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OBJECTIVE: To evaluate the influence of posterior subtenon injection of 40 mg of triamcinolone acetonide (TA) on blood glucose, cortisol and adrenocorticotrophic hormone (ACTH) in patients with clinically significant diabetic macular oedema. PATIENTS AND METHODS: This prospective clinical study included 33 type 2 diabetic patients assigned to receive subtenon injection of 40 mg of TA (study group: 20 patients, 9 women and 11 men, mean age 60.8 ± 10.1 years) or subtenon injection of 1 ml of saline solution (control group: 13 patients, 7 women and 6 men, mean age 57.9 ± 7.5 years) as an adjunct to focal/grid laser therapy. Pre-injection laboratory tests consisted of fasting blood glucose (FBG), glicolised hemoglobin (HbA1c), fructosamine, ACTH and cortisol. Post-injection measurements were performed in a following schedule: FBG in day 1; FBG, ACTH and cortisol at week 1; FBG, fructosamine, ACTH and cortisol at month 1, 2 and 3. HbA1c was also measured at 3 months. The mean ± SD values of groups at each visit were compared. The time-related changes in the parameters in each group were also analyzed using SPSS (Statistical Package for Social Sciences) for Windows 15.0 software. RESULTS: Pre-injection FBG, HbA1c, fructosamine, ACTH and cortisol were similar in both groups (p > 0.05 for all). Pre-injection and final HbA1c values were similar in the study (8.6% ±1.9 and 8.7% ± 1.8, respectively) and control groups (8.6% ±1.7 and 8.5% ± 1.8, respectively) (p > 0.05 for all). None of the patients had a decrease in plasma cortisol that decreased below normal values at either time point. There was no statistically significant difference between groups and between each visit in groups according to FBG levels, blood fructosamine, ACTH and cortisol levels (p > 0.05 for all). No adverse event was observed. CONCLUSIONS: Subtenon injection of 40 mg of TA does not increase blood sugar levels significantly, and it does not suppress blood cortisol or ACTH levels at 1 week or later in patients with diabetes mellitus. Subtenon injection of 40 mg TA seems to be safe in respect to elevation of blood sugar levels or systemic corticosteroid pathways. [ABSTRACT FROM AUTHOR]

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ObjectiveTo analyse the long-term results of surgical removal of plaque-like diabetic foveal hard exudates.MethodsIn this retrospective, interventional, non-randomized, controlled study, vitrectomy and excision of submacular hard exudates was performed on 11 eyes of 11 patients with plaque-like hard exudates. The mean preoperative LogMAR best corrected visual acuity (BCVA) and exudate diameter were 1.35±0.3 and 1.19 disks (range, 0.5–1.8), respectively. In the control group, which consisted of 10 eyes of 7 patients who refused the surgery, baseline mean BCVA and exudate diameter were 1.06±0.2 and 1.2 disks (range, 0.7–2.0), respectively. Main outcome measures included BCVA, fundus photography, and surgical complications.ResultsThe mean follow-up was 39.1±3.2 months for the study group and 32.5±3.6 months for the control group. In the study group, BCVA improved in 8 (73%) eyes at the final examination. The mean final BCVA was 1.08±0.4 (P=0.021). Macular oedema and exudates resolved completely in all eyes. In the control group, final LogMAR visual acuity declined to 1.53±0.1 (P=0.005). Macular pigment epithelium atrophy or scar formation was observed in 7 (64%) eyes in the study group and in all eyes in the control group.ConclusionSurgical excision of plaque-like foveal hard exudates resulted in better anatomical and functional outcome when compared to observation alone.Eye (2008) 22, 1099–1104; doi:10.1038/sj.eye.6702877; published online 20 July 2007 [ABSTRACT FROM AUTHOR]

PurposeTo report the effects of arteriovenous adventitial sheathotomy on anatomical and functional improvements in patients with macular oedema due to branch retinal vein occlusion (BRVO).MethodsPars plana vitrectomy and arteriovenous sheathotomy was performed on 11 patients with BRVO who had vision loss due to macular oedema. Ten patients with macular oedema due to BRVO and who have been treated with grid laser photocoagulation were included in the control group. The measurement of visual acuity with ETDRS chart was taken preoperatively and at 1, 3, 6, and 9 months follow-up in the study group and at 1, 3, 6, and 9 months after grid laser in the control group.ResultsThe mean preoperative logMAR visual acuity was 0.84±0.3 in the surgical group and 1.06±0.4 in the control group. The postoperative mean logMAR visual acuity was 0.41±0.2, 0.40±0.2, 0.40±0.3, and 0.36±0.3 at 1, 3, 6, and 9 months follow-up, respectively. In the control group the postlaser mean logMAR visual acuity was 0.92±0.3, 0.87±0.4, 0.85±0.3, and 0.82±0.3 at 1, 3, 6, and 9 months follow-up, respectively. The improvements of visual acuity in both groups were statistically significant when compared to pretreatment (P=0.003 and P=0.007 at 9 months in the study and control group, respectively).ConclusionArteriovenous sheathotomy for decompression of BRVO in patients who have vision loss due to macular oedema was safe and effective for anatomical and functional improvement and resulted in significantly better visual outcomes than a matched control group of laser-treated eyes.Eye (2008) 22, 120–127; doi:10.1038/sj.eye.6702633; published online 27 October 2006 [ABSTRACT FROM AUTHOR]

