Aflibercept vs. dexamethasone implant for recalcitrant diabetic macular edema in pseudophakic eyes - 1-year outcomes from a quazi-randomized study in India.

PURPOSE: To assess the safety and efficacy of intravitreal Aflibercept (IVA) versus dexamethasone (DEX) implant for treating recalcitrant diabetic macular edema (DME) in pseudophakic eyes at 1-year follow-up. DESIGN: Retrospective comparative case series. PARTICIPANTS: Data of all patients diagnosed with DME between January 2019 and December 2021, who underwent 4-monthly doses of intravitreal ranibizumab but had persistent DME [central macular thickness (CMT) within 10% of baseline value] were extracted from a computerized database. Of these, only pseudophakic eyes that underwent either IVA or DEX implant and had at least 1-year follow-up were included for analysis. METHODS: DEX implant was preferred before December 2020 and IVA after this time point. In the IVA group, patients were followed up every month while DEX were followed at least every 3 months. Reinjections were considered when vision dropped by at least 1 Snellen's line or CMT increased by at least 10% from the previous visit in both groups. MAIN OUTCOME MEASURES: Comparison of change in vision and CMT at 1-year follow-up in DEX versus IVA groups. RESULTS: Eighty-four eyes of 84 patients aged 54.4 + 4.4 years were included, 39 (46%) received DEX and 45 (54%) received IVA. Groups were comparable for baseline vision and CMT. Vision improved equally in both groups from 0.83 + 0.15 logMAR to 0.52 + 0.10 logMAR at 3 months ( P < 0.01) and then stabilized till 1 year. However, eyes in the IVA group were 6.5 times more likely (Odds ratio = 6.45, 95% CI = 1.3 - 31.9) to achieve >3-line improvement in vision. The CMT reduction was also comparable between groups (-169 + 51 in DEX vs. -174 + 49 in IVA, P = 0.67). More eyes in the IVA group required >3 injections (91% vs. 69% in DEX, P = 0.01). The IOP was significantly higher at 6 and 9 months in the DEX group and 5 eyes (13%) required IOP lowering medications. CONCLUSION: In pseudophakic eyes with recalcitrant DME not responding to ranibizumab, switching to IVA or DEX implant results in equal visual improvement and CMT reduction. Though >3-line improvement occurs more frequently with IVA, this comes at the expense of a greater number of injections and follow-up visits.

Topical bromfenac reduces multiple inflammatory cytokines in the aqueous humour of pseudophakic patients.

Intraocular surgery is associated with increased ocular inflammation. If maintained for a prolonged period after surgery, this inflammation can cause various complications, including subconjunctival fibrosis and bleb scarring. This clinical trial was a prospective, randomised, single-blind, interventional study comparing the efficacy and safety of 0.1% bromfenac sodium ophthalmic solution and 0.02% fluorometholone ophthalmic suspension in the inhibition of multiple inflammatory cytokines in the aqueous humour of 26 patients with pseudophakic eyes who had undergone phacoemulsification and intraocular lens implantation. The patients were randomly assigned to one of the trial drugs, and aqueous humour samples were collected before and after drug administration. Platelet-derived growth factor-AA levels significantly decreased in both drug groups, but they were significantly higher in the fluorometholone group than in the bromfenac group (P = 0.034). Bromfenac also significantly decreased vascular endothelial growth factor level (P = 0.0077), as well as monocyte chemoattractant protein-1 level (P = 0.013), which was elevated for a prolonged period after phacoemulsification. These data suggest that bromfenac is useful to alleviate prolonged microenvironmental alterations in the aqueous humour of pseudophakic eyes.

Treatment of cytomegalovirus anterior segment infection with intravitreal injection of ganciclovir in adjunction with or without oral valganciclovir: a long-term results.

