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Intravitreal dexamethasone implant for macular edema following uncomplicated phacoemulsification
Get PDFIntravitreal dexamethasone implant for macular edema following uncomplicated phacoemulsification
No full textPurpose: To retrospectively study the efficacy of a single 0.7-mg dexamethasone intravitreal implant in eyes with refractory macular edema secondary to uncomplicated phacoemulsification and intraocular lens implant. Methods: In 11 eyes of 11 consecutive patients with persistent refractory macular edema, secondary uncomplicated cataract extraction, and intraocular lens implant, the injection of 0.7-mg dexamethasone implant was performed at the Clinica Oculistica, University of Bari, Italy. Best-corrected visual acuity (BCVA), central retinal thickness measured by spectral-domain optical coherence tomography, and intraocular pressure (IOP) was evaluated at baseline, 1 month, and 6 months. Results: After a mean follow-up of 6.27 ± 0.47 months, BCVA was significantly increased from 20/40 to 20/22 (p<0.0001), mean central retinal thickness decreased significantly from 462 ± 100 to 276 ± 8 μm (p<0.0001), and IOP did not change significantly (p = 0.053). In no case were postoperative complications observed. Conclusions: A single injection of 0.7-mg dexamethasone intravitreal implant was effective in the treatment of persistent refractory macular edema secondary to uneventful phacoemulsification and in-bag lens implant. © 2013 Wichtig Editore
Cauterization of Ozurdex wound for the prevention of scleral leakage in vitrectomized eyes
No full textPURPOSE:
To study if cauterization of the scleroconjuctival wound secondary to intravitreal dexamethasone implant in vitrectomized eyes is effective to avoid scleral leakage and hypotony.
METHODS:
A total of 35 vitrectomized eyes of 35 consecutive patients with macular edema who underwent a single intravitreal dexamethasone implant injection in the operating room at the Eye Clinic of the University of Bari, Italy, from 2013 to 2017 were retrospectively reviewed. At the end of the injection, transconjuctival/scleral bipolar cauterization was applied at the injection site and the presence or absence of leakage or hypotony was studied.
RESULTS:
At the end of the procedure, no patient showed fluid leakage from the cauterized scleroconjuctival wound. No ocular hypotony of other ophthalmic complications were observed at 1 hour and 1 day from injection and intraocular pressure did not change significantly from baseline at 1 hour and 1 day after injection.
CONCLUSIONS:
Cauterization of the scleral wound after intravitreal dexamethasone implant injection in vitrectomized eyes is safe and effective to avoid scleral leakage with secondary hypotony, obtaining a watertight wound closure
In vivo evidence of epiretinal membrane formation secondary to acute macular microhole after posterior vitreous detachment
No full textThe authors present the case of an idiopathic epiretinal membrane (ERM) secondary to an acute self-repaired macular microhole documented by optical coherence tomography (OCT). A 65-year-old phakic woman presenting with acute onset of light flashes, myodesopsia, and central negative scotoma in the right eye was diagnosed with age-related posterior vitreous detachment. Spectral-domain OCT showed a tiny defect of the outer retina, consistent with the diagnosis of macular microhole, which spontaneously closed after 4 weeks. Six months later, the patient developed a contracting ERM, and her visual acuity significantly worsened. This case represents the first in vivo documentation of retinal pigment epithelium cell migration through a macular microhole, highlighting the importance of OCT in understanding idiopathic ERM pathogenesis
Dexamethasone intravitreal implant along with femtosecond laser assisted cataract surgery in patients with diabetic macular edema and cataract
No full textPurpose To assess the safety and efficacy of intraoperative dexamethasone intravitreal (DEX) implant in patients with diabetic macular edema (DME) undergoing femtosecond laser assisted cataract surgery (FLACS). Methods In this single-center retrospective study, the charts of patients who underwent combined FLACS and DEX implant in the previous three months were reviewed. Primary outcome measures were ocular complications; secondary outcome measures were the change of best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Results 20 eyes of 20 patients were included. None developed intraoperative or postoperative complications. Mean BCVA was 20/120 (logMAR, 0.78 +/- 0.31) at baseline