The impact of vision impairment on vision-related quality of life of patients with neovascular age-related macular degeneration.

PURPOSE: To investigate the validity and reliability of the Greek Impact of Vision Impairment Questionnaire (IVI) and to explore the predictors of vision-related quality of life (VRQoL) in individuals with neovascular age-related macular degeneration (nAMD). METHODS: About 191 patients completed the IVI and the SF-12 Health Survey, and were assessed on visual exams. A random group of 20 participants completed the IVI twice with a 2 weeks interval, to assess test-retest reliability. About 102 patients completed the IVI 1 year later in a follow-up examination. Rasch analysis was used to evaluate response category functioning, scale precision, unidimensionality, scale targeting and differential item functioning. Stepwise multiple linear regression analyses identified predictors of VRQoL. RESULTS: Test-retest reliability of IVI items was calculated from 0.86 to 0.98. The six response categories were merged into four to figure out disordered thresholds. Rasch analysis concluded in three scales: Mobility and Independence, Reading and Accessing Information, and Emotional Wellbeing. Regarding convergent validity, the IVI scores had significant associations with SF-12 components (ρ = 0.28-0.47) and measurements of visual acuity (ρ = 0.39-0.66). Worse VRQoL at 1 year follow-up was correlated with decline in distance and near VA. Distance VA and the SF-12 components were common predictors for all three subscales. The duration of disease was a significant predictor for the emotional subscale. CONCLUSION: The Greek IVI was found to assess AMD patients' perceptions of VRQoL in a valid, reliable and responsive to eyesight manner. VRQoL was mainly established by patients' distance VA and mental health.

Corneal endothelial cells and central corneal thickness in patients with neurofibromatosis type 1.

Purpose: The aim of this study was to evaluate the morphological properties of corneal endothelial cells and central corneal thickness (CCT) in patients with neurofibromatosis type 1 (NF1) and to compare them with age-matched healthy controls. Methods: Nineteen NF1 patients and 38 healthy individuals were recruited. All participants underwent complete ophthalmological examination as well as noncontact specular microscopy to measure endothelial cell density (ECD), average cell area (AVG), coefficient of variation of cell area (CV), the percentage of hexagonal cells, and CCT. Eyes with previous ocular trauma, inflammation or surgery, and preexisting corneal and ocular surface diseases were excluded. Results: NF1 patients had higher ECD compared to healthy controls of the same age (2764.2 ± 270.4 versus 2570.4 ± 449.2 cells/mm, respectively), although at a borderline level (P = 0.051). Patients with NF1 presented significantly lower CV and AVG when compared to controls (32.9 ± 4.6 versus 37.8 ± 9.5%, P = 0.011 and 364.9 ± 34.4 versus 406.0 ± 107.4 µm, P = 0.038, respectively). The NF1 group had significantly higher hexagonality in comparison with controls (55.7 ± 6.5 versus 50.5 ± 9.9%, P = 0.025). CCT was similar between the two groups (P = 0.955). Conclusion: Our results show that corneal endothelium has more favorable morphological characteristics in NF1 patients compared to healthy individuals of the same age.

Ophthalmologic manifestations of adult patients with cystic fibrosis.

INTRODUCTION: Cystic fibrosis (CF) is the most common life-shortening recessive genetic disease in Caucasians, affecting primarily the lungs. The objective of our study was to investigate potential ophthalmologic involvement in adult patients with CF. METHODS: Fifty adult patients with cystic fibrosis and 60 age- and sex-matched controls underwent complete ophthalmologic examination including tear-film Break-Up Time (BUT), Macular Thickness, and peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness measurements using Spectral Domain-OCT. RESULTS: CF patients had significantly lower nasal-inferior pRNFL thickness (median 82 IQR 67-102 vs 92.5 IQR 82-107, p = 0.005) and lower percentage of normal tear Break-Up Time (56.0% vs 96.7%, p = 0.001) than healthy controls. All CF patients with BUT <10 s were diagnosed with blepharitis at the time of our assessement. The subgroup of patients homozygous for the most common CF mutation, F508del, had lower nasal-inferior pRNFL thickness (p = 0.014) and lower percentage of normal tear Break-Up Time (p = 0.001) compared to the control group. Additional findings, present in the CF group only, were punctuate retinal hemorrhages (four patients), vessel tortuosity (four patients), snail-track degeneration, and retinal tufts (two patients without refractive error). There were no significant differences in visual acuity, refractive errors, gonioscopic findings, or intraocular pressure between the groups. CONCLUSIONS: Our study is, to the best of our knowledge, the largest ophthalmologic study of patients with cystic fibrosis. We found that CF patients had significantly decreased inferior-quadrant peripapillary retinal nerve fiber layer thickness and decreased tear-film break-up time compared to controls. We highlight the importance of careful regular ophthalmologic assessment and follow-up of these patients.