We evaluated the therapeutic outcome of intravitreal injection (IVI) of ganciclovir with/without oral valganciclovir for cytomegalovirus (CMV) anterior segment infection. We enrolled 61 patients (61 eyes) with PCR-proven CMV anterior segment infection. IVI of ganciclovir (2 mg/0.05 mL) was given as a loading dose; subsequent use of oral valganciclovir (900 mg twice daily) was determined according to the severity of anterior chamber inflammation after injection. All eyes had IVI of ganciclovir, and 53 patients received oral valganciclovir as adjunctive therapy with a mean duration of 1.9 months to achieve disease remission. Repeated diagnostic aqueous taps were performed in 37 eyes with suspected recurrence, and CMV DNA was positive in 24 eyes. This therapeutic strategy afforded a median 50% recurrence-free survival time of 47.0 ± 8.12 months. The patients' mean best corrected visual acuity, intraocular pressure and corneal endothelial cell counts stabilized or improved. Corneal transplantation before CMV infection diagnosis was identified as an independent risk factor for recurrence (hazard ratio 6.81, 95% confidence interval 1.21-38.23, P = 0.029). In patients with CMV anterior segment infection, the relative short-term therapeutic strategy, IVI of ganciclovir in adjunction with/without oral valganciclovir, effectively achieved a median recurrence-free survival time of nearly 4 years.

Efficacy and Safety of Combined Vitrectomy with Intravitreal Dexamethasone Implant for Advanced Stage Epiretinal Membrane.

PURPOSE: To evaluate the efficacy and safety of combined 25-gauge (G) pars plana vitrectomy (PPV) with intravitreal dexamethasone implant (DXI) for the treatment of advanced stage epiretinal membrane (ERM). METHODS: Forty consecutive pseudophakic eyes with idiopathic stage 3-4 ERM and intraretinal cysts were randomly assigned to two treatment groups. Twenty eyes underwent combined 25-G PPV, ERM peeling and slow-release DXI (DEX group), whereas 20 eyes underwent standard 25-G PPV with ERM peeling only (control group). Differences in postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT) were evaluated. RESULTS: In all patients, BCVA significantly increased at 1, 3 and 6 months after surgery compared to baseline (all p < 0.05), but at 3 and 6 months, the visual gain was higher in the DEX group (respectively, p = 0.036, p = 0.006). CMT was significantly lower in DEX group compared to control group at 3 and 6 months after surgery (respectively, p = 0.042, p = 0.003). There was no statistically significant difference in IOP change over the course of the follow-up between groups (p > 0.05). CONCLUSION: Combined 25-G PPV with DXI is associated with better anatomical and functional outcomes in patients with advanced stage ERM.

Vitreous hyper-reflective dots in pseudophakic cystoid macular edema assessed with optical coherence tomography.

PURPOSE: This study compares the presence of vitreous hyper-reflective dots (VHDs) detected with optical coherence tomography (OCT) between eyes with pseudophakic cystoid macular edema (CME) and those with no CME after cataract surgery. In addition, we evaluated the impact of VHDs on the responsiveness of pseudophakic CME to cortisone treatment. SETTING: Department of Ophthalmology, Medical University of Graz, Austria. DESIGN: Retrospective, monocenter case-controlled study. METHODS: Inclusion criteria for the study group and the control group were CME and no CME within 12 weeks following uneventful phacoemulsification in otherwise healthy eyes, respectively. VHDs (number and size) and the macular thickness were assessed with OCT. Furthermore, the number of peribulbar or intravitreal steroid injections was assessed. RESULTS: A total of 284 eyes from 267 patients were analyzed, among which 119 met the inclusion criteria for the study (n = 63) and the control group (n = 56). VHDs were observed in 54 (85.7%) study eyes and 21 (37.5%, p = 0.013) control eyes. The number of VHDs was 3.9±3.4 in the study group and 0.7±1 in the control group (p<0.001). The size of the VHDs was 33.5±9.1 µm and 36.6±17.9 µm in the study and control groups, respectively (p = 0.978). Overall, the number of VHDs correlated with central subfield thickness (r = 0.584, p<0.001), cube volume (r = 0.525, p<0.001), and postoperative best-corrected visual acuity (BCVA) (r = -0.563, p<0.001). The number of VHDs did not correlate with the frequency of peribulbar or intravitreal steroid injections. CONCLUSION: VHDs occurred more often in eyes with CME than in eyes without CME following cataract surgery. In addition, the number of VHDs had an impact on the extent of macular thickening and subsequently postoperative BCVA. No correlation was found between the number of VHDs and the frequency of required peribulbar or intravitreal steroid injections.

