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Background: Intraocular dexamethasone implant (DEXi) is an efficient treatment for diabetic macular edema (DME). However, it may be unavailable or contraindicated. Triamcinolone acetonide is another corticosteroid that has proved to be safe and effective in treating macular edema complicating various diseases including diabetes. The purpose of this study is to evaluate the outcomes of a switch from DEXi to subtenon triamcinolone acetonide (STTA) and back, in eyes with DME., Methods: Retrospective study. DME eyes that had been treated with DEXi and switched to STTA between October 2018 and February 2019 (stock shortage of DEXi) were included. The functional and anatomical outcomes of the switch and switch-back were studied., Results: 26 eyes of 17 patients (mean age 67.1 ± 8.2 years) were considered. The mean baseline visual acuity (VA) was 0.35 ± 0.17 decimals remaining stable after DEXi, STTA and switch-back to DEXi. The mean central macular thickness (CMT) was 492.7 ± 32.8 µm initially, decreasing to 294.3 ± 133.4 µm after DEXi, 369.9 ± 182.3 µm after STTA and 297.6 ± 72.0 µm after switching back to DEXi (all p < 0.05 versus baseline). Compared to baseline, the CMT reduction was numerically better after DEXi and switching back to DEXi than after STTA (mean reduction: -200.4 µm, -167.7 µm, and -95.08 µm respectively, p = 0.13). Intraocular pressure was comparable after DEXi and STTA., Conclusion: DEXi is the steroid of choice in DME. However, STTA can be a cost-effective alternative when DEXi is unavailable or contraindicated. This study suggests that STTA may be used in the context of a step therapy in DME., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To investigate the impact of anti-VEGF therapy on vascular metrics in eyes with macular edema secondary to central retinal vein occlusion (CRVO) using wider field swept-source OCT angiography (WF SS-OCTA)., Methods: We included 23 eyes with macular edema associated with non-ischemic CRVO from 22 patients treated with anti-VEGF therapy (median number of injections: 5 [2-9]). Changes in vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ) parameters were measured using WF SS-OCTA. Visual acuity (VA) and central subfield thickness (CST) were also measured., Results: Median CST decreased significantly from 369 µm (305-531) to 267 µm (243-300, p < 0.001). VD and VSD parameters in 12 × 12 mm images showed significant reductions. For instance, VSD in the whole retina decreased from a median of 13.37 (11.22-13.74) to 11.29 (9.36-12.97, p = 0.013). Additionally, a significant increase in FAZ circularity was found, suggesting improved microvascular integrity. Significant inverse correlations were found between the number of anti-VEGF injections and all VSD and VD parameters on the 12 × 12 mm images (p < 0.05). Notably, the reductions in VSD and VD on 12 × 12 mm angiograms in the deep capillary plexus (DCP) after each injection significantly correlated with increased logMAR VA (worse VA)., Conclusion: Anti-VEGF therapy in CRVO patients not only mitigates macular edema but also alters the overall microvascular morphology and functionality as revealed by WF SS-OCTA., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To evaluate the usefulness of the retinal sensitivity in branch retinal vein occlusion (BVO) with macular edema (ME) following the anti-vascular endothelial growth factor (anti-VEGF) treatment., Methods: Best-corrected visual acuity (BCVA), microperimetry, and optical coherence tomography (OCT) measurements were carried out in 20 patients with BVO with ME, at baseline and 1 month after the anti-VEGF treatment. The relationships among BCVA, mean retinal sensitivity (MS), macular volume (MV), central retinal thickness (CRT), integrity of ellipsoid zone (EZ), mean retinal sensitivity in the most affected quadrant (qMS), and macular volume in the most affected quadrant (qMV) were investigated. In addition, the relationships among the change in BCVA at 1 month (ΔBCVA1m), mean sensitivity in the most affected quadrant at 1 month (ΔqMS1m), MV in the most affected quadrant at 1 month (ΔqMV1m), and CRT at 1 month (ΔCRT1m) were analyzed. The optimal model for BCVA at 3 months after the treatment (BCVA3m) was identified., Results: There was not a significant difference in BCVA (paired Wilcoxon test, p = 0.058) between at baseline and after the treatment, but there were significant differences in MS, MV, CRT, qMS, and qMV (p < 0.05). There was a significant relationship between ΔqMS1m and ΔMV1m, ΔCRT1m, and ΔqMV1m, respectively. ΔMS1m or ΔqMS1m and BCVA at baseline and ΔBCVA1m were selected as explanatory variables in the optimal model for BCVA3m., Conclusion: Retinal sensitivity was related to retinal structure, whereas this was not the case with BCVA. In addition, retinal sensitivity was useful to predict BCVA after anti-VEGF therapy.

Purpose: Retinal sensitivity (RS) can be a valuable indicator of retinal function in response to intravitreal steroid or anti-VEGF treatment in the eyes with diabetic macular edema (DME), macular edema post retinal vein occlusion (RVO), or uveitis., Methods: This prospective longitudinal study included 68 patients (96 eyes) with macular edema (ME) secondary to diabetes mellitus (42 eyes), uveitis (36 eyes), or RVO (18 eyes). In addition to best corrected visual acuity (BCVA) and retinal thickness, Nidek MP1 microperimetry was used to quantify RS at baseline visit and to look at the mean difference (MD) at 3-6 months and 1-2 years post intravitreal therapy with corticosteroids or anti-VEGF., Results: There was a significant negative correlation between the central RS and BCVA (r = - 0.47, p < 0.001), including DME (r = - 0.42, p = 0.006) and uveitis (r = - 0.60, p < 0.001), but not RVO (r = - 0.37, p = 0.12). At 2-year follow-up, the overall CST was reduced from baseline (MD - 147 μm, 95% C.I - 192 to - 102, p < 0.001) with improved BCVA (MD - 0.12 LogMAR, 95% C.I - 0.23 to - 0.01, p = 0.01), but no improvement in the RS in any of the disorders. Both anti-VEFG and steroid groups showed significant improvement in CST at 2 years from baseline (MD - 101 μm, p = 0.001 and - 167 μm, p < 0.001, respectively) with only improvement in BCVA among anti-VEGF group (MD - 0.16 LogMAR, 95% C.I - 0.26 to - 0.07, p = 0.008)., Conclusion: The long-term follow-up of ME cases did not show a significant improvement in RS following treatment even with reduced macular thickness at 2-year follow-up.

Purpose: Pars planitis is a commonly observed type of pediatric uveitis. The aim of this study was to evaluate the implications of pars planitis-associated cystoid macular edema (CME) on visual outcome and treatment modalities., Methods: A retrospective review of medical records in a single center with academic practice., Results: Included were 33 children (mean age 8 years, 58 eyes). Eighteen eyes developed CME (31%): in 67% of them, CME was diagnosed at presentation and in 33%, it developed at a mean of 57 months after presentation. Anterior and posterior segment complications were more prevalent in eyes with CME. Papillitis was significantly associated with the development of CME (OR 12.4, 95% CI 2.3 to 65.6, p = 0.003). Patients with CME were 1.7 times more likely to be treated with systemic therapy. By the last follow-up, 50% of patients who never developed CME were without systemic therapy compared with 13% of patients who developed CME (p = 0.034). LogMAR visual acuity improvement between presentation and month 36 was 0.41 for eyes with CME compared with 0.14 for eyes that never developed CME (p = 0.009)., Conclusion: Pars planitis-associated CME entailed higher prevalence of ocular complications, more frequent use of immunomodulatory therapy, and a lower rate of remission.

Purpose: To classify the types of diabetic macular edema (DME) and evaluate its morphological features on spectral domain optical coherence tomography (SD-OCT) and determine correlations between visual acuity and OCT findings., Methods: We assessed 406 eyes of 309 patients with a diagnosis of DME retrospectively. Three types based on SD-OCT were identified: diffuse macular edema, cystoid macular edema, and cystoid degeneration. Morphological features such as serous macular detachment (SMD), vitreomacular interface abnormalities (VMAI), hard exudates, photoreceptor status, and correlations between visual acuity and those morphological features were also evaluated by SD-OCT., Results: The most common type of DME was cystoid edema (68.5%). No statistically significant difference was found between groups in sex (P = 0.40), type of diabetes (P = 0.50), or diabetic retinopathy (P = 0.78). However, the duration of symptoms and BCVA was significantly lower in the group with cystoid degeneration compared with the group with cystoid edema (P < 0.001) and the group with diffuse macular edema (P < 0.001). In the group with cystoid degeneration compared with the groups with cystoid and diffuse edema, the central fovea and central subfield were significantly thicker (both (P < 0.001), the subfoveal choroid was significantly thinner (P = 0.049), rate of serous macular detachment was significantly lower (P < 0.001), and the rate of outer retinal damage was significantly higher (P < 0.001)., Conclusions: Cystoid macular degeneration, which is consistent with poor functional and morphological outcomes, should be differentiated from cystoid macular edema. Serous macular detachment, which is mostly seen in eyes with early stages of DME, should be evaluated as an accompanying morphological finding rather than a type of DME.