Objective: To evaluate orodental, facial, clinical and molecular characteristics of the patients with Noonan Syndrome (NS)., Study Design: The orodental, clinical and molecular characteristics of 29 mutation-positive patients with NS were recorded. Orodental examination was performed in 17 patients. All exons and exonintron boundries of PTPN11 and SOS1 genes were analyzed by Sanger sequencing., Results: A total of 29 patients with NS from 27 unrelated families were included in the study. Seventeen patients were examined by a specialist in oral medicine. The most common orodental findings were high-arched palate (n=13), gingivitis (n=6) and severe caries (n=6). Anterior open bite, posterior cross bite, Class II malocclusion, hypodontia, prognathism (maxillary or mandibular), macroglossia and gingival hyperplasia were also detected. Thirteen different mutations were observed in PTPN11 gene and exon 3 was the hotspot region. Hypodontia was detected in two patients who had the same mutation in PTPN11 gene, c.181G>A, p.D61N., Conclusion: This study indicated a high prevalance of orodental problems including high-arched palate, severe dental caries and gingivitis in patients with mutation-positive NS. The mutation in PTPN11 gene, c.181G>A, p.D61N, may be associated with hypodontia in patients with NS.

Purpose: Investigation of the efficacy of intravitreal dexamethasone implants (0.7 mg) in patients with Behçet disease (BD) who had cystoid macular edema (CME) despite immunomodulatory treatment., Materials and Methods: Twenty-seven eyes of 20 patients who had intravitreal dexameth-asone implant injections and follow-up for more than 6 months were included in this study. Best corrected visual acuities (BCVA), intraocular pressures (IOP), and central macular thicknesses (CMT) were recorded. Systemic immunomodulatory treatment was noted. Injection-related complications and the need for recurrent injections were recorded., Results: Statistically significant anatomical and functional success was achieved with a single injection. BCVA increased from 0.85 ± 0.72 to 0.45 ± 0.52 logMAR, while the mean CMT decreased from 406 ± 190 to 243 ± 101 µm at the sixth month. The peak of visual acuity gain was reached within the first 2 months and a substantial proportion of the patients gained 3 or more lines. There was no complication other than transient IOP elevation in 4 eyes and cataract surgery in 2 eyes., Conclusion: Adjuvant intravitreal dexamethasone implant injections offer promising results in cases of BD with CME. It is effective in preserving the macular anatomy and vision particularly in transition to biological agents., (© 2018 S. Karger AG, Basel.)

Purpose: The evaluation of long-term results of vitreoretinal surgery and retinal capillary hemangioblastoma (RCH) resection in patients with complicated retinal detachment (RD) secondary to RCHs., Methods: Twelve eyes of 12 patients were operated on with vitreoretinal surgery, including occlusion of afferent and efferent feeder vessels with endodiathermy and endolaser photocoagulation, and subsequent resection of RCHs. The long-term anatomical and visual outcomes were retrospectively evaluated., Results: Total exudative RD was detected in six eyes and subtotal exudative RD was found in the remaining six eyes. A tractional component was present in eight eyes, and four eyes had pure exudative RD. Laser treatment had been previously applied to four eyes but vitreoretinal surgery was the primary treatment in eight eyes. A total of 19 RCHs were resected. The quadrant location of RCHs was superior temporal in six, superior nasal in five, inferior nasal in five, and inferior temporal in three. The dimensions of the RCHs ranged between 1 and 4 disk diameters (DD) (1-DD in 1 eye, 1.5-DD in 3, 2-DD in 10, 2.5-DD in 3, 3-DD in 1, and 4-DD in 1). Preoperative mean logarithm of the minimum angle of resolution visual acuity was 1.9 ± 1.0 (3.0-0.7) (20/1,588 ± 20/200 [20/20,000-20/100]). Silicone oil and C3F8 was applied to four and eight eyes, respectively. The median postoperative follow-up was 30.5 (18-48) months. Single operation and final anatomical success was obtained in 9 and 11 eyes, respectively. Mean logarithm of the minimum angle of resolution visual acuity in the postoperative 18th month and at the final visit were 1.05 ± 0.8 (3.0-0.2) (20/224 ± 20/125 [20/20,000-20/32]) and 0.96 ± 0.8 (3.0-0.2) (20/182 ± 20/125 [20/20,000-20/32]), respectively. New RCHs occurred in eight eyes. Rubeosis iridis was not present in any of the eyes., Conclusion: Promising anatomical and visual outcomes were obtained after vitreoretinal surgery and resection of RCHs in eyes with complicated RD secondary to RCH. However, life-long follow-up is needed to recognize recurrent RD seen even in the early period or recurrences of RCHs seen in the long-term period.

