Use of autologous whole blood during internal limiting membrane peeling and macular hole surgery is protective for indocyanine green toxicity

Objective: To compare indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling with and without autologous whole blood (WB) protection during macular hole repair surgery.

Material and methods: We retrospectively reviewed 50 eyes with an idiopathic macular hole. Group 1 contained 22 eyes that underwent ILM peeling with WB protection and group 2 contained 28 eyes that underwent ILM peeling without WB. Anatomic and visual results were compared.

Results: After surgery, macular hole closure was achieved in 96% of the group 1 eyes and in 93% of the group 2 eyes. The preoperative mean best-corrected visual acuity (BCVA) was logarithm of the minimum angle of resolution (logMAR) 0.95 in group 1 and logMAR 0.89 in group 2 (p?=?.544). The postoperative mean BCVA was logMAR 0.57 in group 1 and logMAR 0.92 in group 2 (p?=?.017).

Conclusion: Macular hole surgery protected with WB facilitates improved visual recovery in ICG-assisted ILM peeling.     

The long-term anatomical and visual effect of intravitreal triamcinolone injection during vitrectomy for the treatment of idiopathic macular epiretinal membrane

Purpose: To compare the long-term anatomical and visual outcomes of patients with idiopathic epiretinal membrane (ERM) removed by vitrectomy and membrane peeling with or without the use of intravitreal injection of triamcinolone acetonide (IVTA).

Methods: A retrospective chart review was performed. Subjects who underwent vitrectomy and who were followed over 12 months were included. The study included two groups of patients. In group 1 (71 eyes), the patients underwent vitrectomy and membrane peeling without the use of IVTA. In group 2 (27 eyes), 2?mg of IVTA was given at the end of the surgery. The main outcome measures were best-corrected visual acuity (BCVA), central foveal thickness (CFT) determined by optical coherence tomography (OCT), the number of cataract surgeries, and the use of anti-glaucomatous drugs during the follow-up period.

Results: This study included 98 eyes with ERM from 98 patients. There was no significant difference between the two groups with respect to age, gender, pre- and postoperative lens status, BCVA, CFT, or length of the follow-up period. The mean age for all of the patients was 62.45?±?10.01 (mean ± SD) years, and the mean follow-up length was 20.58?±?9.64 (mean ± SD) months. In all cases, the mean best-corrected logarithm of minimum angle of resolution (logMAR) acuity improved from a preoperative value of 0.91?±?0.32 [Snellen equivalent (SE), 0.16?±?0.14] to a postoperative value of 0.46?±?0.36 (SE, 0.46?±?0.29) (P?<?0.0001). The CFT was reduced from a preoperative value of 473.46?±?96.91 μm to a postoperative value of 302.44?±?69.80 μm (P?<?0.0001). Six patients (22.2%) in group 2 required anti-glaucomatous drugs to control intraocular pressure (IOP) during the follow-up period, and three patients (4.2%) in group 1 required drugs to control IOP (P?=?0.012).

Conclusions: The postoperative visual outcomes for patients with idiopathic ERM were favorable, but CFT did not return to a normal level, even in eyes in which 2?mg IVTA was used. The IVTA use after ERM removal produced no significant benefits during long-term follow-up, but IVTA did increase the risk of increased IOP.     

The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema

Objective: To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema.

Methods: Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40?mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically.

Results: Forty-one eyes of 41 patients with a mean age of 63.49?±?10.99 (55–86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p?<?0.001, p?<?0.001 and p?=?0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p?<?0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case.

Conclusion: PSTA application is an effective and safe option in BRVO-related macular edema.     

Retrospective analysis of the effect of aflibercept loading dose on the retinal vessel diameters in patients with treatment-naive neovascular AMD*

Background: To evaluate the effects of intravitreal aflibercept (IVA) on retinal vessel diameters in patients with neovascular age-related macular degeneration (AMD).

Design, setting, and participants: A retrospective study conducted at the Kutahya Dumlupinar University Faculty of Medicine included 15 eyes of 15 patients with treatment naive neovascular AMD.