Corneal Endothelial Morphology and Thickness Alterations in Patients With Severe Obstructive Sleep Apnea-Hypopnea Syndrome.

PURPOSE: To investigate central endothelial cell density (ECD), morphology, and central corneal thickness (CCT) in patients newly diagnosed with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) and to determine the correlation between these parameters and OSAHS severity. METHODS: This prospective, comparative case series was conducted in a university ophthalmology clinic. In total, 51 patients recently diagnosed with severe OSAHS (apnea-hypopnea index above 30) and a paired, age and sex-matched control group of 44 healthy individuals were enrolled. After detailed ophthalmologic examination, specular microscopy measurement was performed for all participants. Central ECD, average cell area, coefficient of variation (CV) of cell area, hexagonal cell appearance ratio (% Hex), and CCT were compared between the groups. The Pearson correlation test was also used to assess the influence of the polysomnographic findings, that is, the proportion of each stage of sleep, apnea-hypopnea index, SpO2, mean and maximum duration of apneas, oxygen desaturation index, and arousal index on corneal endothelial morphometric parameters and CCT. RESULTS: A total of 190 eyes were examined: 102 eyes of patients with severe OSAHS and 88 eyes of the control group. The mean ECD, CV, % Hex, and CCT values in the OSAHS group were 2439.25 ± 344.36 cells/mm, 41.41 ± 11.62, 45.22 ± 7.06%, and 533.88 ± 40.53 µm, respectively. ECD and CCT did not significantly differ between the groups (P = 0.46, P = 0.55, respectively). CV value was significantly higher (P = 0.009), whereas the %Hex was significantly lower (P = 0.01) in the OSAHS group. We observed a significant negative correlation between CCT and REM sleep percentage (P = 0.005). CONCLUSIONS: Greater pleomorphism and polymegathism of corneal endothelium was found in patients with severe OSAHS when compared with healthy subjects. Low percentage of REM sleep, usually found in patients with OSAHS, may cause an increase in corneal thickness.

Effects of Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea-Hypopnea Syndrome on Corneal Morphological Characteristics.

PURPOSE: To evaluate the effects of continuous positive airway pressure (CPAP) therapy on corneal endothelial morphometry and pachymetry in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: This prospective, observational study included patients with OSAHS who were evaluated right before and after the commencement of CPAP treatment. Each patient underwent a detailed ophthalmologic examination and assessment of their corneal endothelium with a noncontact specular microscope (Tomey EM-3000; Tomey Corp). Endothelial cell density, coefficient of variation of cell area (CV), hexagonal cell appearance ratio (%Hex), and central corneal thickness were measured. The post-CPAP results were compared with the results of a control group. The differences in the corneal parameters between pre- and post-CPAP therapy of the OSAHS group were correlated with the pretreatment polysomnography results. RESULTS: Twenty-seven distinct eyes of 27 patients recently diagnosed with OSAHS and 30 eyes of 30 healthy individuals were used for the statistical analysis. The mean age of patients with OSAHS was 54.2 ± 11.8 years, and after 9.6 months (range 3-18 mo) of good adherence to CPAP treatment, their CV values, indicating polymegathism, decreased from 41.7 ± 8.7 to 38.3 ± 5.8 (P = 0.04), whereas %Hex, indicating pleomorphism, increased from 45.8% ± 8.2% to 48.4% ± 6.6% (P = 0.008). Their post-CPAP corneal parameters did not differ significantly from those of the control group (P > 0.05). A significant positive correlation was observed between the decrease in CV and the duration of the treatment (Rs = 0.566, P = 0.002), as well as the pre-CPAP nonrapid eye movement (NREM) sleep percentage (Rs = 0.459, P = 0.02). A negative correlation was noted between the decrease in CV and the percentage of rapid eye movement (REM) sleep (Rs = -0.459, P = 0.02). CONCLUSIONS: Better oxygenation during sleep, resulting from increased CPAP adherence, had a significant influence on corneal endothelium, providing an improvement in corneal polymegathism and pleomorphism, with a potential return of CV and %Hex to their normal values. Greater improvement in polymegathism was observed in patients with greater proportion of NREM sleep.