Comparison of Subtenon Triamcinolone Acetonide Injection with Topical Nepafenac for the Treatment of Pseudophakic Cystoid Macular Edema.

PURPOSE: To compare the efficacy and safety of subtenon triamcinolone acetonide (TA) injection with topical nepafenac 0.1% for the treatment of pseudophakic cystoid macular edema (CME). METHODS: In this prospective study, the TA group comprised 24 eyes and the nepafenac group 24 eyes. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure measurements, and slit-lamp fundoscopy were performed in all subjects at baseline, 1, 2, 3, and 6 months. RESULTS: Changes in BCVA and CRT over four follow-up visits were statistically significant (p<0.001). The mean CRT decreased from 513.3 to 318.9 µm in the TA group and from 483.7 to 278.0 µm in the nepafenac group. This reduction was statistically significant (p<0.001 for both groups). CONCLUSIONS: Our visual and OCT results suggest that both treatment modalities are effective with few side-effects. However, nepafenac is more efficacious than subtenon TA in terms of visual gain and its correlation with the reduction in CRT.

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine-Gass syndrome: a prospective case series.

PurposeTo determine the preliminary efficacy and safety of off-label dexamethasone implant for treatment of recurrent cystoid macular edema (CME) secondary to Irvine-Gass syndrome (IGS).Patients and methodsThis study was set in Raghudeep Eye Clinic, Ahmedabad and LV Prasad Eye Institute, Hyderabad (India). It is a Prospective Case Series. Prospective case series comprising of patients with uncomplicated pseudophakia and CME due to IGS who recurred after one course of topical steroids with NSAIDS and a sub-Tenon corticosteroid injection. A complete ocular and systemic exam, fluorescein angiography, and central subfield thickness (CST) on optical coherence tomography scans were performed. Follow-up visits were on days 1, 15, and 30 and then monthly for a year. Appropriate statistical analysis was done. The primary outcome measure was the change in CDVA at months 1, 6, and 12. Secondary outcome measures were recurrence of CME and complications if any as noted at months 1, 2, 6, and 12.ResultsAbout 27 patients (27 eyes) with 16 males were included. Median age: 63.24±5.62 years. At 1 month, the CDVA improved to 0.04±0.02 (20/25) logMAR from 0.52±0.12 logMAR (20/70) (P=0.001) with a reduction in CST from 454.2±45.3 to 218.32±38.15 microns(P=0.013). The CDVA was 0.04±0.03 logMAR(P<0.001) at month 6 and 0.05±0.02 logMAR(P<0.001) at month 12. The CST was 221±35.2 microns (P=0.013) at month 6 and 214±43.34 microns (P=0.0124) at month 12. All improvements were maintained for a year. Only one patient required a second injection. No complications were noted.ConclusionThe implant is safe and effective for the treatment of recurrent CME due to IGS.

Dexamethasone 0.7 mg implants in the management of pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images.

Dexamethasone 0. 7 mg implants in the management of pseudophakic cystoid macular edema / Implante de 0, 7 mg de dexametasona no tratamento do edema macular cistóide do pseudofácico

ABSTRACT Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images.