Methods: All eyes received IVA injections once per month for 3?months; untreated contralateral eyes were used as controls. The central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery-vein ratio (AVR) values were measured using a computer-based program before the first IVA injection and 30?days after the first, second, and third injections. The main outcome measurements were the central macular thickness (CMT), best-corrected visual acuity (BCVA), choroidal thickness, CRAE, CRVE, and AVR.

Results: Significant vasoconstriction of the retinal arterioles was observed in all eyes treated with IVA when compared to baseline (p?=?0.009). However, no significant differences were found for CRVE or AVR throughout the study period in treated eyes. In the control group, all parameters measured during each visit were similar to baseline measurements (p?>?0.05). The mean BCVA significantly improved at the end of the loading dose of IVA, when compared to baseline (p?=?0.006). After the IVA injections, the mean CMT and choroidal thickness were significantly reduced at all visits, compared to baseline (p?Conclusions: The current study showed that IVA led to significant retinal arteriolar vasoconstriction and choroidal thinning, which may cause reduced retinal blood flow.     

Influence of serous retinal detachment on the outcome of ranibizumab treatment in diabetic macular oedema

Purpose: The purpose of this study was to evaluate the influence of serous retinal detachment (SRD) on the outcome of intravitreal ranibizumab (IVR) therapy in diabetic macular oedema (DME).

Materials and methods: Fifty-one eyes with cystoid macular oedema (CME) and SRD (study group) and 57 eyes with only CME (control group) that received pro re nata (PRN) IVR injections during a 6-month period were retrospectively evaluated. The outcome measures included changes in the central macular thickness (CMT) and best corrected visual acuity (BCVA) and injection numbers.

Results: The mean initial CMT in the study and control groups was 467?±?101 and 440?±?89?µm, respectively. The mean BCVA in the study and control groups was 0.75?±?0.38 and 0.59?±?0.36 logarithm of minimal angle of resolution (LogMAR), respectively (p?=?0.010). The study group received a mean of 2.2?±?0.92 injections, whereas the control group received a mean of 2.54?±?0.9 injections. The decrease in CMT was greater, but not significantly greater, in the study group than in the control group.

Conclusion: The presence of SRD resulted in a less favourable visual acuity (VA) outcome with IVR. Disruption of the ellipsoid zone and abnormality of the foveal avascular zone at the baseline examination were correlated with a lower VA. Both of the pathologies occurred more frequently in the SRD group.     

玻璃体手术中吲哚青绿对视网膜结构的影响

目的研究吲哚青绿(ICG)辅助视网膜内界膜(ILM)染色的玻璃体切割手术后,不同浓度ICG对视网膜结构的影响。方法选取健康家兔25只,体重2～2.5kg,2个月龄,雌雄不限。从中随机选取5只家兔,作为手术空白对照组(10只眼球)。根据人眼手术中实际应用ICG的浓度,实验分为0.025、0.25、2.5和25g/L4个不同浓度组,每组5只家兔(10只眼球)作为实验组。手术空白对照组与实验组均行模拟人眼的玻璃体切割手术,术中实验组行ICG染色ILM,空白对照组用平衡盐溶液做对照。所有实验动物术后14d摘取眼球制作光镜标本,低浓度组(0.025、0.25g/L)眼球制作电镜标本,观察拍片。结果ICG染色ILM玻璃体切割术后,光镜观察低浓度组,视网膜结构仅见轻微改变。高浓度组(2.5、25g/L)视网膜结构改变明显,感光细胞内外节水肿严重,空隙增大。内外核层极性紊乱,内外丛状层变薄。电镜观察0.025g/L组仅见内核层少许细胞胞质水肿,0.25g/L组可见内外核层及神经节细胞内线粒体空泡变。结论ICG染色ILM玻璃体切割术后,ICG对视网膜的结构有损伤作用。     

Effect of intracameral carbachol in phacoemulsification surgery on macular morphology and retinal vessel caliber

Objective: To investigate the effects of intracameral carbachol in phacoemulsification surgery on central macular thickness (CMT), total macular volume (TMV) and retinal vessel caliber (RVC).

