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AIM: To evaluate the safety and efficacy of a dexamethasone (DEX) intravitreal implant for diabetic macular edema (DME). METHODS: Totally 113 eyes of 84 patients were divided in three subgroups: naive patients (n=11), pseudophakic patients (n=72) and phakic patients (n=30). Inclusive criterion comprised adult diabetic patients with central fovea thickening and impaired visual acuity resulting from DME for whom previous standard treatments showed no improvement in both central macular thickness (CMT) and best corrected visual acuity (BCVA) after at least 3mo of treatment. Outcome data were obtained from patient visits at baseline and at months 1, 3, 5, 9 and 12 after the first DEX implant injection. At each of these visits, patients underwent measurement of BCVA, a complete eye examination and measurement of CMT and macular volume (MV) carried out with optical coherence tomography (OCT) images. RESULTS: Seventy-three eyes (64.5%) received a single implant, 30 (26.5%) received two implants and 10 (9%) received three implants. At baseline, average in BCVA, CMT and MV were 43.5±20.8, 462.8±145 and 12.6±2.5 respectively. These values improved significantly at 1mo (BCVA: 47.2±19.5, CMT: 339.6±120, MV: 11.11±1.4) and 3mo (BCVA: 53.2±18.1, CMT: 353.8±141, MV: 11.3±1.3) (P≤0.05). At 5mo (BCVA: 50.9±19.8, CMT: 425±150, MV: 12.27±2.3), 9mo (BCVA: 48.4±17.6, CMT: 445.5±170, MV: 12.5±2.3) and 12mo (BCVA: 47.7±18.8, CMT: 413.2±149, MV: 12.03±2.5), improvements in the three parameters were no longer statistically significant and decreased progressively but did not reach baseline values. There were no clinical differences between subgroups. Ocular complications were minimal. CONCLUSION: Patients with DEX implants show maximum efficacy at 3mo which then declined progressively, but is still better than baseline values at the end of follow-up.
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PURPOSE: To report a case of complicated exposed scleral buckle in which amniotic membrane was used to repair the extremely thin sclera that showed the underlying choroid. METHODS: Interventional case report. A 65-year-old man presented to our Department with severe eye pain after retinal detachment repair with scleral buckling technique 7 years ago. RESULTS: Examination of the left eye revealed extrusion of the buckle with conjunctival and scleral erosion that allowed distinguishing the choroid. The buckle was removed and successful scleral repair was achieved through the use of amniotic membrane. CONCLUSION: Amniotic membrane graft is a safe and useful scleral substitute that should be considered to cover scleral defects, in the absence of infection.
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PURPOSE: To report a case of central retinal artery occlusion (CRAO) in a patient with biopsy-verified Wegener's granulomatosis (WG) with positive C-ANCA. METHODS: A 55-year-old woman presented with a 3-day history of acute painless bilateral loss of vision; she also complained of fever and weight loss. Examination showed a CRAO in the left eye and angiographically documented choroidal ischemia in both eyes. RESULTS: The possibility of systemic vasculitis was not kept in mind until further studies were carried out; methylprednisolone pulse therapy was then started. Renal biopsy disclosed focal and segmental necrotizing vasculitis of the medium-sized arteries, supporting the diagnosis of WG, and cyclophosphamide pulse therapy was administered with gradual improvement, but there was no visual recovery. CONCLUSION: CRAO as presenting manifestation of WG, in the context of retinal vasculitis, is very uncommon, but we should be aware of WG in the etiology of CRAO. This report shows the difficulty of diagnosing Wegener's granulomatosis; it requires a high index of suspicion, and we should obtain an accurate medical history and repeat serological and histopathological examinations. It emphasizes that inflammation of arteries leads to irreversible retinal infarction, and visual loss may occur.
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PURPOSE: To analyze the priority of morphological and functional defects in glaucoma. METHODS: Nine-hundred seventy-three eyes of 973 subjects were examined with Heidelberg retinal tomograph (HRT II) and Octopus 311 perimeter (TOP strategy). These included 72 controls (C), 659 early and suspect open angle glaucoma (ESG) with perimetric mean defect (MD) lower than 6 dB, and 242 confirmed moderate and advanced glaucomas (AG) with perimetric MD>or=6 dB. RESULTS: I. (Control group): Age was significantly correlated with mean sensitivity (MS) (r=0.50, p<0.00001) and nasal cup shape measure (r=0.33, p=0.005). II. (C and ESG groups): For 95.8% specificity, the best sensitivity was obtained with square root of loss variance (sLV) (ROC area=69.7%, sensitivity=33.7%) and maximum contour elevation (ROC area=69.6%, sensitivity=29.0%). Maximum contour elevation and sLV coincided in diagnosis in 12.4% of cases. An equation using 64 HRT II indices predicted MS with a standard error of estimate (SEE) of 1.87 dB (r=0.67, p<0.00001) and MD (SEE=1.88 dB, r=0.47, p<0.00001). III. (All cases): RB discriminant function value was the best HRT II index to estimate MS values (SEE=5.4 dB, r=0.52, p<0.0001), MD (SEE=5.2 dB, r=0.50, p<0.0001), sLV (SEE=1.9 dB, r=0.41, p<0.0001) and Number of Pathological Points (NPP; SEE=21.3 dB, r=0.49, p<0.0001). Sector correlation of the optic nerve and visual field was high (maximum r=0.66) in cases with superior visual field defects and low in the rest of cases. More than 95% of cases with established glaucoma had abnormal sLV, but <60% had abnormal optic disc indices. DISCUSSION: Perimetry reveals age-related defects slightly more than HRT II. HRT II indices correlated better with MS than with MD, probably because none of them was age corrected. Good correlation between anatomical and functional data in C and ESG, and sensitivity results indicated small differences in early development between both methods. Perimetry identifies defects more clearly than structural measures in established glaucoma.