Evaluation of long-term outcomes associated with extended heavy-silicone oil use for the treatment of inferior retinal detachment.

To evaluate macular status with optical coherence tomography (OCT) in eyes that underwent pars plana vitrectomy (PPV) and heavy-silicone oil (HSO) endotamponade for the treatment of rhegmatogenous retinal detachment (RRD) with inferior breaks. Twenty eyes of 20 patients who have RRD with inferior breaks included in the study. Oxane HD was used as an intraocular tamponade for all surgeries. Postoperatively, anatomic reattachment, macular status using OCT imaging, and any long-term complications were evaluated. The mean age was 60.4 ± 11.2 years (range, 37-83). The duration of HSO endotamponade was 15.3 ± 11.0 months (range, 6-48) with some postoperative complications such as HSO emulsification, intraocular pressure elevation, and epiretinal membrane (ERM) formation. Mean follow-up time was 19.5 ± 10.5 months (range, 10-59) after HSO removal or ERM surgery. Primary reattachment was achieved in 90% of eyes and the success rate was 100% with further interventions. Ellipsoid zone (EZ) was continuous in 13 of 20 eyes in which OCT imaging performed as well as the fellow eye. PPV and heavy-silicone oil injection for the treatment of eyes with RRD from inferior break(s) have a good long-term EZ continuity. ERM formation and its removal do not affect EZ.

Three versus five intravitreal aflibercept injections as the initial loading phase in the treatment of diabetic macular edema: one-year results.

PURPOSE: To compare the efficacy of three initial monthly intravitreal aflibercept injections followed by pro re nata (3+PRN) dosing versus five initial monthly intravitreal aflibercept injections followed by pro re nata (5+PRN) dosing in patients with diabetic macular edema. METHODS: A total of 60 treatment-naïve patients with macular edema who underwent intravitreal aflibercept injections (2 mg/0.05 mL) with at least one year of follow-up were analyzed in this retrospective and comparative study. The patients were divided into two groups according to the number of intravitreal aflibercept injections administered in the loading phase. The 3+PRN group comprised 27 patients, whereas the 5+PRN group comprised 33 patients. The visual and anatomical outcomes were compared between the two groups at baseline and at 3, 6, 9, and 12 months. RESULTS: Both 3+PRN and 5+PRN, showed statistically significant improvements in the best-corrected visual acuity and central macular thicknesse throughout the study period (p<0.001 and, p<0.001, respectively). There were no significant differences between the two groups in terms of changes in the best-corrected visual acuity and central macular thickness (p=0.453 and, p=0.784, respectively). The mean number of intravitreal aflibercept injections was significantly greater in the 5+PRN group (6.1 ± 0.8) than in the 3+PRN group (3.9 ± 0.8) (p<0.001). CONCLUSION: The 3+PRN and 5+PRN regimens showed similar 12-month visual and anatomical outcomes following treatment with intravitreal aflibercept injections in patients with macular edema.

The effect of long-term systemic immunosuppressive drug use on druse formation: a new perspective to age-related macular degeneration

Background/aim: To evaluate the effect of the long-term use of systemic immunosuppressive drugs on druse formation in patients aged over 50 years. Materials and methods: The current retrospective cohort study includes 420 eyes of 420 patients. 210 eyes of 210 patients who used immunosuppressive drugs (Group 1) at least for the last 5 years and 210 eyes of 210 control patients (Group 2) who did not use any drugs were compared. All patients were older than 50 years and selected among patients who were followed by rheumatology and ophthalmology clinic at a tertiary university hospital. All patients had complete ophthalmic examination, fundus photography and optical coherence tomography (OCT). The primary outcome of this study is the difference in macular and paramacular druse formation rates between two groups. Results: Small, intermediate, large, soft, and paramacular druse formation rates were significantly lower in Group 1 than those in Group 2 (P = 0.028, P = 0.001, P = 0.001, P = 0.001, and P = 0.001, respectively). Conclusion: Patients who used long-term systemic immunosuppressive drugs had significantly lower hard and soft druse formation rate than age and sex matched control subjects.