Purpose: To investigate factors associated with the severity of metamorphopsia secondary to diabetic macular edema (ME) by evaluating optical coherence tomography (OCT) parameters including disorganization of the retinal inner layers (DRIL)., Methods: We retrospectively reviewed medical records of 37 eyes of 37 consecutive patients with diabetic ME or resolved diabetic ME, who underwent spectral-domain OCT examination and metamorphopsia assessment with M-CHARTS on the same day between November 2017 and March 2018. Age, sex, visual acuity, lens status, treatment history, and factors analyzed on OCT examination including DRIL length were evaluated in association with M-CHARTS scores., Results: Metamorphopsia was detected in 20 eyes (54%). The patients with metamorphopsia were relatively older than those without it (P = 0.060), and DRIL length was relatively longer in eyes with metamorphopsia (P = 0.065), while visual acuity was significantly better in eyes without metamorphopsia (P = 0.048). In correlation analyses to the severity of metamorphopsia, the DRIL length was the only OCT parameter associated with the M-CHARTS score (P = 0.035), while age, visual acuity, and ME were not significantly associated with the severity of metamorphopsia (P = 0.051, 0.060, and 0.344, respectively)., Conclusion: The DRIL length was significantly associated with the severity of metamorphopsia secondary to diabetic ME. The inner retinal layer plays a key role in the development of metamorphopsia in eyes with diabetic ME. Metamorphopsia should be carefully considered when treating diabetic ME since its severity has been found to be independent of visual acuity and ME status.

Background: Patients with exudative maculopathies (neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO)) are faced with a high burden of examinations and treatments. This study was conceived to analyze the accuracy of a subjective evaluation of visual acuity (VA) and metamorphopsia to detect disease reactivation, compared to morphological signs of reactivation assessed by means of SD-OCT., Methods: Retrospective study of 888 patients treated for nAMD (n = 638), DME (84), BRVO (110), and CRVO (56) was conducted. Subjective evaluation of the patient at an examination (i.e., change of VA and/or metamorphopsia) was compared to clinical evaluation of disease activity as assessed by SD-OCT. Sensitivity and specificity, negative and positive predictive values (PPV/NPV) for detection of active disease were calculated. Factors associated with false-negative subjective evaluation were analyzed by regression analysis., Results: The sensitivity of the subjective evaluation to detect disease reactivation was < 0.50 in all exudative maculopathies. Sensitivity was increased to ≥ 0.60 by combining subjective worsening with loss of 1 line in the VA test in RVO, but not in DME and nAMD. The specificity was > 0.85 in all patients. PPV was > 0.85 in patients with RVO. Regression analysis did not reveal any factors that could reliably identify patient subgroups in which OCT could be omitted, though CRVO patients with a visual acuity of < 0.3 logMAR had an odds ratio of 0.20 for false-negative subjective evaluation (p = 0.009)., Conclusion: The accuracy of subjective evaluation to discriminate disease activity in patients with different exudative maculopathies was low and cannot substitute for frequent SD-OCT exams. Routinely assessed clinical parameters such as age, visual acuity, or treatment experience were of no use to predict the validity of subjective evaluation of disease activity., Trial Registration: This trial was registered at the DRKS (Deutsches Register Klinischer Studien, drks.de; No 00006851) prior to the inclusion of the first patient.

Purpose: To determine the effects of an intravitreal injection of ranibizumab (IVR) on the choroidal structure and blood flow in eyes with diabetic macular edema (DME)., Methods: Twenty-eight consecutive patients with DME who received an IVR and 20 non-diabetic, age-matched controls were followed for 1 month. The eyes with DME were divided into those with prior panretinal photocoagulation (PRP, n = 16) and those without prior PRP (no-PRP, n = 12). The enhanced depth imaging optical coherence tomography (EDI-OCT) scans and Niblack's image binarization were performed to determine the choroidal structure. The choroidal blood flow was determined by laser speckle flowgraphy., Results: The subfoveal choroidal thickness at the baseline was significantly thicker in the no-PRP group than in the PRP-treated group. After IVR, the best-corrected visual acuity (BCVA) and central retinal thickness in eyes with DME were significantly improved compared to the baseline values. There were significant differences in the choroidal thickness, total choroidal area, and choroidal vascularity index between the groups after IVR. Choroidal vascular index and choroidal blood flow were significantly reduced only in the no-PRP group and not in the PRP-treated group. In addition, the correlation between the central retinal thickness and the choroidal blood flow was significant in the no-PRP group (r = 0.47, P < 0.05)., Conclusions: A single IVR will reduce the central retinal thickness and improve the BCVA in eyes with DME in both the no-PRP and PRP-treated group. IVR affected the choroidal vasculature and blood flow significantly, and a significant correlation was found between the central retinal thickness and the choroidal blood flow in eyes without PRP.

Background: As numerous factors account for diabetic maculopathy, retinal thickness alone is poorly correlated to visual function in diabetic macular edema. En face optical coherence tomography (OCT) enables assessing retinal changes at specific layers. By averaging several planes, overall changes can be better appreciated., Methods: Retrospective analysis of a consecutive group of 16 patients (30 eyes) with diabetic macular edema in at least one eye, was compared to a control group of 17 healthy subjects (34 eyes). Healthy volunteers and diabetic patients being seen as part of their regular care underwent swept source OCT fundus imaging. En face Integrated Central Avascular Zone (EFICAZ) was manually determined and measured on images obtained by swept-source optical coherence tomography (OCT). EFICAZ was then compared between both populations and, for diabetic patients, correlated with best corrected visual acuity, as measured by the Snellen chart., Results: In healthy subjects, a moderate correlation was found between age and EFICAZ (Pearson's coefficient = 0.45, P = 0.01). In age-matched populations (mean age of 63 ± 3.8 years for eight healthy subjects and 62.7 ± 8.9 years for diabetic patients; P = 0.9), EFICAZ was significantly higher in diabetic than non-diabetic eyes (2.92 ± 1.10 mm 2 versus 1.86 ± 0.53 mm 2 ; P < 0.01). In diabetic patients, correlation between the size of EFICAZ and visual acuity (Pearson's correlation coefficient = -0 .72, P < 0.001) was stronger than between OCT measured central subfield retinal thickness and visual acuity (Pearson's correlation coefficient = -0.02, N.S)., Conclusions: EFICAZ increases with age in normal subjects. It is significantly larger in diabetic than in non-diabetic subjects. It offers a better way to determine visual acuity than OCT measurement of central retinal thickness. This new approach, which takes into account several factors involved in diabetic maculopathy, could be useful in monitoring response to therapy. It can easily be combined with other modalities.

Purpose: We aimed to investigate the relationship between the severity of metamorphopsia and the foveal microstructure measured with spectral-domain optical coherence tomography (SD-OCT) in patients with cystoid macular edema caused by branch retinal vein occlusion (BRVO-CME)., Methods: The study included 30 eyes of 30 patients with BRVO-CME. We examined visual acuity and the severity of metamorphopsia using M-CHARTS. Central foveal thickness, central retinal thickness at the fovea (CRT-1 mm), and macular volume were measured with SD-OCT software. The status of ellipsoid zone (EZ), external limiting membrane (ELM), outer retinal cyst, and inner retinal cyst was also evaluated., Results: The mean metamorphopsia score was 0.77 ± 0.50, with 28 of 30 patients (93 %) having metamorphopsia (metamorphopsia score ≥ 0.2). The vertical metamorphopsia score (0.89 ± 0.54) was significantly higher than the horizontal metamorphopsia score (0.64 ± 0.53) (p < 0.005). The status of EZ and ELM was significantly associated with visual acuity, but not with the mean metamorphopsia score. The mean metamorphopsia score was significantly related to CRT-1 mm (p < 0.05) and the presence of inner retinal cyst (p < 0.05)., Conclusions: The severity of metamorphopsia was significantly associated with central retinal thickness and the presence of inner retinal cyst.