Ganglion cell layer thickening in patients suffering from Obstructive Sleep Apnea-Hypopnea syndrome with long Mean Apnea-Hypopnea Duration during sleep.

PURPOSE: To study the effects of mean apnea-hypopnea duration (MAD), a useful indicator of blood oxygenation, on peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell to inner plexiform layer (GC-IPL) and macular retinal thickness in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: Sixty-five patients recently diagnosed with OSAHS and 35 healthy individuals were enrolled in this cross-sectional study. OSAHS patients were divided according to their MAD values into group 1 with 16 participants (MAD:10-15.5 s), group 2 with 17 participants (MAD:15.5-19 s), group 3 with 17 participants (MAD:19-30 s) and group 4 with 15 participants (MAD > 30 s). The average and sectorial values of RNFL, GC-IPL and retinal thickness were measured by SS-OCT (DRI OCT Triton, Topcon). Intraocular pressure was recorded by Goldmann Applanation and Pascal Dynamic Contour Tonometer (DCT-IOP). RESULTS: The average RNFL and retinal thickness values were higher in group 4, but did not reach statistical significance. With the exception of the central 1 mm at the fovea, GC-IPL was always thickened in group 4, and significant differences were evident when its average value was compared with group 2 (p = 0.03), its superior and inferior-nasal values were compared with group 2 (p = 0.02, p = 0.006, respectively) and group 3 (p = 0.01, p = 0.02, respectively), its superior-temporal value was compared with group 3 (p = 0.003) and the control group (p = 0.03), and its superior-nasal value was compared with group 2 (p = 0.03), group 3 (p = 0.001) and the control group (p = 0.03). DCT-IOP was significantly positively correlated with the duration of sleep in which oxygen saturation (SaO2 ) was decreased under 90% (r = 0.359, p = 0.01). CONCLUSION: We report a novel observation of GC-IPL thickening in OSAHS patients experiencing long MAD, a parameter which incorporates the severity of breathing events during sleep. Higher DCT-IOP was noted with advancing hypoxemia.

A Multicenter, Cross-Sectional Study of the Incidence of Major Macular Diseases That Cause Visual Impairment and Require Therapeutic Intervention in Greece: The ADVICE Study.

PURPOSE: This multicenter, epidemiological, cross-sectional study aimed to estimate the annual cumulative incidence of major macular diseases that cause visual impairment and require therapeutic intervention in the routine care of Greece. METHODS: The study was carried out between December 2012 and May 2015 in 20 ophthalmology clinics. Over a one-year recruitment period per study site, all treatment naïve adult patients newly diagnosed with wet age-related macular degeneration, visual impairment due to diabetic macular edema or macular edema secondary to retinal vein occlusion requiring therapeutic management and who had not been diagnosed or treated for the same disease in the past were enrolled after providing informed consent. Study data were collected during the single study visit. RESULTS: A total of 1532 incident cases were enrolled. The estimated annual cumulative incidence of wet age-related macular degeneration, diabetic macular edema and macular edema secondary to retinal vein occlusion requiring therapeutic management was 0.82 [95% confidence interval (CI): 0.76, 0.88; n=723], 0.63 (95% CI: 0.58, 0.69; n=559), and 0.29 (95% CI: 0.25, 0.32; n=250) per 10,000 cases, respectively. CONCLUSION: The study provides estimates of the incidence of major macular diseases causing visual impairment and requiring treatment in outpatient hospital settings in Greece, indicating a considerable socioeconomic burden to the healthcare system.

Erratum to "Visual Outcomes of Ultrathin-Descemet Stripping Endothelial Keratoplasty versus Descemet Stripping Endothelial Keratoplasty".

[This corrects the article DOI: 10.1155/2018/5924058.].

Visual Outcomes of Ultrathin-Descemet Stripping Endothelial Keratoplasty versus Descemet Stripping Endothelial Keratoplasty.

