Cystoid puncture for chronic cystoid macular oedema

OBJECTIVE: To evaluate the new surgical technique of cystoid macular oedema puncture (CMOP) in patients with longstanding cystoid macular oedema refractory to standard treatments. DESIGN: Interventional, retrospective case series METHODS: Retrospective review of patients with chronic cystoid macular oedema from vascular retinopathy for whom maximal medical or surgical treatment failed and who underwent pars plana vitrectomy and CMOP. Clinical findings, best-corrected Snellen visual acuity, stereo colour fundus photography, intravenous fluorescein angiograms, and optical coherence tomography were obtained before and after treatment to evaluate the efficacy and safety of the treatment. RESULTS: Seven patients were included in the study. Cystoid macular oedema was due to diabetic retinopathy in five patients, central retinal vein occlusion in one patient and branch retinal vein occlusion in one patient. Preoperative intravitreal steroids failed for all patients, and three patients also had focal grid photocoagulation. Previous pars plana vitrectomy, with elevation of the posterior hyaloid, internal limiting membrane peeling, and intravitreal steroid injection, had failed in three patients. The median time to CMOP was 488 days. Resolution or improvement of cystoid oedema occurred in all patients as determined by fluorescein angiography or optical coherence tomography, or both. However, visual acuity was unchanged in five patients, declined in one patient and stable in one patient. CONCLUSIONS: Although cystoid macular oedema does improve quantitatively after CMOP, the technique fails to improve visual acuity in patients.     

Bilateral CRAO and CRVO from thrombotic thrombocytopenic purpura: OCT findings and treatment with triamcinolone acetonide and bevacizumab.

A patient with thrombotic thrombocytopenic purpura secondary to adult-onset Still's disease presented with bilateral combined central retinal artery occlusion and central retinal vein occlusion, a rare complication reported only once before. Fundus appearance and fluorescein angiography were similar to the previous case. Optical coherence tomography findings demonstrated aspects consistent with both central retinal artery occlusion and central retinal vein occlusion. Treatment of one eye with intravitreal triamcinolone acetonide (4 mg) was not effective in improving visual acuity. Treatment of both eyes with intravitreal bevacizumab (1.25 mg) and panretinal photocoagulation was effective in eliminating iris neovascularization, although the patient lost all visual function.     

Combined radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide for central retinal vein occlusion.

To evaluate the efficacy of radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide for central retinal vein occlusion. Eight consecutive eyes with central retinal vein occlusion with a duration of less than 6 months, cystoid macular edema, and best-corrected visual acuity (BCVA) of less than 20/200 were enrolled. BCVA, intraocular pressure, fluorescein angiography, and optical coherence tomography were evaluated. After 4.75 +/- 0.7 months, BCVA significantly improved, intraocular pressure was well controlled, and fluorescein angiography showed perfused state and reduction of the number of retinal hemorrhages in all eyes. Optical coherence tomography revealed significant reduction of macular thickness. Bleeding in the neurotomy site occurred in 3 cases. Radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide may be useful in the management of central retinal vein occlusion with macular edema.     

Intravitreal bevacizumab (Avastin) for occult choroidal neovascularization in age-related macular degeneration.