RESUMO O edema macular cistóide do pseudofácico (PCME) é uma frequente complicação no acompanhamento pós-operatório da cirurgia de catarata. Embora a maioria dos pacientes apresente-se sem sintomas, PCME ainda permanece como importante causa de baixa visão após facectomia. Sua patogênese ainda permanece obscura, porém, autores sugerem que fatores que promovem maior inflamação possuem papel fundamental em sua origem. Não há um algoritmo padrão no manejo do PCME. O implante biodegradável de dexametasona 0,7 mg surgiu como possível arma terapêutica, após aplicação intra-vítrea. Essa droga consegue agir sobre mediadores inflamatórios, além de já ter sido aprovada no tratamento do edema de macula secundário à oclusões venosas da retina, e uveítes posteriores de origem não infecciosa. Na seguinte série de casos, relatamos a evolução de 6 pacientes com PCME, submetidos a terapia com implante de dexametasona 0,7 mg. A melhora anatômica foi documentada com imagens de SD OCT.

Longitudinal analysis of the structural pattern of pseudophakic cystoid macular edema using multimodal imaging.

PURPOSE: To describe the relationship between pseudophakic cystoid macular edema (CME) progression and retinal structural changes observed by spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography. METHODS: Retrospective, consecutive, longitudinal imaging analysis of patients with acute pseudophakic cystoid macular edema. Two observers at two study centers evaluated all images and categorized the macular structural features based on the retinal layer involved with cystic changes and/or subretinal fluid. A time series of the structural pattern and visual acuity was constructed for 1-month intervals over a 6-month study period. RESULTS: Thirty nine patients presented with CME. The mean time since cataract extraction was 48 ±38 days (range 5-71). CME included inner nuclear layer (INL) cystic changes, outer plexiform layer (OPL) cystic changes, and subretinal fluid. Isolated INL changes were observed in four phakic fellow eyes. Isolated OPL morphology was not observed, and additional inner layers remained uninvolved. Resolution occurred rapidly following administration of periocular glucocorticoids, and typically demonstrated a reverse structural pattern or delayed subretinal fluid resolution. Isolated subretinal fluid or a combined INL and subretinal fluid structure indicated CME resolution. CONCLUSION: Acute and recurrent pseudophakic CME involves a directional progression of the retinal layer involved with cystic changes and a clinical course. CME begins with INL cystic changes, progresses to combined INL and OPL morphology, and may continue to involve subretinal fluid. The inner nuclear layer is the most frequently involved layer, and isolated INL cysts may occur in phakic fellow eyes. A three-layer structure, the presence of OPL morphology, or isolated INL early in the postoperative period indicates disease activity.

Estudio de la eficacia del implante intravítreo de dexametasona en el edema macular pseudofáquico. Resultados preliminares / Study of the effect of intravitreal dexamethasone implant in pseudophakic macular edema. Preliminary

OBJETIVO: Estudiar la eficacia del implante intravítreo de dexametasona (Ozurdex) en el tratamiento del edema macular (EMQ) pseudofáquico. MATERIAL Y MÉTODOS: Se ha realizado un estudio descriptivo observacional retrospectivo de un periodo de un año de duración (desde el 1 de enero de 2013 hasta el 31 de diciembre del 2013) sobre todos aquellos pacientes con EMQ pseudofáquico tratados con dexametasona intravítrea en el Hospital Universitario de La Ribera. Las variables a estudio son la agudeza visual (AV), el espesor macular y el tiempo de duración del efecto del tratamiento. RESULTADOS: Los resultados preliminares obtenidos muestran una disminución del espesor macular de 83,75 μ de media, comparando la media de los valores previos al tratamiento (414 μ) y los de un mes tras el tratamiento (330,25 μ). La AV aumentó, con una AV media pretratamiento de 0,3 mientras que la AV media al mes y a los 3 meses de tratamiento fue de 0,575. La media de la duración del efecto fue de 3,5 meses. CONCLUSIONES: El implante intravítreo de dexametasona (Ozurdex) es un posible tratamiento para el síndrome de Irvine-Gass, dado que reduce el espesor macular y mejora la AV de estos pacientes

