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Sample records for macular edema cme

  1. What Is Macular Edema?

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    Full Text Available ... Español Eye Health / Eye Health A-Z Macular Edema Sections What Is Macular Edema? What Causes Macular ... Edema Diagnosis Macular Edema Treatment What Is Macular Edema? Dec. 01, 2010 Macular edema is swelling or ...

  2. Cystoid macular edema

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    Tryfon G Rotsos

    2008-10-01

    Full Text Available Tryfon G Rotsos1, Marilita M Moschos21Medical Retina Service, Moorfields Eye Hospital, London, UK; 2Department of Ophthalmology, University of Athens, GreeceAbstract: We review the epidemiology, pathophysiology, and etiology of cystoid macular edema (CME. Inflammatory, diabetic, post-cataract, and macular edema due to age-related macular degeneration is described. The role of chronic inflammation and hypoxia and direct macular traction is evaluated in each case according to different views from the literature. The different diagnostic methods for evaluating the edema are described. Special attention is given to fluoroangiography and the most modern methods of macula examination, such as ocular coherence tomography and multifocal electroretinography. Finally, we discuss the treatment of cystoid macular edema in relation to its etiology. In this chapter we briefly refer to the therapeutic value of laser treatment especially in diabetic maculopathy or vitrectomy in some selected cases. Our paper is focused mainly on recent therapeutic treatment with intravitreal injection of triamcinolone acetonide and anti-VEGF factors like bevacizumab (Avastin, ranibizumab (Lucentis, pegaptamid (Macugen, and others. The goal of this paper is to review the current status of this treatment for macular edema due to diabetic maculopathy, central retinal vein occlusion and post-cataract surgery. For this reason the results of recent multicenter clinical trials are quoted, as also our experience on the use of intravitreal injections of anti-VEGF factors and we discuss its value in clinical practice.Keywords: cystoid macular edema, anti-VEGF, fluoroangiography, OCT, multifocal electroretinography

  3. Cystoid Macular Edema in Bietti's Crystalline Retinopathy

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    Ali Osman Saatci

    2014-01-01

    Full Text Available A 27-year-old man with progressive bilateral visual decline was diagnosed to have Bietti's crystalline dystrophy (BCD. Fluorescein angiography revealed bilateral petaloid type late hyperfluorescence implicating concurrent cystoid macular edema (CME. Optical coherence tomography exhibited cystoid foveal lacunas OU. During the follow-up of six years, intraretinal crystals reduced in amount but CME persisted angiographically and tomographically. CME is among the rare macular features of BCD including subfoveal sensorial detachment, subretinal neovascular membrane, and macular hole.

  4. What Is Macular Edema?

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    Full Text Available ... Tips & Prevention News Ask an Ophthalmologist Patient Stories Español Eye Health / Eye Health A-Z Macular Edema ... Edema Treatment What Is Macular Edema? Leer en Español: ¿Qué Es un Edema Macular? Dec. 01, 2010 ...

  5. Cystoid Macular Edema in Bietti's Crystalline Retinopathy

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    Ali Osman Saatci; Hasan Can Doruk; Aylin Yaman

    2014-01-01

    A 27-year-old man with progressive bilateral visual decline was diagnosed to have Bietti's crystalline dystrophy (BCD). Fluorescein angiography revealed bilateral petaloid type late hyperfluorescence implicating concurrent cystoid macular edema (CME). Optical coherence tomography exhibited cystoid foveal lacunas OU. During the follow-up of six years, intraretinal crystals reduced in amount but CME persisted angiographically and tomographically. CME is among the rare macular features of BCD in...

  6. What Is Macular Edema?

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    Full Text Available ... Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center Global Ophthalmology Guide Eye ... What Is Macular Edema? Dec. 01, 2010 Macular ...

  7. Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab.

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    Barone, Antonio; Prascina, Francesco; Russo, Vincenzo; Iaculli, Cristiana; Primavera, Vito; Querques, Giuseppe; Stella, Andrea; Delle Noci, Nicola

    2008-07-01

    A 67-year-old woman developed refractory pseudophakic cystoid macular edema (CME) after uneventful phacoemulsification. Three months after an intravitreal injection of bevacizumab (1.25 mg), the CME was completely resolved, with resultant improvement in visual acuity.

  8. What Is Macular Edema?

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    Full Text Available ... Tips & Prevention News Ask an Ophthalmologist Patient Stories Español Eye Health / Eye Health A-Z Macular Edema ... for Thinning Retina Mar 10, 2014 Leer en Español: ¿Qué Es un Edema Macular? Find an Ophthalmologist ...

  9. What Is Macular Edema?

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    Full Text Available ... or recognize a face. Macular edema develops when blood vessels in the retina are leaking fluids. The macula ... Your Laser Pointer Dangerous Enough to Cause Eye Injury? Dec 20, 2013 Study Finds Tablets Help People ...

  10. What Is Macular Edema?

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    Full Text Available ... may be mild to severe, but in many cases, your peripheral (side) vision remains. Macular edema is often a complication of diabetic retinopathy , and is the most common form of vision loss for people with ... Related Studies Show Zika Virus May Cause More Serious Eye ...

  11. Diabetic Macular Edema

    Science.gov (United States)

    Lobo, Conceição; Pires, Isabel; Cunha-Vaz, José

    The optical coherence tomography (OCT), a noninvasive and noncontact diagnostic method, was introduced in 1995 for imaging macular diseases. In diabetic macular edema (DME), OCT scans show hyporeflectivity, due to intraretinal and/or subretinal fluid accumulation, related to inner and/or outer blood-retinal barrier breakdown. OCT tomograms may also reveal the presence of hard exudates, as hyperreflective spots with a shadow, in the outer retinal layers, among others. In conclusion, OCT is a particularly valuable diagnostic tool in DME, helpful both in the diagnosis and follow-up procedure.

  12. [Pathopshysiological mechanisms in macular edema].

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    Turlea, Cristian; Zolog, Ileana; Blăjan, Codruta; Roşca, C; Turlea, Magdalena; Munteanu, Mihnea; Boruga, Ovidiu

    2014-01-01

    The treatment of diabetic macular edema has known a fast development in the last 5 years where the transition from laser monotherapy to intravitreal pharmacotherapy is becoming standard practice. Intravitreal injections therapy is in a continuous development with promising positive results. The use of intratvitreal devices in the treatment of macular edema of vascular cause has become a viable alternative also in treating diabetic macular edema. Several clinical studies have revealed the superiority of intravitreal treatment versus laser monotherapy. This article is evaluating and reviewing present and future treatments used to combat diabetic macular edema. [corrected].

  13. Cystoid Macular Edema Induced by Low Doses of Nicotinic Acid

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    Daniela Domanico

    2013-01-01

    Full Text Available Cystoid macular edema (CME is a condition that involves the macula, causing painless vision loss. In this paper, we report a case of niacin-induced bilateral cystoid macular edema (CME in a middle-age woman taking low dose of niacin (18 mg of nicotinic acid. Optical coherence tomography (OCT showed retinal thickening and cystoid spaces in both eyes, whereas fluorescein angiography (FA; HRA 2, Heidelberg Engineering revealed the absence of fluorescein leakage also in later phases. Four weeks after discontinuation of therapy there were a complete disappearance of macular edema at funduscopic examination and an improvement of visual acuity in both eyes. Furthermore OCT showed a normal retinal profile in both eyes. In our opinion considering the wide availability of niacin, medical monitoring and periodical examination should be considered during niacin administration. To our knowledge, this is the first report in the literature that described the very low-dose niacin-induced bilateral niacin maculopathy.

  14. Current status in diabetic macular edema treatments

    National Research Council Canada - National Science Library

    Pedro Romero-Aroca

    2013-01-01

    ... status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME...

  15. What Is Macular Edema?

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    Full Text Available ... health and preserving your vision. Privacy Policy Related Studies Show Zika Virus May Cause More Serious Eye Damage in Babies Than Thought May 31, 2016 Study Compares Eylea, Lucentis and Avastin for Diabetic Macular ...

  16. [Therapeutic approach in persistent diabetic macular edema].

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    Brănişteanu, Daniel; Moraru, Andreea

    2014-01-01

    Terminology of persistent diabetic macular edema has been initially reserved to cases unresponsive to conventional laser photocoagulation according to ETDRS criteria. While knowledge about pathophysiology of macular edema evolved and new drugs became available, the terminology of persistent diabetic macular edema expanded to include resistance to most current therapies. The purpose of this paper is to review medical and surgical options in the treatment of such difficult cases according to literature data and personal experience.

  17. Edema macular diabético Diabetic macular edema

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    J. Andonegui

    2008-01-01

    Full Text Available El edema macular diabético representa la primera causa de pérdida visual en los pacientes con diabetes mellitus. Su complejidad, unida a la aparición de nuevos métodos de diagnóstico así como de novedosas alternativas de tratamiento, hace que el enfoque de esta enfermedad suponga un importante reto para el oftalmólogo. A lo largo de este artículo se describen su patofisiología, manifestaciones clínicas, clasificación, diagnóstico y tratamiento, haciendo especial énfasis en los nuevos métodos diagnósticos y en las diferentes opciones terapéuticas.Diabetic macular edema is the principal cause of visual loss in patients with diabetes mellitus. Its complexity, together with the appearance of new methods of diagnosis and new alternatives for treatment, mean that the approach to this disease is an important challenge for ophthalmologists. This article describes its pathophysiology, clinical manifestations, classification, diagnosis and treatment, with special emphasis on the new diagnostic methods and on the different therapeutic options.

  18. Characteristics of fundus autofluorescence in cystoid macular edema

    Institute of Scientific and Technical Information of China (English)

    PENG Xi-jia; SU Lan-ping

    2011-01-01

    Background Fundus autofluorescence (FAF) imaging is a fast and noninvasive technique developed over the last decade.The authors utilized fluorescent properties of lipofuscin to study the health and viability of the retinal pigment epithelium (RPE)-photoreceptor complex.Observing the intensity and distribution of FAF of various retinal diseases is helpful for ascertaining diagnosis and evaluating prognosis.In this study,we described the FAF characteristics of cystoid macular edema (CME).Methods Sixty-two patients (70 eyes) with CME were subjected to FAF and fundus fluorescein angiography (FFA) by a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2 (HRA2)).Characteristics of FAF images were compared with FFA images.Results FAF intensity in normal subjects was highest at the posterior pole and dipped at the fovea.All cases of CME showed fluorescein dye accumulated into honeycomb-like spaces in macular and formated a typical petaloid pattern or atypical petaloid pattern in the late phases of the angiography.Sixty-one eyes with CME on FAF images showed mild or moderate hyperautofluorescence petaloid pattern in fovea,the FAF patterns of these CME was perfectly corresponding with shape in their FFA images;nine eyes with CME secondary to exudative age related macular degeneration (AMD) showed expansion of the hypoautofluorescence without petaloid pattern in macula.Conclusion FAF imaging can be used as a new rapid,non-invasive and ancillary technique in the diagnosis of the majority of CME,except for AMD and small part of other fundus diseases.

  19. Spontaneous resolution of macular edema after silicone oil removal

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    Eyyup Karahan

    2014-12-01

    Full Text Available AIM:To investigate the macular changes in eyes filled with silicone oil (SO and course of these changes after SO removal.METHODS:A retrospective optical coherence tomography scan review was conducted for twenty-four patients who underwent uncomplicated pars plana vitrectomy with SO tamponade for complex retinal detachments were detected with optical coherence tomography before, and one week, one month and three months after SO removal.RESULTS:Mean duration of SO tamponade was 3.6±1.0mo (range:3-7mo. Cystoid macular edema (CME was detected in 3 eyes before SO removal. Submacular fluid was represented in 1 eye before silicone SO removal. Resolution of CME and submacular fluid was achieved 1mo after SO removal in all eyes. Mean best corrected visual acuity (BCVA was 1.15±0.65 (range, hand movement to 0.2 before SO removal in the eyes without macular changes. After SO removal, the mean BCVA values at 1wk and 1 and 3mo, and 0.82±0.23, 0.76±0.21, and 0.70±0.19, all of which were significantly better than baseline (P=0.030, 0.017, 0.006 respectively. In the eyes with macular CME and subretinal fluid the mean BCVA was significantly improved at 3mo after SO removal compared with baseline (P=0.037.CONCLUSION:Decreased visual acuity in eyes filled with SO could be caused by macular complications due to SO. CME and subretinal fluid may resolve without any additional macular surgery after SO removal.

  20. Update on treatments of diabetic macular edema

    Institute of Scientific and Technical Information of China (English)

    YANG Xiao-lu; LIU Kun; XU Xun

    2009-01-01

    Objective To review the update research progress about the treatment of diabetic macular edema and to give helpful guidelines in the treatment of diabetic macular edema based on available evidence to date.Data sources A literature search of all English articles was performed on the online electronic PubMed database dated 1984 to 2009. The keywords searched included: macular edema, therapy, laser coagulation, intravitreal triamcinolone acetonide, vascular endothelial growth factor inhibitor, protein kinase C inhibitor and Pars plana vitrectomy. After finding relevant articles within these search limits, a manual search was conducted through the references from these articles.Study selection Original articles and critical reviews were reviewed and selected to address the stated purpose.Results To date, demonstrated means to reduce the risk of vision loss from diabetic macular edema include focal/grid laser photocoagulation and improved metabolic control. Emerging pharmacologic therapies (intravitreal triamcinolone acetonide, vascular endothelial growth factor inhibitors and protein kinase C beta-isoform inhibitors) and Pars plana vitrectomy have shown early promise in the treatment of diabetic macular edema.Conclusions As there has been extensive development in multiple treatments of diabetic macular edema, choice of the most suitable treatment for specific patients becomes important. Combination therapy of laser, pharmacological and surgical treatment modalities may offer an alternative to treatment of diabetic macular edema.

  1. Cystoid macular edema after bone marrow transplantation

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    Khetan Vikas

    2009-01-01

    Full Text Available We report a case of cystoid macular edema in a patient who underwent bone marrow transplant for aplastic anemia. After having ruled out all the other causes of cystoid macular edema, we concluded that it was secondary to the bone marrow transplant. The patient had mild visual impairment and did not recover the lost vision. In this case report, we describe in detail the clinical presentation, follow-up, and course of medication that this patient had. It is an illustrated case report of cystoid macular edema after bone marrow transplant with mild visual impairment and no recovery.

  2. Combined therapy for diabetic macular edema

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    Saba Al Rashaed

    2013-01-01

    Full Text Available Diabetic macular edema (DME is the main cause of visual impairment in diabetic patients. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. The management of DME is complex and often multiple treatment approaches are needed. This review demonstrates the benefits of intravitreal triamcinolone, bevacizumab and ranibizumab as adjunctive therapy to macular laser treatment in DME. The published results indicate that intravitreal injections of these agents may have a beneficial effect on macular thickness and visual acuity, independent of the type of macular edema that is present. Therefore, pharmacotherapy could complement focal/grid laser photocoagulation in the management of DME. For this review, we performed a literature search and summarized recent findings regarding combined therapy for DME.

  3. Corticosteroid Treatment in Diabetic Macular Edema

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    Burcu Nurözler Tabakcı

    2017-06-01

    Full Text Available Diabetic macular edema is the most common cause of visual impairment in patients with diabetes mellitus. The pathogenesis of macular edema is complex and multifactorial. For many years, laser photocoagulation has been considered the standard therapy for the treatment of diabetic macular edema; however, few patients achieve significant improvements in visual acuity. Today the intravitreal administration of anti-inflammatory or anti-angiogenic agents together with the use of laser photocoagulation represents the standard of care for the treatment of this complication. The intravitreal route of administration minimizes the systemic side effects of corticosteroids. Steroid-related ocular side effects are elevated intraocular pressure and cataract, while injection-related complications include endophthalmitis, vitreous hemorrhage, and retinal detachment. In order to reduce the risks and complications, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated injections for the management of diabetic macular edema. In this review, the efficacy, safety, and therapeutic potential of intravitreal corticosteroids in diabetic macular edema are discussed with a review of recent literature.

  4. Combination Therapy for Diabetic Macular Edema

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    Dinah Zur

    2012-01-01

    Full Text Available Diabetic macular edema is a main reason for visual loss in diabetic patients. Until recent years, macular laser photocoagulation was the only available therapy. The awareness that inflammation is an important factor in the pathogenetic process of DME gave reason for intravitreal treatment with corticosteroids. The introduction of anti-VEGF drugs brought a revolutionary change in the treatment of DME. This paper will review the important clinical trials with an emphasis on combination therapies.

  5. Macular edema in uveitis with emphasis on ocular sarcoidosis

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    Norel, J. van

    2015-01-01

    This thesis investigates the accumulation of fluid in the yellow spot (macular edema) in ocular inflammation (uveitis). Macular edema may result in definitive loss of vision.Two methods of imaging of macular edema are fluorescein angiography (FA) and optical coherence tomography (OCT). The first met

  6. Macular edema in uveitis with emphasis on ocular sarcoidosis

    NARCIS (Netherlands)

    Norel, J. van

    2015-01-01

    This thesis investigates the accumulation of fluid in the yellow spot (macular edema) in ocular inflammation (uveitis). Macular edema may result in definitive loss of vision.Two methods of imaging of macular edema are fluorescein angiography (FA) and optical coherence tomography (OCT). The first met

  7. Current status in diabetic macular edema treatments

    Institute of Scientific and Technical Information of China (English)

    Pedro; Romero-Aroca

    2013-01-01

    Diabetes is a serious chronic condition,which increase the risk of cardiovascular diseases,kidney failure and nerve damage leading to amputation.Furthermore the ocular complications include diabetic macular edema,is the leading cause of blindness among adults in the industrialized countries.Today,blindness from diabetic macular edema is largely preventable with timely detection and appropriate interventional therapy.The treatment should include an optimized control of glycemia,arterial tension,lipids and renal status.The photocoagulation laser is currently restricted to focal macular edema in some countries,but due the high cost of intravitreal drugs,the use of laser treatment for focal and diffuse diabetic macular edema(DME),can be valid as gold standard in many countries.The intravitreal anti vascular endothelial growth factor drugs(ranibizumab and bevacizumab),are indicated in the treatment of all types of DME,but the correct protocol for administration should be defined for the different Retina Scientific Societies.The corticosteroids for diffuse DME,has a place in pseudophakic patients,but its complications restricted the use of these drugs for some patients.Finally the intravitreal interface plays an important role and its exploration is mandatory in all DME patients.

  8. Serous retinal detachment in patients with macular edema secondary to branch retinal vein occlusion

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    Erkan Celık

    2016-02-01

    Full Text Available ABSTRACT Purpose: The aim of the present study was to evaluate visual acuity (VA and central macular thickness (CMT to assess the influence of serous retinal detachment (SRD in eyes with macular edema (ME secondary to branch retinal vein occlusion (BRVO. Methods: Sixty-one eyes with BRVO from 61 patients with ME were analyzed and divided into two groups according to the spectral domain optical coherence tomography (OCT findings of SRD and cystoid macular edema (CME. All patients underwent complete ophthalmic examinations and OCT measurements (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA. Patients with marked retinal hemorrhage, diabetic retinopathy, previous laser photocoagulation, and/or intravitreal injection were excluded. Results: The mean age of included patients (37 males, 24 females was 65.4 ± 11.4 (53-77 years. There were 21 patients with SRD and 40 patients with CME. All of the 21 patients with SRD had CME. VA was significantly worse in the SRD group compared with the CME (non-SRD group (0.82 ± 0.34 logMAR vs 0.64 ± 0.38 logMAR; P=0.005. Conversely, CMT was significantly greater in the SRD group than in the CME group (465 ± 115 µ vs 387 ± 85 µ; P=0.00004. Conclusion: SRD may be associated with decreased VA. The prognosis of patients with BRVO and SRD requires further investigation.

  9. Management of pseudophakic cystoid macular edema.

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    Guo, Suqin; Patel, Shriji; Baumrind, Ben; Johnson, Keegan; Levinsohn, Daniel; Marcus, Edward; Tannen, Brad; Roy, Monique; Bhagat, Neelakshi; Zarbin, Marco

    2015-01-01

    Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks.

  10. Current Treatments of Diabetic Macular Edema

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    Wei-Chun Chan

    2011-12-01

    Full Text Available Diabetic macular edema (DME is a major cause of visual impairment in diabetic patients. Laser photocoagulation is the standard management strategy for macular edema, but its results remain unsatisfactory. Several clinical trials of new treatment modalities for DME have been conducted over the past 10 years. We performed a literature search of English articles, published between 2000 and 2010, by using the PubMed database. The keywords searched included “diabetic macular edema and treatment” with limits set to include only clinical trials and review articles, over 50 articles were reviewed. Among the newer treatment modalities reviewed, therapy with anti-vascular endothelial growth factor (VEGF antibodies showed significantly better efficacy, with level I evidence. However, multiple injections were required to maintain its efficacy. Therefore, the associated complications and cost implications are the major limitations of this treatment. Several combinations of different modalities have been evaluated in the literature, but none are more efficacious than monotherapy with anti-VEGF antibodies. Since DME is a multifactorial disease, further studies involving combinations of modalities or new treatments modalities may be needed to reduce the number of injections required or improve the visual outcomes in case of DME.

  11. Cystoid Macular Edema during Treatment with Paclitaxel and Bevacizumab in a Patient with Metastatic Breast Cancer: A Case Report and Literature Review

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    Takamichi Yokoe

    2017-07-01

    Full Text Available We present a case of a metastatic breast cancer patient with cystoid macular edema (CME occurring during treatment with paclitaxel and bevacizumab. She had a history of neoadjuvant chemotherapy and partial mastectomy plus axillary lymph node dissection for stage IIB left-breast cancer. Twenty-four months later, she was diagnosed with multiple bone metastases and underwent chemotherapy with paclitaxel and bevacizumab. Thirty-three months after the initiation of the chemotherapy, she noticed bilateral blurred vision. The retinal thickening with macular edema was observed by optical coherence tomography, resulting in a diagnosis of CME. With cessation of paclitaxel and administrating ocular instillation of a nonsteroidal anti-inflammatory drug, her macular edema gradually reduced and disappeared in a month. While CME caused by chemotherapy is very rare, taxane may cause ocular adverse events such as CME. It is important to urge patients to consult an ophthalmologist promptly when they have visual complaints during taxane chemotherapy.

  12. Intravitreal Triamcinolone Acetonide for Macular Edema in HLA-B27 Negative Ankylosing Spondylitis

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    M.M. Moschos

    2010-12-01

    Full Text Available We report a case of a human leukocyte antigen B27 (HLA-B27-negative patient with cystoid macular edema (CME and ankylosing spondylitis (AS after treatment with triamcinolone acetonide. The patient complained of deterioration of visual acuity of the right eye during the last 10 days. At presentation visual acuity of the right eye was 0.2, and the ophthalmic examination did not reveal any sign of active uveitis. Fluorescein angiography (FA and ocular coherent tomography (OCT showed CME. The left eye was normal with a visual acuity of 0.9. Eight weeks after intravitreal injection of triamcinolone acetonide, visual acuity improved to 0.8 and OCT revealed regression of macular edema. Six months later no recurrence was observed. Our case report indicates for the first time that CME may occur in AS independently of the presence of HLA-B27 and intraocular inflammation. Intravitreal use of triamcinolone acetonide can reduce macular edema and restore visual acuity.

  13. Update on corticosteroids for diabetic macular edema

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    Schwartz SG

    2016-09-01

    Full Text Available Stephen G Schwartz,1 Ingrid U Scott,2,3 Michael W Stewart,4 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 2Department of Ophthalmology, 3Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, 4Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA Abstract: Diabetic macular edema (DME remains an important cause of visual loss. Although anti-vascular endothelial growth factor (VEGF agents are generally used as first-line treatments for patients with center-involving DME, there is an important role for corticosteroids as well. Corticosteroids may be especially useful in pseudophakic patients poorly responsive to anti-VEGF therapies, in patients wishing to reduce the number of required injections, and in pregnant patients. Intravitreal triamcinolone acetonide has been used for many years but is not approved for this indication. An extended-release bioerodable dexamethasone delivery system and an extended-release nonbioerodable fluocinolone acetonide insert have both achieved regulatory approval for the treatment of DME. All intravitreal corticosteroids are associated with risks of cataract progression, elevation of intraocular pressure, and endophthalmitis. There is no current consensus regarding the use of corticosteroids, but they are valuable for selected patients with center-involving DME. Keywords: diabetic macular edema, vascular endothelial growth factor, triamcinolone acetonide, dexamethasone, fluocinolone acetonide, randomized clinical trial

  14. LASER PHOTOCOAGULATION IN DIABETIC MACULAR EDEMA: EFFECTS ON VISUAL ACUITY AND MACULAR EDEMA

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    M.H. Dehghan

    1999-06-01

    Full Text Available Due to the importance of clinically significant macular edema in diabetic patients, this study is aimed to determine if laser photocoagulation is effective in the treatment of clinically significant diabetic macular edema. In addition, the effects of risk factors arc surveyed* This is an existing data study considering patients with clinically significant diabetic macular edema, treated with argon-green laser photocoagulation in Labbafinejad hospital, department of lasertherapy, from 1995 to 1997. in 60 (42.6% eyes the treatment method was focal, in 22 (15.6% eyes grid, and in 59 (41.84 modified grid laser photocoagulation was performed. The results are based upon deterioration of visual acuity, occurance of moderate visual loss and improvement or persistence of CSME. We studied 114 eyes from 87 patients. Two years after initial treatment, visual acuity improved in 19.1% of eyes, unchanged in 9.5% and worsened in 71.4% of eyes. After this period the rate of moderate visual loss was 28.6% and CSME was improved in 23.8% of eyes. According to our study, baseline visual acuity and retinopathy severity were two important intervening factors in response to lasertherapy. Comparing our results with natural course of diabetic macular edema, indicates that in assessing visual outcome laser photocoagulation is an effective modality in treatment of CSME, but it is not effective in maintaining or improving visual acuity, which is due to patients delay in visiting ophthalmologists and paying not enough attention to follow-up visits.

  15. Unilateral macular edema with central retinal vein occlusion in systemic lupus erythematosus: a case report

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    Noma H

    2013-05-01

    Full Text Available Hidetaka Noma,1 Hiroshi Shimizu,1 Tatsuya Mimura21Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, 2Department of Ophthalmology, Medical Center East, Tokyo Women's Medical University, Tokyo, JapanAbstract: Central retinal vein occlusion (CRVO is frequent in patients with systemic lupus erythematosus (SLE, but the treatment of the macular edema with this disease is extremely difficult. We report a case of cystoid macular edema (CME secondary to unilateral CRVO in a patient with SLE that responded to intravitreous injection of an anti-vascular endothelial growth factor (VEGF agent. A 33-year-old Japanese woman was referred to our department with unilateral impairment of vision. Microperimetry (MP-1 showed a cessation of foveal sensitivity. Fluorescein angiography showed CME without ischaemia of the macular region or peripheral retina (nonischemic CRVO. A diagnosis of CME and unilateral nonischemic CRVO combined with SLE was made and intravitreous anti-VEGF therapy was given. A sample of aqueous humor was harvested at the start of intravitreous injection after obtaining informed consent. Then the levels of VEGF and monocyte chemotactic protein (MCP-1 were measured in the aqueous humor by enzyme-linked immunosorbent assay, revealing that VEGF was 234 pg/mL and MCP-1 was 501 pg/mL. Two weeks later, left eye vision improved to 20/20. Optical coherence tomography (OCT showed considerable amelioration of retinal swelling and CME. MP-1 showed a marked increase of foveal sensitivity. However, she had recurrence of edema 3 months later. After harvesting aqueous humor again, intravitreous injection of an anti-VEGF agent was repeated for CME. The aqueous VEGF and MCP-1 levels were 156 pg/mL and 360 pg/mL, respectively. These findings suggest that inflammation was improved by intravitreous injection of bevacizumab. Intravitreous injection of anti-VEGF agents may be effective for CME due to nonischemic CRVO in SLE patients

  16. [Physiopathology of macular edema in central vein occlusion].

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    Stanca, Horia T; Manea, Georgiana

    2012-01-01

    Retinal Vein Occlusions are vascular diseases affecting the Central Retinal Vein and its branches causing decreased retinal drainage resulting in significant clinical and functional pathological changes. RVO determines the increase of vascular permeability, with edema and hemorrhage and development of collateral vessels in a few weeks. Among the serious consequences of venous occlusion is the installation of macular edema to which depends long-term visual prognosis. Macular Edema is the accumulation of intraretinal serous fluid in the macular area caused by the breakdown of blood-retinal barrier.

  17. Acute macular edema following intracorporeal prostaglandin injection for erectile dysfunction

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    Asahi MG

    2015-07-01

    Full Text Available Masumi G Asahi, Calvin Chou, Ron P Gallemore Retina Macula Institute, Torrance, CA, USA Purpose: We aimed to describe the first case of macular edema following intracorporeal injection of alprostadil, a prostaglandin E1. Methods: This was a retrospective case report followed with optical coherence tomography, fundus photos, and fluorescein angiography images. Results: A patient developed bilateral cystoid macular edema following intracorporeal injection of alprostadil, a prostaglandin E1 for treatment of erectile dysfunction. The edema resolved following treatment with nonsteroidal anti-inflammatory drugs (NSAIDs and corticosteroids, with subsequent recovery in visual acuity. Discussion: Systemic prostaglandin administration can cause macular edema and vision loss, indicating that elevated systemic prostaglandin levels may affect visual function. This has potential implications for other systemic disorders and treatments that could affect macular function. Keywords: alprostadil, inflammation

  18. Acute effect of pure oxygen breathing on diabetic macular edema

    DEFF Research Database (Denmark)

    Vinten, Carl Martin; La Cour, Morten; Lund-Andersen, Henrik

    2012-01-01

    Purpose. A small-scale pilot study of the pathophysiology of diabetic macular edema (DME) was made by assessing concomitant changes in macular volume (MV), mean arterial blood pressure (MABP), intraocular pressure (IOP), retinal artery diameter (RAD), and retinal vein diameter (RVD) in response t...

  19. Acute effect of pure oxygen breathing on diabetic macular edema

    DEFF Research Database (Denmark)

    Vinten, Carl Martin; La Cour, Morten; Lund-Andersen, Henrik;

    2012-01-01

    Purpose. A small-scale pilot study of the pathophysiology of diabetic macular edema (DME) was made by assessing concomitant changes in macular volume (MV), mean arterial blood pressure (MABP), intraocular pressure (IOP), retinal artery diameter (RAD), and retinal vein diameter (RVD) in response...

  20. Treatment of cystoid macular edema with the new-generation NSAID nepafenac 0.1%

    Science.gov (United States)

    Hariprasad, Seenu M; Akduman, Levent; Clever, Joseph A; Ober, Michael; Recchia, Franco M; Mieler, William F

    2009-01-01

    Purpose: To describe the use of nepafenac 0.1% for cystoid macular edema (CME). Methods: This was a multicenter retrospective review of 22 CME cases (20 patients) treated with nepafenac 0.1% (six with concomitant prednisolone acetate 1%) from December 2005 to April 2008: three acute pseudophakic CME cases, 13 chronic/recalcitrant pseudophakic CME cases, and six cases of uveitic CME. Pre- and post-treatment retinal thickness and visual acuity were reported. Results: Following treatment for six weeks to six months, six eyes with uveitic CME showed a mean retinal thickness improvement of 227 ± 168.1 μm; mean best-corrected visual acuity (BCVA) improvement was 0.36 ± 0.20 logMAR. All three cases of acute pseudophakic CME improved after four to 10 weeks of nepafenac, with a mean improvement in retinal thickness of 134 ± 111.0 μm. BCVA improved in two patients (0.16 and 0.22 logMAR) but not in the third due to underlying retinal pigment epithelium changes. Thirteen eyes with chronic/recalcitrant pseudophakic CME demonstrated a mean improvement in retinal thickness of 178 ± 128.7 μm after nepafenac and mean BCVA improvement of 0.33 ± 0.19 logMAR. Conclusion: The positive outcomes of these 22 eyes strongly suggest that nepafenac 0.1% is a promising drug for the treatment of CME. Additional study under randomized controlled conditions is warranted. PMID:19668559

  1. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

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    Pedro Romero-Aroca

    2016-01-01

    Full Text Available Diabetic macular edema (DME can cause blindness in diabetic patients suffering from diabetic retinopathy (DR. DM parameters controls (glycemia, arterial tension, and lipids are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug.

  2. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

    Science.gov (United States)

    Baget-Bernaldiz, Marc; Pareja-Rios, Alicia; Lopez-Galvez, Maribel; Navarro-Gil, Raul; Verges, Raquel

    2016-01-01

    Diabetic macular edema (DME) can cause blindness in diabetic patients suffering from diabetic retinopathy (DR). DM parameters controls (glycemia, arterial tension, and lipids) are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF) is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug.

  3. Treatment of cystoid macular edema with the new-generation NSAID nepafenac 0.1%

    Directory of Open Access Journals (Sweden)

    Seenu M Hariprasad

    2009-01-01

    Full Text Available Seenu M Hariprasad1, Levent Akduman2, Joseph A Clever2, Michael Ober3,4, Franco M Recchia5, William F Mieler1,61Department of Ophthalmology and Visual Sciences, Vitreoretinal Service; 6Department of Ophthalmology and Visual Sciences, University of Chicago, Chicago, IL, USA; 2Vitreoretinal Service, Saint Louis University Eye Institute, Saint Louis, MO, USA; 3Vitreoretinal Service, Henry Ford Health Systems, West Bloomfield, MI, USA; 4Retinal Consultants of Michigan, Southfield, MI, USA; 5Vitreoretinal Service, Vanderbilt Eye Institute, Nashville, TN, USAPurpose: To describe the use of nepafenac 0.1% for cystoid macular edema (CME.Methods: This was a multicenter retrospective review of 22 CME cases (20 patients treated with nepafenac 0.1% (six with concomitant prednisolone acetate 1% from December 2005 to April 2008: three acute pseudophakic CME cases, 13 chronic/recalcitrant pseudophakic CME cases, and six cases of uveitic CME. Pre- and post-treatment retinal thickness and visual acuity were reported.Results: Following treatment for six weeks to six months, six eyes with uveitic CME showed a mean retinal thickness improvement of 227 ± 168.1 μm; mean best-corrected visual acuity (BCVA improvement was 0.36 ± 0.20 logMAR. All three cases of acute pseudophakic CME improved after four to 10 weeks of nepafenac, with a mean improvement in retinal thickness of 134 ± 111.0 μm. BCVA improved in two patients (0.16 and 0.22 logMAR but not in the third due to underlying retinal pigment epithelium changes. Thirteen eyes with chronic/recalcitrant pseudophakic CME demonstrated a mean improvement in retinal thickness of 178 ± 128.7 μm after nepafenac and mean BCVA improvement of 0.33 ± 0.19 logMAR.Conclusion: The positive outcomes of these 22 eyes strongly suggest that nepafenac 0.1% is a promising drug for the treatment of CME. Additional study under randomized controlled conditions is warranted.Keywords: macular edema, NSAID, nepafenac, cataract surgery

  4. Consistency of ocular coherence tomography fast macular thickness mapping in diabetic diffuse macular edema

    Energy Technology Data Exchange (ETDEWEB)

    Saraiva, Fabio Petersen; Costa, Patricia Grativol; Inomata, Daniela Lumi; Melo, Carlos Sergio Nascimento; Helal Junior, John; Nakashima, Yoshitaka [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Dept. de Oftalmologia]. E-mail: fabiopetersen@yahoo.com.br

    2007-07-01

    Objectives: To investigate optical coherence tomography consistency on foveal thickness, foveal volume, and macular volume measurements in patients with and without diffuse diabetic macular edema. Introduction: Optical coherence tomography represents an objective technique that provides cross-sectional tomographs of retinal structure in vivo. However, it is expected that poor fixation ability, as seen in diabetic macular edema, could alter its results. Several authors have discussed the reproducibility of optical coherence tomography, but only a few have addressed the topic with respect to diabetic maculopathy. Methods: The study recruited diabetic patients without clinically evident retinopathy (control group) and with diffuse macular edema (case group). Only one eye of each patient was evaluated. Five consecutive fast macular scans were taken using Ocular Coherence Tomography 3; the 6 mm macular map was chosen. The consistency in measurements of foveal thickness, foveal volume, and total macular volume for both groups was evaluated using the Pearson's coefficient of variation. The T-test for independent samples was used in order to compare measurements of both groups. Results: Each group consisted of 20 patients. All measurements had a coefficient of variation less than 10%. The most consistent parameter for both groups was the total macular volume. Discussion: Consistency in measurement is a mainstay of any test. A test is unreliable if its measurements can not be correctly repeated. We found a good index of consistency, even considering patients with an unstable gaze. Conclusions: Optical coherence tomography is a consistent method for diabetic subjects with diffuse macular edema. (author)

  5. Cystoid Macular Edema: Possible Complication of Infliximab Therapy in Behçet’s Disease

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    Junko Ikewaki

    2010-06-01

    Full Text Available Aim: Infliximab, an anti-tumor necrosis factor (TNF-α monoclonal antibody, has been reported to be effective in refractory uveoretinitis in Behçet’s disease. Because it has been used clinically for a short time, information on its adverse effects is limited. We report a patient who developed cystoid macular edema (CME following infliximab use for uveoretinitis associated with Behçet’s disease. Case Report: A 27-year-old man had refractory uveoretinitis and neuro-Behçet’s disease, and intravenous infliximab was administered. Results: One day after infliximab infusion, the patient complained of a decrease in the vision in his left eye. The visual acuity had decreased from 1.2 to 0.5. Daily optical coherence tomographic evaluations showed a progressive worsening of the CME, and fluorescein angiography showed a typical staining with a cystic pattern. Two weeks later, the height of CME appeared to reach a maximum level and thereafter gradually resolved in spite of the continuation of infliximab administration. The visual acuity improved while the patient was treated with repeated subtenon injections of steroids in addition to continuation of infliximab and finally increased from 0.15 to 1.2. Conclusions: Although the mechanism of CME is not known, clinicians should be aware that infliximab therapy might cause a development and worsening of CME. Thus, it is crucial to rule out preexisting abnormalities in the macula prior to commencing infliximab infusion.

  6. Aspectos atuais na fisiopatologia do edema macular diabético Recent aspects on physiopathology of diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Mário Martins dos Santos Motta

    2008-02-01

    Full Text Available O edema macular é a principal causa de baixa visual em pacientes diabéticos. Seu mecanismo de formação é complexo e envolve alterações bioquímicas e estruturais. Os autores fazem uma revisão e atualização dos conceitos fisiopatológicos envolvidos na maculopatia diabética.Macular edema is the leading cause of poor vision in diabetic patients.The mechanism of edema formation is complex and involves biochemical and structural changes. The authors review and update the physiopathologic concepts related to diabetic maculopathy.

  7. Angiographically Documented Macular Ischemia after Single Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion.

    Science.gov (United States)

    Lee, Kyou Ho; Kang, Eui Chun; Koh, Hyoung Jun

    2017-05-01

    This report describes a case of angiographically documented foveal avascular zone (FAZ) enlargement after a single intravitreal injection of bevacizumab for macular edema secondary to central retinal vein occlusion (CRVO). A 71-year-old female was treated with an intravitreal bevacizumab injection for macular edema following CRVO. Despite successfully decreased edema one month after injection, the postinjection best-corrected visual acuity immediately decreased from 20/40 to 20/1000 (Snellen equivalent). The FAZ area increased from 0.37 mm² to 3.11 mm² (8.4-fold increase). While intravitreal anti-vascular endothelial growth factor is effective and should be considered as a first-line treatment for macular edema secondary to CRVO, it may aggravate macular ischemia. © Copyright: Yonsei University College of Medicine 2017.

  8. Navigated macular laser decreases retreatment rate for diabetic macular edema: a comparison with conventional macular laser

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    Neubauer AS

    2013-01-01

    Full Text Available Aljoscha S Neubauer,1,* Julian Langer,1,* Raffael Liegl,1 Christos Haritoglou,1 Armin Wolf,1 Igor Kozak,2 Florian Seidensticker,1 Michael Ulbig,1 William R Freeman,2 Anselm Kampik,1 Marcus Kernt,1 1Ludwig-Maximilians University, Department of Ophthalmology, Munich, Germany; 2Jacobs Retina Center, University of California San Diego, La Jolla, CA, USA*These authors contributed equally to this workBackground: The purpose of this study was to evaluate and compare clinical outcomes and retreatment rates using navigated macular laser versus conventional laser for the treatment of diabetic macular edema (DME.Methods: In this prospective, interventional pilot study, 46 eyes from 46 consecutive patients with DME were allocated to receive macular laser photocoagulation using navigated laser. Best corrected visual acuity and retreatment rate were evaluated for up to 12 months after treatment. The control group was drawn based on chart review of 119 patients treated by conventional laser at the same institutions during the same time period. Propensity score matching was performed with Stata, based on the nearest-neighbor method.Results: Propensity score matching for age, gender, baseline visual acuity, and number of laser spots yielded 28 matched patients for the control group. Visual acuity after navigated macular laser improved from a mean 0.48 ± 0.37 logMAR by a mean +2.9 letters after 3 months, while the control group showed a mean −4.0 letters (P = 0.03. After 6 months, navigated laser maintained a mean visual gain of +3.3 letters, and the conventional laser group showed a slower mean increase to +1.9 letters versus baseline. Using Kaplan-Meier analysis, the laser retreatment rate showed separation of the survival curves after 2 months, with fewer retreatments in the navigated group than in the conventional laser group during the first 8 months (18% versus 31%, respectively, P = 0.02.Conclusion: The short-term results of this pilot study suggest

  9. EVALUATION OF MULTIPLE DEXAMETHASONE INTRAVITREAL IMPLANTS IN PATIENTS WITH MACULAR EDEMA ASSOCIATED WITH RETINAL VEIN OCCLUSION.

    Science.gov (United States)

    Bakri, Sophie J; Omar, Ahmed F; Iezzi, Raymond; Kapoor, Kapil G

    2016-03-01

    Limited data have evaluated multiple injections of the dexamethasone 700 μg implant (DEX) (Ozurdex; Allergan, Inc.) for cystoid macular edema (CME) secondary to retinal vein occlusion (RVO) over an extended regimen. This retrospective study evaluated patients treated with DEX for CME associated with RVO. Each patient had ophthalmologic evaluation, optical coherence tomography (OCT), and 4 weeks to 6 weeks follow-up intervals. Retreatment criterion was fluid on OCT. Outcome measures included best-corrected visual acuity, intraocular pressure (IOP), central macular thickness on OCT, fluid resolution on OCT, and required treatment for elevated IOP and cataract. Thirty-one patients had 82 DEX injections, with 19 patients having ≥2, 12 having ≥3, 10 having ≥4, 6 having ≥5, and 4 having ≥6 DEX injections. All patients were followed at least 12 weeks and had a mean follow-up period of 344.94 days. Fourteen patients (45%) developed ocular hypertension (≥22 mmHg), and 40% of phakic patients required cataract surgery. Mean interval of OCT fluid resolution was 52 days (range, 28-245; SD, ±8), and mean retreatment interval was 119 days (range, 42-309; SD, ±9). No patients required glaucoma surgery or developed endophthalmitis. This study suggests that repeated, as needed, DEX injections for CME associated with RVO may be performed. Patients should be monitored and treated for ocular hypertension and cataract progression.

  10. Effect of an ultraviolet-filtering intraocular lens on cystoid macular edema

    Energy Technology Data Exchange (ETDEWEB)

    Kraff, M.C.; Sanders, D.R.; Jampol, L.M.; Lieberman, H.L.

    1985-03-01

    A prospective double-masked study of 301 patients was undertaken to compare the effect of ultraviolet (UV) filtering in implant intraocular lenses (IOL) on the angiographic incidence of cystoid macular edema (CME) in patients undergoing extracapsular cataract extraction. Patients were randomized to receive either a posterior chamber IOL that contained UV-absorbing chromophore or an identical IOL which did not contain such a chromophore. All patients were scheduled for fluorescein angiography between three and six months after surgery; 228 angiograms were obtained that were readable for the presence or absence of angiographic CME. The mean interval following surgery was 4.3 months. The incidence of CME was 18.8% (21 of 112) in patients who received lenses without UV-filtering chromophore and 9.5% (11 of 116) in patients who received IOLs that contained UV-filtering chromophore. These findings show that UV-filtering-IOLs resulted in a statistically significant decrease in the incidence of CME. The presence or absence of the UV-filtering chromophore did not, however, significantly affect visual acuity in the early postoperative period.

  11. Peripheral blood metabolic and inflammatory factors as biomarkers to ocular findings in diabetic macular edema.

    Science.gov (United States)

    Figueras-Roca, Marc; Molins, Blanca; Sala-Puigdollers, Anna; Matas, Jessica; Vinagre, Irene; Ríos, José; Adán, Alfredo

    2017-01-01

    To study the association between peripheral blood metabolic and inflammatory factors and presence of diabetic macular edema (DME) and its related anatomic features in type 2 diabetic mellitus (T2DM) patients. Observational cross-sectional study on a proof of concept basis. Seventy-six T2DM included patients were divided based on the presence (n = 58) or absence of DME (n = 18) according to optical coherence tomography (OCT). Ultra-widefield fluorescein angiography (UWFA) was performed in DME patients. Fasting peripheral blood sample testing included glycemia, glycated hemoglobin, creatinin and lipid levels among others. Serum levels of a broad panel of cytokines and inflammatory mediators were also analysed. OCT findings included central subfoveal thickness, diffuse retinal thickness (DRT), cystoid macular edema (CME), serous retinal detachment and epirretinal membrane. UWFA items included pattern of DME, presence of peripheral retinal ischemia and enlarged foveal avascular zone (FAZ). Metabolic and inflammatory factors did not statistically differ between groups. However, several inflammatory mediators did associate to certain ocular items of DME cases: IL-6 was significantly higher in patients with DRT (p = 0.044), IL-10 was decreased in patients with CME (p = 0.012), and higher IL-8 (p = 0.031) and VEGF levels (p = 0.031) were observed in patients with enlarged FAZ. Inflammatory and metabolic peripheral blood factors in T2DM may not be differentially associated to DME when compared to non-DME cases. However, some OCT and UWFA features of DME such as DRT, CME and enlarged FAZ may be associated to certain systemic inflammatory mediators.

  12. Triamcinolona subtenoniana en el edema macular diabético Subtenon triamcinolone in the diabetic macular edema

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    Eddy Mesa Hernández

    2009-12-01

    Full Text Available INTRODUCCIÓN: La prevalencia de la retinopatía diabética está determinada por el tipo de diabetes mellitus y por el tiempo de evolución de la enfermedad. El edema macular es la principal causa de la disminución de la agudeza visual en el paciente diabético. Un diagnóstico precoz y certero de esta enfermedad, unido al establecimiento de un tratamiento adecuado es crucial en el esfuerzo por reducir la incapacidad visual. El propósito de este trabajo fue determinar la efectividad de la triamcinolona subtenoniana como tratamiento del edema macular en un grupo de pacientes diabéticos. MÉTODOS: Se realizó un estudio descriptivo-prospectivo de caso control. La muestra estuvo formada por 30 pacientes diabéticos que fueron atendidos en el Hospital Clínicoquirúrgico "Dr. Miguel Enríquez, desde enero a junio de 2007, con diagnóstico de edema macular diabético que cumplieron con los criterios de inclusión. RESULTADOS: Predominó el sexo femenino, el grupo de edades más frecuentes fue de 55 a 65 años. Se relacionó el tiempo de evolución con la presencia de edema macular, se evidenció una involución de esta patología, así como una mejoría en la agudeza visual después de aplicado el tratamiento y no se presentaron complicaciones graves. CONCLUSIONES: El tratamiento con acetato de triamcinolona por vía subtenoniana posterior es una alternativa efectiva en el tratamiento de el edema macular.INTRODUCTION: Prevalence of diabetic retinopathy is determined by type of diabetes mellitus and the length of development of the disease. Macular edema is the main cause of reduction in visual acuity of the diabetic patient. An early exact diagnosis of the disease together with an adequate treatment is essential to decrease visual disability. The objective of this paper was to evaluate the effectiveness of subtenon triamcinolone as therapy for macular edema in a group of diabetics. METHODS: A prospective descriptive case-control study was

  13. Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema

    OpenAIRE

    Lai, Timothy Y. Y.; Fong

    2013-01-01

    Angie HC Fong,1 Timothy YY Lai1,2 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong; 22010 Retina and Macula Centre, Tsimshatsui, Kowloon, Hong Kong Abstract: Neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME) are major causes of visual impairment in the elderly population worldwide. With the aging population, the prevalence of neovascular AMD and DME has increased substantially o...

  14. Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema

    OpenAIRE

    Fong, Angie HC; Lai, Timothy YY

    2013-01-01

    Neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME) are major causes of visual impairment in the elderly population worldwide. With the aging population, the prevalence of neovascular AMD and DME has increased substantially over the recent years. Vascular endothelial growth factor (VEGF) has been implicated as playing an important role in the pathogenesis of both neovascular AMD and DME. Since its introduction in 2006, ranibizumab, a recombinant, humanized, mon...

  15. Diabetic macular edema, retinopathy and age-related macular degeneration as inflammatory conditions

    OpenAIRE

    Das, Undurti N

    2016-01-01

    Diabetic macular edema (DME) and diabetic retinopathy (DR) are complications affecting about 25% of all patients with long-standing type 1 and type 2 diabetes mellitus and are a major cause of significant decrease in vision and quality of life. Age-related macular degeneration (AMD) is not uncommon, and diabetes mellitus affects the incidence and progression of AMD through altering hemodynamics, increasing oxidative stress, accumulating advanced glycation end products, etc. Recent studies sug...

  16. Intravitreal gas injection for the treatment of diabetic macular edema

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    McHugh D

    2011-10-01

    Full Text Available Dominic McHugh, Bhaskar Gupta, Manzar Saeed King's College Hospital, Denmark Hill, London, England, UK Purpose: This study investigates the efficacy of an intravitreal gas injection in inducing a posterior vitreous detachment (PVD in patients with clinically significant diabetic macular edema refractory to laser therapy. Methods: A local ethics committee-approved technique of an intravitreal injection of pure perfluoropropane gas (C3F8 was performed for all participants. After a period of prone positioning, the patients underwent regular and detailed clinical review. Main outcome measures: The induction of a PVD, change in macular thickness, change in visual acuity. Results: A PVD was induced in all five eyes with subsequent signs of reduction in macular thickness and resolution of exudates. Mean visual improvement was 11 ETDRS (Early Treatment Diabetic Retinopathy Study letters (range 4–21. Apart from a transient vitreous hemorrhage in one eye, there were no significant treatment-related complications. Conclusion: The induction of a PVD by pneumatic retinopexy appears to have a significant influence on diabetic macular edema in eyes which have not successfully responded to macular laser therapy. A randomized clinical trial is justified on the basis of the initial promising data. Keywords: optical coherence tomography, OCT, posterior vitreous detachment, perfluoropropane

  17. Grid pattern Argon Laser photocoagulation for diabetic diffuse macular edema

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    Karkhane R

    1998-05-01

    Full Text Available Purpose: to determine the effect of Grid pattern laser photocoagulation on diabetic diffuse macular edema with assessment of visual outcome. Patients & Methods: The author reviewed the medical records of 84 eyes of 62 patients with diabetic diffuse macular edema treated with Grid pattern green Argon laser photocoagulation in Farabi Eye Hospital between the years 1992-1995, the follow-up period was 16-48 months (average 24.55±6.42, median 28 mounths. Results: Visual acuity was improved in 11.9%; unchanged in 65.4% and worsened in 22.7% of eyes. Conclusion: In assessing long-term visual outcome, Grid laser photocoagulation is an effective modality in maintaining or improving visual acuity.

  18. Updates in the Management of Diabetic Macular Edema

    OpenAIRE

    Christopher Mathew; Anastasia Yunirakasiwi; Srinivasan Sanjay

    2015-01-01

    Diabetes mellitus is a chronic disease which has multiple effects on different end-organs, including the retina. In this paper, we discuss updates on diabetic macular edema (DME) and the management options. The underlying pathology of DME is the leakage of exudates from retinal microaneurysms, which trigger subsequent inflammatory reactions. Both clinical and imaging techniques are useful in diagnosing, classifying, and gauging the severity of DME. We performed a comprehensive literature sear...

  19. Is there a correlation between structural alterations and retinal sensitivity in morphological patterns of diabetic macular edema?

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    Abhishek R Kothari

    2013-01-01

    Full Text Available Spectral domain optical coherence tomography (SDOCT enables enhanced visualization of retinal layers and delineation of structural alterations in diabetic macular edema (DME. Microperimetry (MP is a new technique that allows fundus-related testing of local retinal sensitivity. Combination of these two techniques would enable a structure-function correlation with insights into pathomechanism of vision loss in DME. To correlate retinal structural derangement with retinal sensitivity alterations in cases with diabetic macular edema, using SDOCT and MP. Prospective study of 34 eyes of 30 patients with DME. All patients underwent comprehensive ophthalmic examination, fluorescein angiography, microperimetry and SDOCT. Four distinct morphological patterns of DME were identified- diffuse retinal thickening (DRT, cystoid macular edema (CME, schitic retinal thickening (SRT and neourosensory detachment (NSD of fovea. Some retinal loci presented with a mixture of above patterns There was significant difference in retinal thickness between groups (P<0.001. Focal retinal sensitivity measurement revealed relatively preserved retinal sensitivity in areas with DRT (13.8 dB, moderately reduced sensitivity (7.9 dB in areas with CME, and gross retinal sensitivity loss in areas with SRT (1.2 dB and NSD (4.7 dB (P<0.001. Analysis of regional scotoma depth demonstrated similar pattern. Retinal sensitivity showed better correlation to OCT pattern (r=-0.68, P<0.001 than retinal thickness (r=-0.44, P<0.001. Structure-function correlation allows better understanding of the pathophysiology of visual loss in different morphological types of DME. Classification of macular edema into these categories has implications on the prognosis and predictive value of treatment.

  20. Efficacy of intravitreal dexamethasone implant for prostaglandin-induced refractory pseudophakic cystoid macular edema: case report and review of the literature

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    Sacchi M

    2014-07-01

    Full Text Available Matteo Sacchi, Edoardo Villani, Francesca Gilardoni, Paolo Nucci University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy Background: Macular edema is a known complication even after uneventful cataract surgery. The chronic use of prostaglandin analogs is a risk factor for the development of pseudophakic cystoid macular edema (CME. Nonsteroidal anti-inflammatory drugs (NSAIDs are considered first-line therapy but refractory postsurgical CME represents a therapeutic challenge, as there is not an evidence-based treatment.Objective: To report the use of a single implant of intravitreal dexamethasone for tafluprost-associated pseudophakic CME refractory to NSAIDs and to sub-Tenon’s corticosteroid injections.Case report: A 64-year-old female with ocular hypertension treated with tafluprost experienced decreased vision (visual acuity 20/60 and metamorphopsia 2 months after uneventful cataract extraction. Spectral domain optical coherence tomography (SD-OCT revealed CME. After 1 month of topical and oral NSAIDs, CME was still evident on SD-OCT (visual acuity 20/50. Two sub-Tenon’s betamethasone injections were performed at a 2-week interval. As CME was still present, 2 months after the diagnosis of CME (visual acuity 20/40, the patient underwent a single dexamethasone intravitreal implant. One month later, macular appearance was normal, and visual acuity increased to 20/30. This result was maintained throughout the 6 months of follow-up.Conclusion: In this report, a single implant of intravitreal dexamethasone successfully treated pseudophakic CME associated with the use of prostaglandin analogs unresponsive to NSAIDs and sub-Tenon’s betamethasone. The results of this report need to be corroborated by powered, prospective, randomized trials. The need for repeated treatments as well as the retreatment interval in patients requiring more than a single injection are issues still needing further investigations. Keywords

  1. Dexamethasone intravitreal implant in the treatment of diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Dugel PU

    2015-07-01

    Full Text Available Pravin U Dugel,1,2 Francesco Bandello,3 Anat Loewenstein4 1Retinal Consultants of Arizona, Phoenix, AZ, 2Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 3Department of Ophthalmology, University Vita-Salute Scientific Institute San Raffaele, Milan, Italy; 4Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Abstract: Diabetic macular edema (DME resembles a chronic, low-grade inflammatory reaction, and is characterized by blood–retinal barrier (BRB breakdown and retinal capillary leakage. Corticosteroids are of therapeutic benefit because of their anti-inflammatory, antiangiogenic, and BRB-stabilizing properties. Delivery modes include periocular and intravitreal (via pars plana injection. To offset the short intravitreal half-life of corticosteroid solutions (~3 hours and the need for frequent intravitreal injections, sustained-release intravitreal corticosteroid implants have been developed. Dexamethasone intravitreal implant provides retinal drug delivery for ≤6 months and recently has been approved for use in the treatment of DME. Pooled findings (n=1,048 from two large-scale, randomized Phase III trials indicated that dexamethasone intravitreal implant (0.35 mg and 0.7 mg administered at ≥6-month intervals produced sustained improvements in best-corrected visual acuity (BCVA and macular edema. Significantly more patients showed a ≥15-letter gain in BCVA at 3 years with dexamethasone intravitreal implant 0.35 mg and 0.7 mg than with sham injection (18.4% and 22.2% vs 12.0%. Anatomical assessments showed rapid and sustained reductions in macular edema and slowing of retinopathy progression. Phase II study findings suggest that dexamethasone intravitreal implant is effective in focal, cystoid, and diffuse DME, in vitrectomized eyes, and in combination with laser therapy. Ocular complications of

  2. Multifocal electroretinogram in evaluating retinal function of diabetic macular edema after pars plana vitrectomy

    Institute of Scientific and Technical Information of China (English)

    马进; 吴德正; 高汝龙; 吕林; 张少冲; 文峰; 黄时洲

    2004-01-01

    @@ Beneficial effects of vitrectomy for diabetic macular edema (DME) have been demonstrated in a series of clinical trials. Vitreous surgery is useful in reducing the edema and improving visual acuity.

  3. One day wonder: Fast resolution of macular edema following intravitreal ranibizumab in retinal venous occlusions

    Directory of Open Access Journals (Sweden)

    Lalit Verma

    2013-01-01

    Full Text Available Macular edema is a significant cause of vision loss in patients with central retinal vein occlusions and branch retinal vein occlusions. Vascular endothelial growth factor (VEGF appears to be a key factor in the pathogenesis of this disease. Anti-VEGF therapy, such as intravitreal ranibizumab provides an effective treatment against vision-threatening macular edema. We report three patients of retinal vein occlusion with macular edema who demonstrated overnight resolution of macular edema following treatment with intravitreal ranibizumab (0.5 mg. 3D optical coherence tomography (Optovue was used as a tool for comparison of the macular thickness before and after treatment. The significant reductions in the central foveal thickness demonstrated in these patients one night after intravitreal injections could have significant influence on modifying current treatment protocols. Early treatment of macular edema related to retinal venous occlusive disease with anti-VEGF injections could result in faster visual rehabilitation in these patients.

  4. Localized bi-nasal macular edema in optic chiasmal syndrome

    Directory of Open Access Journals (Sweden)

    Alejandro J Lavaque

    2013-01-01

    Full Text Available A 28-year-old healthy male complaining of vision loss in his right eye was discovered to have localized bi-nasal macular edema in the presence of a pituitary adenoma. The presence of a junctional scotoma composed by a central scotoma in the right eye associated with superior temporal quadrantanopia in the fellow eye was seen. The pattern detected in the visual field suggested the presence of an expansive mass at the level of the optic chiasm. Optical coherence tomography findings also revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae. This report illustrates the importance of suspecting a pituitary adenoma in the light of uncharacteristic retinal alterations.

  5. Utility of hard exudates for the screening of macular edema.

    Science.gov (United States)

    Litvin, Taras V; Ozawa, Glen Y; Bresnick, George H; Cuadros, Jorge A; Muller, Matthew S; Elsner, Ann E; Gast, Thomas J

    2014-04-01

    The purpose of this study was to determine whether hard exudates (HEs) within one disc diameter of the foveola is an acceptable criterion for the referral of diabetic patients suspected of clinically significant macular edema (CSME) in a screening setting. One hundred forty-three adults diagnosed as having diabetes mellitus were imaged using a nonmydriatic digital fundus camera at the Alameda County Medical Center in Oakland, CA. Nonstereo fundus images were graded independently for the presence of HE near the center of the macula by two graders according to the EyePACS grading protocol. The patients also received a dilated fundus examination on a separate visit. Clinically significant macular edema was determined during the dilated fundus examination using the criteria set forth by the Early Treatment Diabetic Retinopathy Study. Subsequently, the sensitivity and specificity of HEs within one disc diameter of the foveola in nonstereo digital images used as a surrogate for the detection of CSME diagnosed by live fundus examination were calculated. The mean (±SD) age of 103 patients included in the analysis was 56 ± 17 years. Clinically significant macular edema was diagnosed in 15.5% of eyes during the dilated examination. For the right eyes, the sensitivity of HEs within one disc diameter from the foveola as a surrogate for detecting CSME was 93.8% for each of the graders; the specificity values were 88.5 and 85.1%. For the left eyes, the sensitivity values were 93.8 and 75% for each of the two graders, respectively; the specificity was 87.4% for both graders. This study supports the use of HE within a disc diameter of the center of the macula in nonstereo digital images for CSME detection in a screening setting.

  6. Practice management of french retinal specialists in diabetic macular edema

    OpenAIRE

    QU-KNAFO, Mo lise

    2015-01-01

    Purpose: To evaluate the practice management of french vitreoretinal (VR) specialists in the treatment of diabetic macular edema (DME)Methods: A 31-item survey investigating real life practice in diagnosis and treatment of DME was mailed to specialists identified from the Société Française d’Ophtalmologie and the Club Francophone des Spécialistes de la Rétine. Answers were analysed anonymously by an online survey software. Results: 95 specialists answered the survey. 25%, 36% and 32% of respo...

  7. Effect of macular photocoagulation on visual acuity of Omani patients with clinically significant macular edema

    Directory of Open Access Journals (Sweden)

    Zafar A Zaidi

    2009-01-01

    Full Text Available Background: The aim of this study was to determine the effect of macular laser treatment on the visual acuity (VA of Omani diabetic patients with clinically significant macular edema (CSME. Visual outcome was also correlated with duration and control of diabetes and presence or absence of hypertension and hyperlipidemia. Materials and Methods: This is a retrospective noncomparative cohort study involving 101 eyes of 72 Omani diabetic patients. Change in VA was determined using Snellen′s VA chart. The mean duration of follow-up was approximately 21 months (range, 16-24 months. Results: 29.7% of the patients maintained their vision, 35.6% showed improvement, whereas 34.7% showed a decrease in their vision. Positive visual outcome showed a statistically significant direct relationship with tight control of diabetes and absence of hypertension and an inverse relationship with the duration of diabetes. Presence of hyperlipedemia did not show a statistically significant relationship with positive visual outcome. However, it showed a trend to better visual outcome in the absence of hyperlipedemia. Peak incidence of macular edema was seen at the age of 52.3 years. Conclusion: Macular photocoagulation was found to be an effective method of treatment for CSME among Omani diabetic patients, which has resulted in a positive visual outcome in 65.3% of the patients (stable and improved vision. Effective control of diabetes, duration of diabetes, and hypertension are the factors which influence the postlaser visual outcome.

  8. Volcano like pattern in optical coherence tomography in chronic diabetic macular edema.

    Science.gov (United States)

    Pai, Sivakami A; Hussain, Nazimul; Hebri, Sudhira P; Lootah, Afra M; Dekhain, Moza A

    2014-04-01

    In this article we herein report an interesting vitreo-macular interface abnormality associated with chronic diabetic cystoid macular edema. It is an observational case study of three diabetic patients examined in the diabetic clinic. All the patients had proliferative diabetic retinopathy with chronic macular edema. A serial cross sectional OCT examination and tracking of both the longitudinal progression of macular thickening and vitreo-macular interface revealed cystoid macular edema with a characteristic hyperreflective vitreous shadow emerging from the vitreofoveal interface. All the patients had dehiscence of inner retinal layers. This particular morphological feature at the vitreo-foveolar interface, which we name as "volcano sign", has not been described earlier. The probable mechanism of such a finding probably could be due to slow progressive leakage of chronic cytoid fluid into the vitreous with condensation of the overlying vitreous. Vitreo-macular traction followed by posterior vitreous detachment probably would have contributed to such a morphological event.

  9. Etiology and treatment of the inflammatory causes of cystoid macular edema

    Directory of Open Access Journals (Sweden)

    Hyung Cho

    2009-10-01

    Full Text Available Hyung Cho1, Assumpta Madu11Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USAAbstract: Cystoid macular edema in its various forms can be considered one of the leading causes of central vision loss in the developed world. It occurs in a wide variety of pathologic conditions and represents the final common pathway of several basic processes. Therapeutic approaches to cystoid macular edema depend on a clear understanding of its contributing pathophysiologic mechanisms. This review will discuss the mechanism of ocular inflammation in cystoid macular edema with a particular focus on the inflammatory causes: post-operative, uveitic, and after laser procedures. A variety of pharmacologic agents targeting inflammatory molecules have been shown to reduce macular edema and improve visual function. However, the long-term efficacy and safety of most new therapies have yet to be established in controlled clinical trials.Keywords: ocular inflammation, cystoid macular edema, uveitis

  10. Treatment of cystoid macular edema secondary to chronic non-infectious intermediate uveitis with an intraocular dexamethasone implant

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    Julia Dutra Rossetto

    2015-06-01

    Full Text Available ABSTRACT Purpose: To evaluate the use of a slow-release dexamethasone 0.7-mg intravitreal implant for cystoid macular edema (CME secondary to intermediate uveitis and refractory to systemic steroids. Methods: A retrospective study of the best-corrected visual acuity (BCVA, intraocular inflammation, intraocular pressure (IOP, fundus photography, optical coherence tomography (OCT, inflammation, and adverse reactions of five patients (women, mean age of 35 years with cystoid macular edema treated with a dexamethasone implant. Patients were evaluated in seven visits until the 150th day after the implant. Results: Four patients had bilateral pars planitis and one had bilateral intermediate uveitis associated with juvenile idiopathic arthritis. Six dexamethasone devices were implanted, under topical anesthesia (one each in six eyes, five patients. The mean follow-up time was 5 months. The best-corrected visual acuity improved in all eyes that received an implant, with five having improvements of two or more lines. Optical coherence tomography showed thinning of the macula in all eyes treated, and we saw a correlation between the best-corrected visual acuity and retinal thinning. No serious adverse events occurred and no significant increase in intraocular pressure was observed. Conclusions: Slow-release dexamethasone intravitreal implants can effectively treat CME secondary to intermediate uveitis and refractory to systemic steroids.

  11. Dexamethasone intravitreal implant in the treatment of diabetic macular edema.

    Science.gov (United States)

    Dugel, Pravin U; Bandello, Francesco; Loewenstein, Anat

    2015-01-01

    Diabetic macular edema (DME) resembles a chronic, low-grade inflammatory reaction, and is characterized by blood-retinal barrier (BRB) breakdown and retinal capillary leakage. Corticosteroids are of therapeutic benefit because of their anti-inflammatory, antiangiogenic, and BRB-stabilizing properties. Delivery modes include periocular and intravitreal (via pars plana) injection. To offset the short intravitreal half-life of corticosteroid solutions (~3 hours) and the need for frequent intravitreal injections, sustained-release intravitreal corticosteroid implants have been developed. Dexamethasone intravitreal implant provides retinal drug delivery for ≤6 months and recently has been approved for use in the treatment of DME. Pooled findings (n=1,048) from two large-scale, randomized Phase III trials indicated that dexamethasone intravitreal implant (0.35 mg and 0.7 mg) administered at ≥6-month intervals produced sustained improvements in best-corrected visual acuity (BCVA) and macular edema. Significantly more patients showed a ≥15-letter gain in BCVA at 3 years with dexamethasone intravitreal implant 0.35 mg and 0.7 mg than with sham injection (18.4% and 22.2% vs 12.0%). Anatomical assessments showed rapid and sustained reductions in macular edema and slowing of retinopathy progression. Phase II study findings suggest that dexamethasone intravitreal implant is effective in focal, cystoid, and diffuse DME, in vitrectomized eyes, and in combination with laser therapy. Ocular complications of dexamethasone intravitreal implant in Phase III trials included cataract-related events (66.0% in phakic patients), intraocular pressure elevation ≥25 mmHg (29.7%), conjunctival hemorrhage (23.5%), vitreous hemorrhage (10.0%), macular fibrosis (8.3%), conjunctival hyperemia (7.2%), eye pain (6.1%), vitreous detachment (5.8%), and dry eye (5.8%); injection-related complications (eg, retinal tear/detachment, vitreous loss, endophthalmitis) were infrequent (implant offers a

  12. Severe Macular Edema in Patients with Juvenile Idiopathic Arthritis-Related Uveitis

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    Maria Pia Paroli

    2013-01-01

    unilateral macular edema. OCT revealed massive macular thickening (range from 550 μm to 1214 μm. Conclusions. Macular edema appeared in female adolescent patients in eyes with long-dating CAU submitted to cataract surgery. In such patients, in presence of age-related microvascular changes due to the enhancer effect of sex hormones, cataract extraction should be a factor triggering the retinal complication.

  13. Three-dimensional imaging of cystoid macular edema in retinal vein occlusion.

    Science.gov (United States)

    Yamaike, Noritatsu; Tsujikawa, Akitaka; Ota, Masafumi; Sakamoto, Atsushi; Kotera, Yuriko; Kita, Mihori; Miyamoto, Kazuaki; Yoshimura, Nagahisa; Hangai, Masanori

    2008-02-01

    To study the pathomorphologic features of cystoid macular edema (CME) associated with retinal vein occlusion by three-dimensional (3D) optical coherence tomography (OCT) and to study the relationship of the ocular findings to visual function. Observational case series. Twenty eyes of 20 patients with retinal vein occlusion. A prototype 3D OCT system based on Fourier-domain OCT technology was fabricated for patient examination in this study. This system uses a superluminescent diode, which has a center wavelength of 830 nm and a bandwidth of 50 nm, as the light source, resulting in 4.3-microm axial resolution in tissue. Data acquisition rates of approximately 18 700 axial scans per second and a sensitivity of 98 dB were achieved. Three-dimensional imaging was performed by volume rendering based on the 3D data set acquired with a raster scan of 256x256 axial scans. Images of CME pathologic features obtained by 3D OCT and by Stratus OCT (Carl Zeiss, Dublin, CA). The 3D OCT imaging system generates a realistic 3D image of CME with high resolution. In 16 eyes, 3D OCT showed large foveal cystoid spaces, most of which were accompanied by small cystoid spaces in the parafoveal region. Cystoid spaces were seen often in the inner nuclear layer and outer plexiform layer, but were detected to some extent in all retinal layers. The 3D OCT showed clearly a thin back-reflecting line corresponding to the external limiting membrane (ELM) in 18 eyes; of these, cystoid spaces were located on the inside of the ELM in 7 eyes and appeared to be in contact with the ELM in 9 eyes. In 2 eyes, the ELM line could not be seen clearly beneath the large foveal cystoid spaces. Integrity of the ELM in the foveal region had a direct correlation with visual acuity. Observation of CME using 3D OCT enabled visualization of its spatial extent in each retinal layer and discernment of its relationship to the ELM. The use of 3D OCT thus may improve the monitoring of CME progression and its response to

  14. Visual loss related to macular subretinal fluid and cystoid macular edema in HIV-related optic neuropathy

    DEFF Research Database (Denmark)

    Gautier, David; Rabier, Valérie; Jallet, Ghislaine;

    2012-01-01

    Optic nerve involvement may occur in various infectious diseases, but is rarely reported after infection by the human immunodeficiency virus (HIV). We report the atypical case of a 38-year-old patient in whom the presenting features of HIV infection were due to a bilateral optic neuropathy associ...... associated with macular subretinal fluid and cystoid macular edema, which responded well to antiretroviral therapy....

  15. Strategy for the Management of Diabetic Macular Edema: The European Vitreo-Retinal Society Macular Edema Study

    Directory of Open Access Journals (Sweden)

    Ron Adelman

    2015-01-01

    Full Text Available Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME. Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s performed, the pre- and posttreatment visual acuities, and other clinical findings. The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies. Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results. The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatment with threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies.