Three versus five intravitreal aflibercept injections as the initial loading phase in the treatment of diabetic macular edema: one-year results / Três versus cinco injeções intravítreas de aflibercept como carga inicial do tratamento de edema macular diabético: resultados de um ano

ABSTRACT Purpose: To compare the efficacy of three initial monthly intravitreal aflibercept injections followed by pro re nata (3+PRN) dosing versus five initial monthly intravitreal aflibercept injections followed by pro re nata (5+PRN) dosing in patients with diabetic macular edema. Methods: A total of 60 treatment-naïve patients with macular edema who underwent intravitreal aflibercept injections (2 mg/0.05 mL) with at least one year of follow-up were analyzed in this retrospective and comparative study. The patients were divided into two groups according to the number of intravitreal aflibercept injections administered in the loading phase. The 3+PRN group comprised 27 patients, whereas the 5+PRN group comprised 33 patients. The visual and anatomical outcomes were compared between the two groups at baseline and at 3, 6, 9, and 12 months. Results: Both 3+PRN and 5+PRN, showed statistically significant improvements in the best-corrected visual acuity and central macular thicknesse throughout the study period (p<0.001 and, p<0.001, respectively). There were no significant differences between the two groups in terms of changes in the best-corrected visual acuity and central macular thickness (p=0.453 and, p=0.784, respectively). The mean number of intravitreal aflibercept injections was significantly greater in the 5+PRN group (6.1 ± 0.8) than in the 3+PRN group (3.9 ± 0.8) (p<0.001). Conclusion: The 3+PRN and 5+PRN regimens showed similar 12-month visual and anatomical outcomes following treatment with intravitreal aflibercept injections in patients with macular edema.

RESUMO Objetivo: Comparar a eficácia de três injeções intravítreas mensais iniciais de aflibercept, seguidas de dosagem de pro re nata (3+PRN) versus cinco injeções mensais iniciais intravítreas de aflibercept, seguidas de doses de pro re nata (5 + PRN) em pacientes com edema macular diabético. Métodos: Foram analisados neste estudo retrospectivo e comparativo 60 pacientes que não receberam tratamento prévio com edema macular e foram submetidos a injeções intravítreas de aflibercept (2 mg/0,05 mL) com pelo menos um ano de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com o número de injeções intravítreas de aflibercept administradas na fase inicial. O grupo 3+PRN compreendeu 27 pacientes, enquanto o grupo 5+PRN compreendeu 33 pacientes. Os resultados visuais e anatômicos foram comparados entre os dois grupos no período inicial e aos 3, 6, 9 e 12 meses. Resultados: Tanto os grupos 3+PRN quanto 5+PRN mostraram melhoras estatisticamente significativas na acuidade visual melhor corrigida e na espessura macular central ao longo do período de estudo (p<0,001 e p <0,001, respectivamente). Não houve diferenças significativas entre os dois grupos em termos de alterações na acuidade visual melhor corrigida e na espessura macular central (p=0,453 e p=0,784, respectivamente). O número médio de injeções intravítreas de aflibercept foi significativamente maior no grupo 5+PRN (6,1 ± 0,8) do que no grupo 3+PRN (3,9 ± 0,8) (p <0,001). Conclusão: Os regimes 3+PRN e 5+PRN mostraram resultados visuais e anatômicos semelhantes em 12 meses após o tratamento com injeções intravítreas de aflibercept em pacientes com edema macular.

A comparison of the effect of intravitreal dexamethasone implant on macular and branch retinal vein occlusion. A real life experience.

PURPOSE: This study aimed to compare the effects of intravitreal dexamethasone (IVDx) implants on branch retinal vein occlusions (BRVOs) and macular vein occlusions (MVOs). METHODS: Seventeen consecutive patients with MVO and 18 patients with BRVO, whose foveal thicknesses were greater than 300 µm, were recruited for this study. BRVO and MVO patients were diagnosed by means of fundus fluorescein angiography. Patients were treatment-naive. Initially, each patient in both the BRVO and MVO groups received an IVDx implant, and then a pro re nata IVDx regimen was initiated. Primary outcomes included VA gain, intraocular pressure (IOP) changes, macular ischemia, central macular thickness, retinal neovascularization, and number of IVDx injections. Follow-up time was 12 months. RESULTS: The MVO group initially had significantly lower central macular thickness and a lower percentage of macular ischemia and systemic hypertension than those in the BRVO group (p = 0.001, 0.045, and 0.010, respectively). There was a statistically significant VA gain in both groups (p < 0.001), but the VA gain of the MVO group was greater than that of the BRVO group (p < 0.001). The mean total number of IVDx injections administered throughout the study period was significantly lower in the MVO group than in the BRVO group (1.3 ± 0.4 vs 2.0 ± 0.0; p = 0.001). DISCUSSION: MVO and BRVO have different disease characteristics, and IVDx implants were more effective on the visual gain in patients with MVO than that of patients with BRVO who had higher numbers of IVDx injections.