Objective: To investigate whether the Tei index, which is an indicator of global myocardial function and an independent predictor of cardiac death, is increased in patients with branch retinal vein occlusion (BRVO)., Methods: The Tei index was used to evaluate myocardial performance, in addition to conventional echocardiographic evaluation of myocardial structural and functional changes, in patients with BRVO, patients with hypertension and healthy controls., Results: Out of 36 patients with BRVO (18 female, 18 male; 17 hypertensive, 19 normotensive), 29 patients with hypertension (15 female, 14 male) and 28 healthy controls (15 female, 13 male), there were no significant between-group differences in age and sex. The mitral A wave was higher and mitral E/A ratio, mitral E wave and ejection time were lower, in patients with BRVO than in healthy controls. Mean Tei index was significantly higher in the BRVO group than in patients with hypertension or healthy controls. Compared with healthy controls, the Tei index was significantly higher in hypertensive and normotensive patients with BRVO., Conclusion: Myocardial performance is decreased in patients with BRVO, independent of whether or not they have hypertension., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Purpose: To investigate whether there is an association between known age-related macular degeneration genetic risk variants in the CFH, ARMS2, and HTRA1 genes and response to anti-vascular endothelial growth factor (VEGF) (ranibizumab or bevacizumab) treatment for wet age-related macular degeneration., Methods: A retrospective review of 150 patients with documented wet age-related macular degeneration based on clinical examination and fluorescein angiogram was performed. Patients received anti-VEGF therapy with ranibizumab and/or bevacizumab. Patients were genotyped for the single-nucleotide polymorphism rs1061170, rs10490924, rs3750848, rs3793917, rs11200638, and rs932275 and for the indel del443ins54 spanning the CFH, ARMS2, and HTRA1 genes., Results: There were 57 patients who were characterized as negative responders to anti-VEGF therapy, and 93 patients who were characterized as positive responders. There was no significant difference in mean baseline visual acuity between the groups. Negative responders were followed for a mean duration of 24.0 months, while positive responders were followed for a mean duration of 22.0 months. Although the frequency of the at-risk alleles was higher in the positive responders when compared with the negative responder, this did not reach statistical significance. Additionally, there was no significant association between genotype and the number of injections or absolute change in visual acuity in both groups of responders., Conclusion: In our patient cohort, there was no statistically significant association between response to anti-VEGF therapy and the genotype in both positive-responder and negative-responder groups. Larger studies with more power are necessary to further determine whether a pharmacogenetic association exists between wet age-related macular degeneration and anti-VEGF therapy.

Purpose: To compare the efficacy of intravitreal and sub-Tenon (ST) posterior triamcinolone injection in the treatment of bilateral diabetic diffuse macular edema (DDME)., Methods: 28 eyes of 14 diabetic patients with bilateral DDME were included in this prospective randomized study. One eye of each individual received a sub-Tenon (ST) posterior triamcinolone injection (ST group), whereas the fellow eye received an intravitreal triamcinolone injection (IV group). All eyes were treated with supplementary focal laser after the injections. Cases were evaluated 1, 2, 3 and 6 months after the initial treatment., Results: Both groups had visual improvement and macular edema reduction following the injections. This temporary effect was prominent for 24 weeks in the IV group and for 8 weeks in the ST group. Edema resorption and visual improvement were more pronounced in the IV group, although this difference was not statistically significant. No major complications were observed except for moderate and reversible intraocular pressure elevation in some cases., Conclusion: Both intravitreal and ST injections of triamcinolone appear to yield a significant visual recovery and prompt resolution of DDME. The beneficial outcome appears to be more longstanding with intravitreal injection., (Copyright © 2011 S. Karger AG, Basel.)