Materials and methods: In this prospective consecutive case series, 82 patients underwent uneventful phacoemulsification and in-the-bag intraocular lens implantation. Unlike patients in the control group (43 eyes), patients in the study group (42 eyes) were injected with intracameral 0.01% carbachol during surgery. Spectral-domain optical coherence tomography (OCT) was used to analyze the parameters of CMT, TMV and RVC.

Results: On the first postoperative day, mean CMT and TMV decreased markedly in the carbachol group, though these values did not change significantly in the control group. During follow-up visits, no statistically significant differences between the groups occurred regarding changes in mean CMT (p?=?0.25, first day; p?=?0.80, first week; p?=?0.95, first month). However, change in mean TMV between groups on the first postoperative day was statistically significant (p?=?0.01, first day; p?=?0.96, first week; p?=?0.68, first month). RVC values were similar on the preoperative and postoperative first days in both groups (p?>?0.05).

Discussion: Results suggest that the effect of intracameral carbachol on macular OCT is related to pharmacological effects, as well as optic events (e.g. miosis).

Conclusion: Intracameral carbachol given during cataract surgery decreases macular thickness and volume in the early postoperative period but does not exert any gross effect on RVC.     

Clinical trial evaluating Viscoat and Visthesia ophthalmic viscosurgical devices in corneal endothelial loss after cataract extraction and intraocular lens implantation

Purpose: To assess and compare the safety and the efficacy of VisThesia? and Viscoat® in cataract surgery.

Methods: This prospective randomized clinical trial included 44 eyes of 44 patients that were assigned randomly to undergo phacoemulsification either with VisThesia? or with Viscoat®. Preoperative data included age, gender, visual acuity, IOP and mean endothelial cell density. Postoperative, best corrected visual acuity (BCVA), IOP, mean endothelial cell density and painful sensation during surgery were recorded.

Results: BCVA, evaluated with Snellen chart in decimal fraction, was statistically improved in both groups. Specifically, mean BCVA in VisThesia group was increased from 0.28?±?1.8 SD preoperatively to 0.83?±?1.4 SD postoperatively, whereas, in the Viscoat group, BCVA was increased from 0.31?±?2.1 SD preoperatively, to 0.85?±?1.2 SD after surgery (p?>?0.1). The mean postoperative IOP was lower in the VisThesia group, but the difference was not statistically significant (p?>?0.1). Preoperatively, the mean endothelial cell count was 2322.3?±?161.1 SD cells/mm² in Viscoat group and 2304.8?±?142.8 SD cells/mm² in the VisThesia group, similar between groups (p?>?0.1). At day 15 after cataract surgery the postoperative endothelial cell count was 2102.9?±?182.8 SD cells/mm² in Viscoat group and 2032.6?±?160.4 SD cells/mm² in the VisThesia group (p?>?0.1). The mean endothelial cell decrease was 212?cells/mm² (9.1%) in the Viscoat group and 272?cells/mm² (11.8%) in the VisThesia group. The difference was not statistically significant between the two groups (t-test?=?0.18, p?>?0.1). This value is within standard normal endothelial cell decrease after a cataract surgery. Painful sensation was not reported during any stage of the procedure.

Conclusions: Topical-intracameral anesthesia with VisThesia? allows cataract surgery without any painful sensation in the majority of patients. Both Viscoat® and VisThesia? have similar safety profile during intra- and post-operative period and identical endothelial protection, as endothelial cell loss is within normal limits.     

Does sulfur-hexafluoride tamponade,as an adjunct to vitrectomy and internal-limiting-membrane peeling,suffice for the treatment of retinal detachment associated with macular hole?

Objective: To evaluate the efficacy of sulfur hexafluoride tamponade, as an adjunct to vitrectomy and internal-limiting-membrane peeling, for the treatment of retinal detachment (RD) associated with macular hole (MH).

Materials and methods: Our study was a retrospective interventional case series. We evaluated 9 phakic eyes of 9 consecutive patients with retinal detachment secondary to macular hole (MHRD) treated with 20-gauge (g) pars plana vitrectomy, which was followed with trypan blue–assisted internal-limiting-membrane peeling, fluid–air exchange, and 20% sulfur hexafluoride tamponade (SF₆) gas exchange. All patients underwent optical coherence tomography, best-corrected visual acuity (BCVA) measurement, and dilated fundus examination with indentation, pre- and postoperatively.

