Expert recommendations for the management of diabetic macular edema with intravitreal dexamethasone implant: A Turkish Delphi study.

PURPOSE: To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. METHODS: A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. RESULTS: A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION: This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.

Internal ophthalmomyiasis presenting as endophthalmitis associated with an intraocular foreign body.

Ophthalmomyiasis interna infestation by fly larva can present in various forms. A 3-year-old girl with a 15-day history of pain, redness, and tearing of the right eye was referred to our clinic with the diagnosis of endophthalmitis associated with an intraocular foreign body, based on clinical and ultrasonographic findings. The patient underwent pars plana vitrectomy, during which an 8-mm long larva was encountered within the vitreous cavity. It was removed and identified as a cattle botfly. The patient developed a retinal detachment 1 month postoperatively, but the family refused further treatment and the patient was lost to follow-up. Ophthalmomyiasis should be included in the differential diagnosis of endophthalmitis and intraocular foreign bodies in patients from rural areas.

Evaluation of the functions of the parvocellular and magnocellular pathways in strabismic amblyopia.

PURPOSE: To evaluate the functions of the magnocellular and parvocellular pathways in strabismic amblyopia. METHODS: Visual evoked potentials produced by achromatic and chromatic stimuli in 14 children with strabismic amblyopia were compared with those in 14 age-matched control subjects. The achromatic sine-wave grating with low spatial frequency was used to stimulate the magnocellular pathway, whereas the parvocellular pathway was stimulated by the chromatic sine-wave grating (isoluminant red-green) with low and high spatial frequencies. RESULTS: When the achromatic stimuli with low spatial frequency were used, the latencies of the N1 and P1 components and the amplitude of the N1-P1 complex were similar in the children with strabismic amblyopia and the control subjects. There also were no differences between the amblyopic and non-amblyopic eyes of the children with strabismic amblyopia. When chromatic stimuli with low and high spatial frequencies were used, the latencies of the N1 and P1 components were significantly longer and the amplitude of the N1-P1 complex was significantly smaller in the children with strabismic amblyopia than in the control group. When the amblyopic and non-amblyopic eyes of the children with strabismic amblyopia were compared, the latencies of the N1 and P1 components were longer and the amplitude of the N1-P1 complex was smaller in the amblyopic eyes. CONCLUSION: In strabismic amblyopia, the cells in the parvocellular pathway may be more involved, whereas the magnocellular pathway may be relatively spared.

Excitability changes at brainstem and cortical levels in blind subjects.

OBJECTIVES: This study was designed to search potential changes in trigemino-facial system in blind subjects by the use of relatively well-established electrophysiological methods. Excitability changes in the motor cortex were also investigated by transcranial magnetic stimulation studies (TMS) with the expectation of finding some abnormal interactions between the cortex and brainstem. METHODS: Twenty blind (BS) and 13 control subjects (CoS) were included in the study. Blink reflex and its recovery with paired electrical stimulation were studied at 150, 200, 300, 400 and 500 ms interstimulus intervals (ISI). Facial F waves elicited by buccal branch stimulation were recorded from nasalis muscles. Motor cortex excitability with recordings from left first dorsal interosseus muscle was studied by using magnetically elicited silent periods and paired magnetic stimuli, subthreshold conditioning and suprathreshold test, given at ISIs of 2, 3, 4, 10, 12, 15 and 20 ms. RESULTS: Blink reflex recovery was significantly reduced in BS group comparing to CoS at 400 and 500 ms ISIs. This difference between the groups was more prominent for the responses evoked by the initial stimulation side and faded away with stimulations on the contralateral side. Facial F wave amplitudes and F/M amplitude ratios were higher in BS group. In TMS studies, the early inhibitions at 2 and 4 ms were found to be significantly less in BS as compared to that of CoS. CONCLUSIONS: The reduced blink reflex recovery and its fast restoration with continuing stimulation might be explained by conditioning and extinction processes which have been shown to be mainly carried out by cerebellar-brainstem pathways. Our TMS studies showed reduced intracortical inhibition in the motor cortices of BS cases and facial F wave studies revealed the possible effect of this altered excitability on the facial motor nuclei. SIGNIFICANCE: Firing probabilities of facial motor neurons in BS are probably determined by the equilibrium between the low-set excitability of blink reflex interneurons and the enhanced excitability brought on by the descending motor pathways.

Assessment of anterior chamber inflammation after intravitreal bevacizumab injection in different ocular exudative diseases.

PURPOSE: To investigate the inflammation of the anterior chamber after intravitreal bevacizumab injection in different ocular exudative diseases. METHODS: The study included 76 eyes from 62 consecutive patients with different ocular exudative diseases. The patients were divided into the 3 following groups: group 1 (nonproliferative diabetic retinopathy), group 2 (choroidal neovascularization secondary to age-related macular degeneration), and group 3 (macular edema with branch or central retinal vein occlusion). The study also included 32 age-matched control patients. Inflammation of the anterior chamber was examined with flare-cell photometry before and after an intravitreal injection of 1.25 mg of bevacizumab. RESULTS: There were no statistically significant differences between the measurements at baseline and postoperative day 1, 3, 7, or 30 in any of the groups (p>0.05). CONCLUSIONS: The extent of inflammation in the anterior chamber did not change after intravitreal bevacizumab injection in patients with nonproliferative diabetic retinopathy, choroidal neovascularization secondary to age-related macular degeneration, or macular edema due to branch or central vein occlusion.