OBJECTIVE: To evaluate the efficacy of intravitreal dexamethasone implant on the treatment of pseudophakic macular edema (PME). MATERIAL AND METHODS: A retrospective, observational, descriptive study was conducted on 4 patients who received an intravitreal injection of dexamethasone implant due to PME in the period from 1st January 2013 to 31st December 2013 in the Hospital Universitario de La Ribera (Alzira, Valencia, Spain). A complete ophthalmic examination was performed on these patients. Best-corrected visual acuity (BCVA), macular thickness), and duration of the effect of the treatment were studied. RESULTS: At baseline, the mean MT was 414 μm. After dexamethasone implant, mean values of MT decreased to 330.25 μm at month one. The mean change from baseline MT was 83.75 μm. The baseline mean BCVA was 0.3 and improved to 0.575 at month one and 3. The mean duration of the effect of the treatment was 3.5 months. CONCLUSIONS: Intravitreal dexamethasone implant is a possible treatment for Irvine-Gass syndrome as it improved visual acuity and reduced the macular thickness of these patients

Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants.

PURPOSE: Diabetic macular oedema (DMO) is a leading cause of blindness in working-age adults. Slow-release, nonbioerodible fluocinolone acetonide (FAc) implants have shown efficacy in the treatment of DMO; however, the National Institute for Health and Care Excellence recommends that FAc should be used in patients with chronic DMO considered insufficiently responsive to other available therapies only if the eye to be treated is pseudophakic. The goal of this analysis was to examine treatment outcomes in phakic patients who received 0.2 µg/day FAc implant. METHODS: This analysis of the phase 3 FAME (Fluocinolone Acetonide in Diabetic Macular Edema) data examines the safety and efficacy of FAc implants in patients who underwent cataract extraction before (cataract before implant (CBI) group) or after (cataract after implant (CAI) group) receiving the implant. The data were further examined by DMO duration. RESULTS: Best corrected visual acuity (BCVA) after 36 months was comparable in the CAI and CBI groups. Both the percentage of patients gaining ≥ 3 lines of vision and mean change in BCVA letter score were numerically greater in the CAI group. In addition, most patients who underwent cataract surgery experienced a net gain in BCVA from presurgery baseline as well as from original study baseline. CONCLUSIONS: These data support the use of 0.2 µg/day FAc implants in phakic as well as in pseudophakic patients. These findings will serve as a pilot for design of future studies to evaluate the potential protective effect of FAc implants before cataract surgery in patients with DMO and cataract.

Dexamethasone intravitreal implant for pseudophakic cystoid macular edema in patients with diabetes.

BACKGROUND AND OBJECTIVE: Diabetic patients are at a higher risk of developing pseudophakic cystoid macular edema (PCME) after cataract surgery. This study evaluated the effect of dexamethasone intravitreal implant (DEX Implant 0.7 mg, Ozurdex; Allergan, Irvine, CA) in diabetic patients with PCME. PATIENTS AND METHODS: In this prospective case series, six patients with diabetes who developed PCME despite topical anti-inflammatory therapy were treated with a single dexamethasone implant. Outcome measures included best corrected visual acuity (BCVA) and central subfoveal thickness. RESULTS: The mean increase in BCVA from baseline to day 180 was 14 letters (P = .03); four of six patients (67%) achieved greater than 10-letter improvement in BCVA. The mean decrease in central subfoveal thickness was 100 µm (P < .01 vs baseline) by day 30 and 72 µm by day 180 (P = .004). CONCLUSIONS: A dexamethasone implant may be an effective treatment for diabetic patients who develop pseudophakic cystoid macular edema after cataract surgery.

Management of pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks.

Comparison of dexamethasone intravitreal implant and intravitreal triamcinolone acetonide for the treatment of pseudophakic cystoid macular edema in diabetic patients.