Results: The mean (± standard deviation) follow-up time was 13 ± 3 months (range 9–18). Postoperatively, all eyes demonstrated an attached retina, whereas MH closure was achieved in only 1 eye, and in a second eye after additional injection of gas and further posturing. The BCVA improved from 2.2 ± 0.4 logMAR (logarithm of the minimum angle of resolution) at baseline to 2.0 ± 0.5 logMAR at the end of follow-up (p?=?.05).

Conclusion: The failure in MH closure in most of our cases strengthens the view that short-term tamponade with SF₆ may not suffice for achieving MH closure, and either prolonged tamponade (with C₃F₈ or silicone oil) or additional photocoagulation may be a better option for eyes with MHRDs. In addition, it is possible that intravitreal injection of gas might be an option for the treatment of persistent MHs after vitrectomy for MHRD, especially when the MH is small. Further studies are required to evaluate the above findings, although the implementation of large series studies remains a challenge because of the rarity of cases with MHRDs.     

Efficacy of topical ketorolac tromethamine 0.4% for control of pain or discomfort associated with cataract surgery

SUMMARY

Objective: To evaluate the efficacy of ketorolac 0.4% ophthalmic solution for control of pain and discomfort associated with cataract surgery.

Methods: This was a single-center, double-masked, randomized, fellow-eye placebo-controlled clinical study of 25 patients (mean age 72?years; 76% female) requiring bilateral cataract surgery. Patients received either ketorolac tromethamine 0.4% ophthalmic solution (Acular LS*) or placebo, 1 drop QID for 3?days prior to and 1?day following phacoemulsification and intraocular lens implantation on their first eye, and the other treatment for surgery on the second, fellow eye 1?week–4?weeks later. The physician rated patient cooperation and ocular pain or discomfort during surgery, and patients rated ocular pain or discomfort immediately and 24?h after surgery.

Results: Patients reported significantly less ocular pain during the 24?h following surgery when treated with ketorolac 0.4% than with placebo (?p = 0.02). Ocular pain was reported for only a single ketorolac 0.4%-treated eye (4%) during that period, compared with 39% of placebo-treated eyes (?p = 0.004). No significant differences between eyes treated with ketorolac 0.4% and placebo were observed in patient cooperation, and ocular pain or discomfort during or immediately after surgery. No adverse events occurred during the study.

Limitations: Evaluation of pain is subjective, and the severity of pain experienced in the control, vehicle-treated eyes was low.

Conclusions: The reduction in pain associated with cataract surgery afforded by ophthalmic ketorolac 0.4%, together with its favorable safety profile, make it an important tool to help surgeons meet the high expectations of today's cataract and refractive surgery patients.     

Safety and efficacy of autologous serum eye drop for treatment of dry eyes in graft-versus-host disease

Purpose: To evaluate the treatment of autologous serum eye drops (ASED) on dry eyes in patients with graft-versus-host disease (GVHD).

Methods: A retrospective chart review of 35 patients with a history of ocular GVHD following hematopoietic stem cell transplantation that used ASED to alleviate dry eye symptoms was performed. Patients were categorized into three different groups. If patients had available ophthalmic data before and after starting treatment was group 1 (n?=?14), had available ophthalmic data after starting treatment in group 2 (n?=?10) and had available ophthalmic data before treatment or did not have any data after starting treatment in group 3 (n?=?11). Data were collected on patient’s age, gender, primary diagnosis, visual acuity and fluorescein corneal staining were collected on individual eyes in order to evaluate the efficacy of the ASED on alleviating dry eye-related signs and symptoms.

Results: No adverse ocular effect from the ASED was found in our series (except one fungal keratitis). All patients reported either improvement (55%) or stability (45%) in their ocular symptoms upon the use of ASED. In patients with available data before and after starting treatment, the corneal staining score improved by a median of 1 (p?=?0.003) and the LogMAR visual acuity had a non-significant improvement.