Bariatric surgery might aggravate proliferative diabetic retinopathy.

PURPOSE: This study aimed to assess the changes experienced by patients with proliferative diabetic retinopathy (PDR) after bariatric surgery (BS). METHODS: This retrospective observational study includes 37 eyes of 21 patients with PDR who underwent BS at a tertiary university hospital over the period of 2014-2018. The control group (CG) comprised 37 eyes of 27 patients with PDR who attended the same research hospital for diabetes care without undergoing BS. Preoperative and postoperative glycated haemoglobin (HbA1c) levels, weight and diabetic retinopathy screening results were collected from the medical records of the patients. Patients who had undergone preoperative retinal screening and at least one postoperative retinal screening were included in the analysis. RESULTS: Both groups exhibited statistically significant visual acuity (VA) loss at 6 months and 1 year (p < 0.001). At postoperative 6 months the VA loss experienced by the control BS group was significantly more severe than that experienced by the CG (p = 0.03). The first-year HbA1c levels of the BS group were significantly lower than those of the CG (p = 0.02). The BS group had significantly higher intraocular haemorrhage (p = 0.04), neovascular glaucoma (p = 0.04) and retinal vein occlusion (p = 0.04) rates than the CG group. All complications occurred at different patients. CONCLUSION: Patients with PDR who received BS showed more severe retinopathy than patients who were matched for age, sex, HbA1c levels and follow-up duration and who did not receive BS.

Effect of intravitreal ranibizumab on serous retinal detachment in branch retinal vein occlusion.

PURPOSE: The aim of this study was to evaluate the effect of initial intravitreal ranibizumab injection on visual acuity (VA) and central macular thickness (CMT) for the treatment of macular edema (ME) with and without serous retinal detachment (SRD) secondary to branch retinal vein occlusion (BRVO). MATERIALS AND METHODS: Fifty-two BRVO eyes, treated with intravitreal ranibizumab injection for ME with and without SRD, were retrospectively reviewed. Patients were divided into two groups according to spectral domain optical coherence tomography (SD-OCT). The efficacy of intravitreal ranibizumab injection at first month was assessed by analyzing the change in best-corrected VA and reduction in CMT with SD-OCT. RESULTS: There were 21 patients with SRD and 31 patients with only CME (no-SRD). CMT was significantly greater in the SRD group than in the CME group (451±62.2 µm vs 383.5±37.2 µm, respectively, P<0.05). After initial intravitreal ranibizumab injection, mean VA improved from 0.87±0.26 logarithm of the minimum angle of resolution (LogMAR) to 0.54±0.27 LogMAR (P<0.01) and CMT decreased from 451±62.2 µm to 379.3±58.6 µm (P<0.001) in the SRD group. In the no-SRD group, mean VA improved from 0.69±0.25 LogMAR to 0.44±0.25 LogMAR (P<0.001) and the CMT decreased from 383.5±37.2 µm to 337.7±39.4 µm (P<0.001) at the first month visit. Eyes with SRD revealed better anatomic results and greater reduction of CMT after intravitreal ranibizumab injection (P<0.01). CONCLUSION: VA and CMT can be improved by intravitreal ranibizumab injection in BRVO patients with and without SRD. However, more marked improvement in macular morphology was achieved in patients with SRD than those without SRD.