We executed a genome-wide association scan for age-related macular degeneration (AMD) in 2,157 cases and 1,150 controls. Our results validate AMD susceptibility loci near CFH (P < 10(-75)), ARMS2 (P < 10(-59)), C2/CFB (P < 10(-20)), C3 (P < 10(-9)), and CFI (P < 10(-6)). We compared our top findings with the Tufts/Massachusetts General Hospital genome-wide association study of advanced AMD (821 cases, 1,709 controls) and genotyped 30 promising markers in additional individuals (up to 7,749 cases and 4,625 controls). With these data, we identified a susceptibility locus near TIMP3 (overall P = 1.1 x 10(-11)), a metalloproteinase involved in degradation of the extracellular matrix and previously implicated in early-onset maculopathy. In addition, our data revealed strong association signals with alleles at two loci (LIPC, P = 1.3 x 10(-7); CETP, P = 7.4 x 10(-7)) that were previously associated with high-density lipoprotein cholesterol (HDL-c) levels in blood. Consistent with the hypothesis that HDL metabolism is associated with AMD pathogenesis, we also observed association with AMD of HDL-c-associated alleles near LPL (P = 3.0 x 10(-3)) and ABCA1 (P = 5.6 x 10(-4)). Multilocus analysis including all susceptibility loci showed that 329 of 331 individuals (99%) with the highest-risk genotypes were cases, and 85% of these had advanced AMD. Our studies extend the catalog of AMD associated loci, help identify individuals at high risk of disease, and provide clues about underlying cellular pathways that should eventually lead to new therapies.

Purpose. To determine the relationship of six genetic variants (rs10490924, rs3750848, del443ins54, rs3793917, rs11200638, and rs932275) localized to the ARMS2-HTRA1 region of chromosome 10, region q26, as risk factors for age-related macular degeneration (AMD), to define the haplotype structure of these six loci, and to confirm their genetic association with the disease. Methods. Caucasian patients (n = 482) were stratified into categories based on AREDS (Age-Related Eye Disease Study) grading criteria (groups 0 and 1 served as the control, groups 3 and 4 contained subjects with AMD, and group 2 was excluded from the analysis). The six genetic variants in the ARMS2-HTRA1 region were genotyped and analyzed both independently and as a joint haplotype for association in subjects with disease (n = 291) compared with the control (n = 191). Results. The six high-risk alleles all showed a statistically significant association with AMD (the most significant SNP was rs10490924 [P < or = 3.31 x 10(-5), OR = 1.86]; the least significant SNP was rs932275 [P < or = 9.15 x 10(-5), OR = 1.78]). Multimarker analysis revealed that all six markers were in strong linkage disequilibrium with each other, and the two major haplotypes that captured >98% of the genetic variation in the region were both significantly associated with the disease: One increased the risk of AMD and contained only risk alleles (P < or = 2.20 x 10(-5)), and the other haplotype decreased the risk of AMD and contained only wild-type alleles (P < or = 6.81 x 10(-5)). Furthermore, 36 individuals comprising both cases and controls were identified outside of these two major haplotypes, with at least one discordant marker. Conclusions. The results replicate the previously reported association between the high-risk alleles and AMD and independently confirm, for the first time, an association with AMD and the indel (del443ins54) polymorphism in a Caucasian population. Two major haplotypes that are associated with AMD and many minor novel haplotypes were identified. The novel haplotypes, identified from 36 cases and controls with discordant alleles spanning the ARMS2-HTRA1 region provide unique opportunities to gauge the relative phenotypic contributions of each of these genetic risk factors. With the identification of more discordant patients in the future, it may be possible to resolve the ongoing controversy as to which of the risk alleles and genes (ARMS2 vs. HTRA1) has the greatest impact on disease susceptibility. Future work should include the analysis of larger and more diverse populations, to further define the linkage structure of the region with a focus on phenotypic effects on AMD of the various haplotypes involving 10q26, as well as a functional analysis of the normal ARMS2 protein.

Background: Aortic distensibility (AD) and pulse wave velocity (PWV) reflect arterial stiffness, which is linked to increased cardiovascular morbidity and mortality in different diseases such as atherosclerosis, hypertension, and diabetes mellitus, all of which are also common risk factors in patients with branch retinal vein occlusion (BRVO). In the present study, we aimed to determine whether arterial stiffness in different segments of the arterial tree is increased in patients with BRVO., Methods: The study group consisted of 35 patients with BRVO (20 female, 15 male, mean age: 55.9+/-6.8) and the age-matched control groups consisted of 19 patients with hypertension (9 female, 10 male, mean age: 55.2+/7.6) and 17 healthy subjects (9 female, 8 male, mean age: 53.4+/-9.6). Radial artery PWV was measured using a Pulse Wave Sensor HDI system, which measures non-invasively the radial pulse-wave recording with computer analysis of the diastolic decay, and provides separate assessment of the large arterial elasticity index (LAEI) and small artery elasticity index (SAEI). Aortic strain and AD was determined echocardiographically based on the relationship between changes in aortic diameter and pressure with each cardiac pulse. Patients with diabetes mellitus or inflammatory BRVO, and control patients with any occlusive vascular eye disease, were excluded. The results of the three groups were compared., Results: Compared to the subjects of the healthy control group, those with BRVO had lower LAEI (p<0.05). Both AD and aortic strain were significantly lower in the BRVO group than in both control groups (p<0.05 for both) and in the hypertensive control group than the healthy controls (p<0.05). The AD, LAEI and SAEI were positively correlated (p=0.021, r=0.307 and p=0.041, r=0.269 respectively)., Conclusions: The results of this study show that the arterial stiffness indices (large arterial elasticity index and aortic distensibility) are abnormal in patients with BRVO compared to the healthy and hypertensive controls. Arterial stiffness may play a role in the onset or progression of BRVO. Further studies are needed to determine the exact role of AS in the pathogenesis of BRVO, and to reveal its value in predicting systemic morbidity and mortality in patients with BRVO.