Conclusion: In our study, ASED used by patients with ocular GVHD were both safe and effective. ASED should be considered in patients with GVHD who suffer from dry eyes.     

Incidence of cystoid macular oedema with intracameral cephalosporin or vancomycin in cataract surgery

Abstract

Purpose: To compare the incidence of pseudophakic cystoid macular oedema (CME) in patients who receive intracameral cephalosporin versus intracameral vancomycin during cataract surgery.

Methods: A retrospective chart review was conducted on subjects with the diagnosis of CME between January 1 2010 and July 31 2017. Inclusion criterion was the documentation of CME after cataract extraction. Exclusion criteria were intraoperative complication, prior history of macular oedema, epiretinal membrane, uveitis, other pre-existing retinal pathology, or other post-operative pathology including other ocular surgery in the post-operative period.

Results: The final analysis included 89 eyes with optical coherence tomography (OCT) proven CME. The incidence of pseudophakic CME in our population of 10,165 cataract surgeries after applying the above-stated exclusion criteria was 0.88%. The incidence of pseudophakic CME in subjects who received intracameral cephalosporin was 0.87% (mean age in years 69?±?11; 31 male [39%], 48 female [61%]). The incidence of pseudophakic CME in subjects who received intracameral vancomycin was 0.96% (mean age in years 66?±?13; 4 male [40%], 6 female [60%]). Pearson’s chi-square test demonstrated no significant difference between these groups (p?=?0.7705).

Conclusions: There was no statistical difference in the incidence of pseudophakic CME in subjects who received intracameral cephalosporin versus intracameral vancomycin during cataract surgery.     

Effects of cigarette smoking on choroidal and retinal thickness and ocular pulse amplitude

Background: In our study, we aimed to show the effects of smoking on choroidal thickness and ocular pulse amplitude. It is known that the anatomy and physiologic functions of the choroid is important in ocular diseases like glaucoma and age-related macular degeneration. Choroidal thickness is measured by the spectral domain optical coherence tomography (SD-OCT). The ocular pulse amplitude (OPA) is the difference between the systolic and diastolic intraocular pressure (IOP) and it is an index of choroidal perfusion.

Design: This was a cross-sectional prospective observational study at the Turgut Ozal University Hospital setting.

Participants: The test subjects were divided into two groups: the smokers group which consisted in 24 participants (20 male, 4 female) and the control group with 22 participants (16 male, 6 female).

Methods: The participants underwent full ophthalmological examination including best-corrected visual acuity (BCVA), spherical equivalent (SE) values of refractive errors, intraocular pressure (IOP), ocular pulse amplitude (OPA), central corneal thickness (CCT), axial length (AL) and choroidal thickness. The IOP and the OPA were measured with the dynamic contour tonometer. The CCT and the AL were measured with the Nidek AL-Scan (Nidek Co., Ltd., Gamagori, Japan). The choroidal thickness was measured by the Cirrus high-definition optical coherence tomography (Cirrus Version 6.0; Carl Zeiss Meditec, Dublin, CA).

Results: Gender did not differ significantly between the groups (p?=?0.12). The age, SE, IOP, OPA, CCT and AL did not differ significantly in smokers and control groups (p?=?0.12, p?=?0.37, p?=?0.54, p?=?0.80, p?=?0.56 and p?=?0.82, respectively). The nasal, temporal, central retinal (p?=?021, p?=?021, p?=?0.11) and nasal, temporal, central choroidal thicknesses (p?=?0.80, p?=?0.39, p?=?0.75) did not differ significantly between smokers and control groups.

Conclusions: We could not find a significant difference in OPA, retinal and choroidal thicknesses between smokers and non smokers. Further studies including histopathological changes in larger groups are needed to show the effect of smoking on choroidal thickness especially in patients with ocular diseases like age-related macular degeneration.     