BACKGROUND: The purpose of the study is to report data on short-term safety of intravitreal bevacizumab treatment and its effect on visual function, central retinal thickness, and angiographical changes of occult choroidal neovascularization due to age-related macular degeneration. METHODS: A consecutive interventional case series of 30 patients with active subfoveal occult choroidal neovascularization secondary to age-related macular degeneration was followed after one intravitreal injection of 1.25 mg bevacizumab at baseline and subsequent injections following standardized criteria. At baseline and follow-up visits patients had visual acuity assessment, intraocular pressure measurement, fluorescein angiography, and optical coherence tomography imaging. RESULTS: No serious ocular or systemic adverse events were identified. A significant increase of intraocular pressure or signs of retinal toxicity or endophthalmitis were not detected in any patient. Optical coherence tomography revealed significant decrease (p < 0.001) in central retinal thickness after 1 week, 4 weeks, and 12 weeks, respectively. Fluorescein leakage decreased within 1 week and improvement was maintained at week 12 in the majority of patients. Visual acuity improved or remained stable in 29 of 30 patients; improvement of 3 or more lines was seen in 14 of 30 patients; one patients showed improvement of 6 lines. No patient had severe vision loss of 6 lines or more; moderate vision loss of 3 lines was seen in one patient. Re-injections of bevacizumab according to standard criteria were performed one to two times during the follow-up period of 12 weeks with a re-injection interval of 4 to 18 weeks (median 8 weeks). CONCLUSIONS: Short-term results suggest that intravitreal injection of bevacizumab is well tolerated and for the majority of patients with occult choroidal neovascularization in AMD results in improvement of visual acuity, decrease in central retina thickness, and reduction of angiographic leakage of the lesion. Bevacizumab as intravitreal treatment may provide a novel therapeutic option for selected patients with exudative AMD. Randomized prospective multicenter trials seem justified to further evaluate long term effects and impact of intravitreal bevacizumab on different subtypes of AMD compared to established therapies.     

Ischemic maculopathy following intravitreal bevacizumab for refractory diabetic macular edema

A 58-year-old male presented with decreased visual acuity from persistent diffuse diabetic macular edema despite multiple interventions including laser photocoagulation and intravitreal triamcinolone acetonide injections. Following treatment with 1.25 mg of intravitreal bevacizumab, reduction in macular leakage was shown by fluorescein angiography and resolution of edema was shown by optical coherence tomography (OCT); however, visual acuity deteriorated and fluorescein angiograms demonstrated progressive enlargement of the foveal avascular zone (FAZ), which had shown no abnormalities before the injection. Despite normalisation of macular thickness on OCT and cessation of leakage on angiography, visual acuity remained at the same level until 6 months of follow-up. Intravitreal bevacizumab must be used with caution in patients with chronic, persistent diabetic macular edema. Disruption of the fragile fine foveal network of capillaries with induction of macular ischemia may result following treatment even if there are no pre-existing defects in the FAZ and may be responsible for non-improvement or decrease in visual acuity.     

Foveal Exudative Macroaneurysm Treated with Intravitreal Ranibizumab

PurposeWe report a case of a foveal macroaneurysm with long-standing macular edema in a rare location, successfully treated with intravitreal ranibizumab.MethodsWe report the case of a 52-year-old man with left eye long-term visual loss due to macular edema caused by a retinal macroaneurysm, localized about 400 μm from the center of the fovea, and its response to 6 monthly ranibizumab intravitreal injections. His best-corrected visual acuity and morphological data evaluated by optical coherence tomography and fluorescein angiography are presented.ResultsHis best-corrected visual acuity improved from 1/10 to 3/10 after the 3rd injection, and from 1/10 to 4/10 after the 6th one. The central retinal thickness was evaluated by optical coherence tomography and improved from 310 to 233 μm, with the resolution of both the associated serous detachments and the cystoid macular edema; an almost complete reabsorption of the hard exudates at the end of the treatment was also observed. The macroaneurysm lumen almost obliterated after the 3rd injection and completely collapsed at the end of treatment.ConclusionsIntravitreal ranibizumab may be effective in the treatment of long-standing macular edema associated with foveal macroaneurysms. To the best of our knowledge, this is the first report of a retinal macroaneurysm located so close to the foveal avascular zone.Key Words: Exudative retinal macroaneurysm, Fovea, Intravitreal ranibizumab     

Arteriovenous sheathotomy for persistent macular edema in branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. METHODS: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. RESULTS: The mean preoperative BCVA (log MAR) were 0.79 +/- 0.29 and postoperative BCVA (log MAR) at 3 months was 0.57 +/- 0.33. And improvement of visual acuity > or = 2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22 +/- 76.83 microm (510-737 microm) and postoperative fovea thickness was 217.60 +/- 47.33 microm (164-285 microm). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.     