  16. EFFICACY AND SAFETY OF GRID PHOTOCOAGULATION IN DIFFUSE DIABETIC MACULAR EDEMA IN RURAL SETUP

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    Narendra P

    2014-04-01

    Full Text Available Macular edema is a common cause of visual impairment in non-proliferative diabetic retinopathy. Laser photocoagulation is considered to be the standard treatment for diabetic macular edema. This study was taken up to find out the efficacy and safety of grid photocoagulation in diffuse diabetic macular edema in our rural setup. OBJECTIVES: To assess visual improvement and document adverse effects if any in diffuse diabetic macular edema after grid photocoagulation. MATERIALS AND METHODS: In this study, 30 eyes of 17 patients with diffuse diabetic macular edema were evaluated at retina clinic at Tamaka, Kolar. The visual acuities, fundoscopic findings and adverse effects at 3 months, 6 months and 1 year checkup following laser were used in present analysis. RESULTS: After one year of follow up, visual acuity in 8 eyes (26.6% improved by one or more line, 17 (56.6% did not change and 5 (16.6% lost by one or more lines. Macular edema was found to regress in 23 (76.6% lasered eyes, found same in 6 (20%, worsened in 1 (3.3%. In our study 83.33% had positive visual acuity and 96.66% had positive fundoscopic finding. CONCLUSION: Grid photocoagulation is of benefit in maintaining vision and resolution of diffuse diabetic macular edema

  17. Evidence-Based Treatment of Diabetic Macular Edema.

    Science.gov (United States)

    Barham, Rasha; El Rami, Hala; Sun, Jennifer K; Silva, Paolo S

    2017-01-01

    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.

  18. Cystoid macular edema in a patient with Danon disease

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    Heather G Mack

    2014-01-01

    Full Text Available To report a patient with Danon retinopathy with cystoid macular edema treated with topical dorzolamide 2% eye drops and oral acetazolamide. A 37-year-old Caucasian man with Danon disease treated with topical and oral carbonic anhydrase inhibitors participated in the study. Examinations performed before and during treatment included visual acuity (VA, spectral-domain optical coherence tomography, and electroretinography. Following total 48 weeks of treatment, VA decreased from 20/30 OD, 20/200 OS, to 20/40 OD, CF OS. The mean central retinal thickness was unchanged from baseline 263 μm OD , 226 μm OS, after treatment 283 μm OD and 202 μm OS. In our case, carbonic anydrase inhibitors were not effective. However, a general recommendation cannot be given based on a single case.

  19. El ruboxistaurin, una alternativa en el edema macular diabético The ruboxistaurin, an alternative in the diabetic macular edema

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    María Emoé Pérez Muñoz

    2012-04-01

    Full Text Available Antecedentes: el edema macular es la principal causa de baja visión en personas con retinopatía diabética. Objetivo: revisar los resultados del tratamiento con ruboxistaurin en el edema macular diabético. Desarrollo: la hiperglucemia, entre otras alteraciones metabólicas, activa la proteína quinasa C, lo que contribuye a la disfunción microvascular, trastorno importante en la patogenia del edema macular diabético. Diversos procederes terapéuticos se han utilizado en su tratamiento. En los últimos años el ruboxistaurin ha demostrado su capacidad de inhibir la activación de la proteína quinasa C. Algunos autores opinan que este fármaco es capaz de mejorar el edema macular diabético, y por tanto, la visión. Se ha comunicado que la administración de 32 mg diarios de ruboxistaurin, previene la progresión de la retinopatía diabética y atenúa el riesgo de pérdida visual por edema macular diabético. Otros estudios describen resultados similares, y además, refieren, que el ruboxistaurin disminuye el riesgo de empeoramiento y progresión del edema macular diabético, así como reduce la necesidad de tratamiento con láser. Conclusiones: el uso del ruboxistaurin abre nuevas perspectivas en la prevención y tratamiento del déficit visual por retinopatía diabética y por edema macular diabético, sin embargo, se piensa que los estudios realizados hasta el momento son insuficientes para llegar a conclusiones valederas. Se imponen estudios a más largo plazo para definir su costo/beneficio.Backgrounds: the macular edema is the main cause of low vision in persons with diabetic retinopathy. Objective: to analyze the results of treatment with ruboxistaurin in cases of diabetic macular edema. Development: the hyperglycemia among other metabolic alterations, to active the kinase C protein contributing to microvascular dysfunction, an important disorder in the pathogenesis of the diabetic macular edema. Different therapeutical procedures

  20. Assessment of Macular Sensitivity and Fixation Stability by MP-1 Microperimetry in Diabetic Macular Edema

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    Tuncay Küsbeci

    2012-12-01

    Full Text Available Pur po se: To evaluate macular light sensitivity and fixation stability in subjects with clinically significant macular edema (CSME related to diabetes mellitus. Ma te ri al and Met hod: Thirty eyes of 22 patients with CSME, as defined by Early Treatment Diabetic Retinopathy Study, and 32 eyes of 32 healthy subjects were enrolled in this study. Microperimetry was performed with the Micro Perimeter MP-1 in both groups. The mean retinal sensitivities at central 4°, at central 12° and at central 20° were measured. The mean extent of preferred retinal locus (PRL, fixation stability and fixation location were calculated using fixation test in MP-1 microperimeter. Statistical analysis was performed using student t-test and chisquare test. Re sults: The mean best-corrected visual acuity (BCVA was significantly lower in the CSME group than the control group (p<0.001. The mean retinal sensitivities at central 4°, 12° and 20° areas were significantly lower in the CSME group compared to the control group (p<0.001, for each central degrees. In subjects with CSME, fixation stability was detected as stable in 8 (26.7% eyes, relatively unstable in 21 (70% eyes and unstable in 1 (3.3% eye. Significant decrease was found in fixation stability and fixation location scores in eyes with CSME compared to control subjects (p<0.001. The difference of mean extent in PRL between the groups was statistically significant (p<0.001. Dis cus si on: The macular light sensitivity and fixation stability are affected in patients with CSME. MP-1 micropeimetry might be helpful to evaluate the extent of PRL and useful for evaluation of severity and progression of diabetic macular edema. (Turk J Ophthalmol 2012; 42: 310-5

  1. Intravitreal bevacizumab for persistent macular edema with proliferative diabetic retinopathy.

    Science.gov (United States)

    Gulkilik, Gokhan; Taskapili, Muhittin; Kocabora, Selim; Muftuoglu, Gulipek; Demirci, Goktug

    2010-12-01

    To evaluate the effectiveness of an intravitreal bevacizumab injection on retinal neovascularization and diabetic macular edema (DME) refractory to laser photocoagulation therapy. Thirty-four eyes of 22 patients with proliferative diabetic retinopathy and DME refractory to laser photocoagulation therapy received an intravitreal injection of 1.25 mg/0.05 ml of bevazicumab. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), regression of neovascularization over time, and correlation between BCVA and CMT were evaluated. Follow-up visits were at weeks 1, 2 and 4 and months 3 and 6. Mean BCVA was significantly better than baseline only at week 2 (P = 0.036). Mean CMT decreased significantly from baseline at weeks 1, 2, and 4 (P = 0.001). At months 3 and 6, mean CMT increased, albeit insignificantly (P = 0.804 and P = 1.0). The decrease in fluorescein leakage was moderate in all eyes at the end of week 1. At week 2, there was total resolution of fluorescein leakage in 24 (70.5%) eyes and moderate resolution in 10 (29.5%) eyes. At the end of month 3, the fluorescein leakage was fully resolved in 5 (14.7%) eyes, moderately resolved in 24 (70.5%) eyes, and was similar to baseline in 5 (14.7%) eyes. At month 6, the fluorescein leakage was fully resolved in 3 (8.8%) eyes, moderately resolved in 20 (58.8%) eyes, and was similar to baseline in 11 (32.4%) eyes. A moderate but insignificant negative correlation was found between visual acuity and CMT (P > 0.05). Persistence or recurrence of neovascular tissue after panretinal photocoagulation may be attributed to the production of vascular endothelial growth factor by the residual ischemic retina, which also results in persistent or recurrent DME despite macular grid photocoagulation.

  2. Microperimetry Findings of a Patient with Macular Edema Secondary to Retinitis Pigmentosa

    Directory of Open Access Journals (Sweden)

    Cem Ozgonul

    2013-08-01

    Full Text Available Sixty-nine year old male patient with a diagnosis of retinitis pigmentosa admitted to our clinic. In ophthalmologic examination fundoscopy was compatible with retinitis pigmentosa. For evaluation of macular edema, optical coherence tomography and microperimetry were performed to examine the structure and function of the macula. Chronic macular edema findings were obtained with optical coherence tomography. By microperimetry, mean retinal sensitivity in the central 20 degrees of both eyes was measured 8-10 decibels. The aim of this study is, to emphasize the importance of microperimetry for the evaluation of retinal function in a patient with macular edema secondary to retinitis pigmentosa.

  3. Efficacy of intravitreal ranibizumab injection combined with macular grid photocoagulation for diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Hu-Lin Jiang

    2014-07-01

    Full Text Available AIM:To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with macular grid photocoagulation for diabetic macular edema(DME.METHODS:Totally 60 eyes(60 patientswith DME were randomly divided into 2 groups: 30 eyes of simple injection group underwent intravitreal injection of ranibizumab, and 30 eyes of combined treatment group underwent intravitreal injection of ranibizumab and macular grid photocoagulation 1wk later. The best corrected visual acuity(BCVA, central macular thickness(CMTmeasured by optical coherence tomography(OCTand postoperative complications were observed.RESULTS:In simple injection group, the BCVA after operation were separately 0.390±0.075(4wk, 0.367±0.088(8wkand 0.319±0.064(12wk,the CMT after operation were separately 221.63±112.34μm(4wk, 337.73±99.56μm(8wkand 432.92±100.46μm(12wk, which were much better than pre-operation. But during follow-up, the BCVA presented down trend and the CMT was on the rise slowly. In combined treatment group, the BCVA after operation were separately 0.385±0.036(4wk, 0.382±0.079(8wkand 0.377±0.097(12wk,the CMT after operation were separately 249.77±106.55μm(4wk, 270.40±92.88μm(8wkand 275.84±97.34μm(12wk, which were satisfactory and steady during follow-up, better than simple injection group(PCONCLUSION:Intravitreal injection of ranibizumab can effectively improve visual acuity and decrease central foveal thickness for patients with DME, combining with macular grid photocoagulation can ensure therapeutic effects steady and permanent.

  4. Prostaglandin-Induced Cystoid Macular Edema Following Routine Cataract Extraction

    Directory of Open Access Journals (Sweden)

    Negin Agange

    2010-01-01

    patient first developed CME OD 4-months post uncomplicated cataract extraction. XALATAN (Latanoprost had been restarted after surgery and discontinued at onset of CME. While off XALATAN (Latanoprost, the patient's CME resolved, but his IOP rose. The patient was started on LUMIGAN (Bimatoprost to control the IOP, but within weeks his CME recurred. The patient's CME was again treated and his IOP remained acceptable, but then progressively increased. TRAVATAN (Travoprost was attempted, but he presented with a third round of CME. Definitive conclusions about causal relationships cannot be made without well-designed, prospective clinical trials addressing this issue.

  5. Etiology and treatment of the inflammatory causes of cystoid macular edema.

    Science.gov (United States)

    Cho, Hyung; Madu, Assumpta

    2009-01-01

    Cystoid macular edema in its various forms can be considered one of the leading causes of central vision loss in the developed world. It occurs in a wide variety of pathologic conditions and represents the final common pathway of several basic processes. Therapeutic approaches to cystoid macular edema depend on a clear understanding of its contributing pathophysiologic mechanisms. This review will discuss the mechanism of ocular inflammation in cystoid macular edema with a particular focus on the inflammatory causes: post-operative, uveitic, and after laser procedures. A variety of pharmacologic agents targeting inflammatory molecules have been shown to reduce macular edema and improve visual function. However, the long-term efficacy and safety of most new therapies have yet to be established in controlled clinical trials.

  6. Etiology and treatment of the inflammatory causes of cystoid macular edema

    Science.gov (United States)

    Cho, Hyung; Madu, Assumpta

    2009-01-01

    Cystoid macular edema in its various forms can be considered one of the leading causes of central vision loss in the developed world. It occurs in a wide variety of pathologic conditions and represents the final common pathway of several basic processes. Therapeutic approaches to cystoid macular edema depend on a clear understanding of its contributing pathophysiologic mechanisms. This review will discuss the mechanism of ocular inflammation in cystoid macular edema with a particular focus on the inflammatory causes: post-operative, uveitic, and after laser procedures. A variety of pharmacologic agents targeting inflammatory molecules have been shown to reduce macular edema and improve visual function. However, the long-term efficacy and safety of most new therapies have yet to be established in controlled clinical trials. PMID:22096351

  7. One-year progression of diabetic subclinical macular edema in eyes with mild nonproliferative diabetic retinopathy

    DEFF Research Database (Denmark)

    Tejerina, Amparo Navea; Vujosevic, Stela; Varano, Monica

    2015-01-01

    PURPOSE: To characterize the 1-year progression of retinal thickness (RT) increase occurring in eyes with subclinical macular edema in type 2 diabetes. METHODS: Forty-eight type 2 diabetic eyes/patients with mild nonproliferative diabetic retinopathy (NPDR; levels 20 and 35 in the Early Treatment...... Diabetic Retinopathy Study) classified as presenting subclinical macular edema at baseline completed the 1-year follow-up period, from a sample of 194 followed in a 12-month observational and prospective study (ClinicalTrials.gov identifier: NCT01145599). Automated segmentation of the retinal layers...... in these eyes was performed, followed by verification and correction by a human grader. RESULTS: The highest increase in RT over the 1-year follow-up period for the 48 eyes/patients with subclinical macular edema was found in the inner nuclear layer (INL). Progression to clinical macular edema was also...

  8. Diabetic macular edema: it is more than just VEGF [version 1; referees: 2 approved

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    Michael A. Singer

    2016-05-01

    Full Text Available Diabetic macular edema is a serious visual complication of diabetic retinopathy. This article reviews the history of previous and current therapies, including laser therapy, anti-vascular endothelial growth factor agents, and corticosteroids, that have been used to treat this condition. In addition, it proposes new ways to use them in combination in order to decrease treatment burden and potentially address other causes besides vascular endothelial growth factor for diabetic macular edema.

  9. Longstanding refractory pseudophakic cystoid macular edema resolved using intravitreal 0.7 mg dexamethasone implants

    DEFF Research Database (Denmark)

    Brynskov, Troels; Laugesen, Caroline Schmidt; Halborg, Jakob;

    2013-01-01

    Refractory pseudophakic cystoid macular edema (PCME) following cataract surgery has long posed a challenge to clinicians, but intravitreal injections with a sustained delivery 0.7 mg dexamethasone implant has emerged as a promising therapy for this condition.......Refractory pseudophakic cystoid macular edema (PCME) following cataract surgery has long posed a challenge to clinicians, but intravitreal injections with a sustained delivery 0.7 mg dexamethasone implant has emerged as a promising therapy for this condition....

  10. Arginine-Restricted Therapy Resistant Bilateral Macular Edema Associated with Gyrate Atrophy

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    Sibel Doguizi

    2015-01-01

    Full Text Available Introduction. Gyrate atrophy is a rare genetical metabolic disorder affecting vision. Here, we report a 9-year-old boy with gyrate atrophy associated with bilateral macular edema at the time of diagnosis and the effect of long term metabolic control on macular edema. Case Presentation. A 9-year-old boy presented with a complaint of low visual acuity (best corrected visual acuity: 20/80 in both eyes, refractive error: −12.00 D. Dilated fundus examination revealed multiple bilateral, sharply defined, and scalloped chorioretinal atrophy areas in the midperipheral and peripheral zone. Spectral-domain optical coherence tomography revealed bilateral cystoid macular edema in both eyes. Serum ornithine level was high (622 μmol/L. An arginine-restricted diet reduced serum ornithine level (55 μmol/L. However, visual findings including macular edema remained unchanged in 2 years of follow-up. Conclusion. Arginine-restricted diet did not improve macular edema in our patient with gyrate atrophy. A more comprehensive understanding of the underlying factors for macular edema will lead to the development of effective therapies.

  11. Spectral domain optical coherence tomography documented rapid resolution of pseudophakic cystoid macular edema with topical difluprednate

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    Chalam KV

    2012-01-01

    Full Text Available KV Chalam, Vijay Khetpal, Chirag J PatelDepartment of Ophthalmology, University of Florida Jacksonville, FL, USAIntroduction: Pseudophakic cystoid macular edema is a common cause of poor vision after cataract surgery, and topical corticosteroids and nonsteroidal anti-inflammatory drugs are used for its treatment. We investigated the effectiveness of difluprednate (Durezol®, recently approved by the US Food and Drug Administration in the treatment of cystoid macular edema, assisted with spectral domain optical coherence tomography (SD-OCT.Case report: A 63-year-old African-American woman presented 6 weeks after uneventful cataract surgery in her left eye with decreased vision and associated distortion of the central visual field. Fluorescein angiogram and SD-OCT confirmed pseudophakic cystoid macular edema. Difluprednate was topically administered twice daily and monitored with serial imaging. Resolution was noted after 1 month of topical therapy, with improvement in visual acuity and resolution of distortion.Conclusion: Difluprednate is an effective treatment for patients with severe pseudophakic cystoid macular edema. SD-OCT allows the physician to monitor resolution of the macular edema easily.Keywords: cystoid macular edema, difluprednate, spectral domain optical coherence tomography, pseudophakic

  12. Ranibizumab in the treatment of patients with visual impairment due to diabetic macular edema

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    Bandello F

    2011-09-01

    Full Text Available Francesco Bandello1, Umberto De Benedetto1, Karl Anders Knutsson1, Maurizio Battaglia Parodi1, Maria Lucia Cascavilla1, Pierluigi Iacono21Department of Ophthalmology, University Vita-salute, Scientific Institute San Raffaele, Milan, Italy; 2Fondazione G B Bietti per l’Oftalmologia, IRCCS, Rome, ItalyAbstract: Diabetic macular edema is the major cause of visual acuity impairment in diabetic patients. The exact etiopathogenesis is unknown and, currently, grid/focal retinal laser photocoagulation represents the recommended treatment. It has been demonstrated that vascular endothelial growth factor (VEGF plays a key role in the pathogenesis of diabetic macular edema by mediating vascular permeability and accumulation of intracellular and extracellular fluid, and thereby represents an appealing candidate as a therapeutic target for the treatment of diabetic macular edema. The advent of intravitreal anti-VEGF drugs has opened up a new era for the management of diabetic macular edema. At present, three anti-VEGF substances are available for routine clinical use, ie, pegaptanib, ranibizumab, and bevacizumab. The aim of this review is to summarize the evidence supporting the use of ranibizumab in clinical practice. Most of the studies analyzed in this review are prospective, controlled clinical trials that have focused on documenting the therapeutic effect of ranibizumab and its safety, providing encouraging results.Keywords: ranibizumab, diabetic macular edema, anti-VEGF, diabetic macular edema

  13. Pearl necklace sign in diabetic macular edema: Evaluation and significance

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    Kshirasagar Ajay

    2016-01-01

    Full Text Available Purpose: (1 The purpose of this study was to describe significance and prevalence of the newly reported pearl necklace spectral domain optical coherence tomography (SDOCT sign, in diabetic macular edema (DMO, (2 to track the course of this sign over a period of at least 10 months. Materials and Methods: The pearl necklace SDOCT sign refers to hyperreflective dots in a contiguous ring around the inner wall of cystoid spaces in the retina, recently described for the first time in 21 eyes with chronic exudative maculopathy. A retrospective analysis was performed of SDOCT images of all patients presenting to the DMO referral clinic of a tertiary eye care center, over a period of 24 months. Images of patients displaying this sign were sequentially analyzed for at least 10 months to track the course of the sign. Results: Thirty-five eyes of 267 patients (13.1% were found to display the pearl necklace sign. Twenty-eight eyes responded to intravitreal ranibizumab treatment with resolution of edema. In 21 eyes, the dots coalesced to form a clump, visible in the infrared fundus photograph as hard exudates; in seven eyes, dots disappeared without leaving visible exudates. In three eyes, the sign was seen in subfoveal cystoid spaces, with subsequent development of hard exudates, and drop in visual acuity of 20 letters or more. Conclusion: Pearl necklace SDOCT sign is not infrequent in DMO. This sign is a precursor to hard exudates in the majority of cases. If this sign is seen subfoveally, drop in visual acuity can be expected, despite treatment.

  14. Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema

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    Fong AH

    2013-04-01

    Full Text Available Angie HC Fong,1 Timothy YY Lai1,2 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong; 22010 Retina and Macula Centre, Tsimshatsui, Kowloon, Hong Kong Abstract: Neovascular age-related macular degeneration (AMD and diabetic macular edema (DME are major causes of visual impairment in the elderly population worldwide. With the aging population, the prevalence of neovascular AMD and DME has increased substantially over the recent years. Vascular endothelial growth factor (VEGF has been implicated as playing an important role in the pathogenesis of both neovascular AMD and DME. Since its introduction in 2006, ranibizumab, a recombinant, humanized, monoclonal antibody fragment against all isoforms of VEGF-A, has revolutionized the treatment of neovascular AMD and DME. The efficacy and safety of ranibizumab in neovascular AMD has been demonstrated in the ANCHOR and MARINA trials. Further studies including the PIER, PrONTO, and SUSTAIN trials have also evaluated the optimal dosing regimen of ranibizumab in neovascular AMD. The CATT and IVAN trials compared the safety and efficacy of ranibizumab with off-label use of bevacizumab. Studies such as SUSTAIN and HORIZON have shown that ranibizumab has a good safety profile and is well tolerated for over 4 years with very few serious ocular and systemic adverse events. For DME, Phase II RESOLVE study and Phase III RISE and RIDE studies have demonstrated superiority of ranibizumab treatment in improving vision over placebo controls. Phase II READ and Phase III RESOLVE and REVEAL studies have shown that ranibizumab is more effective both as monotherapy and in combination with laser compared with laser monotherapy. The 3-year results from the DRCRnet protocol I study found that ranibizumab with deferred laser resulted in better long-term visual outcome compared with ranibizumab with prompt laser. This review summarizes various

  15. Interventions for the treatment of uveitic macular edema: a systematic review and meta-analysis

    Science.gov (United States)

    Karim, Rushmia; Sykakis, Evripidis; Lightman, Susan; Fraser-Bell, Samantha

    2013-01-01

    Background Uveitic macular edema is the major cause of reduced vision in eyes with uveitis. Objectives To assess the effectiveness of interventions in the treatment of uveitic macular edema. Search strategy Cochrane Central Register of Controlled Trials, Medline, and Embase. There were no language or data restrictions in the search for trials. The databases were last searched on December 1, 2011. Reference lists of included trials were searched. Archives of Ophthalmology, Ophthalmology, Retina, the British Journal of Ophthalmology, and the New England Journal of Medicine were searched for clinical trials and reviews. Selection criteria Participants of any age and sex with any type of uveitic macular edema were included. Early, chronic, refractory, or secondary uveitic macular edema were included. We included trials that compared any interventions of any dose and duration, including comparison with another treatment, sham treatment, or no treatment. Data collection and analysis Best-corrected visual acuity and central macular thickness were the primary outcome measures. Secondary outcome data including adverse effects were collected. Conclusion More results from randomized controlled trials with long follow-up periods are needed for interventions for uveitic macular edema to assist in determining the overall long-term benefit of different treatments. The only intervention with sufficiently robust randomized controlled trials for a meta-analysis was acetazolamide, which was shown to be ineffective in improving vision in eyes with uveitic macular edema, and is clinically now rarely used. Interventions showing promise in this disease include dexamethasone implants, immunomodulatory drugs and anti-vascular endothelial growth-factor agents. When macular edema has become refractory after multiple interventions, pars plana vitrectomy could be considered. The disease pathophysiology is uncertain and the course of disease unpredictable. As there are no clear guidelines from

  16. Clinical evaluation of microcystic macular edema in patients with glaucoma.

    Science.gov (United States)

    Murata, N; Togano, T; Miyamoto, D; Ochiai, S; Fukuchi, T

    2016-11-01

    PurposeTo investigate the prevalence of microcystic macular edema (MME) in patients with glaucoma and the relationship between glaucomatous visual field defects and MME.Patients and methodsWe analyzed 636 eyes of 341 glaucoma patients who underwent spectral domain optical coherence tomography (SD-OCT). MME was defined as vacuoles observed in the inner nuclear layer (INL) on SD-OCT. Quantitative assessment of MME area was performed using en-face imaging obtained swept-source OCT (SS-OCT) and Adobe Photoshop CS6 Extended software. These values were compared with the visual field results with the Humphrey field analyzer.ResultsMME was observed in 1.6% of eyes. The visual field mean deviation (MD), pattern standard deviation (PSD) and visual acuity was significantly worse (P= 0.023, P=0.037, and P=0.018, respectively) in eyes with MME. The average MME area was 2.38±1.43%. There was no significant correlation between visual field deficits and MME area.ConclusionsThe MME detection rate based on general inspection was 1.6%. MME in glaucomatous eyes were associated with worse MD, PSD, and visual acuity. Further research is needed to increase the number of cases to allow for more detailed analysis.

  17. Diabetic Macular Edema: From Old Concepts to New Therapeutic Avenues.

    Science.gov (United States)

    Mansour, Ahmad M; Pulido, Jose S; Arevalo, J Fernando

    2015-01-01

    Diabetic macular edema (DME) is a significant cause of blindness in the working population and is currently challenging to treat. Current interventions include focal laser or intravitreal injections. This article outlines a new treatment protocol based on the theory that peripheral ischemia is the precursor to angiogenesis, which will ultimately gather its momentum at the fovea. Extreme peripheral light laser panretinal photocoagulation (PRP) back to the equator reduces excessive production of the vascular endothelial growth factor (VEGF) in the eye. This decreases VEGF-induced DME and provides long-term protection against the development of neovascularization. Initial exacerbation of DME often accompanies PRP. Therefore, injections of anti-VEGF agents (with or without dexamethasone implants) initially can forestall worsening of DME and prevent loss of vision. However, on the other hand, applying peripheral PRP and intraocular injections can induce posterior vitreous detachment (PVD). This could help release vitreomacular adhesions (VMA) and vitreomacular traction (VMT), thereby decreasing DME severity and improving the response to intravitreal injections. In the current approach, peripheral retinal photocoagulation should stop the drive for VEGF release; moreover, laser ablation should produce secondary, accidental, and beneficial PVD. This approach precludes focal laser therapy and paves the path for prolonged intervals between anti-VEGF therapy.

  18. Pharmacologic therapies for diabetic retinopathy and diabetic macular edema.

    Science.gov (United States)

    Rechtman, Ehud; Harris, Alon; Garzozi, Hanna J; Ciulla, Thomas A

    2007-12-01

    Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of blindness in the working-aged population of most developed countries. The increasing number of persons with diabetes worldwide suggests that DR/DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Early detection of retinopathy in persons with diabetes is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients. The control of diabetes-associated metabolic abnormalities (ie, hyperglycemia, hyperlipidemia, and hypertension) is also important in preserving visual function, as these conditions have been identified as risk factors for both the development and progression of DR/DME. The non-pharmacologic interventions for DR/DME, laser photocoagulation and vitrectomy, only target advanced stages of disease. Several biochemical mechanisms, including increased vascular endothelial growth factor production, protein kinase C beta activation, oxidative stress, and accumulation of intracellular sorbitol and advanced glycosylation end products, may contribute to the vascular disruptions that characterize DR/DME. The inhibition of these pathways holds the promise of the intervention for diabetic retinopathy with higher success rate and also at earlier, non-sight-threatening stages.

  19. Microcystic macular edema detection in retina OCT images

    Science.gov (United States)

    Swingle, Emily K.; Lang, Andrew; Carass, Aaron; Ying, Howard S.; Calabresi, Peter A.; Prince, Jerry L.

    2014-03-01

    Optical coherence tomography (OCT) is a powerful imaging tool that is particularly useful for exploring retinal abnormalities in ophthalmological diseases. Recently, it has been used to track changes in the eye associated with neurological diseases such as multiple sclerosis (MS) where certain tissue layer thicknesses have been associated with disease progression. A small percentage of MS patients also exhibit what has been called microcystic macular edema (MME), where uid collections that are thought to be pseudocysts appear in the inner nuclear layer. Very little is known about the cause of this condition so it is important to be able to identify precisely where these pseudocysts occur within the retina. This identi cation would be an important rst step towards furthering our understanding. In this work, we present a detection algorithm to nd these pseudocysts and to report on their spatial distribution. Our approach uses a random forest classi er trained on manual segmentation data to classify each voxel as pseudocyst or not. Despite having a small sample size of ve subjects, the algorithm correctly identi es 84.6% of pseudocysts as compared to manual delineation. Finally, using our method, we show that the spatial distribution of pseudocysts within the macula are generally contained within an annulus around the fovea.

  20. Hospitalized cardiovascular events in patients with diabetic macular edema

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    Nguyen-Khoa Bao-Anh

    2012-07-01

    Full Text Available Abstract Background Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI and cerebrovascular accidents (CVA in patients with diabetic macular edema (DME compared with diabetic patients without retinal diseases. Methods This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519 and diabetes controls without retinal disease (n = 10557 were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated. Results The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p  Conclusion Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes.

  1. Updates on the Clinical Trials in Diabetic Macular Edema.

    Science.gov (United States)

    Demirel, Sibel; Argo, Colby; Agarwal, Aniruddha; Parriott, Jacob; Sepah, Yasir Jamal; Do, Diana V; Nguyen, Quan Dong

    2016-01-01

    In this era of evidence-based medicine, significant progress has been made in the field of pharmacotherapeutics for the management of diabetic macular edema (DME). A. number of landmark clinical trials have provided strong evidence of the safety and efficacy of agents such as anti-vascular endothelial growth factors for the treatment of DME. Decades of clinical research, ranging from the early treatment of diabetic retinopathy study to the present-day randomized clinical trials (RCTs) testing novel agents, have shifted the goal of therapy from preventing vision loss to ensuring a maximum visual gain. Systematic study designs have provided robust data with an attempt to optimize the treatment regimens including the choice of the agent and timing of therapy. However, due to a number of challenges in the management of DME with approved agents, further studies are needed. For the purpose of this review, an extensive database search in English language was performed to identify prospective, RCTs testing pharmacological agents for DME. In order to acquaint the reader with the most relevant data from these clinical trials, this review focuses on pharmacological agents that are currently approved or have widespread applications in the management of DME. An update on clinical trials presently underway for DME has also been provided.

  2. Retinal layer location of increased retinal thickness in eyes with subclinical and clinical macular edema in diabetes type 2

    DEFF Research Database (Denmark)

    Bandello, Francesco; Tejerina, Amparo Navea; Vujosevic, Stela

    2015-01-01

    PURPOSE: To identify the retinal layer predominantly affected in eyes with subclinical and clinical macular edema in diabetes type 2. METHODS: A cohort of 194 type 2 diabetic eyes/patients with mild nonproliferative diabetic retinopathy (ETDRS levels 20/35) were examined with Cirrus spectral......-domain optical coherence tomography (OCT) at the baseline visit (ClinicalTrials.gov identifier: NCT01145599). Automated segmentation of the retinal layers of the eyes with subclinical and clinical macular edema was compared with a sample of 31 eyes from diabetic patients with normal OCT and an age......-matched control group of 58 healthy eyes. RESULTS: From the 194 eyes in the study, 62 had subclinical macular edema and 12 had clinical macular edema. The highest increases in retinal thickness (RT) were found in the inner nuclear layer (INL; 33.6% in subclinical macular edema and 81.8% in clinical macular edema...

  3. Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines

    Science.gov (United States)

    Das, Taraprasad; Aurora, Ajay; Chhablani, Jay; Giridhar, Anantharaman; Kumar, Atul; Raman, Rajiv; Nagpal, Manish; Narayanan, Raja; Natarajan, Sundaram; Ramasamay, Kim; Tyagi, Mudit; Verma, Lalit

    2016-01-01

    The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians. PMID:26953019

  4. Efficacy of first Ranibizumab intravitreal injection on macular edema caused by retinal vein occlusion

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    Hong Cao

    2015-09-01

    Full Text Available AIM: To observe the efficacy of first Ranibizumab intravitreal injection on macular edema caused by retinal vein occlusion(RVO. METHODS: Thirty-nine eyes of 39 patients with macular edema due to RVO were treated in our hospital during June 2014 to December 2014. Patients received intravitreal injection of 0.05mL ranibizumab. Best corrected visual acuity(BCVA, central macular thickness(CMTand cube average thickness(CATwere analyzed at 2d, 2, and 4wk after injection, respectively. RESULTS: The baseline BCVA(LogMAR, CMT and CAT were 0.82±0. 45, 541±136μm and 382±107μm before treatment. After first ranibizumab intravitreal injection, mean BVCA significantly improved at 2d(0. 56±0.35,PPPPPPPPPCONCLUSION: First intravitreal injection of ranibizumab can improve macular edema caused by RVO in short-term, but long-term effects is needed further observed.

  5. Correlation between the optical coherence tomography and electroretinogram in retinal vein occlusion macular edema

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    Ya Xu

    2014-11-01

    Full Text Available AIM: To evaluate the correlation between retinal thickness and photopic flash electroretinogram(ERGparameters(Cone a-wave, Cone b-wave, and 30Hz flickerin patients with central retinal vein occlusion(CRVOand macular edema. METHODS: A total of 25 patients(25 CRVO eyes and 25 unaffected fellow eyeswith CRVO underwent the examination of optical coherence tomography(OCTand photopic falsh ERG. The amplitude and implicit time of the ERG parameters were extracted from the ERG traces. Retinal thicknesses were measured by OCT in nine macular subfields. Then the correlations between ERG parameters and macular morphological parameters were analyzed. RESULTS: The Cone b-wave and 30Hz flicker implicit time were correlated with macular retinal thickness in seven out of nine subfields, excluding the temporal subfields. CONCLUSION: The retinal thickness of the macular edema may be associated with inner retinal function in CRVO patients.

  6. Diabetic macular edema, retinopathy and age-related macular degeneration as inflammatory conditions.

    Science.gov (United States)

    Das, Undurti N

    2016-10-01

    Diabetic macular edema (DME) and diabetic retinopathy (DR) are complications affecting about 25% of all patients with long-standing type 1 and type 2 diabetes mellitus and are a major cause of significant decrease in vision and quality of life. Age-related macular degeneration (AMD) is not uncommon, and diabetes mellitus affects the incidence and progression of AMD through altering hemodynamics, increasing oxidative stress, accumulating advanced glycation end products, etc. Recent studies suggest that DME, DR and AMD are inflammatory conditions characterized by a breakdown of the blood-retinal barrier, inflammatory processes and an increase in vascular permeability. Key factors that seem to have a dominant role in DME, DR and AMD are angiotensin II, prostaglandins and the vascular endothelial growth factor and a deficiency of anti-inflammatory bioactive lipids. The imbalance between pro- and anti-inflammatory eicosanoids and enhanced production of pro-angiogenic factors may initiate the onset and progression of DME, DR and AMD. This implies that bioactive lipids that possess anti-inflammatory actions and suppress the production of angiogenic factors could be employed in the prevention and management of DME, DR and AMD.

  7. Costs and Quality of Life in Diabetic Macular Edema: Canadian Burden of Diabetic Macular Edema Observational Study (C-REALITY

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    John R. Gonder

    2014-01-01

    Full Text Available Purpose. To characterize the economic and quality of life burden of diabetic macular edema (DME in Canadian patients. Patients and Methods. 145 patients with DME were followed for 6 months with monthly telephone interviews and medical chart reviews at months 0, 3, and 6. Visual acuity in the worst-seeing eye was assessed at months 0 and 6. DME-related healthcare costs were determined over 6 months, and vision-related (National Eye Institute Visual Functioning Questionnaire and generic (EQ-5D quality of life was assessed at months 0, 3, and 6. Results. Mean age of patients was 63.7 years: 52% were male and 72% had bilateral DME. At baseline, visual acuity was categorized as normal/mild loss for 63.4% of patients, moderate loss for 10.4%, and severe loss/nearly blind for 26.2%. Mean 6-month DME-related costs/patient were as follows: all patients (n=135, $2,092; normal/mild loss (n=88, $1,776; moderate loss (n=13, $1,845; and severe loss/nearly blind (n=34, $3,007. Composite scores for vision-related quality of life declined with increasing visual acuity loss; generic quality of life scores were highest for moderate loss and lowest for severe loss/nearly blind. Conclusions. DME-related costs in the Canadian healthcare system are substantial. Costs increased and vision-related quality of life declined with increasing visual acuity severity.

  8. Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes

    Science.gov (United States)

    Filho, Paulo Augusto de Arruda Mello; Dias, João Rafael de Oliveira; de Andrade, Gabriel C.; Louzada, Ricardo N.; Ávila, Marcos; Berrocal, Maria; Farah, Michel

    2016-01-01

    Purpose. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (P < 0.001). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 (P < 0.001) 12 months after one (P = 0.001), two (P = 0.041), and three (P < 0.001) implants but not four implants (P = 0.068). The mean baseline CRT decreased significantly (P < 0.001) from 463 to 254 microns after 12 months with one (P < 0.001), two (P = 0.002), and three (P = 0.001) implants but not with four implants (P = 0.114). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%). Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes. PMID:27721989

  9. Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes

    Directory of Open Access Journals (Sweden)

    Eduardo A. Novais

    2016-01-01

    Full Text Available Purpose. To evaluate the best-corrected visual acuity (BCVA, central retinal thickness (CRT, and the number of dexamethasone implants needed to treat cystoid macular edema (CME from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (P<0.001. The mean BCVA of all patients improved from 0.13 at baseline to 0.33 (P<0.001 12 months after one (P=0.001, two (P=0.041, and three (P<0.001 implants but not four implants (P=0.068. The mean baseline CRT decreased significantly (P<0.001 from 463 to 254 microns after 12 months with one (P<0.001, two (P=0.002, and three (P=0.001 implants but not with four implants (P=0.114. The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%. Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes.

  10. Relevance of Retinal Thickness Changes in the OCT Inner and Outer Rings to Predict Progression to Clinical Macular Edema

    DEFF Research Database (Denmark)

    Vujosevic, Stela; Varano, Monica; Egan, Catherine

    2015-01-01

    PURPOSE: To characterize the relevance of macular thickness changes in the inner and outer rings in the progression of macular edema in eyes/patients with diabetes type 2. METHODS: A total of 374 type 2 diabetic patients with mild nonproliferative diabetic retinopathy (ETDRS levels 20-35) were...... included in a 12-month prospective observational study to identify retinopathy progression. Retinal thickness analyses were performed in 194 eyes/patients using Cirrus SD- OCT and 166 eyes/patients using Spectralis SD-OCT. The DRCR.net classification of subclinical and clinical macular edema was used....... A composite grading of macular edema is proposed in this study. RESULTS: A total of 317 eyes/patients completed the study. SD-OCT identified clinical macular edema in 24 eyes/patients (6.7%) and subclinical macular edema in 104 eyes/patients (28.9%) at baseline. Increased thickness of the central subfield...

  11. Combination of Anti-VEGF and Laser Photocoagulation for Diabetic Macular Edema: A Review

    Directory of Open Access Journals (Sweden)

    Laura N. Distefano

    2017-01-01

    Full Text Available Diabetic macular edema (DME is the most common cause of vision loss in diabetic patients. Thirty years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS demonstrated that focal/grid laser photocoagulation reduces moderate vision loss from DME by 50% or more; thus, macular photocoagulation became the gold standard treatment for DME. However, with the development of anti-VEGF drugs (bevacizumab, ranibizumab, and aflibercept, better outcomes were obtained in terms of visual acuity gain and decrease in macular thickness in some studies when antiangiogenic drugs were administered in monotherapy. Macular laser therapy may still play an important role as an adjuvant treatment because it is able to improve macular thickness outcomes and reduce the number of injections needed. Here, we review some of the clinical trials that have assessed the efficacy of macular laser treatment, either as part of the treatment protocol or as rescue therapy.

  12. Bilateral Intravitreal Dexamethasone Implant for Retinitis Pigmentosa-Related Macular Edema

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    Ali Osman Saatci

    2013-03-01

    Full Text Available Purpose: To report the efficacy of intravitreal dexamethasone implant in a patient with retinitis pigmentosa and bilateral cystoid macular edema unresponsive to topical carbonic anhydrase inhibitors. Case Report: A 36-year-old man with bilateral cystoid macular edema associated with retinitis pigmentosa that was unresponsive to topical carbonic anhydrase inhibitors underwent bilateral 0.7-mg intravitreal dexamethasone implants two weeks apart. Spectral domain optical coherence tomography revealed resolution of macular edema one week following each injection in both eyes and his visual acuity improved. However, macular edema recurred two months later in OS and three months later in OD. Second implant was considered for both eyes. No implant-related complication was experienced during the follow-up of seven months. Conclusion: Inflammatory process seems to play a role in retinitis pigmentosa. Intravitreal dexamethasone implant may offer retina specialists a therapeutic option especially in cases unresponsive to other treatment regimens in eyes with retinitis pigmentosa-related macular edema.

  13. Influence of ischemia on visual function in patients with branch retinal vein occlusion and macular edema

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    Noma H

    2011-05-01

    Full Text Available Hidetaka Noma¹, Hideharu Funatsu¹, Tatsuya Mimura², Katsunori Shimada³¹Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Owada-shinden, Chiba, Japan; ²Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan; ³Department of Hygiene and Public Health II, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, JapanAbstract: Visual function and retinal morphology were investigated to elucidate the influence of ischemia in patients with branch retinal vein occlusion (BRVO and macular edema. In 41 consecutive patients with BRVO aged 68.9 ± 10.0 years (22 women and 19 men, the area of capillary nonperfusion was measured by fluorescein angiography. Retinal thickness and retinal volume were measured by optical coherence tomography, and mean retinal sensitivity was calculated for each of 9 macular subfields. Mean visual acuity and macular sensitivity within the central subfield were not significantly correlated with the nonperfused area. However, the macular sensitivity within the central 5 subfields and all 9 subfields showed significant negative correlations with the nonperfused area. Also, macular thickness and volume within all 9 subfields were significantly correlated with the nonperfused area. In conclusion, evaluation of both the fovea and the entire macular region may be important in patients with ischemic BRVO.Keywords: branch retinal vein occlusion, macular edema, macular sensitivity, ischemia

  14. Interventions for the treatment of uveitic macular edema: a systematic review and meta-analysis

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    Karim R

    2013-06-01

    Full Text Available Rushmia Karim,1 Evripidis Sykakis,2 Susan Lightman,3 Samantha Fraser-Bell4 1Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia; 2Department of Ophthalmology, Whipps Cross University Hospital, 3UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; 4University of Sydney, Clinical Ophthalmology and Eye Health, Sydney Adventist Hospital Clinical School, Sydney, NSW, Australia Background: Uveitic macular edema is the major cause of reduced vision in eyes with uveitis. Objectives: To assess the effectiveness of interventions in the treatment of uveitic macular edema. Search strategy: Cochrane Central Register of Controlled Trials, Medline, and Embase. There were no language or data restrictions in the search for trials. The databases were last searched on December 1, 2011. Reference lists of included trials were searched. Archives of Ophthalmology, Ophthalmology, Retina, the British Journal of Ophthalmology, and the New England Journal of Medicine were searched for clinical trials and reviews. Selection criteria: Participants of any age and sex with any type of uveitic macular edema were included. Early, chronic, refractory, or secondary uveitic macular edema were included. We included trials that compared any interventions of any dose and duration, including comparison with another treatment, sham treatment, or no treatment. Data collection and analysis: Best-corrected visual acuity and central macular thickness were the primary outcome measures. Secondary outcome data including adverse effects were collected. Conclusion: More results from randomized controlled trials with long follow-up periods are needed for interventions for uveitic macular edema to assist in determining the overall long-term benefit of different treatments. The only intervention with sufficiently robust randomized controlled trials for a meta-analysis was acetazolamide, which was shown to be ineffective in improving vision in eyes with uveitic

  15. Long-term effectiveness of ranibizumab for age-related macular degeneration and diabetic macular edema.

    Science.gov (United States)

    Fong, Angie H C; Lai, Timothy Y Y

    2013-01-01

    Neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME) are major causes of visual impairment in the elderly population worldwide. With the aging population, the prevalence of neovascular AMD and DME has increased substantially over the recent years. Vascular endothelial growth factor (VEGF) has been implicated as playing an important role in the pathogenesis of both neovascular AMD and DME. Since its introduction in 2006, ranibizumab, a recombinant, humanized, monoclonal antibody fragment against all isoforms of VEGF-A, has revolutionized the treatment of neovascular AMD and DME. The efficacy and safety of ranibizumab in neovascular AMD has been demonstrated in the ANCHOR and MARINA trials. Further studies including the PIER, PrONTO, and SUSTAIN trials have also evaluated the optimal dosing regimen of ranibizumab in neovascular AMD. The CATT and IVAN trials compared the safety and efficacy of ranibizumab with off-label use of bevacizumab. Studies such as SUSTAIN and HORIZON have shown that ranibizumab has a good safety profile and is well tolerated for over 4 years with very few serious ocular and systemic adverse events. For DME, Phase II RESOLVE study and Phase III RISE and RIDE studies have demonstrated superiority of ranibizumab treatment in improving vision over placebo controls. Phase II READ and Phase III RESOLVE and REVEAL studies have shown that ranibizumab is more effective both as monotherapy and in combination with laser compared with laser monotherapy. The 3-year results from the DRCRnet protocol I study found that ranibizumab with deferred laser resulted in better long-term visual outcome compared with ranibizumab with prompt laser. This review summarizes various important clinical trials on the long-term efficacy and safety of ranibizumab in the treatment of neovascular AMD and DME. The pharmacological properties of ranibizumab, its cost effectiveness, and impact on quality of life will also be discussed.

  16. Consistency of ocular coherence tomography fast macular thickness mapping in diabetic diffuse macular edema Consistência da tomografia de coerência óptica no edema macular difuso diabético

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    Fábio Petersen Saraiva

    2007-01-01

    Full Text Available OBJECTIVES: To investigate optical coherence tomography consistency on foveal thickness, foveal volume, and macular volume measurements in patients with and without diffuse diabetic macular edema. INTRODUCTION: Optical coherence tomography represents an objective technique that provides cross-sectional tomographs of retinal structure in vivo. However, it is expected that poor fixation ability, as seen in diabetic macular edema, could alter its results. Several authors have discussed the reproducibility of optical coherence tomography, but only a few have addressed the topic with respect to diabetic maculopathy. METHODS: The study recruited diabetic patients without clinically evident retinopathy (control group and with diffuse macular edema (case group. Only one eye of each patient was evaluated. Five consecutive fast macular scans were taken using Ocular Coherence Tomography 3; the 6 mm macular map was chosen. The consistency in measurements of foveal thickness, foveal volume, and total macular volume for both groups was evaluated using the Pearson's coefficient of variation. The T-test for independent samples was used in order to compare measurements of both groups. RESULTS: Each group consisted of 20 patients. All measurements had a coefficient of variation less than 10%. The most consistent parameter for both groups was the total macular volume. DISCUSSION: Consistency in measurement is a mainstay of any test. A test is unreliable if its measurements can not be correctly repeated. We found a good index of consistency, even considering patients with an unstable gaze. CONCLUSIONS: Optical coherence tomography is a consistent method for diabetic subjects with diffuse macular edema.OBJETIVOS: Investigar a consistência das medidas de espessura foveal, volume foveal e volume macular total feitas pela tomografia de coerência óptica em pacientes com e sem edema macular difuso diabético. INTRODUÇÃO: A tomografia de coerência óptica é uma t

  17. Localized changes in Retinal Vessel Caliber after focal/grid laser treatment in Patients with Diabetic Macular Edema

    DEFF Research Database (Denmark)

    Lundberg, Lars Kristian; Kawasaki, Ryo; Sjølie, Anne K

    2013-01-01

    PURPOSE:: To compare retinal vessel caliber changes at the macula region and surrounding the optic disk after focal/grid laser treatment for diabetic macular edema. METHODS:: The study included 69 eyes from 46 patients treated with focal/grid laser for diabetic macular edema. Retinal photographs ...

  18. Retro-Mode Scanning Laser Ophthalmoscopy Planning for Navigated Macular Laser Photocoagulation in Macular Edema

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    Ernest V. Boiko

    2016-01-01

    Full Text Available Purpose. To compare treatment areas and navigated macular laser photocoagulation (MLP plans suggested by retro-mode scanning laser ophthalmoscopy (RM-SLO image versus optical coherence tomography (OCT central retinal thickness map and treatment planning among retina specialists. Methods. Thirty-nine eyes with diabetic or branch retinal vein occlusion-related ME undergoing navigated MLP with navigated photocoagulator had OCT and RM-SLO taken. OCT map and RM-SLO image were imported to the photocoagulator and aligned onto the retina. Two retina specialists placed laser spot marks separately based on OCT and RM-SLO images in a random fashion. The spots placed by each physician were compared between OCT and RM-SLO and among physicians. The areas of retinal edema on OCT and RM-SLO of the same eye were also compared. Results. The average number of laser spots using RM-SLO and OCT template was 189.6±77.4 and 136.6±46.8, respectively, P=0.003. The average area of edema on RM-SLO image was larger than that on OCT map (14.5±3.9 mm2 versus 10.3±2.8 mm2, P=0.005 because of a larger scanning area. There was narrow variability in treatment planning among retina specialists for both RM-SLO (P=0.13 and OCT (P=0.19. Conclusion. The RM-SLO image superimposed onto the fundus of the same eye can be used to guide MLP with narrow variability in treatment planning among retina specialists. The treatment areas suggested by RM-SLO-guided MLP plans for ME were shown to be larger than those suggested by OCT-guided plans.

  19. Retro-Mode Scanning Laser Ophthalmoscopy Planning for Navigated Macular Laser Photocoagulation in Macular Edema.

    Science.gov (United States)

    Boiko, Ernest V; Maltsev, Dmitrii S

    2016-01-01

    Purpose. To compare treatment areas and navigated macular laser photocoagulation (MLP) plans suggested by retro-mode scanning laser ophthalmoscopy (RM-SLO) image versus optical coherence tomography (OCT) central retinal thickness map and treatment planning among retina specialists. Methods. Thirty-nine eyes with diabetic or branch retinal vein occlusion-related ME undergoing navigated MLP with navigated photocoagulator had OCT and RM-SLO taken. OCT map and RM-SLO image were imported to the photocoagulator and aligned onto the retina. Two retina specialists placed laser spot marks separately based on OCT and RM-SLO images in a random fashion. The spots placed by each physician were compared between OCT and RM-SLO and among physicians. The areas of retinal edema on OCT and RM-SLO of the same eye were also compared. Results. The average number of laser spots using RM-SLO and OCT template was 189.6 ± 77.4 and 136.6 ± 46.8, respectively, P = 0.003. The average area of edema on RM-SLO image was larger than that on OCT map (14.5 ± 3.9 mm(2) versus 10.3 ± 2.8 mm(2), P = 0.005) because of a larger scanning area. There was narrow variability in treatment planning among retina specialists for both RM-SLO (P = 0.13) and OCT (P = 0.19). Conclusion. The RM-SLO image superimposed onto the fundus of the same eye can be used to guide MLP with narrow variability in treatment planning among retina specialists. The treatment areas suggested by RM-SLO-guided MLP plans for ME were shown to be larger than those suggested by OCT-guided plans.

  20. Hemiretinal vein occlusion with macular hemorrhage and edema treated with intravitreal bevacizumab

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    Yalamanchi S

    2011-10-01

    Full Text Available Shalini Yalamanchi, Harry W Flynn Jr.Department of Ophthalmology, Bascom Palmer Eye Institute, Miami Miller School of Medicine Miami, FL, USAAbstract: A 39-year-old male with decreased visual acuity and extensive macular hemorrhage and edema secondary to a hemiretinal vein occlusion was treated with multiple intravitreal injections of bevacizumab 1.25 mg every four to six weeks for over one year. Treatment outcomes were assessed by visual acuity and Cirrus spectral domain optical coherence tomography. Treatment resulted in ongoing visual and anatomic improvement, with resolution at the last visit.Keywords: retinal vein occlusion, macular edema, bevacizumab

  1. Intravitreal bevacizumab (Avastin treatment of diffuse diabetic macular edema in an Indian population

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    Kumar Atul

    2007-01-01

    Full Text Available Background: To report the anatomic and visual acuity response after intravitreal bevacizumab (Avastin in patients with diffuse diabetic macular edema. Design: Prospective, interventional case series study. Materials and Methods: This study included 20 eyes of metabolically stable diabetes mellitus with diffuse diabetic macular edema with a mean age of 59 years who were treated with two intravitreal injections of bevacizumab 1.25 mg in 0.05 ml six weeks apart. Main outcome measures were 1 early treatment diabetic retinopathy study visual acuity, 2 central macular thickness by optical coherence tomography imaging. Each was evaluated at baseline and follow-up visits. Results: All the eyes had received some form of laser photocoagulation before (not less than six months ago, but all of these patients had persistent diffuse macular edema with no improvement in visual acuity. All the patients received two injections of bevacizumab at an interval of six weeks per eye. No adverse events were observed, including endophthalmitis, inflammation and increased intraocular pressure or thromboembolic events in any patient. The mean baseline acuity was 20/494 (log Mar=1.338±0.455 and the mean acuity at three months following the second intravitreal injection was 20/295 (log Mar=1.094±0.254, a difference that was highly significant ( P =0.008. The mean central macular thickness at baseline was 492 µm which decreased to 369 µm ( P =0.001 at the end of six months. Conclusions: Initial treatment results of patients with diffuse diabetic macular edema not responding to previous photocoagulation did not reveal any short-term safety concerns. Intravitreal bevacizumab resulted in a significant decrease in macular thickness and improvement in visual acuity at three months but the effect was somewhat blunted, though still statistically significant at the end of six months.

  2. Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery

    Science.gov (United States)

    Jarstad, Allison R.; Chung, Gary W.; Tester, Robert A.; Day, Linda E.

    2017-01-01

    Purpose To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME). Setting Ambulatory surgical center. Methods Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests. Results Mean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/−5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). Conclusions Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater. Synopsis Immediate postoperative IOP adjustment

  3. Emerging therapies for the treatment of neovascular age-related macular degeneration and diabetic macular edema.

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    Emerson, M Vaughn; Lauer, Andreas K

    2007-01-01

    Diabetic macular edema (DME) and choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD) are the leading causes of vision loss in the industrialized world. The mainstay of treatment for both conditions has been thermal laser photocoagulation, while there have been recent advances in the treatment of CNV using photodynamic therapy with verteporfin. While both of these treatments have prevented further vision loss in a subset of patients, vision improvement is rare. Anti-vascular endothelial growth factor (VEGF)-A therapy has revolutionized the treatment of both conditions. Pegaptanib, an anti-VEGF aptamer, prevents vision loss in CNV, although the performance is similar to that of photodynamic therapy. Ranibizumab, an antibody fragment, and bevacizumab, a full-length humanized monoclonal antibody against VEGF, have both shown promising results, with improvements in visual acuity in the treatment of both diseases. VEGF trap, a modified soluble VEGF receptor analog, binds VEGF more tightly than all other anti-VEGF therapies, and has also shown promising results in early trials. Other treatment strategies to decrease the effect of VEGF have used small interfering RNA to inhibit VEGF production and VEGF receptor production. Corticosteroids have shown efficacy in controlled trials, including anacortave acetate in the treatment and prevention of CNV, and intravitreal triamcinolone acetonide and the fluocinolone acetonide implant in the treatment of DME. Receptor tyrosine kinase inhibitors, such as vatalanib, inhibit downstream effects of VEGF, and have been effective in the treatment of CNV in early studies. Squalamine lactate inhibits plasma membrane ion channels with downstream effects on VEGF, and has shown promising results with systemic administration. Initial results are also encouraging for other growth factors, including pigment epithelium-derived factor administered via an adenoviral vector. Ruboxistaurin, which decreases protein

  4. Critical appraisal of ranibizumab in the treatment of diabetic macular edema

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    Stewart MW

    2013-06-01

    Full Text Available Michael W StewartDepartment of Ophthalmology, Mayo School of Medicine, Jacksonville, FL, USAAbstract: Diabetic retinopathy is the leading cause of blindness among individuals of working age in industrialized nations, with most of the vision loss resulting from diabetic macular edema (DME. The formation of DME depends on the action of several growth factors and inflammatory mediators, but vascular endothelial growth factor (VEGF appears to be critical for breaking down the blood-retinal barrier and promoting the accumulation of macular edema. Laser photocoagulation has been the standard-of-care for three decades, and although it stabilizes vision, significant gains in visual acuity after treatment are unusual. Several VEGF inhibitors (pegaptanib, aflibercept, and ranibizumab have been initially developed and tested for the treatment of age-related macular degeneration and subsequently for DME. In Phase I, II, and III trials for DME, ranibizumab has been shown to be superior to macular laser photocoagulation and intraocular triamcinolone acetonide injections for improving visual acuity and drying the macula. As a result, ranibizumab is the only anti-VEGF drug that has been approved by the United States Food and Drug Administration for the treatment of DME. Most experts now consider intravitreal anti-VEGF therapy to be standard-of-care for DME involving the fovea.Keywords: aflibercept, bevacizumab, diabetic macular edema, diabetic retinopathy, ranibizumab, vascular endothelial growth factor

  5. Changes in retinal oxygen saturation after intravitreal aflibercept in patients with diabetic macular edema

    DEFF Research Database (Denmark)

    Blindbæk, Søren Leer; Peto, Tunde; Grauslund, Jakob

    2017-01-01

    Design of study: Three months prospective interventional study. Purpose: To evaluate changes in retinal arterial and venous oxygen saturation after intravitreal aflibercept in patients with diabetic macular edema (DME). Methods: We included 17 patients with DME, central retinal thickness (CRT) >300...

  6. Iatrogenic subretinal injection of Ozurdex® implant and its effect on macular edema

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    Smita Shriram Karandikar

    2017-01-01

    CONCLUSION: A more widespread application of any technology always portends a more significant risk for complications, and an ophthalmologist should be aware of this potential risk. Though subretinal, corticosteroid implant was capable of reducing macular edema by 181 microns by 1 month and its effect wore off by 2 months.

  7. Uso de triamcinolona intravítrea en edema macular del diabético Intravitreal triamcinolone to treat diabetic macular edema

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    Meysi Ramos López

    2007-12-01

    Full Text Available Se estima que en el mundo hay 120 millones de diabéticos y que cada 15 años el número de estos se duplica. Algunos datos son descriptivos y reflejan la situación actual: en los países avanzados solo 30 % de los diabéticos tipo I están adecuadamente controlados y 7 % de los tipo 2 con características de alto riesgo no han sido revisados nunca por ningún oftalmólogo. La prevalencia de la retinopatía diabética está determinada por el tipo de diabetes mellitus y por la edad del paciente, disminuye según aumenta la edad. La retinopatía diabética más frecuente es la no proliferativa en un 80 %, contra un 20 %, la proliferativa. La diabetes mellitus en Cuba tiene una prevalencia aproximadamente de 1/10 000. Estudios recientes revelan una prevalencia de la retinopatía diabética de alrededor de 20-25 % entre los pacientes diabéticos. La detección temprana de la retinopatía, el edema macular, y el tratamiento precoz son cruciales en el esfuerzo por reducir la incapacidad visual presentada en los pacientes con diabetes. En este trabajo se evalúa la efectividad de la triamcinolona intravítrea como tratamiento general antiangiogénico y antiinflamatorio del edema macular en un grupo de pacientes diabéticos que fueron atendidos en el Instituto Cubano Oftalmológico "Ramón Pando Ferrer, desde enero hasta julio de 2006. Se realizó un estudio descriptivo-prospectivo de caso control, en el cual, el paciente constituyó su propio control. La muestra estuvo formada por 30 pacientes diabéticos, con diagnóstico de edema macular diabético que fueron candidatos a la aplicación del medicamento. Predominó el sexo femenino con más de 6 años de edad, a pesar que se mejora la agudeza visual, esta no se correspondía con la disminución evidente del edema macular. Los pacientes que no tuvieron tratamiento láser previo, respondieron mejor al medicamento aplicado, como complicaciones postratamiento se presentó hipertensión ocular, involuci

  8. Macular laser photocoagulation guided by spectral-domain optical coherence tomography versus fluorescein angiography for diabetic macular edema

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    Gallego-Pinazo R

    2011-05-01

    Full Text Available Roberto Gallego-Pinazo1,2, Ana Marina Suelves-Cogollos1, Rosa Dolz-Marco1, J Fernando Arevalo3, Salvador García-Delpech1, J Luis Mullor4, Manuel Díaz-Llopis1,2,51Department of Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 2Centro de Investigación Biomédica en Red de Enfermedades Raras, Valencia, Spain; 3Retina and Vitreous Service, Clinical Ophthalmology Center, Caracas, Venezuela; 4Unit of Experimental Ophthalmology, Hospital Universitario La Fe, Valencia, Spain; 5University of Valencia, Faculty of Medicine, Valencia, SpainBackground: The aim of this study was to compare the efficacy of spectral-domain optical coherence tomography (SD-OCT and fluorescein angiography (FA in the guidance of macular laser photocoagulation for diabetic macular edema.Methods: This was a prospective interventional clinical comparative pilot study. Forty eyes from 24 consecutive patients with diabetic macular edema were allocated to receive laser photocoagulation guided by SD-OCT or FA. Best-corrected visual acuity (BCVA, central macular thickness, and retinal volume were assessed at baseline and two months after treatment.Results: Subjects treated using FA-guided laser improved BCVA from the logarithm of the minimum angle of resolution (logMAR 0.52 ± 0.2 to 0.37 ± 0.2 (P < 0.001, and decreased mean central macular thickness from 397.25 ± 139.1 to 333.50 ± 105.7 µm (P < 0.001 and retinal volume from 12.61 ± 1.6 to 10.94 ± 1.4 mm3 (P < 0.001. Subjects treated using SD-OCT guided laser had improved BCVA from 0.48 ± 0.2 to 0.33 ± 0.2 logMAR (P < 0.001, and decreased mean central macular thickness from 425.90 ± 149.6 to 353.4 ± 140 µm (P < 0.001 and retinal volume from 12.38 ± 2.1 to 11.53 ± 1.1 mm3 (P < 0.001. No significant differences between the groups were found in two-month BCVA (P = 0.505, two-month central macular thickness (P = 0.660, or two-month retinal volume (P = 0.582.Conclusion: The short-term results of this pilot study

  9. Change in macular thickness in a case of refractory diabetic macular edema with dexamethasone intravitreal implant in comparison to intravitreal bevacizumab: A case report

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    Ashish Sharma

    2012-01-01

    Full Text Available We report on the significant improvement of central macular thickness in a case of clinically significant macular edema after dexamethasone 0.7 mg sustained-release intravitreal implant (Ozurdex®; Allergan, Inc, Irvine, CA, USA. Patient presented to us with persistent clinically significant macular edema (CSME in both eyes. Right eye received dexamethasone implant and left eye received two intravitreal bevacizumab injections 1.25 mg/0.05 mL (Avastin®; Genentech Inc., South San Francisco, CA, USA with an interval of four weeks. After six weeks of follow-up, dexamethasone implant in the right eye showed normal macular thickness whereas persistent macular edema (ME was found even after second intravitreal bevacizumab injection in the left eye.

  10. Early change of central macular thickness after intravitreous triamcinolone or bevacizumab in diabetic macular edema or retinal vein occlusion.

    Science.gov (United States)

    Sonoda, Yasushi; Arimura, Noboru; Shimura, Masahiko; Sakamoto, Taiji

    2011-02-01

    To evaluate the immediate changes after intravitreous triamcinolone acetonide or intravitreous bevacizumab in diabetic macular edema (DME). A nonrandomized interventional study. Type 2 diabetic patients were included. Intravitreous triamcinolone acetonide (4 mg) was injected for 22 eyes with DME and IVB (1.25 mg) for 18 eyes with DME. The early time-dependent changes of central macular thickness were evaluated by optical coherence tomography before and from 1 hour to 1 month after intervention. Intravitreous bevacizumab was also tested in patients with retinal vein occlusion as a control of non-DME. Visual acuity was also examined. Compared with the baseline, central macular thickness of eyes with DME decreased significantly 1 hour after intravitreous triamcinolone acetonide (P central macular thickness was observed significantly from 3 hours after IVB in retinal vein occlusion (P retinal vein occlusion than DME after IVB. Visual acuity improved significantly in DME with intravitreous triamcinolone acetonide or IVB at 1 month (P retinal vein occlusion. Although no conclusion can be drawn, immediate decrease in central macular thickness after intravitreous triamcinolone acetonide might indicate the possible involvement of a nongenomic pathway of triamcinolone acetonide action.

  11. Retinal oxygen saturation in relation to retinal thickness in diabetic macular edema

    DEFF Research Database (Denmark)

    Blindbæk, Søren Leer; Peto, Tunde; Grauslund, Jakob

    to retinal thickness in patients with diabetic macular edema (DME). Methods: We included 18 patients with DME that all had central retinal thickness (CRT) >300 µm and were free of active proliferative diabetic retinopathy. Optical coherence tomography (Topcon 3D OCT-2000 spectral domain OCT) was used...... for paracentral edema, the oxygen saturation in the upper and lower temporal arcade branches were compared to the corresponding upper and lower subfield thickness. Spearman’s rank was used to calculate correlation coefficients between CRT and retinal oximetry. Results: Median age and duration of diabetes was 59....... 92.3%, p=0.52). We found no correlation between CRT and retinal oxygen saturation, even when accounting for paracentral edema (p>0.05). Furthermore, there was no difference in retinal oxygen saturation between the macular hemisphere that was more or less affected by DME (p>0.05). Conclusion: Patients...

  12. Spectral domain optical coherence tomography changes following intravitreal dexamethasone implant, Ozurdex ® in patients with uveitic cystoid macular edema

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    Pooja Bansal

    2015-01-01

    Full Text Available Purpose: To correlate the structural and functional changes following intravitreal injection of dexamethasone 0.7 mg (Ozurdex ® implant in patients with recalcitrant uveitic cystoid macular edema (CME. Materials and Methods: In a prospective, interventional, nonrandomized study, 30 eyes (27 patients with uveitic CME received Ozurdex ® implant and were followed-up for 24 weeks at periodic intervals to monitor structural alterations seen on spectral domain optical coherence tomography (SD-OCT. The outcome measures included change in central macular thickness (CMT and best-corrected visual acuity (BCVA as well as structural alterations seen on OCT such as change in the height of cystoid spaces (CSs and sub-foveal serous retinal detachment (SSRD. The integrity of external limiting membrane and inner-outer segment junction was assessed at baseline and follow-up visits. Results: Mean age of the patients was 46.09 ± 15.66 years. The mean CMT decreased by 96 μm at 1-day, 231.64 μm at 1-week, 254.21 μm at 4 weeks and 249.14 μm at 12 weeks (P < 0.001 compared with baseline. BCVA improved from a baseline mean of 0.62 LogMAR units to 0.49 on day 1 to 0.31 at 24 weeks (P < 0.001. A decrease in the mean height of CS, that is, 133.28 μm from a baseline of 317.71 μm was noted on the 1 st day (P < 0.001. 4 eyes demonstrated the presence of CS at 4 weeks, 1 eye at 6 weeks and 3 eyes at 12 weeks. At baseline, 16 eyes (53.33% demonstrated the presence of SSRD. Among these, 11 eyes showed resolution of SSRD on day 1. SSRD resolved in all patients at 4 weeks and was maintained up to 24 weeks. Conclusions: Ozurdex ® implant improves the visual outcome of patients with recalcitrant uveitic CME. Reversibility of retinal changes may be possible following treatment with dexamethasone implant. Thus final visual outcome may be independent of pretreatment CMT, the height of CS or SSRD.

  13. Machine learning based detection of age-related macular degeneration (AMD) and diabetic macular edema (DME) from optical coherence tomography (OCT) images

    OpenAIRE

    Wang, Yu; Zhang, Yaonan; Yao, Zhaomin; Zhao, Ruixue; Zhou, Fengfeng

    2016-01-01

    Non-lethal macular diseases greatly impact patients’ life quality, and will cause vision loss at the late stages. Visual inspection of the optical coherence tomography (OCT) images by the experienced clinicians is the main diagnosis technique. We proposed a computer-aided diagnosis (CAD) model to discriminate age-related macular degeneration (AMD), diabetic macular edema (DME) and healthy macula. The linear configuration pattern (LCP) based features of the OCT images were screened by the Corr...

  14. Letter to the editor: dexamethasone intravitreal implant in the treatment of diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Hall J

    2015-11-01

    Full Text Available John Hall Alimera Sciences Ltd., Aldershot, Hampshire, UK I read “Dexamethasone intravitreal implant in the treatment of diabetic macular edema” published July 2015 by Dugel et al.1This article is very interesting in terms of providing an outline of the role of inflammation in the pathogenesis of diabetic macular edema and explaining the value of corticosteroids in the treatment of diabetic macular edema. However, I would like to draw your attention to the data presented for ILUVIEN® (fluocinolone acetonide; FAc in Table 2, which has been presented incorrectly and does not reflect the approved product and dose in Europe. ILUVIEN is indicated in Europe for the treatment of vision impairment associated with chronic diabetic macular edema, considered insufficiently responsive to available therapies2 and is approved in Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, the Netherlands, Norway, Poland, Portugal, Spain, Sweden, and the United Kingdom. ILUVIEN was launched in the United Kingdom in April 2013, Germany in May 2013, and Portugal in January 2015.3View original paper by Dugel et al.

  15. Clinical therapeutic effects of intravitreal Ranibizumab injection combined laser photocoagulation for macular edema in BRVO

    Directory of Open Access Journals (Sweden)

    Bin Liu

    2014-11-01

    Full Text Available AIM: To evaluate the clinical therapeutic efficacy of intravitreal ranibizumab injection combined grid laser photocoagulation for macular edema secondary to branch retinal vein occlusion(BRVO. METHODS: Forty-two confirmed cases(42 eyeswith macular edema secondary to BRVO were randomized into 3 groups, each group contained 14 eyes. The ranibizumab group was received intravitreal injection of ranibizumab(0.05mL, the laser group was received grid laser photocoagulation, and the combined group was received a second therapy of grid laser photocoagulation after 1wk of the intravitreal injection of ranibizumab. Recorded the best-corrected visual acuity(BCVAand the central macular thickness(CMTpreoperative and at 1, 3, 6mo after therapy. RESULTS: The BCVA and the CMT had no differences among three groups pretherapy(P>0.05. While BCVA was much better and CMT was reduced significantly posttherapy than pretherapy in all three groups(PPP>0.05. While the BCVA was better and the CMT was thinner in the combined group than ranibizumab group and laser group at every time point(PPCONCLUSION: The intravitreal ranibizumab injection combined grid laser photocoagulation is an effective treatment method for the macular edema secondary to BRVO, it is more effective in improving BCVA than intravitreal ranibizumab or grid laser photocoagulation alone.

  16. Comparison between intravitreal Ranibizumab and Tramicinolone acetonide for macular edema secondary to central retinal vein occlusion

    Directory of Open Access Journals (Sweden)

    Miao Zeng

    2014-08-01

    Full Text Available AIM:To compare the efficacy and safety of intravitreal ranibizumab to those of triamcinolone acetonide(TAinjection for the treatment of macular edema secondary to central retinal vein occlusion(CRVO.METHODS:This retrospective study included 40 eyes of 40 patients with macular edema associated with CRVO. Twenty patients 20 eyes were treated with intravitreal injection of triamcinolone acetonide(1mg, 0.1mL, the other 20 patients 20 eyes accepted intravitreal ranibizumab(0.5mg, 0.05mL. The change of best corrected visual acuity(BCVA, central macular thickness(CMT, and intraocular pressure(IOPbefore treatment and at 1, 2wk, 1, 2,3,6mo post-injection in the two groups were observed. RESULTS:BCVA was improved at 1, 2wk, 1, 2,3,6mo post-injection in the TA group(PPP>0.05. CMT decreased significantly within each group(PP>0.05. In the TA group, the IOP was significantly higher at 2wk and 4wk than before treatment(PP>0.05. However, the IOP at 1mo was significantly higher in the TA group than that in the ranibizumb group(PCONCLUSION:Intravitreal ranibizumab is an effective and safe treatment method for macular edema secondary to CRVO. It can effectively improve BCVA and reduce CMT without ocular and systemic complications compared with intravitreal TA.

  17. Effects of Vitrectomy on Recurrent Macular Edema due to Branch Retinal Vein Occlusion after Intravitreal Injection of Bevacizumab

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    Tatsuya Yunoki

    2013-01-01

    Full Text Available Purpose. To evaluate the effects of pars plana vitrectomy (PPV on recurrent macular edema due to branch retinal vein occlusion (BRVO after intravitreal injections of bevacizumab (IVB. Methods. This retrospective study included 22 eyes of 22 patients who underwent single or multiple IVB injections for macular edema due to BRVO and showed a recurrence of macular edema. All patients then underwent PPV and were followed up for more than 6 months after the surgery with examinations of best corrected visual acuity (BCVA and optical coherence tomography (OCT. OCT parameters were central macular thickness (CMT and average retinal thickness in a 1-mm-diameter circular region at the fovea (MRT. Results. Mean BCVA, CRT, and MRT were significantly improved from the baseline after PPV. Greater improvement of BCVA, CRT, and MRT was obtained after 1 month of IVB than after 6 months of PPV. No eyes showed worsening of macular edema after the surgery. Conclusion. PPV improved BCVA and recurrent macular edema due to BRVO, but PPV that was less effective than IVB had been in the same patients. PPV may be one of the treatment options for recurrent macular edema due to BRVO after IVB.