Liver function assessment by indocyanine green plasma disappearance rate in patients with intra-abdominal hypertension after “non-hepatic” abdominal surgery

Background and objective: Liver function assessment in patients with intra-abdominal hypertension (IAH) after major abdominal surgery is complex and often confounding. Elevated intra-abdominal pressure (IAP) often occurs after major abdominal surgery, and is associated with decreased abdominal blood flow and organ dysfunction, and it could cause abdominal compartment syndrome (ACS), which is a life-threatening condition. Plasma disappearance rate (PDR) of indocyanine green (ICG) and ICG retention rate after 15?min (R15) were used to evaluate liver function and as a prognostic parameter after major abdominal surgery.

Methods: In this prospective/observational study, 51 patients were followed in the surgical intensive care unit after major abdominal surgery (operation of the small and large intestine, stomach, pancreas, spleen, or resection of the abdominal aorta), 29 had IAH. The PDR-ICG and R15 were analyzed 24?h after surgery concurrently with IAP, APP, bilirubin, AST, ALT, prothrombin time, albumin, cardiac index, arterial lactate, oxygen delivery, MAP (mean arterial pressure), APACHE II (acute physiology and chronic health evaluation), SOFA (sequential organ failure assessment), and SAPS II (simplified acute physiology score). IAH has been defined as a peak intra-abdominal pressure (IAP) value of ≥12?mmHg, at a minimum, as two standardized measurements obtained 1–6?h apart.

Results: The PDR-ICG measured 24?h after surgery was not different among groups (20.95% [SD?=?10.34] vs 25.40% [SD?=?7.42]), p?=?.094. ICG R15 was significantly higher in patients with IAH, 11.10% [SD?=?13.82] vs 8.30 [SD?=?11.46], p?p?Conclusions: The results suggest that PDR/ICG and ICG R15 are useful dynamic tests for evaluation of complex liver function and survival prediction after major abdominal surgery in patients with IAH.     

Impact of intravitreal triamcinolone acetonide versus intravitreal bevacizumab on retrobulbar hemodynamic in patients with diabetic macular edema

Purpose: To evaluate and compare retrobulbar hemodynamic changes measured with color Doppler imaging (CDI) in diabetic patients receiving intravitreal triamcinolone acetonide (IVTA) versus bevacizumab.

Methods: Patients with diffuse diabetic macular edema were assessed prospectively by CDI following intravitreal injection of triamcinolone acetonide (group I, 12 eyes) versus bevacizumab (group II, 14 eyes). CDI was used to measure the peak systolic velocity (PSV), end diastolic velocity (EDV) and the resistive index (RI) of the central retinal artery (CRA), ophthalmic artery (OA) and posterior ciliary arteries (PCA) one day preoperatively and one week postoperatively.

Results: In group I, EDV of OA and CRA decreased significantly (p?=?0.007 and 0.018, respectively). The PSV and RI of PCA decreased significantly (p?=?0.035 and 0.002, respectively). In group II, both the PSV and EDV of the CRA decreased significantly (p?=?0.000). Comparing the percentage of change in both groups, PSV of the CRA decreased significantly in group II (p?=?0.034), while IVTA has more significant effect on the ophthalmic artery hemodynamic parameters as EDV decreased and RI increased significantly (p?=?0.045 and 0.043, respectively)

Conclusion: Intravitreal injections of triamcinolone acetonide and bevacizumab have a significant effect on the ocular hemodynamic. The effect of bevacizumab is statistically significant on the PSV of CRA compared to IVTA.     

Ocular surface effects of repeated application of povidone iodine in patients receiving frequent intravitreal injections

Background: The aim of this study was to investigate the patient reported symptoms and objective signs of tear film and ocular surface abnormalities experienced by patients undergoing repeated exposure to povidone iodine as a consequence of requiring frequent intravitreal injections for wet macular degeneration.

Methods: This was a prospective study of consecutive patients who had received recent povidone 5% solution for sterile preparation of intravitreal injection less than 3?months prior to inclusion with a total of at least 3 intravitreal injections for macular degeneration. Each patient had one study eye which was undergoing regular intravitreal injection and a fellow eye which was not undergoing any injections. Each patient underwent evaluations of various tear film parameters on a single occasion for both eyes. The primary outcome was severity of dry eye symptoms as measured by the Schein dry eye questionnaire. The secondary outcomes were tear film osmolarity and corneal punctate staining using the Oxford Grading Scale.