Purpose: To evaluate quantitatively the apoptotic activity after intravitreal injections of pegaptanib sodium and bevacizumab in the rabbit retina., Methods: Different doses of bevacizumab (0.25, 0.625, 1.25, and 2.5 mg) and pegaptanib sodium (0.15, 0.3, and 0.6 mg) were injected intravitreally in 48 rabbits. The eyes were enucleated at different times for early studies at day 14 and for late studies at 3 months after a single injection or at 3 months, with 1 injection in each of the 3 months (day 90). The time course and dose-response of photoreceptor cells in the rabbit retina after intravitreal injection of bevacizumab or pegaptanib sodium were examined by histologic analysis with hematoxylin and eosin (H&E) staining, caspase-3 and -9 immunostaining, and in situ terminal-deoxynucleotidyl transferase-mediated biotin-deoxyuridine triphosphate nick-end labeling (TUNEL) of DNA fragments of paraffin-embedded sections., Results: No sign of retinal toxicity was seen in H&E stained histologic sections of eyes that had received bevacizumab or pegaptanib sodium. Nuclear DNA fragmentation in the outer retinal layers shown by the TUNEL method was evident in the high-dose groups (55.3% with 1.25 mg and 64.5% with 2.5 mg bevacizumab, and 48.5% with 0.6 mg pegaptanib sodium) at 14 days and also in the clinical dose groups (49.8% with three injections [1 each month] of 0.625 mg bevacizumab and 44.3% with 0.15 mg pegaptanib sodium) at 90 days. The ratios of TUNEL-positive cells in physiologic saline and the sham-control groups were 32.3% and 21%, respectively., Conclusions: Intravitreal injection of bevacizumab and pegaptanib sodium caused a significant increase in apoptotic activity in rabbit photoreceptor cells. However, although bevacizumab caused increasing apoptotic activity at higher doses, similar dose-dependent adverse effects were not evident for pegaptanib sodium.

Background: Serpiginous choroidopathy (SC) is a chronic, inflammatory disease which progresses with recurrences leading to visual loss. Diverse immunosuppressive regimens have been used for treatment. In case of an unanticipated side effect with immunosuppressive agents, alternative modalities in SC are limited., Methods: A 38-year-old woman presented with slight deterioration in visual acuity in her right eye. She had had a visually devastating episode of SC in the left eye 8 months previously. She received combination therapy of prednisone, cyclosporine, and intravitreal triamcinolone for the left eye. With that treatment, vision in her left eye declined to light perception due to macular involvement and renal functions were impaired. Eight months later, she was hospitalized with the diagnosis of SC in the right eye. In the quest for an alternative modality, a combination of antituberculosis medications was given initially, because of the high PPD reading. Despite 10 days of treatment, the lesion persistently progressed. Subsequently, interferon (INF) α-2a therapy was initiated solely as daily injections of 1 million unit (MIU) subconjunctivally. The frequency of injections was tapered within the course. Currently, injections are still being dispensed once a month., Results: Throughout the 12 months of follow-up, the patient had no major side effects due to INF α-2a therapy. At present, SC in the right eye is inactive and the macula is safe in terms of incurring. The vision is 20/20 in the right eye, whereas it is light perception in the left eye., Conclusion: Interferon α-2a administration in SC can be an efficient modality and is free of immunosuppression related side effects. Subconjunctival application seems to be a promising and safe tool for treatment.

Background: The visual outcome in untreated nonarteritic anterior ischemic optic neuropathy (NAION) is dismal. Because intravitreal triamcinolone (IVTA) has shown promise in improving edematous retinal disorders, a pilot trial of this therapy in NAION was considered reasonable., Methods: Four eyes of 4 patients with severe visual loss due to NAION were treated with 4 mg IVTA (study group). The control group consisted of 6 consecutive patients with NAION who received no treatment. Patients were evaluated by the visual acuity and visual field measurements of the Early Treatment Diabetic Retinopathy Study (ETDRS) and fluorescein angiography., Results: All patients completed at least 9 months of follow-up. In the study group, the mean improvement in visual acuity were 4, 5.8, and 6.2 ETDRS lines at the first and third weeks and final visit, respectively. Optic disc swelling and leakage had markedly decreased at the first postinjection week and had disappeared by the third week examination in all eyes. In the control group, the mean improvements in visual acuity were 0, 0.7, and 1.3 ETDRS lines at the first and third weeks and final visit, respectively. Control eyes showed resolution of the optic disc swelling between the fourth week and third month visits. No marked change in visual field defects was observed in either group., Conclusions: IVTA provided relatively improved recovery of visual acuity and relatively rapid resolution of optic disc swelling in a small sample of patients with acute NAION. It did not provide visual field improvement. A larger trial is merited by the results of this small pilot study.