Congenital retinal macrovessel: atypical presentation using optical coherence tomography

To describe a congenital retinal macrovessel with macular thickening. This case was investigated using fundus photography, fluorescein angiography, Spectralis optical coherence tomography and a 10–2 visual field test. A 23-year-old man was referred to our clinic with decreased vision in the right eye. Fundus examination of the right eye revealed a congenital retinal macrovessel that originated inferior to the superotemporal branch of the central retinal vein. Using fluorescein angiography, early filling and delayed emptying of the aberrant vein were observed. Spectralis optical coherence tomography demonstrated macular thickening and was supported by a 10–2 visual field test that revealed a relative scotoma corresponding to the same location. At the 18-month follow-up, visual acuity remained stable. Although rare, this case demonstrated that macular thickening can cause decreased visual acuity in the presence of a congenital retinal macrovessel.     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

Optical coherence tomography study in tamoxifen maculopathy

CASE REPORT: We describe the case of a patient who presented with progressive and bilateral loss of vision. She had been treated with tamoxifen for 13 years. We performed fluorescein angiography and optical coherence tomography in order to study the macula. DISCUSSION: Loss of visual acuity related to tamoxifen maculopathy may be caused either by retinal nerve fibre atrophy or macular oedema. Macular findings obtained by fluorescein angiography and optical coherence tomography are complementary.     

Intravitreal bevacizumab (Avastin) for occult choroidal neovascularization in age-related macular degeneration

Background The purpose of the study is to report data on short-term safety of intravitreal bevacizumab treatment and its effect on visual function, central retinal thickness, and angiographical changes of occult choroidal neovascularization due to age-related macular degeneration. Methods A consecutive interventional case series of 30 patients with active subfoveal occult choroidal neovascularization secondary to age-related macular degeneration was followed after one intravitreal injection of 1.25 mg bevacizumab at baseline and subsequent injections following standardized criteria. At baseline and follow-up visits patients had visual acuity assessment, intraocular pressure measurement, fluorescein angiography, and optical coherence tomography imaging. Results No serious ocular or systemic adverse events were identified. A significant increase of intraocular pressure or signs of retinal toxicity or endophthalmitis were not detected in any patient. Optical coherence tomography revealed significant decrease (p < 0.001) in central retinal thickness after 1 week, 4 weeks, and 12 weeks, respectively. Fluorescein leakage decreased within 1 week and improvement was maintained at week 12 in the majority of patients. Visual acuity improved or remained stable in 29 of 30 patients; improvement of 3 or more lines was seen in 14 of 30 patients; one patients showed improvement of 6 lines. No patient had severe vision loss of 6 lines or more; moderate vision loss of 3 lines was seen in one patient. Re-injections of bevacizumab according to standard criteria were performed one to two times during the follow-up period of 12 weeks with a re-injection interval of 4 to 18 weeks (median 8 weeks). Conclusions Short-term results suggest that intravitreal injection of bevacizumab is well tolerated and for the majority of patients with occult choroidal neovascularization in AMD results in improvement of visual acuity, decrease in central retina thickness, and reduction of angiographic leakage of the lesion. Bevacizumab as intravitreal treatment may provide a novel therapeutic option for selected patients with exudative AMD. Randomized prospective multicenter trials seem justified to further evaluate long term effects and impact of intravitreal bevacizumab on different subtypes of AMD compared to established therapies.     

Intravitreal bevacizumab for macular edema from idiopathic juxtafoveal retinal telangiectasis.

To assess the potential visual benefit of intravitreal bevacizumab in a patient with idiopathic juxtafoveal retinal telangiectasis refractory to focal laser treatment, an intravitreal injection of bevacizumab (1.25 mg) was given. Within 1 week, visual acuity improved from 20/50 to 20/25 and optical coherence tomography demonstrated complete resolution of macular edema. There was no adverse effect. The macular edema recurred after 3 months, requiring a repeat injection of bevacizumab with subsequent resolution of macular edema. An intravitreal injection of bevacizumab may provide potential short-term visual benefit in patients with macular edema from idiopathic juxtafoveal retinal telangiectasis.     

Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion

PURPOSE: To assess the long-term safety and efficacy of intravitreal triamcinolone acetonide injection in the management of macular oedema caused by central, hemi-, and branch retinal vein occlusion (CRVO, HRVO, or BRVO). METHODS: This prospective, interventional case series included 13 patients (13 eyes) with retinal vein occlusion and macular oedema. They received an intravitreal injection of 4 mg triamcinolone acetonide. Follow-up was for 1 year with repeat injections where appropriate. Outcome measures were visual acuity and macular thickness measured using ocular coherence tomography (OCT). RESULTS: There were four patients with CRVO, one with HRVO, and eight with BRVO (13 eyes). Mean duration of symptoms before intravitreal triamcinolone acetonide injection was 6.8 months (SD 4.5 months). Eight eyes (62%) responded well with improved visual acuity and macular thickness 1-3 months postinjection. All eight eyes developed recurrent macular oedema and five received repeat injections. Three patients declined a second injection. No improvement in visual acuity or OCT macular thickness was seen after the second injection with visual acuity returning to baseline levels at 1-year follow-up. Three eyes (23%) showed no response to the initial injection (no improvement in macular thickness or visual acuity). Seven patients (54%) had a rise in intraocular pressure with six (46%) requiring treatment. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide is effective as a short-term treatment of macular oedema owing to retinal vein occlusion, improving both visual acuity and macular thickness. However, this effectiveness is not maintained after 1 year despite repeat injections.     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

Intravitreal triamcinolone and laser photocoagulation for retinal angiomatous proliferation

BACKGROUND: Recently, the entity of retinal angiomatous proliferation (RAP) as a subtype of exudative age-related macular degeneration was described, but no treatment options have been established as yet. The only two therapeutic modalities being discussed are surgical lysis of the feeding arteriole and draining venule, and the use of photodynamic therapy combined with intravitreal triamcinolone injection. AIM: To examine focal laser treatment of early extrafoveal intraretinal neovascularisation of RAP. METHODS: Prospective case series. We included 13 consecutive patients with an extrafoveal RAP stage I lesion. All patients underwent a complete ophthalmic examination, including fluorescein angiography and optical coherence tomography (OCT) III before treatment and at 2 weeks, 1, 2 and 4 months afterwards. In cases with marked macular oedema (>350 mum retinal thickening in OCT III, r = 12), intravitreal injection of 4 mg triamcinolone was given before focal laser treatment to reduce the oedema. RESULTS: This case series indicates anatomical improvement or stabilisation in patients with an extrafoveal RAP lesion after treatment. Initial visual acuity ranged from 0.1 to 0.6 on the Snellen chart. By calculating logarithmic values, visual acuity was seen to be improved in five cases (2 to 5 log lines), deteriorated in four cases (-2 to 5 log lines) and stabilised in four cases (-1 to +1 log line change). Exudation on fluorescein angiography was stopped in 11 cases. CONCLUSIONS: This preliminary case series suggests laser photocoagulation combined with prior intravitreal triamcinolone injection as a viable treatment option for RAP stage I. In cases with marked macular oedema, intravitreal triamcinolone injection improved visual acuity. For long-term stabilisation, additional laser treatment is mandatory. These preliminary results warrant a more detailed prospective clinical trial.     

视网膜光凝联合雷珠单抗玻璃体内注射治疗视网膜中央静脉阻塞

目的：研究氩激光视网膜光凝联合雷珠单抗玻璃体内注射治疗缺血型视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)伴发黄斑水肿及视网膜新生血管的临床疗效。

方法：回顾性分析2012-01/2013-05就诊于我院眼科确诊的缺血型CRVO 24例24眼患者行氩激光视网膜光凝联合雷珠单抗玻璃体内注射治疗。观察治疗前及治疗后1wk; 1,3,6mo的最佳矫正视力、眼压、眼底病变情况,治疗前和治疗后1,3,6mo的眼底荧光血管造影(FFA)表现和光学相干断层扫描(OCT)测量黄斑中心凹视网膜厚度(CMT)的改变。

结果：随诊时间大于6mo。20例(83%)患者视力有不同程度提高,其中17例(71%)患者黄斑水肿明显减轻或消失; 4例患者视力维持于就诊时水平。1例治疗前有虹膜新生血管,治疗后1mo虹膜新生血管消退无继发新生血管性青光眼发生。

