CMT (p<0,001) e melhora na acuidade visual (p<0,001). No grupo controle, embora a mudança de CMT tenha sido significativa (p<0,001), a melhora da acuidade visual não foi significativa quando comparada com o grupo de estudo. Conclusões: No curto prazo, observou-se uma influência negativa da ERM sobre o IVR em DME.

Retinal Nerve Fiber Layer Thickness Changes in Age-Related Macular Degeneration Treated with Multiple Intravitreal Ranibizumab.

PURPOSE: The objective of this study was to investigate the effect of multiple intravitreal ranibizumab (IVR) injections on the retinal nerve fiber layer (RNFL) in neovascular age-related macular degeneration (nAMD). METHODS: One hundred sixty-eight eyes of 168 patients with nAMD who received an IVR at least 3 times were included in this prospective interventional case series. The RNFL thickness data on 80 healthy eyes, used as the control group, were obtained. The patients were grouped as follows: 3-10 injections (group 1, 62 eyes, 37%), 10-20 injections (group 2, 62 eyes, 37%), and ≥20 injections (group 3, 44 eyes, 26%). The RNFL thickness was measured by spectral domain optical coherence tomography. RESULTS: The mean baseline measurement of the RNFL thickness was 97.4 ± 6.4 µm in the control group, 96.4 ± 5.6 µm in group 1, 93.8 ± 4.6 µm in group 2, and 93.2 ± 5.3 µm in group 3. At the last follow-up, it was 95.1 ± 2.4 µm in the control group, 93.4 ± 7.3 µm in group 1, 90.5 ± 3.6 µm in group 2, and 89.2 ± 4.9 µm in group 3 (all P values >0.050). A statistically significant difference was not found between the mean total RNFL thickness of the eyes that received injections and that of the eyes in the healthy control group (P value >0.050). A statistically significant difference was not found in all the treatment groups between the intraocular pressure level taken 1 day after the administration of the injections and that recorded preintervention (all P values >0.050). CONCLUSION: Repeated IVR did not lead to a significant change in RNFL thickness in patients with nAMD.

In vivo biometric evaluation of Schlemm's canal with spectral-domain optical coherence tomography in pseuduexfoliation glaucoma.

PURPOSE: To perform in vivo imaging of the Schlemm's canal (SC) with anterior segment spectral-domain optical coherence tomography [AS-spectral-domain (SD)-OCT] and also to measure its biometric parameters including the SC length and SC area in patients with pseudoexfoliation (PEX) glaucoma. METHODS: Forty-one consecutive patients with PEX glaucoma and 41 age- and sex-matched normal subjects were enrolled. All subjects underwent imaging with SD-OCT. The SC length and SC area were examined in the temporal sections and measured with customized software. RESULTS: The percentages of the temporal sections in which SC was observable were similar between the two groups. Mean SC length was found significantly shorter, and mean SC area was found significantly smaller in patients with PEX glaucoma than in controls (p = 0.044 and p = 0.036, respectively). Mean intra-ocular pressure (IOP) values were also similar between two groups. No significant correlations were found between SC measurements and IOP. CONCLUSIONS: Anterior segment spectral-domain optical coherence tomography offers non-invasive, in vivo measurement of the SC, and it could be used for investigating the SC changes in patients with PEX glaucoma.

Combined Intravitreal Ranibizumab and Sub-Tenon Injection of Triamcinolone for the Treatment of Diabetic Macular Edema with Retinal Detachment.

PURPOSE: To evaluate the efficacy of intravitreal ranibizumab (IVR) combined with posterior sub-Tenon injection of triamcinolone acetonide (STTA) for treatment of diabetic macular edema (DME) with serous retinal detachment (SRD). METHODS: Eighty-five eyes of 65 patients with DME and SRD were enrolled in this retrospective study. Fifty-eight eyes were treated with IVR and STTA (combined group), whereas 27 eyes were treated with pro re nata (PRN) IVR (control group). The combined group patients received a single and the control group patients received mean 1.29 ± 0.46 injections and followed for 3 months. The primary outcome measures were change in central macular thickness (CMT) and best corrected visual acuity (BCVA). The secondary outcome measure was the complication rate. RESULTS: In the combined group, mean initial CMT was 543.9 ± 133.5 µm. Macular thickness was significantly reduced both after 1 month (334 ± 88 µm; P < 0.001) and after 3 months (387.6 ± 131.9 µm; P < 0.001) of treatment. At the 3-month follow-up, BCVA improved in 37.2% of the eyes. Complications were drug reflux at the time of STTA injection, elevation of intraocular pressure, and migration of hard exudates to the fovea. The decrease in CMT was statistically significant in the combined group in the first month, but not in the third month compared with the control group. The improvement in BCVA was not statistically significant between the 2 groups both after the first and third months. SRD disappeared with a higher rate with the combined therapy in the first month. CONCLUSION: IVR and STTA seem to be effective in improving BCVA in DME with SRD.

Influence of the epiretinal membrane on ranibizumab therapy outcomes in patients with diabetic macular edema.

PURPOSE:: To investigate the influence of the epiretinal membrane (ERM) on intravitreal ranibizumab (IVR) therapy for diabetic macular edema (DME). METHODS:: This retrospective study included 56 eyes of 48 patients with DME divided into two groups: the DME with ERM (study) and only DME (control) groups. Changes in the central macular thickness (CMT) and best-corrected visual acuity (BCVA) were evaluated. RESULTS:: In the study group, although the CMT was significantly reduced following the first injection (p<0.001), BCVA did not improve significantly (p=0.296). However, after the first injection, the control group exhibited both a significant decrease in CMT (p<0.001) and improvement in BCVA (p<0.001). However, the improvement in BCVA in the control group was not significantly different from the outcome of the study group. CONCLUSIONS:: We observed a negative short-term influence of the ERM on IVR treatment for DME.