Purpose: To assess the efficacy and safety of intraocular injections of bevacizumab in patients with macular edema (ME) following branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO)., Methods: Retrospective, non-comparative case series. Patients ≥18 years of age with ME secondary to BRVO or CRVO who received a minimum of one intravitreal injection of bevacizumab with a follow-up >3 months were included. Primary endpoints were mean change in best corrected visual acuity (BCVA) from baseline to 12 and 24 months, and mean change in central macular thickness (CMT) after 3 injections. Secondary endpoints were mean change in BCVA and CMT from baseline to end of follow-up, number of injections, and ocular adverse events., Results: Eighty-seven eyes with BRVO and 65 eyes with CRVO were included. Mean follow-up time was 24.4 and 26.1 months in the BRVO and CRVO groups, respectively. The mean change in BCVA was 0.25 LogMAR in the BRVO group and -0.118 LogMAR in the CRVO group., Conclusion: Visual acuity outcomes in the CRVO group were poorer, especially in patients with low baseline BCVA.

Purpose: To analyze the influence of spectral-domain optical coherence tomography (SD-OCT) features on visual acuity changes in patients with idiopathic epiretinal membranes (ERMs)., Methods: Seventy-nine eyes of 71 patients were included in this study. SD-OCT was performed for all patients; data were collected upon ERM diagnosis and at the final visit. The patients were divided into subgroups based on their SD-OCT features. The initial best corrected visual acuity (BCVA) and changes in BCVA for each subgroup were compared. A multivariate analysis was performed to assess the factors associated with changes in BCVA., Results: During a mean follow-up period of 20.78 months, the mean change in logMAR visual acuity was 0.052 ± 0.089. Eyes with inner segment/outer segment (IS/OS) junction disruption and cystoid macular edema (CME) had a significantly lower mean initial BCVA than those without disruption and CME (P = 0.036 and P = 0.012, respectively). However, only eyes with CME had significant changes in BCVA (P = .034). Multivariate analysis revealed the presence of CME as the only factor that had a significant correlation with VA changes., Conclusions: In patients with idiopathic ERMs, the presence of CME and IS/OS disruption detected by OCT correlated with a poorer initial BCVA. Most patients' visual acuity remained stable during follow-up. The presence of CME with OCT represented a predictor of the progression of visual acuity. These results may provide valuable clinical information regarding the management of patients with idiopathic ERMs. We demonstrated that the presence of CME and IS/OS disruption detected with OCT correlated with a poorer BCVA in idiopathic ERMs. The visual acuity of most patients was stable during the follow-up period. The presence of CME in OCT represented a predictor of vision deterioration for patients with idiopathic ERMs.

Purpose: To evaluate changes in macular sensitivity as measured via microperimetry (MP) in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) after dexamethasone implantation (DEX implantation, Ozurdex), in comparison to distance visual acuity, reading ability, and spectral domain optical coherence tomography (SD-OCT)., Methods: Twenty-three patients with ME secondary to RVO were treated with a DEX implantation in this prospective, observational case study. Patients were controlled at baseline and then monthly with microperimetry and assessment of distance visual acuity, reading ability, and SD- OCT. Side effects of the DEX implant were monitored by measuring the intraocular pressure (IOP) and lens grading with Lens Opacities Classification System (LOCS) charts., Results: The 23 patients with RVO included 16 patients with branch retinal vein occlusion (BRVO) and 7 patients with central retinal vein occlusion (CRVO). Improvement in distance visual acuity, reading ability, and in central 8-points microperimetry showed statistical significance from month 1 to 3, whereas the 40-points microperimetry improved with statistical significance from month 1 to 2. The reduction of central retinal thickness measured with SD-OCT remained statistically significant until month 4. Subgroup analysis of patients with BRVO and CRVO confirmed the best test results observed at month two after DEX implantation., Conclusions: The highest macular sensitivity was measured two months after DEX implantation. This corresponds to the best test results for distance visual acuity, reading ability, and SD-OCT observed two months after treatment.

Purpose: This study was initiated to investigate whether the presence of macular oedema influenced intraocular lens (IOL) power calculation in eyes with epiretinal membrane., Methods: The files of patients undergoing combined phacoemulsification were retrospectively reviewed. Two groups were defined according to presence of macular oedema. The main outcome measure was the IOL power prediction error (PE). Secondary outcome measures were the correlation between preoperative macular thickness, absolute change of macular thickness and dioptric shift. The mean postoperative PE achieved with the Haigis formula was compared with the PE that would have been obtained had the SRKII and HofferQ formulas been used., Results: We investigated 47 eyes of 47 consecutive patients. Regardless of the IOL formula used, the PE was on average higher in eyes without macula oedema (group 1). The myopic dioptric shift was dependent on preoperative macular thickness and absolute change of macular thickness. This association was more markedly pronounced in group 1., Conclusions: Increased retinal thickness is the main cause for underestimation of the cornea-photoreceptor layer distance, and therefore could contribute to inaccuracy in IOL power calculations. The current results show that a myopic shift tends to be less pronounced in cases where a macula oedema is present. Eyes with pure traction have less predictable refractive results in terms of higher PE and dioptric shift.

Purpose: To identify the incidence and risk factors of macular edema development following single-session pattern scan laser panretinal photocoagulation (PRP) for eyes with diabetic retinopathy., Methods: Medical records were reviewed in consecutive patients who underwent single-session PRP for diabetic retinopathy. The eyes with baseline central subfield retinal thickness (CRT) less than 300 μm were included., Results: Macular edema developed in 11 (8.5%) of 129 eyes 1 months after PRP. In the multivariate analysis, baseline CRT (μm) (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.00-1.08, p = 0.048) and presence of intraretinal cystoid spaces or subretinal fluid on spectral-domain optical coherence tomography (SD-OCT) images (OR = 38.33; 95% CI = 1.36-1,083.14, p = 0.032) were significantly associated with macular edema development at 1-month visit. Macular edema developed in two (2.1%) of 97 eyes without cystoid spaces or subretinal fluid. The macular edema was spontaneously resolved in five (45.5%) of 11 cases at 3-month visit., Conclusions: SD-OCT may be helpful in predicting the development of macular edema, although the macular edema rarely developed after single-session pattern scan laser PRP and was spontaneously resolved in many cases.

Purpose: To investigate the correlation between hyperreflective foci (HF) on spectral-domain optical coherence tomography at baseline and visual outcomes after intravitreal bevacizumab injection (IVB) in branch retinal vein occlusion., Methods: We retrospectively studied 97 eyes of 97 patients with macular edema secondary to BRVO, who were treated with IVB. The eyes were divided into three groups according to the location of HF on SD-OCT: HF in outer retinal layers, HF in inner retinal layers, and no HF. The baseline and final best-corrected visual acuity (BCVA), foveal thickness (FT), external limiting membrane (ELM) status, junction between photoreceptor inner and outer segments (IS/OS) status, and the number of HF were evaluated and compared among three groups., Results: Baseline BCVA was correlated with baseline FT (R = 0.366, p < 0.001), but final BCVA was not correlated with final FT (R = -0.008, p = 0.942). Baseline BCVA was significantly better in eyes with intact ELM at baseline (p = 0.006), and final BCVA was significantly better in eyes with intact ELM and IS/OS at final visit (p <  0.001, p = 0.003 respectively). At the final visit, 15 of 37 eyes (40.5%) with HF in outer retinal layers had a disrupted ELM (p = 0.001), while 28 of 37 eyes (75.7%) with HF in outer retinal layers had a disrupted IS/OS (p <  0.001). Final BCVA was poorer in eyes with HF in outer retinal layers groups than those in the other two groups (p <  0.001), although baseline BCVA was not different between them., Conclusions: HF on SD-OCT at baseline might predict the photoreceptor status and final VA after IVB in BRVO.

