Cystoid Macular Edema after Retinal Detachment Surgery

One hundred eyes in 98 patients were studied by fluorescein angiography and stereo color photography six weeks after successful scleral buckling surgery. Twenty-five percent of 67 phakic eyes and 40% of 33 aphakic eyes demonstrated cystoid macular edema. Older phakic patients were at significantly greater risk to develop cystoid macular edema than younger phakic patients. Seventeen percent of successfully repaired eyes demonstrated distortion of the macula by preretinal membranes; 16 of these 17 eyes showed leakage of fluorescein dye into the surrounding retina sometimes also causing cystoid edema. Either cystoid macular edema or macular distortion was present in 38% of the phakic eyes and 64% of the phakic eyes after successful retinal detachment surgery.     

Epidemiology of Macular Edema in Uveitis

Purpose: To describe the epidemiology of macular edema (ME) in patients with uveitis.

Methods: Review of articles listed on PubMed pertaining to uveitic ME.

Results: Reported rates of uveitic ME ranging from 20% to 70%, depending on the ancillary tests used (fundus examination, fluorescein angiography, optical coherence tomography). Macular edema might develop due to uveitis itself, or occur as an adverse effect of drugs taken for different diseases. It is more frequently observed in adults than in children, in chronic uveitis, and in intermediate uveitis. Males with ankylosing spondylitis are more prone to develop ME than females. Three patterns of uveitic ME are observed, either isolated or in combination: cystoid ME, the most frequently encountered pattern seen in up to 80% of cases, diffuse ME and serous retinal detachment.

Conclusion: Older age, chronicity of uveitis and intermediate uveitis are risk factors for the development of ME in patients with uveitis.     

Complications of Femtosecond-Assisted Laser In-Situ Keratomileusis Flaps

Abstract

Femtosecond-assisted laser in-situ keratomileusis flaps have revolutionized refractive surgery since their introduction. Although these lasers are exceedingly safe, complications still do occur. This review focuses specifically on examining the literature and evidence for flap complications during femtosecond-assisted laser in-situ keratomileusis as well as their management.     

LASEK与LASIK治疗高度近视

目的:对比观察准分子激光上皮瓣下角膜磨削术(LASEK)与准分子激光原位角膜磨削术(LASIK)治疗高度近视的临床疗效。评估2种手术的安全性和有效性。方法:对行LASEK治疗的39例75只眼和同期行LASIK治疗的41例79只眼高度近视分别进行6个月以上的临床观察。结果:LASEK组术后1周至1个月达最佳矫正视力,术后3个月部分出现视力回退,术后6个月裸眼视力达术前矫正视力占95.83%,主要并发症有术后高眼压及Haze形成;LASIK组术后6个月裸眼视力达术前矫正视力占94.35%,主要并发症为屈光回退,角膜上皮内生或角膜瓣皱折等。结论:LASIK与LASEK均能安全、有效地矫正高度近视。     

Selective Laser Trabeculoplasty Complicated by Cystoid Macular Edema: Report of Two Cases

 Purpose: Selective laser trabeculoplasty, a relatively novel treatment for open angle glaucoma, is frequently associated with mild post-operative intraocular inflammation. Methods: We report two uncommon cases of cystoid macular edema within a few weeks of routine selective laser trabeculoplasty. Results: Visual acuities and macular thicknesses of the two cases returned to baseline after medical treatment, but in one case, the cystoid macular edema persisted for months. Conclusion: Cystoid macular edema after selective laser trabeculoplasty is fortunately a rare complication, but it might be more common in patients with predisposing factors, and it can be resistant to treatment.     

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema

Purpose

To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy.

Methods

Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both.

Results

The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 ± 0.15, 0.36 ± 0.18, 0.31 ± 0.14, and 0.34 ± 0.22, respectively. The mean CSTs were 433.3 ± 77.9, 329.9 ± 59.4, 307.2 ± 60.2, and 310.1 ± 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012).

Conclusions

Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.     

