Neuroprotection with rasagiline in patients with macula-off retinal detachment: A randomized controlled pilot study.

We aimed to evaluate the neuroprotective efficacy of rasagiline in pseudophakic patients who had surgery for macula-off rhegmatogenous retinal detachment (RRD). This was a 6-month, prospective, randomized, double-blind, placebo-controlled pilot study. Patients presenting with acute macula-off RRD were recruited and randomized 1:1 to receive rasagiline 1 mg/day or placebo for 7 days. Best-corrected visual acuity (BCVA) and optical coherence tomography were acquired 1 day before as well as 2 days, 3 weeks, 3 months and 6 months after surgery. We screened 26 patients with RRD whereof 23 were eventually included and randomized. The primary outcome was final BCVA. Secondary outcomes included central retinal thickness (CRT) and adverse events (AE). We evaluated photoreceptor cells (prc) recovery through morphological measurements. The baseline characteristics were comparable between groups. BCVA significantly improved in both groups (letters gained: rasagiline 61.5 ± 18.1 vs placebo 55.3 ± 29.2, p = 0.56), but no significant inter-group difference was found at any visit. CRT was stable 3 weeks after surgery onwards, with no inter-group difference. No treatment-emergent AE occurred. Significant prc restoration was observed from 3 weeks to 6 months after surgery, without inter-group difference at either visit. Ellipsoid zone integrity (ß = 0.517, p = 0.008) and foveal bulge (ß = 0.387, p = 0.038) were significant predictors of good final BCVA. In conclusion, perioperative oral treatment with rasagiline 1 mg/day for 7 days did not show significant benefits on visual or anatomical outcomes in macula-off RRD patients.

The ocular pulse amplitude at different intraocular pressure: a prospective study.

PURPOSE: To investigate changes in ocular pulse amplitude (OPA) during a short-term increase in intraocular pressure (IOP) and to assess possible influences of biometrical properties of the eye, including central corneal thickness (CCT) and axial length. METHODS: In a prospective, single centre study, OPA and IOP as measured by dynamic contour tonometry (DCT) were taken before baseline- and post-OPA (delta) intravitreal injection of 0.05 ml anti-vascular endothelial growth factor agents. Analysis was performed employing linear regression with baseline- and post (delta)-OPA differences as the dependent and post-IOP as well as delta IOP as the independent variable. A multilinear regression analysis with delta OPA as the dependent variable and baseline IOP, post-IOP, CCT and axial length as independent variables was conducted. RESULTS: Forty eyes of 40 patients were included. IOP and OPA increased significantly after injection (IOP mean increase ± SD: 17.83 ± 9.83 mmHg, p < 0.001; OPA mean increase ± SD: 1.39 ± 1.16 mmHg, p < 0.001). For every mmHg increase in IOP, the OPA showed a linear increase of 0.05 mmHg (slope 0.05, 95% CI: 0.02-0.09, p = 0.003, r(2) = 0.20). Multiple regression analysis with delta OPA as the dependent variable revealed a partial correlation coefficient of 0.47 (p = 0.003) for post-IOP as the only significant contribution. CONCLUSION: A clear positive relationship between OPA measurements and IOP levels was shown in a clinical routine setting using DCT focusing on baseline and postinterventional comparisons of OPA values after intravitreal injections in patients with exudative age related macular degeneration. When considering the OPA for diagnostic purposes, we recommend indication of corresponding IOP values.

Tunnelled versus straight intravitreal injection: intraocular pressure changes, vitreous reflux, and patient discomfort.

PURPOSE: To compare tunnelled scleral intravitreal injection with straight scleral intravitreal injection concerning short-term intraocular pressure (IOP) changes, occurrence and amount of vitreous reflux, and patient discomfort. METHODS: Sixty patients were randomly allocated to two groups (tunnelled intravitreal injection and straight intravitreal injection). IOP was measured before and directly (<1 minute) after the injection of 0.05 mL of an antivascular endothelial growth factor agent and then every 5 minutes until IOP was <30 mmHg. Occurrence and amount of vitreous reflux were recorded. Patient discomfort during injection was assessed with a Wong-Baker faces pain rating scale. RESULTS: IOP (mmHg +/- SD) increased significantly directly after injection to 35.97 +/- 8.13 (tunnelled intravitreal injection) and 30.19 +/- 12.14 (straight intravitreal injection). These pressure spikes differed significantly between both groups (P = 0.01, mean difference: -7.11). Five minutes after injection, there was no significant difference in IOP increase between the groups. All IOP measurements were <30 mmHg after 15 minutes. Occurrence and amount of vitreous reflux were significantly higher with straight intravitreal injection. There was no significant difference in Wong-Baker faces pain rating scale score between both groups. CONCLUSION: Tunnelled intravitreal injection seems to be the technique of choice for low-volume intravitreal injection (0.05 mL). There is neither a difference in patient discomfort nor a difference in IOP increase 5 minutes after injection between both groups. Significantly less vitreous reflux with tunnelled intravitreal injection should lead to less postinjectional drug loss.