PURPOSE: To examine the impact of graft thickness (GT) on postoperative visual acuity and endothelial cell density after ultrathin-Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus conventional DSAEK. METHODS: The medical records of all patients who underwent DSAEK at our institute during a 2-year period were reviewed. After excluding subjects with low visual potential, 34 eyes were divided into two groups based on the postoperative GT as measured with anterior segment optical coherence tomography (AS-OCT): an UT-DSAEK group (GT ≤ 100 µm, n=13 eyes) and a DSAEK group (GT > 100 µm, n=21 eyes). The groups were compared with regard to best-corrected visual acuity (BCVA), subjective refraction, central corneal thickness (CCT), GT, and endothelial cell density (ECD). RESULTS: Preoperative BCVA (logMAR) was 1.035 ± 0.514 and 0.772 ± 0.428 for UT-DSAEK and DSAEK, respectively (P=0.072). At 6 months postoperatively, BCVA was 0.088 ± 0.150 following UT-DSAEK and 0.285 ± 0.158 following DSAEK (P=0.001). CONCLUSION: DSAEK grafts with a thickness under 100 µm offered better visual outcomes during the early postoperative period.

Supradescemetic voriconazole injection for Candida parapsilosis keratitis.

PURPOSE: To describe a technique for intracorneal application of voriconazole into the supradescemetic space in a case of deep recalcitrant Candida parapsilosis keratitis of a penetrating cornea graft. METHODS: A deep intracorneal incision reaching the center of the corneal infiltrate was created with a 20-gauge MVR blade. Then, a 27-gauge hydrodissection cannula was inserted deep into the corneal pocket, and 0.1 ml of voriconazole 0.5 mg/ml was injected until a bullous detachment of Descemet membrane (DM) covered 1/3 of the graft's area. DM detachment was documented by anterior segment optical coherence tomography (AS-OCT). RESULTS: AS-OCT confirmed the creation of a drug depot in the supradescemetic space, which partially regressed during the following hours; 24 h after the injection, a complete reattachment of DM was documented. After 4 weeks, the stromal infiltrate has cleared completely and no signs of recurrence were observed 3 months after injection. CONCLUSION: In the present case, the supradescemetic voriconazole injection led to resolution of a deep recalcitrant fungal infiltrate. The herein described technique could be tried in similar cases, where an intrastromal injection is indicated, as it may offer a larger intracorneal drug depot.

Iris cysts: A comprehensive review on diagnosis and treatment.

Iris cysts, both primary and secondary, are a diagnostic and treatment challenge. Primary cysts arise either from the iris pigment epithelium or the iris stroma. Posterior pigment epithelial cysts are subdivided according to their location as central, midzonal, and peripheral. Iris stromal cysts are classified either as congenital or acquired. Free-floating cysts are usually dislodged pigment epithelial cysts. Secondary cysts are classified according to the underlying cause as implantation cysts, drug-induced, uveitic, tumor-induced, parasitic, or as cysts associated with systemic disorders. Differential diagnosis is based on the clinical presentation and imaging. Ultrasound biomicroscopy is the gold standard for the imaging of iris cysts, combining excellent resolution with sufficient tissue penetration. Treatment of iris cysts depends largely on whether they become symptomatic or not. Symptoms include obstruction of the visual axis, corneal decompensation, secondary uveitis, and secondary glaucoma. Treatment options cover a range from simple observation to fine-needle aspiration (with or without intracystic injection of absolute alcohol or antimitotic agents), laser (argon, Nd:YAG), or surgical excision. In the past, the prevailing notion was that of a radical surgical intervention in the form of iridectomy or iridocyclectomy. Given the high rate of recurrence, a stepwise conservative approach is currently favored by most clinicians.

Treatment satisfaction of patients with neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents.

PURPOSE: To assess the psychometric properties of the Greek Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and evaluate the factors that influence treatment satisfaction of patients with neovascular age-related macular degeneration (nAMD). METHODS: The MacTSQ was translated into Greek and administered to 176 patients. All patients completed the SF-12 Health Survey and the Macular disease Dependent Quality of Life Questionnaire (MacDQoL) and underwent vision measurements. For test-retest reliability, a subset of 19 participants completed the MacTSQ twice, two weeks apart. Stepwise multiple linear regression analyses were performed to identify predictors of treatment satisfaction. Change in MacTSQ scores over time was assessed on 83 patients who completed the MacTSQ at a follow-up visit, one year later. RESULTS: The intraclass correlation coefficients between the first and second test-retest administration ranged from 0.88 to 0.98 for the items and total score. Internal reliability of the total score was adequate (Cronbach's a = 0.837). Principal component analysis revealed three subscales (effectiveness, information provision and convenience, impact). The MacTSQ score showed significant correlations with SF-12 summary scales and MacDQoL scores (ρ = 0.16-0.27). The most important factor that determined the satisfaction was mental health. Distance visual acuity (VA) in better eye was the best predictor of the effectiveness subscale, and the total number of injections was a negative predictor for the convenience subscale. Treatment satisfaction increased at one-year follow-up, despite the deterioration in distance VA. CONCLUSIONS: The Greek MacTSQ is a reliable and valid instrument for assessing nAMD patients' perceptions of treatment satisfaction, especially using its three new subscales. Treatment satisfaction is multifactorial and was primarily determined by patients' mental health status.