and improved significantly to 20/63 (logMAR, 0.52 +/- 0.24; p = 0.01), 20/58 (LogMAR, 0.48 +/- 0.28; p < 0.001) and to 20/58 (LogMAR, 0.48 +/- 0.31; p < 0.001) at month 1,2 and 3, respectively. A mean improvement of 0.30 LogMAR was recorded at month 1 and 3. Mean CRT decreased significantly from 416.6 +/- 76.1 mu m at baseline to 322.4 +/- 46.4 mu m (p < 0.001), to 300.7 +/- 29.7 mu m (p < 0.001), and to 319.8 +/- 54.7 mu m (p < 0.001) at month 1,2 and 3, respectively. Comparing to the 1-month follow-up, the largest mean reduction in CRT (112.4 +/- 68.9 mu m) was observed at month 2 (p = 0.001). Fourteen patients (70%) had an improvement of CRT over the first 2 months followed by a recurrence of edema at month 3. Conclusion DEX implant following FLACS seems to be a safe and effective approach for patients with coexisting cataract and DME
Choroidal neovascularization due to choroidal osteoma treated with anti–vascular endothelial growth factor therapy: An optical coherence tomography angiography study
No full textPurpose: To evaluate the response to anti–vascular endothelial growth factor therapy for choroidal neovascularization secondary to choroidal osteoma using optical coherence tomography angiography. Methods: This retrospective study included four eyes of four females with choroidal osteoma complicated by choroidal neovascularization, treated with ranibizumab. All patients underwent full ophthalmologic examination, including ocular ultrasound, retinography, fluorescein angiography, spectral-domain or swept-source optical coherence tomography, and optical coherence tomography angiography. These images were analyzed to measure choroidal osteoma and to study choroidal neovascularization changes after intravitreal anti–vascular endothelial growth factor. Results: In all cases, fluorescein angiography revealed the presence the choroidal neovascularization, as an early hyperfluorescence area increasing during the exam. Optical coherence tomography showed both the choroidal osteoma and choroidal neovascularization and intra- or subretinal fluid as activity sign. In optical coherence tomography angiography, choroidal osteoma vessels were valuable in outer retina and choroidal slabs, and were irregular and did not change after ranibizumab injection; neovascular network correlating with choroidal neovascularization showed a hyperflow tangled vessels in outer retina, decreasing in density after anti–vascular endothelial growth factor therapy. Conclusion: Optical coherence tomography angiography seems to be a useful tool in visualizing and distinguishing vascular networks of choroidal osteoma and of choroidal neovascularization secondary to choroidal osteoma better than fluorescein angiography
SD-OCT AND MICROPERIMETRIC CORRELATED CHANGES IN PROGRESSIVE X-LINKED RETINOSCHISIS AFTER VITRECTOMY: A CASE REPORT
No full textTo report optical coherence tomography and microperimetric correlated changes in a case of bilateral foveal schisis in progressive X-linked retinoschisis (XLRS) treated with vitrectomy, inner limiting membrane (ILM) peeling, and air tamponade
OCT-angiography follow-up of choroidal neovascularization treated with treat-and- extend aflibercept regimen to avoid over-treatment
No full textPurpose To propose optical coherence tomography angiography (OCT-A) for the follow-up of neovascular age-related macular degeneration (nAMD) treated with a treat-and-extend (T&E) aflibercept regimen to avoid overtreatment. Methods Retrospective, cohort, pilot study. We analysed 16 consecutive-treatment naive nAMD eyes following up 2-years at the Eye Clinic, Bari, Italy. Intravitreal aflibercept injections in the T&E regimen for no less than 12 months, during which the macula was dry without any sign of intraretinal or subretinal fluid (SRF) at each visit, were performed. Parametric data were evaluated using an analysis of variance (ANOVA); any non-parametric statistical calculations were performed using the Wilcoxon and Mann-Whitney test. Results The average number of injections during follow-up was: 8.8 +/- 1. Treatment regimen adjustments were 4 weeks (W), 8W (4 + 4), 10W (8 + 2), 12W (8 + 4, or 10 + 2). No significant CNV size change from 4 to 8W (-0.027 +/- 0.22 mm(2), p = 0.088), and from 8 to 12W (-0.04 +/- 0.11 mm(2), p = 0.065) were found. Likewise, no significant decrease in choriocapillaris flow (CF) was detected (p = 0.056). Conclusion We suggest that OCT-A may be useful in the evaluation of dry macula to decide the best approach for perchance adjusting injection intervals based on changes of CNV size
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