Retrobulbar alcohol injection in blind painful eyes.

We studied 39 blind painful eyes in 39 patients who were treated with retrobulbar injection of absolute (96%) alcohol for their severe ocular pain at the King Khaled Eye Specialist Hospital from January 1984 to January 1987. There were 21 (54%) male and 18 (46%) female patients; all were followed for at least three months. The protracted ocular pain was mainly due to: end-stage (absolute) glaucoma in 31 (80%) eyes, uveitis or endophthalmitis in four (10%) eyes, or corneal ulcer in two (5%) eyes. One eye had painful phthisis bulbi, and one eye had infraorbital neuralgia. The complications encountered were transient and included blepharoptosis in eight (21%) eyes, external ophthalmoplegia, and corneal epithelial defect. The effective time of the injection to relieve pain ranged from two weeks to two years (mean, 29 weeks). The authors believe that there is still a place for retrobulbar alcohol injection for blind painful eyes when enucleation or evisceration is not possible.     

Retinal detachment in East Africa

PURPOSE: To report the causes of retinal detachment in an African setting and the outcome after surgery. DESIGN: Noncomparative interventional case series. PARTICIPANTS: A total of 361 eyes in 345 patients. METHODS: Data were collected from patients' case notes. A minimum of 2 months' follow-up was available for 254 eyes. Risk factors for poor anatomic or visual outcome were analyzed by logistic regression. MAIN OUTCOME MEASURES: Primary anatomic success, which was defined as an attached retina at least 2 months after the initial surgery, without any additional interventions; final anatomic success, defined as an attached retina at least 2 months after the latest intervention; and visual outcome, defined as the corrected visual acuity at least 2 months after the last operation. RESULTS: The macula was detached at presentation in 332 (91.9%) eyes. In 203 (56.2%) eyes, the retina had been detached for >1 month. Proliferative vitreoretinopathy (PVR)-grade C1 or worse-was present in 63 (17.5%) eyes. Thirty eyes (8.3%) had giant retinal tears. Ninety-five patients (27.5%) were blind (<20/400 in the better eye) at presentation. The retina was successfully reattached with 1 operation in 186 (73.2%) eyes. The most frequent cause of primary failure was missed breaks or new breaks. The final anatomic success rate in eyes observed for at least 8 weeks after the last operation was 88.2%. Giant retinal tear and PVR were significant independent predictors of anatomic failure. In eyes with successfully reattached retinas, 63.9% achieved 20/200 vision or better. Among successfully reattached macula-off detachments, risk factors for a poor visual outcome (<20/200) were macular hole, duration of retinal detachment >1 month, and poor preoperative acuity. Of 74 blind patients with 2 months' follow-up, only 23 (31.1%) remained blind at the latest follow-up. CONCLUSIONS: Retinal detachment is a treatable cause of blindness in Africa. Despite late presentation and complex pathology, surgical repair is frequently successful and often restores navigational vision. Greater emphasis should be given to the recognition and treatment of retinal detachment in regional training programs for ophthalmologists and primary eye care workers.     

Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments.

BACKGROUND: Intravitreal silicone oil injection used for managing complicated retinal detachments can be associated with elevated intraocular pressure (IOP). This study was undertaken to determine the incidence of glaucoma in patients who underwent silicone oil injection, as well as to evaluate the effectiveness of medical and surgical therapy in patients in whom glaucoma developed. METHODS: The postoperative courses of 50 eyes of 47 consecutive patients who underwent pars plana vitrectomy and silicone oil injection for the management of complicated retinal detachments were reviewed retrospectively. The outcomes of patients who underwent silicone oil removal and/or glaucoma surgery also were evaluated. RESULTS: The mean overall postoperative IOP before any glaucoma surgery was 16.7 +/- 9.3 mmHg (range, 0 to 45 mmHg), with a mean follow-up of 16.6 +/- 12.1 months (range, 2 to 51 months). Twenty-four (48%) eyes had postoperative IOPs of at least 25 mmHg and IOP elevations of at least 10 mmHg above the preoperative levels. Twenty-one (42%) eyes underwent complete removal of silicone oil and/or glaucoma surgery to effect IOP control. The IOPs were controlled to 21 mmHg or less (but > 5 mmHg) in 8 of 14 eyes that underwent removal of silicone oil alone, in 3 of 5 eyes that underwent Molteno implantation, and in 1 eye that underwent Nd:YAG transscleral cyclophotocoagulation, but not in 1 eye that underwent a modified Schocket procedure (mean follow-up, 13.5 +/- 11.0 months; range, 0.2 to 33 months). CONCLUSION: Intraocular pressure elevation is a common occurrence after intravitreal silicone oil injection. The underlying mechanism may often be multifactorial in nature. Patients in whom uncontrolled IOP develops may benefit from aggressive medical and/or surgical treatment with silicone oil removal, glaucoma implants, or cyclodestructive procedures.     