Early Retinal and Choroidal Coat Thickness Changes after Intravitreal Dexamethasone Implant Injection for Diabetic Macular Edema

Background: Intravitreal steroid injection is one of the treatment options for diabetic macular edema. Dexamethasone implant is the most novel form of intravitreal steroid therapy. Improvement in macular thickness is a well-known effect of Dexamethasone implant however, subfoveal choroidal coat thickness changes require investigation. Aims: To evaluate the early central macular thickness and subfoveal choroidal thickness alterations after single-dose dexamethasone implant injection in diabetic macular edema. Study Design: Cross-sectional study. Methods: We identified 29 patients with diabetic macular edema (29 eyes) who underwent optical coherence tomography and fundus fluorescein angiography. All patients received a single-dose intravitreal Dexamethasone implant and were followed up for central macular thickness and subfoveal choroidal thickness alterations for 1 hour, 1 week, 1 month, and 3 months post-injection. Results: The preoperative mean central macular thickness and subfoveal choroidal thickness measurements were 592.3±122.3 (412­879) µm and 264.8±53.7 (165­397) µm, respectively. Central macular thickness measurements decreased significantly in the first hour (p<0.050) and continued to decrease until the third month (p<0.001), whereas the subfoveal choroidal thickness decrement was only significant on the first day (p<0.05). Decreases in subfoveal choroidal thickness and central macular thickness of 1.5% and 5% were observed at 1 hour; however, the difference was not significant (p>0.050). The decrease in central macular thickness was significantly greater than that in subfoveal choroidal thickness at 1 day, 1 week, 1 month, and 3 months (p<0.001). Conclusion: Intravitreal Dexamethasone implant has a meaningful effect on central macular thickness in patients with diabetic macular edema, while subfoveal choroidal thickness decreases significantly at first day.

Choroidal Thickness of Helicobacter-Positive Patients without Central Serous Chorioretinopathy.

PURPOSE: To evaluate the effect of Helicobacter pylori (H. pylori) infection on subfoveal choroidal thickness (SFCT) in patients without clinical central serous chorioretinopathy (CSC). MATERIALS AND METHODS: This prospective study included 50 patients with pathologically proven H. pylori infection (H. pylori (+)) and 50 patients without H. pylori infection (H. pylori (-)). All of the recruited patients were previously admitted to the Gastroenterology Department of the Namik Kemal University School of Medicine over the period of July 2014 to September 2015. All patients had 20/20 vision and underwent complete ophthalmological examination, macular optical coherence tomography (OCT), and enhanced depth imaging OCT. RESULTS: All patients had 20/20 vision and similar macular thicknesses. The mean SFCT of patients in the H. pylori (+) group was 309 ± 41.1 µm and 315 ± 18.2 µm in the H. pylori (-) group (p = 0.174). The right and left eyes of patients in the H. pylori (+) and (-) groups were not statistically significantly different (p = 0.852, p = 0.937). The age, sex, and choroidal thicknesses of patients in the H. pylori (+) and (-) groups were not correlated. CONCLUSION: H. pylori infection does not have an effect on choroidal thickness in patients without any ocular pathology.

Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy.

AIM: To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). PATIENTS AND METHODS: In this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. RESULTS: The mean follow-up period was 8 months (range: 4-23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye. CONCLUSION: The segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.

Anti-inflammatory and ultrastructural effects of Turkish propolis in a rat model of endotoxin-induced uveitis.

INTRODUCTION: Experimental animal models of acute uveitis, an inflammatory eye disease, can be established via endotoxin-induced inflammation. Propolis, a natural substance collected by honeybees from buds and tree exudates, has antioxidant, antibacterial, antiviral, and anti-inflammatory effects. We investigated the effects of propolis, obtained from the Sakarya province of Turkey, on endotoxin-induced uveitis using immunohistochemical, ultrastructural, and biochemical approaches. MATERIAL AND METHODS: Male Wistar albino rats (n = 6/group) received intraperitoneal (ip) lipopolysaccharide (LPS) endotoxin (150 µg/kg) followed by aqueous extract of propolis (50 mg/kg ip) or vehicle; two additional groups received either saline (control) or propolis only. After 24 h, aqueous humor (AH) was collected from both eyes of each animal for analysis of tumor necrosis factor-α (TNF-α) and hypoxia-inducible factor-1α (HIF-1α). Right eyeballs were paraffin-embedded for immunohistochemical staining of nuclear factor κB (NF-κB)/p65 and left eyeballs were araldite-embedded for ultrastructural analysis. RESULTS: Treatment of LPS-induced uveitis with propolis significantly reduced ciliary body NF-κB/p65 immunoreactivity and AH levels of HIF-1α and TNF-α. Ultrastructural analysis showed fewer vacuoles and reduced mitochondrial degeneration in the retinal pigment epithelium, as compared to the uveitis group. The intercellular spaces of the inner nuclear layer and outer limiting membrane were comparable with those of the control group; no polymorphonuclear cells or stasis was observed in intravascular or extravascular spaces. CONCLUSIONS: This is the first report demonstrating an anti-inflammatory effect of Turkish propolis in a rat model of LPS-induced acute uveitis, suggesting a therapeutic potential of propolis for the treatment of inflammatory ophthalmic diseases.