CAPILLARY NONPERFUSION AND PHOTORECEPTOR LOSS IN BRANCH RETINAL VEIN OCCLUSION: Spatial Correlation and Morphologic Characteristics.

PURPOSE: To evaluate the photoreceptor layer in eyes with branch retinal vein occlusion associated with macular ischemia, using a method of en face optical coherence tomography (OCT) representation of the ellipsoid zone. METHODS: Customized macular OCT scans of 9 patients (10 eyes) with branch retinal vein occlusion and macular ischemia were exported and subsequently postprocessed (removal of vascular and cystic spaces' shadows, segmentation, and alignment to the retinal pigment epithelium). The ellipsoid band was then isolated, aligned, and used to produce an en face OCT image. Areas with photoreceptor loss (hyporeflective ellipsoid) were compared with ischemic areas as identified in an early-phase fluorescein angiography. RESULTS: The areas of capillary nonperfusion (as detected in fluorescein angiography) were closely associated with disruption of the ellipsoid zone (depicted as areas of low reflectance in the en face reconstruction of the OCT images). The ellipsoid zone disruption had a patchy appearance and either sharp or fuzzy borders, depending on the grade of the loss of reflectance. CONCLUSION: En face OCT reconstruction and subsequent representation of ellipsoid zone revealed a close association between capillary nonperfusion and photoreceptor disruption in eyes with branch retinal vein occlusion. It seems that the deep capillary plexus plays an important role on the metabolic demands of outer retina and, consequently, an ischemia at the level of deep capillary plexus has significant impact on the integrity of the photoreceptors.

Reliability, validity and responsiveness of the Greek MacDQoL individualized measure of the impact of macular degeneration on quality of life.

PURPOSE: To assess the psychometric properties of the Greek Macular Disease-Dependent Quality of Life Questionnaire (MacDQoL). METHODS: The MacDQoL was translated in Greek and administered to 191 patients with neovascular age-related macular degeneration (AMD). To assess validity, all patients completed the Greek SF-12 health survey and underwent vision measurements. For test-retest reliability, a subset of twenty participants completed the MacDQoL twice, 2 weeks apart. Responsiveness was assessed on 102 patients who completed the MacDQoL at a follow-up visit, 1 year later. Rasch analysis was used to assess the Greek MacDQoL's response category functioning, precision, unidimensionality, targeting and differential item functioning. RESULTS: Internal and test-retest reliability of the average weighted impact (AWI) was 0.952 and 0.97, respectively. Test-retest reliability of MacDQoL items ranged from 0.78 to 0.99. Principal component analysis revealed three subscales (activities, embarrassment and family life), which were also confirmed by confirmatory factor analysis. Rasch analysis revealed poor functionality of response categories and that was resolved by collapsing response categories and using the impairment scores only. In terms of convergent validity, the AWI and revised MacDQoL scales showed significant correlations with SF-12 summary scales (ρ = 0.21-0.30) and vision assessments (ρ = 0.31-0.46). Poorer AMD-related QoL at 1-year follow-up was associated with deterioration in distance visual acuity and worse eye near visual acuity. CONCLUSIONS: The Greek MacDQoL is a reliable, valid and sensitive to change in vision instrument for assessing AMD patients' perceptions of QoL. However, Rasch analysis revealed that its multiplicative rating scale is flawed. Scientific measurement was restored with a number of revisions to the questionnaire.

Case report: Aqueous and Vitreous amino-acid concentrations in a patient with maple syrup urine disease operated on rhegmatogenous retinal detachment.