Anterior Vitrectomy for Chronic Aphakic Cystoid Macular Edema

This report describes a series of 13 patients who underwent anterior vitrectomies for chronic aphakic cystoid macular edema (CME). All eyes had formed vitreous adherent to the intracapsular wound, vision of 20/50 or worse, and fluorescein angiographically documented CME for six months or more. Following the presentation of the results (success rate of 69%) and a discussion of this form of treatment, the beginning of a national, randomized, prospective study designed to evaluate the effectiveness of this treatment is described.     

Dry Eye after Laser In-Situ Keratomileusis

Abstract

Laser-assisted in-situ keratomileusis (LASIK) is one of the most commonly performed refractive procedures with excellent visual outcomes. Dry eye syndrome is one of the most frequently seen complications after LASIK, with most patients developing at least some mild dry eye symptoms postoperatively. To achieve improved visual outcomes and greater patient satisfaction, it is essential to identify patients prone to dry eyes preoperatively, and initiate treatment early in the course. Enhanced understanding of the pathophysiology of post-LASIK dry eye will help advance our approach to its management.     

Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery

Purpose

To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME).

Methods

A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery.

Results

Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery.

Conclusions

Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.     

准分子激光原位角膜磨镶术手术治疗超高度近视合并散光

目的观察准分子激光原位角膜磨镶术（LASIK）治疗超高度近视合并散光的临床效果。方法采用准分子激光原位角膜磨镶术治疗52例（101眼）超高度近视合并散光患者,球镜度-10.00D～-14.00D,散光-0.50～-4.50DC。结果术后1天、1、3、6月裸眼视力与术前预期最佳矫正视力符合率分别为78.2%、85.1%、92.1%、87.1%;术后6个月,实际矫正屈光度与术前预期矫正符合率球镜93.1%、柱镜87.1%。结论LASIK治疗超高度近视合并散光,视力恢复快,安全可靠。     

Somatostatin for Uveitic Cystoid Macular Edema (CME)

Purpose: To report the favorable response of bilateral recalcitrant uveitic cystoid macular edema (CME) to treatment with a somatostatin analog. Methods: Medical ophthalmic history and the results of ophthalmic examinations were recorded. Fluorescein angiography (FA) studies were reviewed. Results: A 52-year-old white female with intermediate uveitis developed bilateral recalcitrant CME. Treatment with subcutaneous injections of the somatostatin analog octreotide resulted in partial resolution of the CME and improvement of visual acuity. Conclusions: Somatostatin may play a role in the treatment of CME secondary to uveitis.     

黄斑囊样水肿的多焦视网膜电图

目的:评价黄斑囊样水肿患者于视网膜后极部不同部位的视功能。 方法:应用VERIS 4.0视诱发反应仪检测了黄斑囊样水肿24例27只眼(包括中央静脉阻塞,糖尿病性视网膜病变,葡萄膜炎)的多焦视网膜电图(multifocal electroretinogram,mfERG),年龄30～75岁,平均(55.58±13.31)岁,病程均在1年以上;正常对照组为25例29只眼,年龄34～71岁,平均(51.08±9.27)岁。记录后极部26.6°X22.1°视野内103个视网膜区域的一阶反应曲线和三维功能图。 结果:黄斑囊样水肿患者的mfERG的N1波和P1波的潜伏期于全区和6个环区域均较正常对照组明显延迟(P<0.01)。于1、2、3环N1波的平均反应密度降低,与对照组比较均有非常显著性差异(P<0.01),而于4、5、6环区平均反应密度无显著性改变(P>0.05),P1波的平均反应密度于全区和6个环区域与对照组比较均有显著性差异(P<0.05)。 结论:mfERG是评价黄斑囊样水肿于视网膜后极部不同部位视功能的有效工具。N1波的反应密度是分析黄斑水肿较好的指标。眼科学报 2003;19:253-256。     

Surgical Therapy for Chronic Aphakic Cystoid Macular Edema

Aphakic cystoid macular edema (ACME) is a common condition seen after intracapsular cataract extractions. In an overwhelming majority of these cases, the condition improves spontaneously. Those cases that persist for months or years, however, are often associated with vitreous strands adherent to the surgical wound and distortion of the pupil. This article reviews the surgical and photocoagulation therapies for this condition that have been reported over the past two decades. All studies report encouraging results, but all have been nonrandomized, uncontrolled trials. This paper describes two randomized, controlled clinical studies that are attempting to evaluate objectively the role of vitrectomy for chronic cases of aphakic cystoid macular edema.     