Cyclodiode laser therapy for painful, blind glaucomatous eyes

AIMS: To determine the ability of cyclodiode laser treatment to relieve discomfort in painful blind glaucomatous eyes. METHODS: 30 eyes underwent cyclodiode to reduce intraocular pressure (IOP) and relieve pain. Patients graded their pre-cyclodiode and post-cyclodiode pain. RESULTS: After a minimum follow up of 6 months, a single cyclodiode treatment lowered mean IOP from 51 mm Hg (95% CI plus or minus 3.7 mm Hg) to 26 mm Hg (95% CI plus or minus 5.8 mm Hg) providing pain relief in 73.3% (22/30). After retreatment of six eyes, mean IOP was reduced to 22 (95% CI plus or minus 5.3) mm Hg and pain relief was obtained in 96.7% (29/30). For eyes achieving pain relief after one treatment, IOP was reduced by >30% in 81.0% (17/21). For eyes not achieving pain relief after one treatment, IOP was reduced by >30% in only 22.2% (2/9) (p=0.0042, Fisher's exact test). CONCLUSION: Cyclodiode was highly successful in providing pain relief in painful blind hypertensive glaucomatous eyes. The best predictor of successful pain relief was IOP reduction of > 30% from baseline.     

Retinal angiomatous proliferation treated by intravitreal triamcinolone and photodynamic therapy with verteporfin

Purpose To examine combined treatment of intravitreal triamcinolone acetonide (IVT) and photodynamic therapy (PDT) for retinal angiomatous proliferation (RAP).Methods Ten eyes of eight consecutive patients with RAP underwent a single injection (about 20 mg) of IVT followed 1 month later by PDT. Best-corrected visual acuity (BCVA) was measured by standardized protocol refraction.Results Median BCVA was 20/160, 20/64, 20/98, 20/89, 20/89, 20/125 at baseline and 1, 3, 6, 9 and 12 months, respectively. Of ten eyes, six (60%) improved BCVA of at least 3 lines at 1, 3, 6 and 9 months. Four (40%) eyes improved BCVA of at least 3 lines at 12 months. Three eyes (30%) lost >3 lines at 12 months. In all patients intraocular pressure was well controlled. No endophthalmitis, retinal detachment or vitreous haemorrhage developed.Conclusions Improvement of BCVA suggests that combination treatment with IVT and PDT for RAP merits further investigation.The authors do not have any proprietary interests.     

Intravitreal triamcinolone acetonide for diabetic macular edema: a prospective, randomized study.

PURPOSE: The aim of this study was to examine the visual outcome of patients receiving an intravitreal injection of triamcinolone acetonide (TA) as treatment of diffuse diabetic macular edema (DDME). METHODS: This prospective, placebo-controlled, randomized, clinical interventional study included 40 eyes (38 patients) with DDME, with 28 (70%) eyes randomized to treatment and 12 (30%) eyes randomized to receive a placebo injection. Thirty-six (36) (90%) eyes completed the 3-month study visit, and 32 (80%) eyes completed the 6-month study visit. The treatment group received an intravitreal injection of approximately 20 mg of TA. RESULTS: Visual acuity increased significantly (P < 0.001) in the study group by 3.4 +/- 2.5 Snellen lines. In the control group, visual acuity did not change significantly (P = 0.07) during follow-up. Difference in change of best visual acuity was significant (P < 0.001) between both groups. At 3 months after baseline, 11 (11/26; 42%) eyes and 10 (10/26; 39%) eyes, respectively, improved by at least 2 and 3 lines, respectively, in the study group, versus 2 (2/10; 20%) eyes and 1 (1/10; 10%) eye in the control group. At 6 months after baseline, 11 (11/23; 48%) eyes and 9 (9/23; 39%) eyes, respectively, improved by at least 2 and 3 lines, respectively, in the study group, versus 0 (0%) eyes and 0 (0%) eyes in the control group. The difference was significant for the 2-line improvement (P = 0.01) and 3-line improvement (P = 0.03). CONCLUSIONS: Using a dosage of approximately 20 mg of intravitreal TA, visual acuity temporarily increases for 6 months after injection.     

Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain

AIMS: To assess the effectiveness of enucleation or evisceration in relieving pain from painful blind eyes. METHODS: 24 patients with intractable ocular pain underwent enucleation or evisceration with or without an orbital implant. RESULTS: Complete pain relief was achieved in all patients at an average time of 3 months (range 1-15 months). Seven patients required further medical or surgical treatment in addition to removal of the globe. CONCLUSION: Enucleation and evisceration were effective in relieving ocular pain in all patients with a painful blind eye in our study. However, complications of surgery and orbital implants can cause recurrent pain.     

Rescue of failed filtering blebs with ab interno trephination

We evaluated the effectiveness of ab interno automated trephination as a technique for rescuing failed mature filtering blebs. A retrospective chart review of 40 failed blebs of 38 patients who had a posttrephination follow-up period of at least 3 months was done. With success defined as intraocular pressure (IOP) <21 mm Hg and at least a 20% reduction from baseline on the same or fewer number of pretrephination medications, 30/40 eyes (75%) fit these criteria over the entire course of follow-up. Among all 40 eyes, there was a significant reduction of IOP from pretrephination to 3 months (P<.001). The percentage of patients requiring 2 or more medications declined from 90% pretrephination to 21% at 3 months (P<.0001), and was stable thereafter. Some patients were able to eliminate all medications. Patients who did not meet the criteria of success regained successful IOP control with other modalities of management. Complications were few. We believe that ab interno trephination is an excellent option for rescuing selected failed filtering blebs.     

Kinetics of indocyanine green (ICG) and clinical use for enhancement of transpupillary thermotherapy (TTT) in hypopigmented small choroidal melanomas

BACKGROUND: To determine the efficacy of intravenous indocyanine green (ICG) as an adjuvant to TTT for hypopigmented choroidal melanomas. PATIENTS AND METHODS: ICG kinetics in melanoma tissue were evaluated by taking standardized ICG angiograms in 28 eyes with small choroidal melanomas. In a prospective non-randomized analysis 12 eyes with hypopigmented choroidal melanomas (posterior to the equator with thickness 相似文献   

Intravitreal triamcinolone acetonide injection in blind painful eyes. Intraocular steroids as a treatment for blind painful red eyes

PURPOSE: Phthisis bulbi results from different ocular conditions. We evaluated intravitreal triamcinolone acetonide as a treatment option in blind painful eyes. METHODS: Thirty-one patients with unilateral phthisis were randomly divided into two groups. Group A received 0.3 ml (12.5 mg) triamcinolone acetonide intravitreally and Group B 0.3 ml balanced salt solution after retrobulbar anesthesia. Treatment success was assessed by subjective response to pain and clinically by biomicroscopic evaluation of conjunctival congestion. Tonometry was done before and after treatment. Follow-ups were at 24 hours, 3 weeks, 3 and 6 months, and 1 and 2 years. RESULTS: Throughout the two-year follow-up, only two patients in Group A reported pain after the procedure and were retreated, one at week 4 and the other at week 7. Conjunctival congestion was significantly lower in Group A. Two patients with hypotony before treatment had normal tension after triamcinolone. All Group B patients were reinjected with triamcinolone because pain continued after balanced salt solution injection. No severe complications were found. CONCLUSIONS: Intravitreal triamcinolone acetonide may be effective and safe for treating blind painful eyes.     