BACKGROUND: Maple syrup urine disease (MSUD) is a rare metabolic disorder, affecting the metabolism of branched chain amino-acids (Valine, Leukine, Isoleukine). We present a rare case of rhegmatogenous retinal detachment (RRD) in a MSUD patient. CASE PRESENTATION: We performed amino acid analysis of aqueous humour, vitreous and serum samples obtained during surgery from a 24 year old female MSUD patient successfully operated on RRD. Serum values for a-amino-butyric acid, valine, isoleucine, leucine, tyrosine, phenylalanine, ornithine and histidine were low, while values for citrulline, methionine and lysine were borderline low, all attributed to the patient's special diet. Serum glutamate was above normal, probably due to the breakdown of glutamine to glutamate. In the aqueous and vitreous the amino acids implicated in MSUD (Valine, Leukine Isoleukine), were within normal range. Glutamate was absent in the vitreous and presented low levels in the aqueous. Glutamate has been reported to play an important role in retinal damage. Elevated glutamate levels have been reported in vitreous specimens from patients subjected to vitrectomy or buckling surgery for RRD. In MSUD, glutamate has been implicated in the pathogenesis of brain damage. Low levels of glutamate have been observed in the cerebellum of experimental MSUD animals, as well as postmortem brain tissue from a child that died of leucine intoxication. The reduction was attributed to the elevation of a-ketoisocaproic which reverses the net direction of nitrogen flow. It could be argued that this could impact on amino acid concentration in aqueous and vitreous fluids. CONCLUSIONS: Although no definite conclusions can be drawn by this extremely rare case, the low vitreous and aqueous levels of Glutamate is an interesting finding. Further studies are needed to provide a better insight in the role of amino acids as neurotransmitters in the human eye in health and disease.

Spontaneous Corneal Clearance in the Presence of a Partially Detached Graft after Non-Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To report the explantation of a detached and opaque donor disc as an alternative to secondary keratoplasty in a case of persistent graft detachment followed by spontaneous clearance of the recipient cornea after non-Descemet stripping automated endothelial keratoplasty (non-DSAEK). RESULTS: Four months after graft explantation, BSCVA was 0.5 and endothelial cell density (ECD) was 1,221 cells/m(2). After 13 months, BSCVA was still 0.6 while ECD had fell to 800, and 2 years later, the endothelium decompensated. BSCVA was 0.3 and ECD was not measurable. CONCLUSIONS: To our knowledge this is the first report of explantation of an endothelial graft as an alternative to re-keratoplasty in a case of spontaneous corneal clearance. This minimally invasive treatment may be considered in similar cases. However, due to the ongoing loss of endothelial cells after endothelial keratoplasty, a re-keratoplasty may still be needed in the long term.

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

The purpose of this study is to evaluate the long-term visual, anatomical and electrophysiological outcomes of repeated intravitreal injections of bevacizumab for macular edema due to retinal vein occlusion (RVO) and investigate any possible toxic effects on the central fovea. This is a prospective, noncomparative, interventional case series. Thirty-three eyes of 33 patients with macular edema secondary to RVO were treated with 1.25 mg/0.05 ml intravitreal bevacizumab. Nine patients had nonischemic central retinal vein occlusion (CRVO) and 24 patients had branch retinal vein occlusion (BRVO). The main outcome measures were best-corrected visual acuity, central retinal thickness (CRT), and multifocal electroretinography (mfERG) responses changes at baseline, 1 month after the third injection and at the end of the 2-year long follow-up period. Patients with CRVO had mean best-corrected Snellen visual acuity of 0.10 at baseline, which improved significantly to 0.31 after 2 years (P = 0. 028).The mean CRT at presentation was 756.28 µm and reduced significantly to 439.14 µm after 2 years (P = 0.05). Patients with BRVO had mean best-corrected Snellen visual acuity of 0.19 at baseline, which improved significantly to 0.40 after 2 years (P < 0.001). The mean CRT at presentation was 681.04 µm and reduced significantly to 369.81 µm after 2 years (P < 0.001). Mean mfERG responses within central 10° (ring1, ring2) showed statistically significant differences on P1 parameters in terms of response density and implicit time after 2 years in both CRVO and BRVO patients. Repeated intravitreal bevacizumab injections for macular edema due to either CRVO or BRVO resulted in long-term improvement of visual acuity, a reduction in CRT and statistically significant changes in the mfERG responses with nondemonstrable toxic effects on the central fovea.

Scleral melt following Retisert intravitreal fluocinolone implant.

Intravitreal fluocinolone acetonide implant (Retisert) has a high potency, a low solubility, and a very short duration of action in the systemic circulation, enabling the steroid pellet to be small and reducing the risk of systemic side effects. Scleral melt has not been reported as a possible complication of Retisert implant. The authors describe the occurrence of scleral melt 18 months after the implantation of fluocinolone acetonide implant in a 42-year-old Caucasian woman. To the authors' knowledge, this is the first report of this possible complication.