Endothelial cell loss: Biaxial small-incision torsional phacoemulsification versus biaxial small-incision longitudinal phacoemulsification.

PURPOSE: To compare clinical results of biaxial small-incision torsional phacoemulsification and biaxial small-incision longitudinal phacoemulsification. SETTING: Department of Ophthalmology, School of Medicine, Namik Kemal University, Tekirdag, Turkey. DESIGN: Randomized controlled clinical trial. METHODS: Eyes with high-density nuclear cataract were assigned to have biaxial longitudinal (microburst mode) or biaxial torsional phacoemulsification. The main outcomes included corrected distance visual acuity (CDVA), central corneal thickness (CCT), central endothelial cell density (ECD), total ultrasound time (UST), cumulative dissipated energy (CDE), percentage total equivalent power in position 3, and balanced salt solution volume. Postoperative follow-up was at 1 day, 1 week, and 1 and 3 months. RESULTS: Each group comprised 35 patients (35 eyes). Three months postoperatively, the mean CDVA for each group was 0.02 logMAR and the mean CCT returned to the preoperative level (P=.589 and P=.554, respectively). During the postoperative follow-up, the percentage of mean endothelial cell loss in both groups was between 35.4% and 39.1%; there was no statistically significant difference between the groups (P>.05). The mean CDE, UST, percentage total equivalent power in position 3, and balanced salt solution volume values were similar in the 2 groups (P>.05). CONCLUSION: The risk for high endothelial cell loss should be considered when the phacoemulsification of high-density nuclear cataracts is performed using either method. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intravitreal tigecycline treatment in experimental Acinetobacter baumannii endophthalmitis.

PURPOSE: To investigate the clinical and microbiological effectivity of intravitreal tigecycline in an experimental rabbit endophthalmitis model caused by imipenem resistant Acinetobacter baumannii. MATERIALS AND METHODS: Forty-eight eyes of 24 New Zealand white albino rabbits were divided into six groups (n=8 in each). The right eyes were divided into three groups and defined as infected group; left eyes were divided into three groups and defined as uninfected group. Infected group received 0.1 ml intravitreal A. baumannii suspension. Twenty-four hours after bacterial inoculation, group 1 received 1 mg/0.1 ml tigecycline and group 2 received 0.5 mg/0.1 ml tigecycline. Group 3 eyes received no treatment. In group 4, 0.1 ml of saline solution was injected. Groups 5 and 6 were received intravitreal tigecycline injection of 1 mg/0.1 ml and 0.5 mg/0.1 ml respectively. The eyes were enucleated for histopathological evaluation on the sixth day. Clinical and histological scoring systems were used to evaluate clinical and histological severity of the intraocular infection. RESULTS: The mean clinical scores of the six groups at the sixth day were 11±1.92, 12.4±6.2, 8.5±2.7, 0, 3±1.3, and 3±1.4 respectively. Mean histopathological scores were 7.8±2.8, 7.0±1.5, 5.6±1.4, 0, 0, and 0 respectively. There was no significant difference in mean clinical and histopathological scores of infected group (groups 1, 2 and 3). There was significant difference in mean clinical scores of groups 5 and 6 compared with group 4. Groups 4, 5 and 6 showed normal histological structure in histopathological evaluation and showed no significant difference. Microbiological cure was achieved in all infected eyes. CONCLUSIONS: Experimental rabbit endophthalmitis model caused by imipenem resistant A. baumannii was microbiologically cured by intravitreal tigecycline injection. However, a hypersensitivity-like reaction due to intravitreal application of tigecycline limits the use of this antimicrobial agent in A. baumannii endophthalmitis.