Susac's syndrome is a vasospastic disease resulting from bilateral microangiopathy of the brain, cochlea and retina. It is characterized by encephalopathy, bilateral sensorineural fluctuating hearing loss and visual loss. It is very uncommon and usually affects women during young adulthood. Since all three symptoms of the triad may not be present, the clinical diagnosis is difficult. Therefore, neuroimaging, particularly magnetic resonance imaging, has an important role in establishing the diagnosis. In this case report, we present a young woman who had all the symptoms of Susac's syndrome. This is the first Susac's syndrome case reported in Turkey.

Purpose: To determine the efficacy and safety of intravitreal triamcinolone in chronic diffuse diabetic macular oedema., Methods: This prospective, interventional consecutive case series study consisted of 59 eyes (36 patients) with chronic diffuse diabetic macular oedema, which received an intravitreal injection of 4 mg triamcinolone acetonide. The results were evaluated by clinical examination and fluorescein angiography. Potential complications such as a rise in intraocular pressure, cataract progression and endophthalmitis were recorded., Results: All patients completed at least 6 months follow up. The mean visual acuity improved significantly from 0.17 +/- 3.4 to a maximum of 0.30 +/- 3.3 at the third postinjection month (P < 0.01). Mean improvements in visual acuity measured were 2.15 +/- 1.66, 2.42 +/- 2.66, 1.13 +/- 2.74, 0.96 +/- 2.01 and 0.08 +/- 2.34 lines at the 1, 3, 6, 9 and 12 months follow-up intervals, respectively. In all eyes in fluorescein angiography, macular oedema was resolved (63%) or decreased (37%) during the follow up. However, the macular oedema reached the pretreatment level in 29 (49%) of the eyes at 6 months and 15 of 21 eyes (71%) at 9 months after injection. Intraocular pressure exceeded 21 mmHg in 10 eyes, which were controlled by topical medication. Four eyes showed cataract progression. Endophthalmitis was not observed in any of the eyes., Conclusions: Intravitreal injection of 4 mg triamcinolone acetonide appears to be an effective and relatively safe therapeutic method for diffuse diabetic macular oedema. Further studies are warranted to assess the long-term efficacy, safety and the need for reinjection.

Background: The purpose of the study was to determine the efficacy and safety of intravitreal triamcinolone acetonide (TA) in chronic diabetic macular oedema with severe hard exudates., Methods: This prospective, interventional consecutive case series study consisted of 33 eyes of 28 patients with chronic diabetic macular oedema and severe foveal hard exudates who received an intravitreal injection of 4 mg of TA. The patients were divided into two groups according to the type of foveal hard exudates: group I, plaque-like (17 eyes) and group II, dot-like scattered hard exudates (16 eyes). The results of both groups, evaluated by colour fundus photography and fluorescein angiography, were compared and complications were recorded., Results: All patients completed at least 6 months of follow-up. In all eyes, the hard exudates were completely resolved (24% in group I and 50% in group II) or decreased (76% in group I and 50% in group II). In group I, the mean diameter of the exudates plaques significantly decreased from 5.5+/-3.8 mm(2) in the pre-treatment period to 2.2+/-2.7 mm(2) at the end of the follow-up period. There was no recurrence of the hard exudates in either of the groups. The mean +/- SD visual acuity (VA) improved from 0.07+/-2.5 at the baseline to a maximum of 0.09+/-2.1 lines in group I (P<0.01) and from 0.13+/-3.9 to a maximum of 0.27+/-2.7 lines in group II (P<0.01). The mean VA improvement in group II was better than group I (3.2+/-2.5 vs. 1.4+/-1.0 lines, P<0.05). Intraocular pressure exceeded 21 mmHg in 10 eyes (30%), which was then controlled by topical medication. Three eyes (9%) exhibited signs of subcapsular cataract progression., Conclusions: Intravitreal TA appears to be a valuable treatment in chronic diabetic macular oedema with severe foveal hard exudates. In all eyes in this study the hard exudates were completely resolved or decreased, and the mean VA improved significantly in both groups. However, the VA improvement was significantly worse in eyes with plaque-like exudates suggesting the possible value of earlier treatment. Further studies would enable the assessment of the universal effectiveness of this treatment.