  18. Quantitive study for retinal function before and after photocoagulation in patients with diabetic macular edema

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    Rui-Xue Sun

    2017-03-01

    Full Text Available AIM: To study the retinal function in patients with diabetic macular edema after photocoagulation. METHODS: A total of 30 eyes in 19 patients with diabetic macular edema(DME, who were diagnosed through fundus fluorescein angiography, consecutively recruited from March 2010 to March 2014 and were treated with macular grid pattern photocoagulation. Multifocal electroretinogram(mfERGsystem(version 3.15was performed before and after photocoagulation therapy for 3mo. All data were statistically analyzed. RESULTS: The amplitude densities of a-ware and b-ware for the fovea increased after macular grid pattern photocoagulation therapy, and there were significantly changes relative to its preoperation(t=-3.7683, Pt=-3.6570, Pt=1.7103, P>0.05; t=1.5623, P>0.05 . Compared with pretreatment, the amplitude densities of a-ware and b-ware at macular were statistically larger(t=4.8337, Pt=-2.0376, Pt=-2.1892, Pt=-3.5024, Pt=-1.4387, P>0.05; t=-0.1766, P>0.05. It was significant longer in the latency of a-wave and b-wave at paramacular after photocoagulation(t=-2.0905, Pt=-2.5646, PCONCLUSION: The laser photocoagulation treatment for DME can improve the retinal function at fovea, which benefits the vision acuity. Unfortunately,it induces extensively damaging effects on the macula and paramacular.

  19. Computer Aided Diagnosis of Macular Edema Using Color Fundus Images: A Review

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    Devashree R. Zinjarde,

    2014-03-01

    Full Text Available Diabetic retinopathy is the leading cause of blindness in the western working age population and micro aneurysms are one of the first pathologies associated with diabetic retinopathy. Diabetic retinopathy (DR is caused by damage to the blood vessels of the retina which affects the vision. But when DR becomes severe it results into macular edema. Macula is the region near the centre of the eye that provides the vision. Blood vessels leak fluid onto the macula leading to the swelling which blurs the vision eventually leading to complete loss of vision. This paper is based on the detection of the edema affected image from the normal image. If the image is edema affected it also states its severity of the disease using a rotational asymmetry metric by examining the symmetry of the macular region. Diabetic macular edema (DME is an advanced symptom of diabetic retinopathy and can lead to irreversible vision loss. A feature extraction technique is introduced to capture the global characteristics of the fundus images and discriminate the normal from DME images.

  20. Spontaneous Resolution of Vitreomacular Traction in Two Patients with Diabetic Macular Edema

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    David R.P. Almeida

    2014-02-01

    Full Text Available The nature of the vitreoretinal interface in conditions like diabetic macular edema (DME remains incompletely understood. Furthermore, it is not clear what the role of pharmacological enzymatic vitreolysis will play in cases of vitreomacular traction (VMT associated with macular disease like DME. We describe the spontaneous resolution of VMT in 2 patients with DME. As both surgical and pharmacologic interventions have been suggested to treat DME in the setting of VMT, we feel that a clarification of the nomenclature and reporting of these cases of natural history may be useful in more fully understanding the complex decision-making involved when determining whether to treat this subset of patients.

  1. 黄斑水肿的光学相干扫描之形态学分析%Morphology analysis of OCT images of macular edema

    Institute of Scientific and Technical Information of China (English)

    王长虹; 叶红; 姚琼晶

    2014-01-01

    AIM: To analyze the characteristic shapes of cystoid macular edema ( CME ) and the macular edema ( ME ) caused by central serous chorioretinopathy ( CSC ) through optical coherence tomography ( OCT ) examination, and to analyze the accumulate liquid in retina to explain their relationships with blood-retina barrier. METHODS: A total of 29 cases (30 eyes) with relative disease were enrolled, including one case with both eyes selected.The macular area of all patients was scanned by OCT horizontally and vertically. RESULTS: The OCT images of CME indicated: there were a lot of low reflection dark regions which had an oval honeycomb structure andcystoid shape; these regions were found between the outer nuclear layer and inner plexiform layer of retinal nerve fiber layer ( RNFL ); cyst wall appeared to be existed.The OCT images of ME result from CSC indicated: there were low reflection dark regions between photoreceptor inner segment/outer segment ( IS/OS ) junction layer and retinal pigment epithelium ( RPE ) layer; the RNFL was upheaved; RPE presented strong reflection but its shape was not different with that of normal macular. CONCLUSION:The image of OCT is a type of sectional anatomyfigures, the cystoids of CME exist not only in the outer plexiform layer, but also in the outer nuclear layer. The characteristic shapes of accumulated liquid of CME and CSC prove the existence of inner-outer barrier in retina.%目的:用眼科光学相干断层图像( optical coherence tomography ,OCT )来分析黄斑囊样水肿( cystoid macular edema,CME)和中心性浆液性视网膜脉络膜病( central serous chorioretinopathy , CSC )引起的黄斑水肿( macular edema,ME)的特征性,对积液特点进行分析,揭示它们和视网膜屏障的关系。  方法:在相关OCT图像中选取29例30眼,其中1例是双眼。对选定对象的黄斑区进行断层水平位和垂直位扫描。结果:CME 的 OCT 图像显示:

  2. Dose-ranging evaluation of intravitreal siRNA PF-04523655 for diabetic macular edema (the DEGAS study)

    DEFF Research Database (Denmark)

    Nguyen, Quan Dong; Schachar, Ronald A; Nduaka, Chudy I;

    2012-01-01

    To evaluate the safety and efficacy of three doses of PF-04523655, a 19-nucleotide methylated double stranded siRNA targeting the RTP801 gene, for the treatment of diabetic macular edema (DME) compared to focal/grid laser photocoagulation.......To evaluate the safety and efficacy of three doses of PF-04523655, a 19-nucleotide methylated double stranded siRNA targeting the RTP801 gene, for the treatment of diabetic macular edema (DME) compared to focal/grid laser photocoagulation....

  3. Laser-Based Strategies to Treat Diabetic Macular Edema: History and New Promising Therapies

    Directory of Open Access Journals (Sweden)

    Young Gun Park

    2014-01-01

    Full Text Available Diabetic macular edema (DME is the main cause of visual impairment in diabetic patients. The management of DME is complex and often various treatment approaches are needed. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal pharmacologic therapies (e.g., corticosteroids and anti-VEGF drugs, laser photocoagulation still remains the current standard in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME and describe the developments in laser systems. And we will also discuss the new laser techniques and review the latest results including benefits of combined therapy. In this paper, we briefly summarize the major laser therapeutics for the treatment of diabetic macular edema and allude to some future promising laser therapies.

  4. Intravitreal bevacizumab (Avastin in the treatment of macular edema secondary to retinal vein occlusion

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    Juan Carlos Mesa Gutiérrez

    2008-09-01

    Full Text Available Juan Carlos Mesa Gutiérrez, Luis Arias Barquet, Josep Maria Caminal Mitjana, Sergi Prades Almolda, Nùria Planas Domènech, Octavi Pujol Goita, Marc Rubio Caso, Jorge Arruga GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainObjective: To evaluate efficacy and safety of intravitreal injections of bevacizumab in the treatment of macular edema secondary to retinal vein occlusion (RVO.Methods: Prospective study, noncomparative, interventional case series. Twelve consecutive patients (12 eyes with macular edema associated with nonischemic retinal vein occlusion were treated with intravitreal bevacizumab (1.25 mg. All subjects underwent standardized ophthalmic evaluation at baseline and at weeks 1, 4, 12, and 24, consisting of visual acuity (VA measurement using ETDRS charts, and imaging with ocular coherence tomography evaluating changes in foveal thickness (FT and macular volume (MV.Results: The median age was 66 years (± 4.16, and the median duration of symptoms was 4 months (± 1.81. There were six cases of inferior branch vein occlusion and six cases of superior branch retinal vein occlusion. Mean VA improved from 1.32 ± 0.24 (logMAR values at baseline to 0.8 ± 0.15 (p = 0.0003 at the 6-month follow-up. The macular edema responded promptly, and a trend to restoration of normal macular anatomy was observed at by the seventh day. Mean FT improved from 615.50 ± 116.29 microns to 420 ± 72.53 microns (p = 0.001, and the mean MV improved from 19.81 ± 2.31mm3 to 9.23 ± 1.38 (p = 0.0001 at the 6-month follow-up.Keywords: Bevacizumab, retinal vein occlusion, intravitreal injection, vascular endothelial growth factor

  5. Microperimetric changes after intravitreal triamcinolone acetonide injection for macular edema due to central retinal vein occlusion.

    Science.gov (United States)

    Senturk, Fevzi; Ozdemir, Hakan; Karacorlu, Murat; Karacorlu, Serra Arf; Uysal, Omer

    2010-09-01

    The purpose of this study was to evaluate the effect of intravitreal triamcinolone acetonide on macular function in cases of macular edema because of central retinal vein occlusion. Twelve eyes of 12 patients with central retinal vein occlusion were included in this study. In each eye, at baseline and 1, 3, and 6 months after intravitreal triamcinolone acetonide injection, logarithm of the minimum angle of resolution visual acuity, macular sensitivity, fixation stability and fixation location by MP-1 microperimetry, and foveal thickness by optical coherence tomography were assessed. Patients' ages ranged from 50 to 75 years (mean +/- SD, 59 +/- 8 years). All patients were classified as nonischemic. At 1, 3, and 6 months, the mean foveal thickness had decreased from 453 +/- 108 microm to 254 +/- 40.3 microm, 297 +/- 90 microm, and 320 +/- 82 microm and the mean retinal sensitivity had increased from 5.5 +/- 3.3 dB to 9.4 +/- 3.5 dB, 7.8 +/- 3.3 dB, and 7.2 +/- 4.2 dB, respectively. At baseline, fixation was stable in one, relatively unstable in six, and unstable in five eyes. However, 6 months after intravitreal triamcinolone acetonide injection, fixation was stable in 8, relatively unstable in 3, and unstable in one. At baseline, in eyes with macular edema, fixation location was predominantly central in 2, poor central in 4, and predominantly eccentric in 6. And 6 months after treatment, fixation location was predominantly central in 8, poor central in 3, and predominantly eccentric in 1. In eyes with macular edema in central retinal vein occlusion, a short-term improvement in retinal sensitivity and fixation properties can be achieved by intravitreal triamcinolone acetonide injection.

  6. Edema quístico macular diagnosticado por tomografía de coherencia óptica en pacientes operados de catarata Cystoid macular edema diagnosed with optical coherente tomography in patients operated on from cataract

    Directory of Open Access Journals (Sweden)

    Omar Díaz Arencibia

    2009-12-01

    Full Text Available OBJETIVOS: Describir la frecuencia de edema quístico macular diagnosticado por tomografía de coherencia óptica en pacientes operados de catarata senil en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", de diciembre 2006 a febrero 2007. MÉTODOS: Se realizó un estudio descriptivo, prospectivo en 108 ojos de 94 pacientes operados, a los que se les realizó un examen con el Stratus OCT 3000 de Zeiss Meditec AG. RESULTADOS: El 20,3 % de los pacientes presentó edema quístico macular. El 59,1 % de pacientes con edema quístico macular no manifestaron sintomatología alguna. Existió mayor probabilidad de desarrollar edema quístico macular cuando ocurrieron complicaciones durante la cirugía. Se observó por biomicroscopia del polo posterior, quistes intrarretiniales perifoveolares en el 81,8 % de los operados, y una relación inversamente proporcional entre el grosor macular y la agudeza visual alcanzada. CONCLUSIONES: Un número apreciable de pacientes con edema quístico macular fueron diagnosticados por tomografía de coherencia óptica. Se presentó de manera asintomática en la mayoría de los pacientes. Existe mayor probabilidad de desarrollar edema quístico macular cuando ocurren complicaciones durante la cirugía, en especial la ruptura de la cápsula posterior con vitreorragia. Los cambios morfológicos que se presentan en estos pacientes determinan que exista una relación inversamente proporcional entre el grosor macular y la agudeza visual alcanzada.OBJECTIVES: To describe the frequency of cystoid macular edema diagnosed with optical coherence tomography in patients operated on from senile cataract at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology in the period from December 2006 to February 2007. METHODS: A prospective and descriptive study of 106 eyes from 94 surgical patients was conducted; they were examined with Zeiss Meditec AG Stratus OCT 3000. RESULTS: Of the total number of patients, 20,3 % presented

  7. Intravitreal Triamcinolone Acetonide for Patients with Macular Edema due to Branch Retinal Vein Occlusion

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    Kai-Chun Cheng

    2006-07-01

    Full Text Available We designed a case series study to evaluate the outcome of intravitreal triamcinolone acetonide for the treatment of macular edema due to branch retinal vein occlusion (BRVO. The prospective comparative nonrandomized clinical interventional study included 27 patients (27 eyes with macular edema due to BRVO. The study group consisted of 16 patients who had accepted an intravitreal injection (IVI of 4 mg triamcinolone acetonide. The control group included 11 patients without IVI of triamcinolone acetonide. The mean follow-up was 103.00 36.24 days in the study group and 94.55 36.31 days in the control group. In the study group, visual acuity measurements improved significantly (p 0.001 from 0.77 0.43 logarithm of minimal angle of resolution (logMAR preoperatively to a best postoperative visual acuity of 0.44 0.43 logMAR. Fourteen eyes (87.5% gained improvement in visual acuity, with 10 eyes (62.5% showing an increase in visual acuity of at least two Snellen lines. All 16 patients showed significant macular edema resolution in optical coherence tomography examination (p 0.001 and perivascular leakage decrease in fluorescein angiography post-IVI. In the control group, baseline best-corrected visual acuity and best-corrected visual acuity during the follow-up did not vary significantly (p 0.294. In conclusion, IVI of triamcinolone acetonide can lead to an increase in visual acuity and a resolution of macular edema in patients with BRVO.

  8. Visual prognosis and vitreous molecules after vitrectomy for macular edema with branch retinal vein occlusion

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    Hidetaka Noma

    2011-02-01

    Full Text Available Hidetaka Noma1, Hideharu Funatsu1, Tatsuya Mimura2, Shuichiro Eguchi3, Katsunori Shimada41Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Yachiyo, Chiba, Japan; 2Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; 3Department of Ophthalmology, Eguchi Eye Hospital, Hakodate, Japan; 4Department of Hygiene and Public Health II, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, JapanAbstract: This study investigated whether vascular endothelial growth factor (VEGF, soluble intercellular adhesion molecule-1 (sICAM-1, and pigment epithelium-derived factor (PEDF influence the visual prognosis of patients with macular edema and branch retinal vein occlusion (BRVO. In 47 consecutive patients (47 eyes undergoing vitrectomy, retinal thickness was examined by optical coherence tomography. Best-corrected visual acuity and the vitreous fluid levels of VEGF, sICAM-1, and PEDF were also determined. Patients were followed for at least 6 months after surgery. Vitreous fluid levels of VEGF and sICAM-1 were significantly lower in the patients with more marked improvement of visual acuity after vitrectomy, while PEDF was significantly higher. VEGF and sICAM-1 levels were significantly higher in patients with greater postoperative improvement of macular edema, while PEDF was significantly lower. In BRVO patients, vitreous fluid levels of VEGF, sICAM-1, and PEDF may influence both the response of macular edema to vitrectomy and the visual prognosis.Keywords: branch retinal vein occlusion, macular edema, vitrectomy, vascular endothelial growth factor, soluble intercellular adhesion molecule-1, pigment epithelium-derived factor 

  9. Study of 27 Aqueous Humor Cytokines in Type 2 Diabetic Patients with or without Macular Edema.

    Science.gov (United States)

    Dong, Ning; Xu, Bing; Chu, Liqun; Tang, Xin

    2015-01-01

    The aim of the present study was to compare the changes in the levels of 27 aqueous humor cytokines between diabetic patients with macular edema (ME) and diabetic patients without ME. Undiluted aqueous humor samples were obtained from 68 consecutive type 2 diabetic patients without ME and 56 consecutive type 2 diabetic patients with ME. The concentrations of 27 cytokines in the aqueous humor samples were measured using a multiplex bead immunoassay. Compared with diabetic patients without ME, diabetic patients with ME had significantly higher concentrations of IL-1β, IL-6, IL-8, IP-10, MCP-1, and VEGF in the aqueous humor. However, the concentrations of IL-10 and IL-12 were significantly lower in the diabetic patients with ME. The aqueous humor levels of IL-1β, IL-6, IL-8, MCP-1, IP-10, and VEGF were closely correlated with retinal macular thickness, retinal macular volume and the severity of ME. In addition, the aqueous humor levels of IL-10 and IL-12 decreased with increasing the severity of ME. A variety of cytokines associated with inflammation and angiogenesis may contribute to the pathogenesis of diabetic macular edema, and both anti-inflammatory and antiangiogenic agents should be included in the treatment of ME simultaneously.

  10. Monoscopic versus stereoscopic photography in screening for clinically significant macular edema.

    Science.gov (United States)

    Welty, Christopher J; Agarwal, Anita; Merin, Lawrence M; Chomsky, Amy

    2006-01-01

    The purpose of the study was to determine whether monoscopic photography could serve as an accurate tool when used to screen for clinically significant macular edema. In a masked randomized fashion, two readers evaluated monoscopic and stereoscopic retinal photographs of 100 eyes. The photographs were evaluated first individually for probable clinically significant macular edema based on the Early Treatment Diabetic Retinopathy Study criteria and then as stereoscopic pairs. Graders were evaluated for sensitivity and specificity individually and in combination. Individually, reader one had a sensitivity of 0.93 and a specificity of 0.77, and reader two had a sensitivity of 0.88 and a specificity of 0.94. In combination, the readers had a sensitivity of 0.91 and a specificity of 0.86. They correlated on 0.76 of the stereoscopic readings and 0.92 of the monoscopic readings. These results indicate that the use of monoscopic retinal photography may be an accurate screening tool for clinically significant macular edema.

  11. Automated detection of exudates and macula for grading of diabetic macular edema.

    Science.gov (United States)

    Akram, M Usman; Tariq, Anam; Khan, Shoab A; Javed, M Younus

    2014-04-01

    Medical systems based on state of the art image processing and pattern recognition techniques are very common now a day. These systems are of prime interest to provide basic health care facilities to patients and support to doctors. Diabetic macular edema is one of the retinal abnormalities in which diabetic patient suffers from severe vision loss due to affected macula. It affects the central vision of the person and causes total blindness in severe cases. In this article, we propose an intelligent system for detection and grading of macular edema to assist the ophthalmologists in early and automated detection of the disease. The proposed system consists of a novel method for accurate detection of macula using a detailed feature set and Gaussian mixtures model based classifier. We also present a new hybrid classifier as an ensemble of Gaussian mixture model and support vector machine for improved exudate detection even in the presence of other bright lesions which eventually leads to reliable classification of input retinal image in different stages of macular edema. The statistical analysis and comparative evaluation of proposed system with existing methods are performed on publicly available standard retinal image databases. The proposed system has achieved average value of 97.3%, 95.9% and 96.8% for sensitivity, specificity and accuracy respectively on both databases. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Singh R

    2012-08-01

    Full Text Available Rishi Singh,1 Louis Alpern,2 Glenn J Jaffe,3 Robert P Lehmann,4 John Lim,5 Harvey J Reiser,6 Kenneth Sall,7 Thomas Walters,8 Dana Sager91Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, 2The Cataract, Glaucoma, and Refractive Surgery Center, El Paso, TX, 3Duke Eye Center, Duke Reading Center, Duke University, Durham, NC, 4Lehmann Eye Center, Nacogdoches, TX, 5Houston Eye Associates, Houston, TX, 6Eye Care Specialists, Kingston, PA, 7Sall Research Medical Center, Artesia, CA, 8Texan Eye, Austin, TX, 9Alcon Research Ltd, Fort Worth, TX, USABackground: The purpose of this study was to evaluate nepafenac ophthalmic suspension 0.1% (Nevanac®; Alcon Research Ltd in the prevention of macular edema following cataract surgery in diabetic retinopathy patients.Methods: This was a multicenter, randomized, double-masked, vehicle-controlled study of 263 adult diabetic patients with nonproliferative diabetic retinopathy requiring cataract surgery. Patients were randomized (1:1 to instill nepafenac or vehicle three times daily beginning 1 day prior to surgery through day 90. Efficacy included the percentage of patients who developed macular edema (≥30% increase in central subfield macular thickness from baseline and the percentage of patients with decreases of more than five letters in best-corrected visual acuity from day 7 to 90.Results: A significantly lower percentage of patients in the nepafenac group developed macular edema relative to patients in the vehicle group (3.2% versus 16.7%; P < 0.001. A significantly lower percentage of patients in the nepafenac group had best-corrected visual acuity decreases of more than five letters relative to patients in the vehicle group on day 30 (P < 0.001, day 60 (P = 0.002, and day 90 (P = 0.006. The mean central subfield macular thickness and mean percent change from baseline in macular volume were also significantly lower in the nepafenac group versus the vehicle group at days 14 through 90 (P

  13. Macular edema in underserved diabetic patients: Improving detection by enhancing the optical signature and data analysis techniques

    Science.gov (United States)

    Alhamami, Mastour Abdullah

    Diabetic retinopathy and diabetic macular edema are chief causes of vision loss in working adults. Thus, retinal screening of patients with diabetes has become standard practice in some countries to prevent visual impairment and blindness from diabetic retinopathy. One goal is to improve techniques currently used to diagnose diabetic retinopathy. Another goal is to probe pathophysiological changes seen with imaging methods. Analysis was performed on a novel dataset from more than 2000 underserved adult diabetic patients, who were recruited for a screening study for diabetic eye disease. Data were collected from four county clinics at Alameda Health, Alameda County, CA. Over 90% of patients self-identified as a racial/ethnic identity other than non-Hispanic white. We investigated the prevalence and optical properties of macular edema. In the first study, a retrospective cohort study was performed to compare macular thickness in diabetic patients with and without macular edema to determine the presence of damage to the external limiting membrane or and the relation of damage to the ELM to damage to photoreceptors. In the second study, we investigated whether the information in red light better visualizes cysts in diabetic macular edema, as compared to green light. In the third study, we investigated whether the demographic and blood glucose information predict diabetic macular edema. Three logistic regression analyses were compared. In the fourth study, we examined how different outcome measures of retinal thickness vary with demographic and blood glucose measures, using a trichotomous variable for retinal thickness. The findings point strongly to large individual differences in the development of macular edema, which is difficult to diagnose with the most common methods in dark eyes. Further, while blood glucose was found to be important, there are additional differences in the potential for macular edema that are associated with ethnic group and gender.

  14. Profilaxia e tratamento do edema macular cistoide após cirurgia de catarata

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    Pedro C. Carricondo

    2015-04-01

    Full Text Available O edema macular cistoide é uma das principais causas de baixa de visão após cirurgia de catarata. O processo inflamatório parece ser o principal fator causal do edema. São considerados fatores de risco complicações cirúrgicas, doenças retinianas prévias, diabetes, uveítes e uso de colírios de prostaglandinas. O diagnóstico é feito clinicamente, mas a angiografia fluoresceínica e a tomografia de coerência óptica também são ferramentas importantes para detectar o edema e auxiliar no diagnóstico diferencial. Apesar da profilaxia pré-operatória não ter evidência científica, ela é preconizada especialmente nos casos com fatores de risco. O tratamento inicial é realizado com associação de corticoide e anti-inflamatório não hormonais tópicos. Os casos crônicos e refratários têm diversas alternativas de tratamento, sendo o uso de triancinolona e antiangiogênicos intravítreos as mais utilizadas. Este artigo se propõe a discutir diversos aspectos do edema macular cistoide pseudofácico.

  15. Factors affecting reading speed in patients with diabetic macular edema treated with laser photocoagulation.

    Directory of Open Access Journals (Sweden)

    Elizabeth Pearce

    Full Text Available PURPOSE: To study the factors that may affect reading speed in patients with diabetic macular edema previously treated with laser photocoagulation. METHODS: Consecutive patients with type II diabetes treated with laser photocoagulation for diabetic macular edema (DME at least twelve months previously, with best corrected visual acuity of better than 65 letters (approximately 20/40 measured with Early Treatment Diabetic Retinopathy Study (ETDRS charts were included in this study. Patients previously treated with pan-retinal photocoagulation, vitrectomy, intravitreal steroid or anti-VEGF therapy were excluded. Any other ocular co-morbidities that may influence reading ability such as cataract, glaucoma or macular degeneration were also excluded. All patients were refracted by a certified examiner, the following measurements were collected: best corrected visual acuity (BCVA, contrast sensitivity with Pelli-Robson chart, reading speed with MNREAD chart, microperimetry with Nidek MP1, and central subfield thickness with Zeiss spectral domain optical coherent topography. RESULTS: The slow reading group had poorer contrast sensitivity (p = 0.001, reduced retinal sensitivity (p = 0.027 and less stable fixation (p = 0.013. Most interestingly the reduced retinal sensitivity findings were driven by the microperimetry value on the right subfield (p = 0.033, (nasal to the fovea in the right eye and temporal to the fovea in the left eye. Multiple linear regression analysis showed that contrast sensitivity is probably the most important factor that affects reading speed (p = 0.001. CONCLUSION: Reduced retinal sensitivity after laser treatment is associated with reduced reading speed in patients with diabetic macular edema.

  16. Aqueous levels of erythropoietin in acute retinal vein occlusion with macular edema

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    Hyun Jin Shin

    2014-06-01

    Full Text Available AIM: To investigate the aqueous erythropoietin (EPO levels and associated factors in patients with acute retinal vein occlusion (RVO.METHODS:The aqueous EPO level was measured in patients with macular edema (ME secondary to acute branched retinal vein occlusion (BRVO or central retinal vein occlusion (CRVO. Aqueous fluid from cataract patients served as the control. We also evaluated whether aqueous level of EPO was associated with factors such as serum EPO level, non-perfusion area, central macular thickness (CMT, and arterio-venous (AV transit timeRESULTS:Twenty-seven RVO patients (16 BRVO, 11 CRVO and 9 control subjects were enrolled in the study. The aqueous EPO level (mU/mL was higher in RVO (68.2±54.3 than that in the control subjects (12.9±5.9. More specifically, the aqueous EPO level was higher in CRVO (118.9±52.1 than that in BRVO (33.3±10.8. However, no differences were found in serum EPO levels among three groups. CMT in RVO patients had a positive correlation with the aqueous EPO level (r=0.66. Also, in terms of non-perfusion area, the aqueous EPO levels were more elevated in the ischemic subgroup than in the non-ischemic subgroup in both BRVO and CRVO.CONCLUSION:Aqueous EPO levels are elevated in patients with macular edema secondary to recent onset RVO. Patients with CRVO have higher EPO levels than those with BRVO. The aqueous EPO level in RVO has a positive correlation with CMT and is associated with non-perfusion area. These results suggest that the aqueous EPO level could be associated with retinal ischemia and may be involved in the pathogenesis of macular edema secondary to RVO.

  17. Evaluation of curative effect of macular edema in retinal vein occlusion

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    Chang-Jun Hou

    2013-12-01

    Full Text Available AIM: To compare the efficiency of intravitreal injection of triamcinolone acetonide(TAor general treatment for the treatment of macular edema in retinal vein occlusion. METHODS: Seventy-five eyes of 75 patients with macular edema of retinal vein occlusion were diagnosed by examination of regular inspection, fundus fluorescein angiography(FFAand optic coherence tomography(OCT. There were 31 patients in general treatment group and 44 patients in TA group. There were no significant differences between the two groups with regards to patient's age, duration of disease, intraocular pressure(IOP, best-corrected visual acuity(BCVA, central macular thickness(CMTat baseline. Comprehensive ophthalmic evaluation was performed at baseline and at week 4 and 12 after treatment. Main outcome measures included IOP, BCVA and CMT by OCT.RESULTS: Separate within-group analysis of showed significant reduction in CMT from baseline in TA group at week 12. The results showed significant improvement in BCVA in TA group and general treatment group. But no significant interaction between groups were observed of BCVA at week 4 and 12. There was a significant increase in IOP(>5mmHgin the TA group when compared with the general treatment group at week 4, but no significant interaction between groups at week 12.CONCLUSION: The result shows that general approach and intravitreal injection of triamcinolone acetonide are well tolerated wiht a significant improvement in BCVA and decrease in macular edema in retinal vein occlusion. But we must be attention to the increased IOP after intravitreal injection of TA.

  18. Intravitreal ranibizumab for macular edema secondary to central retinal vein occlusion.

    Science.gov (United States)

    Risard, Sarah M; Pieramici, Dante J; Rabena, Melvin D; Basefsky, Jessica C; Avery, Robert L; Castellarin, Alessandro A; Nasir, Ma'an A; See, Robert F; Couvillion, Stephen S

    2011-06-01

    To evaluate the safety and efficacy of intravitreal ranibizumab for macular edema secondary to central retinal vein occlusion. Patients with macular edema secondary to perfused central retinal vein occlusion were enrolled in this ongoing, prospective, open-label study. Treatment was initiated with monthly intravitreal ranibizumab for 3 months. In the first year, additional injections were administered for edema in quarterly intervals as needed (PRN) for Cohort 1 (n = 10) and monthly PRN for Cohort 2 (n = 10). In the second year of treatments, all patients received monthly PRN treatment. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, central retinal thickness, fundus photographs, and fluorescein angiograms were evaluated, and the incidence and severity of adverse events were documented. Mean change in best-corrected visual acuity and central retinal thickness improved during the induction phase in both groups. During the remainder of the first year for Cohort 1, initial gains were lost during quarterly treatment but returned with monthly PRN treatment in the second year. For Cohort 2, improvement in best-corrected visual acuity and central retinal thickness from the induction phase was maintained through Month 24. Nineteen of 20 patients experienced a reduction in intraretinal hemorrhage, optic nerve swelling, and/or venous diameter after treatment. One myocardial infarction, one cerebrovascular accident, and no serious ocular adverse events were reported. Iris neovascularization was developed in none of the eyes. Ranibizumab was well tolerated and associated with a greater reduction in macular edema and improvement in visual acuity in the monthly PRN regimen compared with quarterly treatment. Vision lost during the quarterly PRN injection intervals in the first year of Cohort 1 could be regained by switching to monthly PRN dosing.

  19. Treatment of macular edema due to retinal vein occlusions

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    Channa R

    2011-05-01

    Full Text Available Roomasa Channa, Michael Smith, Peter A CampochiaroDepartments of Ophthalmology and Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Retinal vein occlusion (RVO is a prevalent retinal vascular disease, second only to diabetic retinopathy. Previously there was no treatment for central retinal vein occlusion (CRVO and patients were simply observed for the development of severe complications, generally resulting in poor visual outcomes. The only treatment for branch vein occlusion (BRVO was grid laser photocoagulation, which reduces edema very slowly and provides benefit in some, but not all patients. Within the past year, clinical trials have demonstrated the effects of three new pharmacologic treatments, ranibizumab, triamcinolone acetonide, and dexamethasone implants. The benefit/risk ratio is best for intraocular injections of ranibizumab, making this first-line therapy for most patients with CRVO or BRVO, while intraocular steroids are likely to play adjunctive roles. Standard care for patients with RVO has changed and will continue to evolve as results with other new agents are revealed.Keywords: vascular endothelial growth factor, triamcinolone acetonide, dexamethosone implant, sustained release, vascular leakage, ischemia

  20. Comparison of Cysts in Red and Green Images for Diabetic Macular Edema.

    Science.gov (United States)

    Alhamami, Mastour A; Elsner, Ann E; Malinovsky, Victor E; Clark, Christopher A; Haggerty, Bryan P; Ozawa, Glen Y; Cuadros, Jorge A; Baskaran, Karthikeyan; Gast, Thomas J; Litvin, Taras V; Muller, Matthew S; Brahm, Shane G; Young, Stuart B; Miura, Masahiro

    2017-02-01

    To investigate whether cysts in diabetic macular edema are better visualized in the red channel of color fundus camera images, as compared with the green channel, because color fundus camera screening methods that emphasize short-wavelength light may miss cysts in patients with dark fundi or changes to outer blood retinal barrier. Fundus images for diabetic retinopathy photoscreening were acquired for a study with Aeon Imaging, EyePACS, University of California Berkeley, and Indiana University. There were 2047 underserved, adult diabetic patients, of whom over 90% self-identified as a racial/ethnic identify other than non-Hispanic white. Color fundus images at nominally 45 degrees were acquired with a Canon Cr-DGi non-mydriatic camera (Tokyo, Japan) then graded by an EyePACS certified grader. From the 148 patients graded to have clinically significant macular edema by the presence of hard exudates in the central 1500 μm of the fovea, we evaluated macular cysts in 13 patients with cystoid macular edema. Age ranged from 33 to 68 years. Color fundus images were split into red, green, and blue channels with custom Matlab software (Mathworks, Natick, MA). The diameter of a cyst or confluent cysts was quantified in the red-channel and green-channel images separately. Cyst identification gave complete agreement between red-channel images and the standard full-color images. This was not the case for green-channel images, which did not expose cysts visible with standard full-color images in five cases, who had dark fundi. Cysts appeared more numerous and covered a larger area in the red channel (733 ± 604 μm) than in the green channel (349 ± 433 μm, P < .006). Cysts may be underdetected with the present fundus camera methods, particularly when short-wavelength light is emphasized or in patients with dark fundi. Longer wavelength techniques may improve the detection of cysts and provide more information concerning the early stages of diabetic macular edema or the outer

  1. Comparison of Cysts in Red and Green Images for Diabetic Macular Edema

    Science.gov (United States)

    Alhamami, Mastour A.; Elsner, Ann E.; Malinovsky, Victor E.; Clark, Christopher A.; Haggerty, Bryan P.; Ozawa, Glen Y.; Cuadros, Jorge A.; Baskaran, Karthikeyan; Gast, Thomas J.; Litvin, Taras V.; Muller, Matthew S.; Brahm, Shane G.; Young, Stuart B.; Miura, Masahiro

    2017-01-01

    ABSTRACT Purpose To investigate whether cysts in diabetic macular edema are better visualized in the red channel of color fundus camera images, as compared with the green channel, because color fundus camera screening methods that emphasize short-wavelength light may miss cysts in patients with dark fundi or changes to outer blood retinal barrier. Methods Fundus images for diabetic retinopathy photoscreening were acquired for a study with Aeon Imaging, EyePACS, University of California Berkeley, and Indiana University. There were 2047 underserved, adult diabetic patients, of whom over 90% self-identified as a racial/ethnic identify other than non-Hispanic white. Color fundus images at nominally 45 degrees were acquired with a Canon Cr-DGi non-mydriatic camera (Tokyo, Japan) then graded by an EyePACS certified grader. From the 148 patients graded to have clinically significant macular edema by the presence of hard exudates in the central 1500 μm of the fovea, we evaluated macular cysts in 13 patients with cystoid macular edema. Age ranged from 33 to 68 years. Color fundus images were split into red, green, and blue channels with custom Matlab software (Mathworks, Natick, MA). The diameter of a cyst or confluent cysts was quantified in the red-channel and green-channel images separately. Results Cyst identification gave complete agreement between red-channel images and the standard full-color images. This was not the case for green-channel images, which did not expose cysts visible with standard full-color images in five cases, who had dark fundi. Cysts appeared more numerous and covered a larger area in the red channel (733 ± 604 μm) than in the green channel (349 ± 433 μm, P < .006). Conclusions Cysts may be underdetected with the present fundus camera methods, particularly when short-wavelength light is emphasized or in patients with dark fundi. Longer wavelength techniques may improve the detection of cysts and provide more information concerning the early

  2. Macular edema in multiple evanescent white dot syndrome Edema macular na síndrome dos múltiplos pontos brancos evanescentes

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    Raul N. G. Vianna

    2010-02-01

    Full Text Available Eletroretinographic findings show that the transient decreased vision seen in patients with the multiple evanescent white dot syndrome (MEWDS is related to metabolic disturbances at the level of the retinal pigment epithelium and photoreceptor complex. In this paper, we present a patient with a typical picture of MEWDS associated to macular edema, which could also be a factor to reduce vision in this disorder. Case report of a 53-year-old woman complaining about unilateral decreased vision of 7 days' duration was sent to our retina clinic. A complete ophthalmic examination was performed as well as fluorescein angiography, indocyanine green angiography, Goldmann visual fields and optical coherence tomography (OCT. Best-corrected visual acuity was 20/40 and 20/20, in the right and left eye respectively. Ophthalmoscopy of the affected eye revealed multiple focal outer retinal gray lesions in the perimacular and peripapillary region. There were several orange puntate lesions in the foveolar region. Fluorescein angiography disclosed faint multiple foci of staining in the perimacular and peripapillary area, and some staining of the optic disc. A discrete hyperfluorescence was also observed in the foveal region. OCT disclosed an increase in foveal thickness (231 µm, approximately 25% thicker than the opposite normal eye (186 µm. Within 3 months her visual acuity had returned to 20/20 and the foveal thickness returned to a normal value (189 ìm. Although the mechanism of transitory blurred vision is not completely elucidated in cases of MEWDS, we suggest that macular edema may play a role.PRPÓSITO: Achados eletroretinográficos revelam que a baixa visual transitória observada em pacientes com a síndrome dos múltiplos e evanescentes pontos brancos na retina (MEWDS está relacionada a distúrbios metabólicos ao nível do epitélio pigmentado da retina e dos fotorreceptores. No presente artigo, nós apresentamos um paciente com um quadro típico de

  3. Machine learning based detection of age-related macular degeneration (AMD) and diabetic macular edema (DME) from optical coherence tomography (OCT) images.

    Science.gov (United States)

    Wang, Yu; Zhang, Yaonan; Yao, Zhaomin; Zhao, Ruixue; Zhou, Fengfeng

    2016-12-01

    Non-lethal macular diseases greatly impact patients' life quality, and will cause vision loss at the late stages. Visual inspection of the optical coherence tomography (OCT) images by the experienced clinicians is the main diagnosis technique. We proposed a computer-aided diagnosis (CAD) model to discriminate age-related macular degeneration (AMD), diabetic macular edema (DME) and healthy macula. The linear configuration pattern (LCP) based features of the OCT images were screened by the Correlation-based Feature Subset (CFS) selection algorithm. And the best model based on the sequential minimal optimization (SMO) algorithm achieved 99.3% in the overall accuracy for the three classes of samples.

  4. Dexamethasone 0.7 mg implants in the management of pseudophakic cystoid macular edema

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    José Maurício Botto de Barros Garcia

    2016-04-01

    Full Text Available ABSTRACT Pseudophakic cystoid macular edema (PCME is a common complication following cataract surgery. Although majority of patients with PCME remain asymptomatic, it remains an important cause of vision loss after cataract surgery. The pathogenesis of PCME remains unclear, but most authors agree that inflammation plays a major role in its development. There is no standard algorithm for treatment procedures for PCME. A biodegradable 0.7 mg dexamethasone intravitreal implant can be used to deliver medication into the posterior segment of eyes. This drug acts on all inflammatory mediators and has been approved for the treatment of macular abnormalities secondary to retinal vein occlusion and for non-infectious posterior uveitis. In this case series, we report six patients who presented with PCME and were treated with a 0.7 mg dexamethasone intravitreal implant. Favorable anatomical outcomes were demonstrated by spectral domain-optical coherence tomography images.

  5. INTRAVITREAL TRIAMCINOLONE IN DIABETIC MACULAR EDEMA : A COMPARATIVE STUDY OF 1 MG AND 4MG DOSES

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    Sikander A . K

    2015-06-01

    Full Text Available Macular edema is a frequent manifestation of diabetic retinopathy and animportant cause of visual disturbance in diabetic patients. AIM: To compare the efficacy and safety of 1mg and 4mg intravitreal triamcinolone acetonide (IVTA in the management of diabetic macular edema. SETTING: Sarojini Devi Eye Hospital, Hyderabad. MATERIAL AND METHODS: 42 eyes of 42 patients with diabetic macular edema were randomly assigned torecei ve either 1 - mg or 4 - mg dose of Intravitreal triamcinolone acetonide (IVTA. Each patient underwent a complete comprehensive eye examination at baseline andat each visit.Fundus fluorescein angiography and optical coherence angiographywas done at baseline an d at 1, 3 and 6 months.BCVA, lens status, IOP wererecorded at each follow up visit. Each patient’s BCVA was measured in snellen’s lines and converted into logarithm of minimum angle of resolution (log MAR scale for analysis. STATISTICAL ANALYSIS USED : The data were statistically evaluated using the Wilcoxon signedrank test, Mann - Whitney test and t tests wherever applicable. A p value of lessthan . 05 was considered significant. RESULTS: There was no statistically significant difference in the mean foveal thickness measurement at baseline (p=.723 or at 3 rd month (p=.878 between the sub - groups. BCVA significantly improved from baseline to subsequent visits in both the groups, but there was no statistically significant difference observed in the mean baseli ne BCVA between the two sub - groups (p=.754. There was no statistically significant difference observed in IOP between the two sub - groups at any follow up visit. CONCLUSIONS: The results of our study suggest that 1 - mg dose of IVTA is as effective as 4 - mgdo se of IVTA in improving the functional and anatomical outcome in macularedema associated with diabetic retinopathy.

  6. Fellow Eye Macular Edema Improvement after Intravitreal Bevacizumab for Radiation Retinopathy

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    Isis A. S. Brito

    2015-01-01

    Full Text Available Radiation retinopathy (RR is a progressive, chronic condition directly related to the amount of radiation administered to the retina. We report a 37-year-old patient with medulloblastoma that was treated with external beam radiation and presented to us with bilateral cystoid macular edema. He was treated with monthly bevacizumab injections only in his worst seeing eye. There was a significant improvement in his fellow eye, with marked retinal thickness reduction. Therefore, we present clinical evidence of systemic absorption and fellow eye activity of the drug (bevacizumab. One must be aware of distant side effects after intravitreal injections.

  7. Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops

    DEFF Research Database (Denmark)

    Kessel, Line; Tendal, Britta; Jørgensen, Karsten Juhl

    2014-01-01

    PURPOSE: Favorable outcome after cataract surgery depends on proper control of the inflammatory response induced by cataract surgery. Pseudophakic cystoid macular edema is an important cause of visual decline after uncomplicated cataract surgery. DESIGN: We compared the efficacy of topical steroids...... with topical nonsteroidal anti-inflammatory drugs (NSAIDs) in controlling inflammation and preventing pseudophakic cystoid macular edema (PCME) after uncomplicated cataract surgery. PARTICIPANTS: Patients undergoing uncomplicated surgery for age-related cataract. METHODS: We performed a systematic literature...... for age-related cataract. MAIN OUTCOME MEASURES: Postoperative inflammation and pseudophakic cystoid macular edema. RESULTS: Fifteen randomized trials were identified. Postoperative inflammation was less in patients randomized to NSAIDs. The prevalence of PCME was significantly higher in the steroid group...

  8. Photopic negative response in branch retinal vein occlusion with macular edema.

    Science.gov (United States)

    Noma, Hidetaka; Mimura, Tatsuya; Kuse, Manami; Yasuda, Kanako; Shimura, Masahiko

    2015-02-01

    In patients with branch retinal vein occlusion (BRVO) and macular edema, the relations among full-field electroretinogram (ffERG) parameters and parameters of retinal function or morphology remain uncertain. The objective of this study was to investigate the correlations between parameters of the ffERG, including the photopic negative response (PhNR), and retinal functional or morphological parameters in these patients. In 62 consecutive BRVO patients (mean age: 68.5 ± 10.6 years; 32 women and 30 men), the amplitude and implicit time of the a-wave cone, b-wave cone, 30 Hz flicker, and PhNR were calculated from the ffERG. Microperimetry was employed to measure the macular sensitivity within the central 4°, 10°, and 20° fields, while macular thickness and volume within these fields were measured by optical coherence tomography. Best-corrected visual acuity (BCVA) was determined on the logarithm of the minimum angle of resolution scale. The cone b-wave, 30 Hz flicker, and PhNR amplitudes showed a significant correlation with BCVA. In addition, the cone a-wave, cone b-wave, 30 Hz flicker, and PhNR amplitudes all showed a significant correlation with macular sensitivity within the central 4°, 10°, and 20° fields. Only the 30 Hz flicker amplitude showed a significant correlation with the macular thickness and volume within the 4°, 10°, and 20° fields, while the other ERG parameters did not. These findings suggest that PhNR may be a useful ERG parameter for evaluating inner retinal function in BRVO patients.

  9. Estudo do tratamento do edema macular difuso do diabético com triancinolona intravítrea e fotocoagulação Use of intravitreal triamcinolone and laser photocoagulation for the treatment of diffuse diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Fábio Petersen Saraiva

    2008-08-01

    Full Text Available OBJETIVO: Avaliar a eficácia do uso intravítreo da triancinolona acetonida associada a fotocoagulação com laser no tratamento do edema macular difuso diabético. Comparar esta associação terapêutica com o uso isolado de cada tratamento. MÉTODOS: Após controle clínico sistêmico, trinta pacientes portadores de edema macular difuso diabético foram divididos em 3 grupos de tratamento: (1 fotocoagulação macular em grade com laser de argônio; (2 aplicação intravítrea de 4 mg de triancinolona acetonida; (3 associação dos itens anteriores. O seguimento foi realizado em intervalos predeterminados de um dia, uma semana e mensalmente, até completar 6 meses. Foram analisados os parâmetros: acuidade visual corrigida LogMAR, espessura macular central, volume macular total e pressão intra-ocular. RESULTADOS: A fotocoagulação com laser não reduziu de forma estatisticamente significativa a espessura macular central e o volume macular total. Esta redução foi significativa e estatisticamente semelhante nos outros dois grupos. Todos os grupos apresentaram melhora da acuidade visual, entretanto, o grupo que recebeu a associação do laser com a triancinolona intravítrea obteve maior porcentagem de pacientes com ganho de 10 ou mais letras de visão. CONCLUSÃO: O uso simultâneo da fotocoagulação com a triancinolona intravítrea pode ser considerado uma opção terapêutica para o edema macular difuso diabético.PURPOSE: To assess the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and to compare it with the separate use of each treatment. METHODS: After systemic clinical control, thirty patients with diffuse diabetic macular edema were divided into 3 treatment groups: (1 macular grid photocoagulation; (2 intravitreal injection of 4 mg of triamcinolone acetonide; (3 combination of the two previous therapies. Follow-up was scheduled at

  10. Cystoid macular edema secondary to immune recovery uveitis in a man with cytomegalovirus retinitis and AIDS

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    Kathir Yoganathan

    2010-09-01

    Full Text Available Kathir YoganathanHIV/Genito-Urinary Medicine, Abertawe Bro Morgannwg University Health Board, Singleton hospital, Swansea, UKAbstract: Cytomegalovirus (CMV is the most common intraocular opportunistic infection in profoundly immunocompromised patients with AIDS. It is characterized by an acute, progressive, necrotizing retinitis in patients with a CD4 count of <50 cells/µL. Although the incidence of CMV retinitis has declined because of the introduction of antiretroviral therapy (ART, a new syndrome of intraocular inflammation has emerged in patients with rising CD4 lymphocyte counts following ART. This is called immune recovery uveitis (IRU. It is thought to occur as a result of restored immunity to various infectious agents, commonly mycobacterial, Cryptococcus, and herpes virus infections. We report a man who was treated for CMV retinitis and later developed IRU in the form of cystoid macular edema (CMO even though his CMV retinitis remained inactive. His CMO resolved and visual acuity improved 2 years after the onset of CMO without any treatment interventions.Keywords: HIV, cystoid macular edema, AIDS, CMV retinitis

  11. Retinal vein occlusion and macular edema – critical evaluation of the clinical value of ranibizumab

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    Keane PA

    2011-06-01

    Full Text Available Pearse A Keane1, Srinivas R Sadda21NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; 2Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USAAbstract: Retinal vein occlusions (RVOs constitute the second most common cause of retinal vascular disease after diabetic retinopathy, with a prevalence of between 1% and 2% in persons older than 40 years of age. Despite the existence of numerous potential therapeutic options, none is entirely satisfactory, and many patients with RVO suffer irreversible visual loss. Fortunately however, the recent introduction of antivascular endothelial growth factor (VEGF agents, such as ranibizumab (Lucentis®, Genentech, South San Francisco, CA and bevacizumab (Avastin®, Genentech, offers a potentially new treatment approach for clinicians managing this disorder. The results of the BRAVO and CRUISE trials have provided the first definitive evidence for the efficacy and safety of ranibizumab in the treatment of RVO. As a result, ranibizumab has recently been approved by the US Food and Drug Administration for the treatment of RVO-associated macular edema. In this review, we provide a critical evaluation of clinical trial data for the safety and efficacy of ranibizumab, and address unresolved issues in the management of this disorder. Keywords: ranibizumab, retinal vein occlusion, vascular endothelial growth factor, macular edema

  12. Role of implants in the treatment of diabetic macular edema: focus on the dexamethasone intravitreal implant

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    Cebeci Z

    2015-11-01

    Full Text Available Zafer Cebeci, Nur KirDepartment of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, TurkeyAbstract: Diabetic macular edema (DME is the leading cause of sight-threatening complication in diabetic patients, and several treatment modalities have been developed and evaluated to treat this pathology. Intravitreal agents, such as anti-vascular endothelial growth factors (anti-VEGF or corticosteroids, have become more popular in recent years and are widely used for treating DME. Sustained release drugs appear to be mentioned more often nowadays for extending the period of intravitreal activity, and corticosteroids play a key role in inhibiting the inflammatory process in DME. A potent corticosteroid, dexamethasone (Ozurdex®, in the form of an intravitreal implant, has been approved for various ocular etiologies among which DME is also one. This review evaluates the role of implants in the treatment of DME, mainly focusing on the dexamethasone intravitreal implant.Keywords: diabetes mellitus, diabetic macular edema, vascular endothelial growth factor, dexamethasone, Iluvien, corticosteroid

  13. Long-Term Outcome after Vitrectomy for Macular Edema with Retinal Vein Occlusion Dividing into the Occlusion Site

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    Takeshi Iwase

    2014-01-01

    Full Text Available Purpose. To investigate the efficacy of treatment for macular edema secondary to retinal vein occlusion (RVO with vitrectomy. Methods. This retrospective study identified patients with macular edema associated with RVO between January 2004 and April 2006. Inclusion criteria were eyes with (1 preoperative visual acuity (VA of 20/40 or worse, (2 a central foveal thickness (CFT greater than 250 μm, and (3 vitrectomy with internal limiting membrane and intravitreal triamcinolone acetonide. Each patient had their RVO classified as a major or macular BRVO or hemispheric RVO (HSRVO. Results. Forty-six eyes with major BRVO, 18 eyes with macular BRVO, and 17 eyes with HSRVO were investigated. VA was significantly improved at 24 months after surgery for each group (P<0.05. Vision in the macular BRVO group 24 months after surgery was significantly better than that in other groups (P<0.05. For each group, a concomitant reduction of CFT was noted at every time point when compared to preoperative values (P<0.001. Conclusions. In macular BRVO, the postoperative vision 24 months after surgery was significantly better than the other groups. These findings suggest that additional and earlier treatments might be more important for patients with major BRVO and HSRVO than for those with macular BRVO.

  14. Dorzolamide Chlorhydrate Versus Acetazolamide in the Management of Chronic Macular Edema in Patients with Retinitis Pigmentosa: Description of Three Case Reports

    OpenAIRE

    Elena Pacella; Loredana Arrico; Valentina Santamaria; Paolo Turchetti; Maria Rosaria Carbotti; Giuseppe La Torre; Fernanda Pacella

    2014-01-01

    AIMS To assess the efficacy of topical dorzolamide for treating cystoid macular edema in patients with retinitis pigmentosa and minimize the secondary effects of maintenance therapy in patients with retinitis pigmentosa (RP) who present with chronic microcystic macular edema. METHODS To replace acetazolamide systemic treatment, with a topical treatment using 2% dorzolamide in three patients. The methods performed were OCT scan with a Spectralis HRA-OCT, for the measurement of macular thicknes...

  15. Intravitreal bevacizumab injections for diabetic macular edema – predictors of response: a retrospective study

    Science.gov (United States)

    Joshi, Lavnish; Bar, Asaf; Tomkins-Netzer, Oren; Yaganti, Satish; Morarji, Jiten; Vouzounis, Panayiotis; Seguin-Greenstein, Sophie; Taylor, Simon R; Lightman, Sue

    2016-01-01

    Background Outcomes of intravitreal antivascular endothelial growth factor injections are variable among patients with diabetic macular edema (DME). The aim of this study was to determine the ocular and systemic predictors of DME response to intravitreal bevacizumab (IVB). Methods Retrospective review over 2 years of 78 eyes from 54 patients. An anatomical response to IVB was defined as a 20% reduction in central macula thickness after the first course (three injections) of IVB. Results Twenty-eight percent of patients had an anatomical response after the first course of IVB. Systemic hypertension (odds ratio, 95% confidence interval: 12.1, 0.7–21) was a statistically significant predictor (P=0.025) of a good response to IVB, whereas previous macular laser was a statistically significant (P=0.0005) predictor of a poor response (0.07, 0.01–0.32). Sixty-eight percent of eyes underwent subsequent treatment for DME after the first course of IVB. The visual acuity gain at 24 months in hypertensive (0.7±3.6 letters) and nonhypertensive (5.2±3.7 letters) patients was not significantly different (P=0.41). Conclusion Hypertension and previous macular laser were positive and negative predictors of response to IVB, respectively. However, long-term visual acuity changes were not significantly different between eyes with and without systemic hypertension. PMID:27799737

  16. Consecutive Macular Edema and Visual Outcome in Branch Retinal Vein Occlusion

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    Sung Uk Baek

    2014-01-01

    Full Text Available Purposes. The study introduced the concept of “consecutive macular edema” and evaluated the validity of visual outcome in macular edema (ME secondary to branch retinal vein occlusion (BRVO. Methods. Patients were categorized into the gainer group and the nongainer group according to the final visual acuity. We analyzed clinical characteristics involving total and consecutive duration of ME between the two groups. Results. Among the total 71 eyes of 71 patients, intravitreal bevacizumab injection (26 patients, triamcinolone (21, and natural course (33 were enrolled. The consecutive duration of ME was shorter in the gainer group than in the nongainer group (3.33 ± 1.50 and 5.24 ± 2.39 months; P=0.000. After exclusion of macular ischemia, consecutive duration of ME in gainer group was also significantly shorter than in nongainer group (3.62 ± 1.60 and 6.11 ± 4.20 months; P=0.010. Conclusions. The duration of ME in the nongainer group was longer than in the gainer group. In particular, the consecutive duration was an important factor in determining the final visual outcome. Clinical Trial Registration. Approval by Hallym University Sacred Heart Hospital Institutional Review Board/Ethics Committee was obtained for this retrospective study.

  17. Topical dorzolamide for macular edema in the early phase after vitrectomy and epiretinal membrane removal

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    Suzuki T

    2013-04-01

    Full Text Available Takahiro Suzuki, Kenji Hayakawa, Yoshihiro Nakagawa, Hiromi Onouchi, Masafumi Ogata, Kenji KawaiDepartment of Ophthalmology, Tokai University School of Medicine, Isehara, JapanBackground: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.Methods: Forty patients were included, all of whom had undergone vitrectomy combined with phacoemulsification and intraocular lens implantation for epiretinal membrane. Twenty eyes from 40 patients received topical 2% dorzolamide three times a day. The patients were followed up for at least 3 months. In this study, we evaluated the effect of dorzolamide on visual acuity, intraocular pressure, central macular thickness, and aqueous flare.Results: Mean logarithm of the minimum angle of resolution (logMAR best-corrected visual acuity preoperatively and 2 weeks, 1 month, and 3 months after surgery was 0.48 ± 0.23, 0.60 ± 0.16, 0.40 ± 0.29, and 0.24 ± 0.32, respectively, in the treatment group, and 0.40 ± 0.09, 0.44 ± 0.12, 0.32 ± 0.10, and 0.16 ± 0.09, respectively, in the control group. No statistically significant difference was observed between the two groups. Mean central macular thickness preoperatively and at 2 weeks and 3 months after surgery was 572.6, 427.2, and 333.4 µm, respectively, in the treatment group, and 571.4, 485.2, and 388.4 µm, respectively, in the control group. Mean aqueous flare preoperatively, and 1 month and 3 months after surgery was 8.6, 34.2, and 23.5 photon counts per millisecond (pc/ms, respectively, in the treatment group, and 9.7, 24.7, and 23.4 pc/ms, respectively, in the control group. No statistically significant differences were observed between data from the two groups. However, statistically significant (P < 0.05 differences in mean central macular thickness at 1 month and mean aqueous flare at 2 weeks after surgery were found between the treatment group (358.8 µm, 36.8 pc

  18. Intravitreal injection with Ranibizumab combined with laser therapy for macular edema caused by branch retinal vein occlusion

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    Cong Zhang

    2014-08-01

    Full Text Available AIM:To investigate the efficacy of intravitreal ranibizumab combined with laser therapy in the treatment of macular edema caused by branch retinal vein occlusion(BRVO. METHODS:There were 78 patients(78 eyeswho were diagnosed with macular edema caused by BRVO using fundus fluorescence angiography(FFAand optical coherence tomography(OCT. Group A: randomly selected 26 cases(26 eyeswere given grid laser photocoagulation(GLP. Group B: randomly selected 26 cases(26 eyeswere given GLP first, and then received intravitreal ranibizumab 1wk later. Group C: randomly selected 26 cases(26 eyesundergone intravitreal ranibizumab first, and then given GLP 1wk later. There was no significant difference in macular edema. We analyzed the changes in the best corrected visual activity(BCVA, central macular thickness(CMTbefore and 1wk, 1,6mo after treatment. RESULTS: Compared with before treatment, 1wk after treatment: mean value changes of BCVA and CMT were no significant difference in group A(P>0.05; mean value changes of BCVA was improved and mean value of CMT was decreased in groups B and C, the difference was statistically significant(PPPPP>0.05between groups A and B after 6mo treatment; mean BCVA improved and CMT average value was decreased in group C, the difference was statistically significant(PPCONCLUSION: Intravitreal injection ranibizumab combined laser therapy can effectively reduce BRVO induced macular edema, enhance vision acuity. Compared with GLP, combination therapy has more rapid onset of treatment, and reduce macular edema better; Intravitreal ranibizumab should be given in front of the GLP, and the treatment effect is more precise, more stability.

  19. Effect of Hemodialysis on Retinal Thickness in Patients with Diabetic Retinopathy, with and without Macular Edema, Using Optical Coherence Tomography.

    Science.gov (United States)

    Azem, Nur; Spierer, Oriel; Shaked, Meital; Neudorfer, Meira

    2014-01-01

    Background. Effects of hemodialysis (HD) treatment on retinal thickness and macular edema are unclear. Objective. To evaluate changes in retinal thickness using optical coherence tomography (OCT) in end stage renal disease (ESRD) patients with diabetic retinopathy (DR), with and without diabetic macular edema (DME), undergoing HD. Methods. Nonrandomized prospective study. Forty eyes of DR patients with ESRD treated with HD were divided into two groups: patients with macular edema and patients without macular edema. Both eyes were analyzed. Patients underwent an ophthalmic examination including OCT measurements of retinal thickness, blood albumin and hemoglobin A1C levels, blood pressure, and body weight, 30 minutes before and after HD. Results. We found no significant effects of HD on retinal thickness among patients both with and without DME. The former showed a trend towards reduction in retinal thickness in foveal area following HD, while the latter showed an increase. There was no correlation between retinal thickness and mean blood pressure, weight, kinetic model value-Kt/V, glycemic hemoglobin, or albumin levels before and after HD. Conclusions. HD has no significant effect on retinal thickness among patients with or without DME. Further studies on larger cohorts and repeated OCT examinations are needed to confirm the preliminary findings in this study.

  20. Effect of Hemodialysis on Retinal Thickness in Patients with Diabetic Retinopathy, with and without Macular Edema, Using Optical Coherence Tomography

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    Nur Azem

    2014-01-01

    Full Text Available Background. Effects of hemodialysis (HD treatment on retinal thickness and macular edema are unclear. Objective. To evaluate changes in retinal thickness using optical coherence tomography (OCT in end stage renal disease (ESRD patients with diabetic retinopathy (DR, with and without diabetic macular edema (DME, undergoing HD. Methods. Nonrandomized prospective study. Forty eyes of DR patients with ESRD treated with HD were divided into two groups: patients with macular edema and patients without macular edema. Both eyes were analyzed. Patients underwent an ophthalmic examination including OCT measurements of retinal thickness, blood albumin and hemoglobin A1C levels, blood pressure, and body weight, 30 minutes before and after HD. Results. We found no significant effects of HD on retinal thickness among patients both with and without DME. The former showed a trend towards reduction in retinal thickness in foveal area following HD, while the latter showed an increase. There was no correlation between retinal thickness and mean blood pressure, weight, kinetic model value—Kt/V, glycemic hemoglobin, or albumin levels before and after HD. Conclusions. HD has no significant effect on retinal thickness among patients with or without DME. Further studies on larger cohorts and repeated OCT examinations are needed to confirm the preliminary findings in this study.

  1. Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema : the RESTORE extension study

    NARCIS (Netherlands)

    Schmidt-Erfurth, Ursula; Lang, Gabriele E; Holz, Frank G; Schlingemann, Reinier O; Lanzetta, Paolo; Massin, Pascale; Gerstner, Ortrud; Bouazza, Abdelkader Si; Shen, Haige; Osborne, Aaron; Mitchell, Paul

    2014-01-01

    OBJECTIVE: To evaluate long-term efficacy and safety profiles during 3 years of individualized ranibizumab treatment in patients with visual impairment due to diabetic macular edema (DME). DESIGN: Phase IIIb, multicenter, 12-month, randomized core study and 24-month open-label extension study. PARTI

  2. Microaneurysm turnover in the macula is a biomarker for development of clinically significant macular edema in type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Ribeiro L

    2013-01-01

    Full Text Available Luisa Ribeiro, Sandrina Nunes, José Cunha-VazAssociation for Innovation and Biomedical Research on Light and Image and Faculty of Medicine, University of Coimbra, Coimbra, PortugalAbstract: The evolution and progression of diabetic retinopathy varies between individuals and does not necessarily progress to vision loss in every patient. However, it is difficult in clinical practice to predict the clinical course and to identify which eyes will develop vision-threatening complications, ie, clinically significant macular edema or proliferative retinopathy. There is a clear need to identify biomarkers of disease progression. Microaneurysm turnover computed automatically in digital color fundus photography images using the RetmarkerDR is a good biomarker for worsening of retinopathy and development of clinically significant macular edema. For long-term prediction (ten years, a microaneurysm formation rate higher than two per year predicts development of clinically significant macular edema. For short-term prediction (2 years, a microaneurysm turnover rate lower than nine indicates that development of clinically significant macular edema is highly unlikely.Keywords: biomarker, diabetes type 2, diabetic retinopathy, microaneurysms, retina

  3. Direct photocoagulation to leakage points to treat chronic macular edema associated with branch retinal vein occlusion: a pilot study

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    Sakimoto S

    2014-10-01

    Full Text Available Susumu Sakimoto, Motohiro Kamei, Hirokazu Sakaguchi, Mihoko Suzuki, Nagakazu Matsumura, Kentaro Nishida, Kohji NishidaDepartment of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, JapanSummary statement: Direct photocoagulation reduces the central foveal thickness (CFT in cases with chronic branch retinal vein occlusion (BRVO of longer than 12 months duration. Photocoagulation might be effective for chronic macular edema due to branch retinal vein occlusion.Background: The aim was to investigate the effect of direct photocoagulation for treating chronic macular edema associated with BRVO.Methods: This study was a noncomparative, pilot interventional case series. We examined the CFT and best-corrected visual acuity over 6 months in patients with BRVO treated with direct photocoagulation.Results: Sixteen eyes of 16 patients had been treated with direct photocoagulation (mean follow-up period, 20.5 months. The mean CFT decreased significantly (P<0.001 between the baseline (465 µm and the final visit (304 µm. The mean (logarithm of the minimum angle of resolution equivalent best-corrected visual acuity at the baseline was 0.39 and improved significantly (P<0.001 to 0.20 at the final visit.Conclusion: Direct photocoagulation to leakage points is beneficial for treating chronic macular edema associated with chronic BRVO of longer than 12 months duration.Keywords: branch retinal vein occlusion, macular edema, optical coherence tomography, photocoagulation, VEGF

  4. Foveal thickness reduction after anti-vascular endothelial growth factor treatment in chronic diabetic macular edema

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    Gabriel Willmann

    2017-05-01

    Full Text Available AIM: To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor (anti-VEGF therapy for center-involving diabetic macular edema (DME. METHODS: Foveal thickness was assessed with optical coherence tomography to determine the central subfield foveal thickness (CSFT and macular volume in 42 eyes with DME (CSFT>275 µm. Evaluations also included measurement of best-corrected visual acuity (BCVA, and were performed at baseline, and upon foveal depression recovery achieved after 12 monthly intravitreal injections of either 1.5 mg/0.06 mL bevacizumab (n=21 or 0.5 mg/0.05 mL ranibizumab (n=21. Data was compared to 42 eyes of normally sighted, non-diabetic, healthy individuals with similar age, gender and race distributions. RESULTS: Mean baseline BCVA was 0.59±0.04 and 0.32± 0.03 logMAR (P<0.001 after treatment and resolution of DME, with all, but 3 eyes, showing BCVA improvement. Mean CSFT before treatment was 422.0±20.0 µm, and after treatment, decreased to 241.6±4.6 µm (P<0.001, which is significantly thinner than CSFT found in control subjects (272.0±3.4 µm; P<0.001. Moreover, in 33/42 DM eyes (79%, CSTF was thinner than the matched control eye. Macular volume showed comparable results, but with lower differences between groups (control: 8.5±0.4 mm3; DME: 8.2±1.0 mm3; P=0.0267. CONCLUSION: DME eyes show significantly lower foveal thickness than matched controls after DME resolution achieved with one-year anti-VEGF therapy. Further investigation into the reasonsfor this presumable retinal atrophy using fluorescein angiography and functional parameters as well as establishing possible predictors is warranted. This finding should be considered during the treatment of DME.

  5. Efficacy of patterned scan laser in treatment of macular edema and retinal neovascularization

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    Dimple Modi

    2009-08-01

    Full Text Available Dimple Modi, Paulpoj Chiranand, Levent AkdumanSaint Louis University School of Medicine, Department of Ophthalmology, Saint Louis University Eye Institute, St. Louis, Missouri, USAPurpose: To analyze the benefits, efficacy, and complications of the PASCAL® photocoagulation laser system (OptiMedica, Santa Clara, CA, USA in patients treated at our institution.Methods: We conducted a retrospective chart review of 19 patients (28 eyes who underwent laser treatment using the PASCAL® photocoagulation system from November 2006 to November 2007. These 28 eyes were divided into two groups; group 1 eyes underwent macular grid laser and group 2 eyes underwent panretinal photocoagulation. Treatment was performed for macular edema or for iris or retinal neovascularization. Outcomes measured included best-corrected visual acuity (BCVA, efficacy of laser treatment, complications, duration of the procedure, and pain perception, which were noted in the charts for panretinal treatments.Results: Follow-up was 5.9 ± 2.6 months for group 1 and 5.9 ± 4.0 months for group 2. In group 1, 9/28 eyes required a second treatment for remaining edema. BCVA was stable or better in 66% (14/21 and average central foveal thickness on ocular coherence tomography improved in 71% (15/21. Time to completion for a number of laser patterns for grid photocoagulation was felt to be too long for completing the total pattern safely, although we have not noted any related complications. In group 2, the neovascularization regressed at least partially in 3/7 patients. Patient-reported pain perception was 3.6 on a scale of 1 to 10 for group 2. Occasional hemorrhages occurred secondary to irregular laser uptake at different spots in the patterns. We observed no visual outcome consequences because of these hemorrhages during follow-up.Conclusions: Retinal photocoagulation by the PASCAL® laser has comparable efficacy to historical results with conventional retinal photocoagulation in short

  6. Bromfenac 0.09% bioavailability in aqueous humor, prophylactic effect on cystoid macular edema, and clinical signs of ocular inflammation after phacoemulsification in a Mexican population

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    Palacio C

    2016-01-01

    Full Text Available Claudia Palacio,1 Lourdes Fernández De Ortega,2 Francisco R Bustos,3 Eduardo Chávez,4 Aldo A Oregon-Miranda,5 Arieh R Mercado-Sesma5 1Anterior Segment Department, Fundación Hospital Nuestra Señora de la Luz, México City, México; 2Anterior Segment Department, Asociación Para Evitar la Ceguera en México, Hospital Dr Luis Sánchez Bulnes, México; 3Anterior Segment Department, Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México; 4Anterior Segment Department, Instituto de Oftalmología, Fundación de Asistencia Privada Conde de Valenciana, IAP, México; 5Clinical Research Department, Laboratorios Sophia, SA de CV, Zapopan, Jalisco, México Purpose: The purpose of this study was to evaluate the aqueous humor bioavailability and clinical efficacy of bromfenac 0.09% vs nepafenac on the presence of cystoid macular edema (CME after phacoemulsification.Material and methods: A Phase II, double-blind, masked, active-controlled, multicenter, clinical trial of 139 subjects, randomized to either a bromfenac 0.09% ophthalmic solution (n=69 or nepafenac 0.1% (n=70. Subjects instilled a drop three times a day for a period of 30 days. Follow-up visits were on days 2, 7, 15, 30, and 60. Biomicroscopy, clinical ocular signs, and assessment of posterior segment were performed. The primary efficacy endpoints included the presence of CME evaluated by optical coherence tomography. Safety evaluation included intraocular pressure, transaminase enzymes, lissamine green, and fluorescein stain.Results: The demographic and efficacy variables were similar between groups at baseline. The presence of pain, photophobia, conjunctival hyperemia, chemosis, cellularity, and corneal edema disappeared by day 30 in both groups. The central retinal thickness did not show significant changes after treatment when compared to baseline as follows: in the bromfenac group (247.2±32.9 vs 252.0±24.9 µm; P=0.958 and in nepafenac group (250.8±34

  7. SAFETY AND EFFICACY OF INTRAVITREAL DEXAMETHASONE IMPLANTS IN THE MANAGEMENT OF MACULAR EDEMA SECONDARY TO INFECTIOUS UVEITIS.

    Science.gov (United States)

    Fonollosa, Alex; Llorenç, Victor; Artaraz, Joseba; Jimenez, Beatriz; Ruiz-Arruza, Ioana; Agirrebengoa, Koldo; Cordero-Coma, Miguel; Costales-Mier, Felipe; Adan, Alfredo

    2016-09-01

    To assess the safety and efficacy of intravitreal dexamethasone implants in the treatment of macular edema secondary to infectious uveitis. We retrospectively reviewed clinical records from three uveitis referral units in Spain. The main outcome measures were rate of reactivation of infection, improvements in visual acuity and resolution of macular edema, as measured by optical coherence tomography. We included eight eyes from seven patients with a median age of 64 years (30-75). Etiologies of the infections were Herpes simplex virus-type 1, Varicela-Zoster virus, Treponema pallidum, Brucella mellitensis, Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus. Median visual acuity was 20/160 (20/30-20/400) at baseline and 20/70 (20/25-20/200) at the last follow-up visit. Mean macular thickness was 516 μm (115) at baseline and 266.3 μm (40) at the last follow-up visit. Visual acuity improved in 100% of the eyes and none of the eyes showed macular edema at the last follow-up visit. Five patients required reinjections of the implant. Only one patient required antiglaucoma drops for a temporary increase in ocular pressure. There were no cases of reactivation of the infectious ocular disease. Median follow-up time was 18 months. In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.