Acanthamoeba sclerokeratitis: treatment with systemic immunosuppression

OBJECTIVE: This study describes the clinical features, management, and outcome of 19 patients who had severe Acanthamoeba sclerokeratitis (ASK) unresponsive to conventional management, requiring systemic immunosuppression to control disease. DESIGN: Retrospective, non-comparative, interventional case series. PARTICIPANTS: Records of all patients with Acanthamoeba keratitis treated at Moorfields Eye Hospital between 1989 and 2000 were reviewed. From more than 200 patients, 19 who developed ASK treated with systemic immunosuppression were identified. MAIN OUTCOME MEASURES: Visual acuity, level of pain, and degree of inflammation were recorded after immunosuppressive treatment. RESULTS: ASK requiring immunosuppression occurred in 20 eyes of 19 patients (11 males and 8 females). The mean age (mean +/- standard deviation) at onset was 38.6 +/- 13.2 years. On presentation, best-corrected visual acuity was counting fingers or worse in 11 eyes (55%), 6/18 to 6/60 in 5 eyes (25%), and 6/12 or better in 4 eyes (20%). The mean time between onset of initial symptoms of Acanthamoeba keratitis and commencement of systemic immunosuppression was 4.8 +/- 3.5 months. The mean duration of immunosuppression required to control inflammation was 7.2 +/- 3.9 months. Severe scleritic pain remained uncontrolled in two patients and resulted in enucleation. Best-corrected visual acuity at final follow-up was counting fingers or worse in eight eyes (40%), 6/18 to 6/60 in six eyes (30%), and 20/40 or better in six eyes (30%). The mean follow-up period after resolution of inflammation was 24.3 +/- 20.9 months (range, 0.2-59.7 months). CONCLUSIONS: ASK is an uncommon complication of Acanthamoeba keratitis. The scleritis associated with this infection seems to be an immune-mediated response. After topical amebicidal treatment, systemic immunosuppression may be required to control the pain and tissue destruction associated with ASK.     

Argon laser peripheral iridoplasty in the management of phacomorphic glaucoma.

BACKGROUND AND OBJECTIVE: To document the efficacy and safety of argon laser peripheral iridoplasty (ALPI) as a temporizing measure in the treatment of phacomorphic glaucoma and to evaluate the mid-term visual outcomes. PATIENTS AND METHODS: The clinical records of all patients with phacomorphic glaucoma treated with ALPI from December 1999 to December 2002 were retrospectively reviewed. The primary outcome measure was the rate of successful control of intraocular pressure. Successful cases with at least 12 months of follow-up were further analyzed regarding their outcomes after cataract surgery, including visual acuity, intraocular pressure (IOP), and angle status. RESULTS: ALPI was performed as an initial step in the management of phacomorphic glaucoma in 21 eyes of 21 patients. IOP was successfully controlled in 17 eyes (80.75%), with a statistically significant decrease at 2 and 24 hours postoperatively (P < .0001). Elective cataract surgery was performed in 16 of the 17 successful cases and 12 of these patients completed at least 12 months of follow-up. After a mean follow-up period of 25.58 months, IOP was normal without medications in 11 eyes and only 1 patient required antiglaucoma eye drops to control IOP. All patients achieved a visual acuity of at least 1/60 and 8 (66.67%) of them achieved a visual acuity of 6/21 or better. All patients maintained an open angle without further surgical intervention. No complication was noted directly attributable to ALPI. CONCLUSION: ALPI is a safe and efficacious measure for the initial management of phacomorphic glaucoma, simultaneously obviating the need to operate in highly inflamed eyes in an emergency setting and achieving satisfactory mid-term visual outcome.     

Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results

PURPOSE: To investigate the long-term efficacy and safety of non-penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5-fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery. METHODS: Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP)or=20% drop in IOP or a reduction of at least two medications. RESULTS: Twenty-three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8+/-7.8 to 15.4+/-4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long-term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery. CONCLUSION: NPGS augmented with small-volume MMC/5FU provides good long-term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.     

Trans-tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion remaining after vitrectomy

PURPOSE: To evaluate the effectiveness and safety of trans-Tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion (BRVO) after vitrectomy. DESIGN: Prospective interventional case series. METHODS: The study included 20 eyes of 20 patients with BRVO, characterized by macular edema lasting more than 3 months after vitrectomy. Trans-Tenon retrobulbar injection of 40 mg triamcinolone was performed, and visual and anatomic responses were evaluated. RESULTS: Mean foveal thickness was 499.4 +/- 209.1 microm preoperatively, 281.8 +/- 110.1 microm at 2-week follow-up, and 196.9 +/- 92.1 microm at 6-month follow-up (P < .0001, at 2 weeks and 6 months, paired t test). Improvement of visual acuity by at least 0.2 logMAR (logarithm of the minimum angle of resolution) was seen in 14 (70%) of the 20 eyes. CONCLUSIONS: Trans-Tenon retrobulbar injection of triamcinolone may be an alternative for additional treatment of eyes with BRVO that remains after vitrectomy.     

Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration

PURPOSE: To report on the follow-up of patients who received an intravitreal triamcinolone acetonide injection (IVTA) as treatment of exudative age-related macular degeneration. METHODS: The clinical interventional case-series study included 205 patients (222 eyes) with progressive exudative age-related macular degeneration with subfoveal neovascularization who consecutively received an IVTA of about 20 mg as only therapeutic procedure and for whom follow-up was at least 3 months. Mean follow-up was 10.4+/-7.1 months (range, 3-35.7 months). RESULTS: Visual acuity improved significantly (P<0.001) from baseline (0.90+/-0.45 logarithm of the minimum angle of resolution (LogMar)) to a mean minimum of 0.79+/-0.42 LogMar during follow-up. In 86 (38.7%) eyes and in 55 (24.8%) eyes, best visual acuity increased by at least two and three Snellen lines, respectively. Comparing the measurements at specific postinjection examination dates showed that visual acuity measurements taken at 1, 2, and 3 months after injection were not significantly different from the baseline value. Measurements taken at 6, 9, and 12 months after the injection were significantly (P<0.001) lower than the measurements at baseline. Mean loss at 6 months was 1.4+/-3.8 Snellen lines, at 9 months, 2.5+/-4.6 lines, and at 12 months after the injection, 2.6+/-4.0 lines. Intraocular pressure increased significantly (P<0.001) during the first 6 months, and returned to baseline at 9 months after injection. CONCLUSIONS: Single injection high-dosage IVTA did not show an apparent benefit at 12 months after injection in patients with neovascular age-related macular degeneration.     

玻璃体腔注射Bevacizumab治疗视网膜分支静脉阻塞性黄斑水肿(英文)

目的:观察玻璃体腔注射bevacizumab(Avastin)治疗视网膜分支静脉阻塞性黄斑水肿的有效性和安全性。方法:观察一组视网膜分支静脉阻塞引起黄斑水肿的连续病例,对其进行玻璃体腔注射bevacizumab(Avastin)后的疗效进行分析。所有患者在治疗开始前以及治疗后随诊时间点均进行完全的眼科相关检查,包括视力测定,OCT和/或FFA检查。结果:对32例患者(32眼)分别至少进行一次玻璃体腔注药(1～3次),术后平均观察时间为4.7mo。平均视力:治疗前为20/200-,治疗后1mo20/100-,治疗后3mo及最近一次检查为20/100+(P<0.01);黄斑中心1mm区厚度:治疗前为483μm,治疗后1,3mo及最近一次分别为275,314和301μm(P<0.01)。没有观察到任何不良副作用。结论:玻璃体腔注射bvacizumab(Avastin)治疗能显著减轻视网膜分支静脉阻塞性黄斑水肿、提高视力且没有不良反应。     

Prospective, randomized clinical trial of intravitreal triamcinolone treatment of neovascular age-related macular degeneration: one-year results

PURPOSE: To investigate the effect of intravitreal injection of high-dose (20-25 mg) triamcinolone acetonide on minimally classic or occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: A prospective, double-masked, placebo-controlled, randomized clinical trial included 39 eyes with minimally classic or occult CNV secondary to AMD. The treatment group (21 eyes) received intravitreal injection (20-25 mg) of triamcinolone acetonide and the control group (18 eyes) received intravitreal injection (500 mug) of dexamethasone at 6-month intervals. Best-corrected ETDRS (Early Treatment Diabetic Retinopathy Study) score, contrast sensitivity score, and central macular volume were measured at 1 month, 3 months, 6 months, and 12 months. RESULTS: Mean baseline best-corrected visual acuity (BCVA [logarithm of the minimal angle of resolution]) was 0.64 (Snellen equivalent, 20/80) in each group. At 1 month, 3 months, and 6 months after the injection, neither group had a significant change in BCVA. At 12 months, mean BCVA +/- SD significantly decreased to 1.06 +/- 0.34 (Snellen equivalent, 20/200) in the treatment group (paired t-test, P < 0.001), whereas it was 0.78 +/- 0.52 (Snellen equivalent, 20/125) in the control group (P = 0.23). The difference was marginally significant (P = 0.06, Student's t-test). All phakic eyes in the treatment group developed marked cataract progression. CONCLUSIONS: Intravitreal injection of high-dose triamcinolone had no beneficial effect on eyes with minimally classic or occult CNV secondary to AMD and was associated with outcomes similar to those associated with intravitreal injection of dexamethasone, which was used as placebo.     