Purpose: To investigate if triamcinolone acetonide (TA) can be an adjunct to laser treatment in patients with concomitant non-high-risk proliferative diabetic retinopathy (PDR) and diffuse clinically significant diabetic macular oedema (CSMO)., Methods: This prospective, interventional and comparative clinical study included 32 eyes of 16 patients with bilateral concomitant non-high-risk PDR and diffuse CSMO. Each patient received 4 mg intravitreal TA for the eye with worse visual acuity (study group) and macular focal and grid laser photocoagulation (MP) for the other eye (control group). One month later, each patient received four sessions of panretinal photocoagulation for both eyes plus MP for the eyes in the study group. The visual and angiographic results of both groups were compared., Results: In the study group, the mean visual acuity (VA) improved from 0.12 +/- 2.3 lines at the baseline to 0.19 +/- 3.1 (P = 0.004), 0.20 +/- 3.2 (P = 0.004), 0.19 +/- 3.6 (P = 0.009) and 0.19 +/- 3.3 lines (P = 0.091) at the 1-, 3-, 6- and 9-month follow-up intervals, respectively. The macular oedema was found to be resolved in 11 eyes (69%) and decreased in five eyes (31%). In the control group, the mean VA deteriorated progressively from 0.41 +/- 3.1 lines at the baseline to 0.20 +/- 3.1 lines (P = 0.026) at the end of the study and the macular oedema decreased only in three eyes (19%) at the sixth follow-up month., Conclusions: During the follow-up period of the study, intravitreal TA as an adjunct in the treatment of concomitant non-high-risk PDR and diffuse CSMO led to a more-favourable clinical outcome than conventional laser treatment.

Purpose: In this study we evaluated the efficiency of diluted triamcinolone particles in peeling of the internal limiting membrane (ILM) in cases of diffuse diabetic macular oedema., Methods: A prospective observational study of thirteen consecutive patients with diffuse diabetic macular oedema who had undergone ILM peeling aided by use of a diluted (1 mg mL(-1)) suspension of triamcinolone particles (0.05 mg). The results were assessed by measurement of visual acuity and intraocular pressure, by ophthalmoscopy, and by fluorescein angiography., Results: ILM peeling in all eyes could be performed easily and completely with the aid of triamcinolone particles homogeneously dispersed over the macular ILM. During the peeling procedure, triamcinolone particles resulted in clear contrast between the peeled and unpeeled ILM thus enabling us to easily find the edge of the ILM and to be able to continue peeling at further attempts. In twelve of the thirteen eyes the macular oedema was completely resolved or reduced. Visual acuity improved by at least two lines in nine eyes (70%). The intraocular pressure increase did not exceed 21 mmHg in any of the patients., Conclusions: The diluted triamcinolone suspension enables good visualisation of the ILM during the ILM peeling procedure in cases of diffuse diabetic macular oedema. Use of a diluted suspension may reduce the risk of intraocular pressure increase and the potential toxicity of triamcinolone.

Background and Objective: To determine whether deep-topical anesthesia is suitable for small-incision manual extracapsular cataract extraction (ECCE)., Patients and Methods: Three hundred twenty-six eyes of 253 patients had small-incision manual ECCE under topical anesthesia with a 4% lidocaine-soaked sponge. The severity of the pain, eye movements, blepharospasm, and intraoperative complications were recorded. Patient and surgeon satisfaction levels were assessed., Results: Operations on 323 eyes (99%) were completed with topical anesthesia. Intraoperatively, topical anesthesia was converted to peribulbar anesthesia in 3 eyes (0.9%) because of excessive eye movements. The cauterization of the scleral vessels and conjunctiva and the subconjunctival injection were the stages causing severe pain. The most frequent intraoperative complication was posterior capsule rupture in 6 eyes (1.8%). The satisfaction level was 95% for the patients and 90% for the surgeon., Conclusion: Deep-topical, nerve-block anesthesia provides anesthesia with sufficient quality for small-incision manual ECCE.

Background: To evaluate the results of pars plana vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with chronic macular oedema., Methods: PPV with indocyanine green (ICG) assisted peeling of the ILM was performed in 33 eyes with diabetic (21 eyes) or non-diabetic (12 eyes) macular oedema. Postoperatively, resolution of macular oedema, improvement of visual acuity (VA) and complications were documented. The peeled membranes were submitted for light and transmission electron microscopic evaluation., Results: The mean follow-up time was 12.2 months. The macular oedema decreased or was resolved in 17 (81%) eyes in the diabetic group and in 11 (92%) eyes in the non-diabetic group. VA improved by at least 2 lines in 11 (52%) eyes in the diabetic group and in 7 (58%) eyes in the non-diabetic group. The difference between visual acuity improvements of the two groups was not statistically significant (P>0.05). However, in the diabetic group the difference of visual improvement between cystoid and diffuse type of macular oedema eyes was statistically significant (14% versus 71%, P=0.02). Light and transmission electron microscopy showed the presence of ILM in all specimens. During the follow-up period no recurrence of macular oedema or epiretinal membrane formation was observed., Conclusion: Pars plana vitrectomy with peeling of the ILM and epiretinal membrane leads to the resolution of macular oedema in the majority of eyes. This however, is not always associated with VA improvement. In diabetic eyes, cystoid type of macular oedema appears to be a poor prognostic factor for improved VA.