Results: A total of 90 patients were included in the study. 43.3% n?=?39, were using ocular lubricating medication on a regular basis. A significantly greater proportion of study eyes had a Schein dry eye questionnaire score of 7 or higher; 12.2%, n?=?11 amongst study eyes vs 4.4%, n?=?4 amongst control, fellow eyes (p?p?=?0.087). The study eyes had statistically significantly worse corneal staining as determined by the Oxford grading scale; 0.69 in study eyes vs 0.58 in control, fellow eyes (p?=?0.02).

Conclusion: Our results confirm the detrimental impact of repeated application of povidone iodine for intravitreal injection procedures on symptoms of dry eyes as experienced and reported by patients.     

玻璃体腔注射康柏西普治疗糖尿病性和视网膜静脉阻塞性黄斑水肿的疗效对比观察

目的：对比研究糖尿病和视网膜静脉阻塞继发黄斑水肿患者玻璃体腔注射康柏西普治疗临床疗效差异。方法：选取自2016年3月-2017年10月收入某院行玻璃体腔注射康柏西普治疗糖尿病性黄斑水肿者21例/30只眼,视网膜静脉阻塞性黄斑水肿者35例/35只眼。回顾性对比观察这2组患者治疗后1个月、3个月及末次随诊时者最佳矫正视力（BCVA）和中央黄斑区视网膜厚度（CMT）及其变化,以及治疗有效率、黄斑水肿复发率、治疗病程和注药次数等,采用方差分析的方法对这些指标进行组间和组内统计学比较。结果：比较康柏西普玻璃体腔内注射治疗后1个月、3个月及末次随访时与治疗前基线的BCVA差值（ΔBCVA）和CMT差值（ΔCMT）,静脉阻塞组均高于糖尿病组并具有显著性（P<0.05）。静脉阻塞组和糖尿病组治疗有效率分别为100%和86.7%,复发率为14.3%和20.0%;静脉阻塞组和糖尿病组的患者治疗病程分别为（4.40±1.90）个月和（5.72±3.03）个月,注药次数为（2.51±0.74）次和（3.07±1.34）次,均具有显著性（P<0.05）。所有患者治疗随访过程中未见明显与药物、玻璃体腔注射相关的眼部和全身不良事件的发生。结论：玻璃体腔内注射康柏西普治疗视网膜静脉阻塞性和糖尿病性黄斑水肿均有较好疗效,但静脉阻塞患者其黄斑水肿消退和视力提升更为显著和迅速,而糖尿病患者治疗病程更长,需要更多次（3次以上甚至更多次）注药才能控制黄斑水肿的病情。     

Morphologic changes and visual outcomes in resolved central serous chorioretinopathy treated with ranibizumab

Context: Central serous chorioretinopathy (CSC).

Objective: To evaluate the effect of intravitreal ranibizumab injection and the correlation between foveal morphologic changes and visual outcomes in patients with resolved CSC.

Materials and methods: We measured outer nuclear layer (ONL) thickness, outer layer (OL) thickness and evaluated the integrity of the photoreceptor inner-outer segment (IS/OS) junction, the status of the external limiting membrane (ELM) at the central fovea using spectral-domain optical coherence tomography (OCT) in 35 eyes of 35 patients with resolved CSC. The eyes were divided into two groups: The initial medical treatment administered to Group1 (n?=?17) then received intravitreal ranibizumab injections, Group 2 (n?=?18) received medical treatment. Group 3 was composed of normal eyes (n?=?20, as a control). We also investigated a correlation between the ONL thickness and best corrected visual acuity (BCVA).

Results: The mean age was 45.7?±?7.2 (ranged from 27 to 55 years). The mean follow-up period was 14.2 months (minimum 6, maximum 24 months). The mean ONL and OL thickness in Group 1 were significantly thinner than Group 3 (p?r?=?0.681, p?=?0.001). Thirty-tree patients had improvement in BCVA after treatment. Discontinuity of the IS/OS junction was found in 15 eyes (88.2%) in Group 1, in 5 eyes (27.7%) in Group 2 and in no eyes in Group 3.