Background: The use of anti-tumor necrosis factor (TNF)-α agents for uveitis has been increasing since the first efficacy studies in 2004. However, information on their specific role in cystic macular edema remains sparse. The aim of this study was to evaluate the efficacy of anti-TNF-α agents for the treatment of uveitis-related refractory cystoid macular edema., Methods: The files of 23 consecutive patients treated for cystoid macular edema at the uveitis services of two tertiary medical centers in 2006-2011 were reviewed for demographic data, visual acuity, and optical coherence tomography measurements at baseline and 3, 6, and 12 months after treatment. Changes in mean visual acuity and macular thickness were analyzed. Findings were compared between patients treated with a conventional immunosuppressive regimen only (n = 18, 27 eyes) and patients treated with an anti-TNF-α agent after proving refractory to conventional treatment (n = 9, 15 eyes)., Results: Mean duration of cystoid macular edema before initiation of anti-TNF-α therapy was 12 ± 8 months. The two groups had similar baseline values of mean central macular thickness and visual acuity. Significant improvement in macular thickness was noted at 3 months in both groups, with a maximal effect at 6 months for the anti-TNF-α group (p = 0.002). Maximal improvement in visual acuity was achieved at 3 months in both groups, with a reduced effect towards 12 months. Mean visual acuity at 12 months was similar in both groups., Conclusions: Anti-TNF-α agents may serve as an effective lasting treatment for long-standing refractory uveitis-related cystoid macular edema. Their role as first-line therapy in this setting warrants further investigation.

Background: Factors predictive for response of diabetic macular edema (DME) to intravitreal bevacizumab (IVB) remain unclear. In this study, we assess the predictability of DME response to IVB based on the response to IVB in a previously treated fellow eye and other known pre-injection factors in (DME)., Methods: Retrospective chart review was conducted on 28 patients (56 eyes) with bilateral DME who underwent bilateral IVB therapy. Responses in both eyes were measured by change in central subfield thickness (CSFT) via optic coherence tomography (OCT), and change in visual acuity. Age, lens status, and starting macular thickness were recorded., Results: We found 21 % of the reduction in CSFT after IVB on OCT in the study eye may be explained by the percentage change in CSFT in the previously treated fellow eye [CI: 0.092-0.716; p-value = 0.0141]. Also, the pre-injection CSFT predicts 14 % of the response to IVB in the same eye [R² = 9.6 %, p-value = 0.018]. When combined in a multi-factorial model, 33 % of the change in CSFT following IVB may be explained by these two factors. Lens status, change in visual acuity, and age were not statistically significant predictors of response., Conclusions: In DME, the response to IVB in an eye is partially explained by the pre-injection retinal thickness in the same eye and by the response to IVB in the previously treated fellow eye. Lens status, change in visual acuity, and age were not statistically significant predictors of response in this study.

Purpose: To evaluate the efficacy of bromfenac drops alone or with a single intravitreal injection of bevacizumab (IVB) or triamcinolone acetonide (IVTA) in the treatment of uveitic macular edema (UME)., Design: Comparative case series. STUDY PARTICIPANT: Sixty-seven eyes (of 55 patients) with UME that received either bromfenac drops alone (n = 34), IVB plus bromfenac (n = 21) or IVTA plus bromfenac (n = 12)., Methods: Chart review of patients at the Massachusetts Eye Research and Surgery Institution (MERSI) was done. Eyes that received either bromfenac drops alone (Br), IVB plus bromfenac (IVB/Br) or IVTA plus bromfenac (IVTA/Br), with follow-up of up to 3 months, were included., Main Outcome Measure: Visual acuity., Results: There was no statistically significant effect seen in VA or CMT in the Br group, with 17 of 34 eyes (50 %) needing re-injection before 3 months of follow-up. Mean change in CMT at 4 weeks for the Br group was 5.06 µm. Compared to baseline, both the IVTA/Br and IVB/Br groups showed significant decrease in CMT and improvement in VA at 1 and 3 months follow-up. There was also a continuous decrease in CMT up to 3 months of follow-up with the IVTA/Br group, which was found to be significant in comparison with the IVB/Br group; this trend was not seen in the IVB/Br group at 3 months. The greatest mean change in CMT at 1 month was seen in the IVTA/Br group (154.33 ±178.22 µm), and this was statistically significant in comparison with the other groups (p = <0.0001). However, in terms of mean change in VA, there was no change in the Br group (0.01 ± 0.11 VA logMAR), and only 0.12 ± 0.19 and 0.15 ± 0.20 in the IVB/Br and IVTA/Br groups, respectively., Conclusion: IVB and IVTA are both effective in improving VA and decreasing CMT up to 3 months. Bromfenac is ineffective alone for UME treatment, but may have a synergistic effect with IVTA in reducing CMT up to 3 months of follow-up.

Background: To evaluate the anatomical and functional outcomes of intravitreal dexamethasone implant in patients with macular edema (ME) secondary to retinitis pigmentosa (RP)., Methods: Three patients (four eyes), aged 24 to 46 years, presented with refractory ME secondary to RP. Intravitreal dexamethasone implant (Ozurdex) was administered to treat ME. The anatomical (central macular thickness [CMT]) and functional (best-corrected visual acuity [BCVA]) outcomes as well as adverse events were recorded., Results: All patients completed 6 months follow-up. After intravitreal Ozurdex all patients showed regression of ME. At baseline, mean CMT was 443 ± 185 μm (range 213-619 μm); ME improved to 234 ± 68 μm (range 142-307 μm) at 1 month, to 332 ± 177 μm (range 139-513 μm) at 3 months, and to 305 ± 124 μm (range 144-447 μm) at 6 months. Recurrent ME was recorded in 2 patients (both patients at 3 months from intravitreal dexamethasone implant). Retreatment with intravitreal Ozurdex was performed in two patients. Mean BCVA improved form 20/160 (range 20/50-20/200) (baseline) to 20/100 (range 20/40-20/125) at 1 month, to ∼20/125 (range 20/100-20/200) at 3 months, and to ∼ 20/125 (range 20/100-20/160) at 6 months. No serious ocular and systemic adverse events were observed during the study period., Conclusions: Intravitreal dexamethasone implant provides anatomic and functional improvements and may represent a valuable treatment option for patients with ME secondary to RP.

Background: To evaluate the predictors of visual improvement using spectral-domain optical coherence tomography (SD-OCT) in eyes with resistant diabetic macular edema (DME) treated with pars plana vitrectomy., Methods: Thirty-four eyes with resistant DME were evaluated in a retrospective manner. Several SD-OCT variables including photoreceptor inner segment/outer segment (IS/OS) junction, external limiting membrane (ELM) integrity, and central macular thickness (CMT) before and after the surgery, were evaluated by two experienced observers, masked to visual acuity. The visual improvement was used as the outcome measure for a stepwise regression, while the OCT factors were used as predictors., Results: The strongest predictor of vision improvement was pre-operative damage to the ELM (p = 0.0277) compared to IS/OS junction (p = 0.03). Pretreatment central macular thickness was a very weak predictor (p = 0.18) of visual improvement. For each percentage increase of ELM integrity there was a 0.13 letter gain in vision. ELM integrity explained 16% of the visual acuity improvement after treatment, which rose to 21% with the addition of CMT. The addition of IS/OS junction in the model did not add predictive information., Conclusions: Evaluation of ELM preoperatively predicts the vision improvement more accurately than the IS/OS junction and CMT in eyes with DME.

Introduction: This systematic review assesses the effectiveness of intravitreal bevacizumab (IVB) versus a comparison group in the treatment of branch retinal vein occlusion (BRVO)-associated macular edema, and explores its effects on visual acuity (VA) and central macular thickness (CMT)., Methods: The authors searched the following databases: Medline (1950-October week 3, 2011), The Cochrane Library (Issue 10, 2011), EMBASE (up to 24 October 2011), and the TRIP Database (up to 24 October 2011), using no language or other limits. Trials that were included consisted of patients with BRVO-associated macular edema, those comparing a 1.25 mg IVB injection with a comparison group, those reporting both VA and CMT outcomes, and those having a minimum follow-up of 4 weeks., Results: In the four trials comparing IVB with a comparison group, IVB was effective in improving VA and CMT values in the long-term (12 weeks) in patients with BRVO-associated macular edema. Furthermore, statistically significant improvements in VA in the short-term (4 weeks) could also be seen., Discussion: Clinicians should use this review as an indicator that IVB is effective in improving VA and CMT values in the long-term in patients with BRVO-associated macular edema. It is important to note, however, that statistically significant improvements in VA in the short term could be seen. This review's main aim was to serve as an evidence base for potentially using other modalities, such as IVB, which seems to be reserved for certain cases.