  8. Increase of aqueous inflammatory factors in macular edema with branch retinal vein occlusion: a case control study

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    Noma Hidetaka

    2010-08-01

    Full Text Available Abstract Background This study investigated whether soluble intercellular adhesion molecule-1 (sICAM-1 has a role in the pathogenesis of macular edema associated with branch retinal vein occlusion (BRVO together with vascular endothelial growth factor (VEGF. Methods A retrospective case control study was performed in 22 patients with BRVO and macular edema, as well as 10 patients with nonischemic ocular diseases as the control group. Retinal ischemia was evaluated by measuring the area of capillary non-perfusion with Scion Image software, while the severity of macular edema was examined by optical coherence tomography. Aqueous humor samples were obtained during the performance of combined vitrectomy and cataract surgery. sICAM-1 and VEGF levels in aqueous humor and plasma specimens were determined by enzyme-linked immunosorbent assay. Results Aqueous humor levels of sICAM-1 (median: 6.90 ng/ml and VEGF (median: 169 pg/ml were significantly elevated in BRVO patients compared with the control group (median: 3.30 pg/ml and 15.6 pg/ml, respectively (P = 0.005 and P P = 0.025. In addition, aqueous levels of both sICAM-1 and VEGF were correlated with the size of the non-perfused area of the retina in BRVO patients (P = 0.021 and P P = 0.020 and P = 0.005, respectively. Conclusions Both sICAM-1 and VEGF may be involved in the pathogenesis of macular edema associated with BRVO. Measurement of aqueous humor sICAM-1 levels may be useful for assessment of BRVO patients with macular edema, in addition to measurement of VEGF.

  9. [Efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema].

    Science.gov (United States)

    Razo Blanco-Hernández, Dulce Milagros; Lima-Gómez, Virgilio; Asbun-Bojalil, Juan

    2014-01-01

    Photocoagulation reduces the incidence of visual loss in diabetic patients with focal macular edema, but it can induce it for Efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema 6 weeks after treatment and produces visual improvement in some cases. Topical ketorolac may reduce the inflammation caused by photocoagulation and improve visual outcome. To determine the efficacy of topical ketorolac for improving visual function after photocoagulation in diabetic patients with focal macular edema. An experimental, comparative, prospective, longitudinal study in diabetic patients with focal macular edema was conducted. Eyes were randomized into two groups of topical treatment for 3 weeks after photocoagulation (A: ketorolac, B: placebo). Best corrected visual acuity before and after treatment was compared in each group (paired t test), and the proportion of eyes with visual improvement was compared between groups (χ(2)). The evaluation was repeated after stratifying for initial visual acuity (≥ 0.5, visual acuity changed from 0.50 to 0.58 (p= 0.003), and from 0.55 to 0.55 in group B (n= 59, p= 0.83); mean percent change was 22.3% in group A and 3.5% in group B (p= 0.03). Visual improvement was identified in 25 eyes from group A (54.3%) and 19 from group B (32.2%, p= 0.019, RR 1.65); the difference only persisted when initial visual acuity was ≥ 0.5 (10 [40%], group A, 5 [14.7%], group B, p= 0.02, RR 2.72). Topical ketorolac was more effective than placebo to improve best corrected visual acuity in diabetic patients with focal macular edema.

  10. Delivery of Intraocular Triamcinolone Acetonide in the Treatment of Macular Edema

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    Brent Siesky

    2012-03-01

    Full Text Available Macular edema (ME is one of the eventual outcomes of various intraocular and systemic pathologies. The pathogenesis for ME is not yet entirely understood; however, some of the common risk factors for its development have been identified. While this investigation will not discuss the numerous etiologies of ME in detail, it appraises the two most widely studied delivery modalities of intraocular corticosteroids in the treatment of ME—intravitreal injection (IVI and sub-Tenon’s infusion (STI. A thorough review of the medical literature was conducted to identify the efficacy and safety of IVI and STI, specifically for the administration of triamcinolone acetonide (TA, in the setting of ME in an attempt to elucidate a preferred steroid delivery modality for treatment of ME.

  11. Classification of Diabetic Macular Edema and Its Stages Using Color Fundus Image

    Institute of Scientific and Technical Information of China (English)

    Muhammad Zubair; Shoab A. Khan; Ubaid Ullah Yasin

    2014-01-01

    Diabetic macular edema (DME) is a retinal thickening involving the center of the macula. It is one of the serious eye diseases which affects the central vision and can lead to partial or even complete visual loss. The only cure is timely diagnosis, prevention, and treatment of the disease. This paper presents an automated system for the diagnosis and classification of DME using color fundus image. In the proposed technique, first the optic disc is removed by applying some preprocessing steps. The preprocessed image is then passed through a classifier for segmentation of the image to detect exudates. The classifier uses dynamic thresholding technique by using some input parameters of the image. The stage classification is done on the basis of anearly treatment diabetic retinopathy study (ETDRS) given criteria to assess the severity of disease. The proposed technique gives a sensitivity, specificity, and accuracy of 98.27%, 96.58%, and 96.54%, respectively on publically available database.

  12. Macular edema in central retinal vein occlusion: correlation between optical coherence tomography, angiography and visual acuity.

    Science.gov (United States)

    Martinet, Virginie; Guigui, Benjamin; Glacet-Bernard, Agnès; Zourdani, Alain; Coscas, Gabriel; Soubrane, Gisèle; Souied, Eric H

    2012-08-01

    To analyze the characteristics and the course of macular edema secondary to central retinal vein occlusion (CRVO) using optical coherence tomography (OCT) and to determine correlations between clinical, tomographic and angiographic data, in particular including retinal ischemia. In this retrospective study, 53 consecutive patients with CRVO were included. At each follow-up visit, patients underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) and OCT. Fluorescein angiography was performed at baseline and on demand during follow-up. 243 OCTs were analyzed. Mean age was 61 years and mean follow-up 13 months. The first structural change, observed very early after the onset of the occlusion, was a diffuse increase at the level of the outer nuclear layer without change at the level of the inner retina. This early change seemed characteristic of retinal vein occlusion. Cystoid spaces were subsequently observed in all retinal layers and were combined with serous retinal detachment in 51 %. During the first 6 months, central retinal thickness was higher in ischemic CRVO (mean, 691 μm) than in non-ischemic CRVO (mean, 440 μm, p central retinal thickness without subretinal fluid) of 700 μm or greater, peripheral ischemia was present in 69 % of eyes, final BCVA was 20/200 or less in 75 % and never reached 20/40 during follow-up. The integrity of the junction of the photoreceptors' inner and outer segments was correlated with a better prognosis (p < 0.05). Foveal thickness was inversely correlated to BCVA at each visit and could have a prognostic value. OCT examination in CRVO revealed useful data for the diagnosis of CRVO and its prognosis. The largest macular edemas seemed to be the hallmark of ischemic CRVO.

  13. [New perspectives in the approach to diabetic macular edema. Aflibercept therapy].

    Science.gov (United States)

    Ruiz-Moreno, J M

    2015-03-01

    The VISTA and VIVID trials were conducted to compare the safety and efficacy of two intravitreal injection (IVI) regimens of aflibercept versus macular laser photocoagulation for the treatment of diabetic macular edema (DME). These double-masked, phase III clinical trials randomized (461/402) patients with DME to receive either 2mg aflibercept IVI every 4 weeks (2q4) or 2mg aflibercept IVI every 8 weeks (2q8) after 5 initial monthly doses vs macular laser photocoagularion. The primary efficacy endpoint was the mean change in best corrected visual acuity (BCVA) from baseline to week 52. Secondary efficacy endpoints were the change in central retinal thickness (CRT), the proportion of patients who gained ≥10 amd ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and the change in the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in near and distance vision. The mean BCVA gains in the 2q4 and 2q8 groups versus the laser group were 12.5 and 10.7 versus 0.2 letters (p 2 levels in the severity of diabetic retinopathy was significant in the treatment groups versus the laser group. Mean reductions in CRT in the 2q4 and 2q8 groups vs the laser group were 185.9 and 183.1 versus 73.3 μm (p<0.0001) in VISTA, and 195.0 and 192.4 versus 66.2 μm (p<0.0001) in VIVID. The incidences of ocular and nonocular adverse events were similar in all groups. In conclusion, IIV aflibercept demonstrated statistically significant superiority in improvement in BCVA and reduction in DME over laser, with similar efficacy in the 2q4 and 2q8 groups in VISTA and VIVID.

  14. Macular thickness measured by stratus optical coherence tomography in patients with diabetes type 2 and mild nonproliferative retinopathy without clinical evidence of macular edema.

    Science.gov (United States)

    Pires, Isabel; Santos, Ana Rita; Nunes, Sandrina; Lobo, Conceição

    2013-01-01

    To evaluate macular thickness in eyes with mild nonproliferative diabetic retinopathy (NPDR), patients with diabetes type 2, NPDR level 20 or 35, and without evidence of clinical macular edema underwent best-corrected visual acuity assessment, color fundus photography and Stratus optical coherence tomography. Mean center point thickness (CPT) and mean central subfield (CSF) thickness were compared with those of a healthy control population. 410 eyes/patients aged 61.2 ± 8.3 years, and with glycosylated hemoglobin of 7.9 ± 1.5% were included. Mean CPT and CSF were 186.6 ± 28.4 and 215.2 ± 25 µm, respectively, significantly increased compared to healthy subjects (p < 0.001). CSF thickness was abnormally increased in 17.6% of the patients, with values within the normal range in 79.5%, and abnormally decreased in 2.9%. CPT and CSF thickness were significantly thicker in men. No systemic factors showed a significant association. A significant increase in the macular thickness was found in eyes/patients with mild NPDR without clinical macular edema; however, only 17.6% of the eyes/patients had abnormally increased values and less than 3% abnormally decreased values.

  15. Simultaneous segmentation of retinal surfaces and microcystic macular edema in SDOCT volumes

    Science.gov (United States)

    Antony, Bhavna J.; Lang, Andrew; Swingle, Emily K.; Al-Louzi, Omar; Carass, Aaron; Solomon, Sharon; Calabresi, Peter A.; Saidha, Shiv; Prince, Jerry L.

    2016-03-01

    Optical coherence tomography (OCT) is a noninvasive imaging modality that has begun to find widespread use in retinal imaging for the detection of a variety of ocular diseases. In addition to structural changes in the form of altered retinal layer thicknesses, pathological conditions may also cause the formation of edema within the retina. In multiple sclerosis, for instance, the nerve fiber and ganglion cell layers are known to thin. Additionally, the formation of pseudocysts called microcystic macular edema (MME) have also been observed in the eyes of about 5% of MS patients, and its presence has been shown to be correlated with disease severity. Previously, we proposed separate algorithms for the segmentation of retinal layers and MME, but since MME mainly occurs within specific regions of the retina, a simultaneous approach is advantageous. In this work, we propose an automated globally optimal graph-theoretic approach that simultaneously segments the retinal layers and the MME in volumetric OCT scans. SD-OCT scans from one eye of 12 MS patients with known MME and 8 healthy controls were acquired and the pseudocysts manually traced. The overall precision and recall of the pseudocyst detection was found to be 86.0% and 79.5%, respectively.

  16. Vitrectomy for Diffuse Refractory Diabetic Macular Edema Associated with a Taut Premacular Posterior Hyaloid

    Directory of Open Access Journals (Sweden)

    Hooshang Faghihi

    2008-12-01

    Full Text Available

    PURPOSE: To evaluate the anatomic and visual results and complications of vitrectomy in eyes with diffuse refractory diabetic macular edema associated with a taut posterior hyaloid. METHODS: This prospective interventional case series was conducted on 25 eyes of 22 patients with diffuse refractory clinically significant diabetic macular edema, macular thickness greater than 250 mm on optic coherence tomography (OCT and thickened posterior hyaloid. Best-corrected visual acuity (BCVA and macular thickness measured by OCT were evaluated preoperatively and repeated 3 and 6 months postoperatively. Macular perfusion was evaluated by fluorescein angiography, pre- and six months postoperatively. RESULTS: Mean BCVA was 1.14±0.51 LogMAR, preoperatively which improved to 0.89±0.53 LogMAR six months postoperatively (P=0.005. Mean preoperative macular thickness was 506±121.9 µm which decreased to 318±90.5 µm, six months postoperatively (P=0.001. CONCLUSION: Vitrectomy and removal of the posterior hyaloid membrane appears beneficial in eyes with diffuse diabetic macular edema unresponsive to laser therapy and a taut premacular posterior hyaloid.

  1. Qualitative and quantitative characteristics of near-infrared autofluorescence in diabetic macular edema.

    Science.gov (United States)

    Yoshitake, Shin; Murakami, Tomoaki; Horii, Takahiro; Uji, Akihito; Ogino, Ken; Unoki, Noriyuki; Nishijima, Kazuaki; Yoshimura, Nagahisa

    2014-05-01

    To study the characteristics of near-infrared autofluorescence (NIR-AF) imaging and its association with spectral-domain optical coherence tomography (SD-OCT) findings and logarithm of the minimal angle of resolution (logMAR) visual acuity (VA) in diabetic macular edema (DME). Retrospective, observational, cross-sectional study. One hundred twenty-one consecutive eyes of 87 patients with center-involved DME for whom NIR-AF and SD-OCT images of sufficient quality were obtained. The NIR-AF images were acquired using Heidelberg Retina Angiograph 2 (Heidelberg Engineering, Heidelberg, Germany), and sectional retinal images were obtained using Spectralis OCT (Heidelberg Engineering). The presence of a mosaic pattern and cystoid signs were determined qualitatively. We quantified the average fluorescence intensity in the central 1-mm subfield. The characteristics of the NIR-AF images were compared with the OCT findings and logMAR VA. Qualitative and quantitative characteristics of the NIR-AF images and their association with SD-OCT findings and logMAR VA. Fifty-seven eyes with a mosaic pattern in the NIR-AF macular images had worse logMAR VA (0.355±0.239 vs. 0.212±0.235; P = 0.001), a thicker central subfield (CSF) (530±143 μm vs. 438±105 μm; P qualitative and quantitative NIR-AF characteristics in the macula indicated the clinical relevance and suggested the pathogenesis in DME. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  2. Characteristics of Macular Edema in Behcet Disease after Intravitreal Bevacizumab Injection

    Science.gov (United States)

    Ghassemi, Fariba; Mirak, Sohrab Afshari; Chams, Hormoz; Sabour, Siamak; Ahmadabadi, Mehdi Nilli; Davatchi, Fereidoun; Shahram, Farhad

    2017-01-01

    Purpose: To investigate the effect of intravitreal bevacizumab (IVB) injection on macular edema (ME) secondary to Behcet's disease. Methods: This prospective case series included 15 patients with bilateral ME due to Behcet's disease. Intravitreal bevacizumab was injected into the more severely involved eye; the contralateral eye was evaluated as the control. Patients were followed up with comprehensive ocular examination, optical coherence tomography, and fluorescein angiography (FA) for a minimum of 6 months by a single ophthalmologist. Results: Patients with a mean age of 30.6 ± 7.4 years received a mean number of 3.3 IVB injections during the 6 months. The mean preinjection vision was 0.6 ± 0.3 and 0.4 ± 0.4 LogMAR in the case and control groups, respectively, with no significant improvement at 6 months. Mean central foveal thickness was 375.3 ± 132.1 and 307.2 ± 84.5 μm in the case and control groups, respectively, and these changed to 401 ± 199.9 (P = 0.65) and 307.7 ± 82.8 μm (P = 0.73) at month 6, respectively. A statistically nonsignificant improvement in ME was observed during the first 3 months in the case group. However, it did not persist up to month 6 on an as-needed basis. IVB injections caused a disproportionate decrease in the thickness of macular subfields. A reduction in disc leakage was observed on FA (P = 0.058). Logistic regression analysis revealed no statistically significant predictive factor for an improvement in visual acuity (VA) and a reduction in foveal thickness. Conclusion: During a 6-month period, IVB injections based on an as-needed protocol provided no statistically significant improvement in VA and ME. PMID:28299006

  3. Intraocular soluble intracellular adhesion molecule-1 correlates with subretinal fluid height of diabetic macular edema

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    Dan Zhu

    2014-01-01

    Full Text Available Objective: To investigate the correlations between aqueous concentrations of vascular endothelial growth factor (VEGF, monocyte chemoattractant protein-1 (MCP-1, soluble intracellular adhesion molecule-1 (sICAM-1 and diabetic macular edema (DME. Materials and Methods: VEGF, MCP-1 and sICAM-1 concentrations in aqueous humor samples of 22 patients with DME and 23 patients with cataract of a control group were measured with solid-phase chemiluminescence immunoassay. Results: Aqueous VEGF (89.2 ± 58.5 pg/ml versus 48.5 ± 27.8 pg/ml, P = 0.006, MCP-1 (684.2 ± 423.4 pg/ml versus 432.4 ± 230.4 pg/ml, P = 0.019 and sICAM-1 (3213.8 ± 2581.6 pg/ml versus 260.2 ± 212.2 pg/ml, P < 0.001 all vary significantly between DME group and control group. Maximum height of submacular fluid measured by Optical coherence tomography (OCT was significantly associated with aqueous sICAM-1 (r = -0.45, P = 0.034. The maximum height of macular thickness measured by OCT was not significantly associated with either VEGF (P = 0.300, MCP-1 (P = 0.320 or sICAM-1 (P = 0.285. Conclusions: Our results suggest that sICAM-1 may majorly contribute to the formation of subretinal fluid in DME patients and imply that MCP-1 and sICAM-1 may be the potential therapy targets, besides VEGF.

  4. Comparison of subthreshold diode laser micropulse therapy versus conventional photocoagulation laser therapy as primary treatment of diabetic macular edema

    OpenAIRE

    Farhad Fazel; Majid Bagheri; Khodayar Golabchi; Hamidreza Jahanbani Ardakani

    2016-01-01

    Purpose: The aim of the present study was to investigate the effect of subthreshold diode laser micropulse (SDM) in comparison with conventional laser photocoagulation in the treatment of the diabetic macular edema (DME). Methods: Sixty-eight eyes from 68 patients with clinically significant DME were divided randomly into two equal groups. In the first group, SDM photocoagulation was employed, while conventional laser photocoagulation was performed on the eyes of the second group. Central ...

  5. Association of aqueous humor cytokines with the development of retinal ischemia and recurrent macular edema in retinal vein occlusion.

    Science.gov (United States)

    Jung, Sang Hoon; Kim, Kyung-A; Sohn, Sea Woon; Yang, Sung Jae

    2014-04-09

    We evaluated the association of angiogenic and inflammatory cytokine levels in the aqueous humor with development of retinal ischemia and recurrent macular edema in retinal vein occlusion (RVO) patients. This was a retrospective cross-sectional study, and patients with RVO (n = 41) and age-matched control subjects (n = 25) were included. The concentrations of angiogenic and inflammatory cytokines, including VEGF, PDGF-AA, IL-1a, IL-6, IL-8, MCP-1, TNF-α, and IP-10, in the aqueous humor were measured before intravitreal injection of bevacizumab using suspension array technology. After retinal hemorrhage disappeared, fluorescein angiography (FA) images were obtained. Based on FA data, RVO patients were divided into a nonischemic group and an ischemic group. We investigated the presence of recurrent macular edema using optical coherent tomography (OCT) during the follow-up period. We compared the levels of cytokines between RVO patients and control subjects, between nonischemic and ischemic groups, and between patients with and without recurrent macular edema. The levels of VEGF, PDGF-AA, IL-1a, IL-6, IL-8, MCP-1, TNF-α, and IP-10 in the aqueous humor were higher in the RVO group than in the control group. The levels of IL-8, PDFGF-AA, TNF-α, and VEGF in the aqueous humor were significantly higher in the ischemic RVO group than in the nonischemic RVO group. We did not observe any association between cytokine levels and recurrent macular edema. Angiogenic and inflammatory cytokines were overexpressed in RVO patients. Additionally, increased levels of IL-8, PDFGF-AA, TNF-α, and VEGF in the aqueous humor at the onset of RVO were associated with the development of future retinal ischemia in RVO patients.

  6. Presence of foveal bulge in optical coherence tomographic images in eyes with macular edema associated with branch retinal vein occlusion.

    Science.gov (United States)

    Hasegawa, Taiji; Ueda, Tetsuo; Okamoto, Masahiro; Ogata, Nahoko

    2014-02-01

    To determine whether a significant correlation exists between the presence of a bulge in the photoreceptor inner segment/outer segment (IS/OS) line and the best-corrected visual acuity (BCVA) in eyes with resolved macular edema associated with branch retinal vein occlusion (BRVO). Retrospective, observational case series. We retrospectively reviewed the medical records of patients who had a complete resolution of macular edema and had an intact IS/OS line in the central fovea in the spectral-domain optical coherence tomographic (SDOCT) images. Thirty-one eyes with macular edema associated with BRVO (BRVO group) and 31 unaffected fellow eyes (control group) of 31 patients were evaluated. In normal eyes, the intact IS/OS line determined by SDOCT has a bulge at the central fovea, called the foveal bulge. The eyes in the BRVO group were classified by the presence or absence of foveal bulge, and the characteristics of the 2 groups were compared. A foveal bulge was present in 7 of 31 eyes in the BRVO group. The incidence of a foveal bulge was significantly lower in the BRVO group (22.6%) than in the control group (100%; P < .0001). All 7 eyes with foveal bulge had a decimal BCVA of ≥1.0 at the final visit. The incidence of a foveal bulge was significantly higher in eyes with BCVA of ≥1.0 (77.8%) than in the eyes with BCVA of <1.0 (0%; P < .0001). The foveal bulge is a good marker of the functional properties of the fovea in eyes with resolved macular edema associated with BRVO. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Two functional variants of IRF5 influence the development of macular edema in patients with non-anterior uveitis.

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    Ana Márquez

    Full Text Available OBJECTIVE: Interferon (IFN signaling plays a crucial role in autoimmunity. Genetic variation in interferon regulatory factor 5 (IRF5, a major regulator of the type I interferon induction, has been associated with risk of developing several autoimmune diseases. In the current study we aimed to evaluate whether three sets of correlated IRF5 genetic variants, independently associated with SLE and with different functional roles, are involved in uveitis susceptibility and its clinical subphenotypes. METHODS: Three IRF5 polymorphisms, rs2004640, rs2070197 and rs10954213, representative of each group, were genotyped using TaqMan® allelic discrimination assays in a total of 263 non-anterior uveitis patients and 724 healthy controls of Spanish origin. RESULTS: A clear association between two of the three analyzed genetic variants, rs2004640 and rs10954213, and the absence of macular edema was observed in the case/control analysis (P FDR =5.07E-03, OR=1.48, CI 95%=1.14-1.92 and P FDR =3.37E-03, OR=1.54, CI 95%=1.19-2.01, respectively. Consistently, the subphenotype analysis accordingly with the presence/absence of this clinical condition also reached statistical significance (rs2004640: P=0.037, OR=0.69, CI 95%=0.48-0.98; rs10954213: P=0.030, OR=0.67, CI 95%=0.47-0.96, thus suggesting that both IRF5 genetic variants are specifically associated with the lack of macular edema in uveitis patients. CONCLUSION: Our results clearly showed for the first time that two functional genetic variants of IRF5 may play a role in the development of macular edema in non-anterior uveitis patients. Identifying genetic markers for macular edema could lead to the possibility of developing novel treatments or preventive therapies.

  8. Intravitreal bevacizumab injection in the treatment of macular edema secondary to branch retinal vein occlusion

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    Şeref İstek

    2014-06-01

    Full Text Available AIM:To evaluate the 12mo results of intravitreal bevacizumab injection on central macular thickness(CMTand visual acuity in the treatment of macular edema(MEsecondary to branch retinal vein occlusion(BRVO.METHODS:Thirty-two patients who underwent intravitreal bevacizumab(Altuzan®0.125mg/0.05mL injection for ME secondary to BRVO at least 12mo follow up period have been studied respectively. Patients with diagnosis of ME secondary to BRVO were applied an ophthalmic examination, CMT measurement, and fluorescein angiography, so patients whose CMT above 250μm were offered intravitreal bevacizumab treatment. Patients who had macular ischemia on fluorescein angiography, neovascularisation elsewhere secondary to other types of diseases, received any intraocular treatment before(such as laser treatment, intravitreal injection or eye surgeryhave been out of trial. Data of logMAR best corrected visual acuity(BCVAand CMT in control visits have been evaluated. For statistical analysis Student's paired t-test was used by Minitab15.0 software and a P-value RESULTS: Mean logMAR BCVA changes and mean CMT changes were statistically significant compared to pre-injection values at last visit(P0.01. Mean BCVA increment was 0.477±0.235, mean CMT decline was 257.906±88.865 compared to pre-injection at last visit. Ten(31%of the patients had a positive response with a single injection and no recurrence of ME for a mean of 12.6±0.66mo. Five(15.6%patients received injection two times and 17(53%patients more than 3 injections. Mean injection per eye was 2.18±0.91(1~4respectively. Recurrence of ME was seen aproximately in 2.45±0.63mo at the first control, 2.58±0.66mo at the second control and 3.17±0.48mo at the third control respectively. Five(15.6%of the patients needed multiple injections for reducing ME whereas visual acuity gain was not achieved as ME reduced in those patients. CONCLUSION: Treatment of ME secondary to BRVO with intravitreal bevacizumab seems

  9. Clinical study on Bevacizumab for macular edema induced by retinal vein occlusion

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    Zhi-Guang Duan

    2014-09-01

    Full Text Available AIM: To evaluate the safety and efficacy of intravitreal bevacizumab injection in patients with macular edema(MEinduced by retinal vein occlusion(RVO.METHODS: The records of patients treated with intravitreal injection of 1.75mg bevacizumab for ME induced by RVO were retrospectively reviewed. All patients were evaluated by complete ophthalmic examination, optical coherence tomography(OCTand fundus fluorescein angiography(FFA, etc. Best corrected visual acuity(BCVA, intraocular pressure, the change of lens and vitreous, central foveal thickness(CFTwere observed at 1, 2, 3, 6mo after treatment and compared with before treatment. Repeated treatment with intravitreous bevacizumab occurred if there were signs of persistent or recurrent exudation. All the cases were followed up at least 6mo. An intravitreal injection of bevacizumab(1.75mgwas given at 6wk intervals.RESULTS: Fifty patients(56 eyeswith the average of(57±18.56years old were included. The mean baseline of BCVA, CFT were(logMAR0.82±0.63,(626.5±178.0μm respectively. Although there was no significant decrease in mean CFT at 1wk after injection, the mean BCVA had significant improvement. Followed up at mean 10.26±5.87mo, BCVA, CFT showed significant improvements over baseline values. The statistics of CFT at 1, 2, 3mo after injection were significant differences compared with before injection in each of the three groups. CFT at 1, 3, 12mo after injection were(365.11±23.212μm,(333.42±35.526μm,(267.6±116.8μm, which had a significant difference(PP>0.05. OCT image showed that after injection macular retinal thickness was becoming thinner. FFA showed that after injection macular fluorescein leakage decreased. BCVA was improved by at least two lines in 48 eyes(86%,remained stable in 8 eyes(14%at the last visit. A total of 112 injections were performed and the average number of injections was 1.96 in the group. About 50% of reinjections gained at least two lines of vision improvement at 1

  10. Subthreshold micropulse laser photocoagulation with intravitreous anti-VEGF for macular edema secondary to branch retinal vein occlusion

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    Yi Chen

    2017-06-01

    Full Text Available AIM:To investigate the efficacy of subthreshold micropulse 577nm laser photocoagulation with intravitreous anti-vascular endothelial growth factor(anti-VEGFtreatment for macular edema secondary to branch retinal vein occlusion(BRVO. METHODS: A retrospective case series study was sixteen patients(16 eyesof macular edema secondary to BRVO whose course was not more than 3mo were examined by fundus fluoresceine angiography(FFAand optical coherence tomography(OCT. Eight eyes were given subthreshold micropulse 577nm laser with anti-VEGF treatment(micropulse laser group. Meantime another 8 eyes were given conventional grid laser photocoagulation with anti-VEGF treatment(grid laser group. The followed up was 6mo. The best corrected visual acuity(BCVAand central foveal thickness(CFTwere analyzed.RESULTS: The baseline BCVA of the micropulse laser group was 0.34±0.18(LogMARand was improved to 0.07±0.01(PPPPP>0.05.CONCLUSION: Subthreshold micropulse 577nm laser with anti-VEGF and conventional grid laser photocoagulation with anti-VEGF had equivalent effects on the treatment of macular edema secondary to BRVO.

  11. Ranibizumab versus aflibercept for macular edema due to central retinal vein occlusion: 18-month results in real-life data.

    Science.gov (United States)

    Chatziralli, Irini; Theodossiadis, George; Moschos, Marilita M; Mitropoulos, Panagiotis; Theodossiadis, Panagiotis

    2017-06-01

    The objective of this study was to compare the anatomical and functional outcomes of ranibizumab versus aflibercept for the treatment of macular edema due to central retinal vein occlusion (CRVO) in routine clinical practice. Participants in this observational study included 62 treatment-naïve patients with CRVO who received intravitreal injections of either ranibizumab or aflibercept. The demographic data, best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) characteristics were evaluated at baseline and at months 1, 2, 3, 6, 12 and 18 post-treatment. At month 18, the mean BCVA of ranibizumab-treated eyes increased 7.9 letters, compared to 7.4 letters for eyes receiving aflibercept, with a similar number of injections. There was no statistically significant difference between the two groups in letters or in central subfield thickness at month 18. At the end of the follow-up, 50% of patients in the ranibizumab group and 42.9% in the aflibercept group showed complete resolution of macular edema. Ranibizumab and aflibercept demonstrated similar anatomical and functional outcomes over 18-month follow-up in patients with macular edema due to CRVO, with a similar number of injections.

  12. 23G vitrectomy outcomes of macular edema in retinal vein occlusion combined with vitreomacular traction or epiretinal membrane

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    Sheng-Xiang Guo

    2017-09-01

    Full Text Available AIM: To evaluate 23G vitrectomy for macular edema in eyes with retinal vein occlusion(RVOcombined with vitreoretinal traction(VMTor epiretinal membrane(ERM.METHODS: Totally 22 patients(22 eyesdiagnosed with macular edema of RVO combined with VMT or ERM were retrospectively analyzed. Twelve cases performed with 23G vitrectomy together with peeling of inner limiting membrane(ILMand/or ERM were considered as the observation group or intervention group. Ten cases without vitrectomy were recruited as control group. The best corrected visual acuity(BCVAand central retinal thickness(CRTat baseline, 1, 3 and 6mo were recorded and compared.RESULTS: At baseline, the difference of BCVA and CRT between observation group and control group was not statistically significant(P=0.645, 0.206. After vitrectomy, the BCVA and CRT of RVO patients in observation group were significantly improved compared with baseline at each follow-up(F=2.895, P=0.048; F=16.431, PCONCLUSION: The 23G vitrectomy could markedly improve BCVA and reduce CRT in RVO patients with macular edema combined with VMT and/or ERM.

  13. Learning-Based Visual Saliency Model for Detecting Diabetic Macular Edema in Retinal Image.

    Science.gov (United States)

    Zou, Xiaochun; Zhao, Xinbo; Yang, Yongjia; Li, Na

    2016-01-01

    This paper brings forth a learning-based visual saliency model method for detecting diagnostic diabetic macular edema (DME) regions of interest (RoIs) in retinal image. The method introduces the cognitive process of visual selection of relevant regions that arises during an ophthalmologist's image examination. To record the process, we collected eye-tracking data of 10 ophthalmologists on 100 images and used this database as training and testing examples. Based on analysis, two properties (Feature Property and Position Property) can be derived and combined by a simple intersection operation to obtain a saliency map. The Feature Property is implemented by support vector machine (SVM) technique using the diagnosis as supervisor; Position Property is implemented by statistical analysis of training samples. This technique is able to learn the preferences of ophthalmologist visual behavior while simultaneously considering feature uniqueness. The method was evaluated using three popular saliency model evaluation scores (AUC, EMD, and SS) and three quality measurements (classical sensitivity, specificity, and Youden's J statistic). The proposed method outperforms 8 state-of-the-art saliency models and 3 salient region detection approaches devised for natural images. Furthermore, our model successfully detects the DME RoIs in retinal image without sophisticated image processing such as region segmentation.

  14. Exudate-based diabetic macular edema detection in fundus images using publicly available datasets

    Energy Technology Data Exchange (ETDEWEB)

    Giancardo, Luca [ORNL; Meriaudeau, Fabrice [ORNL; Karnowski, Thomas Paul [ORNL; Li, Yaquin [University of Tennessee, Knoxville (UTK); Garg, Seema [University of North Carolina; Tobin Jr, Kenneth William [ORNL; Chaum, Edward [University of Tennessee, Knoxville (UTK)

    2011-01-01

    Diabetic macular edema (DME) is a common vision threatening complication of diabetic retinopathy. In a large scale screening environment DME can be assessed by detecting exudates (a type of bright lesions) in fundus images. In this work, we introduce a new methodology for diagnosis of DME using a novel set of features based on colour, wavelet decomposition and automatic lesion segmentation. These features are employed to train a classifier able to automatically diagnose DME through the presence of exudation. We present a new publicly available dataset with ground-truth data containing 169 patients from various ethnic groups and levels of DME. This and other two publicly available datasets are employed to evaluate our algorithm. We are able to achieve diagnosis performance comparable to retina experts on the MESSIDOR (an independently labelled dataset with 1200 images) with cross-dataset testing (e.g., the classifier was trained on an independent dataset and tested on MESSIDOR). Our algorithm obtained an AUC between 0.88 and 0.94 depending on the dataset/features used. Additionally, it does not need ground truth at lesion level to reject false positives and is computationally efficient, as it generates a diagnosis on an average of 4.4 s (9.3 s, considering the optic nerve localization) per image on an 2.6 GHz platform with an unoptimized Matlab implementation.

  15. Automatic Diabetic Macular Edema Detection in Fundus Images Using Publicly Available Datasets

    Energy Technology Data Exchange (ETDEWEB)

    Giancardo, Luca [ORNL; Meriaudeau, Fabrice [ORNL; Karnowski, Thomas Paul [ORNL; Li, Yaquin [University of Tennessee, Knoxville (UTK); Garg, Seema [University of North Carolina; Tobin Jr, Kenneth William [ORNL; Chaum, Edward [University of Tennessee, Knoxville (UTK)

    2011-01-01

    Diabetic macular edema (DME) is a common vision threatening complication of diabetic retinopathy. In a large scale screening environment DME can be assessed by detecting exudates (a type of bright lesions) in fundus images. In this work, we introduce a new methodology for diagnosis of DME using a novel set of features based on colour, wavelet decomposition and automatic lesion segmentation. These features are employed to train a classifier able to automatically diagnose DME. We present a new publicly available dataset with ground-truth data containing 169 patients from various ethnic groups and levels of DME. This and other two publicly available datasets are employed to evaluate our algorithm. We are able to achieve diagnosis performance comparable to retina experts on the MESSIDOR (an independently labelled dataset with 1200 images) with cross-dataset testing. Our algorithm is robust to segmentation uncertainties, does not need ground truth at lesion level, and is very fast, generating a diagnosis on an average of 4.4 seconds per image on an 2.6 GHz platform with an unoptimised Matlab implementation.

  16. Glucocorticoids: structure, signaling and molecular mechanisms in the treatment of diabetic retinopathy and diabetic macular edema.

    Science.gov (United States)

    Zhang, X; Wang, N; Schachat, A P; Bao, S; Gillies, M C

    2014-03-01

    Diabetic retinopathy (DR) is one of the leading causes of blindness in the working population worldwide. Vascular leakage, angiogenesis and neuronal degeneration are key features of DR. Current effective interventions for DR include treatment of systemic risk factors such as elevated blood glucose, blood pressure and dyslipidemia. Ocular treatments include vascular endothelial growth factor A (VEGF-A) inhibitors, laser photocoagulation and surgery. While anti-VEGF therapy has become as first-line treatment for diabetic macular edema (DME) that causes reduced vision, intravitreal glucocorticoids also have been shown to be efficacious in this situation. It has been reported that all the major pathological processes of DR are susceptible to glucocorticoid treatment. The effects of glucocorticoids on vascular leakage and angiogenesis may be mediated through their well established anti-inflammatory role. Alternatively, glucocorticoids may affect other mechanisms known to be activated in DR. Potential mechanisms for the anti-inflammatory effects of glucocorticoids include blockage of cytokine production and inhibition of leukocyte adhesion induced by VEGF-A. Glucocorticoids decrease the expression of VEGF-A directly, and increase the production, or decrease phosphorylation, of tight junction-associated proteins. Glucocorticoids have also been shown to be neuroprotective, in contrast to VEGF-A inhibitors which animal studies suggest may be neurotoxic. This review outlines the biological properties of synthetic glucocorticoids, with particular emphasis on the potential beneficial effect of combining glucocorticoids with anti-VEGF treatment for DME and DR.

  17. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies.

    Science.gov (United States)

    Ciulla, Thomas A; Amador, Armando G; Zinman, Bernard

    2003-09-01

    Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of blindness in the working-age population of most developed countries. The increasing number of individuals with diabetes worldwide suggests that DR and DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Early detection of retinopathy in individuals with diabetes is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients. The control of diabetes-associated metabolic abnormalities (i.e., hyperglycemia, hyperlipidemia, and hypertension) is also important in preserving visual function because these conditions have been identified as risk factors for both the development and progression of DR/DME. The currently available interventions for DR/DME, laser photocoagulation and vitrectomy, only target advanced stages of disease. Several biochemical mechanisms, including protein kinase C-beta activation, increased vascular endothelial growth factor production, oxidative stress, and accumulation of intracellular sorbitol and advanced glycosylation end products, may contribute to the vascular disruptions that characterize DR/DME. The inhibition of these pathways holds the promise of intervention for DR at earlier non-sight-threatening stages. To implement new therapies effectively, more individuals will need to be screened for DR/DME at earlier stages-a process requiring both improved technology and interdisciplinary cooperation among physicians caring for patients with diabetes.

  18. The Role of Anti-VEGF Therapy in the Treatment of Diabetic Macular Edema.

    Science.gov (United States)

    Moshfeghi, Darius M; Kaiser, Peter K; Michels, Stephan; Midena, Edoardo; Kitchens, John W; Prenner, Jonathan L; Regillo, Carl D; Reichel, Elias

    2016-06-01

    Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults. DR often leads to diabetic macular edema (DME), which often goes unnoticed until a patient presents with vision loss. However, treatment options and data for DME are continually improving. We know that vascular endothelial growth factor (VEGF) plays a key role in DME progression; therapies that act by inhibiting VEGF production seem to improve visual acuity in patients with DME. Of the anti-VEGF therapies available, two have been approved by the U.S. Food and Drug Administration to treat DME: ranibizumab (Lucentis; Genentech, South San Francisco, CA) and aflibercept (Eylea; Regeneron, Tarrytown, NY). Bevacizumab (Avastin; Genentech, South San Francisco, CA), which is approved for the treatment of certain types of cancer, is occasionally used off-label to treat DME. Anti-VEGF therapy can stop vision loss and even improve visual acuity. Other treatments remain effective, and these various treatment options fuel a need for new data and discussion. This roundtable discussion, which took place during the 2015 annual meeting of the American Academy of Ophthalmology, outlines the current protocols used to treat DME and provides clinical opinions about selecting and treating with an appropriate anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:S5-14.].

  19. Advances in retinal imaging for diabetic retinopathy and diabetic macular edema.

    Science.gov (United States)

    Tan, Colin Siang Hui; Chew, Milton Cher Yong; Lim, Louis Wei Yi; Sadda, Srinivas R

    2016-01-01

    Diabetic retinopathy and diabetic macular edema (DME) are leading causes of blindness throughout the world, and cause significant visual morbidity. Ocular imaging has played a significant role in the management of diabetic eye disease, and the advent of advanced imaging modalities will be of great value as our understanding of diabetic eye diseases increase, and the management options become increasingly varied and complex. Color fundus photography has established roles in screening for diabetic eye disease, early detection of progression, and monitoring of treatment response. Fluorescein angiography (FA) detects areas of capillary nonperfusion, as well as leakage from both microaneurysms and neovascularization. Recent advances in retinal imaging modalities complement traditional fundus photography and provide invaluable new information for clinicians. Ultra-widefield imaging, which can be used to produce both color fundus photographs and FAs, now allows unprecedented views of the posterior pole. The pathologies that are detected in the periphery of the retina have the potential to change the grading of disease severity, and may be of prognostic significance to disease progression. Studies have shown that peripheral ischemia may be related to the presence and severity of DME. Optical coherence tomography (OCT) provides structural detail of the retina, and the quantitative and qualitative features are useful in the monitoring of diabetic eye disease. A relatively recent innovation, OCT angiography, produces images of the fine blood vessels at the macula and optic disc, without the need for contrast agents. This paper will review the roles of each of these imaging modalities for diabetic eye disease.

  20. Kernel regression based segmentation of optical coherence tomography images with diabetic macular edema.

    Science.gov (United States)

    Chiu, Stephanie J; Allingham, Michael J; Mettu, Priyatham S; Cousins, Scott W; Izatt, Joseph A; Farsiu, Sina

    2015-04-01

    We present a fully automatic algorithm to identify fluid-filled regions and seven retinal layers on spectral domain optical coherence tomography images of eyes with diabetic macular edema (DME). To achieve this, we developed a kernel regression (KR)-based classification method to estimate fluid and retinal layer positions. We then used these classification estimates as a guide to more accurately segment the retinal layer boundaries using our previously described graph theory and dynamic programming (GTDP) framework. We validated our algorithm on 110 B-scans from ten patients with severe DME pathology, showing an overall mean Dice coefficient of 0.78 when comparing our KR + GTDP algorithm to an expert grader. This is comparable to the inter-observer Dice coefficient of 0.79. The entire data set is available online, including our automatic and manual segmentation results. To the best of our knowledge, this is the first validated, fully-automated, seven-layer and fluid segmentation method which has been applied to real-world images containing severe DME.

  1. Segmentation of microcystic macular edema in Cirrus OCT scans with an exploratory longitudinal study

    Science.gov (United States)

    Swingle, Emily K.; Lang, Andrew; Carass, Aaron; Al-Louzi, Omar; Saidha, Shiv; Prince, Jerry L.; Calabresi, Peter A.

    2015-03-01

    Microcystic macular edema (MME) is a term used to describe pseudocystic spaces in the inner nuclear layer (INL) of the human retina. It has been noted in multiple sclerosis (MS) as well as a variety of other diseases. The processes that lead to MME formation and their change over time have yet to be explained sufficiently. The low rate at which MME occurs within such diverse patient groups makes the identification and consistent quantification of this pathology important for developing patient-specific prognoses. MME is observed in optical coherence tomography (OCT) scans of the retina as changes in light reflectivity in a pattern suggestive of fluid accumulations called pseudocysts. Pseudocysts can be readily identified in higher signal-to-noise ratio (SNR) images, however pseudocysts can be indistinguishable from noise in lower SNR scans. In this work, we expand upon our earlier MME identification methods on Spectralis OCT scans to handle lower quality Cirrus OCT scans. Our approach uses a random forest classifier, trained on manual segmentation of ten subjects, to automatically detect MME. The algorithm has a true positive rate for MME identification of 0.95 and a Dice score of 0.79. We include a preliminary longitudinal study of three patients over four to five years to explore the longitudinal changes of MME. The patients with relapsing-remitting MS and neuromyelitis optica appear to have dynamic pseudocyst volumes, while the MME volume appears stable in the one patient with primary progressive MS.

  2. Nuevo esteroide tópico en el tratamiento del edema macular

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    Ceija Molina Cisneros

    Full Text Available El pilar principal de tratamiento de las inflamaciones oculares tanto postquirúrgicas como endógenas, se basa en el uso de esteroides. Aunque estos medicamentos son efectivos, su empleo no está exento de riesgos como la hipertensión ocular y la aceleración de la formación de la catarata, principalmente en el caso de los esteroides más fuertes como la prednisolona y la betametasona. Esta revisión estuvo encaminada a la profundización del conocimiento sobre la bioquímica y el desarrollo del difluprednate, nueva droga esteroidea sintética de alta potencia, cuyo uso está aprobado por la Food and Drug Administration (FDA para el tratamiento del edema macular después de la cirugía del segmento anterior. Se analizaron algunos aspectos de este medicamento off-label como la farmacocinética, el metabolismo, la distribución ocular del medicamento y utilidad en las fases I, II y III de ensayos clínicos sobre su utilización en pacientes con inflamaciones posoperatorias, tanto del segmento anterior como posterior y con uveítis anterior.

  3. Caspase-14 Expression Impairs Retinal Pigment Epithelium Barrier Function: Potential Role in Diabetic Macular Edema

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    Selina Beasley

    2014-01-01

    Full Text Available We recently showed that caspase-14 is a novel molecule in retina with potential role in accelerated vascular cell death during diabetic retinopathy (DR. Here, we evaluated whether caspase-14 is implicated in retinal pigment epithelial cells (RPE dysfunction under hyperglycemia. The impact of high glucose (HG, 30 mM D-glucose on caspase-14 expression in human RPE (ARPE-19 cells was tested, which showed significant increase in caspase-14 expression compared with normal glucose (5 mM D-glucose + 25 mM L-glucose. We also evaluated the impact of modulating caspase-14 expression on RPE cells barrier function, phagocytosis, and activation of other caspases using ARPE-19 cells transfected with caspase-14 plasmid or caspase-14 siRNA. We used FITC-dextran flux assay and electric cell substrate impedance sensing (ECIS to test the changes in RPE cell barrier function. Similar to HG, caspase-14 expression in ARPE-19 cells increased FITC-dextran leakage through the confluent monolayer and decreased the transcellular electrical resistance (TER. These effects of HG were prevented by caspase-14 knockdown. Furthermore, caspase-14 knockdown prevented the HG-induced activation of caspase-1 and caspase-9, the only activated caspases by HG. Phagocytic activity was unaffected by caspase-14 expression. Our results suggest that caspase-14 contributes to RPE cell barrier disruption under hyperglycemic conditions and thus plays a role in the development of diabetic macular edema.

  4. Laser Treatment for Diabetic Macular Edema in the 21st Century

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    Romero-Aroca, Pedro; Reyes-Torres, Javier; Baget-Bernaldiz, Marc; Blasco-Suñe, Cristina

    2014-01-01

    Diabetic macular edema (DME) is the leading cause of blindness in the diabetic population. The diabetes Control and Complications Trial reported that 27% of patients affected by type 1 diabetes develop DME within 9 years of onset. Other studies have shown that in patients with type 2 diabetes, the prevalence increased from 3% to 28% within 5 years of diagnosis to twenty years after the onset. At the present time, despite the enthusiasm for evaluating several new treatments for DME, including the intravitreal therapies for DME (e.g., corticosteroids, and anti-VEGF drugs), laser photocoagulation remains the current gold standard and the only treatment with proven efficacy in a wide range of clinical trials for this condition. Despite being the standard technique for comparison and evaluation of the emerging treatments, we have generally poor understanding of the ETDRS recommendations, and we often forget about the results of laser in DME. The purpose of this review is to update our knowledge on laser photocoagulation for DME with an extensive review of the ETDRS results and discuss the laser techniques. Furthermore, we will describe the new developments in laser systems and review the current indications and results. Finally, we will discuss the results of laser treatments versus the current pharmacological therapies. We conclude by trying to provide a general overview that which laser treatment must be indicated and what types of lasers are currently recommended. PMID:24852439

  5. Intravitreal bevacizumab for macular edema secondary to branch retinal vein occlusion.

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    Ehlers, Justis P; Decroos, Francis Char; Fekrat, Sharon

    2011-10-01

    To evaluate the effect of intravitreal bevacizumab on the visual and anatomical outcome in eyes with macular edema secondary to branch retinal vein occlusion. A retrospective, consecutive case series identified 53 consecutive patients with a branch retinal vein occlusion treated with intravitreal bevacizumab. Clinical variables were analyzed, including best-corrected visual acuity, angiographic characteristics, central foveal thickness, and complications. Fifty-three eyes were identified with a mean initial best-corrected visual acuity of 20/137 and final best-corrected visual acuity of 20/96 (P = 0.05). The mean final line change was +1.6 lines (95% confidence interval, +0.7 to +2.3; +8 letters [95% confidence interval, +3.5 to 11.5]). At final follow-up, 28% gained ≥ 3 lines, whereas a loss of >3 lines was seen in 6% of eyes. The mean initial central foveal thickness of 425 μm decreased to 289 μm (P retinal vein occlusion showed improved functional outcomes (e.g., final best-corrected visual acuity, mean line change) as compared with those treated with >6 months of symptoms (P retinal vein occlusion in many subjects. Eyes treated with intravitreal bevacizumab showed a significant reduction in central foveal thickness and improvement in visual acuity. Early treatment with intravitreal bevacizumab resulted in a greater improvement in visual acuity compared with delayed treatment.

  6. Outcomes of microincision vitrectomy surgery with internal limiting membrane peeling for macular edema secondary to branch retinal vein occlusion

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    Sato S

    2015-03-01

    Full Text Available Shimpei Sato,1 Maiko Inoue,2 Shin Yamane,2 Akira Arakawa,2 Mikiro Mori,1 Kazuaki Kadonosono2 1Department of Opthalmology, Toranomon Hospital, Tokyo, Japan; 2Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan Purpose: To evaluate the anatomic and functional effect of microincision vitrectomy surgery (MIVS with internal limiting membrane (ILM peeling for macular edema secondary to branch retinal vein occlusion (BRVO.Methods: The medical records of 101 eyes of 101 patients who had undergone MIVS with ILM peeling for macular edema secondary to BRVO were studied. Patients were classified into ischemic and non-ischemic BRVO based on angiograph. The best-corrected visual acuity (BCVA and central foveal thickness (CFT, determined by spectral domain optical coherence tomography, were evaluated at baseline and at 1, 3, 6, and 12 months postoperatively.Results: Preoperative mean logarithm of the minimum angle of resolution (logMAR BCVA ± standard deviation (SD was 0.52±0.43 and mean CFT ± SD was 489.4±224.9 µm. Postoperative mean BCVA ± SD values were 0.41±0.35, 0.35±0.41, 0.29±0.36, and 0.25±0.41, and mean CFT values were 370.1±148.9, 327.5±157.5, 310.9±154.9, and 274.4±135.3 µm at 1, 3, 6, 12 months, respectively. The mean BCVA was significantly improved at 3, 6, and 12 months postoperatively (all P<0.05, and the mean CFT was significantly decreased at all postoperative follow-up time points (all P<0.05. At the 12-month postoperative evaluation, BCVA had improved by 0.2 logMAR units in 50 eyes (60.0% with ischemic BRVO and in nine eyes (50.0% with non-ischemic BRVO. Six eyes (6.0% experienced recurrence or persistence of macular edema at 12 months postoperatively.Conclusion: MIVS with ILM peeling for macular edema secondary to BRVO is effective in improving visual acuity and foveal morphology with low recurrence of macular edema. Keywords: MIVS, ILM, BRVO, central foveal thickness, CFT

  7. Efficacy and visual prognostic factors of intravitreal bevacizumab as needed for macular edema secondary to central retinal vein occlusion

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    Hirose M

    2014-11-01

    Full Text Available Miki Hirose, Wataru Matsumiya, Shigeru Honda, Makoto NakamuraDepartment of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Hyogo, JapanPurpose: Our aim was to investigate the efficacy and prognostic factors of intraocular injections of bevacizumab as needed in patients with macular edema secondary to central retinal vein occlusion (CRVO.Methods: This is a retrospective study including 28 eyes of 27 consecutive patients with macular edema due to CRVO and followed for at least 6 months. The mean age of the patients was 66.3 years. The patients underwent an intravitreal injection of bevacizumab (1.25 mg at the initial visit. Retreatments were performed when macular edema was persistent or worsened (as-needed regimen. The primary outcome measure was the mean change in best-corrected visual acuity (BCVA. The change in central retinal thickness (CRT was evaluated as the secondary outcome. Finally, the factors useful for predicting BCVA outcome were determined.Results: The mean number of injections was 1.8 over a period of 6 months. The mean BCVA (logarithm of minimum angle of resolution was significantly improved at 1 (-0.097, 3 (-0.14, and 6 months (-0.25 after the initial injection (P<0.05, <0.01, and <0.001, respectively. The mean CRT was also improved significantly at 1 (-250.4, 3 (-150.0, and 6 months (-187.2 (P<0.001 each. Earlier treatment and better improvement in BCVA at 1 month after the initial treatment were the prognostic factors significantly associated with better visual outcomes at 6 months (P=0.047 and 0.029, respectively.Conclusion: Intravitreal injection of bevacizumab as needed significantly improved visual acuity and macular edema in CRVO patients. Time before the treatment and early response to the treatment were important factors for the visual outcome.Keywords: central retinal vein occlusion, bevacizumab, macular edema, efficacy, prognostic factor, pro re nata regimen

  8. Edema

    Science.gov (United States)

    ... problem worse. Edema can also be a side effect of taking certain medicines.Some health problems, such as congestive heart failure, liver disease and kidney disease, can cause edema. You cannot ...

  9. Edema

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    Edema means swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles ... it can involve your entire body. Causes of edema include Eating too much salt Sunburn Heart failure ...

  10. Blood-retinal barrier glycerol permeability in diabetic macular edema and healthy eyes: estimations from macular volume changes after peroral glycerol

    DEFF Research Database (Denmark)

    Thornit, Dorte Nellemann; Vinten, Carl Martin; Sander, Birgit

    2010-01-01

    PURPOSE: To compare the changes in macular volume (MV) between healthy subjects and patients with diabetic macular edema (DME) after an osmotic load and to determine the glycerol permeability (P(gly)) of the blood-retinal barrier (BRB). METHODS: In this unmasked study, 13 patients with DME and 5...... model of glycerol and osmotic water movements across the BRB was constructed to estimate P(gly). RESULTS: Median MV decreased from 7.30 mm(3) (range, 6.68-7.35) to the maximum median DeltaMV of -0.30 mm(3) (25%-75% quartile: -0.34 to -0.25) in the healthy volunteers and from 7.97 mm(3) (range, 6...

  11. Subthreshold Micropulse Photocoagulation for Persistent Macular Edema Secondary to Branch Retinal Vein Occlusion including Best-Corrected Visual Acuity Greater Than 20/40

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    Keiji Inagaki

    2014-01-01

    Full Text Available To assess the efficacy of subthreshold micropulse diode laser photocoagulation (SMDLP for persistent macular edema secondary to branch retinal vein occlusion (BRVO, including best-corrected visual acuity (BCVA > 20/40, thirty-two patients (32 eyes with macular edema secondary to BRVO were treated by SMDLP. After disease onset, all patients had been followed for at least 6 months prior to treatment. Baseline Snellen visual acuity was used to categorize the eyes as BCVA ≤ 20/40 (Group I or BCVA > 20/40 (Group II. Main outcome measures were reduction in central macular thickness (CMT in optical coherence tomography (OCT and BCVA at 6 months. In the total subject-pool at 6 months, BCVA had not changed significantly but CMT was significantly reduced. Group I exhibited no significant change in CMT at 3 months but exhibited significant reductions at 6 and 12 months. Group II exhibited a marginally significant reduction in CMT at 3 months and a significant reduction at 6 months. In patients with persistent macular edema secondary to BRVO, SMDLP appears to control macular edema with minimal retinal damage. Our findings suggest that SMDLP is an effective treatment method for macular edema in BRVO patients with BCVA > 20/40.

  12. VISUAL ACUITY AND MULTIFOCAL ELECTRORETINOGRAPHIC CHANGES AFTER ARTERIOVENOUS CROSSING SHEATHOTOMY FOR MACULAR EDEMA ASSOCIATED WITH BRANCH RETINAL VEIN OCCLUSION

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    Chung, Eun Jee; Freeman, William R.; Koh, Hyoung Jun

    2009-01-01

    Purpose To evaluate the influence of arteriovenous (AV) sheathotomy on retinal function with central multifocal electroretinography (mfERG) in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). Methods Fifteen patients (15 eyes) who underwent AV sheathotomy for macular edema secondary to BRVO were included in the study. Best-corrected visual acuity and mfERG responses from the most central seven hexagons were analyzed before and 6 months after the operation. Results The mean preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score ± SD was 34.1 ± 12.7 letters (Snellen equivalent, 20/50) and significantly improved up to 40.5 ± 10.9 letters (Snellen equivalent, 20/40) at 6 months after AV sheathotomy (P = 0.027, Wilcoxon signed rank test). The mean preoperative P1 amplitude ± SD of the most central 7 hexagons was 39.30 ± 10.86 nV/deg2 for the affected eye versus 47.72 ± 6.67 nV/deg2 for the normal fellow (control) eye (P = 0.013, Mann–Whitney U test) and significantly increased up to 50.71 ± 15.58 nV/deg2 at 6 months after the operation (P = 0.014, Wilcoxon signed rank test). Significant correlations between preoperative and postoperative ETDRS score and preoperative P1 amplitude were present (r = 0.929, P < 0.001; r = 0.768, P = 0.001; respectively [Spearman correlation]). Conclusions AV sheathotomy improved macular function and anatomical outcome as measured by ETDRS score and mfERG responses in patients with macular edema due to BRVO. PMID:18301026

  13. Sensitivity and specificity of time-domain versus spectral-domain optical coherence tomography in diabetic macular edema

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    Nishal Patel

    2013-01-01

    Full Text Available Purpose: The purpose was to evaluate the sensitivity and specificity of measurements of central macular thickness (CMT in diabetic macular edema using stratus time-domain and cirrus spectral-domain optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA. Materials and Methods: A total of 36 eyes from 19 patients with clinically significant diabetic macular edema (DME were included. All participants underwent automated scanning patterns using cirrus HD-OCT and stratus OCT examinations on the same day. The sensitivity/specificity of retinal thickness measurements was calculated from published normative data. Agreement was calculated using Bland--Altman method. The receiver operating characteristic curves (ROC and areas under the ROC were plotted. Results: The mean difference between the cirrus HD-OCT and stratus OCT in the central foveal zone was 49.89 μm. Bland--Altman analysis confirmed that the retinal thickness measurements had poor agreement in patients with DME. The areas under the ROC for retinal thickness measurements were 0.88 using cirrus HD-OCT and 0.94 with stratus. Conclusions: In patients with DME, the cirrus HD-OCT gives a higher reading than stratus OCT with poor agreement between the devices in most regions within the nine subfield zones. The sensitivity and specificity of the stratus OCT was comparable to the cirrus.

  14. EFFECT ON MACULAR EDEMA IN NON-ISCHEMIC CRVO: COMPA RISON BETWEEN INTRAVITREAL BEVACIZUMAB AND COMBINED INTRAVITREAL BEVACIZUMAB AND TRIAMCINOLONE

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    Murali Mohan

    2013-05-01

    Full Text Available PURPOSE : to compare the efficacy of intravitreal bevacizum ab and combined bevacizumab and Triamcinolone, in the treatment of macular edema in CRVO. The efficacy is studied by the anatomical and visual improvements. BACKGROUND : macular edema is the most common cause of visual loss in central retinal vein occlusion. Many treatments have been advocated with the recent trend being the usage of intravitreal anti-VEGF age nts and steroids. METHODS : 30 eyes of 30 patients (17 male and 13 female with recent onset non-ischemic CRVO were enrolled in a prospective randomized consecutive comparative stud y. Group I with 15 eyes were given intravitreal injection of 1.25 mg/0.05 ml of Avasti n and group II with 15 eyes were given intravitreal combination of 1.25 mg/0.05 ml Avastin and 2 mg/0.05 ml of Triamcinolone. All eyes were examined at baseline and at six weeks of injec tion. Changes in best corrected visual acuity (letters of ETDRS chart and central macular thickn ess were studied. IOP was also focused on.

  15. Macular edema in Asian Indian premature infants with retinopathy of prematurity: Impact on visual acuity and refractive status after 1-year

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    Anand Vinekar

    2015-01-01

    Full Text Available Purpose: To report the impact of transient, self-resolving, untreated "macular edema" detected on spectral domain optical coherence tomography in Asian Indian premature infants with retinopathy of prematurity (ROP on visual acuity (VA and refraction at 1-year of corrected age. Materials and Methods: Visual acuity and refraction of 11 infants with bilateral macular edema (Group A was compared with gestational age-matched 16 infants with ROP without edema (Group B and 17 preterms infants without ROP and without edema (Group C at 3, 6, 9 and 12 months of corrected age using Teller Acuity Cards and cycloplegic retinoscopy. Sub-group analysis of the previously described pattern A and B macular edema was performed. Results: Visual acuity was lower in infants with macular edema compared with the other two control groups throughout the study period, but statistically significant only at 3 months. Visual improvement in these infants was highest between the 3 rd and 6 th month and plateaued by the end of the 1 st year with acuity comparable to the other two groups. The edema cohort was more hyperopic compared to the other two groups between 3 and 12 months of age. Pattern A edema had worse VA compared to pattern B, although not statistically significant. Conclusion: Macular edema, although transient, caused reduced VA as early as 3 months of corrected age in Asian Indian premature infants weighing <2000 g at birth. The higher hyperopia in these infants is possibly due to visual disturbances caused at a critical time of fovealization. We hypothesize a recovery and feedback mechanism based on the principles of active emmetropization to explain our findings.

  16. Dexamethasone intravitreal implants for diabetic macular edema refractory to ranibizumab monotherapy or combination therapy.

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    Gutiérrez-Benítez, L; Millan, E; Arias, L; Garcia, P; Cobos, E; Caminal, M

    2015-10-01

    To determine the effectiveness and local safety of dexamethasone intravitreal implants as a treatment in diabetic macular edema (DME) refractory to intravitreal injections of ranibizumab monotherapy or combination therapy. A retrospective study conducted on patients with DME refractory to ranibizumab monotherapy or combined with other treatments treated with dexamethasone intravitreal implants. The parameters analyzed were visual acuity (VA) by ETDRS (Early Treatment Diabetic Retinopathy Study) charts and foveal thickness by spectral-domain optical coherence tomography (SD-OCT) before the treatment, 2 months after treatment, and at the end of the follow-up. A total of 14 eyes of 14 patients were included, with a mean age of 64 years (SD: 9.5; range 41-78) and a mean follow-up of 7.6 months. The mean VA improved from 53 letters to 59 letters at 2 months (P=.03), and 57 at the end of the follow-up period (P=.3). The mean foveal thickness decreased from 502 μ to 304 μ at 2 months (P=.001), and 376 μ at the end of the follow-up period (P=.009). Further treatment with intravitreal dexamethasone was required in 43% of the patients, and 21% had increased intraocular pressure, which was controlled with topical medication. Intravitreal dexamethasone implant is an effective and locally safe treatment for the management of DME refractory to ranibizumab monotherapy or combined with other treatments. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Trends in the Care of Diabetic Macular Edema: Analysis of a National Cohort.

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    Brian L VanderBeek

    Full Text Available To evaluate how the monitoring and treatment for diabetic macular edema (DME has changed in a national sample.Retrospective cohort study.Administrative medical claims data from a large, national U.S. insurer.Beneficiaries of a U.S. insurance company.All incident cases of DME were found. Those in years 2002/3, 2006 and 2010 were followed for a 2-year observation period and those from 2009, 2010 and 2011 for a 1-year observation period.Types and frequencies of treatment were tallied and compared over each of the cohorts.Two-year cohorts had 233, 251 and 756 patients in 2002/3, 2006 and 2010 respectively. One-year cohorts had 1002, 1119 and 1382 patients in 2009, 2010 and 2011, respectively. Both percentage of patients receiving therapy and number of treatments given increased across the 2-year cohorts for both focal laser and anti-vascular endothelial growth factor (anti-VEGF (p<0.001. The highest use of anti-VEGF agents in any of the cohorts was in the 2011 1-year group that only averaged 3.78 injections. Focal laser was used 2.5x as frequently as anti-VEGF injections in the most recent cohorts with only a high of 14.0% of DME patients receiving anti-VEGF therapy in any of the cohorts.Regardless of treatment modality (laser or injection DME patients received vastly fewer treatments than patients in randomized control trials. Despite the proven superior visual outcomes of anti-VEGF agents over focal laser in DME, focal laser was still used more frequently.

  18. Implantable MicroPump for Drug Delivery in Patients with Diabetic Macular Edema

    Science.gov (United States)

    Humayun, Mark; Santos, Arturo; Altamirano, Juan Carlos; Ribeiro, Ramiro; Gonzalez, Roberto; de la Rosa, Alejandro; Shih, Jason; Pang, Changling; Jiang, Fukang; Calvillo, Philip; Huculak, John; Zimmerman, Jenna; Caffey, Sean

    2014-01-01

    Purpose To demonstrate the safety and surgical feasibility of the first-in-man ocular implant of a novel Posterior MicroPump Drug Delivery System (PMP) in patients with diabetic macular edema (DME) and to report on the device capabilities for delivering a programmable microdose. Methods This was a single center, single arm, open-label, prospective study. Eleven patients with DME and visual acuity equal to or worse than 20/40 were included. The PMP prefilled with ranibizumab was implanted into the subconjunctival space. After implantation, the PMP was wirelessly controlled to deliver a programmed microdose. Comprehensive ophthalmic exams and optical coherence tomography were performed biweekly for 90 days. At the end of the study, the PMP was explanted and the subjects thereafter received standard of care for DME (i.e., laser or intravitreal injections). Results All 11 surgical implantations were without complications and within the skill sets of a retinal surgeon. No serious adverse events occurred during the follow-up period. At no point were visual acuity and central foveal thickness worse than baseline in the implanted eye. The PMP delivered the programmed ranibizumab dosage in seven subjects. The remaining four patients received a lower than target dose, and the treatment was complemented with standard intravitreal injection. Conclusions This study demonstrates the first-in-man safety of the Replenish MicroPump implant for a period of 90 days and its capability to deliver a microdose into the vitreous cavity. Further studies to enable longer-term safety and to demonstrate the feasibility of multiple programmable drug delivery are necessary. PMID:25653883

  19. Comparison between ranibizumab and aflibercept for macular edema associated with central retinal vein occlusion.

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    Saishin, Yoshitsugu; Ito, Yuka; Fujikawa, Masato; Sawada, Tomoko; Ohji, Masahito

    2017-01-01

    We compared the efficacy of bimonthly intravitreal injections of ranibizumab (IVR) with that of bimonthly intravitreal injections of aflibercept (IVA) in two prospective, consecutive groups of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). Eyes with ME after CRVO received either bimonthly IVR (ranibizumab group; n = 13) or IVA (aflibercept group; n = 13) injections and were followed monthly for 6 months. Three patients in the ranibizumab group and two in the aflibercept group were lost to follow-up and excluded from the study. The best-corrected visual acuity (BCVA), central foveal thickness (CFT) on optical coherence tomography, and aqueous vascular endothelial growth factor (VEGF) concentrations were evaluated before and after treatment. From baseline to month 6, significant improvements occurred in mean logMAR BCVA (ranibizumab group: 0.78-0.47; p < 0.05; aflibercept group: 0.74-0.54; p < 0.05) and mean CFT (ranibizumab group: 685-311 µm; p < 0.05; aflibercept group: 695-230 µm; p < 0.05). Fluctuations in CFT were seen at months 2, 4, and 6 in the ranibizumab group. Mean aqueous VEGF concentration decreased from baseline to month 2 in the ranibizumab group (509.9-348.2 pg/ml) and aflibercept group (412.1 pg/ml to undetectable limits in eight of 11 eyes and to 13.6, 15.6, and 24.1 pg/ml in the other three eyes, respectively). There was no significant improvement of visual acuity in one group compared with another; VEGF may not be completely neutralized by bimonthly injections of ranibizumab.

  20. Dorzolamide Chlorhydrate Versus Acetazolamide in the Management of Chronic Macular Edema in Patients with Retinitis Pigmentosa: Description of Three Case Reports

    Science.gov (United States)

    Pacella, Elena; Arrico, Loredana; Santamaria, Valentina; Turchetti, Paolo; Carbotti, Maria Rosaria; La Torre, Giuseppe; Pacella, Fernanda

    2014-01-01

    AIMS To assess the efficacy of topical dorzolamide for treating cystoid macular edema in patients with retinitis pigmentosa and minimize the secondary effects of maintenance therapy in patients with retinitis pigmentosa (RP) who present with chronic microcystic macular edema. METHODS To replace acetazolamide systemic treatment, with a topical treatment using 2% dorzolamide in three patients. The methods performed were OCT scan with a Spectralis HRA-OCT, for the measurement of macular thickness and morphology; best corrected visual acuity was assessed using Early Treatment Diabetic Retinopathy Study (ETDRS), was assessed slit-lamp biomicroscopy, ocular tonometry, fundus biomiocrosopy, and color fundus photography. This therapeutic protocol has been applied and described in three patients. RESULTS In all three tested patients, following the administration of dorzolamide in eye drop, we observed a remarkable decrease in macular edema, almost comparable to that obtained with acetazolamide per os. CONCLUSION The study confirms the anti-edematogenic effect of topical dorzolamide in RP with recurring macular cysts, as this can have a favorable response with topical dorzolamide. In all the three examined patients, the instillation of topical dorzolamide caused a remarkable reduction in their macular edema, as highlighted on OCT. PMID:24932106

  1. Radiation Macular Edema after Ru-106 Plaque Brachytherapy for Choroidal Melanoma Resolved by an Intravitreal Dexamethasone 0.7-mg Implant

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    Andrea Russo

    2012-02-01

    Full Text Available Purpose: To report the effective treatment of radiation macular edema following ruthenium-106 plaque brachytherapy for a choroidal melanoma with a dexamethasone 0.7-mg (Ozurdex® intravitreal implant. Methods: An interventional case report with optical coherence tomography (OCT scans. Results: A 65-year-old Caucasian woman was suffering from radiation macular edema following ruthenium-106 plaque brachytherapy for a choroidal melanoma on her left eye. She had undergone one intravitreal injection of 0.5 mg bevacizumab (Avastin®, Genentech/Roche in the following months without functional or anatomical improvement. Seven months after the development of radiation macular edema, she received a single intravitreal injection of dexamethasone 0.7 mg (Ozurdex. Four weeks following the injection, her best-corrected visual acuity improved from 0.3 to 0.5. Radiation macular edema resolved with a reduction of central retinal thickness from 498 µm before Ozurdex injection to 224 µm after Ozurdex injection, as measured by OCT scan. Conclusion: Dexamethasone 0.7 mg (Ozurdex has proven to be an effective treatment option in retinal vein occlusion and noninfectious uveitis. It can also be considered as off-label treatment in radiation macular edema following ruthenium-106 plaque brachytherapy for a choroidal melanoma.

  2. The effect of intravitreal administration of bevacizumab on macular edema and visual acuity in age-related macular degeneration with subfoveolar choroidal neovascularisation

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    Ristić Dragana

    2013-01-01

    Full Text Available Background/Aim. Age-related macular degeneration (AMD is a leading cause of the loss of central visual acuity in population older than 70 years. We can distinguish wet and dry form of AMD. The aim of the study was to present our early results in treatment of the wet (neovascular form of AMD with intravitreal administration of bevacizumab. Methods. The study included 39 patients. Each patient underwent a complete ophthalmological examination, fluorescein angiography (FA and optical coherence tomography (OCT. All the patients received 1.25 mg of intravitreal bevacizumab (0.05 mL of commercial phial of Avastin®. The total of three doses was given with a one-month interval between doses. Results. Among 39 patients, 24 were women and 15 men. The average best corrected visual acuity (BCVA was improved from 0.09 before the therapy to 0.24 after the administration of all the three doses of bevacizumab (p < 0.001. The average central macular thickness (CMT measured by OCT was improved from 474 μm in the beginning to 341 μm after the administration of all the three doses of the drug (p < 0.001. There were no side effects. Conclusions. Our short-term experience indicates that intravitreal administration of three doses of bevacizumab in one-month intervals between the doses leads to a significant reduction of macular edema and improvement of BCVA in patients with neovascular AMD.

  3. Intravitreal bevacizumab for macular edema due to proton beam radiotherapy: Favorable results shown after eighteen months follow-up

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    Eleni Loukianou

    2010-05-01

    Full Text Available Eleni Loukianou, Dimitrios Brouzas, Eleni Georgopoulou, Chrysanthi Koutsandrea, Michael ApostolopoulosEye Department, University of Athens, Athens, GreecePurpose: To evaluate the safety and efficacy of intravitreal injections of bevacizumab (Avastin® as a treatment option for radiation maculopathy secondary to proton beam radiotherapy for choroidal melanoma.Case: A 61-year-old woman presented with a gradual decrease in left eye visual acuity (VA 29 months after proton beam radiotherapy for choroidal melanoma. On presentation, her best-corrected VA (BCVA was 2/10 in the left eye and the intraocular pressure was 15 mmHg. Fundoscopy revealed cystoid macular edema, intraretinal hemorrhages, epiretinal membrane in the posterior pole, and residual tumor scar with exudative retinal detachment and hard exudates in the periphery of the superotemporal quadrant. A treatment with intravitreal injections of bevacizumab (Avastin® was recommended. The injections were performed on a six-weekly basis.Results: The central retinal thickness prior to the treatment was 458 μm. After the first intravitreal injection of bevacizumab, the retinal thickness at the centre of the fovea was reduced to 322 μm. After the third injection, the central retinal thickness was 359 μm and 18 months after presentation, it reduced to 334 μm. The BCVA increased to 3/10 after the intravitreal injections of bevacizumab and remained stable during the follow-up period. The intraocular pressure was within normal range during the follow-up period.Conclusion: Bevacizumab should be regarded as a treatment option for macular edema due to proton beam radiotherapy for choroidal melanoma. By reducing the central retinal thickness, intravitreal bevacizumab can improve VA or ameliorate further decline caused by radiation maculopathy.Keywords: bevacizumab (Avastin®, choroidal melanoma, macular edema, radiation retinopathy

  4. Clinical, anatomical, and electrophysiological assessments of the central retina following intravitreal bevacizumab for macular edema secondary to retinal vein occlusion.

