The effect of topical diclofenac on choroidal blood flow in early postoperative pseudophakias with regard to cystoid macular edema formation.

PURPOSE: To study the chronological change in choroidal blood flow (ChBFlow), disruption of the blood-aqueous barrier, and incidence of cystoid macular edema (CME) in early postoperative pseudophakic eyes, as well as the effect of nonsteroidal anti-inflammatory drug (NSAID) eye drops on these phenomena. METHODS: Fifty patients who underwent phacoemulsification and foldable intraocular lens (IOL) implantation were randomized to receive either topical diclofenac or fluorometholone for 5 postoperative weeks. An additional 20 subjects, with long-standing pseudophakia served as the control. The blood-aqueous barrier was examined by laser flarimetry and choroidal blood velocity (ChBVel), volume (ChBVol), and ChBFlow by laser Doppler flowmetry (LDF) at 2 days and 1, 2, and 5 weeks after surgery. The incidence and severity of CME were evaluated by fluorescein angiography at 2 and 5 weeks after surgery. RESULTS: Compared with patients taking diclofenac, those receiving fluorometholone showed significantly reduced ChBVol at 2 weeks (0.38 +/- 0.08 vs. 0.32 +/- 0.07, P = 0.022) and ChBFlow at 1 (11.01 +/- 1.74 vs. 9.35 +/- 1.51, P = 0.003) and 2 (11.15 +/- 1.43 vs. 8.47 +/- 1.27, P = 0.000) weeks after surgery, as well as a significantly elevated amount of anterior flare at 1 (8.9 +/- 2.2 vs. 24.4 +/- 18.9, P = 0.001) and 2 (9.2 +/- 3.5 vs. 16.7 +/- 12.3, P = 0.025) weeks after surgery. The ChBVol and ChBFlow in the fluorometholone group, however, returned to normal and was not different from the diclofenac group at 5 weeks after surgery. The incidence of fluorescein angiographic CME trended to be higher (P = 0.08) at 2 weeks and was significantly higher (P = 0.001) at 5 weeks after surgery in eyes with fluoromethalone than with diclofenac. CONCLUSIONS: Reduction of ChBFlow, disruption of the blood-aqueous barrier, and incidence of CME in early postsurgical pseudophakic eyes were more effectively prevented chronologically in eyes treated with diclofenac than in those treated with fluorometholone.

Relationship between blood-aqueous barrier disruption and ischemic macular edema in patients with branch or central retinal vein occlusion: effects of sub-tenon triamcinolone acetonide injection.

PURPOSE: The aim of this study was to study the effects of the sub-Tenon triamcinolone acetonide (STA) injection on ischemic cystoid macular edema (CME) or macular edema (ME) and blood-aqueous barrier (BAB) disruption associated with branch or central retinal vein occlusion (BRVO or CRVO). METHODS: Prior to, and 1, 2, 3, and 4 months after, STA injection, central retinal thickness was measured by using optical coherence tomography and the amount of aqueous flare by using laser flare metry. RESULTS: In the BRVO group treated by STA, the amount of flare was significantly less at 1, 2, and 3 months after injection than in the untreated BRVO group (P < 0.05). In the CRVO group treated by STA, the amount was significantly less at 1 month after injection than in the untreated CRVO group (P < 0.05). In the BRVO group with STA treatment, central retinal thickness was significantly less at 1 and 2 months after the treatment than in the untreated BRVO group (P < 0.05). In the CRVO group with STA treatment, the thickness was significantly less at 1 month after treatment than in the untreated CRVO group (P < 0.05). A correlation test revealed the amount of aqueous flare and the central retinal thickness to be well correlated (P < 0.01). CONCLUSIONS: The effects of STA and its time course on CME or ME correlated well with those on BAB disruption. Since there is the close correlation between the BAB and blood-retinal barrier function, the effects of medical treatment on ME associated with BRVO or CRVO can be evaluated by means of the BAB function.

Dynamic aniseikonia measurement: prismatic effect appears on the hess chart.

PURPOSE: To determine if aniseikonia appears on the Hess [Screen] Chart and if it can be measured thereby; and to compare such measurement to the standard Awaya New Aniseikonia Test in both artificial and pathologic aniseikonia. SUBJECTS AND METHODS: Twenty normal subjects with 20% artificial induced aniseikonia (Group 1) and 21 patients with pathologic aniseikonia (Group 2) were examined with the New Aniseikonia Test (NAT) and the Hess Chart. Group 2 was divided into three subgroups: Group 2-1, 13 patients with aphakia, whose operated eyes were more hypermetropic that their better eyes; Group 2-2, 3 patients with myopic anisometropia more than 5 diopters; and Group 2-3, 5 patients who had received macular translocation surgery (MTS). RESULTS: In normals, measurement of the 20% artificial aniseikonia ranged from 10% to 21% (mean 15%) using the NAT, and from 16% to 39% (mean 27.1% vertically and 24.6% horizontally) using the Hess Chart. In the 21 patients with pathologic aniseikonia, the NAT measurements ranged from 0% to 24% (upper limit of the NAT) and the Hess Chart measurements ranged from 0% to 65%. A large amount of the aniseikonia that appeared on the Hess Chart disappeared or was significantly reduced by changing the spectacle correction to a contact lens or intraocular lens. CONCLUSION: The aniseikonia that appeared on the Hess Chart was dynamic aniseikonia, due to rotational magnification inherent and unavoidable in the execution of the aniseikonia measurement on the Hess Chart. Aniseikonia, not due to refractive errors brought on by retinal surgery such as MTS, is difficult to correct with iseikonic lenses or other optical means.

ESCRS Binkhorst lecture 2002: Pseudophakic preservative maculopathy.

Many antiglaucoma eyedrops are reported to cause cystoid macular edema (CME) in aphakia and pseudophakia. We review 4 clinical and laboratory studies that compare the incidence of CME in early postoperative pseudophakia in eyes that received preserved latanoprost and timolol, nonpreserved timolol, and the preserved and nonpreserved vehicle for these drugs and looked at the morphological damage to cells and the changes in the indicators of cytokine and prostaglandin (PG) synthesis caused by latanoprost and timolol and the preservative benzalkonium chloride. Based on the findings of these studies, which indicate that the preservative causes increased synthesis of PGs and other substances and intensified postoperative inflammation, the term pseudophakic preservative maculopathy is proposed for CME caused by antiglaucoma eyedrops.

Localized liquefied after-cataract.

We report 2 cases with a new type of after-cataract. In both, a milky white substance accumulated in a semicircular, closed chamber formed by the intraocular lens optic and the posterior lens capsule. Unlike in previous reports, the closed chamber did not cover the entire capsule but was based on residual lens remnants in the equatorial region of the lens capsule.