Background: Cystoid macular edema (CME) is one of the common complications of retinitis pigmentosa (RP), and is responsible for patient complications such as blurred and reduced visual acuity and for subsequent atrophic changes in the fovea. The objective of this work was to evaluate the clinical efficacy of a topical dorzolamide (a carbonic anhydrase inhibitor) in CME associated with RP., Methods: Sixteen eyes of nine patients with CME secondary to typical forms of RP were included in the study. Baseline visual acuity, visual field, and optical coherence tomography (OCT) measurements were obtained for all patients. All patients used 1% dorzolamide three times daily in each eye. Patients underwent follow-up exams at 1, 3, and 6 months after treatment. The response to treatment was monitored by visual acuity and visual field measurement testing using the Humphrey Field Analyzer (HFA: the central 10-2 Program); in addition, foveal thickness was measured by OCT. Evaluation of macular sensitivity calculated by HFA as the average of 12 central points., Results: Thirteen (81.3%) of 16 eyes showed a clear decrease in retinal thickness after treatment. Evaluation of macular sensitivity, calculated by HFA as the average of 12 central points (with the exception of foveal point data, showed an improvement of more than 1.0 dB in nine (56.3%) of 16 eyes. Moreover, both the mean deviation value and macular sensitivity were significantly improved. No severe side-effects were seen in any of the patients examined., Conclusions: The results demonstrated that a topical dorzolamide is effective for the treatment of CME in patients with RP, and that the positive treatment effects last for up to 6 months.

Purpose: To study the correlation of retinal sensitivity with both morphologic changes in the macula and status of retinal capillary perfusion, after resolution of the macular edema associated with retinal vein occlusion (RVO)., Methods: Retinal sensitivity in the macular area was examined with the Micro Perimeter 1 in 24 eyes after resolution of the macular edema associated with RVO. Using spectral-domain optical coherence tomography, 6 mm × 6 mm areas of macula were examined with 256 sequential horizontal scans. Condition of the photoreceptor layer was evaluated depending upon detection of the junctions between inner and outer segments of the photoreceptors (IS/OS). Fluorescein angiography was performed in 19 eyes., Results: Mean retinal sensitivity on the affected side of the retina was significantly decreased (p < 0.001). On the affected side, the mean retinal sensitivity within the area of deteriorated IS/OS was significantly less (3.8 ± 4.8 dB) than that within areas with complete IS/OS (10.1 ± 6.4 dB, p < 0.001). Mean retinal sensitivity within nonperfused areas was extremely low (0.3 ± 1.3 dB), compared with that in perfused retina (10.9 ± 5.9 dB, p < 0.001). In eyes with a broken foveal capillary ring (FCR), the marked decline in retinal sensitivity was seen within the area where the FCR was broken; this was not seen in eyes with an intact FCR., Conclusion: Retinal function was decreased markedly in areas with a damaged photoreceptor layer due to RVO, and was lethally decreased within nonperfused areas. Due to the various limitations of the current study, including implementation of fluorescein angiography in limited number of eyes, wide range of follow-up, and heterogeneity of pretreatments, further prospective studies are necessary to confirm the current findings.

Background: The present study was performed to compare the effects of pars plana vitrectomy (PPV) and single intravitreaous triamcinolone acetonide (IVTA) on diabetic macular edema (DME) in paired eyes., Methods: Prospective comparative study on randomized paired-eyes was carried out at two hospitals. Forty eyes of 20 patients with bilateral DME were included. One randomly-selected eye was treated with PPV (PPV group), and the other eye was treated with IVTA (4 mg, IVTA group). The central macular thickness (CMT) measured by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) were monitored for 12 months after treatment. Changes from baseline and differences between groups were analyzed using a mixed model., Results: At 1 and 3 months, CMT decreased significantly in the IVTA group compared to baseline (p < 0.0001 both), but CMT then increased gradually and no significant difference was found at 12 months (p = 0.90). In the PPV group, CMT decreased continuously and reached a significant level at 12 months (p < 0.0001). CMT of the IVTA group was significantly less than that of the PPV group at 1 month (p = 0.009); however, there was no significant difference at 3 months. Conversely, CMT was significantly less in the PPV group than in the IVTA group at 12 months (p = 0.0003). The changes of BCVA paralleled those of CMT, but no significant difference was detected between baseline BCVA and any time point., Conclusions: Despite the short-term improvement, DME recurred 6 months after IVTA, while it remained resolved after PPV. Although this study did not reveal a significant change of BCVA with either treatment, PPV resolved DME more effectively than IVTA at 1 year.

Purpose: To investigate the correlation between foveal photoreceptor integrity and final visual acuity (VA) after treatment of eyes with diabetic macular edema (DME), and to determine the visual prognostic factors., Methods: We retrospectively studied 61 eyes of 52 patients with DME who were treated successfully with intravitreal triamcinolone injection (IVTA). Using spectral domain optical coherence tomography (SD-OCT), the eyes were categorized into three groups at the final visit according to restoration of the photoreceptor inner and outer segment junction (IS/OS) and the external limiting membrane (ELM): (1) the A group, with a completely visible IS/OS and ELM, (2) the B group, with a disrupted IS/OS and intact ELM, and (3) the C group, with a disrupted or loss of the IS/OS and ELM. Disrupted IS/OS length (DIL), disrupted ELM length (DEL), and mean disrupted IS/OS and ELM length (DIEL) were measured at the initial and final visits. Foveal thickness (FT), macular center thickness (MCT), and outer nuclear layer (ONL) thickness were also measured at the initial and final visits. Multivariate analysis testing was performed over the measured SD OCT variables., Results: Final VA was closely associated with IS/OS integrity at the final visit; final VA (logMAR) in the A group (0.21 ± 0.14; 31 eyes) or B group (0.31 ± 0.21; 15 eyes) was significantly better than that in the C group (0.45 ± 0.33; 15 eyes) (p < 0.001). Shorter DIL, DEL, and DIEL at the final visit were associated with better final VA. Multivariate analysis showed that DIEL (r = 0.564) have the greatest correlation coefficient with final VA compared to DIL (r = 0.561) and DEL (r = 0.540). Better VA, preservation of the IS/OS and ELM at the initial visit were associated with intact photoreceptor integrity after resolution of DME. However, MCT, FT, and ONL thickness had no significant correlation with photoreceptor integrity., Conclusion: IS/OS and ELM are useful hallmarks for use in evaluation of foveal photoreceptor layer integrity, and are closely associated with final VA in DME. Pretreatment VA and photoreceptor status can predict potential restoration of photoreceptor integrity and subsequent visual recovery in DME.

Background: Diabetic macular edema (DME) is a leading cause of blindness in the developed world. Sirolimus has been shown to inhibit the production, signaling, and activity of many growth factors relevant to the development of diabetic retinopathy. This phase I/II study assesses the safety of multiple subconjunctival sirolimus injections for the treatment of DME, with some limited efficacy data., Methods: In this phase I/II prospective, open-label pilot study, five adult participants with diabetic macular edema involving the center of the fovea and best-corrected ETDRS visual acuity score of ≤74 letters (20/32 or worse) received 20 μl (440 μg) of subconjunctival sirolimus at baseline, month 2 and every 2 months thereafter, unless there was resolution of either retinal thickening on OCT or leakage on fluorescein angiography. Main outcome measures included best-corrected visual acuity and central retinal thickness on OCT at 6 months and 1 year, as well as safety outcomes., Results: Repeated subconjunctival sirolimus injections were well-tolerated, with no significant drug-related adverse events. There was no consistent treatment effect related to sirolimus; one participant experienced a 2-line improvement in visual acuity and 2 log unit decrease in retinal thickness at 6 months and 1 year, two remained essentially stable, one had stable visual acuity but improvement of central retinal thickness of 1 and 3 log units at 6 months and 1 year respectively, and one had a 2-line worsening of visual acuity and a 1 log unit increase in retinal thickness at 6 months and 1 year. Results in the fellow eyes with diabetic macular edema, not treated with sirolimus, were similar., Conclusions: Subconjunctival sirolimus appears safe to use in patients with DME. Assessment of possible treatment benefit will require a randomized trial.

Background: Intravitreal application of triamcinolone and bevacizumab in Coats' disease with macular edema to improve visual outcome., Methods: Testing of best-corrected visual acuity (BCVA), ophthalmoscopy, optical coherence tomography, fluorescein angiography, 30° perimetry, and full-field electroretinography were performed at initial and follow-up visits. Medical treatment consisted of intravitreal injection of 1.25 mg bevazicumab and 1.25 mg triamcinolone, followed by intravitreal injections of 1.25 mg bevazicumab at weeks 4 and 10. Follow-up was 87 weeks., Results: Perimetric results, including a temporal absolute scotoma and reduced electroretinographic amplitudes (photopic and scotopic conditions), did not significantly change during the follow-up, but foveal retinal thickness decreased from 505 μm to 212 μm, and BCVA increased from 0.3 at baseline to 1.25 and remained stable during subsequent follow-up., Conclusions: Combined intravitreal treatment with bevacizumab and triamcinolone resulted in significant decrease of central retinal thickness and improved visual acuity in this case report. Severe local or systemic side-effects were not observed.