    Science.gov (United States)

    Loukianou, Eleni; Brouzas, Dimitrios; Chatzistefanou, Klio; Koutsandrea, Chrysanthi

    2016-02-01

    The purpose of this study is to evaluate the long-term visual, anatomical and electrophysiological outcomes of repeated intravitreal injections of bevacizumab for macular edema due to retinal vein occlusion (RVO) and investigate any possible toxic effects on the central fovea. This is a prospective, noncomparative, interventional case series. Thirty-three eyes of 33 patients with macular edema secondary to RVO were treated with 1.25 mg/0.05 ml intravitreal bevacizumab. Nine patients had nonischemic central retinal vein occlusion (CRVO) and 24 patients had branch retinal vein occlusion (BRVO). The main outcome measures were best-corrected visual acuity, central retinal thickness (CRT), and multifocal electroretinography (mfERG) responses changes at baseline, 1 month after the third injection and at the end of the 2-year long follow-up period. Patients with CRVO had mean best-corrected Snellen visual acuity of 0.10 at baseline, which improved significantly to 0.31 after 2 years (P = 0. 028).The mean CRT at presentation was 756.28 μm and reduced significantly to 439.14 μm after 2 years (P = 0.05). Patients with BRVO had mean best-corrected Snellen visual acuity of 0.19 at baseline, which improved significantly to 0.40 after 2 years (P central 10° (ring1, ring2) showed statistically significant differences on P1 parameters in terms of response density and implicit time after 2 years in both CRVO and BRVO patients. Repeated intravitreal bevacizumab injections for macular edema due to either CRVO or BRVO resulted in long-term improvement of visual acuity, a reduction in CRT and statistically significant changes in the mfERG responses with nondemonstrable toxic effects on the central fovea.

  5. Rebound macular edema following oral acetazolamide therapy for juvenile X-linked retinoschisis in an Italian family

    Science.gov (United States)

    Galantuomo, Maria Silvana; Fossarello, Maurizio; Cuccu, Alberto; Farci, Roberta; Preising, Markus N; Lorenz, Birgit; Napoli, Pietro Emanuele

    2016-01-01

    Background Juvenile X-linked retinoschisis (RS1, OMIM: 312700) is a hereditary vitreoretinal dystrophy characterized by bilateral foveal schisis and, in half of the patients, splitting through the nerve fiber layer in the peripheral retina. In the first decade of life, patients usually develop a decrease in visual acuity. Long-term visual outcomes can be poor due to the limited number of known successful treatments. Purpose The purposes of this study were to present, for the first time, a p.Arg197Cys missense mutation in the RS1 gene (OMIM: 300839) in a four-generation Italian family with RS1 and to examine the clinical response to the treatment with acetazolamide tablets alone or in combination with dorzolamide eye drops as assessed by spectral-domain optical coherence tomography (SD-OCT). Methods Eleven individuals, including two brothers with RS1 (patients 1 and 2), underwent a full medical history examination and a comprehensive ocular assessment that involved SD-OCT, fluorescein angiography, electroretinography and DNA analysis. Each RS1 patient received oral acetazolamide (375 mg daily) during the first three months. Thereafter, patient 1 continued only with dorzolamide eyedrops three times a day for a period of three months, while patient 2 spontaneously stopped both medications. Results Sequence analysis of the RS1 gene identified a hemizygous c.589C>T (p.Arg197Cys) missense mutation in exon 6, which has not been previously reported in an Italian family. A different response to the medical therapy was observed in the four eyes of the two affected brothers hemizygous for this abnormality. Of note, after acetazolamide interruption, a rebound effect on cystoid macular edema reduced the beneficial effects of the initial therapy for RS1 from p.Arg197Cys mutation. Indeed, a minimal rebound effect on cystoid macular edema, and an improvement in visual acuity, was observed in patient 1 during the six months of treatment. Conversely, in patient 2, an initial

  6. Efficacy and safety of different doses of a slow-release corticosteroid implant for macular edema [Corrigendum

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    Liu QY

    2016-04-01

    Full Text Available Liu QY, He MM, Shi H, et al. Drug Des Devel Ther. 2015;9: 2527–2535. In “Efficacy and safety of different doses of a slow release corticosteroid implant for macular edema: meta-analysis of randomized controlled trials” published May 2015, on page 2530, in Table 1 we have mistakenly stated the fluocinolone acetonide (FA intravitreal inserts as Retisert® in the Campochiaro et al study; they were in fact the fluocinolone acetonide intravitreal inserts. We feel sorry about that, and we will be more rigorous to avoid any unnecessary confusion in the future. Read the original article

  7. 葡萄膜炎性黄斑囊样水肿的研究进展%Recent progress on uveitis-related cystoid macular edema

    Institute of Scientific and Technical Information of China (English)

    邢凯; 刘健; 亢泽峰; 杨永升; 张励

    2015-01-01

    Uveitis refers to a groups of inflammatory diseases in the iris , ciliary body, choroid, vitreous, retina and retinal vessels of the eye .Seriously affecting visual function , uveitis occurs most frequently in children , teenagers and young adults .Complications commonly associated with uveitis include cystoid macular edema ( CME), cataract, glaucoma, retinal detachment and choroidal neovascularization . Although uveitic CME is usually not associated with significant pigmentary changes in the macula , it may cause permanent vision impairment .In clinical practice ,CME is often ignored ,thus incuring a delayed or an underlooked diagnosis .In recent years , significant advances have been made in our understanding of the etiology and mechanisms of uveitis and CME , which have resulted remarkable improvement in early detection and timely intervention of uveitis and CME .Due to uveitis can cause patients with retinal and choroidal extensive damage , especially uveitis is often caused by CME , resulting in visual acuity was significantly diminished .In order to treat this complication , in recent years the industry on the pathogenesis of uveitis induced by CME and treatment methods were extensively explored .In the pathogenesis of the disease , the role of the blood retinal barrier , inflammatory factor ,and the role of the vitreous body is the main cause of the disease.Treatment,in addition to the use of corticosteroids ,non steroidal drugs and other traditional methods of treatment, but also to the application of biological agents , immunosuppressive agents , anti vascular endothelial growth factor , iodine preparation , laser therapy and surgical treatment of a wide range of research, and achieved some results .This paper aims to view these recent advances .%葡萄膜炎是一种累及虹膜、睫状体、脉络膜、玻璃体、视网膜及视网膜血管的炎性病变,严重影响着患者的视功能. 多发于青壮年,病因复杂,常反复发作.

  8. Tumor vasoproliferativo primário da retina associado a edema macular cistóide: relato de caso Idiopathic vasoproliferative tumor of the retina associated with macular edema: case report

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    Otacílio de Oliveira Maia Júnior

    2005-12-01

    Full Text Available Tumor vasoproliferativo da retina é doença rara, benigna, caracterizada por lesão exsudativa retiniana periférica. Pode ser de origem primária (idiopática ou secundária a uma gama de acometimentos retinianos prévios. O exame oftalmológico cuidadoso se torna necessário para estabelecer o diagnóstico. As opções terapêuticas incluem: observação, crioterapia, fotocoagulação a laser e braquiterapia. No presente estudo, os autores ilustram um caso de tumor vasoproliferativo idiopático da retina associado a edema macular. Serão discutidos aspectos do tumor na fundoscopia, angiofluoresceinografia, ultra-sonografia e tomografia de coerência óptica.Retinal vasoproliferative tumor is a rare and benign disease that presents with an exsudative lesion in the retinal periphery. The lesion can be classified as primary (idiopathic or secondary to a number of previous retinal injuries. Diagnosis is based on a careful ophthalmic examination. Therapeutic options include observation, cryotherapy, laser photocoagulation and brachytherapy. We present a case of idiopathic retinal vasoproliferative tumor associated with macular edema. The aspects of the tumor on fundus examination, fluorescent angiography, echography and optic coherence tomography are discussed.

  9. Short-term variation of autorefraction in Diabetic Macular Edema (DME *

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    A. Y. Sukha

    2007-01-01

    Full Text Available Very few studies have investigated autorefraction in diabetic subjects presenting either with diabetic retinopathy (DR and/ or diabetic macular edema (DME. To the best of our knowledge this is the first study using multivariate methods for investigating short-term autorefraction in a small sample of subjects diagnosedwith DME. Forty consecutive autorefractor measurements were taken over a short interval on each of seven diabetic subjects with varying stages of DME, and the results were compared to a smaller group of four diabetic control subjects without DME (reasons for the differences in sample sizes will be explained later. Measurements were obtained from both the right and left eyes of all subjects.  Subjects in the two groups were similarly matched according to duration of diabetes mellitus (DM, age and glycated hemoglobin (HbA1c values. Normality of data distribution was mostly achieved with the removal of outliers (where necessary until profiles of skewness, kurtosis, and standard mean deviation exhibited near-normal distribution. Thereafter, stereo-pair scatter plots with 95% surfaces of constant probability density (distribution ellipsoids were generated and compared between the experimental and control subjects.The diabetic subjects with DME demonstrated a larger spread of measurements in the eyes with the more severe DME, with the exception of one subject (subject 5. The volumes and orientation of the distribution ellipsoids also differed between the subject’s eyes. Some eyes with severe DME and poor visual acuitydisplayed more stigmatic variation (for example, subjects 2 and 4, while others (subjects 1 and 3 displayed more ortho-antistigmatic variation or near oblique antistigmatic variation (subject 7.  In all experimental subjects, with the exception of subject 5, the eye with the more severe DME had a larger distribution ellipsoidvolume, indicating greater variation in autorefraction and thus it might be surmised that this

  10. Edema

    Science.gov (United States)

    ... one position for too long Eating too much salty food Premenstrual signs and symptoms Pregnancy Edema can ... Do you restrict your intake of salt and salty foods? Do you drink alcohol? Do you seem ...

  11. INTRAVITREAL DEXAMETHASONE IMPLANT FOR THE TREATMENT OF REFRACTORY MACULAR EDEMA IN RETINAL VASCULAR DISEASES: Results of the KKESH International Collaborative Retina Study Group.

    Science.gov (United States)

    Alshahrani, Saeed T; Dolz-Marco, Rosa; Gallego-Pinazo, Roberto; Diaz-Llopis, Manuel; Arevalo, J Fernando

    2016-01-01

    To evaluate the safety and efficacy of intravitreal dexamethasone implant (Ozurdex) for treating refractory macular edema in retinal vascular diseases. This is a retrospective consecutive series of 53 eyes with refractory macular edema secondary to central retinal vein occlusion (13 eyes), branch retinal vein occlusion (14 eyes), and diabetic macular edema (26 eyes) treated with a single 0.7 mg dexamethasone implant. Data were collected on best-corrected visual acuity, intraocular pressure, and central macular thickness preoperatively and at 1, 3, and 6 months postoperatively. Baseline best-corrected visual acuity was 20/160 and improved statistically significantly to 20/80 and 20/60 at 1 months and 3 months, respectively (P 0.05). The central macular thickness at baseline was 569.96 ± 178.11 μm, and it decreased statistically significantly to 305.81 ± 155.94 μm, 386 ± 210.79 μm, and 446.41 ± 221.21 μm at 1, 3 and 6 months, respectively (P central macular thickness that remained stable to 3 months and 6 months, respectively.

  12. Impact of injection therapy on retinal patients with diabetic macular edema or retinal vein occlusion

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    Sivaprasad S

    2016-05-01

    Full Text Available Sobha Sivaprasad,1 Sesan Oyetunde2 1NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, 2Allergan Holdings Ltd., Marlow, UK Purpose: An important factor in the choice of therapy is the impact it has on the patient’s quality of life. This survey aimed to understand treatment burden, treatment-related anxiety and worry, and practical issues such as appointment attendance and work absence in patients receiving injection therapy for diabetic macular edema (DME or retinal vein occlusion (RVO.Patients and methods: A European sample of 131 retinal patients completed a detailed questionnaire to elucidate the impact of injection therapy on individuals with DME or RVO.Results: RVO and DME greatly impact a patient’s quality of life. An intensive injection regimen and the requirements for multiple hospital visits place a large practical burden on the patient. Each intravitreal injection appointment (including travel time was reported to take an average of 4.5 hours, with a total appointment burden over 6 months of 13.5 hours and 20 hours for RVO and DME patients, respectively. This creates a significant burden on patient time and may make appointment attendance difficult. Indeed, 53% of working patients needed to take at least 1 day off work per appointment and 71% of patients required a carer’s assistance at the time of the injection appointment, ~6.3 hours per injection. In addition to practical issues, three-quarters of patients reported experiencing anxiety about their most recent injection treatment, with 54% of patients reporting that they were anxious for at least 2 days prior to the injection. Patients’ most desired improvement to their treatment regimen was to have fewer injections and to require fewer appointments, to achieve the same visual results.Conclusion: Patients’ quality of life is clearly very affected by having to manage an intensive intravitreal injection regimen, with a considerable treatment burden

  13. [Multicenter Ozurdex® assessment for diabetic macular edema: MOZART study].

    Science.gov (United States)

    Guigou, S; Hajjar, C; Parrat, E; Merite, P Y; Pommier, S; Matonti, F; Prost-Magnin, O; Meyer, F

    2014-06-01

    To evaluate the efficiency and safety of intravitreal implant of 0.7mg dexamathasone in visual impairment due to diabetic macular edema (DME). This was a retrospective, multicenter, study. Seventy-four patients, with a mean age of 65 years, followed for at least 6 months (mean follow-up: 9.8 months) were included in 5 French eye clinics (P 1.5 collective). The mean systolic blood pressure was 138mmHg and the mean HbA1c was 7.2%. We monitored 2 systemic parameters: blood pressure and glycemic balance. Best-corrected visual acuity (BCVA), central retinal thickness (CRT, Spectralis OCT), intraocular pressure (IOP) and cataract progression are studied at baseline and then at 1, 2, 4 and 6 months. The average CRT decrease was: 239μm at month 2 (M2) and 135μm at month 6 (M6). The mean improvement from baseline of BCVA is 8.5 letters at M2 and 7.6 letters at M6. A gain greater than 15 letters is found in 27% of patients at M6. For naive patients the BCVA is 71 letters versus 60 letters (P<0.05). Patients with a baseline CRT <500mmHg have a BCVA of 66 letters versus 57 letters (P<0.05). The mean rate injections was 1.2 at 6 months with an average of 5.4 months for reinjection. Ocular hypertension greater than 25mmHg, managed by topical treatment, is observed in 13.4% of patients. No glaucoma surgery was necessary. Dexamethasone has an anatomical and functional effectiveness in the treatment of DME. Outcomes for naive patients and lower CRT suggest that the duration of diabetes mellitus and previous treatments are negative factors of recovery. Side effects are rare and manageable. Ozurdex(®) seems to be a treatment for visual impairment due to DME with a favorable safety profile. Patient follow-up must be adapted to half-life of the product with a control before M1 (intraocular pressure) and before M5 (DME recurrence, BCVA). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Optical coherence tomography for age-related macular degeneration and diabetic macular edema: an evidence-based analysis.

    Science.gov (United States)

    2009-01-01

    The purpose of this evidence-based review was to examine the effectiveness and cost-effectiveness of spectral-domain (SD) optical coherence tomography (OCT) in the diagnosis and monitoring of patients with retinal disease, specifically age-related macular degeneration (AMD) and diabetic macular edema (DME). Specifically, the research question addressed was: What is the sensitivity and specificity of spectral domain OCT relative to the gold standard? TARGET POPULATION AND CONDITION The incidence of blindness has been increasing worldwide. In Canada, vision loss in those 65 years of age and older is primarily due to AMD, while loss of vision in those 18 years of age and older is mainly due to DME. Both of these conditions are diseases of the retina, which is located at the back of the eye. At the center of the retina is the macula, a 5 mm region that is responsible for what we see in front of us, our ability to detect colour, and fine detail. Damage to the macula gives rise to vision loss, but early detection of asymptomatic disease may lead to the prevention or slowing of the vision loss process. There are two main types of AMD, 'dry' and 'wet'. Dry AMD is the more prevalent of the two, accounting for approximately 85% of cases and characterized by small deposits of extracellular material called "drusen" that build up in Bruch's membrane of the eye. Central vision loss is gradual with blurring and eventual colour fading. Wet AMD is a less prevalent condition (15% of all AMD cases) but it accounts for 90% of severe cases. It's characterized by the appearance of retinal fluid with vision loss due to abnormal blood vessels/leakage within weeks to months of diagnosis. In 2003, the Canadian National Institute for the Blind (CNIB) prevalence estimate for AMD was 1 million Canadians, including approximately 400,000 affected Ontarians. The incidence in 2003 was estimated to be 78,000 new cases in Canada, with approximately one-third of these cases arising in Ontario (n=26

  15. Quantitative evaluation of reduction of plaque-like hard exudates in diabetic macular edema after intravitreal triamcinolone injection.

    Science.gov (United States)

    Cekiç, Osman; Bardak, Yavuz; Tiğ, U Sahin; Yildizoğlu, Uzeyir; Bardak, Handan

    2008-04-01

    To describe a new method of quantifying the amount of plaque-like hard exudates after intravitreal triamcinolone acetonide injection in diabetic macular edema. This study included 22 eyes of 14 patients (mean age, 63 years) with chronic diabetic macular edema and plaque-like hard exudates. The patients were injected with a single dose of 4 mg intravitreal triamcinolone acetonide. The optic disc size as relative size unit was taken to quantify the hard exudates: Total areas of exudates and the optic nerve head were computed from fundus pictures with a digital analysis program on magnified images. The former was divided by the latter, and the results were expressed as a percentage value. The ratio was used to track improvements in a given eye over 6 months. Average ratio of hard exudates to optic nerve head area reduced to 81% of its initial value at 1 month (P=0.007), to 54% at 3 months (Pexudates to optic disc area of diabetic plaque-like hard exudates following 4 mg intravitreal triamcinolone.

  16. Comparison of intravitreal ranibizumab and bevacizumab for the treatment of macular edema secondary to retinal vein occlusion

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    Alex Yuan

    2014-02-01

    Full Text Available AIM:To compare the efficacy of ranibizumab and bevacizumab for macular edema due to retinal vein occlusion (RVO.METHODS:A retrospective study was conducted at a single academic institution. Eighty-one patients naïve to anti-VEGF therapy with RVO and macular edema were identified. Twenty-six eyes were treated with ranibizumab, 33 eyes with bevacizumab, and 22 eyes with bevacizumab then switched to ranibizumab (crossover. The main outcome was change in visual acuity at 3 months, 6 months, and final visit.RESULTS:The mean visual acuity improved from 20/80 to 20/40 in the ranibizumab (R group and from 20/125 to 20/60 in the bevacizumab (B group (P=0.66. The mean change in central subfield thickness (CST was -186 and -212µm, respectively (P=0.69. Mean time between injections was 94±21.1d in the R group and 103.8±10.5d in the B group (P=0.78. In the crossover group, mean initial visual acuity was 20/125, reached 20/60 at crossover, and remained 20/60 at conclusion (P=0.91.CONCLUSION:Both ranibizumab and bevacizumab are effective for the treatment of RVO and appear to have similar visual and anatomic outcomes. Changing treatments from bevacizumab to ranibizumab did not result in further gains in visual acuity.

  17. DEXAMETHASONE IMPLANT FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION IN PATIENTS YOUNGER THAN 50 YEARS.

    Science.gov (United States)

    Battaglia Parodi, Maurizio; Iacono, Pierluigi; Sacconi, Riccardo; Parravano, Mariacristina; Varano, Monica; Bandello, Francesco

    2015-07-01

    To evaluate the effects of dexamethasone implant for macular edema secondary to central retinal vein occlusion in patients younger than 50 years. Patients with no previous treatment, macular edema with central foveal thickness >250 μm and best-corrected visual acuity between 1.30 LogMAR and 0.30 LogMAR were prospectively recruited for a 12-month follow-up study. After baseline dexamethasone implant, re-treatment was performed starting from the fourth month if a best-corrected visual acuity deterioration with central foveal thickness >250 μm occurred after an initial improvement. The primary outcome was the change in the best-corrected visual acuity. Secondary outcomes included the proportion of eyes gaining at least 3 Early Treatment Diabetic Retinopathy Study lines, the change in the central foveal thickness, and the number of treatments. Mean best-corrected visual acuity changed significantly from 0.60 ± 0.38 LogMAR at baseline to 0.43 ± 0.48 at the 12-month examination (P = 0.03). Eight of 16 eyes (50%) gained 3 Early Treatment Diabetic Retinopathy Study lines. Mean central foveal thickness improved significantly from 705 ± 202 μm at baseline to 408 ± 196 μm at 12-month visit (P central retinal vein occlusion.

  18. EFFICACY AND FREQUENCY OF INTRAVITREAL AFLIBERCEPT VERSUS BEVACIZUMAB FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION.

    Science.gov (United States)

    Lotfy, Ayman; Solaiman, Kamal A M; Abdelrahman, Ayman; Samir, Ahmed

    2017-08-01

    To compare the safety, efficacy, and frequency of intravitreal injection of aflibercept and bevacizumab for treatment of macular edema secondary to central retinal vein occlusion. Prospective, comparative, randomized, interventional study. Eyes with macular edema secondary to central retinal vein occlusion were randomized between two groups according to the intravitreal injection used. Group A included eyes treated with intravitreal aflibercept, and Group B included eyes treated with intravitreal bevacizumab injections. The inclusion criteria were macular edema secondary to central retinal vein occlusion and follow-up duration of at least 12 months after the first injection. Exclusion criteria were macular ischemia, associated diabetes, hypertensive or renal retinopathy, other retinal disease, and previous anti-vascular endothelial growth factor injection. The main outcome measures are central foveal thickness, best-corrected visual acuity, time intervals between injections, improved retinal nonperfusion, and any reported complication. Group A included 39 patients with a mean age of 57.4 ± 8.2 years. Group B included 40 eyes with a mean age of 56.5 ± 9.1 years. Twelve months after the first injection, central foveal thickness significantly improved from 475.45 ± 71.05 m to 259.11 ± 20.67 m in Group A and from 460.22 ± 89.38 m to 264.29 ± 32.05 m in Group B; best-corrected visual acuity significantly improved from 0.81 ± 0.16 logarithm of the minimum angle of resolution (20/125) to 0.34 ± 0.14 logarithm of the minimum angle of resolution (20/40) in Group A and from 0.73 ± 0.15 logarithm of the minimum angle of resolution (20/100) to 0.33 ± 0.17 logarithm of the minimum angle of resolution (20/40) in Group B; the mean number of injections was 3.72 ± 2.93 in Group A and was 5.44 ± 2.85 in Group B (P Retinal nonperfusion improved in 9/12 eyes in Group A and in 3/8 eyes in Group B (P central retinal vein occlusion without significant complications. However

  19. Effect of retinal photocoagulation on intraretinal lipid exudates in diabetic macular edema documented by optical coherence tomography.

    Science.gov (United States)

    Deák, Gábor Gy; Bolz, Matthias; Kriechbaum, Katharina; Prager, Sonja; Mylonas, Georgios; Scholda, Christoph; Schmidt-Erfurth, Ursula

    2010-04-01

    To study the changes in the distribution and morphologic features of intraretinal microexudates after macular photocoagulation. Prospective cohort study. Thirteen treatment-naïve patients with clinically significant macular edema in type 2 diabetes. Patients were treated with focal macular photocoagulation. Changes in the localization of hyperreflective foci were analyzed by spectral domain (SD) optical coherence tomography (OCT) during follow-up at day 1, week 1, and months 1, 2, 3, and 4 in defined areas. Further, fundus photography and infrared imaging were performed at all visits and findings were correlated to OCT results. Changes in retinal morphologic features detected in OCT. A dynamic change in the distribution pattern of hyperreflective foci was observed over 4 months after the photocoagulation. With the decrease of retinal thickness, the dots either resolved completely or became confluent at the apical border of the outer nuclear layer, and finally formed ophthalmoscopically detectable hard exudates during extended follow-up. In the event of retinal thickening despite laser treatment, the hyperreflective dots maintained their previous distribution throughout all retinal layers. As a fourth response, dissemination of plaques of hard exudates into multiple, separate, hyperreflective foci were detected. Hyperreflective foci in the retina seem to represent precursors or components of hard exudates. Their specific localization depends greatly on the presence of microvascular extravasation and intraretinal fluid accumulation. Retinal photocoagulation has a major impact on retinal edema and subsequently on the distribution of intraretinal lipid deposits. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  20. Differences in aqueous concentrations of cytokines in macular edema secondary to branch and central retinal vein occlusion.

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    Jing Feng

    Full Text Available PURPOSE: This study investigates the differential aqueous concentrations of interleukin 6, 8, 1β (IL-6, IL-8, IL-1β, respectively, serum amyloid A (SAA, transforming growth factor (TGF-β, basic fibroblast growth factor (bFGF, and vascular endothelial growth factor (VEGF in eyes with macular edema as a result of a branch retinal vein occlusion (BRVO or central retinal vein occlusion (CRVO. PRINCIPAL FINDINGS: Significantly higher concentrations of IL-6, IL-8, IL-1β, TGF-β, bFGF, SAA, and VEGF were found in the aqueous humor of CRVO and BRVO patients than in the aqueous humor of control patients. A significant correlation was observed between the concentration of bFGF and the inner central macular thickness (CMT of BRVO patients (r = 0.688; P = 0.02. A significant correlation was observed between the concentration of SAA and both the full and outer CMT of the ischemic group (r = 0.545 and 0.683, respectively; P = 0.04 and 0.01, respectively. In the non-ischemic group, the level of IL-6 was significantly associated with inner CMT (r = 0.560; P = 0.03. The full and outer CMT was significantly reduced in CRVO patients when compared with BRVO patients (P = 0.02 and 0.02, respectively after injection of intravitreal bevacizumab (IVB at 4 weeks. SIGNIFICANCE: Serum amyloid A as a major protein involved in the acute and chronic stages of inflammation, and IL-6 and bFGF were significantly associated with the extent of macular edema in patients with RVO. Besides VEGF, other inflammatory cytokines and angiogenesic factors may be associated with RVO. This finding may have implications for the medical treatment of RVO.

  1. Distribution of intraretinal exudates in diabetic macular edema during anti-vascular endothelial growth factor therapy observed by spectral domain optical coherence tomography and fundus photography.

    Science.gov (United States)

    Pemp, Berthold; Deák, Gábor; Prager, Sonja; Mitsch, Christoph; Lammer, Jan; Schmidinger, Gerald; Scholda, Christoph; Schmidt-Erfurth, Ursula; Bolz, Matthias

    2014-12-01

    To evaluate changes in the distribution and morphology of intraretinal microexudates and hard exudates (HEs) during intravitreal anti-vascular endothelial growth factor therapy in patients with persistent diabetic macular edema. Twenty-four patients with persistent diabetic macular edema after photocoagulation were investigated in this prospective cohort study. Each eye was assigned to a loading dose of three anti-vascular endothelial growth factor treatments at monthly intervals. Additional single treatments were performed if diabetic macular edema persisted or recurred. Intraretinal exudates were analyzed over 6 months using spectral domain optical coherence tomography (SD-OCT) and fundus photography. Before treatment, microexudates were detected by SD-OCT as hyperreflective foci in 24 eyes, whereas HEs were seen in 22 eyes. During therapy, HE increased significantly in number and size. This was accompanied by accumulation of microexudates in the outer retina. Enlargement of hyperreflective structures in SD-OCT was accompanied by enlargement of HE at corresponding fundus locations. A rapid reduction in diabetic macular edema was seen in all patients, but to varying degrees. Patients with hemoglobin A1c levels exudates at corresponding locations in fundus photography and SD-OCT. Intraretinal aggregates of microexudates detectable as hyperreflective foci by SD-OCT may compose and precede HE before they become clinically visible.

  2. Comparing the effectiveness and costs of Bevacizumab to Ranibizumab in patients with Diabetic Macular Edema : a randomized clinical trial (the BRDME study)

    NARCIS (Netherlands)

    Schauwvlieghe, A M E; Dijkman, G; Hooymans, J M; Verbraak, F D; Hoyng, C B; Dijkgraaf, M G W; Van Leeuwen, R; Vingerling, J R; Moll, A C; Schlingemann, Reinier O

    2015-01-01

    BACKGROUND: The effectiveness of ranibizumab in the treatment of diabetic macular edema has been proven with large clinical trials. For bevacizumab only two clinical trials have been published and a head-to-head comparison is lacking to date. However, if proved non-inferior to ranibizumab, use of th

  3. Effect of ruboxistaurin in patients with diabetic macular edema : Thirty-month results of the randomized PKC-DMES clinical trial

    NARCIS (Netherlands)

    Aiello, Lloyd Paul; Ai, Everett; Aiello, Lloyd M.; Anand, Rajiv; Blumenkranz, Mark; Boyer, David; Brucker, Alexander J.; Chandler, Thomas; Chong, Lawrence; Connor, Thomas; Danis, Ron; Dehning, Doug; Dodson, Paul; Eaton, Alexander; Faber, David; Finkelstein, Dan; Forrester, John V.; Frank, Robert N.; Garcia, Charles; Gardner, Thomas W.; Gehrs, Karen M.; Goodart, Roy A.; Gottlieb, Justin; Greven, Craig M.; Guyer, David R.; Hainsworth, Dean; Hooper, Philip; Jackson, Willliam E.; Kinyoun, James L.; Kipnes, Mark; Klein, Michael L.; Kohner, Eva M.; Kuppermann, Baruch; Lewis, Hilel; Li, Helen K.; Lund-Anderson, Henrik; Ma, Colin; Martin, Daniel F.; Orellana, Juan; Paden, Philip Y.; Polak, Bettine; Ross, Stuart A.; Sharuk, George; Singerman, Lawrence J.; Smiddy, William E.; Trese, Michael; Tweeten, James P.; Vine, Andrew; Vora, Jiten; Wolffenbuttel, Bruce

    2007-01-01

    Objective: To evaluate the safety and efficacy of orally administered ruboxistaurin (RBX) as a mesylate salt in patients with diabetic macular edema (DME). 1 Design: Multicenter, double-masked, randomized, placebo-controlled study of 686 patients receiving placebo or RBX orally ( 4, 16, or 32 mg/d)

  4. Using Patient-Level Data to Develop Meaningful Cross-Trial Comparisons of Visual Impairment in Individuals with Diabetic Macular Edema

    DEFF Research Database (Denmark)

    Sivaprasad, Sobha; Regnier, Stephane A; Fajnkuchen, Franck

    2016-01-01

    INTRODUCTION: The aim of this study was to assess the impact of baseline characteristics on visual outcome of patients with diabetic macular edema and compare the results of clinical trials with different patient populations. METHODS: A model was created with patient-level data from the RESPOND...

  5. Comparing the effectiveness and costs of Bevacizumab to Ranibizumab in patients with Diabetic Macular Edema : a randomized clinical trial (the BRDME study)

    NARCIS (Netherlands)

    Schauwvlieghe, A. M. E.; Dijkman, G.; Hooymans, J. M.; Verbraak, F. D.; Hoyng, C. B.; Dijkgraaf, M. G. W.; Van Leeuwen, R.; Vingerling, J. R.; Moll, A. C.; Schlingemann, Reinier O.

    2015-01-01

    Background: The effectiveness of ranibizumab in the treatment of diabetic macular edema has been proven with large clinical trials. For bevacizumab only two clinical trials have been published and a head-to-head comparison is lacking to date. However, if proved non-inferior to ranibizumab, use of

  6. Effect of ruboxistaurin in patients with diabetic macular edema : Thirty-month results of the randomized PKC-DMES clinical trial

    NARCIS (Netherlands)

    Aiello, Lloyd Paul; Ai, Everett; Aiello, Lloyd M.; Anand, Rajiv; Blumenkranz, Mark; Boyer, David; Brucker, Alexander J.; Chandler, Thomas; Chong, Lawrence; Connor, Thomas; Danis, Ron; Dehning, Doug; Dodson, Paul; Eaton, Alexander; Faber, David; Finkelstein, Dan; Forrester, John V.; Frank, Robert N.; Garcia, Charles; Gardner, Thomas W.; Gehrs, Karen M.; Goodart, Roy A.; Gottlieb, Justin; Greven, Craig M.; Guyer, David R.; Hainsworth, Dean; Hooper, Philip; Jackson, Willliam E.; Kinyoun, James L.; Kipnes, Mark; Klein, Michael L.; Kohner, Eva M.; Kuppermann, Baruch; Lewis, Hilel; Li, Helen K.; Lund-Anderson, Henrik; Ma, Colin; Martin, Daniel F.; Orellana, Juan; Paden, Philip Y.; Polak, Bettine; Ross, Stuart A.; Sharuk, George; Singerman, Lawrence J.; Smiddy, William E.; Trese, Michael; Tweeten, James P.; Vine, Andrew; Vora, Jiten; Wolffenbuttel, Bruce

    Objective: To evaluate the safety and efficacy of orally administered ruboxistaurin (RBX) as a mesylate salt in patients with diabetic macular edema (DME). 1 Design: Multicenter, double-masked, randomized, placebo-controlled study of 686 patients receiving placebo or RBX orally ( 4, 16, or 32 mg/d)

  7. Effect of ruboxistaurin in patients with diabetic macular edema : Thirty-month results of the randomized PKC-DMES clinical trial

    NARCIS (Netherlands)

    Aiello, Lloyd Paul; Ai, Everett; Aiello, Lloyd M.; Anand, Rajiv; Blumenkranz, Mark; Boyer, David; Brucker, Alexander J.; Chandler, Thomas; Chong, Lawrence; Connor, Thomas; Danis, Ron; Dehning, Doug; Dodson, Paul; Eaton, Alexander; Faber, David; Finkelstein, Dan; Forrester, John V.; Frank, Robert N.; Garcia, Charles; Gardner, Thomas W.; Gehrs, Karen M.; Goodart, Roy A.; Gottlieb, Justin; Greven, Craig M.; Guyer, David R.; Hainsworth, Dean; Hooper, Philip; Jackson, Willliam E.; Kinyoun, James L.; Kipnes, Mark; Klein, Michael L.; Kohner, Eva M.; Kuppermann, Baruch; Lewis, Hilel; Li, Helen K.; Lund-Anderson, Henrik; Ma, Colin; Martin, Daniel F.; Orellana, Juan; Paden, Philip Y.; Polak, Bettine; Ross, Stuart A.; Sharuk, George; Singerman, Lawrence J.; Smiddy, William E.; Trese, Michael; Tweeten, James P.; Vine, Andrew; Vora, Jiten; Wolffenbuttel, Bruce

    2007-01-01

    Objective: To evaluate the safety and efficacy of orally administered ruboxistaurin (RBX) as a mesylate salt in patients with diabetic macular edema (DME). 1 Design: Multicenter, double-masked, randomized, placebo-controlled study of 686 patients receiving placebo or RBX orally ( 4, 16, or 32 mg/d)

  8. Preliminary results of an intravitreal dexamethasone implant (Ozurdex®) in patients with persistent diabetic macular edema

    Science.gov (United States)

    Pacella, Elena; Vestri, Anna Rita; Muscella, Roberto; Carbotti, Maria Rosaria; Castellucci, Massimo; Coi, Luigi; Turchetti, Paolo; Pacella, Fernanda

    2013-01-01

    Background To evaluate the efficacy and safety of an intravitreal dexamethasone implant (Ozurdex®; Allergan Inc, Irvine, CA, USA) in patients with persistent diabetic macular edema (DME) over a 6-month follow-up period. Methods Seventeen patients (20 eyes) affected by DME were selected. The mean age was 67 + 8 years, and the mean duration of DME was 46.3 + 18.6 months. The eligibility criteria were: age ≥ 18, a best-corrected visual acuity between 5 and 40 letters, and macular edema with a thickness of ≥275 μm. Thirteen patients had also previously been treated with anti-vascular endothelial growth factor medication. Results The mean ETDRS (Early Treatment Diabetic Retinopathy Study) value went from 18.80 + 11.06 (T0) to 26.15 + 11.03 (P = 0.04), 28.15 + 10.29 (P = 0.0087), 25.95 + 10.74 (P = 0.045), 21.25 + 11.46 (P = 0.5) in month 1, 3, 4, and 6, respectively. The mean logMAR (logarithm of the minimum angle of resolution) value went from 0.67 + 0.23 (at T0) to 0.525 + 0.190 (P = 0.03), 0.53 + 0.20 (P = 0.034), and 0.56 + 0.22 (P = 0.12) in month 1, 3, and 4, respectively, to finally reach 0.67 + 0.23 in month 6. The mean central macular thickness value improved from 518.80 + 224.75 μm (at T0) to 412.75 + 176.23 μm, 292.0 + 140.8 μm (P < 0.0001), and 346.95 + 135.70 (P = 0.0018) on day 3 and in month 1 and 3, respectively, to then increase to 476.55 + 163.14 μm (P = 0.45) and 494.25 + 182.70 μm (P = 0.67) in month 4 and 6. Conclusion The slow-release intravitreal dexamethasone implant, Ozurdex, produced significant improvements in best-corrected visual acuity and central macular thickness from the third day of implant in DME sufferers, and this improvement was sustained until the third month. PMID:23901252

  9. Defining Best Practice Standards for the Diagnosis and Management of Diabetic Retinopathy and Diabetic Macular Edema in Latin America

    Directory of Open Access Journals (Sweden)

    Patricio Schlottmann

    2014-10-01

    Full Text Available Purpose: To provide evidence-based recommendations and guidance for the management of diabetic retinopathy (DR and diabetic macular edema (DME based on recently published clinical evidence and clinical experience. Methods: A literature search using PubMed and the Cochrane Library was performed with the terms “diabetic macular edema” or “diabetic retinopathy” to identify studies published from January 2008 to November 2013. This was followed by a manual search of references cited in selected papers published in peer-reviewed journals. The references identified in these literature searches were reviewed and presented by members of the Latin America DME expert panel to the entire group during the 2-day consensus meeting. During this meeting,the experts formulated recommendations with consideration of the health benefits, risks, and adverse effects of interventions. References used to support recommendations were assigned a level of evidence based on the Strength of Recommendation Taxonomy (SORT evidence rating system. Results: Thirty-one consensus recommendations were formulated. These include the recommendation for early glycemic control in diabetic patients in order to reduce the risk of progression of ocular disease. The expert panel also recommended the collection of epidemiological data to further define the prevalence of DR and DME in Latin America and to establish management and treatment algorithms for various stages of the disease. The need for early screening and development of infrastructure to ensure appropriate followup and treatment of those in need is further emphasized. Both fluorescein angiography (FA and optical coherence tomography (OCT are needed for proper assessment of disease progression and response to therapy. Based on available high-level evidence, we recommend ranibizumab as the gold standard for the treatment of DME and panretinal photocoagulation (PRP as the gold standard for proliferative DR. Vitrectomy should

  10. Eplerenone, a new treatment for an old problem: Retinitis pigmentosa with recalcitrant macular edema.

    Science.gov (United States)

    Campos Polo, R; Rubio Sánchez, C; García Guisado, D M; Díaz Luque, M J

    2017-06-14

    The case involves a 35-year-old man, with a history of retinitis pigmentosa, who presented with a bilateral cystoid macular oedema associated with bilateral epiretinal membrane, which was resistant to treatment with oral acetazolamide and intravitreal bevacizumab. The treatment with oral eplerenone was able to improve the visual acuity and macular thickness of this patient. A variety of treatments have been proposed for the management of cystoid macular oedema, associated with retinitis pigmentosa, with variable results. The treatment with oral eplerenone might be a good option for the control of this condition. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Preliminary results of an intravitreal dexamethasone implant (Ozurdex® in patients with persistent diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Pacella E

    2013-07-01

    Full Text Available Elena Pacella,1 Anna Rita Vestri,2 Roberto Muscella,1 Maria Rosaria Carbotti,1 Massimo Castellucci,1 Luigi Coi,1 Paolo Turchetti,3 Fernanda Pacella1 1Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy; 2Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy; 3National Institute for Health, Migration and Poverty (INMP/NIHMP, Rome, ItalyBackground: To evaluate the efficacy and safety of an intravitreal dexamethasone implant (Ozurdex®; Allergan Inc, Irvine, CA, USA in patients with persistent diabetic macular edema (DME over a 6-month follow-up period.Methods: Seventeen patients (20 eyes affected by DME were selected. The mean age was 67 ± 8 years, and the mean duration of DME was 46.3 ± 18.6 months. The eligibility criteria were: age ≥18, a best-corrected visual acuity between 5 and 40 letters, and macular edema with a thickness of ≥275 μm. Thirteen patients had also previously been treated with anti-vascular endothelial growth factor medication.Results: The mean ETDRS (Early Treatment Diabetic Retinopathy Study value went from 18.80 ± 11.06 (T0 to 26.15 ± 11.03 (P = 0.04, 28.15 ± 10.29 (P = 0.0087, 25.95 ± 10.74 (P = 0.045, 21.25 ± 11.46 (P = 0.5 in month 1, 3, 4, and 6, respectively. The mean logMAR (logarithm of the minimum angle of resolution value went from 0.67 ± 0.23 (at T0 to 0.525 ± 0.190 (P = 0.03, 0.53 ± 0.20 (P = 0.034, and 0.56 ± 0.22 (P = 0.12 in month 1, 3, and 4, respectively, to finally reach 0.67 ± 0.23 in month 6. The mean central macular thickness value improved from 518.80 ± 224.75 μm (at T0 to 412.75 ± 176.23 μm, 292.0 ± 140.8 μm (P < 0.0001, and 346.95 ± 135.70 (P = 0.0018 on day 3 and in month 1 and 3, respectively, to then increase to 476.55 ± 163.14 μm (P = 0.45 and 494.25 ± 182.70 μm (P = 0.67 in month 4 and 6.Conclusion: The slow-release intravitreal dexamethasone

  12. Pain and accuracy of focal laser treatment for diabetic macular edema using a retinal navigated laser (Navilas®

    Directory of Open Access Journals (Sweden)

    Kampik A

    2012-02-01

    Full Text Available Marcus Kernt*, Raoul E Cheuteu*, Sarah Cserhati, Florian Seidensticker, Raffael G Liegl, Julian Lang, Christos Haritoglou, Anselm Kampik, Michael W Ulbig, Aljoscha S Neubauer Department of Ophthalmology, Ludwig Maximilian University of Munich, Germany*These authors contributed equally to this studyAim: To investigate treatment-related pain and the accuracy of navigated laser photocoagulation in the treatment of clinically significant macular edema.Methods: Focal laser treatment of diabetic macular edema in 54 consecutive patients was digitally planned on fundus images and performed using the navigated laser photocoagulation system Navilas® (OD-OS GmbH, Teltow, Germany. Treatment-related pain was quantified on a visual analog scale directly after treatment and compared with a matched control group who received conventional laser treatment (n = 46. In addition, for Navilas-treated patients, the accuracy of spot placement on color images was analyzed 1 month after treatment.Results: In total, 5423 laser spots (mean 100 per eye were analyzed. With navigated treatment, 90% of laser spots were visible on color images, of which 96% were within 100 µm from the target. Eighty percent of the laser spots were placed and visible within the 100 µm target on an intention-to-treat basis for color imaging. Optical coherence topography confirmed that laser effects were limited to the outer retina. Treatment-related pain following navigated laser photocoagulation was significantly lower than that of conventional laser treatment (1.6 vs 4.4 on a visual analog scale, P < 0.001.Conclusion: Navigated laser effects could be visualized to a high percentage on post-treatment color images, and their location showed a high concordance to targeted areas. Patients reported that treatment-related pain following Navilas laser photocoagulation was significantly lower than pain following conventional laser treatment.Keywords: diabetic retinopathy, navigated laser therapy

  13. Cystoid macular edema after cataract surgery in a patient with previous severe iritis following argon laser peripheral iridoplasty

    Directory of Open Access Journals (Sweden)

    Bagnis A

    2011-04-01

    Full Text Available Alessandro Bagnis1, Sergio Claudio Saccà2, Michele Iester1, Carlo Enrico Traverso11Centro di Ricerca Clinica e Laboratorio per il Glaucoma e la Cornea, Clinica Oculistica Di NOG, University of Genova, 2Division of Ophthalmology, St. Martino Hospital, Genova, ItalyAbstract: This report describes a patient who had exaggerated responses to different inflammatory stimuli represented by laser and incisional surgery, respectively. These separate episodes should have a common link represented by a genetic predisposition to abnormal release of proinflammatory mediators within the eye. This 51-year old Hispanic woman showed a narrow iridocorneal angle with plateau iris configuration. Nd-YAG laser peripheral iridotomy was successfully performed to both eyes. No substantial changes in the iridotrabecular angle occurred despite patent iridotomies, thus confirming the diagnosis of plateau iris configuration. Argon laser iridoplasty was then performed to the right eye, while the left eye was scheduled for a later session. A severe inflammatory reaction within the anterior chamber developed after tapering of a one-week course of steroid therapy. Phacoemulsification of the lens was performed some months later when no signs of inflammation were detectable; no intraoperative complications occurred during surgery and an intraocular lens was placed. Cystoid macular edema developed four weeks after surgery despite no apparent risk factors, and resolved completely after anti-inflammatory medical therapy. Based on this case report, the unusual occurrence of severe iritis after laser treatment should be regarded as a risk factor for any other incisional or nonincisional procedures because it might indicate that the patient's ocular tissues are prone to release of abnormally elevated proinflammatory mediators. Although further studies are needed to confirm this predisposition, prophylactic adjunctive topical nonsteroidal anti-inflammatory drug administration after

  14. Evaluation of efficacy dexamethasone intravitreal implant compared to treatment with anti-VEGF in the treatment of diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Elena Pacella

    2014-12-01

    Full Text Available Objective: The study compares the effectiveness of an intravitreal slow-release dexamethasone implant respect to an intravitreal injection of a anti-VEGF, ranibizumab, in the treatment of diabetic macular edema (DME. Design: we used a non randomized retrospective study to compare the effectiveness of two treatment approaches to DME Subjects: 50 patients were investigated, 30 of whom underwent injections of ranibizumab and 20 of whom underwent dexamethasone implantation. Methods: When patients were injected with the anti-VEGF ranibizumab, they were monitored every three months. Dexamethasone implant was administered only once in 6 months, different to ranibizumab which was administered monthly . Main Outcome Measures: these were carried out by measuring the improvements in ETDRS (visual acuity scores and CMT (central macular thickness after one month, three months, and six months (T1, T3, T6. intraocular pressure were performed. Results: Data evidenced that the slow-release dexamethasone implant is more efficacious than the intravitreal injection of the anti-VEGF, ranibizumab, in terms of improvement of visual acuity and central macular thickness. Dexamethasone implant at T3 produced an improvement of visual acuity which was significantly better respect to injections of ranibizumab, with a mean ETDRS gain of nearly 8,5 letters, compared to only 4 letters gained in the case of ranibizumab injected patients. This significance, however, is lost by T6, (p=0.516, where those treated with dexamethasone had lost 6 of the eight letters gained, while those with ranibizumab had lost 4 letters. As such, the overall gain at the T6 checkpoint was only 2.5 letters for dexamethasone implant and 2 for ranibizumab. Conclusion: The study highlighted a better initial efficacy of the dexamethasone implant due to its superior performance at 3 and 6 month evaluation points.

  15. Subthreshold diode-laser micropulse photocoagulation as a primary and secondary line of treatment in management of diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Othman IS

    2014-03-01

    Full Text Available Ihab Saad Othman,1 Sherif Ahmed Eissa,1 Mohamed S Kotb,1 Sherin Hassan Sadek21Cairo University, Cairo, 2Fayoum University, Al Fayoum, EgyptBackground: The purpose of this study was to evaluate subthreshold diode-laser micropulse (SDM photocoagulation as a primary and secondary line of treatment for clinically significant diabetic macular edema (CSDME.Methods: In this prospective nonrandomized case series, 220 cases of nonischemic CSDME were managed primarily and secondarily by SDM photocoagulation on a 15% duty cycle with a mean power of 828 mW and a spot size of 75–125 µm. SDM treatment was repeated at 3–4-month intervals if residual leakage was observed. Additional intravitreal pharmacologic therapy was used according to the response. Follow-up varied from 12 to 19 (mean 14±2.8 months. Novel software designed by the authors was used to record the subvisible threshold laser applications and their parameters on the fundus image of the eye. Evaluation of the results of treatment was done using fluorescein angiography and optical coherence tomography (OCT. Primary outcome measures included changes in visual acuity and foveal thickness at OCT. Secondary outcome measures included visual loss of one or more Snellen lines and laser scars detectable on fundus biomicroscopy or fluorescein angiography.Results: In the primary treatment group, there was significant improvement or stabilization of visual acuity after the first 3–4 months, which was stable thereafter. Visual acuity was stable in the secondary treatment group. A corresponding reduction of macular thickness on OCT was noted during the follow-up period in both groups. Additional therapy included repeat SDM photocoagulation, intravitreal injection of triamcinolone, and pars plana vitrectomy. Laser marks seen as changes in retinal pigment epithelium on fundus biomicroscopy and fluorescein angiography were noted in 3.3% and 5.7% of cases. Our novel software could accurately record the

  16. Intravitreal bevacizumab versus triamcinolone acetonide for macular edema due to branch retinal vein occlusion: a matched study

    Institute of Scientific and Technical Information of China (English)

    HOU Jing; TAO Yong; JIANG Yan-rong; LI Xiao-xin; GAO Lei

    2009-01-01

    Background Branch retinal vein occlusion (BRVO) is a common retinal vascular disorder of the elderly and both intravitreal triamcinolone acetonide (TA) and intravitreal bevacizumab were reported to be effective. The purpose of this study was to compare intravitreal bevacizumab with intravitreal TA for the treatment of macular edema resulting from BRVO.Methods The retrospectively comparative interventional study included a bevacizumab group of 34 BRVO patients (1.25 mg bevacizumab) and a TA group of 34 BRVO patients (4.0 mg TA), and the two groups were matched by baseline best corrected visual acuity (BCVA). Examinations were designed to be carried out at 1 day, 3 days, 1 month, 2 months, 3 months, 6 months and 1 year after each injection. The mean follow-up was (148.43±130.56) days. Main outcome parameters were BCVA and morphometric measurements of the macula obtained by optical coherence tomography.Results In all follow-ups, the mean changes of BCVA (LogMAR) between two groups were not significantly different (P >0.10). Similarly, the rates of patients who got BCVA improvement >2 lines or lost BCVA >2 lines were not significantly different, either (P >0.10). In both groups, compared with baseline, the mean central macular thickness (CMT) got reduction from 4 weeks to 1 year after initial injection, however, which lost statistical significance at 6-month follow-up in TA group (P=0.25) and lost significance at 3-month and 6-month follow-up in bevacizumab group (P=0.07, 0.21). The mean CMT between two groups differed at 3-month follow-up (P 0.40). In TA group, retinal pigment epithelium tear occurred in 1 eye at 8 weeks after initial injection and 12 eyes (35.3%) got intraocular pressure >21 mmHg. In bevacizumab group, no severe complications were observed.Conclusion For BRVO, intravitreal bevacizumab versus intravitreal TA causes a similar increase in visual acuity and reduction of macular edema (except 3-month follow-up) with minor complications during 1 year.

  17. Evaluation of the effectiveness and safety of glucocorticoids intravitreal implant therapy in macular edema due to retinal vein occlusion

    Directory of Open Access Journals (Sweden)

    Michalska-Małecka K

    2016-05-01

    Full Text Available Katarzyna Michalska-Małecka,1,2 Aneta Gaborek,2 Mariusz Nowak,3 Tomasz Halat,4 Mariola Pawłowska,2 Dorota Śpiewak2 1Department of Ophthalmology, School of Medicine in Katowice, Medical University of Silesia, Katowice, 2University Center of Ophthalmology and Oncology, Independent Public Clinical Hospital, Medical University of Silesia, Katowice, 3Pathophysiology Division, Department of Pathophysiology and Endocrinology, Medical University of Silesia, School of Medicine with Division of Density, Zabrze, 4Education and Medical Simulation Center, Medical University of Silesia, Katowice, Poland Abstract: The purpose of this study was to evaluate the impact of intravitreal dexamethasone implant (Ozurdex on macular morphology and functions in eyes with macular edema (ME secondary to retinal vein occlusion. Efficacy outcomes of the treatment were best-corrected visual acuity (BCVA and central retinal thickness (CRT. Safety outcomes were intraocular pressure and cornea endothelial cell density. The study was conducted by the prospective analysis on 36 patients (17 women and 19 men aged 28–77 years (the average age was 58±15 years treated with the injection of dexamethasone implant because of the persistent ME at the Department of Ophthalmology and Ophthalmology Outpatient Clinic of the University Centre of Ophthalmology and Oncology in Katowice. The studied group included 16 patients with central retinal vein occlusion (16 eyes, and 20 patients with branch retinal vein occlusion (20 eyes. We found a significant increase of BCVA after first, second, and third month of treatment. Six months after the treatment, BCVA decreased, although not significantly compared with the value obtained in the third month. Two months after the intravitreal implantation of dexamethasone delivery system, CRT was 338±163 µm and was significantly lower compared with pretreatment value. Between third and sixth month after the treatment, we found insignificant increase of

  18. The incidence of cystoid macular edema in patients with or without diabetes after uncomplicated phacoemulsification:A four-year study%糖尿病患者单纯超声乳化术后黄斑囊样水肿的发生率

    Institute of Scientific and Technical Information of China (English)

    Theodoros Mirachtsis; Konstantinos Markou; Eirini Georgiadou; Christos Sioulis; Simeon Lake; Vagia Moschou; Nick Georgiadis

    2016-01-01

    Abstract?AIM:To report the incidence of post-operative c ystoid macular edema ( pCME ) in patients with or without diabetes and its correlation with c umulative dissipated energy ( CDE ) and phaco -time after uncomplicated phacoemulsification.?METHODS:In the study 116 nondiabetic ( Group A) and 101 d iabetic patients ( Grou p B) underwent phacoemulsification.Preoperatively none of the groups ( A+B ) had signs of maculo pathy or diabetic macular edema documented by spectral-domain optical coherence tomography ( SD -OCT ) and fundus fluore scein angiography ( FFA ) . Phaco metrics were documented after surgery.FFA was performed two months after each operation . Patients with indications of pCME were reassessed with SD-OCT.?RESULTS: The incidence o fpCME after uncomplicated pha coemulsification was statistically significant difference between the two groups (15.8% in Group B versus 6.9%in Group A, P =0.03 <0.05).The subclinical pCME appeared in 19 out of 24 patients.There was a significant correlatio n between parametric values ( CDE, phaco -time, hardness of the lens ) and pCME occurrence. Glycosylated Hemoglobin ( HbA1c ) blood level s was statistically significant difference ( P =0.005 <0.05 ) between the patients who developed or not pCME. Cystoid mac ular edema did not correlate with the axial length of the eye.? CONCLUSION: There was statis itcally significant differen ce in the incidence of pCME after uneventful phacoemulsification between nondiabetic subjects and diabetics. Most of these patients with pCME had subclinical appearance.CDE and phaco-time data were important factors and predictors to pCME.Good glycemic controls prevent the incidence of pCME.%目的:调查无糖尿病和糖尿病患者单纯超声乳化术后黄斑囊样水肿( post-operative cystoid macular edema , pCME )的发生率及其与术中累积释放能量( cumulative dissipated energy,CDE)、超声乳化时间的关系。方法:研究纳入116

  19. Health-related quality of life, visual function and treatment satisfaction following intravitreal dexamethasone implant for diabetic macular edema

    Science.gov (United States)

    Ramu, Jayashree; Chatziralli, Irini; Yang, Yit; Menon, Geeta; Bailey, Clare; Eckstein, Michael; Hykin, Phil; Sivaprasad, Sobha

    2017-01-01

    Purpose The aim of this study was to explore and describe quantitatively patient-reported outcome measures (PROMs), ie, health-related quality of life (QoL), visual function and treatment satisfaction, in patients with diabetic macular edema (DME) receiving two different regimens of Ozurdex (intravitreal dexamethasone implant). Methods In this multicenter, prospective study, 100 patients with center-involving refractory DME were randomized 1:1 to either five monthly fixed dosing or optical coherence tomography (OCT)-guided pro re nata (PRN) regimen of dexamethasone intravitreal implant therapy. The primary outcome was the difference between arms in change in PROMs and health-related QoL from baseline to 12 months, as measured by the Retinopathy-Dependent Quality of Life (RetDQoL) questionnaire, Visual Function Questionnaire-25 (VFQ-25) and Retinopathy Treatment Satisfaction Questionnaire (RetTSQ). Results There was no statistically significant difference in the RetDQoL score and VFQ-25 score at month 12 compared to those at baseline, whereas the total mean RetTSQ score increased significantly at the exit visit. The two treatment arms did not differ significantly regarding the change in PROMs and health-related QoL questionnaires. Logistic regression analysis showed that visual acuity (VA) of ≥55 letters, central foveal thickness statistically significant improvement in treatment satisfaction, as measured by RetTSQ, in patients with DME treated with dexamethasone intravitreal implant, independent of the dose regimen, namely, fixed or PRN. However, it should be noted that the clinically meaningful change could not be assessed accurately, since no thresholds for clinically meaningful change currently exist for the RetTSQ. On the other hand, there was no significant change in health-related QoL, as measured using VFQ-25 and RetDQoL. Factors affecting the patients’ treatment satisfaction were the final VA, the central foveal thickness and the macular volume. PMID

  20. Evaluation of the effectiveness and safety of glucocorticoids intravitreal implant therapy in macular edema due to retinal vein occlusion.

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    Michalska-Małecka, Katarzyna; Gaborek, Aneta; Nowak, Mariusz; Halat, Tomasz; Pawłowska, Mariola; Śpiewak, Dorota

    2016-01-01

    The purpose of this study was to evaluate the impact of intravitreal dexamethasone implant (Ozurdex) on macular morphology and functions in eyes with macular edema (ME) secondary to retinal vein occlusion. Efficacy outcomes of the treatment were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety outcomes were intraocular pressure and cornea endothelial cell density. The study was conducted by the prospective analysis on 36 patients (17 women and 19 men) aged 28-77 years (the average age was 58±15 years) treated with the injection of dexamethasone implant because of the persistent ME at the Department of Ophthalmology and Ophthalmology Outpatient Clinic of the University Centre of Ophthalmology and Oncology in Katowice. The studied group included 16 patients with central retinal vein occlusion (16 eyes), and 20 patients with branch retinal vein occlusion (20 eyes). We found a significant increase of BCVA after first, second, and third month of treatment. Six months after the treatment, BCVA decreased, although not significantly compared with the value obtained in the third month. Two months after the intravitreal implantation of dexamethasone delivery system, CRT was 338±163 μm and was significantly lower compared with pretreatment value. Between third and sixth month after the treatment, we found insignificant increase of CRT compared with thickness observed in second month. Two months after the treatment, we found an increase in intraocular pressure in 36% of cases and a further decrease during the final visit 6 months after the treatment. During the treatment, there were no significant differences in endothelial cell density in branch retinal vein occlusion and central retinal vein occlusion. We found the intravitreal dexamethasone implant to be safe, well tolerated, and likely to lead to fast morphological and functional improvement of the macula and visual rehabilitation in patients with ME due to retinal vein occlusion.

  1. Intravítrea de acetato de triamcinolona en el edema macular secundario a oclusión venosa de rama retiniana

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    Silvio Llanes Domínguez

    Full Text Available Objetivos: evaluar los resultados del tratamiento de intravítrea de acetato de triamcinolona, en el edema macular secundario a oclusión de rama venosa retiniana. Métodos: estudio prospectivo, intervencional, no comparativo, que incluyó a 16 pacientes con edema macular secundario a oclusión de rama venosa retiniana. El tratamiento consistió en inyección intravítrea de triamcinolona (hasta 3 dosis y, de ponerse tercer retratamiento se realizó grid macular. La primera dosis se puso a los 3 meses de ocurrido el evento oclusivo y se les dio seguimiento por 12 meses. Se determinaron la mejor agudeza visual corregida, grosor foveal retinal y complicaciones. Resultados: se estudiaron 11 hombres (68,75 % y 5 mujeres (31,25 %, con promedio de 60,1 años de edad. Del total de pacientes, 8 requirieron 1 dosis (50 %, 5 necesitaron de 2 dosis (31,25 % y a 3 hubo de aplicarle 3 dosis (18,75 % más grid macular. La mejor agudeza visual con corrección inicial promedio fue de 0,29 (0,05-0,5 con una mejoría a 0,64 (0,05-1,0 a los 12 meses. El grosor foveal retinal inicial promedio fue de 551,38 (346-967 µm y disminuyó a 204,06 (112-449 µm, a los 12 meses. La complicación más frecuente fue la hipertensión ocular en 4 pacientes (25,0 % Conclusión: la inyección intravítrea de triamcinolona constituyó un tratamiento eficaz en el edema macular secundario a oclusión de rama venosa retiniana.

  2. Contralateral eye-to-eye comparison of intravitreal ranibizumab and a sustained-release dexamethasone intravitreal implant in recalcitrant diabetic macular edema

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    Thomas BJ

    2016-08-01

    Full Text Available Benjamin J Thomas, Yoshihiro Yonekawa, Jeremy D Wolfe, Tarek S Hassan Department of Vitreoretinal Surgery, William Beaumont Hospital, Royal Oak, MI, USA Objective: To compare the effects of intravitreal ranibizumab (RZB or dexamethasone (DEX intravitreal implant in cases of recalcitrant diabetic macular edema (DME.Methods: Retrospective, interventional study examining patients with symmetric bilateral, center-involved DME recalcitrant to treatment with RZB, who received DEX in one eye while the contralateral eye continued to receive RZB every 4–5 weeks for a study period of 3 months.Results: Eleven patients (22 eyes were included: mean logarithm of the minimal angle of resolution (logMAR visual acuity (VA for the DEX arm improved from 0.415 (standard deviation [SD] ±0.16 to 0.261 (SD ±0.18 at final evaluation, and mean central macular thickness (CMT improved from 461 µm (SD ±156 to 356 µm (SD ±110; net decrease: 105 µm, P=0.01. Mean logMAR VA for the RZB arm improved from 0.394 (SD ±0.31 to 0.269 (SD ±0.19 at final evaluation. Mean CMT improved from 421 µm (SD ±147 to 373 µm (SD ±129; net decrease: 48 µm, P=0.26.Conclusion: A subset of recalcitrant DME patients demonstrated significant CMT reduction and VA improvement after a single DEX injection. Keywords: aflibercept, bevacizumab, central macular thickness, macular edema, dexamethasone implant, diabetic macular edema, diabetic retinopathy, ranibizumab

  3. Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review.

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    Amelie Pielen

    Full Text Available BACKGROUND: Intravitreal agents have replaced observation in macular edema in central (CRVO and grid laser photocoagulation in branch retinal vein occlusion (BRVO. We conducted a systematic review to evaluate efficacy and safety outcomes of intravitreal therapies for macular edema in CRVO and BRVO. METHODS AND FINDINGS: MEDLINE, Embase, and the Cochrane Library were systematically searched for RCTs with no limitations of language and year of publication. 11 RCTs investigating anti-VEGF agents (ranibizumab, bevacizumab, aflibercept and steroids (triamcinolone, dexamethasone implant with a minimum follow-up of 1 year were evaluated. EFFICACY CRVO: Greatest gain in visual acuity after 12 months was observed both under aflibercept 2 mg: +16.2 letters (8.5 injections, and under bevacizumab 1.25 mg: +16.1 letters (8 injections. Ranibizumab 0.5 mg improved vision by +13.9 letters (8.8 injections. Triamcinolone 1 mg and 4 mg stabilized visual acuity at a lower injection frequency (-1.2 letters, 2 injections. BRVO: Ranibizumab 0.5 mg resulted in a visual acuity gain of +18.3 letters (8.4 injections. The effect of dexamethasone implant was transient after 1.9 implants in both indications. SAFETY: Serious ocular adverse events were rare, e.g., endophthalmitis occurred in 0.0-0.9%. Major differences were found in an indirect comparison between steroids and anti-VEGF agents for cataract progression (19.8-35.0% vs. 0.9-7.0% and in required treatment of increased intraocular pressure (7.0-41.0% vs. none. No major differences were identified in systemic adverse events. CONCLUSIONS: Anti-VEGF agents result in a promising gain of visual acuity, but require a high injection frequency. Dexamethasone implant might be an alternative, but comparison is impaired as the effect is temporary and it has not yet been tested in PRN regimen. The ocular risk profile seems to be favorable for anti-VEGF agents in comparison to steroids. Because comparative data from head

  4. Five-year outcomes of pars plana vitrectomy for macular edema associated with branch retinal vein occlusion

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    Nishida A

    2017-02-01

    Full Text Available Akihiro Nishida,1,2 Hiroshi Kojima,1,2 Takanori Kameda,1,2 Michiko Mandai,1,3 Yasuo Kurimoto1,2 1Department of Ophthalmology, Kobe City Medical Center General Hospital, 2Department of Ophthalmology, Institute of Biomedical Research and Innovation, 3Laboratory for Retinal Regeneration, RIKEN Center for Developmental Biology, Chuo-ku, Kobe, Hyogo, Japan Purpose: Long-term outcomes of pars plana vitrectomy (PPV for macular edema (ME associated with branch retinal vein occlusion (BRVO have been previously reported, but the studies did not report the number of additional treatments after surgery. During 5 years of follow-up, we therefore investigated the efficacy and safety of PPV for BRVO and evaluated the incidence of additional treatments. Methods: We retrospectively reviewed the medical records of 25 eyes of 24 patients who underwent PPV for ME associated with BRVO and were followed up for at least 5 years. Best-corrected visual acuity was measured, and foveal thickness was assessed by optical coherence tomography. Additional treatments were also investigated. Results: The logarithm of the minimal angle of resolution (logMAR improved from 0.53±0.23 at baseline to 0.16±0.25 at 5 years (P<0.0001. The foveal thickness decreased from 535±222 µm at baseline to 205±143 µm at 5 years (P<0.0001. For the eyes with residual ME, the following additional treatments were performed within 5 years of follow-up: sub-Tenon injection of triamcinolone acetonide in two eyes, intravitreal injection of bevacizumab in three eyes, grid laser photocoagulation in one eye, and direct photocoagulation of macroaneurysm in one eye. Additional surgeries were performed in two eyes: for one eye, phacoemulsification extraction of the ocular lens and intraocular lens implantation were performed because of cataract progression, and for the other eye, additional PPV was done for postoperative retinal detachment. Conclusion: PPV was effective for resolution of ME

  5. Intravitreal aflibercept injection for macular edema due to central retinal vein occlusion: two-year results from the COPERNICUS study.

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    Heier, Jeffrey S; Clark, W Lloyd; Boyer, David S; Brown, David M; Vitti, Robert; Berliner, Alyson J; Kazmi, Husain; Ma, Yu; Stemper, Brigitte; Zeitz, Oliver; Sandbrink, Rupert; Haller, Julia A

    2014-07-01

    To evaluate the efficacy and safety of intravitreal aflibercept injection (IAI) for the treatment of macular edema secondary to central retinal vein occlusion (CRVO). Randomized, double-masked, phase 3 trial. A total of 188 patients with macular edema secondary to CRVO. Patients received IAI 2 mg (IAI 2Q4) (n = 114) or sham injections (n = 74) every 4 weeks up to week 24. During weeks 24 to 52, patients from both arms were evaluated monthly and received IAI as needed, or pro re nata (PRN) (IAI 2Q4 + PRN and sham + IAI PRN). During weeks 52 to 100, patients were evaluated at least quarterly and received IAI PRN. The primary efficacy end point was the proportion of patients who gained ≥ 15 letters in best-corrected visual acuity (BCVA) from baseline to week 24. This study reports week 100 results. The proportion of patients gaining ≥ 15 letters was 56.1% versus 12.3% (Pcentral retinal thickness was 457.2 versus 144.8 μm (P<0.001) at week 24, 413.0 versus 381.8 μm at week 52 (P = 0.546), and 390.0 versus 343.3 μm at week 100 (P = 0.366) in the IAI 2Q4 + PRN and sham + IAI PRN groups, respectively. The mean number (standard deviation) of PRN injections in the IAI 2Q4 + PRN and sham + IAI PRN groups was 2.7 ± 1.7 versus 3.9 ± 2.0 during weeks 24 to 52 and 3.3 ± 2.1 versus 2.9 ± 2.0 during weeks 52 to 100, respectively. The most frequent ocular serious adverse event from baseline to week 100 was vitreous hemorrhage (0.9% vs. 6.8% in the IAI 2Q4 + PRN and sham + IAI PRN groups, respectively). The visual and anatomic improvements after fixed dosing through week 24 and PRN dosing with monthly monitoring from weeks 24 to 52 were diminished after continued PRN dosing, with a reduced monitoring frequency from weeks 52 to 100. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  6. Prospective study of intravitreal triamcinolone acetonide versus bevacizumab for macular edema secondary to central retinal vein occlusion.

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    Ding, Xiaoyan; Li, Jiaqing; Hu, Xuting; Yu, Shanshan; Pan, Jianying; Tang, Shibo

    2011-05-01

    To compare the efficacy and safety of intravitreal triamcinolone acetonide (IVT) versus intravitreal bevacizumab (IVB) for the treatment of macular edema (ME) secondary to central retinal vein occlusion. Prospective, consecutive, clinical interventional study. A total of 31 consecutive patients (32 eyes) with ME associated with central retinal vein occlusion were randomized to 2 groups. Sixteen eyes were treated with intravitreal injection of 4 mg/0.1 mL preservative-free triamcinolone acetonide; 16 eyes received IVB 1.25 mg/0.05 mL. Patients were given additional injections if they had ME as determined by optical coherence tomography 3 months after the first treatment or visual acuity loss of at least 2 lines in a Snellen chart. Best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, fundus fluorescein angiography, optical coherence tomography, the number of required injections, and adverse events were recorded during the 9-month follow-up period. Best-corrected visual acuity was significantly improved at 2 weeks and 1, 3, 6, and 9 months after injection in both the IVT and IVB groups, but no statistical difference was found between the 2 treatment groups during the 9-month follow-up period. The mean central macular thickness decreased at 1, 3, 6, and 9 months after injection within each treatment group, and no statistical difference was found between the 2 treatment groups at any time during the follow-up period (P > 0.05). Patients who received IVT treatment appeared to have quicker visual recovery and improved central macular thickness at Week 2 compared with those who received IVB treatment. Five of 16 eyes in the IVT group and 12 of 16 eyes in the IVB group required a repeated injection because of recurrent ME or unresolved intraretinal or subretinal fluid. The mean number of treatment was 1.31 ± 0.48 in the IVT group, as compared with 2.38 ± 1.04 in the IVB group. Significant intraocular pressure increase was found only in the IVT

  7. CHOROIDAL BLOOD FLOW AND THICKNESS AS PREDICTORS FOR RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION.

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    Okamoto, Masahiro; Yamashita, Mariko; Sakamoto, Taiji; Ogata, Nahoko

    2017-02-23

    To determine the choroidal blood flow and subfoveal choroidal thickness (SCT) in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). Thirty-two eyes of 32 patients with macular edema secondary to a BRVO were treated with a single intravitreal injection of ranibizumab (IVR) and were followed for 2 months. The central retinal thickness and SCT, and the retinal and choroidal blood flows were evaluated, and they were compared between the recurrent and resolved groups. At the baseline, the SCT of eyes with a BRVO was significantly thicker than that of the fellow eye (P retinal blood flow was found only after 1 week in the resolved group. The SCT and choroidal blood flow were significantly reduced during the follow-up period in the resolved group but not in the recurrent group. The choroid is involved in the pathology of BRVO and the SCT at the baseline may be a predictive factor in the treatment of intravitreal injection of ranibizumab for macular edema secondary to BRVO.

  8. Optic neuritis is associated with inner nuclear layer thickening and microcystic macular edema independently of multiple sclerosis.