结论：氩激光视网膜光凝联合雷珠单抗玻璃体内注射治疗缺血型CRVO可有效提高视力,促进视网膜出血、渗出及水肿的吸收,同时可减少视网膜静脉阻塞引起的新生血管,对预防继发性新生血管性青光眼的发生有明显效果。     

Exudative retinal detachment due to small noncalcified retinal astrocytic hamartoma

PURPOSE: To report a case of exudative retinal detachment due to small noncalcified retinal astrocytic hamartoma and review pertinent literature. DESIGN: Case report and review of literature. METHODS: Clinical examination, fluorescein angiography, optical coherence tomography, and laser treatment were performed. RESULTS: Exudative macular detachment caused by a small noncalcified retinal astrocytic hamartoma confirmed by optical coherence tomography regressed completely after laser therapy. Visual acuity improved only slightly because lamellar macular thinning developed after subretinal fluid and macular exudates resolved. CONCLUSIONS: Small noncalcified, parafoveal retinal astrocytic hamartomas may cause macular retinal detachment. Optical coherence tomography may aid in the diagnosis of the tumor. Argon laser photocoagulation may induce tumor regression and resolution of exudative detachment. Final visual acuity may be limited in some cases.     

Intraocular bevacizumab for macular edema due to CRVO. A multifocal-ERG and OCT study

Purpose To evaluate by multifocal electroretinography (MFERG) and optical coherence tomography (OCT) the effectiveness of intravitreal use of bevacizumab (Avastin) in the treatment of macular edema due to central retinal vein occlusion (CRVO). Methods A total of 10 eyes of 10 patients (six males and four females) with macular edema due to CRVO were studied before and after intravitreal use of bevacizumab with MFERG and OCT. The post treatment follow-up was 3 months. Examination included measurement of best-corrected visual acuity (BCVA) for distance, measurement of intraocular pressure (IOP), fluorescein angiography, foveal-retinal thickness measurement by OCT, and MFERG recordings before treatment and 1 and 3 months after treatment. Results Before treatment, OCT shows an increase of the retinal thickness of the fovea. About 1 and 3 months after treatment the foveal thickness decreased to a significant level. The electrical responses in the fovea and parafovea of the MFERG recording depicted a significant improvement at 1 and 3 months after the injection. No patient manifested IOP increase. Conclusion The intravitreal use of bevacizumab may provide anatomical and functional amelioration of the macula in patients with macular edema due to CRVO. However, further study is needed in order to assess the treatment’s long-term efficacy.     

Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular edema from central retinal vein occlusion.

To determine whether bevacizumab could improve visual acuity and optical coherence tomography outcomes in a patient with macular edema from central retinal vein occlusion, an intravitreal injection of bevacizumab (1.0 mg) was given. Prior intravitreal injections of triamcinolone acetonide resulted in vision improvement but worsening cataract and borderline glaucoma. Within 1 week of the bevacizumab injection, visual acuity improved from 20/200 to 20/50 and optical coherence tomography revealed resolution of the cystic maculopathy. The improvements were maintained for at least 4 weeks. Intravitreal injections of bevacizumab may provide another treatment option for patients with macular edema from vein occlusions.     

玻璃体腔注射曲安奈德治疗视网膜静脉阻塞黄斑水肿

目的:评价玻璃体腔注射曲安奈德治疗视网膜静脉阻塞合并黄斑水肿的疗效及并发症。方法:患者30例30眼玻璃体腔注射曲安奈德4mg治疗视网膜静脉阻塞合并黄斑水肿,观察治疗前、后的最佳矫正视力、眼压、裂隙灯显微镜检查、眼底荧光血管造影和光学相干断层扫描的变化,采用SPSS 12.0软件进行统计学分析。结果:所有患者手术后视力均显著提高,平均黄斑中心凹厚度(CMT)显著减少。病程、年龄、注射前CMT及视网膜静脉阻塞的类型和视力预后无相关性,注射前视力与注射后末次视力呈正相关。结论:玻璃体腔注射曲安奈德治疗视网膜静脉阻塞合并黄斑水肿简单、安全、易操作,短期内可以迅速减轻黄斑水肿,最终的视力预后取决于治疗前的视力,部分患者在注射后3 ～6mo可能复发。