Background: Diabetes mellitus, as well as subsequent ocular complications such as cystoid macular edema (CME), are of fundametal socio-economic relevance. Therefore, we evaluated the influence of internal limiting membrane (ILM) removal on longterm morphological and functional outcome in patients with diabetes mellitus (DM) type 2 and chronic CME without evident vitreomacular traction., Method: Forty eyes with attached posterior hyaloid were included in this prospective trial and randomized intraoperatively. Prior focal (n = 31) or panretinal (n = 25) laser coagulation was permitted. Group I (n = 19 patients) underwent surgical induction of posterior vitreous detachment (PVD), group II (n = 20 patients) PVD and removal of the ILM. Eleven patients with detached posterior hyaloid (group III) were not randomized, and ILM removal was performed. One eye had to be excluded from further analysis. Examinations included ETDRS best-corrected visual acuity (BCVA), fluorescein angiography (FLA) and OCT at baseline, 3 and 6 months postoperatively. Main outcome measure was BCVA at 6 months, secondary was foveal thickness., Results: Mean BCVA over 6 months remained unchanged in 85% of patients of group II, and decreased in 53% of patients of group I. Results were not statistically significant different [group I: mean decrease log MAR 95% CI (0.06; 0.32), group II: (-0.02; 0.11)]. OCT revealed a significantly greater reduction of foveal thickness following PVD with ILM removal [group I: mean change: 95% CI (-208.95 μm; -78.05 μm), group II: (-80.90 μm: +59.17 μm)]., Conclusion: Vitrectomy, PVD with or without ILM removal does not improve vision in patients with DM type 2 and cystoid diabetic macular edema without evident vitreoretinal traction. ILM delamination shows improved morphological results, and appears to be beneficial in eyes with preexisting PVD.

Background: Cystoid macular edema (CME) is a well-known complication after cataract surgery, and diabetic retinopathy is reported to be an important risk factor for impaired visual recovery. In this prospective study, we compared visual outcome 6 months after surgery in eyes with moderate retinopathy and no previous ME with a control group, and observed the incidence of ME seen on fluorescein angiography (FA) and optical coherence tomography (OCT)., Methods: Thirty-four patients with type-2 diabetes and 35 controls were enrolled. Best-corrected visual acuity (VA) letters ETDRS was measured pre-op, at day 7, week 6 and month 6. FA performed pre-op and at week 6 was divided into three leakage patterns. OCT performed pre-op, at week 6 and month 6 was qualitatively divided into three types. Macular thickness was measured in three circular fields (central subfield, inner and outer circle) from the macular maps., Results: There was no statistically significant difference in VA before surgery, at day 7 or at 6 months, but at 6 weeks there was a significant difference with lower VA in the diabetic group. Six percent of control and 12% of diabetic eyes developed a clinical CME defined as a loss of >5 letters between day 7 and week 6. Incidence of FA leakage was 23% in control and 76% in diabetic eyes. At 6 weeks, 20% of control and 44% of the diabetic eyes had qualitative changes on OCT. A statistically significant increase in thickness was observed for all three macular areas in both groups, part of it remaining at 6 months. There were, however, no differences in central macular thickness between the groups at any visit. Retinal thickening had poor correlation with VA., Conclusion: The final visual outcome in eyes with mild to moderate retinopathy, without previous ME, is as good as in normal eyes, but an increased frequency of macular changes may protract recovery of full vision. Changes on OCT or FA are often seen without any obvious effect on VA. OCT is as good as FA at detecting a clinical CME, and is the technique recommended for follow-up before FA is considered.

Background: The goal of this work is to compare the visual and anatomical (central macular thickness; CMT) outcomes of intravitreal bevacizumab (IVB) injections relative to sham treatment in eyes with acute (less than 3 months in duration) branch retinal vein occlusion (BRVO)., Methods: In a double-masked randomized clinical trial (RCT), patients with acute BRVO were randomly assigned to one of two treatment groups: IVB (two injections of 1.25 mg IVB 6 weeks apart) or sham treatment. Primary outcome measures included changes in best-corrected visual acuity (BCVA) and CMT in optical coherence tomography (OCT) during follow-up (FU) examinations. Any complications secondary to injections were considered secondary outcomes. FU results after 6 and 12 weeks are reported., Results: Eighty-one eyes (43 OD) of 81 patients (47 females) were enrolled in the study. Forty-two patients were enrolled in the IVB group, and 39 patients were enrolled in the sham group. Visual acuity and CMT improved in the IVB group after week 6 (two Snellen lines and 262 μm, respectively) and week 12 (three Snellen lines and 287 μm, respectively). After week 6, visual improvements in the IVB group were significantly increased relative to that of the sham group. However, visual improvements at week 12 were not significantly different between the two groups (1.5 Snellen lines visual improvement in the sham group at week 12)., Conclusions: In acute BRVO, two IVB injections resulted in significant improvement of vision and CMT at 6 weeks relative to the sham group. However, the visual improvements in the IVB group were not significantly different from those in the sham group at 12 weeks. IVB injections accelerate an initial improvement of visual acuity but do not have any significant effects on vision after 12 weeks.

Background: To identify predictive factors for improvement of visual acuity and central retinal thickness by intravitreal bevacizumab for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO)., Methods: Two hundred and five eyes from 204 patients with ME secondary to BRVO were retrospectively included at six sites. All eyes received intravitreal bevacizumab therapy (1.25 mg/0.05 ml). The mean follow-up was 36.8 ± 12.7 weeks (range, 18 to 54 weeks). Measurement of ETDRS best-corrected visual acuity (BCVA, in all eyes) and optical coherence tomography (OCT, in 87% of eyes) were performed at baseline and at follow-up examinations every 12 weeks. Using fluorescein angiography, the perfusion status of the macula at baseline could be assessed in 84% of the eyes. The main outcome measures were changes in BCVA and central retinal thickness (CRT). For analysis of predictive factors, the results at 24 weeks were used., Results: The median BCVA was 0.6 LogMAR at baseline and improved to 0.4 LogMAR at 24 and 48 weeks. This visual improvement was associated by a significant reduction in CRT, decreasing from a baseline of 454 μm to 267 μm and 248 μm after 24 and 48 weeks respectively. Eyes with ME and intact (perfused) or interrupted (ischemic) foveal capillary ring showed a 2-line increase of median BCVA [45 eyes (22%) and 128 eyes (62%) respectively]. However, the final median BCVA was significantly worse in eyes with ischemic ME (0.6 versus 0.3 logMAR in perfused ME). Other factors for visual improvement were absence of previous treatments of the ME, age younger than 60 years and low baseline BCVA (≥0.6 logMAR) (2, 3, and 2 median BCVA lines increase respectively). Furthermore, eyes with duration of the ME of less than 12 months responded with a 3-line increase of the median BCVA. Final CRT only showed minor differences between the subgroups. During the entire follow-up, retreatments were performed in 85% of the eyes, with a median number of injections of three (mean 3.2; range, 1 to 10) and a median time-interval between injections of 11.6 weeks (mean 14.6 weeks)., Conclusions: Intravitreal injection of bevacizumab resulted in a significant improvement of BCVA and reduction of ME in BRVO. Baseline BCVA, patient's age, and duration of BRVO were found to be of prognostic relevance for visual improvement. A less favorable outcome of the bevacizumab therapy in eyes with longstanding BRVO would advocate initiation of treatment within 12 months after onset.

Purpose: To evaluate the geographic pattern of central retinal sensitivity and its resolution shortly after intravitreal injection of triamcinolone acetonide (IVTA) for diabetic macular edema (DME)., Methods: Twenty eyes of 20 patients who underwent IVTA for the treatment of DME were reviewed retrospectively. Early changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), photoreceptor inner and outer segments (IS/OS) line and central retinal sensitivity were analyzed. Retinal sensitivity was measured at 40 points within the central 10 degrees of the macula with the Micro Perimeter 1 before treatment, and at 1 week and 1 month after IVTA., Results: Mean BCVA and CMT improved significantly at 1 week and 1 month after IVTA. Mean retinal sensitivity, however, showed no significant improvement at 1 week (P = 0.238), but did show significant improvement at 1 month (P = 0.0003). Mean retinal sensitivity of the points at the central 2 degrees, which was significantly lower than that at 6 and 10 degrees before treatment, showed improvement similar to those of 6 and 10 degrees after IVTA. Mean retinal sensitivity in the nasal quadrant of the macular area had the best sensitivity at all time points, and improved more than it did in the other quadrants. Mean retinal sensitivity in the central 2 degrees was better in the eyes with complete IS/OS line (P < 0.0001)., Conclusions: BCVA and CMT improved significantly after IVTA for DME. Retinal sensitivity also showed significant, albeit relatively slow, improvement. The nasal quadrant of the macular area showed more improvement than did any other quadrant.

