New perspectives in the management of post-surgical macular edema

Post-surgical macular edema is the most common cause of vision loss after phacoemulsification, and one of the main causes of reduced vision in patients undergoing other ocular surgery. At present, there are no reliable randomized clinical trials specifically designed to define the best therapeutic approach, and little information is available regarding the treatment algorithm of acute or chronic forms. As a consequence, there is no agreement regarding the current management of post-surgical macular edema. Many therapeutic options have been proposed on the basis of the hypothesized pathogenetic mechanism of post-surgical macular edema. New therapies for post-surgical macular edema include non-steroidal anti-flammatory drugs and intraocular steroid implants. Aim of the review is to update the current management of postsurgical macular edema, reporting on the most recent therapeutic advances. In particular, we discuss the potential applications of recent patents with topical and intravitreal drugs.     

Multimodal morphological and functional characterization of Malattia Leventinese

Background

To analyze the morphological and functional characteristics of malattia leventinese.

Methods

This was a chart review of patients with Malattia Leventinese. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). Microperimetry and Preferential Hyperacuity Perimeter (PHP) were performed in a subset of patients.

Results

Twelve eyes of six patients were included. BCVA ranged from 20/25 to 20/200. The largest drusen were round, not radially distributed, localized in the perimacular area and around the optic disc. The smallest drusen were not round, radially distributed, mostly localized temporally to the macula. FAF revealed an intense autofluorescence of large drusen. On both FA and ICGA, large round drusen turned to hyperfluorescent in the late phase, while small radial drusen progressively decreased their fluorescence. OCT showed the large round drusen as focal or diffuse deposition of hyperreflective material between the RPE and Bruch membrane within the macula, determining focal dome-shaped or diffuse RPE elevation respectively, and the small radial drusen, which ranged from irregular slight thickening of the RPE/Bruch membrane complex to sawtooth RPE elevation. In three patients (six eyes) that underwent microperimetry and PHP, there was a good correspondence between macular sensitivity and PHP score. Functional impairment correlated topographically to sub-RPE deposition of drusenoid material.

Conclusions

In this series, large round drusen of Malattia Leventinese appeared similar to drusen in age-related macular degeneration, while small radial drusen of Malattia Leventinese shared similarities with early-onset cuticular drusen.     

Light panretinal photocoagulation (LPRP) versus classic panretinal photocoagulation (CPRP) in proliferative diabetic retinopathy

Purpose. We misled to verify whether a panretinal photocoagulation (PRP) performed using low levels of ARGON laser energy (light PRP) has the same efficacy as a PRP performed in a conventional fashion using argon green wavelengths (classic PRP) in eyes with high-risk proliferative diabetic retinopathy (HRPDR). Furthermore, we misled to compare the session number performed and the side effects produced by the two techniques. Methods. Sixty-five eyes with HRPDR of 50 consecutive patients were enrolled in a prospective randomized controlled trial. In eyes selected for light PRP, a very light biomicroscopic effect on the retina was obtained for each spot. In eyes assigned to classic PRP, each spot produced a white-yellow biomicroscopic effect. Mean follow-up was 22.4 months ±9.7 in the light PRP and 21.6 months ±9.3 in the classic PRP group (p = 0.727). Results. The initial mean logMAR visual acuity (VA) in the light PRP group was 0.12 ± 0.13 and in the classic PRP group 0.14 ± 0.15 (p = 0.493). The final mean VA in the former was 0.18 ± 0.25, and in the latter 0.27 ± 0.30 (p = 0.231). Median power was 235 mW (100–540 mW) for light and 420 mW (200–950 mW) for classic PRP (p < 0.001). Regression of HRPDR at the end of the follow-up was obtained in 30/31 eyes (97%) treated with classic PRP and in 31/34 eyes (91%) treated with light PRP (p = 0.615). The total mean session number was 7.4 ± 2.4 for light and 9.9 ± 2.2 for the classic PRP group (p < 0.001). Complications were more frequent in the classic PRP group. Conclusions. The efficacy of Light PRP is similar to that of classic Light PRP in eyes with HRPDR. Light PRP is associated with fewer complications and allows the reduction of the number of treatment sessions.     

Blind patients in end-stage inherited retinal degeneration: multimodal imaging of candidates for artificial retinal prosthesis

PurposeTo characterize the imaging features of blind patients with end-stage inherited retinal degeneration (IRD) and to assess possible morpho-functional correlations.MethodsIn this observational cross-sectional study, we reviewed the clinical data and multimodal imaging of 40 eyes of 21 blind (light perception or less) institutional patients affected by end-stage IRD screened for Alpha AMS (Retina Implant AG, Reutlingen, Germany) retinal prosthesis eligibility. Analysis was carried out using spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography and fundus autofluorescence.ResultsAmong patients with IRD-related low vision, the extrapolated prevalence of the blind was roughly 10%, median age 60.4 years with a disease duration of 40.4 years, showing epiretinal membranes (80%), hyperreflective intraretinal nodules (90%) and the absence of the ellipsoid zone (77.5%) on SD-OCT examination. Cystoid macular oedema was present in 52.5% of eyes, the majority of which being of the microcystoid subtype (42.5%), while 37.5% of eyes also lacked outer and inner retinal layer segmentation. Disease duration was found to be predictive of disrupted retinal layers (P = 0.029) and microcystoid macular oedema (P = 0.035), which was also more frequent in eyes without light perception (P = 0.013).ConclusionsEyes without vision due to end-stage IRD have a typical imaging pattern, predominantly characterized by epiretinal membranes, hyperreflective intraretinal nodules and the absence of the ellipsoid zone. Furthermore, microcystoid macular oedema and retinal layer disruption may be considered as signs of longstanding disease.Subject terms: Hereditary eye disease, Biomarkers