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    Falko Kaufhold

    Full Text Available BACKGROUND: Microcystic macular edema (MME and inner nuclear layer thickening (INL were described in multiple sclerosis (MS and neuromyelitis optica (NMO patients using optical coherence tomography (OCT. The cause of these findings is currently unknown and a relation to inflammatory or degenerative processes in the optic nerve is discussed. OBJECTIVE: The aim of our study was to investigate whether INL thickening and MME are related to optic neuritis (ON in various neuro-inflammatory disorders causingON: MS, NMO and chronic inflammatory optic neuropathy. METHODS: We retrospectively analyzed data from 216 MS patients, 39 patients with a clinically isolated syndrome, 20 NMO spectrum disorder patients, 9 patients with chronic inflammatory optic neuropathy and 121 healthy subjects. Intra-retinal layer segmentation was performed for the eyes of patients with unilateral ON. Scanning laser ophthalmoscopy (SLO images were reviewed for characteristic ocular fundus changes. RESULTS: Intra-retinal layer segmentation showed that eyes with a history of ON displayed MME independent INL thickening compared to contralateral eyes without previous ON. MME was detected in 22 eyes from 15 patients (5.3% of all screened patients, including 7 patients with bilateral edema. Of these, 21 had a prior history of ON (95%. The SLO images of all 22 MME-affected eyes showed crescent-shaped texture changes which were visible in the perifoveal region. A second grader who was blinded to the results of the OCT classified all SLO images for the presence of these characteristic fundus changes. All MME eyes were correctly classified (sensitivity = 100% with high specificity (95.2%. CONCLUSION: This study shows that both MME and INL thickening occur in various neuro-inflammatory disorders associated with ON. We also demonstrate that detection and analysis of MME by OCT is not limited to B-scans, but also possible using SLO images.

  9. Multifractal geometry in analysis and processing of digital retinal photographs for early diagnosis of human diabetic macular edema.

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    Tălu, Stefan

    2013-07-01

    The purpose of this paper is to determine a quantitative assessment of the human retinal vascular network architecture for patients with diabetic macular edema (DME). Multifractal geometry and lacunarity parameters are used in this study. A set of 10 segmented and skeletonized human retinal images, corresponding to both normal (five images) and DME states of the retina (five images), from the DRIVE database was analyzed using the Image J software. Statistical analyses were performed using Microsoft Office Excel 2003 and GraphPad InStat software. The human retinal vascular network architecture has a multifractal geometry. The average of generalized dimensions (Dq) for q = 0, 1, 2 of the normal images (segmented versions), is similar to the DME cases (segmented versions). The average of generalized dimensions (Dq) for q = 0, 1 of the normal images (skeletonized versions), is slightly greater than the DME cases (skeletonized versions). However, the average of D2 for the normal images (skeletonized versions) is similar to the DME images. The average of lacunarity parameter, Λ, for the normal images (segmented and skeletonized versions) is slightly lower than the corresponding values for DME images (segmented and skeletonized versions). The multifractal and lacunarity analysis provides a non-invasive predictive complementary tool for an early diagnosis of patients with DME.

  10. High-Resolution En Face Images of Microcystic Macular Edema in Patients with Autosomal Dominant Optic Atrophy

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    Kiyoko Gocho

    2013-01-01

    Full Text Available The purpose of this study was to investigate the characteristics of microcystic macular edema (MME determined from the en face images obtained by an adaptive optics (AO fundus camera in patients with autosomal dominant optic atrophy (ADOA and to try to determine the mechanisms underlying the degeneration of the inner retinal cells and RNFL by using the advantage of AO. Six patients from 4 families with ADOA underwent detailed ophthalmic examinations including spectral domain optical coherence tomography (SD-OCT. Mutational screening of all coding and flanking intron sequences of the OPA1 gene was performed by DNA sequencing. SD-OCT showed a severe reduction in the retinal nerve fiber layer (RNFL thickness in all patients. A new splicing defect and two new frameshift mutations with premature termination of the Opa1 protein were identified in three families. A reported nonsense mutation was identified in one family. SD-OCT of one patient showed MME in the inner nuclear layer (INL of the retina. AO images showed microcysts in the en face images of the INL. Our data indicate that AO is a useful method to identify MME in neurodegenerative diseases and may also help determine the mechanisms underlying the degeneration of the inner retinal cells and RNFL.

  11. Anti-vascular endothelial growth factor pharmacotherapy for diabetic macular edema: a report by the American Academy of Ophthalmology.

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    Ho, Allen C; Scott, Ingrid U; Kim, Stephen J; Brown, Gary C; Brown, Melissa M; Ip, Michael S; Recchia, Franco M

    2012-10-01

    To review the evidence regarding the safety and efficacy of current anti-vascular endothelial growth factor (VEGF) pharmacotherapies for the treatment of diabetic macular edema (DME). Literature searches last were conducted in September 2011, in PubMed with no date restrictions, limited to articles published in English, and in the Cochrane Library without a language limitation. The combined searches yielded 532 citations, of which 45 were deemed clinically relevant for the authors to review in full text and to assign ratings of level of evidence to each of the selected studies with the guidance of the panel methodologists. At this time, there are 5 studies that provide level I evidence for intravitreal ranibizumab, alone or in combination with other treatments for DME. There is also 1 study that provides level I evidence for intravitreal pegaptanib sodium for DME. Nine studies reviewed were rated as level II, and 2 additional studies reviewed were graded as level III. Most studies do not provide information about long-term results (i.e., more than 2 years of follow-up) or the comparative efficacy of anti-VEGF pharmacotherapies. Review of the available literature indicates that anti-VEGF pharmacotherapy, delivered by intravitreal injection, is a safe and effective treatment over 2 years for DME. Further evidence is required to support the long-term safety of these pharmacotherapies and their comparative efficacy. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  12. Switching to Aflibercept in Diabetic Macular Edema Not Responding to Ranibizumab and/or Intravitreal Dexamethasone Implant

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    Antoine Herbaut

    2017-01-01

    Full Text Available Purpose. To assess short-term functional and anatomical outcomes of refractory diabetic macular edema (DME following a switch from ranibizumab or dexamethasone to aflibercept. Methods. We included retrospectively eyes with persistent DME after at least 3 ranibizumab and/or one dexamethasone implant intravitreal injections (IVI. The primary endpoint was the mean change in visual acuity (VA at month 6 (M6 after switching. Results. Twenty-five eyes were included. Before switching to aflibercept, 23 eyes received a median of 9.5 ranibizumab, and among them, 6 eyes received one dexamethasone implant after ranibizumab and 2 eyes received only one dexamethasone implant. Baseline VA, before any IVI, was 52.9 ± 16.5 letters, and preswitch VA was 57.1 ± 19.6 letters. The mean VA gain was +8 letters (p=0.01 between preswitch and M6. The mean central retinal thickness was 470.8 ± 129.9 μm before the switch and 303.3 ± 59.1 μm at M6 (p=0.001. Conclusion. Switching to aflibercept in refractory DME results in significant functional and anatomical improvement. The study was approved by the France Macula Federation ethical committee (FMF 2017-138.

  13. Comparison of dexamethasone intravitreal implant and intravitreal triamcinolone acetonide for the treatment of pseudophakic cystoid macular edema in diabetic patients

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    Dang Y

    2014-09-01

    Full Text Available Yalong Dang,1,* Yalin Mu,2,* Lin Li,3,* Yahui Mu,2 Shujing Liu,2 Chun Zhang,4 Yu Zhu,1 Yimin Xu4 1Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 2Department of Ophthalmology, Yellow River Hospital, Henan University of Science and Technology, Sanmenxia, Henan Province, 3Department of Ophthalmology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan Province, 4Department of Ophthalmology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China *These authors contributed equally to this work. Background and objective: Our objective was to investigate the efficacy and safety of dexamethasone (DEX implant for the treatment of pseudophakic cystoid macular edema (PCME in diabetic patients. Study design: This was a prospective, non-randomized, interventional case series of 43 participants. Eighteen patients were enrolled in the DEX implant group and 25 were enrolled in an intravitreal triamcinolone acetonide (IVTA group. Main outcome measures: The primary efficacy measurement was the percentage of patients who gained improvements of more than ten letters in best corrected visual acuity (BCVA during 6 months of follow-up. Other efficacy measurements included change in BCVA, change in central macular thickness (CMT, and number of retreatments. The primary safety evaluation was the percentage of patients with intraocular hypertension and variation in intraocular pressure (IOP during 6 months of follow-up. Other adverse events, such as conjunctival hemorrhage, eye pain, secondary infection, endophthalmitis, noninfectious inflammation, retinal detachment, and implant migration, were also recorded during follow-up. Results: At month 1, we observed that the percentage of patients gaining improvement of more than ten letters was similar in both groups (P=0.625. As patients in the IVTA group were retreated several times, this

  14. [Status of center point thickness and correlation between anatomic and best corrected visual acuity changes after photocoagulation, in diabetic macular edema].

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    Lima-Gómez, Virgilio; Razo Blanco-Hernández, Dulce Milagros

    2013-01-01

    Antecedentes: el grosor del punto central en pacientes con edema macular diabético cambia después del tratamiento, dependiendo del estado basal; se desconoce si esta variación reduce la correlación entre los cambios anatómicos y de capacidad visual. Objetivo: identificar la contribución del grosor del punto central basal a la correlación entre los cambios anatómicos y de capacidad visual, después de tratar el edema macular diabético. Material y métodos: estudio observacional, prospectivo, longitudinal y analítico, en diabéticos con edema macular tratados con fotocoagulación, estratificado por grupos: capacidad visual < 0.5 con (1) o sin engrosamiento central (2), y capacidad visual = 0.5 con (3) o sin engrosamiento central (4). Se identificó la correlación entre los cambios de grosor del punto central, volumen macular y capacidad visual (Spearman). Resultados: 79 ojos, 17 del grupo 1 (21.5%), 21 del 2 (26.6%), 14 del 3 (17.7%), 27 del 4 (34.2%). El grosor del punto central aumentó en los grupos 2 y 4, la capacidad visual disminuyó en el 3 y el volumen en todos. Las correlaciones entre el grosor del punto central y la capacidad visual en el grupo 3, y entre el volumen y la capacidad visual en el grupo 1 fueron negativas. La correlación de la muestra entre los cambios anatómicos y de capacidad visual fue baja (r= 0.14). Conclusiones: el aumento del grosor del punto central en ojos sin engrosamiento previo generó correlaciones opuestas entre grupos, y redujo la de la muestra. Estratificar conforme al grosor del punto central basal facilitaría identificar variables que afectan la respuesta terapéutica funcional.

  15. Morphological and electrophysiological outcome in prospective intravitreal bevacizumab treatment of macular edema secondary to central retinal vein occlusion.

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    Gardašević Topčić, Ivana; Šuštar, Maja; Brecelj, Jelka; Hawlina, Marko; Jaki Mekjavić, Polona

    2014-08-01

    To evaluate intravitreal bevacizumab (IVB) treatment in patients with central retinal vein occlusion (CRVO) by spectral domain optical coherence tomography (OCT) and electroretinography (ERG). Twenty-two CRVO patients were treated with IVB injections and followed for 1 year. Morphological effect of treatment was observed with fluorescent angiography and OCT. Functional effect was followed with best corrected visual acuity (BCVA) and ERG: combined rod-cone response of the standard full-field ERG (dark adapted 3.0 ERG), photopic negative response (PhNR), and pattern ERG (PERG). Best corrected visual acuity (BCVA) improved by 18.2 letters after 6 months (p ≤ 0.001) and additional 4.7 letters by the 12th month (p ≤ 0.001). The central retinal thickness of 829.8 ± 256.7 μm decreased to 398.8 ± 230 μm (p ≤ 0.001) after 6 months and to 303.7 ± 128.9 μm during the following 6 months (p ≤ 0.001). The total macular volume (14.4 ± 4.2 mm(3)) decreased to 9.6 ± 3.2 mm(3) and 8.5 ± 2.0 mm(3) after 6 months and 1 year of treatment, respectively (p ≤ 0.001). Electrophysiological measures improved significantly after 6 months and 1 year of treatment: the a-wave implicit time of dark adapted 3.0 ERG from 25.6 ± 2.3 to 24.1 ± 2.1 and 24.1 ± 2.0 ms (p ≤ 0.01); the PhNR from -5.9 ± 6.6 to -9.4 ± 6.1 and -10.4 ± 4.6 µV (p ≤ 0.05); the PERG P50 amplitude from 0.2 ± 0.3 to 0.9 ± 0.6 and 1.1 ± 0.6 µV (p ≤ 0.001); and N95 amplitude from 0.4 ± 0.6 to 1.2 ± 0.9 and 1.6 ± 0.9 µV (p ≤ 0.001). Intravitreal bevacizumab (IVB) treatment of macular edema due to CRVO improved standard morphological measures and the electrophysiological function of outer and inner retinal layers, which was most evident in central retina.

  16. Improvement of visual acuity based on optical coherence tomography patterns following intravitreal bevacizumab treatment in patients with diabetic macular edema

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    Haider R. Cheema

    2014-04-01

    Full Text Available AIM:To report the visual outcome based on various patterns of optical coherence tomography (OCT morphology in diabetic macular edema (DME, following treatment with anti-VEGF intravitreal bevacizumab (IVB injection.METHODS:Sixty-seven consecutive subjects with centre involving DME underwent intravitreal injection of Bevacizumab (1.25 mg/0.05 mL in this retrospective, comparative, non randomized study. The DME was classified into one of four categories:focal, diffuse, focal cystoid and neurosensory detachment based on OCT. Best corrected visual acuity (BCVA, macular appearance, and OCT findings were used to decide whether the subject should have a repeat injection of intravitreal bevacizumab. Outcome measures were a change in mean BCVA (Snellen converted to logMAR and central macular thickness (CMT in each group during the six month follow-up period.RESULTS:The mean BCVA improved to logMAR 0.23 at final follow-up from a baseline of 0.32 logMAR (P=0.040 in the focal group, logMAR 0.80 at final follow-up from a baseline of 0.82 logMAR (P=0.838 in the diffuse group, worsened to logMAR 0.53 at final follow-up from a baseline of 0.43 logMAR (P=0.276 in the focal cystoid group, and improved to logMAR 0.79 at final follow-up from a baseline of 0.93 logMAR (P=0.490 in the neurosensory detachment group. The mean CMT before treatment were 298.8±25.03 μm in the focal group, 310.8±40.6 μm in the diffuse group, 397.15±31.05 μm in the focal cystoid group and 401.03±75.1 μm in the neurosensory detachment group. A mean of 2.05 (range:1-5 injections in the focal group, 1.32 (range:1-2 in the diffuse group, 2.6 (range:1-6 in the focal cystoid group and 2.6 (range:1-6 in the neurosensory detachment group were performed during the six month follow-up period. Following intravitreal bevacizumab treatment, vision improved, remained unchanged or worsened in 11, 7 and 2 subjects in focal group; 11, 9 and 8 in diffuse group; 0, 2 and 4 in focal cystoid group and 5

  17. Platform-Independent Cirrus and Spectralis Thickness Measurements in Eyes with Diabetic Macular Edema Using Fully Automated Software.

    Science.gov (United States)

    Willoughby, Alex S; Chiu, Stephanie J; Silverman, Rachel K; Farsiu, Sina; Bailey, Clare; Wiley, Henry E; Ferris, Frederick L; Jaffe, Glenn J

    2017-02-01

    We determine whether the automated segmentation software, Duke Optical Coherence Tomography Retinal Analysis Program (DOCTRAP), can measure, in a platform-independent manner, retinal thickness on Cirrus and Spectralis spectral domain optical coherence tomography (SD-OCT) images in eyes with diabetic macular edema (DME) under treatment in a clinical trial. Automatic segmentation software was used to segment the internal limiting membrane (ILM), inner retinal pigment epithelium (RPE), and Bruch's membrane (BM) in SD-OCT images acquired by Cirrus and Spectralis commercial systems, from the same eye, on the same day during a clinical interventional DME trial. Mean retinal thickness differences were compared across commercial and DOCTRAP platforms using intraclass correlation (ICC) and Bland-Altman plots. The mean 1 mm central subfield thickness difference (standard error [SE]) comparing segmentation of Spectralis images with DOCTRAP versus HEYEX was 0.7 (0.3) μm (0.2 pixels). The corresponding values comparing segmentation of Cirrus images with DOCTRAP versus Cirrus software was 2.2 (0.7) μm. The mean 1 mm central subfield thickness difference (SE) comparing segmentation of Cirrus and Spectralis scan pairs with DOCTRAP using BM as the outer retinal boundary was -2.3 (0.9) μm compared to 2.8 (0.9) μm with inner RPE as the outer boundary. DOCTRAP segmentation of Cirrus and Spectralis images produces validated thickness measurements that are very similar to each other, and very similar to the values generated by the corresponding commercial software in eyes with treated DME. This software enables automatic total retinal thickness measurements across two OCT platforms, a process that is impractical to perform manually.

  18. Ranibizumab for Visual Impairment due to Diabetic Macular Edema: Real-World Evidence in the Italian Population (PRIDE Study

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    Ugo Menchini

    2015-01-01

    Full Text Available Purpose. An expanded access program (PRIDE study in Italy to provide ranibizumab 0.5 mg to diabetic macular edema (DME patients, prior to reimbursement. Methods. Open-label, prospective, phase IIIb study. Majority of patients were not treatment-naïve before enrollment. Patients received ranibizumab as per the EU label (2011. Safety was assessed by incidences of ocular/systemic adverse events (AEs and serious AEs (SAEs and efficacy in terms of visual acuity (VA change from baseline (decimal score or Snellen (20/value. Results. Overall, 515 patients (83.5% completed the study. In unilateral/bilateral patients, commonly observed AEs were cardiac disorders (1.3%/1.3% and nervous system disorders (1.3%/1.1%; SAEs were reported in 4.5%/4.8% of patients. Acute renal failure, lung carcinoma, and cardiac arrest were the causes of death in one unilateral and two bilateral patients. Ranibizumab improved/maintained VA (Snellen (20/value/decimal scores in both unilateral (up to −16.7/1.5 and bilateral patients (up to −23.6/1.2 at Month 5, with a mean of 4.15 and 4.40 injections, respectively. Overall, no difference was observed in the VA outcomes and treatment exposure between unilateral/bilateral patients. Conclusions. The PRIDE study provided early ranibizumab access to >600 Italian patients. Ranibizumab was well-tolerated and improved/maintained VA in 40.2%–68.8% patients, with no differences in case of unilateral or bilateral pathology. The study is registered with EudraCT.

  19. Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT

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    Vinicius F. Kniggendorf

    2016-06-01

    Full Text Available ABSTRACT Purpose: To evaluate choroidal thickness (CT using spectral domain optical coherence tomography (SD-OCT imaging at baseline and 6 months after intravitreal anti-vascular endothelial growth factor (anti-VEGF treatment in patients with diabetic macular edema (DME. Methods: A retrospective chart review was performed to identify patients with DME who underwent intravitreal injection of anti-VEGF (bevacizumab or ranibizumab in a pro re nata (PRN regimen. Subfoveal choroidal thickness was compared between values obtained at baseline and at 6-month follow-up visits. Results: Thirty-nine eyes (15 females, 24 males from 39 patients were enrolled (mean age, 62.43 ± 8.7 years; range, 44-79 years. Twenty-three and 16 eyes were treated with ranibizumab and bevacizumab respectively. The mean number of anti-VEGF injections was 2.28 ± 1.27 (range, 1-5. Mean nasal, subfoveal, and temporal choroidal thickness (CT measurements at baseline were 234.10 ± 8.63 µm, 246.89 ± 8.94 µm, and 238.12 ± 8.20 µm, respectively, and those at 6 months post-treatment were 210.46 ± 8.00 µm, 215.66 ± 8.29 µm, and 212.43 ± 8.14 µm, respectively. Significant differences in CT were observed between baseline and the 6-month follow-up at all measured points (p=0.0327. Conclusions: Over a 6-month period, the use of intravitreal anti-VEGF was associated with significant thinning of the choroid in patients with DME. The clinical significance of a thinner choroid in DME is currently unknown; however, it may contribute to long-term adverse effects on choroidal and retinal function, representing an area requiring future investigation.

  20. Five-year outcomes of pars plana vitrectomy for macular edema associated with branch retinal vein occlusion

    Science.gov (United States)

    Nishida, Akihiro; Kojima, Hiroshi; Kameda, Takanori; Mandai, Michiko; Kurimoto, Yasuo

    2017-01-01

    Purpose Long-term outcomes of pars plana vitrectomy (PPV) for macular edema (ME) associated with branch retinal vein occlusion (BRVO) have been previously reported, but the studies did not report the number of additional treatments after surgery. During 5 years of follow-up, we therefore investigated the efficacy and safety of PPV for BRVO and evaluated the incidence of additional treatments. Methods We retrospectively reviewed the medical records of 25 eyes of 24 patients who underwent PPV for ME associated with BRVO and were followed up for at least 5 years. Best-corrected visual acuity was measured, and foveal thickness was assessed by optical coherence tomography. Additional treatments were also investigated. Results The logarithm of the minimal angle of resolution (logMAR) improved from 0.53±0.23 at baseline to 0.16±0.25 at 5 years (P<0.0001). The foveal thickness decreased from 535±222 µm at baseline to 205±143 µm at 5 years (P<0.0001). For the eyes with residual ME, the following additional treatments were performed within 5 years of follow-up: sub-Tenon injection of triamcinolone acetonide in two eyes, intravitreal injection of bevacizumab in three eyes, grid laser photocoagulation in one eye, and direct photocoagulation of macroaneurysm in one eye. Additional surgeries were performed in two eyes: for one eye, phacoemulsification extraction of the ocular lens and intraocular lens implantation were performed because of cataract progression, and for the other eye, additional PPV was done for postoperative retinal detachment. Conclusion PPV was effective for resolution of ME associated with BRVO and improved visual acuity with a small number of additional treatments during long-term follow-up. PMID:28255227

  1. Differential systemic gene expression profile in patients with diabetic macular edema: Responders versus nonresponders to standard treatment

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    Supriya S Dabir

    2014-01-01

    Full Text Available Introduction: Diabetic macular edema (DME is a vision-threatening complication of diabetic retinopathy. The current practice of management is a" trial and error "method of using intravitreal antivascular endothelial growth factor (VEGF′′ or steroids to treat the patient and watch the response. However, if the patient′s genetic profile helps us choose appropriate medicine, it would help customize treatment option for each patient. This forms the basis of our study. Materials and Methods: A case-control, prospective, observational series, where DME patients were treated with bevacizumab and subclassified as treatment naοve, treatment responders, and treatment nonresponders. Blood samples of 20 subjects were studied, with five patients in each of the groups (nondiabetic- group 1, treatment naοve- group 2, treatment responder- group 3, and treatment nonresponder-group 4. Whole blood RNA extraction followed by labeling, amplification and hybridization was done, and microarray data analyzed. Genes were classified based on functional category and pathways. Results: The total number of genes upregulated among all three experimental groups was 5, whereas 105 genes were downregulated. There were no common genes upregulated between the responders and nonresponders. There was only one gene upregulated between the diabetic and diabetic responders posttreatment. There were 19 genes upregulated and 8 genes downregulated in the inflammatory pathway in group 2 versus group 1. There were no downregulated genes detected in vascular angiogenesis and transcription group. There were identical numbers of genes up- and downregulated in the inflammatory pathway. Seventeen genes were upreguated and 11 genes downregulated in receptor activity, which remained the predominant group in the group classification. Discussion: In summary, this study would provide an insight into the probable signaling mechanisms for disease pathogenesis as well as progression. This type

  2. Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1)

    Science.gov (United States)

    Blinder, Kevin J; Dugel, Pravin U; Chen, Sanford; Jumper, J Michael; Walt, John G; Hollander, David A; Scott, Lanita C

    2017-01-01

    Purpose To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) inhibitors as used in clinical practice for the treatment of diabetic macular edema. Methods Multicenter (10 sites), retrospective chart review in patients (n=156) who received ≥3 anti-VEGF injections. Data collected for ≥6 months after the first injection included Snellen best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by time-domain or spectral-domain optical coherence tomography (TD-OCT or SD-OCT). Results Mean number of anti-VEGF injections (627 bevacizumab, 594 ranibizumab, 1 aflibercept) was 5.8 (year 1), 5.0 (year 2), and 3.4 (year 3). Percentage of patients with BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) ranged from 16.4% to 38.9% after the first 10 injections; 51.9%–62.3% achieved ≥20/40 BCVA and 26.2%–48.0% met CRT criteria. Therapy was well tolerated with 19 treatment-related adverse events (all ocular) reported. Conclusion Anti-VEGF injections were administered less frequently and were less effective than those in the ranibizumab registration trials. After each of the first 9 injections, <25% of patients achieved both BCVA of 20/40 or better and a dry macula. A substantial proportion of patients are suboptimal responders to anti-VEGF therapy; these patients may be candidates for other therapies, including intravitreal corticosteroid and laser therapy.

  3. Development of a semi-automatic segmentation method for retinal OCT images tested in patients with diabetic macular edema.

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    Yijun Huang

    Full Text Available PURPOSE: To develop EdgeSelect, a semi-automatic method for the segmentation of retinal layers in spectral domain optical coherence tomography images, and to compare the segmentation results with a manual method. METHODS: SD-OCT (Heidelberg Spectralis scans of 28 eyes (24 patients with diabetic macular edema and 4 normal subjects were imported into a customized MATLAB application, and were manually segmented by three graders at the layers corresponding to the inner limiting membrane (ILM, the inner segment/ellipsoid interface (ISe, the retinal/retinal pigment epithelium interface (RPE, and the Bruch's membrane (BM. The scans were then segmented independently by the same graders using EdgeSelect, a semi-automated method allowing the graders to guide/correct the layer segmentation interactively. The inter-grader reproducibility and agreement in locating the layer positions between the manual and EdgeSelect methods were assessed and compared using the Wilcoxon signed rank test. RESULTS: The inter-grader reproducibility using the EdgeSelect method for retinal layers varied from 0.15 to 1.21 µm, smaller than those using the manual method (3.36-6.43 µm. The Wilcoxon test indicated the EdgeSelect method had significantly better reproducibility than the manual method. The agreement between the manual and EdgeSelect methods in locating retinal layers ranged from 0.08 to 1.32 µm. There were small differences between the two methods in locating the ILM (p = 0.012 and BM layers (p<0.001, but these were statistically indistinguishable in locating the ISe (p = 0.896 and RPE layers (p = 0.771. CONCLUSIONS: The EdgeSelect method resulted in better reproducibility and good agreement with a manual method in a set of eyes of normal subjects and with retinal disease, suggesting that this approach is feasible for OCT image analysis in clinical trials.

  4. Cystoid macular edema after cataract surgery in a patient with previous severe iritis following argon laser peripheral iridoplasty.

    Science.gov (United States)

    Bagnis, Alessandro; Saccà, Sergio Claudio; Iester, Michele; Traverso, Carlo Enrico

    2011-01-01

    This report describes a patient who had exaggerated responses to different inflammatory stimuli represented by laser and incisional surgery, respectively. These separate episodes should have a common link represented by a genetic predisposition to abnormal release of proinflammatory mediators within the eye. This 51-year old Hispanic woman showed a narrow iridocorneal angle with plateau iris configuration. Nd-YAG laser peripheral iridotomy was successfully performed to both eyes. No substantial changes in the iridotrabecular angle occurred despite patent iridotomies, thus confirming the diagnosis of plateau iris configuration. Argon laser iridoplasty was then performed to the right eye, while the left eye was scheduled for a later session. A severe inflammatory reaction within the anterior chamber developed after tapering of a one-week course of steroid therapy. Phacoemulsification of the lens was performed some months later when no signs of inflammation were detectable; no intraoperative complications occurred during surgery and an intraocular lens was placed. Cystoid macular edema developed four weeks after surgery despite no apparent risk factors, and resolved completely after anti-inflammatory medical therapy. Based on this case report, the unusual occurrence of severe iritis after laser treatment should be regarded as a risk factor for any other incisional or nonincisional procedures because it might indicate that the patient's ocular tissues are prone to release of abnormally elevated proinflammatory mediators. Although further studies are needed to confirm this predisposition, prophylactic adjunctive topical nonsteroidal anti-inflammatory drug administration after cataract surgery should be considered in such cases in order to prevent potentially sight-threatening conditions.

  5. Platform-Independent Cirrus and Spectralis Thickness Measurements in Eyes with Diabetic Macular Edema Using Fully Automated Software

    Science.gov (United States)

    Willoughby, Alex S.; Chiu, Stephanie J.; Silverman, Rachel K.; Farsiu, Sina; Bailey, Clare; Wiley, Henry E.; Ferris, Frederick L.; Jaffe, Glenn J.

    2017-01-01

    Purpose We determine whether the automated segmentation software, Duke Optical Coherence Tomography Retinal Analysis Program (DOCTRAP), can measure, in a platform-independent manner, retinal thickness on Cirrus and Spectralis spectral domain optical coherence tomography (SD-OCT) images in eyes with diabetic macular edema (DME) under treatment in a clinical trial. Methods Automatic segmentation software was used to segment the internal limiting membrane (ILM), inner retinal pigment epithelium (RPE), and Bruch's membrane (BM) in SD-OCT images acquired by Cirrus and Spectralis commercial systems, from the same eye, on the same day during a clinical interventional DME trial. Mean retinal thickness differences were compared across commercial and DOCTRAP platforms using intraclass correlation (ICC) and Bland-Altman plots. Results The mean 1 mm central subfield thickness difference (standard error [SE]) comparing segmentation of Spectralis images with DOCTRAP versus HEYEX was 0.7 (0.3) μm (0.2 pixels). The corresponding values comparing segmentation of Cirrus images with DOCTRAP versus Cirrus software was 2.2 (0.7) μm. The mean 1 mm central subfield thickness difference (SE) comparing segmentation of Cirrus and Spectralis scan pairs with DOCTRAP using BM as the outer retinal boundary was −2.3 (0.9) μm compared to 2.8 (0.9) μm with inner RPE as the outer boundary. Conclusions DOCTRAP segmentation of Cirrus and Spectralis images produces validated thickness measurements that are very similar to each other, and very similar to the values generated by the corresponding commercial software in eyes with treated DME. Translational Relevance This software enables automatic total retinal thickness measurements across two OCT platforms, a process that is impractical to perform manually. PMID:28180033

  6. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema.

    Science.gov (United States)

    Elman, Michael J; Aiello, Lloyd Paul; Beck, Roy W; Bressler, Neil M; Bressler, Susan B; Edwards, Allison R; Ferris, Frederick L; Friedman, Scott M; Glassman, Adam R; Miller, Kellee M; Scott, Ingrid U; Stockdale, Cynthia R; Sun, Jennifer K

    2010-06-01

    Evaluate intravitreal 0.5 mg ranibizumab or 4 mg triamcinolone combined with focal/grid laser compared with focal/grid laser alone for treatment of diabetic macular edema (DME). Multicenter, randomized clinical trial. A total of 854 study eyes of 691 participants with visual acuity (approximate Snellen equivalent) of 20/32 to 20/320 and DME involving the fovea. Eyes were randomized to sham injection + prompt laser (n=293), 0.5 mg ranibizumab + prompt laser (n=187), 0.5 mg ranibizumab + deferred (> or =24 weeks) laser (n=188), or 4 mg triamcinolone + prompt laser (n=186). Retreatment followed an algorithm facilitated by a web-based, real-time data-entry system. Best-corrected visual acuity and safety at 1 year. The 1-year mean change (+/-standard deviation) in the visual acuity letter score from baseline was significantly greater in the ranibizumab + prompt laser group (+9+/-11, Peyes at baseline (n=273), visual acuity improvement in the triamcinolone + prompt laser group appeared comparable to that in the ranibizumab groups. No systemic events attributable to study treatment were apparent. Three eyes (0.8%) had injection-related endophthalmitis in the ranibizumab groups, whereas elevated intraocular pressure and cataract surgery were more frequent in the triamcinolone + prompt laser group. Two-year visual acuity outcomes were similar to 1-year outcomes. Intravitreal ranibizumab with prompt or deferred laser is more effective through at least 1 year compared with prompt laser alone for the treatment of DME involving the central macula. Ranibizumab as applied in this study, although uncommonly associated with endophthalmitis, should be considered for patients with DME and characteristics similar to those in this clinical trial. In pseudophakic eyes, intravitreal triamcinolone + prompt laser seems more effective than laser alone but frequently increases the risk of intraocular pressure elevation. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier

  7. Cystoid macular edema after cataract surgery in a patient with previous severe iritis following argon laser peripheral iridoplasty

    Science.gov (United States)

    Bagnis, Alessandro; Saccà, Sergio Claudio; Iester, Michele; Traverso, Carlo Enrico

    2011-01-01

    This report describes a patient who had exaggerated responses to different inflammatory stimuli represented by laser and incisional surgery, respectively. These separate episodes should have a common link represented by a genetic predisposition to abnormal release of proinflammatory mediators within the eye. This 51-year old Hispanic woman showed a narrow iridocorneal angle with plateau iris configuration. Nd-YAG laser peripheral iridotomy was successfully performed to both eyes. No substantial changes in the iridotrabecular angle occurred despite patent iridotomies, thus confirming the diagnosis of plateau iris configuration. Argon laser iridoplasty was then performed to the right eye, while the left eye was scheduled for a later session. A severe inflammatory reaction within the anterior chamber developed after tapering of a one-week course of steroid therapy. Phacoemulsification of the lens was performed some months later when no signs of inflammation were detectable; no intraoperative complications occurred during surgery and an intraocular lens was placed. Cystoid macular edema developed four weeks after surgery despite no apparent risk factors, and resolved completely after anti-inflammatory medical therapy. Based on this case report, the unusual occurrence of severe iritis after laser treatment should be regarded as a risk factor for any other incisional or nonincisional procedures because it might indicate that the patient’s ocular tissues are prone to release of abnormally elevated proinflammatory mediators. Although further studies are needed to confirm this predisposition, prophylactic adjunctive topical nonsteroidal anti-inflammatory drug administration after cataract surgery should be considered in such cases in order to prevent potentially sight-threatening conditions. PMID:21573094

  8. Injeção intravítrea de cetorolaco de trometamina em pacientes com edema macular diabético refratário à fotocoagulacão retiniana Intravitreal injection of ketorolac tromethamine in patients with diabetic macular edema refractory to retinal photocoagulation

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    Andreia do Ceu Afonso Reis

    2010-08-01

    Full Text Available OBJETIVO: Avaliar o efeito em curto prazo da injeção intravítrea de cetorolaco de trometamina (500 µg/0,1ml em pacientes com edema macular diabético refratário à fotocoagulação retiniana. MÉTODOS: Estudo prospectivo. Foram selecionados 20 pacientes com edema macular diabético refratário à fotocoagulação retiniana em ambos os olhos e apresentando acuidade visual (ETDRS entre 20/50 e 20/200. Foi injetado em um olho de cada paciente, pela via intravítrea, 500 µg em 0,1 ml de cetorolaco de trometamina, sem conservante. O olho contralateral serviu de controle. Exames oftalmológicos, que incluíram a acuidade visual (ETDRS com melhor correção, a aferição da pressão intraocular e a tomografia de coerência óptica, foram realizados em 3 etapas: antes da aplicação, após uma semana e, posteriormente após um mês do tratamento. RESULTADOS: Houve diferença estatisticamente significativa na acuidade visual (ETDRS ao longo do tempo, havendo uma melhora na visão do olho tratado (p=0,039 quando comparado com o olho contralateral. Não foram encontradas diferenças estatisticamente significativas na avaliação da pressão intraocular (p=0,99, espessura foveal (p=0,86 e volume macular total (p=0,23 no decorrer do período. CONCLUSÃO: Pacientes com edema macular diabético refratário à fotocoagulação apresentaram melhora da acuidade visual ao longo de um mês com diferença estatisticamente significativa quando comparados com o olho controle. Não foram encontradas diferenças estatisticamente significativas na pressão intraocular, espessura foveolar e volume macular total entre os olhos tratados e os olhos controle.PURPOSE: To evaluate the effect of a single dose of intravitreous injection of ketorolac tromethamine (500 µg/0.1 ml in patients with diabetic macular edema refractory to retinal photocoagulation. METHODS: Prospective study. Twenty patients with bilateral diabetic macular edema and ETDRS best-corrected visual

  9. Injeção intravítrea de cetorolaco de trometamina em pacientes com edema macular diabético refratário à fotocoagulacão retiniana Intravitreal injection of ketorolac tromethamine in patients with diabetic macular edema refractory to retinal photocoagulation

    OpenAIRE

    2010-01-01

    OBJETIVO: Avaliar o efeito em curto prazo da injeção intravítrea de cetorolaco de trometamina (500 µg/0,1ml) em pacientes com edema macular diabético refratário à fotocoagulação retiniana. MÉTODOS: Estudo prospectivo. Foram selecionados 20 pacientes com edema macular diabético refratário à fotocoagulação retiniana em ambos os olhos e apresentando acuidade visual (ETDRS) entre 20/50 e 20/200. Foi injetado em um olho de cada paciente, pela via intravítrea, 500 µg em 0,1 ml de cetorolaco de trom...

  10. Avaliação da acuidade visual e da pressão intraocular no tratamento do edema macular diabético com triancinolona intravítrea Study of visual acuity and intraocular pressure in the treatment of macular diabetic edema with intravitreous triamcinolone

    Directory of Open Access Journals (Sweden)

    Marcussi Palata Rezende

    2010-04-01

    Full Text Available OBJETIVOS: Avaliar os efeitos do acetato de triancinolona intravítreo em pacientes com edema macular diabético difuso na acuidade visual e pressão intraocular. Relatar os possíveis efeitos adversos e analisar a possível relação da idade dos pacientes com as variações da acuidade visual e pressão intraocular. MÉTODOS: O ensaio clínico controlado incluiu 14 pacientes (28 olhos, sendo que 14 olhos receberam injeção de 4 mg de acetato de triancinolona intravítreo para o tratamento de edema macular diabético difuso. O grupo tratado foi comparado a um grupo controle de 14 olhos sem edema macular diabético difuso. O tempo de seguimento foi de três meses. RESULTADOS: Os picos de pressão intraocular >21 mmHg ocorreram em 28,57%, com diferença significante entre a pressão intraocular do grupo tratado com o grupo controle na primeira semana após o tratamento. A acuidade visual mostrou uma significativa melhora quando comparada com o grupo controle desde o segundo dia após o tratamento. Não houve associação entre a idade com as variações da acuidade visual e a pressão intraocular. CONCLUSÃO: O acetato de triancinolona intravítreo mostrou-se ser eficiente para melhorar a acuidade visual em pacientes com edema macular diabético difuso, nos primeiros três meses de tratamento. A incidência de hipertensão intraocular foi de 28,57%, podendo ser caracterizada como de fácil controle.PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide in patients with diffuse diabetic macular edema on the visual acuity and intraocular pressure. To report the potential adverse events and to analyze the potential relationship between age and visual acuity and intraocular pressure variability. METHODS: This clinical controlled study included 14 patients (28 eyes, 14 of the eyes received an intravitreal injection of 4 mg triamcinolone acetonide for the treatment of diabetic macular edema. The study group was compared to a control

  11. Intravitreal aflibercept injection for macular edema secondary to central retinal vein occlusion: 1-year results from the phase 3 COPERNICUS study.

    Science.gov (United States)

    Brown, David M; Heier, Jeffrey S; Clark, W Lloyd; Boyer, David S; Vitti, Robert; Berliner, Alyson J; Zeitz, Oliver; Sandbrink, Rupert; Zhu, Xiaoping; Haller, Julia A

    2013-03-01

    To evaluate intravitreal aflibercept injections (IAI; also called VEGF Trap-Eye) for patients with macular edema secondary to central retinal vein occlusion (CRVO). Randomized controlled trial. This multicenter study randomized 189 patients (1 eye/patient) with macular edema secondary to CRVO to receive 6 monthly injections of either 2 mg intravitreal aflibercept (IAI 2Q4) (n = 115) or sham (n = 74). From week 24 to week 52, all patients received 2 mg intravitreal aflibercept as needed (IAI 2Q4 + PRN and sham + IAI PRN) according to retreatment criteria. The primary endpoint was the proportion of patients who gained ≥15 ETDRS letters from baseline at week 24. Additional endpoints included visual, anatomic, and quality-of-life NEI VFQ-25 outcomes at weeks 24 and 52. At week 24, 56.1% of IAI 2Q4 patients gained ≥15 letters from baseline compared with 12.3% of sham patients (P < .001). At week 52, 55.3% of IAI 2Q4 + PRN patients gained ≥15 letters compared with 30.1% of sham + IAI PRN patients (P < .001). At week 52, IAI 2Q4 + PRN patients gained a mean of 16.2 letters of vision vs 3.8 letters for sham + IAI PRN (P < .001). The most common adverse events for both groups were conjunctival hemorrhage, eye pain, reduced visual acuity, and increased intraocular pressure. Monthly injections of 2 mg intravitreal aflibercept for patients with macular edema secondary to CRVO resulted in a statistically significant improvement in visual acuity at week 24, which was largely maintained through week 52 with intravitreal aflibercept PRN dosing. Intravitreal aflibercept injection was generally well tolerated. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Prevalence of Clinically Significant Macular Edema [CSME] among Glitazone users and Non- users of type-2 DM patients with Diabetic Retinopathy

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    Arulanandham A

    2012-06-01

    Full Text Available A comparative, Non - randomized, Prospective, Cohort Study was conducted with the intention to identify the association of existence of Clinically Significant Macular Edema (CSME with Thiazolidinedione (Glitazone use among type-2 Diabetes Mellitus patients with Diabetic Retinopathy (DR; which was carried out for a period of 3 years at Retina Vitreous clinic of Aravind Eye Hospital, Madurai. A total of 100 subjects of Diabetic Mellitus with Diabetic Retinopathy are enrolled with Inclusion and exclusion criteria as per protocol. Among two arms; Group 1 (N=50 is Glitazone users & Group 2 (N=50 is Non-Users. Bilateral Retinal evaluation done for Diabetic retinopathy and Macular edema (ME through slit lamp biomicroscopy for grading Clinically Significant Macular Edema and its prevalence. The overall Prevalence of CSME in the population is 37% in Glitazone users which states that the exposure group is at higher risk rate for getting CSME than did the Glitazone Non- User group Subjects. The Relative Risk Ratio (RR by Fisher’s Exact Test done through 2*2 contingency table for the cohort data is 1.423. Statistically analyzed in Graph pad version 3 for the 2 X 2 contingency table for calculating Relative Risk ratio by Fisher’s Exact test in 2 sided method. The Relative Risk ratio is greater than 1 which signifies that the Glitazone exposure group had the higher risk of getting CSME when compared to Glitazone non users. Usage of Thiazolidinediones at the optimal doses will help in preventing hyperglycemia and also dose related adverse effect such as CSME. Therefore rational use of the Glitazones among Diabetic mellitus patients is advisable.

  13. Tomografía óptica espectral no midriática para el diagnóstico precoz del edema macular diabético

    OpenAIRE

    Lara Medina, Francisco Javier

    2010-01-01

    Los tomógrafos de coherencia óptica de dominio espectral son instrumentos adecuados para realizar un rastreo y monitorización del edema macular diabético, utilizados tanto en condiciones de midriasis farmacológica como sin dilatación pupilar. Por ello, podrían ser incorporados en un futuro en protocolos de teleoftalmología para el control de esta enfermedad. Los OCT de dominio espectral han presentado una menor tasa de fracaso en la detección del engrosamiento retiniano que los métodos basado...

  14. Effect of Bevacizumab vs Aflibercept on Visual Acuity Among Patients With Macular Edema Due to Central Retinal Vein Occlusion: The SCORE2 Randomized Clinical Trial.

    Science.gov (United States)

    Scott, Ingrid U; VanVeldhuisen, Paul C; Ip, Michael S; Blodi, Barbara A; Oden, Neal L; Awh, Carl C; Kunimoto, Derek Y; Marcus, Dennis M; Wroblewski, John J; King, Jacqueline

    2017-05-23

    Studies have established the efficacy and safety of aflibercept for the treatment of macular edema due to central retinal vein occlusion. Bevacizumab is used off-label to treat this condition despite the absence of supporting data. To investigate whether bevacizumab is noninferior to aflibercept for the treatment of macular edema secondary to central retinal or hemiretinal vein occlusion. The SCORE2 randomized noninferiority clinical trial was conducted at 66 private practice or academic centers in the United States, and included 362 patients with macular edema due to central retinal or hemiretinal vein occlusion who were randomized 1:1 to receive aflibercept or bevacizumab. The first participant was randomized on September 17, 2014, and the last month 6 visit occurred on May 6, 2016. Analyses included data available as of December 30, 2016. Eyes were randomized to receive intravitreal injection of bevacizumab (1.25 mg; n = 182) or aflibercept (2.0 mg; n = 180) every 4 weeks through month 6. The primary outcome was mean change in visual acuity (VA) letter score (VALS) from the randomization visit to the 6-month follow-up visit, based on the best-corrected electronic Early Treatment Diabetic Retinopathy Study VALS (scores range from 0-100; higher scores indicate better VA). The noninferiority margin was 5 letters, and statistical testing for noninferiority was based on a 1-sided 97.5% confidence interval. Among 362 randomized participants (mean [SD] age, 69 [12] years; 157 [43.4%] women; mean [SD] VALS at baseline, 50.3 [15.2] [approximate Snellen VA 20/100]), 348 (96.1%) completed the month 6 follow-up visit. At month 6, the mean VALS was 69.3 (a mean increase from baseline of 18.6) in the bevacizumab group and 69.3 (a mean increase from baseline of 18.9) in the aflibercept group (model-based estimate of between-group difference, -0.14; 97.5% CI, -3.07 to ∞; P = .001 for noninferiority), meeting criteria for noninferiority. Ocular adverse events in

  15. Macular Findings Obtained by Spectral Domain Optical Coherence Tomography in Retinopathy of Prematurity

    Directory of Open Access Journals (Sweden)

    Muhammet Kazim Erol

    2014-01-01

    Full Text Available Purpose. To examine the macular findings obtained with spectral domain optical coherence tomography (SD OCT in infants with retinopathy of prematurity (ROP. Materials and Methods. The macular SD OCT images of 190 premature infants were analyzed. Data regarding central foveal thickness (CFT, cystoid macular edema (CME, and cyst grading were compared. The relationships of CFT with gestational age and birth weight were investigated. Results. The results were obtained from 358 eyes of 179 infants (81 females and 98 males of a mean gestational age of 30.9±2.7 weeks and a mean birth weight of 1609±477 g. ROP was diagnosed in 126 eyes and CME in 139 eyes. A significantly greater percentage of eyes with ROP were found to have CME (54% compared to eyes without ROP (31%; P=0.001. The incidence of CME was 46.3% for stage 1 ROP, 57.1% for stage 2, and 87.5% for stage 3. There was a weakly inverse correlation between CFT, gestational age, and birth weight (P=0.025, r=-0.227; P=0.002, r=-0.182, resp., Spearman correlation test. Conclusions. High-quality SD OCT images can be obtained from premature infants using the iVue system. Severity and frequency of CME in premature infants increase as stage of ROP increases.

  16. Cost-effectiveness analysis of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema.

    Science.gov (United States)

    Dewan, Vinay; Lambert, Dennis; Edler, Joshua; Kymes, Steven; Apte, Rajendra S

    2012-08-01

    Perform a cost-effectiveness analysis of the treatment of diabetic macular edema (DME) with ranibizumab plus prompt or deferred laser versus triamcinolone plus prompt laser. Data for the analysis were drawn from reports of the Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol I. Computer simulation based on Protocol I data. Analyses were conducted from the payor perspective. Simulated participants assigned characteristics reflecting those seen in Protocol I. Markov models were constructed to replicate Protocol I's 104-week outcomes using a microsimulation approach to estimation. Baseline characteristics, visual acuity (VA), treatments, and complications were based on Protocol I data. Costs were identified by literature search. One-way sensitivity analysis was performed, and the results were validated against Protocol I data. Direct cost of care for 2 years, change in VA from baseline, and incremental cost-effectiveness ratio (ICER) measured as cost per additional letter gained from baseline (Early Treatment of Diabetic Retinopathy Study). For sham plus laser (S+L), ranibizumab plus prompt laser (R+pL), ranibizumab plus deferred laser (R+dL), and triamcinolone plus laser (T+L), effectiveness through 104 weeks was predicted to be 3.46, 7.07, 8.63, and 2.40 letters correct, respectively. The ICER values in terms of dollars per VA letter were $393 (S+L vs. T+L), $5943 (R+pL vs. S+L), and $20 (R+dL vs. R+pL). For pseudophakics, the ICER value for comparison triamcinolone with laser versus ranibizumab with deferred laser was $14 690 per letter gained. No clinically relevant changes in model variables altered outcomes. Internal validation demonstrated good similarity to Protocol I treatment patterns. In treatment of phakic patients with DME, ranibizumab with deferred laser provided an additional 6 letters correct compared with triamcinolone with laser at an additional cost of $19 216 over 2 years. That would indicate that if the gain in VA seen at 2 years

  17. Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1

    Directory of Open Access Journals (Sweden)

    Blinder KJ

    2017-02-01

    Full Text Available Kevin J Blinder,1 Pravin U Dugel,2,3 Sanford Chen,4 J Michael Jumper,5 John G Walt,6 David A Hollander,6 Lanita C Scott6 On behalf of the ECHO Study Group 1The Retina Institute, St Louis, MO, 2Retinal Consultants of Arizona, Phoenix, AZ, 3USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, 4Orange County Retina, Santa Ana, 5West Coast Retina Medical Group, San Francisco, 6Allergan plc, Irvine, CA, USA Purpose: To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF inhibitors as used in clinical practice for the treatment of diabetic macular edema.Methods: Multicenter (10 sites, retrospective chart review in patients (n=156 who received ≥3 anti-VEGF injections. Data collected for ≥6 months after the first injection included Snellen best-corrected visual acuity (BCVA and central retinal thickness (CRT by time-domain or spectral-domain optical coherence tomography (TD-OCT or SD-OCT.Results: Mean number of anti-VEGF injections (627 bevacizumab, 594 ranibizumab, 1 aflibercept was 5.8 (year 1, 5.0 (year 2, and 3.4 (year 3. Percentage of patients with BCVA of 20/40 or better and CRT ≤250 µm on TD-OCT or ≤300 µm on SD-OCT at the same visit (primary endpoint ranged from 16.4% to 38.9% after the first 10 injections; 51.9%–62.3% achieved ≥20/40 BCVA and 26.2%–48.0% met CRT criteria. Therapy was well tolerated with 19 treatment-related adverse events (all ocular reported.Conclusion: Anti-VEGF injections were administered less frequently and were less effective than those in the ranibizumab registration trials. After each of the first 9 injections, <25% of patients achieved both BCVA of 20/40 or better and a dry macula. A substantial proportion of patients are suboptimal responders to anti-VEGF therapy; these patients may be candidates for other therapies, including intravitreal corticosteroid and laser therapy. Keywords: bevacizumab, diabetic

  18. Correlation Between the Findings of Optical Coherent Retinal Tomography (OCT), Stereo Biomicroscopic Images from Fundus of an Eye and Values from Visual Acuity of Diabetic Macular Edema

    Science.gov (United States)

    Nisic, Faruk; Turkovic, Samir; Mavija, Milka; Jovanovic, Nina; Alimanovic, Emina Halilovic-

    2014-01-01

    Introduction: Diabetic maculopathy is the major cause of reduced visual acuity in patients with non-proliferative diabetic retinopathy and occurs on average in 29% of patients who have diabetes for 20 or more years. Aim: The aim of this study is to re examine the correlation between the findings of optical coherence retinal tomography, stereo bio-microscopic images from fundus of an eye and values from visual acuity of diabetic macular edema. In addition, the aim is to show the importance of various ophthalmic tests for establishing diagnosis in time. Material and methods: The research sample consisted of 90 subjects-patients from Cabinet for photographic documentation, fluorescein angiography and laser photocoagulation in Department of Ophthalmology at the University Clinical Centre in Sarajevo. The study was a one-year long, prospective, clinical study. Results: Research has shown a positive correlation between the various tests that are applied for the diagnosis of diabetic macular edema. Accurate and early diagnosis is of great importance for the treatment in time of this disease by applying laser photocoagulation, intravitreal injections of Anti-VEGF drugs or surgical treatment by Pars Plana Vitrectomy. PMID:25395723

  19. Diabetic macular edema: correlations with available diabetes therapies--evidence across a qualitative review of published literature from MEDLINE and EMBASE.

    Science.gov (United States)

    Merante, Domenico; Menchini, Francesca; Truitt, Kenneth E; Bandello, Francesco M

    2010-08-01

    Diabetic macular edema (DME) is the leading cause of visual loss and legal blindness in people with diabetes mellitus. The pathogenesis of DME is complex and multifactorial, and involves both local and systemic risk factors that may alter the blood-retina barrier and allow leakage of protein and fluid into the macula. Recently, in addition to well known risk factors, the use of thiazolidinediones (glitazones) has been related to the development and worsening of DME. This review is based on available literature derived from EMBASE and MEDLINE, from 1950 to May 2010, and focuses on the potential correlations between DME and current available therapies for type 1 and 2 diabetes. This review reveals that the current literature, with the potential exception of glitazones, is not sufficient for a definite statement on the association between DME and currently available diabetic therapies. In fact, among antidiabetic agents, the class of glitazones appears the only one to be potentially associated with DME. Furthermore, adequately powered, prospective studies are warranted to evaluate the exact causal association between glitazones and DME and to exclude the role of other confounding factors potentially able to induce or exacerbate macular edema. Improvement of the quality and reporting in postmarketing surveillance and the use of the 'dechallenge and rechallenge' approach in case of suspicious cause/effect drug relationship of DME are highly encouraged.

  20. Efficacy and tolerability of bilateral sustained-release dexamethasone intravitreal implants for the treatment of noninfectious posterior uveitis and macular edema secondary to retinal vein occlusion

    Directory of Open Access Journals (Sweden)

    Ryder SJ

    2015-06-01

    Full Text Available Steven J Ryder,1 Danilo Iannetta,1 Swetangi D Bhaleeya,2 Szilárd Kiss1 1Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA; 2Department of Ophthalmology, University of South Florida, Tampa, FL, USA Purpose: To report our experience with bilateral placement of dexamethasone 0.7 mg (DEX sustained-release intravitreal implant in the management of noninfectious posterior uveitis or macular edema secondary to retinal vein occlusion.Methods: A retrospective chart review of patients with bilateral noninfectious posterior uveitis and macular edema secondary to retinal vein occlusion who were treated with DEX intravitreal implant was performed. Ocular side effects such as intraocular pressure (IOP, cataract, and tolerability of bilateral injections was reviewed.Results: Twenty-two eyes of eleven patients treated with a total of 32 DEX implants were included. Ten of eleven patients received bilateral implants due to active noninfectious uveitis while the other demonstrated macular edema in both eyes following separate central retinal vein occlusions. Among the patients with bilateral uveitis, the mean interval between DEX implant in the initial eye and the subsequent DEX in the fellow eye was 15.6 days (range 2–71 days. Seven of the ten patients received the second implant in the fellow eye within 8 days of the initial implantation. None of the patients had bilateral implantations on the same day. Seven eyes required reimplantation for recurrence of inflammation (mean interval between first and repeat implantation was 6.00±2.39 months. Following single or, in the case of the aforementioned seven eyes, repeat DEX implantation, all 20 uveitic eyes demonstrated clinical and/or angiographic evidence of decreased inflammation in the form of reduction in vitreous cells on slit lamp ophthalmoscopy, macular edema on ophthalmoscopy, or optical coherence tomography and/or disc and vascular leakage on fluorescein angiography. The mean

  1. What Is Macular Edema?

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  2. What Is Macular Edema?

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  8. Efficacy and safety of different doses of a slow-release corticosteroid implant for macular edema: meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Liu QY

    2015-05-01

    Full Text Available Qingyu Liu,1,2,* Mengmei He,1,2,* Hui Shi,1,3 Qianyi Wang,1,2 Yaru Du,1,3 Junling Liu,1,2 Chengda Ren,1,2 Ding Xu,1 Jing Yu1 1Department of Ophthalmology, Shanghai Tenth People’s Hospital, Shanghai, 2Tongji University School of Medicine, Shanghai, 3Department of First Clinical Medical College, Nanjing Medical University, Nanjing, People’s Republic of China *These authors contributed equally to this work Background: The purpose of this meta-analysis was to assess the efficacy and safety of intravitreal corticosteroid implants for macular edema. Methods: A total of 3,586 patients from previously reported randomized controlled trials were included. The meta-analysis was performed using RevMan 5.2. Summary odds ratios (ORs and 95% confidence intervals (CIs were calculated, employing random-effects or fixed-effects models according to between-study heterogeneity. The main outcome measures were the ORs for effects and safety of intravitreal corticosteroid implants. Results: Four eligible studies were included. Compared with the sham group, the ORs for ≥15 letter improvement of visual acuity in the high-dose and low-dose groups were 1.89 (95% CI 1.33–2.69, P=0.0004 and 1.62 (95% CI 1.10–2.41, P=0.02, respectively. The weight mean differences in central retinal thickness increases were -75.46 (95% CI -90.29, -60.63, P<0.0001 and -46.47 (95% CI -92.08, -0.86, P=0.05, respectively. However, the ORs for increased intraocular pressure in both intervention groups were higher than in the sham group, and were 11.50 (95% CI 7.24–18.28, P<0.00001 and 10.30 (95% CI 6.49–16.36, P<0.00001, respectively. The incidence of cataract was 7.25 (95% CI 5.68–9.25, P<0.00001 and 3.56 (95% CI 1.28–9.96, P=0.02 in the two intervention groups, respectively. There was no significant difference between the intervention groups except for the incidence of cataract in which the OR was 1.59 (95% CI 1.28–1.97, P<0.001.  Conclusion: Intravitreal corticosteroid

  9. Vascular endothelial growth factor Trap-Eye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study.

    Science.gov (United States)

    Boyer, David; Heier, Jeffrey; Brown, David M; Clark, W Lloyd; Vitti, Robert; Berliner, Alyson J; Groetzbach, Georg; Zeitz, Oliver; Sandbrink, Rupert; Zhu, Xiaoping; Beckmann, Karola; Haller, Julia A

    2012-05-01

    To assess the efficacy and safety of intravitreal vascular endothelial growth factor (VEGF) Trap-Eye in eyes with macular edema secondary to central retinal vein occlusion (CRVO). Multicenter, randomized, prospective, controlled trial. One hundred eighty-nine eyes with macular edema secondary to CRVO. Eyes were randomized 3:2 to receive VEGF Trap-Eye 2 mg or sham injection monthly for 6 months. The proportion of eyes with a ≥15-letter gain or more in best-corrected visual acuity (BCVA) at week 24 (primary efficacy end point), mean changes in BCVA and central retinal thickness (CRT), and proportion of eyes progressing to neovascularization of the anterior segment, optic disc, or elsewhere in the retina. At week 24, 56.1% of VEGF Trap-Eye treated eyes gained 15 letters or more from baseline versus 12.3% of sham-treated eyes (P<0.001). The VEGF Trap-Eye treated eyes gained a mean of 17.3 letters versus sham-treated eyes, which lost 4.0 letters (P<0.001). Central retinal thickness decreased by 457.2 μm in eyes treated with VEGF Trap-Eye versus 144.8 μm in sham-treated eyes (P<0.001), and progression to any neovascularization occurred in 0 and 5 (6.8%) of eyes treated with VEGF Trap-Eye and sham-treated eyes, respectively (P = 0.006). Conjunctival hemorrhage, reduced visual acuity, and eye pain were the most common adverse events (AEs). Serious ocular AEs were reported by 3.5% of VEGF Trap-Eye patients and 13.5% of sham patients. Incidences of nonocular serious AEs generally were well balanced between both groups. At 24 weeks, monthly intravitreal injection of VEGF Trap-Eye 2 mg in eyes with macular edema resulting from CRVO improved visual acuity and CRT, eliminated progression resulting from neovascularization, and was associated with a low rate of ocular AEs related to treatment. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  10. Analysis of macular edema characteristics with the spectral domain optical coherence tomography%频域OCT检查对黄斑水肿特点的分析

    Institute of Scientific and Technical Information of China (English)

    李岩; 王兰惠; 韩梅; 解士勇

    2010-01-01

    目的 通过频域OCT对黄斑水肿形态进行观察,了解水肿程度及分布情况,并分析水肿与视力的相关性.方法 选取患黄斑水肿患者25例29只眼,病例包括视网膜中央静脉阻塞所致为8例8只眼,视网膜分支静脉阻塞7例7只眼,葡萄膜炎4例4只眼,糖尿病性视网膜病变6例10只眼.年龄52-83(64.76±8.30)岁.最佳矫正视力(BCVA)0.05~1.0(0.35±0.12).利用最新一代频域RTVueFD-OCT对黄斑区进行扫描.结果 黄斑区15°范围内神经上皮厚度(453.00±103.12)μm,其中各区域神经上皮层厚度为:中心凹(533.10±115.23)μm,旁中心区(488.93±89.71)μm,中心凹边缘区(397.05±83.52)μm.不同区域神经上皮层厚度比较差异有统计学意义(F=2.937,P0.05.患者BCVA与中心凹神经上皮层厚度间存在负相关关系(r=-0.784,P0.05),与中心凹边缘区神经上皮层厚度间无相关关系(r=.275,P>0.05).结论 频域OCT能够精确地对黄斑水肿进行活体组织学成像,具有简便、非侵入性、重复性好等特点.%Objective To find out the degree and distribufion of macular edema and analyze the corelation between macular edema and visual acuity by observing morphology of maeular edema under the spectral domain OCT.Methods Selecting 29 eyes of 25 cases suffered from macular edema.including 8 eyes of 8 cases with central retinal vein occlusion,7 eyes of 7 cases with branch retinal vein occlusion.4 eyes of 4 cases with uveitis,and 10 eyes of 6 cases with diabetic retinopathy.Age was 52~85(average 64.76±8.30),best corrected visual acuity (BCVA) was 0.05~1.0 (average0.35±0.12).Scanning macular with the newest spectral domain RTVue FD-OCT.Results In 15°macular afea,the thickness of neuro-epithelium layers were(453.00±103.12)μ m,thickness of various sectiolls Were:fovea (533.10±115.23)μ m,parafovea (488.93±89.71)μm,perifovea(397.05~83.52)μ m.There was statistically significant difference of neuroep. Ithelium layers thickness in various areas

  11. 糖尿病黄斑水肿的临床诊断方法比较%Comparison among diagnostic methods for diabetic macular edema

    Institute of Scientific and Technical Information of China (English)

    傅永艳; 才娜; 柳丽敏; 刘宁宁; 万超; 陈蕾

    2009-01-01

    目的 对比分析糖尿病黄斑水肿患者光学相干断层扫描(optical coherence tomo-graphy,OCT)、荧光素眼底血管造影(fluorescein fundus angiography,FFA)及裂隙灯显微镜下+90 D前置镜检查所观察到的图像特征,探讨3种检查方法的诊断价值.方法 分析51例(94眼)临床确诊为糖尿病视网膜病变患者的OCT、FFA及裂隙灯显微镜下+90 D前置镜检查结果,将结果进行一致性比较,并观察分析OCT、FFA图像特征,所得结果行单因紊方差分析.结果 OCT与FFA及FFA与+90 D前置镜检查结果有较好的一致性,符合率分别为88.3%、69.1%.OCT、FFA与+90 D前置镜裂隙灯显微镜下检查结果对糖尿病黄斑水肿的检出率分别是86.2%、83.0%及62.8%.OCT所测得的黄斑中心凹平均视网膜厚度值在无渗漏时最低,并随局限性渗漏、弥漫性渗漏、局限合并弥漫性渗漏、黄斑囊样水肿依次增加,经比较它们之间的差异均具有统计学意义(F=40,P均<0.05).结论 OCT能客观的提供糖尿病患者黄斑区结构的变化,尤其对+90D前置镜裂隙灯显微镜下检查及FFA还没有明确变化的早期黄斑水肿诊断敏感.三者的联合应用为揭示糖尿病病理机制、临床诊断糖尿病黄斑水肿、判断糖尿病黄斑水肿的类型及其最佳治疗方案提供参考依据.%Obiective To compare and analyze the features of image of patients with diabetic macular edema by optical coherence tomography(OCT),fluorescence fundns angiography(FFA) and +90 D preset lens examination under slit-lamp microscope, and to evaluate the diagnostic value of these three methods. Methods Ninety-four eyes of 51 patients, who were clinically diagnosed with diabetic retmopathy, were taken OCT,FFA and + 90 D preset lens examination under slit-lamp microscope. The results were analyzed,and comparison of consistency was taken. The features of image by OCT and FFA were observed and analyzed. The results were taken one-factor analysis of

  12. BETTER PROGNOSIS FOR EYES WITH PRESERVED FOVEAL DEPRESSION AFTER INTRAVITREAL RANIBIZUMAB INJECTION FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION.

    Science.gov (United States)

    Kitagawa, Shuta; Yasuda, Shunsuke; Ito, Yasuki; Ueno, Shinji; Iwase, Takeshi; Terasaki, Hiroko

    2017-05-18

    To determine the prognosis of eyes with central retinal vein occlusion that had a preserved foveal depression at the baseline and were treated by intravitreal ranibizumab injections (IRIs). The authors reviewed the medical records of 23 eyes of 23 consecutive treatment-naive patients who received IRIs to treat the macular edema due to central retinal vein occlusion. Eyes were classified by the pre-IRI presence or absence of a foveal depression. A foveal depression was defined as a central foveal thickness that was central fovea. The characteristics of the two groups were compared. Seven of 23 eyes had a preserved foveal depression before the IRI. The mean number of injections within 12 months after the initial IRI was significantly fewer (P central retinal vein occlusion.

  13. Evaluation of Macular Thickness by Optical Coherence Tomography After Phacoemulsification Surgery

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    Mehmet Tetikoğlu

    2014-03-01

    Full Text Available Objectives: To evaluate the incidence of cystoid macular edema (CME, its risk factors, and macular changes by optical coherence tomography (OCT after phacoemulsification. Materials and Methods: This study included 99 eyes of 65 patients who underwent phacoemulsification surgery in Okmeydanı Training and Research Hospital, Department of Ophthalmology. Foveal thickness, macular volume, and mean macular thickness were measured by OCT preoperatively and at 1st day, 1st week, 1st, and 3rd months postoperatively. Results: In this study, the incidence of postoperative CME was 3%. The mean central foveal thickness was preoperatively 250.4 (±18.5 μm, and postoperatively was 252.08 (±23.2 μm at 1st day, 261.4 (±27.8 μm at 1st week, 270.6 (±44.4 μm at 1st month, and 265.4 (±41.6 μm at 3rd month. The statistically significant increase in foveal thickness was defined between preoperative and 1st week, 1st month, 3rd month as well as between 1st week, 1st month, and 3rd month (p<0.01. Increase in macular thickness was demonstrated in 44 eyes (44.4% which was most frequently located in the parafoveal region. Intraoperative complications like iris trauma, posterior capsule tear, and vitreous loss were increased risk of CME (p=0.001. Conclusion: Subclinical macular thickness increment begins at 1st week and reaches maximum point at 1st month. Incidence of CME increased in patients who had a complicated cataract surgery, so they should be followed closely by OCT. (Turk J Ophthalmol 2014; 44: 88-91

  14. Differential diagnosis (occlusion and unocclusal kind of complicated and diffuse diabetic macular edema with optical coherence tomography method in patients with diabetes type II

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    O. V. Zborovskaya

    2013-10-01

    Full Text Available Introduction. Diabetic macular edema (DME is a common manifestation of diabetic retinopathy and an important cause of visual impairment in people with diabetes. DME is the most common cause of decreased vision in patients with diabetes. It can accompany any stage of the disease and occurs on average 10% of patients with diabetes. In this case, due to structural changes in the endothelium of retinal vessels violation of the retinal barrier increased permeability of blood vessels wall and fluid accumulation in the intercellular space retinal optical coherence tomography (OCT is a method of diagnostic morphological structure of the retina and allows high precision of the DME diagnose, assess the severity and observe the dynamics. Materials and methods. During the work general ophthalmic examination, OCT, PAH and immunological studies were performed in all patients. Total 64 patients (128 eyes, including 28 women (43.8% and 36 men (56.3%, whose average age was '58 (SD 10, 24 to 78 years with diabetes type II diabetic macular edema of various kinds took part in the study. Diffuse (occlusal and unocclusal kind and complicated (occlusal and unocclusal DME were studied. Diffuse occlusal DME was diagnosed in 33 cases, diffuse unocclusal DME – in 35 cases, complicated occlusal DME - in 28 cases, complicated unocclusal DME - in 32. Statistical analysis was performed in the program MedCalc 9.0. Results and Discussion: In this clinical study there is a clear pattern between the type and the presence of DME. Conclusions: We can talk about the use of the criterion of the presence or absence of RPE detachment to differentiate species (occlusion or unocclusual diffuse and complicated DME in patients with diabetes type II.

  15. Prolongation of injection interval after switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema secondary to branch retinal vein occlusion

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    Tagami M

    2017-02-01

    Full Text Available Mizuki Tagami, Ryuto Sai, Masahide Fukuda, Atsushi Azumi Ophthalmology Department, Eye Center, Kobe Kaisei Hospital, Kobe, Hyogo, Japan Purpose: This study was conducted to investigate the outcome of switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema (ME secondary to branch retinal vein occlusion (BRVO in daily practice. Materials and methods: This retrospective study enrolled 15 eyes in 15 Japanese patients with ME secondary to BRVO who had been receiving a pro re nata regimen of ranibizumab and had provided written informed consent to switch to aflibercept therapy. The intravitreal injection interval, central retinal thickness, and visual acuity were evaluated before and after switching. Results: The mean period of ranibizumab treatment was 11.8±4.2 months. The mean observation period after switching to aflibercept was 10.6±3.4 months, and seven patients were observed for more than 12 months after switching. The mean intravitreal injection interval was prolonged by 23.6 days with aflibercept (68.2±26.4 days with ranibizumab vs 91.8±33.2 days with aflibercept; P=0.0011. The mean intravitreal injection interval just before the switch was 81.3±35.6 days and was significantly prolonged to 100.8±34.2 days just after the switch to aflibercept (P=0.0309. The mean central retinal thickness did not change before or after the switch to aflibercept (295±55 µm with ranibizumab vs 276±25 µm with aflibercept; P=0.12. The mean visual acuity also remained at an improved level after the switch. No systemic or ocular side effects were evident during the study period. Conclusion: Switching therapy from ranibizumab to aflibercept in Japanese patients with ME secondary to BRVO prolonged the intravitreal injection interval without anatomical or functional degradation. Keywords: branch retinal vein occlusion, macular edema, ranibizumab, aflibercept

  16. Importance of Central Retinal Sensitivity for Prediction of Visual Acuity after Intravitreal Bevacizumb in Eyes with Macular Edema Associated with Branch Retinal Vein Occlusion.

    Science.gov (United States)

    Sugimoto, Masahiko; Ichio, Atsushi; Kondo, Mineo

    2016-01-01

    To determine whether the baseline retinal sensitivity can predict the best-corrected visual acuity (BCVA) at 1 month after intravitreal bevacizumab (IVB) in eyes with macular edema (ME) associated with a branch retinal vein occlusion (BRVO). We evaluated 16 eyes of 16 patients who had ME associated with a BRVO. The mean ± standard deviation age was 69.1 ± 8.9 years, and all had a single IVB injection. The BCVA, central macular thickness (CMT), integrity of the ellipsoid zone (EZ) of the photoreceptors, and retinal sensitivity were determined before (baseline) and at 1 day, 1 week, and 1 month following the IVB. The average threshold retinal sensitivity (AT) within the central 10° was determined by Macular Integrity Assessment. The correlations between the BCVA at 1 month and the CMT, integrity of the EZ, and AT at each visit were determined. One month after IVB, the BCVA improved significantly from 0.56 ± 0.27 logMAR units to 0.32 ± 0.28 logMAR units, and the CMT from 611.4 ± 209.3 μm to 258.7 ± 64.0 μm (P retinal sensitivity (r = 0.76) were moderately correlated with the BCVA at 1 month. These results indicate that both the integrity of the EZ and the AT at 1 day after the IVB can predict the BCVA after treatment for ME associated with BRVO. There is a possibility that these parameters will predict the effectiveness of IVB for each case.