Periocular inflammation after retrobulbar chlorpromazine (thorazine) injection

PURPOSE: Retrobulbar chlorpromazine injection is a relatively recently described method of pain control in nonseeing eyes. This report illustrates severe sterile inflammation as a potential complication. METHODS: In this university-based, retrospective, small case series, we reviewed the records of 2 female patients and 1 male patient (ages, 13 to 89 years) who developed severe inflammation after retrobulbar chlorpromazine injection. RESULTS: Three patients had development of severe periocular edema after retrobulbar chlorpromazine injection. Two had development of chemosis, limited extraocular motility, proptosis, and incomplete eyelid closure, necessitating temporary tarsorrhaphy. The third patient had development of facial edema involving the ipsilateral eyelids, forehead, and cheek. Strikingly, it extended to the contralateral face. All 3 patients denied discomfort. In each case, swelling was first noted the day after injection and progressed for 1 week. All were treated with topical lubrication and two with temporary tarsorrhaphy. Resolution occurred within 3 weeks in each case. CONCLUSIONS: Severe periocular inflammation can result from retrobulbar chlorpromazine injection and may manifest as chemosis, proptosis, limited ocular motility, and facial swelling that may extend well beyond the eyelids. Awareness of this potential adverse reaction is important both for patient counseling before injection and subsequent treatment. Specifically, a sterile inflammatory response should be differentiated from infection to avoid inappropriate therapy.     

Trans-Tenon's Retrobulbar Injection of Triamcinolone Acetonide for Diffuse Diabetic Macular Edema

Purpose To determine whether a trans-Tenon's retrobulbar injection of triamcinolone acetonide (TA) is a safe and effective treatment for diffuse diabetic macular edema. Methods Thirty-nine eyes of 30 diabetic patients with persistent macular edema were treated with 20 mg of TA injection. Central macular thickness (CMT) determined by optical coherence tomography (OCT) and visual acuity were evaluated before the injection and at 1, 2, 3, and 6 months, and up to 1 year in some eyes, after the injection. Results The CMT decreased significantly from 478 ± 129 μm (mean ± SD) before injection to 316 ± 102 μm at 1 month, 307 ± 104 μm at 2 months, and 275 ± 89 μm at 3 months after a single injection of TA. A 20% reduction of CMT from the initial value was maintained by a single injection of TA in 27 of 39 eyes (69.2%) at 3 months, in 14 of 22 eyes (63.6%) at 6 months, and in 5 of 7 eyes at 12 months. A recurrence of macular edema was observed in 10% of the eyes at 3 months, and in 22.7% at 6 months. The 17 eyes in which vitrectomy had been carried out had a more significant improvement in CMT than the eyes without vitrectomy. Conclusion A 20-mg trans-Tenon's retrobulbar TA injection is a safe and effective treatment for diabetic macular edema. Jpn J Ophthalmol 2005;49:509–515 ? Japanese Ophthalmological Society 2005     

Diode laser transscleral cyclophotocoagulation for refractory glaucoma

PURPOSE: To evaluate the efficacy of contact diode laser transscleral cyclophotocoagulation using different treatment parameters. METHODS: All eyes undergoing contact diode laser transscleral cyclophotocoagulation between April 1991 and September 1997 at our two institutions were enrolled. Success was defined as an intraocular pressure less than or equal to 22 mm Hg or absence of pain for poorly sighted and blind eyes. RESULTS: Two hundred six eyes of 204 patients (Salzburg, 117 eyes; New York, 89 eyes) were enrolled. Mean patient age was 65.8 +/- 18.7 years (range, 4-96 years). Mean follow-up was 9.2 +/- 11.2 months (range, 3-56 months). Mean preoperative and postoperative IOPs were 42.1 +/- 11.0 mm Hg (range, 24-76 mm Hg) and 17.3 +/- 10.9 mm Hg (P < 0.001) and 20.3 +/- 13.2 mm Hg (P < 0.001) at 12 and 24 months, respectively. The number of laser applications (mean, 18.6 +/- 4.2; range, 10-40) and maximal laser power (mean, 2,352 +/- 408.5 mW; range, 1,500-3,000) were not associated with a lower postoperative IOP. An IOP less than or equal to 22 mm Hg was achieved in 72.7% of eyes at the mean follow-up of 9 months. Thirty-three (16.0%) eyes required at least one retreatment. Phthisis occurred in four (1.9%) eyes. CONCLUSION: Contact diode laser transscleral cyclophotocoagulation is useful in eyes with refractory glaucoma in which the risks of outflow surgery are deemed unacceptable.