Evidence-Based Treatment of Diabetic Macular Edema

ABSTRACT

Diabetes mellitus is a chronic disease that affects 415 million people worldwide. Despite treatment advances, diabetic eye disease remains a leading cause of vision loss worldwide. Diabetic macular edema (DME) is a common cause of vision loss in diabetic patients. The pathophysiology is complex and involves multiple pathways that ultimately lead to central retinal thickening and, if untreated, visual loss. First-line treatment of DME has evolved from focal/grid laser established by the Early Treatment of Diabetic Retinopathy Study (ETDRS) to intravitreous pharmacologic therapy. Landmark prospective clinical trials examining the effect of intravitreous injections of vascular endothelial growth factor (VEGF) inhibitors in the treatment of DME have demonstrated improved visual outcomes over focal grid laser. This review focuses on the scientific evidence treatment of DME, disease pathophysiology, clinical disease course, current treatment standards, and emerging novel therapeutic approaches.     

Cystoid Macular Edema Secondary to Fluconazole Toxicity

Fluconazole is an antifungal commonly used to treat Coccidioides immitis, but this medication has a number of side effects including fatigue, rash, headache, dizziness, nausea, vomiting, diarrhea, and elevated liver enzymes. We are unaware of any cases of retinal toxicity related to fluconazole. In this case we present a 76 year old woman with longstanding Coccidioides treated with high dose fluconazole. She becomes symptomatic with fluconazole toxicity and subsequently develops bilateral cystoid macular edema. As her dose of fluconazole is decreased and she is transitioned to voriconazole the edema resolves and her visual acuity improves. This patient’s clinical course illustrates retinal toxicity may present with high and prolonged doses of fluconazole.     

Differentiation of Underlying Pathologies of Macular Edema Using Spectral Domain Optical Coherence Tomography (SD-OCT)

Purpose: To describe the morphological characteristics of macular edema (ME) of different origins using spectral domain optical coherence tomography (SD-OCT).

Methods: This article summarizes and highlights key morphologic findings, based on published articles, describing the characteristic presentations of ME of different origins using SD-OCT. The following pathologies were included: uveitic macular edema, pseudophakic cystoid macular edema (PCME), diabetic macular edema (DME), macular edema secondary to central or branch retinal vein occlusion (CRVO/BRVO), microcystic macular edema (MME), ME associated with epiretinal membrane (ERM), and retinitis pigmentosa (RP).

Conclusions: Macular edema of different origins show characteristic patterns that are often indicative of the underlying cause and pathology. Thus, trained algorithms may in the future be able to automatically differentiate underlying causes and support clinical diagnosis. Knowledge of different appearances support the clinical diagnosis and can lead to improved and more targeted treatment of ME.     

Vitrectomy and Cystoid Macular Edema

Twenty-two patients who underwent vitrectomy surgery for chronic cystoid macular edema (CME) were evaluated. These patients all had uneventful intracapsular cataract extraction, but CME with vitreous adhesions to the cataract incision later developed. Vitrectomy was performed to remove the vitreous from the anterior segment structures in each case. Nineteen of the 22 patients showed improved visual acuities within six months, and all but two had complete resolutions of the CME by one year. These two patients did show marked improvements of visual acuity. The majority of patients younger than 65 years of age had final visual acuities of 20/50 or better, whereas the majority of those older than 65 years had less than 20/50. The results were not influenced by the duration or the pattern of the CME prior to vitrectomy. A prospective study to determine the value of vitrectomy in this type of patient is suggested.     