  17. Intravitreal Injection of Ozurdex® Implant in Patients with Persistent Diabetic Macular Edema, with Six-Month Follow-Up

    Science.gov (United States)

    Pacella, Fernanda; Ferraresi, Adriana Francesca; Turchetti, Paolo; Lenzi, Tommaso; Giustolisi, Rosalia; Bottone, Andrea; Fameli, Valeria; Romano, Maria Rosaria; Pacella, Elena

    2016-01-01

    AIM To evaluate the efficacy of intravitreal dexamethasone injections in diabetic macular edema (DME). METHODS A 700 μg slow-release intravitreal dexamethasone implant (Ozurdex®) was placed in the vitreal cavity of 17 patients (19 eyes) affected with persistent DME. Best corrected visual acuity (BCVA) was assessed through Early Treatment Diabetic Retinopathy Study (ETDRS). Central macular thickness (CMT) was measured by spectral-domain optical coherence tomography. BCVA and CMT examinations were carried out at baseline (T0) and repeated after three days, one month (T1), three months (T3), four months (T4), and six months (T6) post injection. RESULTS Dexamethasone implant induced an improvement in ETDRS at T1, T3, T4, and T6 post injection. CMT was reduced at T1, T3, and T4, while at T6, CMT values were not statistically different from baseline. No complications were observed during the follow-up. CONCLUSION Our data suggest that dexamethasone implant is effective in reducing DME symptoms within a six-month frame. PMID:27147895

  18. Retinal thickness measurement and evaluation of natural history of the diabetic macular edema through optical coherence tomography Medida da espessura retiniana e avaliação da história natural do edema macular diabético pela tomografia de coerência óptica

    Directory of Open Access Journals (Sweden)

    Rosana Zacarias Hannouche

    2009-08-01

    Full Text Available PURPOSE: 1 Diagnose, through optical coherence tomography (OCT exam, the occurrence of diabetic macular edema in patients with diabetic retinopathy and visual acuity of 20/40 or better, by measuring the foveal center point thickness, during one year. 2 Evaluate the edema natural history, during this period, associating the center point thickness with hemoglobin A1c and changes in visual acuity. 3 Correlate the obtained results with the control group. METHODS: A prospective study was done, of a sample of 30 patients with diabetic macular edema and visual acuity of 20/40 or better. Measurements of the best corrected visual acuity, hemoglobin A1c level, biomicroscopy with 78-diopter lens, fluorescein angiogram and optical coherence tomography were made. The retinal thickness was selected as the main variable. Besides descriptive statistics, additional tests were applied to analyze the results and determine the correlation between these variables, such as t-Student, Chi-Square, Tukey and ANOVA. The relation of optical coherence tomography with visual acuity and hemoglobin A1c was studied through linear regression. RESULTS: It was found that there is no significant difference between patients and normal individuals, for the variables age and gender. The values of center point thickness found for men were greater than those for women, showing the influence of gender on that thickness. As many as 83.33% of the diabetic patients with clinically significant macular edema presented moderate non-proliferative diabetic retinopathy (NPDR, 10% presented mild NPDR and 6.66% severe non-proliferative diabetic retinopathy. Patients under combined treatment of insulin and oral hypoglycemiant presented influence on the results of center point thickness (through OCT and visual acuity. The mean duration of diabetes was 9.63 years. Values of center point thickness were always found greater for patients than those for normal eyes. Levels of hemoglobin A1c did not have

  19. 糖尿病黄斑水肿类型及视力相关分析%Relationship between the classification of diabetic macular edema and vision

    Institute of Scientific and Technical Information of China (English)

    刘杰; 孙林; 甘林萍

    2011-01-01

    目的 探讨糖尿病黄斑水肿(DME)的类型与视力损害之间的关系.方法 回顾性分析324例(640只眼)荧光素眼底血管造影(FFA)确诊的糖尿病视网膜病变(DR)的检查结果、病变分型及矫正视力.结果 ①640只眼中,436只眼(68.1%)未见黄斑水肿,204只眼(31.9%)存在不同程度DME,其中局部水肿型116只眼(18.1%),弥漫水肿型88只眼(13.8%);②患者视力随着DME加重明显下降.结论 糖尿病患者视力与DME的类型存在显著相关性.%Objective To explore the relationship between the classification of diabetic macular edema ( DME )and vision loss. Methods The results of fundus fluorescein angiography ( FFA ),correct vision and stages were retrospectively analyzed in 640 eyes of 324 cases with diabetic retinopathy ( DR ). Results In the 640 eyes, no leakage type 436 eyes ( 68.1% ), 204 eyes with DME, focal edema type 116 eyes ( 18.1% ), diffuse edema type 88 eyes ( 13.8% ). The visual loss significantly decreased with the development of DME. Conclusion The visual of DR significantly correlated with the classification of DME.

  20. 激光光凝治疗糖尿病性黄斑水肿的临床观察%Clinical observation of the efficacy of laser photoeoagulation for the treatment of diabetic macular edema

    Institute of Scientific and Technical Information of China (English)

    尚志宏; 荆毓陶; 李红

    2012-01-01

    目的 观察激光光凝治疗糖尿病性黄斑水肿(DME)的疗效.方法 对50只眼局限性DME和36只眼弥漫性DME分别进行局灶光凝和格栅光凝治疗.结果 局限性DME组光凝后视力提高18只眼(36%),无变化24只眼(48%),视力下降8只眼(16%),弥漫性DME组光凝后视力提高6只眼(17%),无变化25只眼(69%),视力下降5只眼(14%).两组对比P<0.05,有显著性差异.结论 激光光凝治疗DME安全、有效,局限性DME比弥漫性DME效果好.%Objective To observe the therapeutic effect of laser photoeoagulation on diabetic macular edema (DME). Methods 50 eyes with localized edema were treated by local photoeoagulation , 36 eyes with diffuse edema were treated by grid photoeoagulation. Results Among patients with localized edema , the postoperative visual acuity improved in 18 eyes(36% ) ,remained unchanged in 24 eyes( 48% ) ,and worsened in 8 eyes( 16% ) . Among patients with diffuse edema, the postoperative visual acuity improved in 6 eyes(17% ) ,remained unchanged in 25 eyes( 69% ) ,and worsened in 5 eyes (14 % ) . Conclusion Laser photoeoagulation treatment for diabetic macular edema is effective . It is found that therapeutic response is better in localized edema than that in diffuse edema .

  1. Eficacia del ketorolaco tópico para mejorar la función visual después de la fotocoagulación, en diabéticos con edema macular focal

    OpenAIRE

    Dulce Milagros Razo Blanco-Hernández; Virgilio Lima-Gómez; Juan Asbun-Bojalil

    2014-01-01

    Antecedentes: la fotocoagulación reduce la incidencia de pérdida visual en diabéticos con edema macular focal, aunque puede inducirla durante 6 semanas; la mejoría visual después del tratamiento es excepcional. El ketorolaco tópico puede limitar la inflamación causada por la fotocoagulación, y mejorar el desenlace visual. Objetivo: determinar la eficacia del ketorolaco tópico en la mejoría de la función visual después de la fotocoagulación, en diabéticos con edema macular focal. Material y mé...

  2. Injeção intravítrea de cetorolaco de trometamina em pacientes com edema macular diabético refratário à fotocoagulacão retiniana

    OpenAIRE

    2010-01-01

    OBJETIVO: Avaliar o efeito em curto prazo da injeção intravítrea de cetorolaco de trometamina (500 µg/0,1ml) em pacientes com edema macular diabético refratário à fotocoagulação retiniana. MÉTODOS: Estudo prospectivo. Foram selecionados 20 pacientes com edema macular diabético refratário à fotocoagulação retiniana em ambos os olhos e apresentando acuidade visual (ETDRS) entre 20/50 e 20/200. Foi injetado em um olho de cada paciente, pela via intravítrea, 500 µg em 0,1 ml de cetorolaco de trom...

  3. Comparison of the effects of intravitreal bevacizumab and triamcinolone acetonide in the treatment of macular edema secondary to central retinal vein occlusion

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    Mehmet Demir

    2014-01-01

    Full Text Available Aim: To compare the effects of intravitrealbevacizumab (IVB and intravitreal triamcinolone acetonide (IVT in the treatment of macular edema (ME secondary to central retinal vein occlusion (CRVO. Materials and Methods: There were 20 patients treated with IVB (1.25 mg/0.05 mL and 16 treated with IVT (4 mg/0.1 mL. The two groups were compared with regard to best-corrected visual acuity (BCVA, central macular thickness (CMT on optical coherence tomography (OCT, slit-lamp biomicroscopy and fundus fluorescein angiography results, intraocular pressure (IOP, numbers of injections, and adverse events. Results: The mean follow-up times in the IVB and IVT groups were 17.45±8.1 months (range: 8-33 months and 19.94±10.59 months (range: 6-40 months, respectively (P = 0.431. Visual acuity increased and CMT decreased significantly within both groups, but no differences were observed between the groups (P = 0.718. The percentages of patients with increased IOP and iatrogenic cataracts were significantly higher in the IVT group than in the IVB group. Conclusions: Treatment with IVB and IVT both resulted in significant improvement in visual acuity and a decrease in CMT in patients with ME secondary to non-ischemic CRVO, with no difference between the two treatments. The incidence of adverse events, however, was significantly greater in the IVT group than in the IVB group. IVB may be preferred over IVT for the treatment of ME in patients with non-ischemic CRVO.

  4. A predictive screening tool to detect diabetic retinopathy or macular edema in primary health care: construction, validation and implementation on a mobile application

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    Cesar Azrak

    2015-11-01

    Full Text Available The most described techniques used to detect diabetic retinopathy and diabetic macular edema have to be interpreted correctly, such that a person not specialized in ophthalmology, as is usually the case of a primary care physician, may experience difficulties with their interpretation; therefore we constructed, validated and implemented as a mobile app a new tool to detect diabetic retinopathy or diabetic macular edema (DRDME using simple objective variables. We undertook a cross-sectional, observational study of a sample of 142 eyes from Spanish diabetic patients suspected of having DRDME in 2012–2013. Our outcome was DRDME and the secondary variables were: type of diabetes, gender, age, glycated hemoglobin (HbA1c, foveal thickness and visual acuity (best corrected. The sample was divided into two parts: 80% to construct the tool and 20% to validate it. A binary logistic regression model was used to predict DRDME. The resulting model was transformed into a scoring system. The area under the ROC curve (AUC was calculated and risk groups established. The tool was validated by calculating the AUC and comparing expected events with observed events. The construction sample (n = 106 had 35 DRDME (95% CI [24.1–42.0], and the validation sample (n = 36 had 12 DRDME (95% CI [17.9–48.7]. Factors associated with DRDME were: HbA1c (per 1% (OR = 1.36, 95% CI [0.93–1.98], p = 0.113, foveal thickness (per 1 µm (OR = 1.03, 95% CI [1.01–1.04], p < 0.001 and visual acuity (per unit (OR = 0.14, 95% CI [0.00–0.16], p < 0.001. AUC for the validation: 0.90 (95% CI [0.75–1.00], p < 0.001. No significant differences were found between the expected and the observed outcomes (p = 0.422. In conclusion, we constructed and validated a simple rapid tool to determine whether a diabetic patient suspected of having DRDME really has it. This tool has been implemented on a mobile app. Further validation studies are required in the general diabetic population.

  5. Pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema due to branch retinal vein occlusion after antivascular endothelial growth factor treatments

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    Shirakata Y

    2016-02-01

    Full Text Available Yukari Shirakata,1 Kouki Fukuda,1 Tomoyoshi Fujita,1 Yuki Nakano,1 Hiroyuki Nomoto,2 Hidetaka Yamaji,3 Fumio Shiraga,4 Akitaka Tsujikawa1 1Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, 2Nomoto Eye Clinic, Himeji, 3Department of Ophthalmology, Shirai Eye Hospital, Mitoyo, 4Department of Ophthalmology, Okayama University, Okayama, Japan Purpose: To evaluate the anatomic and functional outcomes of pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema (ME due to branch retinal vein occlusion (BRVO after intravitreal injections of antivascular endothelial growth factor (anti-VEGF agents. Methods: Twenty-four eyes of 24 patients with treatment-naive ME from BRVO were treated with intravitreal injections of anti-VEGF agents. Recurred ME was treated with pars plana vitrectomy combined with internal limiting membrane peeling. Results: After the surgery, ME was significantly reduced at 1 month (P=0.031 and the reduction increased with time (P=0.007 at the final visit. With the reduction in ME, treated eyes showed a slow improvement in visual acuity (VA. At the final visit, improvement in VA was statistically significant compared with baseline (P=0.048. The initial presence of cystoid spaces, serous retinal detachment, or subretinal hemorrhage under the fovea, as well as retinal perfusion status, showed no association with VA improvement. However, the presence of epiretinal membrane showed a significant association with the visual recovery. Although eyes without epiretinal membrane showed visual improvement (-0.10±0.32 in logarithm of the minimum angle of resolution [logMAR], eyes with epiretinal membrane showed greater visual improvement (-0.38±0.12 in logMAR, P=0.012. Conclusion: For recurrent ME due to BRVO after anti-VEGF treatment, particularly when accompanied by epiretinal membrane, pars plana vitrectomy combined with internal limiting membrane peeling might be a

  6. Efficacy of Anti-IL6-Receptor Tocilizumab in Refractory Cystoid Macular Edema of Birdshot Retinochoroidopathy Report of Two Cases and Literature Review.

    Science.gov (United States)

    Calvo-Río, Vanesa; Blanco, Ricardo; Santos-Gómez, Montserrat; Díaz-Valle, David; Pato, Esperanza; Loricera, Javier; González-Vela, María C; Demetrio-Pablo, Rosalía; Hernández, José L; González-Gay, Miguel A

    2016-10-11

    To evaluate tocilizumab (TCZ) efficacy in severe and refractory birdshot chorioretinopathy (BSCR). Assessment of BSCR patients refractory to conventional immunosuppressive and anti-TNF-α drugs who underwent TCZ therapy. Two HLA-A29 positive patients (man/37 years and woman/38 years; four affected eyes) with BSCR were studied. They had a chronic bilateral posterior uveitis. Patient 1 had been treated with intraocular and oral corticosteroids, cyclosporine A, and infliximab whereas Patient 2 received intravenous methylprednisolone pulses, cyclosporine A, azathioprine, and adalimumab. At TCZ onset they had macular edema (four eyes); visual acuity (VA) impairment (four eyes); vitritis (one eye); and diffuse angiographic signs of vasculitis (periphlebitis) (two eyes). Improvement of VA and OCT was observed following TCZ therapy in both patients. After a follow-up of 18 months (Patient 1) and 10 months (Patient 2), respectively, a corticosteroid sparing effect without any adverse effects was achieved in both cases. TCZ was effective in two patients with BSCR refractory to anti-TNF-α agents.

  7. EVOLUTION OF CONTROLLING DIABETIC RETINOPATHY: Changing Trends in the Management of Diabetic Macular Edema at a Single Institution Over the Past Decade.

    Science.gov (United States)

    Jusufbegovic, Denis; Mugavin, Mark O; Schaal, Shlomit

    2015-05-01

    To report the evolution of treatment in managing diabetic macular edema (DME) in a "real world" clinical setting. Retrospective observational case series of 1,862 patients treated for DME over the last decade. Change in selection of treatment modalities used for controlling DME, visual acuity, and degree of DME on optical coherence tomography were recorded. Over the past decade, there was a linear decrease in laser use, with exponential growth in the utilization of intravitreal injections. An increase in the frequency of clinic visits from 3 ± 2 visits per year to 9 ± 2 visits per year with significant visual and anatomical improvements was noted: mean improvement in visual acuity increased from 0.01 ± 0.1 logMAR units (which is equivalent to less than 1 Snellen line) to 0.3 ± 0.2 logMAR units (which is equivalent to 2 Snellen lines) (P controlling DME over the last decade was reflected by the replacement of focal laser therapy with intravitreal injections. This has produced significant improvements in visual and anatomical outcomes but has increased the frequency of office visits.

  8. Onset and duration of visual acuity improvement after dexamethasone intravitreal implant in eyes with macular edema due to retinal vein occlusion.

    Science.gov (United States)

    Kuppermann, Baruch D; Haller, Julia A; Bandello, Francesco; Loewenstein, Anat; Jiao, Jenny; Li, Xiao-Yan; Whitcup, Scott M

    2014-09-01

    To evaluate the onset and duration of improvement in best-corrected visual acuity (BCVA) in eyes treated with dexamethasone intravitreal implant 0.7 mg (DEX implant) for macular edema after branch or central retinal vein occlusion. Post hoc analysis of data from 2 previously reported multicenter, 6-month, randomized sham-controlled clinical trials. Patients received a single DEX implant (n = 427) or sham procedure (n = 426) in the study eye. The primary endpoint was the percentage of eyes with ≥ 15-letter improvement in BCVA from baseline at postimplant Day 7. The baseline mean BCVA was 20/80. At Day 7, 10.3% of DEX implant-treated eyes versus 4.0% of sham-treated eyes (P retinal vein occlusion, 5.1; and central retinal vein occlusion, 5.8) with DEX implant and 1.6 letters (branch retinal vein occlusion, 2.3; and central retinal vein occlusion, 0.1) with sham (P < 0.001). The mean time from initial observation of ≥ 15-letter BCVA gain to the last observation of ≥ 15-letter BCVA gain was 70 days. Dexamethasone intravitreal implant treatment led to improvement in BCVA compared with sham procedure as early as postimplant Day 7. The duration of ≥ 3-line improvement was typically 2 to 3 months.

  9. Intravitreal Dexamethasone Implant versus Intravitreal Ranibizumab for the Treatment of Macular Edema Secondary to Retinal Vein Occlusion in a Chinese Population.

    Science.gov (United States)

    Gu, Xiaoya; Yu, Xiaobing; Song, Shuang; Dai, Hong

    2017-01-01

    The aim of this work was to compare the efficacy of intravitreal dexamethasone implant (Ozurdex) and intravitreal ranibizumab (Lucentis) in the treatment of macular edema (ME) caused by retinal vein occlusion (RVO). Thirty-two ME cases treated with Ozurdex and 32 ME cases treated with ranibizumab were enrolled, with 26 central (C)RVO and 6 branch (B)RVO subjects in each group. We compared the results of best-corrected visual acuity (BCVA), central retinal thickness, number of injections, and intraocular pressure (IOP) at 1, 2, 3, and 6 months after injection. BCVA in both groups at each follow-up were significantly increased compared to baseline with no statistical difference between the groups. Ozurdex and ranibizumab successfully reduced CMT at each follow-up. Both CRVO and BRVO patients had significant between-group differences in the mean number of injections. Among the CRVO patients, IOP in the Ozurdex group was significantly increased compared to baseline and the ranibizumab group at 1, 2, and 3 months postinjection. Intravitreal injection of Ozurdex and ranibizumab can effectively control ME secondary to RVO and increase a patient's BCVA. The advantages of Ozurdex are fewer injections and longer efficacy, while the advantages of ranibizumab include fewer side effects. © 2017 S. Karger AG, Basel.

  10. Multifocal electroretinography changes at the 1-year follow-up in a cohort of diabetic macular edema patients treated with ranibizumab.

    Science.gov (United States)

    Baget-Bernaldiz, Marc; Romero-Aroca, Pedro; Bautista-Perez, Angel; Mercado, Joaquin

    2017-08-04

    To determine the changes in the multifocal electroretinogram (mfERG) at 1 year in a clinical series of diabetic macular edema (DME) patients treated with ranibizumab (RNBZ) using a pro re nata protocol. We analyzed a clinical series of 35 eyes of 35 patients with DME at baseline and after treating them with RNBZ over 1 year, in order to determine the change in the macular function, which was assessed by means of the response density and the implicit time of the first-order kernel (FOK) P1 wave of the mfERG at the foveola (R1), fovea (R2) and parafovea (R3). These electrophysiological parameters were studied taking into account different independent variables, such as DME type, degree of diabetic retinopathy (DR), level of preservation of both the ellipsoid zone (IS/OS) and the external limiting membrane (ELM) and changes in central retinal thickness (CRT) and total macular volume (TMV). We also studied the relationship between the response density and the best-corrected visual acuity (BCVA). Eyes with cystic and spongiform DME showed better response density with respect to the serous type (p < 0.001) at baseline. Similarly, eyes with high IS/OS and ELM preservation rates showed higher initial response density compared to the others (p < 0.001). Eyes with moderate DR had better response density compared to those with severe and proliferative DR (p = 0.001). At the beginning of the study, those eyes with proliferative and severe DR showed longer implicit times with respect to those with moderate DR (p = 0.04). The response density significantly increased in eyes that anatomically restored the IS/OS and the ELM after being treated with RNBZ (both p < 0.001). Similarly, eyes with spongiform DME further improved the response density with respect to those with cystic and serous DME (p < 0.001). On the contrary, eyes with hard exudates showed less improvement in their response density at the end of the study (p < 0.001). We observed a significant

  11. Cases analysis of diabetic retinopathy and diabetic macular edema%糖尿病视网膜病变与糖尿病性黄斑水肿相关性病例分析

    Institute of Scientific and Technical Information of China (English)

    王佳; 张晓峰

    2013-01-01

    Objective To investigate the relationship between the occurrence and severity of diabetic retinopathy (DR) and the occurrence and severity of diabetic macular edema (DME).Method Ten cases (10 eyes) of diabetic retinopathy complicated with macular edema that were diagnosed jointly by endocrinologists and ophthalmologists were enrolled in this study.Recruitment criteria included history of diabetes confirmed by endocrinologists,central visual acuity,intraocular pressure,and established diagnosis of diabetic retinopathy and macular edema with the Results of direct ophthalmoscope and slit lamp joint front mirror fundus examination,dilated fundus photography,optical coherence tomography technique (OCT),and sodium fluorescein angiography (FFA).A careful staging of DR and DME followed detailed history and ophthalmic examination for each patient.The relationship between diabetic retinopathy and diabetic macular edema were analyzed.Results We found that diabetic macular edema presented in all stages of the diabetic retinopathy,but the degree of macular edema was not related to the severity of DR.Conclusion Diabetic macular edema can occur in any stage of the diabetic retinopathy and its severity is not linked to the severity of DR.But the case number in this study is small and there were some limitations as well.Further studies are needed to reveal the real relationship between DR and DME.%目的 观察糖尿病性黄斑水肿(DME)的发生及严重程度与糖尿病视网膜病变(DR)的发生及严重程度之间的关系.方法 经内分泌科及眼科诊断为DR合并DME的患者中随机抽取10例(10只眼)纳入本次研究.纳入标准为:所有入选对象均经内分泌科确诊有数年糖尿病史的糖尿病患者,在眼科均行中心视力、眼压、直接检眼镜、裂隙灯联合前置镜眼底检查、散瞳眼底彩色照相、相干光断层成像术(OCT)、荧光素眼底血管造影(FFA),均符合DR和DME的临床诊断标准.并按照相关标准

  12. Real-world assessment of intravitreal dexamethasone implant (0.7 mg in patients with macular edema: the CHROME study

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    Lam WC

    2015-07-01

    Full Text Available Wai-Ching Lam,1 David A Albiani,2 Pradeepa Yoganathan,3 John Chanchiang Chen,4 Amin Kherani,5 David AL Maberley,6 Alejandro Oliver,7 Theodore Rabinovitch,3 Thomas G Sheidow,8 Eric Tourville,9 Leah A Wittenberg,10 Chris Sigouin,11 Darryl C Baptiste12 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, 2West Coast Retinal Consultants, Vancouver, BC, 3North Toronto Eye Care, North York, ON, 4Department of Ophthalmology, McGill University, Montreal, QC, 5Southern Alberta Eye Center, Calgary, AB, 6Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, 7Timmins and District Hospital, Timmins, ON, 8Ivey Eye Institute, London, ON, 9Center Oculaire de Quebec, Quebec City, QC, 10Retina Surgical Associates, New Westminster, BC, 11Clinwest Research Inc, Burlington, ON, 12Allergan Inc., Markham, ON, Canada Background: The purpose of this study was to evaluate the real-world use, efficacy, and safety of one or more dexamethasone intravitreal implant(s 0.7 mg (DEX implant in patients with macular edema (ME.Methods: This was a retrospective cohort study of patients with ME secondary to retinal disease treated at ten Canadian retina practices, including one uveitis center. Best-corrected visual acuity (BCVA, central retinal thickness (CRT, intraocular pressure (IOP, glaucoma and cataract surgery, and safety data were collected from the medical charts of patients with ≥3 months of follow-up after the initial DEX implant.Results: One hundred and one patient charts yielded data on 120 study eyes, including diagnoses of diabetic ME (DME (n=34, retinal vein occlusion (RVO, n=30; branch in 19 and central in 11, and uveitis (n=23. Patients had a mean age of 60.9 years, and 73.3% of the study eyes had ME for a duration of ≥12 months prior to DEX implant injection(s. Baseline mean (± standard error BCVA was 0.63±0.03 logMAR (20/86 Snellen equivalents and mean CRT was 474.4±18.2 µm. The

  13. Prolongation of injection interval after switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema secondary to branch retinal vein occlusion

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    Tagami, Mizuki; Sai, Ryuto; Fukuda, Masahide; Azumi, Atsushi

    2017-01-01

    Purpose This study was conducted to investigate the outcome of switching therapy from ranibizumab to aflibercept in Japanese patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) in daily practice. Materials and methods This retrospective study enrolled 15 eyes in 15 Japanese patients with ME secondary to BRVO who had been receiving a pro re nata regimen of ranibizumab and had provided written informed consent to switch to aflibercept therapy. The intravitreal injection interval, central retinal thickness, and visual acuity were evaluated before and after switching. Results The mean period of ranibizumab treatment was 11.8±4.2 months. The mean observation period after switching to aflibercept was 10.6±3.4 months, and seven patients were observed for more than 12 months after switching. The mean intravitreal injection interval was prolonged by 23.6 days with aflibercept (68.2±26.4 days with ranibizumab vs 91.8±33.2 days with aflibercept; P=0.0011). The mean intravitreal injection interval just before the switch was 81.3±35.6 days and was significantly prolonged to 100.8±34.2 days just after the switch to aflibercept (P=0.0309). The mean central retinal thickness did not change before or after the switch to aflibercept (295±55 μm with ranibizumab vs 276±25 μm with aflibercept; P=0.12). The mean visual acuity also remained at an improved level after the switch. No systemic or ocular side effects were evident during the study period. Conclusion Switching therapy from ranibizumab to aflibercept in Japanese patients with ME secondary to BRVO prolonged the intravitreal injection interval without anatomical or functional degradation.

  14. RETINAL BLOOD FLOW AFTER INTRAVITREAL BEVACIZUMAB IS A PREDICTIVE FACTOR FOR OUTCOMES OF MACULAR EDEMA ASSOCIATED WITH CENTRAL RETINAL VEIN OCCLUSION.

    Science.gov (United States)

    Matsumoto, Makiko; Suzuma, Kiyoshi; Yamada, Yoshihisa; Tsuiki, Eiko; Fujikawa, Azusa; Kitaoka, Takashi

    2017-02-01

    To investigate whether retinal blood flow levels after intravitreal bevacizumab (IVB) treatment are correlated with the outcomes of patients with macular edema secondary to central retinal vein occlusion. This retrospective observational case study enrolled 44 cases nonischemic central retinal vein occlusion. In each patient, visual acuity, central retinal thickness, and mean blur rate, which was measured by laser speckle flowgraphy and represents retinal blood flow velocity, were examined. At the end of the follow-up period (19.8 ± 8.8 months), 4 of 44 eyes (9.1%) converted to the ischemic type (converted group), whereas 40 (90.9%) remained unchanged (nonischemic group). Mean central retinal thickness significantly decreased and mean visual acuity significantly improved at 1 month after the first IVB injection in each group. Mean mean blur rate in the nonischemic group significantly increased, whereas it was unchanged in the converted group. The difference between the two groups was already significant after the first IVB injection. Subsequently, visual acuity worsened in the converted group. Multiple linear regression analysis indicated that the strongest correlation was between the last visual acuity and the last mean blur rate. Blood flow measurements are useful for evaluating IVB treatments. Blood flow after IVB can predict outcomes in patients with central retinal vein occlusion.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  15. Efficacy and safety of two or more dexamethasone intravitreal implant injections for treatment of macular edema related to retinal vein occlusion (Shasta study).

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    Capone, Antonio; Singer, Michael A; Dodwell, David G; Dreyer, Richard F; Oh, Kean T; Roth, Daniel B; Walt, John G; Scott, Lanita C; Hollander, David A

    2014-02-01

    To evaluate the efficacy, safety, and reinjection interval of dexamethasone intravitreal implant (DEX implant) in branch retinal vein occlusion and central retinal vein occlusion patients receiving ≥ 2 DEX implant treatments. Multicenter (26-site), retrospective chart review study. Data were collected from baseline (at first DEX implant) through 3 months to 6 months after last DEX implant. Patients (n = 289) received 2 to 9 (mean, 3.2) DEX implants as monotherapy (29.1% of patients) or with adjunctive treatments/procedures. Mean duration of macular edema before first DEX implant was 18.4 months. Mean reinjection interval was 5.6 months. Mean peak change in best-corrected visual acuity from baseline through 4 weeks to 20 weeks after final DEX implant was +1.0 line (P central retinal thickness improved significantly from baseline after each of the first 6 DEX implant injections (P ≤ 0.037); 59.7% of branch retinal vein occlusion and 66.7% of central retinal vein occlusion patients achieved ≥ 2-line best-corrected visual acuity improvement. Intraocular pressure increase (≥ 10 mmHg) occurred in 32.6% of patients; 29.1% used intraocular pressure-lowering medication to treat increases associated with DEX implant. Only 1.7% of patients required incisional glaucoma surgery. Retinal vein occlusion patients treated with multiple DEX implant injections, either alone or combined with other therapies, had improved central retinal thickness and visual acuity with each subsequent injection. No new safety concerns developed with multiple implants.

  16. Demographic, medical and visual aspects of Dia- betic Retinopathy (DR and Diabetic Macular Edema (DME in South African diabetic patients*

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    Anusha Y. Sukha

    2009-12-01

    Full Text Available Objective: To investigate some of the demographic, medical, and visual aspects of diabetic retinopathy (DR and diabetic macula edema (DME in diabetics attending an urban clinic in Johannesburg, Gauteng.Design: In this cross-sectional study, 202 diabetic patients were recruited. Demographic variables included age, gender, race, age of diagnosis, duration of diabetes mellitus (DM, and social habits. Medical variables included systemic conditions present, blood pressures, body mass indices (BMI, lipid profiles, glycerated haemoglobin (HbA1c, and other biochemical data. Visual variables included distance, pinhole and near visual acuities, contrast visual acuities (CVA, refractive status, colour vision, central visual field evaluation with the Amsler grid, intraocular pressures (IOP, fundus photography and administration of the Impact of Visual Impairment (IVI questionnaire. All variables were compared between diabetic subjects with and with-out DR and DME in both right and left eyes.Results: Overall prevalence of DR was 22.8% and DME 12.5%. In DR subjects, significant results indicated that Whites were more likely to present with DR (p = 0.002. Subjects with DR had a higher mean duration of DM (p = 0.002 and a higher mean diastolic blood pressure (p = 0.035. Autorefraction suggested that more myopia and less astigmatism might be associated with DR. A higher mean CVA at the 2.5% level in DR was significant in both the right eyes (p = 0.042 and left eyes (p = 0.035. These subjects also reported a higher mean IVI score in the consumer and social interaction domain (p = 0.032. Similarly, DME subjects displayed a higher mean duration of DM (p = 0.042 and a higher mean diastolic blood pressure (p = 0.048. A higher mean CVA was associated at both the 10% level: right eyes (p = 0.021; and left eyes (p = 0.046, and at the 2.5% level: right eyes (p = 0.033 and left eyes (p = 0.045. A higher mean IVI score in leisure and work (p = 0.026, consumer and social

  17. Efficiency and safety of laser photocoagulation with or without intravitreal ranibizumab for treatment of diabetic macular edema: a systematic review and Meta-analysis

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    Tian-Wei Qian

    2017-07-01

    Full Text Available AIM: To compare the therapeutic effect and safety of laser photocoagulation along with intravitreal ranibizumab (IVR versus laser therapy in treatment of diabetic macular edema (DME. METHODS: Pertinent publications were identified through comprehensive searches of PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to identify randomized clinical trials (RCTs comparing IVR+laser to laser monotherapy in patients with DME. Therapeutic effect estimates were determined by weighted mean differences (WMD of change from baseline in best corrected visual acuity (BCVA and central retinal thickness (CRT at 6, 12, or 24mo after initial treatment, and the risk ratios (RR for the proportions of patients with at least 10 letters of improvement or reduction at 12mo. Data regarding major ocular and nonocular adverse events (AEs were collected and analyzed. The Review Manager 5.3.5 was used. RESULTS: Six RCTs involving 2069 patients with DME were selected for this Meta-analysis. The results showed that IVR+laser significantly improved BCVA compared with laser at 6mo (WMD: 6.57; 95% CI: 4.37-8.77; P<0.00001, 12mo (WMD: 5.46; 95% CI: 4.35-6.58; P<0.00001, and 24mo (WMD: 3.42; 95% CI: 0.84-5.99; P=0.009 in patients with DME. IVR+laser was superior to laser in reducing CRT at 12mo from baseline with statistical significance (WMD: -63.46; 95% CI: -101.19 to -25.73; P=0.001. The pooled RR results showed that the proportions of patients with at least 10 letters of improvement or reduction were in favor of IVR+laser arms compared with laser (RR: 2.13; 95% CI: 1.77-2.57; P<0.00001 and RR: 0.37; 95% CI: 0.22-0.62; P=0.0002, respectively. As for AEs, the pooled results showed that a significantly higher proportion of patients suffering from conjunctival hemorrhage (study eye and diabetic retinal edema (fellow eye in IVR+laser group compared to laser group (RR: 3.29; 95% CI: 1.53-7.09; P=0.002 and RR: 3.02; 95% CI: 1.24-7.32; P=0.01, respectively. The

  18. The effect of intravitreal bevacizumab and ranibizumab on macular edema of the contralateral eye: A comparative study of two anti-VEGFs

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    Berker Bakbak

    2016-01-01

    Conclusions: In contrast to ranibizumab, the intravitreal administration of bevacizumab resulted in a statistically significant decrease in macular thickness in the untreated eye in patients with bilateral DME.

  19. Resultados anatómicos y funcionales tras la terapia ANTI-VEGF en el edema macular diabético en la práctica clínica

    OpenAIRE

    2016-01-01

    El edema macular diabético (EMD) representa en la actualidad la causa más frecuente de discapacidad visual severa en las personas con diabetes. La fotocoagulación con láser ha sido considerada el tratamiento “gold standard” para el EMD clínicamente significativo no traccional. Sin embargo diversos ensayos clínicos multicéntricos ponen de manifiesto la superioridad de los fármacos antiangiogénicos, entre ellos ranibizumab, frente al láser. Estos fármacos han cambiado el pronóstico funcional de...

  20. Implante intravítreo de liberação crônica de dexametasona (Ozurdex® para o tratamento de edema macular por retinose pigmentar: relato de caso

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    Guilherme Buchaim

    2013-12-01

    Full Text Available Retinose pigmentar indica um grupo heterogêneo de doenças genéticas oculares raras em que tanto bastonetes quanto cones estão danificados, levando a um prognóstico ruim com eventual perda da visão. Descrevemos o caso de mulher de 22 anos com edema macular recorrente devido à retinose pigmentar. Obteve-se sucesso terapêutico após o tratamento com o implante intravítreo de dexamentasona (Ozurdex®, Allergan,USA.

  1. Two or more dexamethasone intravitreal implants in treatment-naïve patients with macular edema due to retinal vein occlusion: subgroup analysis of a retrospective chart review study.

    Science.gov (United States)

    Dugel, Pravin U; Capone, Antonio; Singer, Michael A; Dreyer, Richard F; Dodwell, David G; Roth, Daniel B; Shi, Rui; Walt, John G; Scott, Lanita C; Hollander, David A

    2015-09-04

    Dexamethasone intravitreal implant (DEX implant) is a biodegradable, sustained-release implant that releases dexamethasone for up to 6 months. We evaluated the efficacy and safety of DEX implant in the treatment of macular edema secondary to retinal vein occlusion (RVO) in treatment-naïve patients. A multicenter, retrospective, open-label chart review study investigated the efficacy and safety of DEX implant treatment in 289 patients with macular edema secondary to branch or central RVO (BRVO, CRVO) who received ≥2 treatments with DEX implant in the study eye. Concomitant adjunctive RVO treatments were permitted. Data collected from the time of the first implant (baseline) to 3-6 months after the last implant included best-corrected visual acuity (BCVA) and central retinal thickness measured with optical coherence tomography. In this subgroup analysis, we evaluated outcomes in patients who had received no previous treatment for RVO complications. Thirty-nine patients were treatment-naïve at the time of their first DEX implant (18 BRVO, 21 CRVO). Before the initial DEX implant, the mean duration of macular edema in treatment-naïve patients was 4.9 months, mean central retinal thickness was 550 μm, and mean Early Treatment Diabetic Retinopathy Study BCVA was 8.5 lines (20/125 Snellen). Treatment-naïve patients received a mean of 2.9 implants, either as monotherapy (n = 12) or with adjunctive RVO treatments (n = 27). The mean interval between implants was 177 days. After the first through sixth implants, mean changes from baseline BCVA ranged from +3.0 - +8.0 lines, and mean decreases from baseline central retinal thickness ranged from 241-459 μm. BCVA improved in both BRVO and CRVO and in both phakic and pseudophakic eyes. Overall, 83.8 % of treatment-naïve patients gained ≥2 lines in BCVA, 70.3 % gained ≥3 lines in BCVA, and 56.4 % achieved central retinal thickness ≤250 μm. The most common adverse event was increased intraocular

  2. Cost-effectiveness of ranibizumab versus aflibercept in the treatment of visual impairment due to diabetic macular edema: a UK healthcare perspective

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    Régnier SA

    2015-05-01

    Full Text Available Stephane A Régnier,1 William Malcolm,2 Jennifer Haig,3 Weiguang Xue41Novartis Pharma AG, Basel, Switzerland; 2Novartis Pharmaceuticals UK Ltd, Frimley Business Park, UK; 3Optum, Burlington, ON, Canada; 4Optum, Uxbridge, UKBackground: Ranibizumab and aflibercept are alternative anti-vascular endothelial growth factor agents approved for the treatment of visual impairment (VI due to diabetic macular edema (DME.Objective: To estimate, from a UK healthcare perspective, the cost-effectiveness of ranibizumab 0.5 mg pro re nata (PRN and ranibizumab 0.5 mg treat and extend (T&E compared with aflibercept 2 mg every 8 weeks after five initial monthly doses (2q8 in the treatment of VI due to DME.Methods: A Markov model previously reviewed by the National Institute for Health and Care Excellence was used to simulate the long-term outcomes and costs of treating DME. Health states were defined by increments of ten letters in best-corrected visual acuity (BCVA, with a 3-month cycle length. Patients could gain (or lose a maximum of two health states between cycles. A 3-year treatment time frame and a lifetime horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Patient baseline characteristics and the efficacy of ranibizumab PRN were derived using data from the RESTORE study. The relative efficacies of ranibizumab PRN, ranibizumab T&E, and aflibercept were assessed with a network meta-analysis. Different utilities were assigned based on BCVA and whether the treated eye was the better- or the worse-seeing eye. Sensitivity analyses tested the robustness of the model.Results: Lifetime costs per patient of treating DME were £20,019 for ranibizumab PRN, £22,930 for ranibizumab T&E, and £25,859 for aflibercept 2q8. Ranibizumab was dominant over aflibercept, with an incremental gain of 0.05 quality-adjusted life-years (QALYs and cost savings of £5,841 (PRN and £2,930 (T&E compared with aflibercept. Ranibizumab PRN and

  3. Grid laser with modified pro re nata injection of bevacizumab and ranibizumab in macular edema due to branch retinal vein occlusion: MARVEL report no 2.

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    Narayanan, Raja; Panchal, Bhavik; Stewart, Michael W; Das, Taraprasad; Chhablani, Jay; Jalali, Subhadra; Hasnat Ali, Mohd

    2016-01-01

    The purpose of this study was to prospectively study the efficacy of grid laser combined with intravitreal bevacizumab or ranibizumab in eyes with macular edema due to branch retinal vein occlusion. Treatment-naïve eyes were enrolled to receive injections of ranibizumab or bevacizumab. During the first 6 months, patients were evaluated monthly and injected if the best-corrected visual acuity changed by five or more letters or fluid was noted on spectral domain optical coherence tomography (OCT); during the next 6 months, patients were evaluated bimonthly and injected only if the best-corrected visual acuity decreased by five or more letters with the associated fluid. Grid laser photocoagulation was performed if there was fluid on OCT and was repeated if patients were eligible after a minimum interval of 3 months. The mean numbers of ranibizumab and bevacizumab injections were, respectively, 3.2±1.5 and 3.0±1.4 in the first 6 months and 0.3±0.6 and 0.3±0.6 in the last 6 months. Moreover, 55/75 (73.33%) participants did not receive any injections in the last 6 months. The mean reductions in central retinal thickness at 12 months were 165.67 μm (P<0.001; 95% confidence interval -221.50 to -135.0) in the ranibizumab group and 184.78 μm (P<0.001; 95% confidence interval -246.49 to -140.0) in the bevacizumab group (P=0.079). More patients in the bevacizumab group compared to those in the ranibizumab group required rescue laser at 12 months (20 vs eleven; P=0.06). Bimonthly evaluations after month 6 with very few pro re nata injections were effective in maintaining visual gains achieved during the first 6 months. Grid laser photocoagulation is effective in maintaining the vision even in the presence of fluid on OCT, although it's required more often in patients treated with bevacizumab.

  4. Efficacy of anti-VEGF and laser photocoagulation in the treatment of visual impairment due to diabetic macular edema: a systematic review and network meta-analysis.

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    Stephane Régnier

    Full Text Available Compare the efficacy of ranibizumab, aflibercept, laser, and sham in the first-line treatment of diabetic macular edema (DME to inform technology assessments such as those conducted by the UK National Institute for Health and Care Excellence (NICE.MEDLINE, Embase, Cochrane Library, congress abstracts, ClinicalTrials.gov registry and Novartis data on file.Studies reporting 6- or 12-month results of randomized controlled trials (RCTs evaluating at least two of ranibizumab 0.5 mg pro re nata, aflibercept 2.0 mg bi-monthly, laser photocoagulation or sham. Study quality was assessed based on likelihood of bias in selection, attrition, detection and performance.Improvement in best-corrected visual acuity (BCVA measured as the proportion of patients gaining ≥10 letters on the Early Treatment Diabetic Retinopathy Study scale. The outcome was chosen following acceptance by NICE of a Markov model with 10-letter health states in the assessment of ranibizumab for DME.Bayesian network meta-analyses with fixed and random effects adjusted for differences in baseline BCVA or central retinal thickness.The analysis included 1,978 patients from eight RCTs. The random effects model adjusting for baseline BCVA was the best model based on total residual. The efficacy of ranibizumab was numerically, but not statistically, superior to aflibercept (odds ratio [OR] 1.59; 95% credible interval [CrI], 0.61-5.37. Ranibizumab and aflibercept were statistically superior to laser monotherapy with ORs of 5.50 (2.73-13.16 and 3.45 (1.62-6.84 respectively. The probability that ranibizumab is the most efficacious treatment was 73% compared with 14% for aflibercept, 12% for ranibizumab plus laser, and 0% for laser.Three of the eight RCTs included are not yet published. The models did not adjust for all potential effect modifiers.Ranibizumab was non-significantly superior to aflibercept and both anti-VEGF therapies had statistically superior efficacy to laser.

  5. A meta-analysis of anti-vascular endothelial growth factor remedy for macular edema secondary to central retinal vein occlusion.

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    Peirong Huang

    Full Text Available BACKGROUND: Central retinal vein occlusion (CRVO associates with severe vision outcome and no proven beneficial treatment. Our meta-analysis intended to appraise the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF agents in macular edema (ME following CRVO. METHODS: Data were collected and analyzed by Review Manager 5.2.1. We employed a random-effects model to eliminate between-study heterogeneity. Nfs (called fail-safe number was calculated to evaluate the publication bias. RESULTS: We included 5 trials consisting 323 cases and 281 controls. Primary outcomes showed that overall comparison of anti-VEGF agents with placebo control yielded a 374% and 136% increased tendency for a gain of 15 letters or more on Early Treatment Diabetic Retinopathy Study (ETDRS chart (95% confidence interval [95% CI]: 2.43-9.23; P<0.00001; I(2 = 59%, 95% CI: 1.60-3.49; P<0.0001; I(2  = 0%, respectively at 6 and 12 months. Secondary outcomes showed that a 90% and 77% decreased risk at 6 and 12 months for a loss of 15 letters or more. The overall mean difference showed a statistically significance in best-corrected visual acuity (BCVA on each time point. However, changes of central retinal thickness (CRT lost significance at 12 months after 6-month as-needed treatment. The incidence of adverse events (AEs had no statistical difference between anti-VEGF and placebo groups. Subgroup analyses indicated that patients receiving Aflibercept got the highest tendency to gain 15 letters or more (OR = 9.78; 95% CI: 4.43-21.56; P<0.00001. Age controlled analysis suggested a weaken tendency of BCVA improvement in age over 50 (MD = 12.26; 95% CI: 7.55-16.98; P<0.00001. Subgroup analysis by clinical classification showed a strengthen difference of BCVA changes at 6 months in ischemic type (MD = 19.65 letters, 95% CI: 13.15 to 26.14 letters, P<0.00001. CONCLUSIONS: Our results showed that anti-VEGF agents were superior to placebo in CRVO-ME treatment with

  6. Inhibición Combinada del Factor de Necrosis Tumoral (TNF y Factor de Crecimiento Vascular Endotelial para el Tratamiento del Edema Macular de Variadas Etiologías: Un Estudio Piloto a Corto Plazo

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    J Fernando Arevalo

    2013-03-01

    Full Text Available Objetivo: Reportar la respuesta anatómica y de agudeza visual mejor corregida (AVMC posterior a la combinación del adalimumab intravítreo (Humira y bevacizumab (Avastin en pacientes con edema macular de variadas etiologías. Métodos: Serie retrospectiva intervencional de casos. Se revisaron los registros médicos de 5 pacientes consecutivos (7 ojos con edema macular de variadas etiologías, incluyendo edema macular pseudofáquico, papiloflebitis diabética, oclusión de la vena central de la retina, oclusión de rama venosa retiniana, y degeneración macular relacionada con la edad. Todos los pacientes fueron tratados con al menos una inyección intravítrea de 1,25 mg/0,05 mL de bevacizumab y 2 mg/0,08 mL de adalimumab. A los pacientes se les cuantificó su AVMC por cartilla del Estudio del Tratamiento Temprano de la Retinopatía Diabética (EDTRS, examen oftalmológico, tomografía de coherencia óptica (TCO y angiografía fluoresceínica (AGF al inicio, y a las visitas en el primer, tercer y sexto mes. Los resultados se basaron en las modificaciones de la AVMC y la TCO. Resultados: La edad media de los pacientes fue de 71,5 ± 9,4 años. La media de inyecciones combinadas de bevacizumab y adalimumab fue de 2,14 por ojo (rango: 1 a 4 inyecciones a 6 meses. La AVMC basal mejoró de 1,19 ± 0,6 logaritmo del mínimo ángulo de resolución (logMAR a 0,94 ± 0,59 logMAR a 6 meses (P < 0,05. Cuatro (57,1% de los siete ojos ganaron ≥ 3 líneas ETDRS de AVMC. El espesor macular central (EMC al inicio por TCO tuvo una media de 416 ± 150 µm, el cual se redujo a una media de 354 ± 205 µm a 6 meses (P < 0,05. No hubo complicaciones oculares o sistémicas. Conclusiones: El tratamiento intravítreo combinado de bevacizumab y adalimumab a dosis de 1,25 mg y 2,0 mg respectivamente impresiona proporcionar mejoría o estabilidad en la AVMC, TCO y AGF en edema macular de variadas etiologías sin complicaciones sistémicas a los 6 meses de seguimiento

  7. Inhibición Combinada del Factor de Necrosis Tumoral (TNF y Factor de Crecimiento Vascular Endotelial para el Tratamiento del Edema Macular de Variadas Etiologías: Un Estudio Piloto a Corto Plazo

    Directory of Open Access Journals (Sweden)

    J Fernando Arevalo

    2013-04-01

    Full Text Available Objetivo: Reportar la respuesta anatómica y de agudeza visual mejor corregida (AVMC posterior a la combinación del adalimumab intravítreo (Humira y bevacizumab (Avastin en pacientes con edema macular de variadas etiologías. Métodos: Serie retrospectiva intervencional de casos. Se revisaron los registros médicos de 5 pacientes consecutivos (7 ojos con edema macular de variadas etiologías, incluyendo edema macular pseudofáquico, papiloflebitis diabética, oclusión de la vena central de la retina, oclusión de rama venosa retiniana, y degeneración macular relacionada con la edad. Todos los pacientes fueron tratados con al menos una inyección intravítrea de 1,25 mg/0,05 mL de bevacizumab y 2 mg/0,08 mL de adalimumab. A los pacientes se les  cuantificó su AVMC por cartilla del  Estudio del Tratamiento Temprano de la Retinopatía Diabética (EDTRS, examen oftalmológico, tomografía de coherencia óptica (TCO y angiografía fluoresceínica (AGF al inicio, y a las visitas en el primer, tercer y sexto mes. Los resultados se basaron en las modificaciones de la AVMC y la TCO. Resultados: La edad media de los pacientes fue de 71,5  ± 9,4 años. La media de inyecciones combinadas de bevacizumab y adalimumab fue de 2,14 por  ojo (rango: 1 a 4 inyecciones a 6 meses. La AVMC basal mejoró de 1,19 ± 0,6 logaritmo del mínimo ángulo de resolución (logMAR a 0,94 ± 0,59 logMAR a 6 meses (P < 0,05. Cuatro (57,1% de los siete ojos ganaron  ≥ 3 líneas ETDRS de AVMC. El espesor macular central (EMC al inicio por TCO tuvo una media de 416 ± 150 µm, el cual se redujo a una media de 354 ± 205 µm a 6 meses (P < 0,05. No hubo complicaciones oculares o sistémicas. Conclusiones: El tratamiento intravítreo combinado de bevacizumab y adalimumab a dosis de 1,25 mg y 2,0 mg respectivamente impresiona proporcionar mejoría o estabilidad en la AVMC, TCO y AGF en edema macular de variadas etiologías sin complicaciones sistémicas a los 6 meses de

  8. Comparison of two doses of intravitreal bevacizumab as primary treatment for macular edema secondary to central retinal vein occlusion: results of the pan American collaborative retina study group at 24 months.

    Science.gov (United States)

    Wu, Lihteh; Arevalo, J Fernando; Berrocal, Maria H; Maia, Mauricio; Roca, José A; Morales-Cantón, Virgilio; Alezzandrini, Arturo A; Díaz-Llopis, Manuel J

    2010-01-01

    The purpose of this study was to compare the injection burden, central macular thickness (CMT), and change in best-corrected visual acuity after injecting 1.25 mg or 2.5 mg bevacizumab as needed in patients with primary macular edema secondary to central retinal vein occlusion. This is an interventional, retrospective, comparative multicenter study of 86 eyes with macular edema secondary to central retinal vein occlusion that were treated primarily with intravitreal bevacizumab (44 eyes, 1.25 mg; 42 eyes, 2.5 mg). The main outcome measures were the CMT and the change of best-corrected visual acuity at 24 months. All patients completed at least 24 months of follow-up. The mean number of injections per eye were 7.2 for the 1.25-mg dose group and 8.1 for the 2.5-mg dose group (P = 0.4492). At 24 months, in the 1.25-mg dose group, the logarithm of the minimal angle of resolution best-corrected visual acuity improved from baseline 0.35 +/- 0.57 units (P or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity and 6 (13.6%) lost >or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. In the 2.5-mg dose group, 24 (57.1 %) eyes improved >or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity and 7 (16.7%) lost >or=3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. The CMT in the 1.25-mg dose group improved from 635 +/- 324 microm to 264 +/- 160 microm (P central retinal vein occlusion. There were no statistically significant differences between the two dose groups with regard to the number of injections, CMT, and change in visual acuity.

  9. OPTICAL COHERENCE TOMOGRAPHY CHARACTERISTICS OF MACULAR EDEMA AND HARD EXUDATES AND THEIR ASSOCIATION WITH LIPID SERUM LEVELS IN TYPE 2 DIABETES.

    Science.gov (United States)

    Davoudi, Samaneh; Papavasileiou, Evangelia; Roohipoor, Ramak; Cho, Heeyoon; Kudrimoti, Shreyas; Hancock, Heather; Hoadley, Suzanne; Andreoli, Christopher; Husain, Deeba; James, Maurice; Penman, Alan; Chen, Ching J; Sobrin, Lucia

    2016-09-01

    To determine whether hyperreflective foci (HF) and macular thickness on spectral domain ocular coherence tomography are associated with lipid levels in patients with Type 2 diabetes. Two hundred and thirty-eight participants from four sites had fundus photographs and spectral domain ocular coherence tomography images graded for hard exudates and HF, respectively. Regression models were used to determine the association between serum lipid levels and 1) presence of HF and hard exudates and 2) central subfield macular thickness, central subfield macular volume, and total macular volume. All patients with hard exudates on fundus photographs had corresponding HF on spectral domain ocular coherence tomography, but 57% of patients with HF on optical coherence tomography did not have hard exudates detected in their fundus photographs. Presence of HF was associated with higher total cholesterol (odds ratio = 1.13, 95% confidence interval = 1.01-1.27, P = 0.03) and higher low-density lipoprotein levels (odds ratio = 1.17, 95% confidence interval = 1.02-1.35, P = 0.02) in models adjusting for other risk factors. The total macular volume was also associated with higher total cholesterol (P = 0.009) and triglyceride (P = 0.02) levels after adjusting for other risk factors. Higher total and low-density lipoprotein cholesterol were associated with presence of HF on spectral domain ocular coherence tomography. Total macular volume was associated with higher total cholesterol and triglyceride levels.

  10. Grid laser with modified pro re nata injection of bevacizumab and ranibizumab in macular edema due to branch retinal vein occlusion: MARVEL report no 2

    Directory of Open Access Journals (Sweden)

    Narayanan R

    2016-06-01

    Full Text Available Raja Narayanan,1 Bhavik Panchal,1 Michael W Stewart,2 Taraprasad Das,1 Jay Chhablani,1 Subhadra Jalali,1 Mohd Hasnat Ali3 On behalf of MARVEL study group 1Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India; 2Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 3Department of Biostatistics, L V Prasad Eye Institute, Hyderabad, India Purpose: The purpose of this study was to prospectively study the efficacy of grid laser combined with intravitreal bevacizumab or ranibizumab in eyes with macular edema due to branch retinal vein occlusion.Patients and methods: Treatment-naïve eyes were enrolled to receive injections of ranibizumab or bevacizumab. During the first 6 months, patients were evaluated monthly and injected if the best-corrected visual acuity changed by five or more letters or fluid was noted on spectral domain optical coherence tomography (OCT; during the next 6 months, patients were evaluated bimonthly and injected only if the best-corrected visual acuity decreased by five or more letters with the associated fluid. Grid laser photocoagulation was performed if there was fluid on OCT and was repeated if patients were eligible after a minimum interval of 3 months.Results: The mean numbers of ranibizumab and bevacizumab injections were, respectively, 3.2±1.5 and 3.0±1.4 in the first 6 months and 0.3±0.6 and 0.3±0.6 in the last 6 months. ­Moreover, 55/75 (73.33% participants did not receive any injections in the last 6 months. The mean reductions in central retinal thickness at 12 months were 165.67 µm (P<0.001; 95% ­confidence interval -221.50 to -135.0 in the ranibizumab group and 184.78 µm (P<0.001; 95% confidence interval -246.49 to -140.0 in the bevacizumab group (P=0.079. More patients in the bevacizumab group compared to those in the ranibizumab group required rescue laser at 12 months (20 vs eleven; P=0.06.Conclusion: Bimonthly evaluations after month 6

  11. 不同病因致黄斑囊样水肿患者视力下降与水肿形态的相关性分析%Co relation of patterns and etiologies with visual ac uity in cystoid macular edema

    Institute of Scientific and Technical Information of China (English)

    Adrien Bironkwaninguvu; 姜伟; 王玉清

    2016-01-01

    Abstract?AIM: To determine the relation between each of the optical coherence tomography ( OCT) patterns, etiologies and visual acuity in patients with cystoid macular edema ( CME) .?METHODS:Fifty-seven eyes with CME from 52 patients were included in our study. The data of this cross sectional study was collected rfom p atient s wtih CME assessed by OCT, who also underwent fun dus photography and visual acuity test the same day. The best corrected visual acuity ( BCVA ) was assessed by using E chart a nd converted in logarithm of the minimum angle of resolution( logMAR ) . Thevisual acuity varied from 2.3 logMAR to 0 logMAR w ith a mean of 1.11±0.57. The etiology was determined from medical history and the fundus ph otograph of the patient. Four O CT grades established according to ratio between the vertical size of largest cyst and the maximum macular thickness (<30 %,≥30% <60%,≥60% <90%and≥90%) were considered. The correlation was established by calculating the Pearson's correlatio n coefficient “r” and the statistical significance was considered when P value was inferior to 0.05.?RESULTS: OCT grade I V was the most associated with very severe visual loss with the greatest mean VA of 1.96± 0.23 logMAR and the correlation between OCT grades and visual acuity was strongly statistically significant ( r =0.729, P <0.001 ). The central retinal vein occlusion ( CRVO) was the most underlying disease associated with worsev ision, with the gre atest mean VA of 2 logMAR and the correlation was statistically significant ( r=0.375, P=0.004).Another associated OCT pattern, the disruption of bot h inner segment/outer segment ( IS/OS) and external limiting membrane ( ELM) , was inversely associated with severe visual loss ( high mean VA=1.11 ±0.57 logMAR, with statistically significant correlation, r=-0.346, P=0.008 ) . The presence of both vitreoretinal traction components and outer retinal layers disruption were significantly associated with OCT grade IV ( r=0

  12. Comparación de la efectividad de ranibizumab intravítreo para el tratamiento del edema macular diabético en ojos vitrectomizados y no vitrectomizados.

    Science.gov (United States)

    Koyanagi, Yoshito; Yoshida, Shigeo; Kobayashi, Yoshiyuki; Kubo, Yuki; Yamaguchi, Muneo; Nakama, Takahito; Nakao, Shintaro; Ikeda, Yasuhiro; Ohshima, Yuji; Ishibashi, Tatsuro; Sonoda, Kohhei

    2017-07-11

    Objetivo: Comparar la efectividad de ranibizumab intravítreo (RIV) para el tratamiento del edema macular diabético (EMD) en ojos con y sin vitrectomía previa. Procedimientos: Evaluamos de manera prospectiva la mejor agudeza visual corregida (MAVC) y el grosor macular central (GMC) tras el tratamiento con RIV durante 6 meses. Resultados: No se observaron diferencias significativas en la MAVC o GMC inicial en ninguno de los dos grupos. En el grupo no vitrectomizado (n = 15), los cambios medios en la MAVC y GMC hasta el sexto mes de tratamiento con respecto al valor inicial resultaron significativos (p < 0,01). En el grupo vitrectomizado (n = 10), se observó una mejora más lenta, y la mejora media en la MAVC no resultó significativa (p = 0,5), aunque la media en la disminución del GMC sí que lo fue (p < 0,05). No se observaron diferencias significativas en los cambios medios en la MAVC y el GMC entre ambos grupos a los 6 meses del tratamiento. Conclusiones: La diferencia en la efectividad de RIV entre ambos grupos no resultó significativa. Ranibizumab intravítreo puede ser una opción de tratamiento incluso en pacientes vitrectomizados con EMD. © 2017 S. Karger AG, Basel.

  13. Therapeutic efficiency of intravitreal triamcinolone acetonide in two different dosages in treating uveitis with cystoid macular edema%不同剂量IVTA治疗葡萄膜炎黄斑囊样水肿的疗效观察

    Institute of Scientific and Technical Information of China (English)

    祝莹; 李军; 徐少凯

    2013-01-01

    目的:观察两种不同剂量曲安奈德玻璃体腔注射(intravitreal triamcinolone acetonide,IVTA)治疗葡萄膜炎黄斑囊样水肿的效果,并对其治疗结果和并发症情况进行比较.方法:分析研究2010-01/2012-01在我院确诊为双眼葡萄膜炎黄斑囊样水肿的患者6例12眼,每例患者双眼随机分为A,B两组进行曲安奈德玻璃体腔注射治疗,A组玻璃体腔注射4mg曲安奈德,B组玻璃体腔注射2mg曲安奈德.术后观察两组视力、眼压、黄斑中心凹厚度、晶状体透明度以及葡萄膜炎复发等.数据比较采用配对t检验.结果:术后视力均有大幅提高,术后OCT显示12眼(100%)黄斑囊样水肿均消失,黄斑中心凹厚度减低,与术前相比差异有统计学意义(P<0.01).术前与术后两组间视力、黄斑区厚度相比差异无统计学意义(P>0.05).两组术后各出现眼压升高3例3眼(50%),A组药物控制后眼压平均为44.33±7.51mmHg,B组为23.33±2.52mmHg,术后两组间眼压差异有统计学意义(P=0.01).2例患者双眼随访期间发生并发性白内障,2例患者双眼葡萄膜炎黄斑囊样水肿复发.结论:IVTA是治疗葡萄膜炎黄斑囊样水肿的有效方法.并发症有眼压升高和并发性白内障.玻璃体腔注射4mg和2mg曲安奈德治疗葡萄膜炎黄斑囊样水肿的疗效相同,后者眼压升高的并发症易于应用药物控制.%AIM: To observe the effects and complications of treatment foruveitis with cystoid macular edema with two different dosages of intravitreal triamcinolone acetonide (IVTA).METHODS: Totally 6 cases (12 eyes) suffering from bilateraluveitis with cystoid macular edema were selected for the study from January 2010 to January 2012 treated in our hospital. Two eyes of each patient was divided into two groups randomly. Group A was treated with IVTA 4mg, group B was treated with IVTA 2mg. The visual acuity, intraocular pressure, foveal thickness, transparency of lens and recurrence of uveitis etc

  14. Pulmonary edema

    Science.gov (United States)

    ... congestion; Lung water; Pulmonary congestion; Heart failure - pulmonary edema ... Pulmonary edema is often caused by congestive heart failure . When the heart is not able to pump efficiently, blood ...

  15. A novel intravitreal fluocinolone acetonide implant (Iluvien® in the treatment of patients with chronic diabetic macular edema that is insufficiently responsive to other medical treatment options: a case series

    Directory of Open Access Journals (Sweden)

    Schmit-Eilenberger VK

    2015-05-01

    Full Text Available Vera K Schmit-Eilenberger Augenklinik Städtisches Klinikum, Karlsruhe, Baden-Württemberg, Germany Background: Iluvien® is a novel, nonbiodegradable, sustained-release drug delivery system (0.2 µg/d fluocinolone acetonide [FAc] indicated in Europe for the treatment of vision impairment associated with chronic diabetic macular edema (DME, considered insufficiently responsive to available therapies.Objective: To evaluate the safety and efficacy of 190-µg FAc implant in patients with chronic DME refractory to other medical treatment options in a clinical setting. Methods: Retrospective registry data were collected by using standard case report forms (CRFs. Prior to intravitreal injection of the FAc implant, all patients were treated either with a vascular endothelial growth factor (VEGF antagonist and/or a steroid (triamcinolone, dexamethasone implant. Patients were excluded from receiving FAc if they had a known history of elevated intraocular pressure (IOP following corticosteroid therapy, glaucoma, ocular hypertension, or any contraindications cited in the summary of product characteristics. Best-corrected visual acuity (BCVA was the main study parameter. Central fovea thickness (CFT and IOP were measured concurrently. These parameters were recorded prior to and after the injection of the 190-µg FAc implant (between 1 week and 9 months. Injections were performed between May 2013 and March 2014.Results: Fifteen eyes from ten patients were treated. Thirteen eyes (nine patients were pseudophakic, and seven eyes (five patients were vitrectomized prior to receiving therapy. BCVA improved in eleven eyes (73.3%, remained unchanged in two eyes (13.3%, and decreased slightly in two eyes (13.3% at the last follow-up visit versus baseline levels. IOP increased in two patients and was controlled using fixed-combination of IOP-lowering eyedrops or sectorial cyclocryotherapy (n=1.Conclusion: The 190-µg FAc implant was efficacious and showed a favorable

  16. The influence of anti-VEGF therapy on present day management of macular edema due to BRVO and CRVO: a longitudinal analysis on visual function, injection time interval and complications.

    Science.gov (United States)

    Papadia, Marina; Misteli, Marie; Jeannin, Bruno; Herbort, Carl P

    2014-12-01

    The purpose of this study was to evaluate the impact of intravitreal bevacizumab injections on the management and outcome of patients affected by retinal vein occlusions, their effectiveness on morphological and functional parameters, the modalities of long-term management and the need for additional laser treatment due to ischemic retinal evolution. Patients diagnosed with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) had a comprehensive work-up including complete ophthalmic examination, fluorangiography (FA), optical coherence tomography (OCT), visual field testing (VFT), microperimetry (MP), and laser flare photometry (LFP). In case of BRVO, intraocular bevacizumab injection was performed if significant macular edema/visual deficit was still present 3 months after onset of occlusion and injections were started at presentation in case of CRVO. Post-injection follow-up examination including best corrected visual acuity (BCVA), intraocular pressure (IOP), LFP, OCT, MP, and VFT were performed monthly and recorded at the end of follow-up. Follow-up FA was performed between 12 and 18 months after diagnosis. Injections were repeated in case of recurrence of a significant central macular edema. Patients were subdivided into 2 groups according to number of injections: 1-4 injections or more than 4 injections. The proportion of resolved cases (no recurrence after a minimum follow-up of 12 months) was calculated and correlated with number of injections. In patients needing sustained injections, management modalities were recorded. The proportion of patients having needed laser photocoagulation treatment because of significant ischemic signs was recorded. Fifty-one patients were diagnosed with retinal vein occlusion between 2006 and 2012 at the Centre for Specialized Ophthalmic Care (COS) in Lausanne, Switzerland. Forty-four had enough data and were included in the study. Nine eyes were affected by CRVO and 35 were affected by BRVO. Mean BCVA

  17. Management of macular epiretinal membrane by vitrectomy and intravitreal triamcinolone

    Directory of Open Access Journals (Sweden)

    Dhananjay Shukla

    2014-01-01

    Full Text Available A patient underwent successful vitrectomy for macular epiretinal membrane with anatomical and functional improvement. 10 weeks later, there was a recurrence of macular edema with corresponding visual decline. An intravitreal injection of triamcinolone acetonide not only restored the macular anatomy but also improved the visual outcome beyond that achieved after surgery.

  18. Octreotide acetate in dominant cystoid macular dystrophy.

    NARCIS (Netherlands)

    Hogewind, B.F.T.; Pieters, G.; Hoyng, C.B.

    2008-01-01

    PURPOSE: Dominant cystoid macular degeneration (DCMD) is an autosomal dominant trait of cystoid macular edema with poor visual prognosis. Until now, no efficient treatments for DCMD have been reported. The authors evaluated a somatostatin-analogue (octreotide acetate) as treatment for DCMD. METHODS:

  19. El efecto de la panfotocoagulación con láser en edema macular diabético con el fotocoagulador Pascal® versus el láser de argón convencional.

    Science.gov (United States)

    Mahgoub, Mohamed M; Macky, Tamer A

    2017-07-11

    Objetivo: El objetivo de este estudio fue comparar el efecto de la panfotocoagulación (PFC) en el edema macular diabético (EMD) en pacientes con retinopatía diabética proliferativa (RDP) con el fotocoagulador Pascal® (FP) vs. un fotocoagulador con láser de argón convencional (FLAC). Métodos: Se aleatorizó el uso de FP o FLAC en ochenta ojos con RDP y EMD con afectación central de la mácula. Ambos grupos tuvieron una evaluación de base de mejor agudeza visual corregida y fueron examinados con tomografía de coherencia óptica y angiografía con fluoresceína. Resultados: El número medio de disparos de láser en los grupos de FP y FLAC fue 1.726,10 y 752,00 en la sesión 1 y 1.589,00 y 830,00 (p 0,05). La MAVC media fue similar durante el periodo de estudio y no hubo ninguna diferencia significativa entre los grupos (p > 0,05). Conclusiones: El FP y el FLAC mostraron efectos similares en el EMD en ojos con RDP y fueron igualmente seguros sin un aumento significativo del GFC. © 2017 S. Karger AG, Basel.

  20. Long-Term Real-Life Efficacy and Safety of Repeated Ozurdex® Injections and Factors Associated with Macular Edema Resolution after Retinal Vein Occlusion: The REMIDO 2 Study.

    Science.gov (United States)

    Pommier, Stéphan; Meyer, Franck; Guigou, Sébastien; Barthelemy, Tony; Gobert, Fréderic; Hajjar, Christian; Merite, Pierre-Yves; Parrat, Eric; Rouhette, Hervé; Matonti, Fréderic

    2016-01-01

    The objective was to study long-term real-life efficacy and safety of repeated Ozurdex® injections and factors associated with macular edema (ME) resolution after retinal vein occlusion. Patients with ME after retinal vein occlusion, receiving Ozurdex®, were included to assess the following endpoints: visual acuity and central retinal thickness, retreatment, number of injections, side effects and ME resolution. ME resolution was defined as permanent discontinuation of intravitreal injections (IVTs) for at least 6 months after the last IVT. A total of 94 eyes were included with an average of 2.6 IVTs (max 6 IVTs). 58.6% of patients gained ≥15 letters and 51.1% of patients showed ME resolution. Among the resolved patients, 64.6% were treatment-naïve, 60.4% had branch retinal vein occlusion, and 78.1% gained ≥15 letters. Ozurdex® seemed to be a valuable treatment which may allow to achieve long-term anatomical and functional improvements and ME resolution with a minimum number of IVTs. © 2016 S. Karger AG, Basel.

  1. Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery - preliminary 6 month results.

    Science.gov (United States)

    Lim, Lyndell L; Morrison, Julie L; Constantinou, Marios; Rogers, Sophie; Sandhu, Sukhpal S; Wickremasinghe, Sanjeewa S; Kawasaki, Ryo; Al-Qureshi, Salmaan

    2016-05-01

    To compare visual and anatomical outcomes between intravitreous bevacizumab (BVB, Avastin) and triamcinolone (TA, Triesence) when administered at the time of cataract surgery in patients with diabetic macular oedema (DME). Prospective, single-masked, randomized clinical trial at The Royal Victorian Eye and Ear Hospital, Melbourne. Patients with clinically significant cataract and either centre-involving DME or DME treated within the previous 24 months. Participants were randomized 1:1 to receive intravitreous BVB 1.25 mg or TA 4 mg during cataract surgery, and at subsequent review if required over 6 months. Change in central macular thickness (CMT) and best corrected visual acuity at 6 months. Forty-one patients (mean age 66.4 years, 73.2% male) were recruited. Visual acuity and CMT were similar between groups at baseline (P > 0.2).After six months, both groups gained vision (mean +21.4 letters in TA group P < 0.0001, +12.5 letters in BVB, P = 0.002), with no significant difference between groups (P = 0.085). In addition, 60.9% of eyes receiving TA achieved a VA of ≥6/12 compared to 73.3% in the BVB group (P = 0.501). However, only TA was associated with a sustained reduction in CMT (-43.8-µm reduction TA vs. +37.3-µm increase BVB, P = 0.006 over 6 months). Following surgery, additional injections were required in 70.6% of participants in the BVB group, compared to 16.7% in the TA group (P < 0.0001). Three patients in the TA group experienced a rise of IOP over 21 mmHg (12.5%) during the 6-month follow-up; BVB had no cases (P = 0.130). There were no cases of endophthalmitis in either group. When administered at the time of cataract surgery in patients with DME, at 6 months both TA and BVB improve visual acuity; however, only TA results in a sustained reduction in CMT. Further follow-up will determine whether this translates into better long-term visual outcomes in the TA group. © 2016 Royal Australian and New

  2. Clinical study of probucol in the treatment of hyperlipidemia diabetic macular edema%普罗布考辅助治疗高血脂糖尿病黄斑水肿的临床观察

    Institute of Scientific and Technical Information of China (English)

    陈忠平; 唐仕波; 王启常; 陈娟; 周增超; 段毅琴

    2013-01-01

    力、降低TG、TC及LDLC,降低8-OHdG.其效果与阿托伐他汀相当或优于阿托伐他汀.普罗布考可作为此类患者的辅助治疗药物.%Objective To determine the clinical efficacy of probucol in patients with diabetic macular edema (DME) and elevated serum lipids after focal/grid laser photocoagulation.Methods A prospective randomized controlled study included 48 type 2 diabetic patients with DME and dyslipidemia which were randomly divided into three groups.For patients with bilateral disease only the more severe eye was included.All patients were subjected to strict metabolic and blood pressure control during enrollment.All cases received macular laser photocoagulation.Besides,sixteen patients in group A were treated with probucol,16 members in group B with atorvastatin and 16 members in group C were not treated with any lipid-lowering therapy for about three months.The outcome measurements were status of macular edema and hard exudates,visual acuity,foveal thickness,serum lipids and urine 8-hydroxy-deoxyguanosine (8-OHdG) during the three months.Results The study included 20 men and 28 women with non-insulin dependent diabetes mellitus who could achieve good metabolic and blood pressure control within three months of inclusion in the study.Thirteen of 16 patients in group A,twelve of 16 patients in group B and five of 16 patients in group C showed reduction in hard exudates.Regression of macular edema was seen in twelve patients in group A,11 in group B and eight in group C (x2 =2.368,P>0.05).The difference of foveal thickness in group A,B and C was statistically significant (t=4.929,4.669; P=0.000).Nine patients in group A,eight in group B and six in group C showed improving of visual acuity (x2 =1.169,P> 0.05).Three months after treatment,triglycerides (TG) (t=7.954,6.832; P<0.05),total cholesterol (TC) (t=6.643,5.368; P<0.05) and low-density lipoprotein cholesterol (LDLC) (t=3.279,3.835; P<0.05) decreased in group A and group B but not in group C,and high

  3. The Effect of Age and Initial Central Retinal Thickness on Earlier Need of Repeat Ozurdex Treatment for Macular Edema Due to Retinal Vein Occlusion: A Retrospective Case Series.