Background: Baseline OCT morphology of macular edema (ME) due to branch (BRVO) or central retinal vein occlusion (CRVO) was evaluated with respect to response to bevacizumab treatment., Methods: Sixty-five patients (33 CRVO, 32 BRVO) were treated with intravitreal injections of 2.5 mg bevacizumab. Reinjections were only performed if ME persisted or recurred. Follow-up ranged from 23 to 128 weeks. OCT (Stratus OCT™, Carl Zeiss Meditec) morphology at baseline was analyzed retrospectively to evaluate its effect on treatment outcome (ETDRS visual acuity and central retinal thickness). Baseline OCT scans were studied with regard to central retinal thickness (CRT), presence and height of subretinal fluid (SRF), intraretinal cystoid spaces (ICS) and maximum horizontal diameter of the largest delimitable ICS., Results: In CRVO patients, baseline CRT is not correlated with CRT at last visit, but there is a significant correlation of baseline CRT with final visual acuity (VA). Presence of SRF and diameter of ICS do not influence functional and morphological response to bevacizumab treatment. Baseline CRT in BRVO patients is not significantly correlated with final VA and final CRT. There is no difference in treatment response between patients with or without baseline SRF. BRVO patients with large ICS >600 μm (13.8%) at baseline had a significantly worse VA at last visit than patients with smaller ICS (p = 0.011), and did not achieve a significant improvement under bevacizumab therapy. The duration of retinal vein occlusion before start of treatment was significantly longer in patients with ICS >600 μm (232 ± 96 weeks versus 17 ± 17 weeks; p < 0.001). There is no correlation of ICS diameter and duration of vein occlusion in patients with ICS <600 µm., Conclusions: In CRVO patients, baseline CRT and final VA are significantly correlated, whereas the presence of SRF or diameter of ICS was not predictive for treatment outcome. In BRVO patients, ICS with a diameter of >600 μm are associated with a long duration of vein occlusion and poor functional response to treatment with bevacizumab. CRT and SRF were not found to be significant prognostic factors.

Background: To evaluate the efficacy of intravitreal injections of ranibizumab in patients with diabetic clinically significant macular edema (CSME), when further focal or grid laser was considered to be unsafe., Methods: In this retrospective, interventional case study, intravitreal injections of ranibizumab were performed in 16 eyes (ten patients) suffering from diabetic retinopathy with CSME. All patients had been treated in the past with focal or grid laser. Additional photocoagulation could not be performed because the leaking points were very close to the avascular zone, and there was also a perifoveal capillary dropout. The patients underwent three injections (months 0, 1 and 2) and were followed monthly. Reinjection was performed if central retinal thickness (CRT) was ≥250 μm associated with fluorescein leakage involving the center of the macula., Results: The patients underwent a median of seven injections (range 6-9) and the median follow-up time was 11 months (range 9-15). The median best-corrected visual acuity (BCVA) was 0.85 logMAR at baseline and 0.54 logMAR at the end of the follow-up time (p = 0.018). BCVA improved in seven eyes (43.75%), remained stable in eight (50%) and decreased in one eye (6.25%). The median CRT decreased from 409.5 μm at baseline to 272 μm at the end of the follow-up time (p = 0.0002). No ocular or systemic adverse events were reported., Conclusions: For a median follow-up time of 11 months, the treatment with intravitreal injections of ranibizumab resulted in stabilization or improvement of the visual acuity in the vast majority of patients with diabetic maculopathy and CSME, when further focal or grid laser was considered to be unsafe.

Background: To evaluate the role of preoperative optical coherence tomography (OCT), multifocal electroretinography (mfERG), and fluorescein angiography (FA) as prognostic factors for vision after pars plana vitrectomy (PPV) in diabetic macular edema (DME)., Methods: Thirty-five eyes of 34 patients who underwent PPV were retrospectively reviewed. Best-corrected visual acuity (VA) was measured at baseline, and at 3, 6, and 9 months after surgery. Patients were categorized into two groups according to the final VA. Group 1 consisted of eyes with 0.2 or more logMAR lines of visual recovery, the rest of the eyes being placed in group 2. Preoperative FA findings, central macular thickness and mfERG responses at the central macula were evaluated to determine their effect on visual outcome., Results: Eighteen eyes showed improved VA after PPV, and were classified into group 1. Seventeen eyes were placed in group 2. The presence of macular ischemia did not affect the postoperative visual outcome between the groups, although a trend was noted toward macular ischemia with delayed implicit time. P1 implicit time at the central seven hexagons (eccentricity of 0-5 degrees ) was the only statistically significant factor predicting unfavorable visual outcome. There was significantly delayed implicit time in group 2 patients compared with those of group 1. MfERG responses at other retinal eccentricities and central macular thickness did not show significant association with visual prognosis., Conclusions: Preoperative mfERG parameters, especially the implicit time, can be useful indicators for predicting functional visual prognosis after PPV in DME.

Background: In patients who have macular edema secondary to retinal vein occlusion, the role of vasoactive molecules such as growth factors and the influence of molecules related to leukocyte adhesion need to be investigated further., Methods: A prospective study was performed to investigate the relations between perifoveal capillary blood flow velocity and the vitreous levels of vascular endothelial growth factor (VEGF) and soluble intercellular adhesion molecule-1 (sICAM-1) in patients with macular edema and retinal vein occlusion. Undiluted vitreous specimens were obtained from 11 eyes of 11 patients with macular edema (nine had branch retinal vein occlusion and two had central retinal vein occlusion). VEGF and sICAM-1 levels were measured by enzyme-linked immunoabsorbent assay. Before vitreous sampling, perifoveal capillary blood flow velocity was measured by fluorescein angiography with a scanning laser ophthalmoscope and the tracing method. The relations between perifoveal capillary blood flow velocity and the vitreous levels of VEGF and sICAM-1 were investigated., Results: There was a significant correlation between perifoveal capillary blood flow velocity and the vitreous level of sICAM-1 (rho = -0.7303, p = 0.03). In contrast, there was no significant association between blood flow velocity and the vitreous level of VEGF (rho = -0.1458, p = 0.67)., Conclusions: The vitreous level of sICAM-1 is associated with perifoveal capillary blood flow velocity in patients who have retinal vein occlusion and macular edema.

Purpose: To test selective retina therapy (SRT) as a treatment of clinically significant diabetic macular edema (DME)., Methods: Prospective two-center interventional uncontrolled phase II pilot study. Thirty-nine eyes of 39 patients with previously untreated non-ischemic DME were treated with focal laser treatment using a Q-switched frequency doubled Nd:YLF laser which selectively affects the retinal pigment epithelium while sparing the photoreceptor layer. Optoacoustic measurements, fundus fluorescein angiography (FFA), and funduscopy were used to determine the individual threshold of RPE damage of each patient. The pulse energy was adjusted to apply angiographically visible but funduscopically invisible effects. Optoacoustic measurements were correlated with funduscopy and FFA. Follow-up examinations at 3 and 6 months post-treatment included best-corrected ETDRS visual acuity (BCVA), FFA, fundus photography, and retinal thickness measured by optical coherence tomography. The primary outcome measure was change of BCVA. Other outcome measures were change of retinal thickness, presence of hard exudates, leakage in FFA, accuracy of optoacoustic measurements, and correlation of BCVA with change of anatomical and systemic parameters., Results: Mean BCVA improved from 43.7 letters (standard deviation, SD=9.1) at baseline to 46.1 letters (SD=10.5) at the 6-month follow-up (p=0.02). BCVA improved (>5 letters) or remained stable (+/-5 letters) in 84% of eyes. Thirteen percent of eyes improved by > or =10 letters, while 16% of eyes lost more than 5 letters. There was no severe loss of vision (> or =15 letters). Overall, retinal thickness, hard exudates, and leakage in FFA did not change significantly (p> 0.05), while improvement of BCVA correlated with a reduction of hard exudates (p=0.01) and central retinal thickness (p=0.01). Specificity and sensitivity of detecting the angiographic visible threshold of RPE damage by optoacoustic measurements were 86% and 70% respectively. No adverse effects or pain were noted during or after treatment. Conclusions Functional and anatomical improvement or stabilization was observed in most patients. SRT appears to be safe. Optoacoustic measurements accurately detect the individual threshold of RPE damage. A randomized trial is required to further test efficacy and safety of SRT as a treatment of clinically significant diabetic macular edema (DME).