单次玻璃体腔注射雷珠单抗联合激光治疗视网膜分支静脉阻塞继发黄斑水肿

目的：观察单次玻璃体腔注射雷珠单抗联合激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿的临床疗效。方法：回顾性系列病例研究。选择2014 年6月至2016 年12 月在台州市眼科医院经荧光素眼底血管造影确诊的视网膜分支静脉阻塞继发黄斑水肿的患者52例（52眼）,根据是否联合雷珠单抗治疗分为单纯激光组和联合治疗组,联合治疗组又根据接受雷珠单抗及激光治疗的先后顺序分为先激光组和后激光组。分别测量并记录患者治疗前,治疗后1、6 个月最佳矫正视力（BCVA）及黄斑中心凹厚度（CMT）。采用重复测量方差分析、单因素方差分析和配对t检验对数据进行统计学分析。结果：治疗前,治疗后1、6个月3组间BCVA总体差异有统计学意义（F=18.28,P=0.011）。治疗后1、6个月同一时间点3 组间BCVA比较,单纯激光组分别低于先激光组和后激光组（P < 0.01）。3 组治疗后6 个月BCVA较治疗前均有所提高,差异均有统计学意义（t=8.49、14.57、20.12,P < 0.01）。治疗前,治疗后1、6 个月3 组间CMT值总体差异有统计学意义（F=5.72,P=0.025）。治疗后1、6 个月同一时间点3 组间CMT值比较,单纯激光组分别大于先激光组和后激光组（P < 0.01）。3 组治疗后1、6 个月较治疗前CMT值均有所下降,差异均有统计学意义（P < 0.01）。结论：单次玻璃体腔注射雷珠单抗联合视网膜激光光凝治疗可有效减轻视网膜分支静脉阻塞继发黄斑水肿,提高患者的视力,其作用较单纯激光光凝治疗更加明显。     

Diabetic Macular Edema: Pathogenesis and Treatment

Diabetic macular edema is a major cause of visual impairment. The pathogenesis of macular edema appears to be multifactorial. Laser photocoagulation is the standard of care for macular edema. However, there are cases that are not responsive to laser therapy. Several therapeutic options have been proposed for the treatment of this condition. In this review we discuss several factors and mechanisms implicated in the etiology of macular edema (vasoactive factors, biochemical pathways, anatomical abnormalities). It seems that combined pharmacologic and surgical therapy may be the best approach for the management of macular edema in diabetic patients.     

Intravitreal Dexamethasone Implant for the Treatment of Macular Edema in Chronic Non-infectious Uveitis

Purpose: To report observations on the single and repeat use of the dexamethasone (DEX) intravitreal implant (Ozurdex; Allergan, Inc, Irvine, CA) for the treatment of macular edema in patients with non-infectious posterior segment uveitis.

Methods: A chart review of 15 consecutive patients (25 eyes) was conducted. The primary outcome measure of the first and subsequent implants was central retinal thickness (CRT) on spectral-domain optical coherence tomography (sdOCT). Secondary outcomes were best-corrected visual acuity (BCVA), time to repeat implant, and adverse events. Multilevel mixed-effects linear regression was used to determine the effect of the DEX implant compared with baseline. The Kaplan–Meier estimator was used to examine survival from relapse.

Results: A total of 35 implants on 25 eyes of 15 patients were included in the analysis. Of these, 91.4% (32 of 35 eyes) had a reduction in CRT and 80% (20 of 25 eyes) had improved BCVA. After the first DEX implant, CRT decreased from 590 µm (SE: 28 µm) at baseline to 370 µm (SE: 31 µm) at 3 months (p < 0.001). The logMAR VA was 0.614 (SE: 0.089) at baseline and improved to 0.35 (SE: 0.10, p = 0.002), reaching a statistically significant difference at 3 months. A repeat implant led to VA improvement of –0.184 logMAR (SE: 0.171 logMAR) and CRT reduction of –291 µm (SE: 74 µm). There was no significant difference in effect between the first repeat implant and the initial implant. Kaplan–Meier estimates of treatment success were 72% between 3 and 6 months.

Conclusions: The DEX implant is an effective adjunct treatment to systemic corticosteroid or immunomodulatory therapy. Additional research is required to determine the efficacy of DEX implant as monotherapy for controlling chronic uveitic macular edema.