    Science.gov (United States)

    Lin, Chun-Ju; Chen, Huan-Sheng; Su, Cheng-Wen; Tien, Peng-Tai; Lin, Jane-Ming; Chen, Wen-Lu; Kuo, Chung-Yuan; Lai, Chun-Ting; Tsai, Yi-Yu

    2017-09-26

    To evaluate the effects of dexamethasone intravitreal implant (Ozurdex) and identify risk factors for repeated treatment in patients with macula edema due to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Patients followed up for at least 6 months were enrolled from 2013 to 2016. Dexamethasone intravitreal implant was given as the baseline treatment. For evaluation of dexamethasone intravitreal implant effects and complications, the demographics, medical history, best-corrected visual acuity (BCVA), intraocular pressure, and central retinal thickness (CRT) were recorded. Multivariate Cox proportional hazard model and logistic regression were used to identify factors for repeated treatment. Twenty-three BRVO and 11 CRVO patients were enrolled. There were 15 males and 19 females. Fifteen (44.12%) patients needed only one dexamethasone intravitreal implant. The peak CRT and BCVA significantly improved. Comparing single-injection with multiple-injection group, age and initial CRT more than 400 μm were significantly higher in the multiple-injection group. From multivariate logistic regression and Cox proportional hazards analysis, patients with age older than 55 years and initial CRT more than 400 μm had higher risk for multiple injections. Patients receiving as-needed schedule of dexamethasone intravitreal implant had significant peak CRT and BCVA improvement. Age older than 55 years and initial CRT more than 400 μm were significant risk factors associated with repeated dexamethasone intravitreal implant treatment.

  4. Intravitreal triamcinolone acetonide injection combined of macular laser grid photocoagulation and macular laser grid photocoagulation only for treatment of diabetic macular edema: a meta-analysis%玻璃体腔注射曲安奈德联合格栅样激光光凝与单纯格栅样激光光凝治疗黄斑水肿临床随机对照试验的meta分析

    Institute of Scientific and Technical Information of China (English)

    张社德; 张天峰; 罗荣; 钟秀华

    2012-01-01

    Objective To evaluate the efficacy and safety of intravitreal triamcinolone acetonide combined of macular laser grid photocoagulation (IVTA/MLG) versus macular laser grid (MLG)photocoagulation only for treatment of diabetic macular edema.Methods A computerized search was conducted in the Cochrane Library, Embase Library, Pubmed,Chinese Biomedical Database,Chinese Journal Full-text Database and Chinese Science and Technology Periodicals Database.Randomized controlled trials (RCT) on IVTA/MLG and MLG only for treatment of diabetic macular edema were selected.After the data extraction,quality of RCT was assessed.The meta analysis was performed by RevMan 5.1.The outcome measures included best-corrected visual acuity (BCVA) and the central foveal thickness (CMT).Results In total,six RCT that fulfilled the eligibility criteria were included in the meta-analysis involving 166 eyes in MLG group and 165 eyes in IVTA/MLG group.The results suggested that there was no significant differences in BCVA (Z =1.27,P =0.20 ), but differences were statistically significant comparing CMT (Z=2.41,P=0.02),incidence of ocular hypertension and cataract (Z=3.62,P<0.01)between MLG and IVTA/MLG groups at the six month follow-up.Conclusions There is no significant advantage of IVTA/MLG as compared with MLG,but it could reduce CMT.However,a high-quality,large sample RCT should be further investigated.%目的 比较单纯黄斑区格栅样激光光凝(MLG)与玻璃体腔注射曲安奈德(IVTA)联合MLG治疗糖尿病黄斑水肿(DME)的有效性及安全性.方法 计算机检索循证医学图书馆、荷兰医学文摘、生物医学数据库、中国生物医学文献数据库、中国期刊全文数据库及中文科技期刊全文数据库.收集IVTA联合MLG与MLG治疗DME临床随机对照试验(RCT),评价纳入研究的质量,提取有效数据,采用荟萃分析软件(RevMan)5.1进行meta分析.比较两种治疗方法对最佳矫正视力(BCVA)及黄斑中

  5. 眼轴长度与糖尿病性视网膜病变及其黄斑水肿相关研究%Relationship between the axial length and risks of diabetic retinopathy and edema of the macular

    Institute of Scientific and Technical Information of China (English)

    杨凯博; 胡悦东; 刘磊; 吴京阳; 张劲松; 卢迪; 陈蕾

    2015-01-01

    Objective To evaluate the association of axial length with diabetic retinopathy (DR) and diabetic macular edema (DME) in persons with type-2 diabetes.Methods A total of 327 participants suffering from type-2 diabetes were chosen in Liaoning Diabetes Eye Center from October 2013 to October 2014,axial length was measured by A-scan ultrasound,refractive error was measured using automatic refractometry,the severity of DR was graded into non-DR,mild NPDR,moderate NPDR,severe NPDR and PDR and DME,severity was classified as no DME,mild DME,moderate DME and severe DME according mydriatic fundus photographs,DME was confirmed by optical coherence tomography.Results In multivariate regression models,eyes with longer axial length were less likely to have severe NPDR (OR,0.50; 95%CI,0.37-0.98; P =0.04) and PDR (OR,0.63; 95%CI,0.26-0.98; P =0.04) and had a lower risk of mild DME (OR,0.61; 95%CI,0.37-0.97; P =0.02),moderate DME (OR,0.61; 95%CI,0.37-0.99; P =0.03) and severe DME (OR,0.50; 95% CI,0.37-0.96,P =0.03).Conclusions Axial length is associated with the presence and severity of DR and DME.Longer axial length is protective of severe DR and any DME.%目的 研究眼轴长度与糖尿病性视网膜病变(diabetic retinopathy, DR)及糖尿病性黄斑水肿(diabetic macular edema,DME)的相关性.方法 临床病例系列研究.收集2013年10月至2014年10月于中国医科大学附属第一医院糖尿病眼病防治中心就诊的2型糖尿病患者327例,应用A型超声测量眼轴长度,自动电脑验光仪测量屈光度,散瞳眼底照相进行DR和DME的分级:无DR、轻度NPDR、中度NPDR、重度NPDR和PDR,以及无DME、轻度DME、中度DME和重度DME,光学相干断层扫描(optical coherence tomography, OCT)确诊糖尿病性黄斑水肿.结果 经过多元回归分析后,眼轴越长越不容易患重度NPDR,差异有统计学意义(OR,0.50; 95%CI,0.37~0.98;P=0.04)和PDR (OR,0.63;95%CI,0.26~0.98;P=0.04).眼轴越长更不容易患轻

  6. Baseline Factors Associated With 6-Month Visual Acuity and Retinal Thickness Outcomes in Patients With Macular Edema Secondary to Central Retinal Vein Occlusion or Hemiretinal Vein Occlusion: SCORE2 Study Report 4.

    Science.gov (United States)

    Scott, Ingrid U; VanVeldhuisen, Paul C; Ip, Michael S; Blodi, Barbara A; Oden, Neal L; King, Jacqueline; Antoszyk, Andrew N; Peters, Mark A; Tolentino, Michael

    2017-06-01

    Macular edema (ME) is the leading cause of decreased visual acuity (VA) associated with retinal vein occlusion (RVO). Identifying factors associated with better outcomes in RVO eyes treated with anti-vascular endothelial growth factor (VEGF) therapy may provide information useful in counseling patients. To investigate baseline characteristics associated with 6-month VA and central subfield thickness (CST) outcomes in participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2). A total of 362 patients with central RVO or hemi-RVO were enrolled between September 17, 2014, and November 18, 2015, and randomized 1:1 in a masked fashion to receive bevacizumab or aflibercept. At month 6, 348 participants (96%) had VA outcomes measured and 335 participants (93%) had spectral domain optical coherence tomography outcomes measured. The current data analysis was conducted from February 27, 2017, to April 7, 2017. Eyes were randomly assigned to receive an intravitreal injection of bevacizumab, 1.25 mg, or aflibercept, 2.0 mg, at baseline and every 4 weeks, with the primary outcome measured at 6 months. Change from baseline in VA letter score (VALS), VALS gain of 15 or more, change from baseline in CST, CST less than 300 µm, and resolution of ME. Baseline factors associated with 6-month outcome at the 0.05 level in univariate regressions were included in multivariate regressions, with those significant after multiplicity control by the Hochberg method reported. The mean (SD) age of patients was 69 (12) years, and 43% were women. Younger patient age (odds ratio [OR], 0.95 per year of age; 95% CI, 0.93-0.98; P = .007) and lower baseline VALS (OR, 0.96 per letter; 95% CI, 0.94-0.98; P < .001) were associated with a 6-month VALS gain of 15 or greater. Compared with bevacizumab, aflibercept treatment was associated with a higher odds of ME resolution (OR, 3.59; 95% CI, 2.22-5.80; P < .001) and CST less than 300 µm (OR,  5.30; 95% CI, 2

  7. Topical Squalamine 0.2% and Intravitreal Ranibizumab 0.5 mg as Combination Therapy for Macular Edema Due to Branch and Central Retinal Vein Occlusion: An Open-Label, Randomized Study.

    Science.gov (United States)

    Wroblewski, John J; Hu, Allen Y

    2016-10-01

    To evaluate the effects of squalamine (OHR-102; Ohr Pharmaceuticals, New York, NY) and ranibizumab (Lucentis; Genentech, South San Francisco, CA) on macular edema (ME) secondary to retinal vein occlusion (RVO). Twenty consecutive, treatment-naïve patients with RVO-related ME received topical squalamine and intravitreal ranibizumab 0.5 mg for 10 weeks, followed by randomization to continue or discontinue squalamine. Groups received as-needed ranibizumab from weeks 2 through 34. The primary endpoint was the proportion of eyes gaining 15 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letters at week 38. Safety and tolerability were assessed. Data from 13 treatment-naïve control eyes previously enrolled in three similar trials evaluating monthly ranibizumab 0.5 mg for RVO-related ME were included for comparison. At baseline, mean best-corrected visual acuity (BCVA) measures were 55.6 ETDRS letters and 55.0 ETDRS letters in the squalamine and control groups, respectively. At week 38, BCVA improved 25.6 letters in the squalamine group; at month 9, BCVA improved 16.3 letters in the control group. This corresponds to a between-treatment-group difference of 9.2 letters. Squalamine and ranibizumab combination therapy was well-tolerated. In patients with RVO-related ME, topical squalamine combined with early, as-needed ranibizumab appears to enhance visual recovery versus ranibizumab alone. Combination therapy appears safe and was well-tolerated. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:914-923.]. Copyright 2016, SLACK Incorporated.

  8. Correlation between the central macular thickness and the visual function in patients with macular edema%黄斑水肿患者中心凹厚度与固视性质及平均敏感度相关性研究

    Institute of Scientific and Technical Information of China (English)

    王雯秋; 王泓; 张磊; 姜媛; 钱锦; 王卫峻; 汪枫桦; 吴颖; 孙晓东

    2009-01-01

    Objective To determine the correlation between central macular thickness (CMT) and the visual function in patients iwht macular edema (ME). Methods The clinical data of 42 eyes of 40 patients with ME which were examined by optical coherence tomography (OCT) and microperimetry (MP-1) wereretrospectively analyzed. In 40 patients (42 eyes), diabetic ME (DME) was in 27 eyes,branch retinal vein occlusion was in 11eyes, and central retinal vein occlusion was in 4 eyes. All of the eyes had undergone OCT,MP-1 and best-corrected visual acuity (BCVA) test. Central macular thickness (CMT) was measured by fast macular scans using OCT. Retinal sensitivity (MS) and fixation patterns were evaluated by Mp-1.The position was chosen :2 disc diameters (DD) temporal to the disc and one third of a DD inferior to the centre of the disc. Results The correlation between CMT and BCVA is not significant (r=-0. 429, P=0. 069) as well as the correlation between CMT and MS (r=-0. 433,P=0. 058). The difference of CMT between the unstable and stable group was significant (F = 3. 262, P = 0. 039). The difference of CMT between the central fixation group and preferred retinal locus (PRL) group was significant (F=3. 173,P=0. 044). Conclusions BCVA and MS have no significant correlation with CMT. When CMT increases, the fixation stability decreases, fixation location, changes, and PRL occurs.%目的 观察黄斑水肿(ME)状态下黄斑中心凹厚度与视功能改变之间的相关性.方法 回顾分析应用光相干断层扫描(OCT)联合微视野计(MP-1)检测的ME患者40例42只眼的临床资料.所有患眼均行验光插片,记录最佳矫正视力(BCVA);采用德国Zeiss-HumphreyOCT仪进行OCT检查;意大利Nidek公司MP-1微视野计进行眼底成像、固视检测和视野检查.OCT及MP-1检查均以视盘颢侧2个视盘直径(DD)、下方1/3 DD作为黄斑中心凹进行检查.采用统计学方法对比分析患眼BCVA、中心凹厚度(CMT)、中心10°的光敏感度(MS

  9. Appropriate selection of the managements based on the understanding of diabetic macular edema%在正确认识糖尿病性黄斑水肿的基础上合理选择其治疗方法

    Institute of Scientific and Technical Information of China (English)

    唐仕波

    2012-01-01

    Diabetic macular edema (DME) is one of causes leading to visual acuity loss in the diabetic population.In recent years,great progress has been achieved in the treatment for DME.While laser photocoagulation and pars plana vitrectomy remain the standard of care,a new wave of methods,including intravitreal corticosteroid and anti-vascular endothelial growth factor (anti-VEGF) medications,is emerging and shows the preliminary safety and efficacy profile for DME by a number of clinical trials.This article introduce the definition,classification,pathogenesis and the different treatment methods for DME,so to aid ophthalmologists in evaluating the most appropriate and up-todate management options in managing DME.Particular attention is paid to summarize recent peer-reviewed literatures of ranibizumab (Lucentis).%糖尿病性黄斑水肿(DME)是糖尿病患者视力损害的主要原因,随着对DME研究的不断深入和对DME认识的加深,其治疗方法不断进步.继标准的激光光凝和玻璃体切除手术之后,眼内注射糖皮质激素和抗血管生成药物等方法有望从其发病机制方面治疗DME,并大大改善视力,其安全性和有效性已通过一系列随机双盲临床试验得到证实.在对DME的定义、分类、发病机制正确认识的基础上,对DME的治疗方法进行介绍,并对抗血管生成药物,特别是ranibizumab的研究情况进行总结,以帮助临床医师更好地把握DME的治疗指征,选择合理的治疗方法.

  10. Macular Hole Progression after Intravitreal Bevacizumab for Hemicentral Retinal Vein Occlusion

    Directory of Open Access Journals (Sweden)

    Manish Nagpal

    2011-01-01

    Full Text Available Macular edema secondary to retinal vein occlusion is commonly being treated with off-label intravitreal bevacizumab with good outcomes. A significant reduction in macular edema and improvement in visual acuity is seen following such a treatment with no serious adverse effects. In the reported case, a full-thickness macular hole was noticed one month after intravitreal bevacizumab for macular edema secondary to hemicentral retinal vein occlusion. On a detailed review of the pre- and postoptical coherence tomography scans, it was realized that there was a preexisting stage 2-3 macular hole which was masked by the hemorrhages and edema at the fovea and the macular hole had progressed following the injection.

  11. Pulmonary Edema

    Science.gov (United States)

    ... Accessed March 13, 2014. Pinto DS, et al. Pathophysiology of cardiogenic pulmonary edema. http://www.uptodate.com/ ... hvd/. Accessed March 10, 2014. What is pulmonary hypertension? National Heart, Lung, and Blood Institute. http://www. ...

  12. Pulmonary Edema

    OpenAIRE

    Tanser, Paul H.

    1981-01-01

    The physician who deals with pulmonary edema from a pathophysiologic basis will seldom make a diagnostic or therapeutic error. Recent additions to preload and afterload therapy have greatly helped in the emergency and ambulatory treatment of pulmonary edema due to left heart failure. Careful follow-up and patient self-monitoring are the most effective means of reducing hospitalization of chronic heart failure patients.

  13. Pigmentos maculares Macular pigments

    Directory of Open Access Journals (Sweden)

    Renata Canovas

    2009-12-01

    Full Text Available A luteína e a zeaxantina são pigmentos amarelos que se localizam na mácula. Devido à sua localização, diminuem e filtram a quantidade de luz principalmente azul que chega aos fotorreceptores, atuam como antioxidantes e podem melhorar a qualidade visual. Esta é uma revisão do seu mecanismo de incorporação, ação, possíveis aplicações e conhecimento científico a respeito.Lutein and Zeaxanthin are yellow pigments located at the macula. Because of your location macular pigments decrease and filter the amount of blue light that reach photoreceptors, protect the outer retina from oxidative stress and may improve the vision quality. This is a review regarding incorporation mechanism, function and knowledge update.

  14. CME Productivity of Active Regions.

    Science.gov (United States)

    Liu, L.; Wang, Y.; Wang, J.; Shen, C.; Ye, P.; Zhang, Q.; Liu, R.; Wang, S.

    2015-12-01

    Solar active regions (ARs) are the major sources of two kinds of the most violent solar eruptions, namely flares and coronal mass ejections (CMEs). Although they are believed to be two phenomena in the same eruptive process, the productivity of them could be quiet different for various ARs. Why is an AR productive? And why is a flare-rich AR CME-poor? To answer these questions, we compared the recent super flare-rich but CME-poor AR 12192, with other four ARs; two were productive in both flares and CMEs and the other two were inert to produce any M-class or intenser flares or CMEs. By investigating the photospheric parameters based on the SDO/HMI vector magnetogram, we find the three productive ARs have larger magnetic flux, current and free magnetic energy than the inert ARs. Furthermore, the two ARs productive in both flares and CMEs contain higher current helicity, concentrating along both sides of the flaring neutral lines, indicating the presence of a seed magnetic structure( that is highly sheared or twisted) of a CME; they also have higher decay index in the low corona, showing weak constraint. The results suggest that productive ARs are always large and have strong current system and sufficient free energy to power flares, and more importantly whether or not a flare is accompanied by a CME is seemingly related to (1) if there is significant sheared or twisted core field serving as the seed of the CME and (2) if the constraint of the overlying arcades is weak enough. Moreover, some productive ARs may frequently produce more than one CME. How does this happen? We do a statistical investigation of waiting times of quasi-homologous CMEs ( CME ssuccessive originating from the same ARs within short intervals) from super ARs in solar cycle 23 to answer this question. The waiting times of quasi-homologous CMEs have a two-component distribution with a separation at about 18 hours, the first component peaks at 7 hours. The correlation analysis among CME waiting times

  15. CME ON CLINICAL RESEARCH

    Directory of Open Access Journals (Sweden)

    Suneel. I. Majagi

    2012-06-01

    Full Text Available Safety and efficacy are the two major concerns for any drug therapy. Globally clinical research plays an inevitable role in bringing a new molecule into the market after its synthesis by the pharmaceutical industries. Availability of large patient population, highly educated and skilled manpower, wide spectrum of diseases and favorable economic environment imply India’s potential as a global hub for clinical research. Pharmaceutical companies and Clinical Research Organization (CROs will require many trained personnel to carry out the clinical research. Keeping in mind these facts a CME with the theme of “Clinical research” had been jointly organized by the Dept of pharmacology, K.L.E University’s J.N.M.C, Belgaum and Indian Pharmacological Society (I.P.S, Belgaum branch on 20th February 2010. In the first scientific session, Dr.P.A.Patil (JNMC spoke on “Preclinical studies”. In vitro and in vivo experiments of various doses of ‘study drug’ can obtain preliminary efficacy, toxicity and pharmacokinetic information suggesting the scientific merit for further development as an investigational new drug (IND. Local or systemic toxicity studies can be conducted (ex: urine analysis, blood biochemical assay, gross and microscopic pathology etc. Dr. B.J. Mahendra Kumar (KLE University’s College of pharmacy talked on “Role of Drug Controller General of India (DCGI in Clinical Trials”. He explained about Drug and cosmetic acts/rules, requirements/guidelines for permission to import and/or to manufacture new drugs or to undertake clinical trials i.e. Schedule Y and its appendices. Dr.N.M.Patil (JNMC elaborated about “Ethical issues in clinical trials”. Ethics is required to: avoid exploitation of the subjects (maintain safety and wellbeing, protect vulnerable groups, children, disabled, elderly etc. Independent Ethics Committees (IEC and Institutional Review Boards (IRB are concerned with medical ethics. IECs review, regulate

  16. Comparison of therapeutic effect of micro-pulse laser and conventional laser on diabetic macular edema%微脉冲激光及传统激光治疗糖尿病性黄斑水肿效果比较

    Institute of Scientific and Technical Information of China (English)

    杨予静; 尚庆丽; 马景学; 叶存喜; 安建斌; 魏素琴

    2016-01-01

    Objective To compare the therapeutic effect of micro-pulse laser,single-spot laser and pattern scan laser for diabetic macular edema(DME).Methods Total of 120 eyes of 60 patients who were confirmed as preproliferative diabetic retinopathy or Ⅳ phase proliferative diabetic retinopathy complicated with clinically significant macular edema were included.These patients were randomized divided into the micro-pulse group with 40 eyes of 20 patients,the single-spot laser group with 40 eyes of 20 patients and the pattern scan laser group with 40 eyes of 20 patients.The patients in micro-pulse group underwent micro-pulse laser therapy in macular region,the single-spot laser group underwent macular laser grid photocoagulation therapy by single-spot laser,the pattern scan laser group underwent macular laser grid photocoagulation therapy by pattern scan laser.The BCVA,central macular thickness (CMT) and mean sensitivity (MS) of all patients were examined before and after the treatment.The changes in BCVA,CMT and MS at 6 months after treatment were observed and compared among the groups.Results At 6 months after the treatment,the BCVA of micro-pulse group increased more significantly compared to that before treatment (P < 0.05),the BCVA of single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment(P < 0.05),the BCVA of the three groups showed no statistical difference (P > 0.05).At 6 months after the treatment,the CMT of micro-pulse group,single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment(P < 0.05),the CMT of the three groups showed no statistical difference (P > 0.05).At 6 months after the treatment,the MS of micro-pulse group increased significantly compared to that before treatment (P < 0.05),the MS of single-spot laser group and pattern scan laser group decreased significantly compared to those before treatment(P < 0.05),the MS of the three

  17. Performance improvement CME: managing chronic pain.

    Science.gov (United States)

    Fishman, Scott M

    2010-12-01

    Performance Improvement CME (PI CME) is an educational activity in which clinicians retrospectively assess their current clinical practice, choose areas for improvement and implement interventions based on treatment guidelines and health care standards, and then re-evaluate their clinical practice to assess the improvements made. This PI CME activity focuses on improving the safety and efficacy of treating chronic pain with opioid medications.

  18. EVALUATION OF MACULAR ISCHEMIA IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study.

    Science.gov (United States)

    Ghashut, Rima; Muraoka, Yuki; Ooto, Sotaro; Iida, Yuto; Miwa, Yuko; Suzuma, Kiyoshi; Murakami, Tomoaki; Kadomoto, Shin; Tsujikawa, Akitaka; Yoshimura, Nagahisa

    2017-06-30

    To quantitatively assess macular perfusion status using optical coherence tomography angiography in eyes with aflibercept-treated central retinal vein occlusion and resolved macular edema and to investigate the impact of macular morphology and perfusion status on visual function. This prospective consecutive case series included 23 patients with central retinal vein occlusion. All patients received intravitreal aflibercept injections before analysis. Visual acuity, macular sensitivity, and the macular nonperfusion area (NPA) were evaluated in eyes without macular edema. The macular NPA was evaluated by optical coherence tomography angiography using 3 mm × 3 mm images of the macula. Foveal ellipsoid zone disruption was also analyzed. The superficial macular NPA measured 4.15 mm ± 0.71 mm (95% confidence interval 3.85-4.46), and the deep macular NPA measured 4.23 mm ± 0.97 mm (95% confidence interval 3.82-4.56). The logarithm of the minimum angle of resolution visual acuity was significantly associated with foveal ellipsoid zone disruption (P = 0.001), the superficial macular NPA (P = 0.015), and the deep macular NPA (P = 0.018). Macular sensitivity correlated negatively with logarithm of the minimum angle of resolution visual acuity (P = 0.007), the superficial macular NPA (P = 0.029), and the deep macular NPA (P = 0.040), but not with the foveal ellipsoid zone disruption (P = 0.435). Optical coherence tomography angiography is a novel technique that enables segmented evaluation of the macular perfusion status in eyes with central retinal vein occlusion and provides visual prognostic information. Enlargement of the macular NPA in the superficial and deep layers was significantly correlated with impaired visual acuity and with decreased macular sensitivity in patients with aflibercept-treated central retinal vein occlusion and resolved macular edema.

  19. 视网膜中央静脉阻塞黄斑水肿玻璃体腔注射曲安奈德后视网膜电图明视负向反应变化%Changes of photopic negative response after intravitreal injection of triamcinolone acetonide for macular edema caused by central retinal vein occlusion

    Institute of Scientific and Technical Information of China (English)

    冯超; 杨安怀; 陈长征; 梅昌娲; 易莲芳

    2011-01-01

    Background Intravitreal injection of triamcinolone acetonide (TA) can effectively eliminate central vein occlusion macular edema and improve visual acuity, and photopic negative response (PhNR) can reflect the inner retinal function of RGCs and their axons. It is possible there is a correlation between these two observations.Objective This study was to evaluate the changes of PhNR of flash electroretinogram (F-ERG) after intravitreal injection of TA for macular edema in central retinal vein occlusion ( CRVO ). Methods Thirteen eyes of 12 patients with macular edema caused by CRVO received an injection of 0. 1 ml (4 rg) of TA. PhNR,visual acuity and retinal thickness of macular area were assessed with Roland RETI scan 3. 15 system,decimal visual chart and Stratus optical coherence tomography (OCT) before and 4 weeks after the administration of TA. Written informed consent was obtained from each subject before any medical procedure. Results Visual acuity was improved in 12 eyes and stable in 1 eye 4 weeks following the intravitreal injection of TA. OCT showed that the retinal thickness of the macular area was reduced ;meanwhile,elevation of the amplitude of PhNR also was seen in the F-ERG after the administration of TA in comparison with before the administration of TA. The calculated results determined that the visual acuities were 0. 32t0. 12 and 0. 48±0. 09 (t=6. 325 ,P=0. 000) ,and the retinal thickness values of the macular area were (459.46± 131.31 ) μm and ( 297.54 ±43.31 ) μm ( t = 5.961, P = 0. 000 ), and the average amplitude of PhNR were ( 80. 23±22.96 ) μV and (61.28 ±20. 16 ) μV ( t = 4. 438, P = 0. 001 ) before and after the intravitreal injection of TA, respectively,showing significant differences. No significant correlation was found between PhNR amplitude and retinal thickness of the macular area both before and after the administration of TA ( before: r = 0. 587, P = 0. 035; after:r=-0. 011 ,P = 0. 971 ). Conclusion PhNR can be used for

  20. Macular Diplopia.

    Science.gov (United States)

    Shippman, Sara; Cohen, Kenneth R; Heiser, Larissa

    2015-01-01

    Maculopathies affect point-to-point foveal correspondence causing diplopia. The effect that the maculopathies have on the interaction of central sensory fusion and peripheral fusion are different than the usual understanding of treatment for diplopia. This paper reviews the pathophysiology of macular diplopia, describes the binocular pathology causing the diplopia, discusses the clinical evaluation, and reviews the present treatments including some newer treatment techniques.

  1. [Cystoid macular oedema after fingolimod treatment in multiple sclerosis].

    Science.gov (United States)

    Asensio-Sánchez, V M; Trujillo-Guzmán, L; Ramoa-Osorio, R

    2014-03-01

    A woman, treated with immunomodulatory and immunosuppressive drugs for multiple sclerosis, developed macular oedema 4 months after oral fingolimod administration. The patient was previously seen by an ophthalmologist, with a normal anterior segment and funduscopic examination. Four months after the treatment she referred to decreased visual acuity in both eyes. The funduscopic and OCT examination now revealed cystoid macular oedema (CME). Attention to visual changes and periodic funduscopic examinations are an important part of monitoring while using fingolimod. In our patient early recognition and discontinuation of fingolimod did not result in resolution of the CME. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  2. Performance improvement CME: managing schizophrenia.

    Science.gov (United States)

    Kane, John M; Correll, Christoph U

    2011-10-01

    Schizophrenia is a highly disabling disorder characterized by positive and negative symptoms and poor functioning in almost every area of life. Multiple antipsychotics have demonstrated varying levels of efficacy in reducing symptoms in schizophrenia, but adverse effects are common, adherence to medication is low, and relapse rates are high. Psychosocial interventions used in conjunction with antipsychotic pharmacotherapy may help improve treatment outcomes. This Performance Improvement CME activity focuses on individualizing treatment for schizophrenia, assessing treatment adherence, minimizing medication-induced adverse events, and preventing relapse, for children, adolescents, and adults with schizophrenia.

  3. Meta-analysis of efficacy of ranibizumab and laser treatment for diabetic macular edema%玻璃体腔穿刺注射雷珠单抗与激光光凝治疗糖尿病性黄斑水肿的疗效与安全性的Meta分析

    Institute of Scientific and Technical Information of China (English)

    高雯; 易湘龙

    2014-01-01

    and retinal laser photocoagulation about treatment of diabetic mac-ular edema from databases such as Pubmed (1966-January 2014),EMbase (1966-January 2014),Cochrane library (January 2014),CBM (1979-January 2014),VIP (2014),CNKI (2014).We tried to obtain the evi-dence of efficacy and safety of the two methods according to Jadad quality assessment rating scale by using Cochrane systematic review methods and RevMan 5 .2 statistical software to do Meta-analysis.Results Five randomized controlled clinical studies about intravitreal Ranibizumab inj ection puncture and laser pho-tocoagulation to cure diabetic macular edema were included in our study (ranibizumab:305 eyes;laser:289 eyes).Meta-analysis showed that there is statistical difference in the efficacy and safety between the two treatments.Patients treated with Ranibizumab showed improvement in visual acuity [95%CI(0.36, 0.84),z=2.77(P=0.006)]and reduction in central macular thickness [95%CI (0.22,0.47),z=5.84 (P<0.0001)].Conclusion In terms of efficacy of improvement in corrected vision and reduction of central macular thickness,puncture inj ection of intravitreal Ranibizumab treatment is superior to retinal laser pho-tocoagulation method in treating diabetic macular edema.Although there showed no significant difference in the safety of two operations so far,a larger sample and long-term prospective randomized controlled clinical trial data is needed to support and convince us of the difference.

  4. 玻璃体腔注射贝伐单抗治疗PDR黄斑水肿后患者的满意度和视力%Patient satisfaction and visual acuity after intravitreal bevacizumab as a treatment for macular edema in proliferative diabetic retinopathy

    Institute of Scientific and Technical Information of China (English)

    Lala Ceklic; Slobodanka Latinovic; Aljoscha S Neubauer; Marijana Malesevic

    2009-01-01

    AIM: To investigate patient assessed visual function and visual acuity after treatment with the unselective anti-VEGF inhibitor bevacizumab in diabetic macular edema after scatter laser photocoagulation due to proliferative diabetic retinopathy(PDR).METHODS: The case series of consecutive 30 eyes of 30 patients with PDR and persistent diabetic macular edema were treated with a single intravitreal dose of 1.25mg bevacizumab in 0.05mL (Avastin) in combination with scatter argon laser photocoagulation. The control group consisted of 30 eyes of 30 patients with PDR who received scatter laser photocoagulation alone. Main outcome measures were Snellen visual acuity,fundus clinical findings and patients self estimated quality of vision evaluated in scale of 0-100 percentages.RESULTS: Baseline visual acuity was mean 0.48±0.58 logMAR in the bevacizumab group and 0.61±0.78 (n.s.) in the control group. After 6 months,visual acuity hat not changed significantly to 0.33±0.41 and 0.52±0.68 in the bevacizumab and control group,respectively. Clinical examination showed only a trend to some improvement in macular edema. Subjective patient assessment of visual function on the visual analogue scale (VAS) showed an improvement from 60.2±17.5 to 76.0±15.6 (P<0.01) 6 months after the injection of bevacizumab. In the control group self-assessed visual function was mean 59.6±19.8,which did not differ from the baseline bevacizumab group (n.s.) but was high significantly (P<0.01) lower than after bevacizumab. CONCLUSION: Self-assessed visual acuity and patient satisfaction were significantly improved after intravitreal bevacizumab (Avastin) as additional therapy to scatter laser photocoagulation therapy for macular edema in PDR than after laser therapy alone. Visual acuity did not change significantly in this comparative case series over 6 months.KEYWORDS: proliferative diabetic retinopathy; visual acuity; self assessment; bevacizumab; scatter laser photocoagulation%目的:增生性

  5. CME Ensemble Forecasting - A Primer

    Science.gov (United States)

    Pizzo, V. J.; de Koning, C. A.; Cash, M. D.; Millward, G. H.; Biesecker, D. A.; Codrescu, M.; Puga, L.; Odstrcil, D.

    2014-12-01

    SWPC has been evaluating various approaches for ensemble forecasting of Earth-directed CMEs. We have developed the software infrastructure needed to support broad-ranging CME ensemble modeling, including composing, interpreting, and making intelligent use of ensemble simulations. The first step is to determine whether the physics of the interplanetary propagation of CMEs is better described as chaotic (like terrestrial weather) or deterministic (as in tsunami propagation). This is important, since different ensemble strategies are to be pursued under the two scenarios. We present the findings of a comprehensive study of CME ensembles in uniform and structured backgrounds that reveals systematic relationships between input cone parameters and ambient flow states and resulting transit times and velocity/density amplitudes at Earth. These results clearly indicate that the propagation of single CMEs to 1 AU is a deterministic process. Thus, the accuracy with which one can forecast the gross properties (such as arrival time) of CMEs at 1 AU is determined primarily by the accuracy of the inputs. This is no tautology - it means specifically that efforts to improve forecast accuracy should focus upon obtaining better inputs, as opposed to developing better propagation models. In a companion paper (deKoning et al., this conference), we compare in situ solar wind data with forecast events in the SWPC operational archive to show how the qualitative and quantitative findings presented here are entirely consistent with the observations and may lead to improved forecasts of arrival time at Earth.

  6. Clinical effectiveness analysis of anti-VEGF for central retinal vein occlusion associated with macular edema : A Meta-analysis%抗VEGF药物治疗视网膜中央静脉阻塞并发黄斑水肿的Meta分析

    Institute of Scientific and Technical Information of China (English)

    刘姝林; 陈有信

    2014-01-01

    、虹膜新生血管2眼等,而用药后全身不良事件罕见. 结论 抗VEGF药物治疗CRVO并发黄斑水肿效果明显,不良反应较少,但疗效维持时间较短.发病早期及时注射抗VEGF药物对患者更有益,但晚期注射仍能取得一定疗效.%Background Central retinal vein occlusion (CRVO) causes macular edema.The treatment options are limited.There have been a series of randomized controlled trials (RCTs) to investigate the effectiveness of anti-vascular endothelial growth factor (VEGF),but the systematic review of the literature to assess the strength of evidence supporting the interventions is lack.Objective This study was to evaluate the effectiveness of anti-VEGF therapy for improving vision and reducing macular edema in patients with CRVO associated with macular edema.Methods A systematic review and Meta-analysis was performed.According to guidelines of Cochrane collaboration,the literature of RCTs for anti-VEGF therapy treating CRVO with macular edema was searched from Cochrane Library,Pubmed,Embase,Wanfang databases and conference documents without the limiting of language or date.The literature was screened independently by two searchers,and the methodology quality of the included papers was estimated.The proportion of patients with the best corrected visual acuity (BCVA) ≥ 15 ETDRS letters,the change ranges of BCVA (LogMAR) and central fovea thickness (CFT) were analyzed.The overall effect size was analyzed using Review Manager 5.1 in The Cochrane Collaboration as weighted mean difference (WSD).Fixed effect mode was used to evaluate and compare the treating effectiveness between the anti-VEGF group and sham treating group.Results Six RCTs were incorporated with 948 eyes and generated 3 comparisons in the study,including 5 multi-central studies and 1 single central study.Pegaptanib was administered in 1 study,and ranibizumab was used in 2 studied,bevacizumab in 1 study and VEGF Trap-Eye in 2 studies.The results demonstrated that anti-VEGF therapy

  7. Effects of a CME on Mars

    DEFF Research Database (Denmark)

    Falkenberg, Thea Vilstrup; Vennerstrøm, Susanne; Brain, D.

    We investigate the effects of a Coronal Mass Ejection (CME) on Mars. The magnetic field in the magnetic pileup region on Mars is dominated by the dynamic pressure from the solar as increased dynamic pressure compresses the magnetic pileup region causing a larger magnetic pressure, until...... this balances the solar wind pressure. As the dynamic pressure is severely increased during a CME, so is the magnetic pressure. A CME are also typically connected to a Solar Energetic Particle (SEP) event, causing large amounts of radiation. When the shock front of a CME arrives at Mars strong signals are seen...... in both the magnetic field data and in the radiation data. Based on Mars Global Surveyor (MGS) Magnetometer (MAG) and Electron Reflectometer (ER) data we study the radiation and magnetic field variations on Mars during a CME event. We also compare the effects on Mars to the effects on Earth for the same...

  8. Effects of a CME on Mars

    DEFF Research Database (Denmark)

    Falkenberg, Thea Vilstrup; Vennerstrøm, Susanne; Brain, D.

    We investigate the effects of a Coronal Mass Ejection (CME) on Mars. The magnetic field in the magnetic pileup region on Mars is dominated by the dynamic pressure from the solar as increased dynamic pressure compresses the magnetic pileup region causing a larger magnetic pressure, until...... this balances the solar wind pressure. As the dynamic pressure is severely increased during a CME, so is the magnetic pressure. A CME are also typically connected to a Solar Energetic Particle (SEP) event, causing large amounts of radiation. When the shock front of a CME arrives at Mars strong signals are seen...... in both the magnetic field data and in the radiation data. Based on Mars Global Surveyor (MGS) Magnetometer (MAG) and Electron Reflectometer (ER) data we study the radiation and magnetic field variations on Mars during a CME event. We also compare the effects on Mars to the effects on Earth for the same...

  9. Spontaneously resolving macular cyst in an infant

    Directory of Open Access Journals (Sweden)

    Anuradha Ganesh

    2013-01-01

    Full Text Available The purpose of this study is to describe transient macular cysts in an infant and correlate their occurrence with normal development events. A newborn Caucasian girl presented with a protruding corneal mass in her left eye at birth. She underwent a complete ophthalmic examination. A keratinized staphylomatous malformation involving the entire cornea and precluding further visualization of the anterior and posterior segment was observed in the left eye. Spectral domain optical coherence tomography (SD-OCT of the right eye performed when the child was approximately 6-week-old had revealed an unexpected finding of macular cysts involving the inner nuclear and outer retinal layers. Corneal transplant in the left eye was performed a month later. Ocular examination under anesthesia just prior to surgery revealed normal intraocular pressure, anterior segment and retina in the right eye. SD-OCT was normal in both eyes and showed complete resolution of the cysts in the right eye. The patient had not been on any medications at that time. Although clinical retinal examination might be unremarkable, SD-OCT may reveal cystic spaces in the macula. In the absence of conditions known to be associated with macular edema, transient macular cysts may arise due to a developmental incompetence of the blood-retinal barrier or may represent transient spaces created during normal migration of retinal cells. Further study is warranted to delineate the entity of transient macular cysts in infancy.

  10. Unilateral pulmonary edema following acute subglottic edema.

    Science.gov (United States)

    Morisaki, H; Ochiai, R; Takeda, J; Nagano, M

    1990-01-01

    Presented here is a case of unilateral pulmonary edema following acute subglottic edema after removal of an endotracheal tube. A 3-year-old boy, diagnosed as having nondiphtheric croup and pectus excavatum deformity, was scheduled for repair of a cleft lip. No complication occurred during the operation. After removal of the endotracheal tube, he showed dyspnea and cyanosis and was later found to have acute subglottic edema. After reintubation of the trachea, frothy pink fluid was discharged from the tube, and chest roentgenogram showed a right-sided alveolar infiltrate. Many factors may cause unilateral pulmonary edema, but it is suggested that acute subglottic edema and unilateral bronchial fragility strongly affected this episode.

  11. Wet Macular Degeneration

    Science.gov (United States)

    ... macular degeneration Overview By Mayo Clinic Staff Wet macular degeneration is a chronic eye disease that causes blurred vision or a blind spot in your visual field. It's generally caused by abnormal blood vessels that leak fluid or blood into ... macular degeneration is one of two types of age-related ...

  12. Screening for macular disorders: the optometrist's perspective

    Directory of Open Access Journals (Sweden)

    Elsner AE

    2015-03-01

    screening, diabetic retinopathy, diabetic macular edema, age-related macular degeneration, degenerative myopia, pediatric vision screening 

  13. [Macular serpiginous choroiditis complicated by macular hole].

    Science.gov (United States)

    Brănişteanu, D; Moraru, Andreea

    2014-01-01

    Macular serpiginouschoroiditis is a rare variant of serpiginous choroiditis characterized by a severe recurrent inflammation of both central choroid and retinal pigment epithelium. Visual prognosis is severe due to subsequent distruction of retinal structures. Permanent central visual loss is the consequence of retinal pigment epithelium hyper or hypoplasia and/or subretinal neovascularization leading to fibrous scarring. This article reports the unusual case of rapid development of a macular hole soon after the onset of characteristic clinical features. Despite anti-inflammatory treatment and successful macular hole surgery the visual function remained significantly impaired by secondary central retinal pigment epithelium changes.

  14. Isolated unilateral disk edema

    OpenAIRE

    Varner P

    2011-01-01

    Paul VarnerJohn J Pershing VAMC, Poplar Bluff, MO, USAAbstract: Isolated unilateral disk edema is a familiar clinical presentation with myriad associations. Related, non-consensus terminology is a barrier to understanding a common pathogenesis. Mechanisms for the development of disk edema are reviewed, and a new framework for clinical differentiation of medical associations is presented.Keywords: disk edema, axoplasmic flow, clinical multiplier, optic neuritis, ischemic optic neuropathy, papi...

  15. Isolated unilateral disk edema

    Directory of Open Access Journals (Sweden)

    Varner P

    2011-07-01

    Full Text Available Paul VarnerJohn J Pershing VAMC, Poplar Bluff, MO, USAAbstract: Isolated unilateral disk edema is a familiar clinical presentation with myriad associations. Related, non-consensus terminology is a barrier to understanding a common pathogenesis. Mechanisms for the development of disk edema are reviewed, and a new framework for clinical differentiation of medical associations is presented.Keywords: disk edema, axoplasmic flow, clinical multiplier, optic neuritis, ischemic optic neuropathy, papilledema

  16. HELCATS Prediction of Planetary CME arrival times

    Science.gov (United States)

    Boakes, Peter; Moestl, Christian; Davies, Jackie; Harrison, Richard; Byrne, Jason; Barnes, David; Isavnin, Alexey; Kilpua, Emilia; Rollett, Tanja

    2015-04-01

    We present the first results of CME arrival time prediction at different planetary locations and their comparison to the in situ data within the HELCATS project. The EU FP7 HELCATS (Heliospheric Cataloguing, Analysis & Techniques Service) is a European effort to consolidate the exploitation of the maturing field of heliospheric imaging. HELCATS aims to catalogue solar wind transients, observed by the NASA STEREO Heliospheric Imager (HI) instruments, and validate different methods for the determination of their kinematic properties. This validation includes comparison with arrivals at Earth, and elsewhere in the heliosphere, as well as onsets at the Sun (http://www.helcats-fp7.eu/). A preliminary catalogue of manually identified CMEs, with over 1000 separate events, has been created from observations made by the STEREO/HI instruments covering the years 2007-2013. Initial speeds and directions of each CME have been derived through fitting the time elongation profile to the state of the art Self-Similar Expansion Fitting (SSEF) geometric technique (Davies et al., 2012). The technique assumes that, in the plane corresponding to the position angle of interest, CMEs can be modelled as circles subtending a fixed angular width to Sun-center and propagating anti-sunward in a fixed direction at a constant speed (we use an angular width of 30 degrees in our initial results). The model has advantages over previous geometric models (e.g. harmonic mean or fixed phi) as it allows one to predict whether a CME will 'hit' a specific heliospheric location, as well as to what degree (e.g. direct assault or glancing blow). We use correction formulae (Möstl and Davies, 2013) to convert CME speeds, direction and launch time to speed and arrival time at any in situ location. From the preliminary CME dataset, we derive arrival times for over 400 Earth-directed CMEs, and for over 100 Mercury-, Venus-, Mars- and Saturn-directed CMEs predicted to impact each planet. We present statistics of

  17. Differentiating full thickness macular holes from impending macular holes and macular pseudoholes

    OpenAIRE

    Tsujikawa, M; Ohji, M; Fujikado, T.; Saito, Y.; Motokura, M.; Ishimoto, I.; Tano, Y.

    1997-01-01

    AIMS—The reliability of scanning laser ophthalmoscope (SLO) microperimetry in differentiating full thickness macular holes from macular pseudoholes and impending macular holes was evaluated.
METHODS—106 eyes with the clinical diagnosis of full thickness macular holes, macular pseudoholes, and impending (stage 1) macular holes were examined for the presence of deep or relative scotoma using SLO microperimetry. The relation between these scotomas and the clinical diagnosis was studied.
RESULTS—...

  18. Side Effects: Edema

    Science.gov (United States)

    Edema, a condition in which fluid builds up in your body’s tissues, may be caused by chemotherapy, cancer, and conditions not related to cancer. Learn about signs of edema, including swelling in your feet, ankles, and legs. Learn how prevent swelling.

  19. Optic Coherence Tomography of Idiopathic Macular Epiretinal Membranes

    Institute of Scientific and Technical Information of China (English)

    Xing Liu; Yunlan Ling; Jingjing Huang; Xiaoping Zheng

    2002-01-01

    bjectives: To study the characteristics of optical coherence tomography (OCT)inopathic macular epiretinal membranes (IMEM) and the relationship between thethickness offovea and the vision of affected eyes.Methods:A total of 67 cases (73 eyes) with clinical diagnosis of IMEM using direct,indirect ophthalmoscope, three mirror contact lens, fundus color photography or fundusfluorescein angiography (FFA)were examined with OCTResults: Epiretinal membranes (ERMs) with macular edema were found in 32 eyes,proliferative ERMs in 20 eyes, ERMs with macular pseudoholes in 14 eyes and ERMswith laminar macular holes in 7 eyes. Based on OCT, the ERMs were clearly andpartially seperated from the retinal (27 eyes, 38.36% ), the retinal thickness of thefovea was the thickest in the proliferative ERMs and the thinnest in the ERMs withlaminar macular holes. The statistical analysis showed there was a negative correlationbetween the thickness of fovea and visual acuity ( r = - 0. 454, P = 0. 000).Conclusion:There were four types of images of OCT in IMEM: ERMs with macularedema, proliferative ERMs, ERMs with macular pseudohole and ERMs with laminarmacular hole; and the thicker the fovea under the OCT, the poorer the vision acuity in the affected eyes with ERMs.

  20. The CME Flare Arcade and the Width of the CME in the Outer Corona

    Science.gov (United States)

    Moore, Ron; Falconer, David; Sterling, Alphonse

    2008-01-01

    Moore, Sterling, & Suess (2007, ApJ, 668, 1221) present evidence that (1) a CME is typically a magnetic bubble, a low-beta gplasmoid with legs h having roughly the 3D shape of a light bulb, and (2) in the outer corona the CME plasmoid is in lateral pressure equilibrium with the ambient magnetic field. They present three CMEs observed by SOHO/LASCO, each from a very different source located near the limb. One of these CMEs came from a compact ejective eruption from a small part of a sunspot active region, another came from a large quiet-region filament eruption, and the third CME, an extremely large and fast one, was produced in tandem with an X20 flare arcade that was centered on a huge delta sunspot. Each of these CMEs had more or less the classic lightbulb silhouette and attained a constant heliocentric angular width in the outer corona. This indicates that the CME plasmoid attained lateral magnetic pressure balance with the ambient radial magnetic field in the outer corona. This lateral pressure balance, together with the standard scenario for CME production by the eruption of a sheared-core magnetic arcade, yields the following simple estimate of the strength B(sub Flare) of the magnetic field in the flare arcade produced together with the CME: B(sub Flare) 1.4(theta CME/theta Flare)sup 2 G, where theta (sub CME) is the heliocentric angular width of the CME plasmoid in the outer corona and theta (sub Flare) is the heliocentric angular width of the full-grown flare arcade. Conversely, theta (sub CME) approximately equal to (R(sub Sun)sup -1(phi(sub Flare)/1.4)sup 1/2 radians, where Flare is the magnetic flux covered by the full-grown flare arcade. In addition to presenting the three CMEs of Moore, Sterling, & Suess (2007) and their agreement with this relation between CME and Flare, we present a further empirical test of this relation. For CMEs that erupt from active regions, the co-produced flare arcade seldom if ever covers the entire active region: if AR is

  1. The Growth, Characteristics, and Future of Online CME

    Science.gov (United States)

    Harris, John M., Jr.; Sklar, Bernard M.; Amend, Robert W.; Novalis-Marine, Cheryl

    2010-01-01

    Introduction: Physician use of online continuing medical education (CME) is growing, but there are conflicting data on the uptake of online CME and few details on this market. Methods: Analyses of 11 years of data from the Accreditation Council for Continuing Medical Education (ACCME) and a survey of 272 publicly available CME Web sites. …

  2. Dexamethasone Intravitreal Implant for Diabetic Macular Edema During Pregnancy

    DEFF Research Database (Denmark)

    Concillado, Michael; Lund-Andersen, Henrik; Mathiesen, Elisabeth R

    2016-01-01

    during pregnancy in the period from 2011 to 2014. Review of charts and photographs comprised best-corrected visual acuity (BCVA), foveal center field thickness assessed by optical coherence tomography, blood pressure, glycated hemoglobin, medications, and changes in such parameters after implant......) and a mean preinjection best-corrected visual acuity (BCVA) of 63 approximated Early Treatment Diabetic Retinopathy Study (approxETDRS) letters (range, 50-77 letters). One eye was unavailable for follow-up. In 7 of 8 eyes injection was followed, within 3 weeks, by a greater than 145 μm reduction in foveal...... dexamethasone therapy by foveal thickness reduction and visual acuity improvement without clinically significant intraocular pressure increases....

  3. CHARACTERISTICS OF KINEMATICS OF A CORONAL MASS EJECTION DURING THE 2010 AUGUST 1 CME-CME INTERACTION EVENT

    Energy Technology Data Exchange (ETDEWEB)

    Temmer, Manuela; Rollett, Tanja; Bein, Bianca; Moestl, Christian; Veronig, Astrid M.; Flor, Olga [Kanzelhoehe Observatory-IGAM, Institute of Physics, University of Graz, Universitaetsplatz 5, A-8010 Graz (Austria); Vrsnak, Bojan; Zic, Tomislav [Hvar Observatory, Faculty of Geodesy, University of Zagreb, Kaciceva 26, HR-10000 Zagreb (Croatia); De Koning, Curt A. [NOAA Space Weather Prediction Center, Boulder, CO 80305 (United States); Liu, Ying [Space Sciences Laboratory, University of California, Berkeley, CA 94720 (United States); Bosman, Eckhard [Space Research Institute, Austrian Academy of Sciences, A-8042 Graz (Austria); Davies, Jackie A.; Bothmer, Volker [Institut fuer Astrophysik, Goettingen University, Friedrich-Hund Platz 1, D-37077 Goettingen (Germany); Harrison, Richard [RAL Space, Rutherford Appleton Laboratory, Harwell Oxford, Didcot OX11 0QX (United Kingdom); Nitta, Nariaki [Solar and Astrophysics Laboratory, Lockheed Martin Advanced Technology Centre, Palo Alto, CA 94304-1191 (United States); Bisi, Mario [Institute of Mathematics and Physics, Aberystwyth University, Ceredigion SY23 3BZ (United Kingdom); Eastwood, Jonathan; Forsyth, Robert [The Blackett Laboratory, Imperial College London, London SW7 2AZ (United Kingdom); Odstrcil, Dusan, E-mail: mat@igam.uni-graz.at [Computational and Data Sciences, George Mason University/NASA Goddard Space Flight Center, Mail Code 674, Greenbelt, MD 20771 (United States)

    2012-04-10

    We study the interaction of two successive coronal mass ejections (CMEs) during the 2010 August 1 events using STEREO/SECCHI COR and heliospheric imager (HI) data. We obtain the direction of motion for both CMEs by applying several independent reconstruction methods and find that the CMEs head in similar directions. This provides evidence that a full interaction takes place between the two CMEs that can be observed in the HI1 field of view. The full de-projected kinematics of the faster CME from Sun to Earth is derived by combining remote observations with in situ measurements of the CME at 1 AU. The speed profile of the faster CME (CME2; {approx}1200 km s{sup -1}) shows a strong deceleration over the distance range at which it reaches the slower, preceding CME (CME1; {approx}700 km s{sup -1}). By applying a drag-based model we are able to reproduce the kinematical profile of CME2, suggesting that CME1 represents a magnetohydrodynamic obstacle for CME2 and that, after the interaction, the merged entity propagates as a single structure in an ambient flow of speed and density typical for quiet solar wind conditions. Observational facts show that magnetic forces may contribute to the enhanced deceleration of CME2. We speculate that the increase in magnetic tension and pressure, when CME2 bends and compresses the magnetic field lines of CME1, increases the efficiency of drag.

  4. Fingolimod Associated Bilateral Cystoid Macular Edema—Wait and See?

    Directory of Open Access Journals (Sweden)

    Refik Pul

    2016-12-01

    Full Text Available Fingolimod 0.5-mg once-daily is an approved therapy for patients with relapsing–remitting multiple sclerosis (MS. Several pivotal and real-world studies have demonstrated that fingolimod is associated with the development of macular edema (ME. Herein, we present a case of a diabetic MS patient who developed severe bilateral ME during fingolimod treatment. By means of this case study we provide a detailed review about fingolimod associated macular edema (FAME, its current incidence with or without diabetes mellitus, and previous therapy attempts and outcomes in MS patients. Intravitreal administration of antibodies raised against vascular endothelial growth factor A (VEGF-A has not yet been used in the management of FAME, however, the excellent therapeutic response in our patient may justify the use of anti-VEGF-A agents in combination with cessation of fingolimod to achieve fast resolution of FAME and to prevent visual deficits, particularly in bilateral FAME.

  5. Reversible retinal edema in an infant with neonatal hemochromatosis and liver failure.

    Science.gov (United States)

    Maldonado, Ramiro S; Freedman, Sharon F; Cotten, C Michael; Ferranti, Jeffrey M; Toth, Cynthia A

    2011-02-01

    We present a case of bilateral severe retinal edema with subretinal fluid in an infant diagnosed with neonatal hemochromatosis and liver failure. A macular cherry-red spot in each eye mimicked the clinical appearance of many metabolic storage diseases. Both the clinical retinal appearance and the anatomic abnormalities observed on spectral domain optical coherence tomography resolved after successful liver transplant.

  6. The CME - Flare Relationship During The Present Solar Cycle

    Science.gov (United States)

    Shaltout, M.; Mahrous, A.; Youssef, M.; Mawad, R.; El-Naway, M.

    The relation between the Coronal mass Ejection CME and the solar flare is statistically studied More than ten thousand CME events observed by SOHO LASCO during the period 1996-2005 have been analyzed The soft x-ray flux measurements provided by the Geostationary Operational Environmental Satellite GEOS recorded more than twenty thousand flares in the same time period The data have been filtered under certain temporal and spatial conditions to select the CME-flare associated events The results show that the lift-off time of CME-flare associated events having a time interval within the range 0 4 sim 0 6 hour after the occurrence time of associated flares The CME events have been classified into a certain categories according to its energy E CME and the classes of the associated flares In addition we found a good linear correlation between the E CME and the x-ray flux of associated flare events

  7. Intraocular lens iris fixation. Clinical and macular OCT outcomes

    Directory of Open Access Journals (Sweden)

    Garcia-Rojas Leonardo

    2012-10-01

    Full Text Available Abstract Background To assess the efficacy, clinical outcomes, visual acuity (VA, incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany were analyzed. Findings The final CDVA was 20/40 or better in 8 eyes (62%, 20/60 or better in 12 eyes (92%, and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. Conclusions We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method.

  8. State of play of CME in Europe in 2015: Proceedings from the Eighth Annual European CME Forum

    Directory of Open Access Journals (Sweden)

    Eugene Pozniak

    2016-06-01

    Full Text Available European CME Forum is a not-for-profit organisation that brings together all stakeholder groups with an interest in European continuing medical education (CME and promote multichannel discussion in an independent and neutral environment. This report summarises the discussions that took place at the 8th Annual European CME Forum in Manchester on 11–12 November 2015. Held at a time of increased scrutiny on the quality and value of the CME, the forum provided a space for attendees to share perspectives on trends, challenges, and opportunities related to European CME accreditation, funding, and regulation. Discussions focused on specific “hot topics” identified through a pre-meeting survey and needs assessment conducted among CME stakeholders in Europe and beyond. Chief among these were issues related to managing the transparency of relationships between industry and healthcare professionals, evolving systems of European CME accreditation, and the future of CME funding. The programme structure included multiple workshops conducted by leaders in the CME field, and plenary sessions that facilitated multidisciplinary interactions with invited guests, including the very learners the CME field is designed to serve. Attendee feedback was gathered to begin shaping the programme for the 9th Annual European CME Forum (#9ECF, which will take place in Amsterdam, The Netherlands, on 9–11 November 2016.

  9. Coronal "wave": Magnetic Footprint Of A Cme?

    Science.gov (United States)

    Attrill, Gemma; Harra, L. K.; van Driel-Gesztelyi, L.; Demoulin, P.; Wuelser, J.

    2007-05-01

    We propose a new mechanism for the generation of "EUV coronal waves". This work is based on new analysis of data from SOHO/EIT, SOHO/MDI & STEREO/EUVI. Although first observed in 1997, the interpretation of coronal waves as flare-induced or CME-driven remains a debated topic. We investigate the properties of two "classical" SOHO/EIT coronal waves in detail. The source regions of the associated CMEs possess opposite helicities & the coronal waves display rotations in opposite senses. We observe deep dimmings near the flare site & also widespread diffuse dimming, accompanying the expansion of the EIT wave. We report a new property of these EIT waves, namely, that they display dual brightenings: persistent ones at the outermost edge of the core dimming regions & simultaneously diffuse brightenings constituting the leading edge of the coronal wave, surrounding the expanding diffuse dimmings. We show that such behaviour is consistent with a diffuse EIT wave being the magnetic footprint of a CME. We propose a new mechanism where driven magnetic reconnections between the skirt of the expanding CME & quiet-Sun magnetic loops generate the observed bright diffuse front. The dual brightenings & widespread diffuse dimming are identified as innate characteristics of this process. In addition we present some of the first analysis of a STEREO/EUVI limb coronal wave. We show how the evolution of the diffuse bright front & dimmings can be understood in terms of the model described above. We show that an apparently stationary part of the bright front can be understood in terms of magnetic interchange reconnections between the expanding CME & the "open" magnetic field of a low-latitude coronal hole. We use both the SOHO/EIT & STEREO/EUVI events to demonstrate that through successive reconnections, this new model provides a natural mechanism via which CMEs can become large-scale in the lower corona.

  10. Helioseismic Ring Analysis of CME Source Regions

    Indian Academy of Sciences (India)

    S. C. Tripathy; S. de Wet; K. Jain; R. Clark; F. Hill

    2008-03-01

    We apply the ring diagram technique to source regions of halo coronal mass ejections (CMEs) to study changes in acoustic mode parameters before, during, and after the onset of CMEs.We find that CME regions associated with a low value of magnetic flux have line widths smaller than the quiet regions, implying a longer life-time for the oscillation modes. We suggest that this criterion may be used to forecast the active regions which may trigger CMEs.

  11. Physics of Coupled CME and Flare Systems

    Science.gov (United States)

    2016-12-21

    loop positions. We took consideration that aspects of the same active region during different phases of its life -time might produce eruptive events. In...are important tracers of historical solar activity. They are important in the prediction of oncoming solar maximum, in the design of life -times of...Earth, Moon, and Planets , Volume 104, Issue 1- 4, pp. 295-313, 2009. [10] Reames, D., Particle acceleration by CME-driven shock waves, AIP Conference

  12. CME Magnetic Structure and Magnetic Cloud Signature

    Science.gov (United States)

    Li, Yan; Luhmann, J.

    2006-06-01

    An interplanetary coronal mass ejection (ICME) is the counterpart of a coronal mass ejection by definition. However, the relationship between the magnetic structures of the CMEs and that of the situ observations of ICMEs is still quite far from clear, due to observational gaps and the state of our understanding of CMEs. Some studies suggested that the magnetic cloud (MC, a group of ICMEs with fluxrope signatures) magnetic polarity follows the solar large scale magnetic field, and others suggested it follows the local magnetic field of the CME source region. Recent studies found that the relationship is more complex. While solar cycle dependence of the magnetic signature of MCs is clearly evident, the polarity of the MCs does not reverse at the same time when the solar large scale field reverses around solar maximum, but begins to have mixed polarities, and the new polarity may only prevail at the midst of the declining phase. Interestingly, in an independent study of the magnetic topology at the CME source regions, we found a similar solar cycle dependence of the bipolar and quadrupolar topologie. In this work, the link between CMEs and ICMEs is made and the results will shed light on our understanding about the relationship between CME and ICME magnetic structures and how these structures are related to solar local and large scale magnetic fields.Acknowledgement: ATM/NSF-0451438, SRT/NASA-NNG06GE51G and CISM/NSF.

  13. Cataracts and macular degeneration.

    Science.gov (United States)

    Shoch, D

    1979-09-01

    The intraocular lens restores general vision and some degree of independence and mobility to patients with dense cataracts and macular degeneration. The patient, however, must be repeatedly warned that fine central vision, particularly reading, will not be possible after the surgery. An aphakic spectacle leaves such patients a narrow band of vision when superimposed over the macular lesion, and contact lenses are too small for the patient to manage insertion without help.

  14. Macular Effects of Silicone Oil Tamponade: Optical Coherence Tomography Findings During and After Silicone Oil Removal.

    Science.gov (United States)

    Lo, Danielle M; Flaxel, Christina J; Fawzi, Amani A

    2017-01-01

    To investigate retinal morphologic changes during silicone oil tamponade and after its removal using spectral domain OCT (SD-OCT) imaging. Retrospective review of 12 patients who underwent silicone oil tamponade for repair of retinal detachments. Macular OCT scans and volumetric thickness maps were examined qualitatively and quantitatively. Volumetric OCT revealed two distinct patterns during silicone oil: macular thickening (Group A) and macular thinning (Group B). In Group A, mean foveal thickness (507 ± 169 µm vs. 407 ± 163 µm, p = 0.003) and mean macular volume (11.6 ± 2.4 mm(3) vs. 9.9 ± 1.5 mm(3)) were significantly increased during tamponade compared to post-oil removal. Group B had significantly decreased mean foveal thickness (210 ± 38 µm vs. 276 ± 58 µm, p = 0.009) and macular volume (7.3 ± 1.8 mm(3) vs. 8.4 ± 1.8 mm(3)) during tamponade. Importantly, resolution of macular changes occurred without further intervention and was associated with improved visual acuity in both groups. Our series suggests that when faced with unexplained macular edema or macular thinning during tamponade, silicone oil removal alone can achieve resolution of these structural changes.

  15. Visual acuity and microperimetric mapping of lesion area in eyes with inflammatory cystoid macular oedema

    DEFF Research Database (Denmark)

    Munk, Marion R; Kiss, Christopher G; Huf, Wolfgang

    2014-01-01

    PURPOSE:   To evaluate the effect of fluid accumulation on local visual function in inflammatory cystoid-macular-edema (ICME). METHODS:   This cross-sectional study applied optical-coherence-tomography over a 12×12 fovea-centered field in 50 patients with ICME and mapped the extent of fluid-fille...

  16. CME-flare association during the 23rd solar cycle

    Science.gov (United States)

    Mahrous, A.; Shaltout, M.; Beheary, M. M.; Mawad, R.; Youssef, M.

    2009-04-01

    The relation between coronal mass ejections (CMEs) and solar flares are statistically studied. More than 10,000 CME events observed by SOHO/LASCO during the period 1996-2005 have been analyzed. The soft X-ray flux measurements provided by the Geostationary Operational Environmental Satellite (GOES), recorded more than 20,000 flares in the same time period. The data is filtered under certain temporal and spatial conditions to select the CME-flare associated events. The results show that CME-flare associated events are triggered with a lift-off time within the range 0.4-1.0 h. We list a set of 41 CME-flare associated events satisfying the temporal and spatial conditions. The listed events show a good correlation between the CME energy and the X-ray flux of the CME-flare associated events with correlation coefficient of 0.76.

  17. X-82 to Treat Age-related Macular Degeneration

    Science.gov (United States)

    2017-01-12

    Age-Related Macular Degeneration (AMD); Macular Degeneration; Exudative Age-related Macular Degeneration; AMD; Macular Degeneration, Age-related, 10; Eye Diseases; Retinal Degeneration; Retinal Diseases

  18. Pulmonary edema: radiographic differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Dong Soo; Choi, Young Hi; Kim, Seung Cheol; An, Ji Hyun; Lee, Jee Young; Park, Hee Hong [Dankook Univ. College of Medicine, Chonan (Korea, Republic of)

    1997-04-01

    To evaluate the feasibility of using chest radiography to differentiate between three different etiologies of pulmonary edema. Plain chest radiographs of 77 patients, who were clinically confirmed as having pulmonary edema, were retrospectively reviewed. The patients were classified into three groups : group 1 (cardiogenic edema : n = 35), group 2 (renal pulmonary edema : n = 16) and group 3 (permeability edema : n = 26). We analyzed the radiologic findings of air bronchogram, heart size, peribronchial cuffing, septal line, pleural effusion, vascular pedicle width, pulmonary blood flow distribution and distribution of pulmonary edema. In a search for radiologic findings which would help in the differentiation of these three etiologies, each finding was assessed. Cardiogenic and renal pulmonary edema showed overlapping radiologic findings, except for pulmonary blood flow distribution. In cardiogenic pulmonary edema (n=35), cardiomegaly (n=29), peribronchial cuffing (n=29), inverted pulmonary blood flow distribution (n=21) and basal distribution of edema (n=20) were common. In renal pulmonary edema (n=16), cardiomegaly (n=15), balanced blood flow distribution (n=12), and central (n=9) or basal distribution of edema (n=7) were common. Permeability edema (n=26) showed different findings. Air bronchogram (n=25), normal blood flow distribution (n=14) and peripheral distribution of edema (n=21) were frequent findings, while cardiomegaly (n=7), peribronchial cuffing (n=7) and septal line (n=5) were observed in only a few cases. On plain chest radiograph, permeability edema can be differentiated from cardiogenic or renal pulmonary edema. The radiographic findings which most reliably differentiated these two etiologies were air bronchogram, distribution of pulmonary edema, peribronchial cuffing and heart size. Only blood flow distribution was useful for radiographic differentiation of cardiogenic and renal edema.

  19. Latest advances in edema

    Science.gov (United States)

    Villavicencio, J. L.; Hargens, A. R.; Pikoulicz, E.

    1996-01-01

    Basic concepts in the physiopathology of edema are reviewed. The mechanisms of fluid exchange across the capillary endothelium are explained. Interstitial flow and lymph formation are examined. Clinical disorders of tissue and lymphatic transport, microcirculatory derangements in venous disorders, protein disorders, and lymphatic system disorders are explored. Techniques for investigational imaging of the lymphatic system are explained.

  20. Differentiating full thickness macular holes from impending macular holes and macular pseudoholes

    Science.gov (United States)

    Tsujikawa, M.; Ohji, M.; Fujikado, T.; Saito, Y.; Motokura, M.; Ishimoto, I.; Tano, Y.

    1997-01-01

    AIMS—The reliability of scanning laser ophthalmoscope (SLO) microperimetry in differentiating full thickness macular holes from macular pseudoholes and impending macular holes was evaluated.
METHODS—106 eyes with the clinical diagnosis of full thickness macular holes, macular pseudoholes, and impending (stage 1) macular holes were examined for the presence of deep or relative scotoma using SLO microperimetry. The relation between these scotomas and the clinical diagnosis was studied.
RESULTS—Deep and relative scotomas were detected in all 57 eyes with clinically defined full thickness macular holes. In contrast, among 49 eyes diagnosed with macular pseudoholes or impending macular holes, no deep and only one relative scotoma was observed. The sensitivity of the presence of a deep scotoma as an indicator of the clinical diagnosis of a full thickness macular hole was 100% (57 of 57), and the specificity was 100% (49 of 49). The sensitivity of the presence of a relative scotoma was 100% (57 of 57) and the specificity was 98.0% (48 of 49).
CONCLUSION—With SLO microperimetry, full thickness macular holes can be precisely and objectively distinguished from other conditions that mimic macular holes.

 PMID:9059244

  1. Occult Macular Dystrophy

    Directory of Open Access Journals (Sweden)

    Işıl Sayman Muslubaş

    2016-04-01

    Full Text Available Occult macular dystrophy is an inherited macular dystrophy characterized by a progressive decline of bilateral visual acuity with normal fundus appearance, fluorescein angiogram and full-field electroretinogram. This case report presents a 20-year-old female patient with bilateral progressive decline of visual acuity for six years. Her visual acuity was 3-4/10 in both eyes. Anterior segment and fundus examination, fluorescein angiogram and full-field electroretinogram were normal. She could read all Ishihara pseudoisochromatic plates. Fundus autofluorescence imaging was normal. There was a mild central hyporeflectance on fundus infrared reflectance imaging in both eyes. Reduced foveal thickness and alterations of the photoreceptor inner and outer segment junction were observed by optical coherence tomography in both eyes. Central scotoma was also found by microperimetry and reduced central response was revealed by multifocal electroretinogram in both eyes. These findings are consistent with the clinical characteristics of occult macular dystrophy

  2. Feasibility of a Knowledge Translation CME Program: "Courriels Cochrane"

    Science.gov (United States)

    Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guylene; Fremont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Legare, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

    2012-01-01

    Introduction: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews ("Courriels Cochrane") were disseminated by e-mail. Program participants…

  3. Feasibility of a Knowledge Translation CME Program: "Courriels Cochrane"

    Science.gov (United States)

    Pluye, Pierre; Grad, Roland; Granikov, Vera; Theriault, Guylene; Fremont, Pierre; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Arroll, Bruce; Luconi, Francesca; Legare, France; Labrecque, Michel; Ladouceur, Roger; Bouthillier, France; Sridhar, Soumya Bindiganavile; Moscovici, Jonathan

    2012-01-01

    Introduction: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews ("Courriels Cochrane") were disseminated by e-mail. Program participants…

  4. Reperfusion pulmonary edema

    Energy Technology Data Exchange (ETDEWEB)

    Klausner, J.M.; Paterson, I.S.; Mannick, J.A.; Valeri, C.R.; Shepro, D.; Hechtman, H.B. (Harvard Medical School, Boston, MA (USA))

    1989-02-17

    Reperfusion following lower-torso ischemia in humans leads to respiratory failure manifest by pulmonary hypertension, hypoxemia, and noncardiogenic pulmonary edema. The mechanism of injury has been studied in the sheep lung lymph preparation, where it has been demonstrated that the reperfusion resulting in pulmonary edema is due to an increase in micro