Background: The changes of perifoveal capillary blood flow velocity (BFV), visual acuity, and retinal thickness after pars plana vitrectomy (PPV) have been unclear in patients with branch retinal vein occlusion (BRVO) and macular edema., Methods: In a prospective study, PPV was performed on six eyes of six consecutive BRVO patients with macular edema (two women and four men; mean age: 66.3 +/- 5.0 years). Patients were examined preoperatively and 6 months postoperatively. BFV was measured by fluorescein angiography using a scanning laser ophthalmoscope and the tracing method. Macular thickness was examined by optical coherence tomography. Visual acuity was measured preoperatively and postoperatively, and data were converted to the logarithm of the minimum angle of resolution (logMAR)., Results: In all six treated eyes, the macular thickness decreased significantly compared with before PPV (464 +/- 98 microm versus 224 +/- 55 microm, P = 0.0082), mean BFV increased significantly compared with before PPV (1.14 +/- 0.14 mm/sec versus 1.46 +/- 0.21 mm/sec, P = 0.0013), and mean logMAR decreased significantly compared with before PPV (0.57 +/- 0.34 versus 0.17 +/- 0.21, P = 0.0036)., Conclusions: PPV may improve perifoveal microcirculation and the visual prognosis in BRVO patients with macular edema.

Background: Cystoid macular edema (CME) is a common vision-limiting complication of uveitis. This study correlated fundus autofluorescence (FAF) and optical coherence tomography (OCT) with visual acuity (VA)., Patients and Methods: Prospective, observational, cross-sectional study with 31 patients (53 eyes) with endogenous uveitis and fluorescein angiographically (FA) confirmed CME. Foveal thickness, epiretinal membrane formation, and altered (increased or decreased) foveal FAF were analyzed with a combined spectral domain OCT/FA device (Spectralis/HRA Heidelberg Retina Angiograph 2). Primary outcome measures were an association between central FAF with foveal thickness and VA (t-test, each). Secondary outcome measures included the association of FAF and epiretinal membrane formation, the presence of cystoid spaces in the outer plexiform and inner nuclear layers, and integrity of the third highly reflective band as detected by OCT (Fisher s exact test, each)., Results: Of the 24 eyes (59%) with altered FAF in the central 500 microm, all had increased foveal FAF, and 10% also had increased perifoveal petaloid FAF. In eyes with altered FAF, the VA was frequently worse (p = 0.019) and foveal thickness increased (p = 0.015). Foveal thickness (mean 369.4 mum) correlated with VA (p < 0.01). FAF alterations correlated with the presence of cystoid spaces in the outer plexiform and inner nuclear layer in OCT (p < 0.001). Epiretinal membrane formation (70%) was associated with increased foveal thickness (p = 0.003) and poor VA (p = 0.08). Irregularity or loss of the third HRB (51%) correlated with poor VA (p < 0.01) and altered central FAF (p = 0.031)., Conclusions: FAF and OCT are useful diagnostic tools for the evaluation of uveitic CME. Increased central FAF, presence of cystoid retinal changes and disrupted third highly reflective band in OCT, and epiretinal membrane formation are associated with poor vision.

Background: To evaluate the long-term outcome of an OCT-guided reinjection scheme for bevacizumab treatment of macular edema (ME) due to retinal vein occlusion., Methods: Patients with persistent ME (>250 microm) due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) received intravitreal bevacizumab 2.5 mg/0.1 ml. Visual acuity (ETDRS), ophthalmic examination and OCT were performed at baseline and at 6- to 8-week intervals. Reinjections were only performed if OCT showed persistent or recurrent ME., Results: Sixty-one patients with a minimum follow-up of 25 weeks were included in this analysis. Mean follow-up was 60 +/- 29 wks. In CRVO patients, central retinal thickness (CRT) decreased from 748 +/- 265 microm to 372 +/- 224 microm (p < 0.001) and visual acuity (VA) improved by 1.9 +/- 3.2 lines. In BRVO patients, mean CRT decreased from 601 +/- 206 microm to 386 +/- 178 microm (p < 0.001) and VA improved by 1.8 +/- 2.6 lines. Thirty-three percent of CRVO and 15% of BRVO patients did not show a ME recurrence for > or =25 wks at last visit. Thirty-seven percent of CRVO and 50% of BRVO patients suffered recurrences of ME within the last 25 wks, whereas 30% of CRVO and 35% of BRVO patients did not achieve a complete resolution of ME at any follow-up visit after receiving a minimum of three injections. CRVO patients with dry interval of > or =25 weeks at last visit were significantly younger, had a thinner CRT at baseline and more often had a complete resolution of ME after the first injection. In CRVO and BRVO, final VA was correlated significantly with initial VA, patients' age and final CRT. Change of VA was correlated with change of CRT in BRVO., Conclusions: Patients with retinal vein occlusion benefit from treatment with bevacizumab. Favourable long-term results without necessity of further injections were achieved in 33% and 15% of CRVO and BRVO patients respectively. The remaining patients needed repeated injections to treat ME recurrences. However, one third of the CRVO/BRVO patients did not improve in VA, and further injections might be discontinued in these patients.

Background/purpose: To evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis) on visual acuity (VA) and central foveal thickness (CFT) for central retinal vein occlusion (CRVO)-induced macular edema., Methods: Our study was a prospective interventional case series. Twelve eyes of 12 consecutive patients diagnosed with CRVO-related macular edema (nine perfused, three ischemic CRVO) treated with repeated (when CFT was >220 microm) intravitreal injections of ranibizumab as a monotherapy within 3 months of onset were evaluated. Optical coherence tomography (OCT) and fluorescein angiography (FA) were performed monthly and every 3 months respectively. Changes in VA (ETDRS) and CFT were analyzed using the student's paired t-test., Results: The mean time from diagnosis until injection was 80 days (2.7 months; range, 63-90 days) and the follow-up time was 12 months. In total, 89 injections were performed (mean 7.4). The mean CFT improved from 480 +/- 166 microm at baseline to 230 +/- 33 microm (P < 0.001) at the end of the follow-up. During the same period, of the 12 eyes, eight demonstrated improved VA (>0.3 LogMAR change, >15 letters), three stable VA and one worse VA as compared to baseline. None of the nine patients with perfused CRVO were converted to ischemic at 12 months, and one of the three eyes with ischemic CRVO developed iris neovascularization despite two ranibizumab injections. No ocular or systemic side-effects were noted., Conclusion: Individualized repeated intravitreal injections of ranibizumab have shown promising results in VA improvement and decrease in CFT in patients with macular edema associated with CRVO. Further studies are needed in order to elucidate the role of intravitreal lucentis in the ischemic form of CRVO, and its efficacy in preventing conversion from the perfused to the ischemic form of the disease.

Unlabelled: We retrospectively investigated the relationship between the appearance of IS/OS line on OCT images and visual acuity after resolution of DME by vitrectomy. Postoperative visual acuity of eyes with complete IS/OS after resolution of DME was significantly better than that without complete IS/OS, though macular edema was completely resolved in both groups., Purpose: To evaluate the correlation between photoreceptor layer status following resolution of diabetic macular edema (DME) by pars plana vitrectomy (PPV) and final visual acuity (VA)., Methods: We retrospectively studied a series of 69 eyes from 58 patients with DME who were treated with PPV. Of the 69 eyes, 37 that were examined by optical coherence tomography (OCT) for at least 6 months and that showed a final macular thickness of less than 250 microm were included in this study. We assessed the integrity of the photoreceptor inner and outer segments (IS/OS) line in the fovea, using OCT in relation to their VA and other characteristics., Results: There were no differences in initial VA or in foveal thickness between eyes with or without complete IS/OS at final observation. However, final VA without complete IS/OS was significantly poorer (P = 0.004). VA had improved by more than 2 lines in eight of ten eyes with complete IS/OS and in ten of 27 eyes without complete IS/OS; the groups differed significantly with regard to this percentage (P = 0.03)., Conclusions: The postoperative photoreceptor status of the fovea is closely related to the final VA after resolution of DME by PPV.