Discussion: We demonstrated that prolonged serous detachment results in photoreceptor cell loss (apoptosis) and thinning of the ONL. Thinning of the ONL correlates with poorer vision, which has been found by other investigators. Furthermore, vascular endothelial growth factor (VEGF) may be neuroprotective to the photoreceptors which might explain the additional thinning in the patients treated with ranibizumab. This raises the possibility that treatment with VEGF inhibitors may be unfavourable to patients with CSC, even though it speeds recovery and vision does improve.

Conclusion: Intravitreal ranibizumab injection leads to thinning of the ONL and the OL in patients with resolved CSC. The ONL thickness reduction and discontinuity of the IS/OS junction results in poor visual prognosis in resolved CSC eyes.     

Intravitreal dexamethasone implant Ozurdex in the treatment of diabetic macular edema in patients not previously treated with any intravitreal drug: a prospective 12-month follow-up study

Abstract

Objective: To evaluate the mid-long-term efficacy and safety of the dexamethasone intravitreal (DEX) implant (Ozurdex¹) in naïve patients with diabetic macular edema (DME).

Methods: Prospective and single-center study conducted on consecutive patients with a diagnosis of DME, who received a DEX implant and were followed up for at least 12?months. The main outcomes measurements were the mean change in best corrected visual acuity (BCVA) and in foveal thickness (FT) as compared to the baseline values.

Results: Of the 84 screened patients 50 were included in the study. The BCVA significantly improved from 52.4 (20.4) letters at baseline to 62.6 (15.6), 61.2 (18.4), 61.6 (18.6), 60.6 (19.0), and 60.6 (18.8) at 2, 4, 6, 12?months and end of follow-up period, respectively (repeated measures ANOVA and the Greenhouse-Geisser correction; p?=?.0008). At the end of the follow-up period, a gain of BCVA of ≥5, ≥10, and ≥15 letters were observed in 26 (52.0%), 18 (36.0%), and 16 (32.0%) patients, respectively. The mean FT was significantly reduced from 446.0 (139.9) µm at baseline to 327.2 (103.6) at the end of follow-up (repeated measures ANOVA and the Greenhouse-Geisser correction; p?=?.0008). During the study follow-up, the patients receive a mean of 3.4 (2.9–3.9) implants. Of the 32 phakic eyes at baseline, 17 (53.1%) either developed new lens opacity or progression of an existing opacity.

Conclusion: In eyes with DME not previously treated with intravitreal drugs, DEX implants provide meaningful functional and anatomical benefits, and these results are sustained mid–long-term.     

芪明颗粒联合雷珠单抗治疗糖尿病性黄斑水肿的临床研究

目的探讨芪明颗粒联合雷珠单抗治疗糖尿病性黄斑水肿的临床疗效。方法选取2015年3月—2016年3月在上海市闵行区中心医院进行治疗的糖尿病性黄斑水肿患者90例,根据治疗方案的差别分为对照组(45例)和治疗组(45例)。对照组患者玻璃体腔内注射雷珠单抗注射液,0.5 mg/次,1次/月。治疗组在对照组的基础上口服芪明颗粒,1袋/次,3次/d。两组患者均连续治疗6个月。评价两组患者临床疗效,比较治疗前后两组患者最佳矫正视力(BCVA)、黄斑中央视网膜厚度(CMT)和玻璃体液中细胞因子。结果治疗后,对照组的总有效率为80.00%,显著低于治疗组的95.56%,两组比较差异具有统计学意义(P0.05)。治疗后,两组血管内皮生长因子(VEGF)和白细胞介素-6(IL-6)水平均明显降低,而色素上皮衍生因子(PEDF)水平显著升高,同组比较差异具有统计学意义(P0.05);且治疗后治疗组上述指标水平显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组BCVA显著升高,CMT显著降低,同组比较差异具有统计学意义(P0.05);且治疗后治疗组BCVA和CMT改善更显著,两组比较差异具有统计学意义(P0.05)。结论芪明颗粒联合雷珠单抗治疗糖尿病性黄斑水肿效果显著,可明显改善患者视力,促进黄斑水肿恢复,具有一定的临床推广应用价值。