Purpose: To describe the effect of coupling solutions used during laser photocoagulation on the ocular surface of patients with noninsulin-dependent diabetes mellitus (NIDDM)., Design: A prospective case-controlled study., Methods: Ninety-two eyes of 46 NIDDM patients with clinically significant macular edema, poor metabolic control of diabetes, and peripheral neuropathy and 100 eyes of 50 normal control subjects were studied. The patients' eyes were assigned to argon green focal/grid laser photocoagulation using an applanation contact lens and one of the coupling fluids; 2% methocel, Thilo-Tears Gel, 1.4% sodium hyaluronate, or 0.9% simple saline. The control subjects received time-matched three-mirror contact lens fundus examinations. All subjects underwent corneal sensitivity measurements, Schirmer test, tear film breakup time, and corneal fluorescein staining before as well as 3 and 8 days after the laser procedures and contact lens examinations. Patients with corneal problems persisting after 8 days were followed longer., Results: Diabetic eyes assigned to 2% methocel and 1.4% sodium hyaluronate had significantly lower mean corneal sensitivities and break-up time values as well as significantly higher mean fluorescein staining scores at all examination points after laser photocoagulation. All diabetic eyes with aqueous deficiency assigned to 2% methocel and 1.4% sodium hyaluronate developed delayed corneal epithelial healing., Conclusion: The use of viscous coupling solutions during applanation contact lens-aided laser procedures may be detrimental for the corneal epithelium in poorly controlled NIDDM patients with peripheral neuropathy and coexisting aqueous deficiency.

Background: To investigate the efficacy of radial optic neurotomy (RON) on visual prognosis and clinical findings in central retinal vein occlusion (CRVO)., Methods: Prospective, non-randomised, self-controlled comparative trial. Six patients with ischemic CRVO who had visual acuity (VA) less than or equal to 0.1 and duration of CRVO at least 1 month, and 6 patients with non-ischemic CRVO who maintained their VA less than or equal to 0.1 during the minimal follow-up of 3 months underwent pars plana vitrectomy and RON. LogMAR VA measurement and fluorescein angiography were performed before and after surgery. Automated perimetry was obtained from 4 patients at the last visit. Main outcome measures were VA and clinical changes in fundus appearance of CRVO evaluated with fundus photography and fluorescein angiography., Results: Radial optic neurotomy was successfully performed in all 12 patients without serious complications. All patients were of clinical improvement of fundus findings. In 11 (92%) patients, a visual improvement of at least 2 lines was observed. After mean follow-up of 9.3 months, mean improvement in VA was 5.1 +/- 3.1 lines (range, 2-14 lines). Cystoid macular oedema and degeneration were observed in 8 (67) patients. Four patients, two of whom had preoperative ocular hypertension had raised intraocular pressure controlled with topical antiglaucoma medication. In late postoperative period, one ischemic eye developed vitreous haemorrhage necessitating vitrectomy and endolaser photocoagulation. Automated perimetry revealed segmental visual field defects in all the examined eyes., Conclusions: Radial optic neurotomy in CRVO yields clinical and visual improvement in majority of the patients. Cystoid macular oedema and degeneration are the major factors responsible for restriction of VA improvement. Further randomised and controlled studies with longer follow-up are essential to establish the appropriate timing and indications of RON in CRVO.

Background and Objective: The efficiency of indocyanine green (ICG) dye in the removal of the internal limiting membrane (ILM) with a fluid needle using passive aspiration was evaluated., Patients and Methods: Eighteen consecutive patients with diffuse diabetic macular edema were studied. After vitrectomy and total fluid-air exchange, 0.1 mL of ICG solution 0.25% was left in the macular area for 1 minute. Then the macular ILM was peeled with a specially designed tapered fluid needle using passive aspiration., Results: In 16 of the 18 eyes, the peeling procedure could be easily performed with a tapered fluid needle using passive aspiration. In 11 eyes, partial development of spontaneous ILM detachment prior to the peeling process was also observed., Conclusions: ICG solution 0.25% appears to reduce the adhesive force of the ILM to the sensory retina, which makes the removal of the ILM much easier by passive aspiration with a fluid needle.