BACKGROUND AND OBJECTIVE: Our objective was to investigate the efficacy and safety of dexa methasone (DEX) implant for the treatment of pseudophakic cystoid macular edema (PCME) in diabetic patients. STUDY DESIGN: This was a prospective, non-randomized, interventional case series of 43 participants. Eighteen patients were enrolled in the DEX implant group and 25 were enrolled in an intravitreal triamcinolone acetonide (IVTA) group. MAIN OUTCOME MEASURES: The primary efficacy measurement was the percentage of patients who gained improvements of more than ten letters in best corrected visual acuity (BCVA) during 6 months of follow-up. Other efficacy measurements included change in BCVA, change in central macular thickness (CMT), and number of retreatments. The primary safety evaluation was the percentage of patients with intraocular hypertension and variation in intraocular pressure (IOP) during 6 months of follow-up. Other adverse events, such as conjunctival hemorrhage, eye pain, secondary infection, endophthalmitis, noninfectious inflammation, retinal detachment, and implant migration, were also recorded during follow-up. RESULTS: At month 1, we observed that the percentage of patients gaining improvement of more than ten letters was similar in both groups (P = 0.625). As patients in the IVTA group were retreated several times, this effect persisted throughout the study (P = 0.941 at month 2, P = 0.553 at month 3, P = 0.856 at month 6). Variations in CMT were noticed at week 1 and reached their maximum at month 1. No significant difference was found between the two groups (P = 0.831 at week 1, P = 0.783 at month 1). At month 1, the variation in IOP reached its maximum in the DEX implant group and then decreased slightly. However, in the IVTA group, it increased continuously throughout the study. Conjunctival hemorrhage and eye pain were found in both groups, but both were rated as mild in severity, and no significant difference was found (P = 0.184, P = 0.766, respectively). CONCLUSION: Both IVTA and DEX implants could effectively restore visual function and recover morphological change in diabetic patients with PCME for at least 6 months, but repeated intravitreal injection was required in the IVTA group. DEX implant is well tolerated. We suggest that intravitreal injection of DEX implant is a promising new therapeutic option for diabetic patients with PCME.

Effects of benzalkonium chloride on the blood-aqueous and blood-retinal barriers of pseudophakic eyes.

PURPOSE: To evaluate the effects of benzalkonium chloride (BAK) on the blood-aqueous (BAB) and blood-retinal barriers (BRB) of pseudophakic eyes. METHODS: Prospective, randomized, investigator-masked, comparative study. Patients were randomly assigned to preservative-free artificial tears or BAK-preserved artificial tears. One drop of artificial tears was instilled 4 times a day in the study eye, starting the day after randomization for 30 days. Anterior chamber flare was assessed by a laser flare meter (LFM) and macular thickness measurements were obtained with optical coherence tomography, before, 15, and 30 days after randomization. RESULTS: A total of 44 healthy eyes of 44 pseudophakic volunteers were recruited. There were no significant differences regarding demographics (age, gender, and race distributions) and clinical characteristics (eye, mean intraocular pressure, and mean best-corrected visual acuity) between the 2 groups (P>0.05). No significant differences in baseline mean LFM values were observed (P=0.262). However, we detected a statistically significant increase in mean LFM measurements in the BAK-preserved group (11.4 ± 5.1 ph/ms) (P=0.017) after 15 days. After 30 days, the BAK-preserved group maintained significantly higher flare values (11.9 ± 5.9 ph/ms) compared with baseline (P=0.043). On the other hand, the preservative-free group showed mean flare values of 8.4 ± 2.5 ph/ms, not significantly different from those obtained at baseline (P=1.00). We observed no statistically significant change in macular thickness measurements at days 15 and 30 in either group (P>0.05). Cystoid macular edema was not detected in this series. CONCLUSIONS: Our results suggest that a short-term exposure to BAK can cause disruption of the BAB, without altering the BRB in pseudophakic eyes.

Role of corneal collagen cross-linking in pseudophakic bullous keratopathy: a clinicopathological study.

OBJECTIVE: To evaluate the clinical and histopathologic changes induced by collagen cross-linking (CXL) in pseudophakic bullous keratopathy (PBK). DESIGN: Randomized, prospective, interventional study. PARTICIPANTS: Twenty-four patients with PBK were included in the study. METHODS: Twenty-four patients with PBK underwent CXL followed by keratoplasty at 1 or 3 months. Twelve patients underwent penetrating keratoplasty 1 month after CXL (group A) and the remaining 12 patients underwent penetrating keratoplasty 3 months after CXL (group B). The main outcome measures were assessed at 1 week and 1 month for all patients and at 3 months for 12 patients only. The corneal buttons underwent histopathologic and immunofluorescence evaluation. MAIN OUTCOME MEASURES: Visual acuity, ocular discomfort (tearing, redness, pain), corneal haze, central corneal thickness, histopathologic evaluation, and immunofluorescent microscopy. RESULTS: Mean visual acuity showed a significant improvement after CXL, from 1.925 ± 0.173 before surgery to 1.75±0.296 at 1 month after surgery (P = 0.010), but deteriorated to 1.81 ± 0.23 at 3 months. Symptomatic relief after CXL was at a maximum at 1 month, with a worsening trend at 3 months. Eighteen patients showed a reduction in corneal haze 1 month after CXL. The effect was maintained in 9 of 12 patients at 3 months. The mean central corneal thickness decreased significantly from 846.46 ± 88.741 to 781.0 ± 98.788 µm at 1 month (P<0.01) after CXL, but increased to 805.08±136.06 µm at 3 months. Immunofluorescence microscopy revealed anterior stromal compaction in 7 of 12 patients (58.3%) in group A and in 5 of 12 patients (41.6%) in group B. Staining of keratocyte nuclei with 4',6-diaminido-2-phenylindole dihydrochloride (Molecular Probes, Carlsband, CA) revealed a relative uniform distribution throughout the stroma. CONCLUSIONS: Collagen cross-linking causes symptomatic relief and a decrease in central corneal thickness and anterior stromal compaction in PBK. However, the effect decreases with time and depends on disease severity.

Dexamethasone intravitreal implant for treatment of patients with recalcitrant macular edema resulting from Irvine-Gass syndrome.

PURPOSE: To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant, over 6 months in patients with recalcitrant CME due to Irvine-Gass syndrome. METHODS: Retrospective review of the medical records of nine patients with refractory macular edema (ME) due to Irvine-Gass syndrome, who underwent a single intravitreal injection of dexamethasone implant, Ozurdex, between November 2010 and January 2012, at the Instituto de Microcirurgia Ocular, Barcelona, Spain. All patients underwent a complete ophthalmic evaluation, including best-corrected visual acuity (BCVA) using standardized ETDRS charts, tonometry, fluorescein angiography, and spectral-domain optical coherence tomography with foveal thickness (FT) measurement. RESULTS: The mean duration of CME before treatment with Ozurdex was 9.1 months (range, 6-13 months). At baseline, the mean FT was 542.22 ± 134.78 µm. Mean (SD) values of FT did decrease to 350.88 ± 98.71 µm (P = 0.001) at month 1 and 319.22 ± 60.96 µm (P = 0.002) at month 3. Data on the 6-month follow-up showed a mild increase 398.33 ± 127.89 µm (P = 0.031). The mean (SD) change from baseline FT was 191.33 µm (a decrease value of 35%) at month 1, and 223.00 µm (decrease value of 41%) and 143.89 µm (decrease value of 26%) at month 3 and month 6, respectively. The baseline BCVA data were 0.62 ± 0.15 logarithm of the minimum angle of resolution (logMAR). The mean BCVA improved to 0.47 ± 0.21 logMAR (P = 0.008) and 0.37 ± 0.24 logMAR (P = 0.001) after month 1 and month 3, respectively. At the last visit (6-month follow-up), the mean BCVA was 0.37 ± 0.26 logMAR (P = 0.002). CONCLUSIONS: In this study, both mean FT and mean BCVA had improved from baseline by 1 month after treatment with a dexamethasone implant, and the improvement remained statistically significant throughout the 6-month study.