Long-term full-field and multifocal electroretinographic changes after treatment with ranibizumab in patients with diabetic macular edema.

PURPOSE: To investigate changes in macular and panretinal neuroretinal functions by electroretinographic examinations in eyes with diabetic macular edema (DME) treated with intravitreal ranibizumab. MATERIAL AND METHODS: Sixty-four patients with DME were included in this prospective study. Patients were treated with ranibizumab injection according to the PRN regimen for over 12 months. Before treatment, all patients underwent fundus fluorescein angiography, optical coherence tomography (OCT), best-corrected visual acuity (BCVA) assessment, full-field (ff-ERG), and multifocal electroretinography (mf-ERG). In monthly visits, BCVA and OCT were performed. Besides, mf-ERG recordings were obtained at months 3, 6, 9, and 12, and ff-ERG was performed at month 12. RESULTS: Fifty-eight patients completed the study. The mean age was 61.1 ± 8.5 (39-80) years. The mean number of injections was 6.19 ± 1.9. The decimal BCVA improved from 0.30 to 0.45 during the 12-month follow-up (p < 0.05). Macular thickness decreased from 413.5 µm to 329.5 µm (p < 0.05). The mf-ERG recordings in the central macular region showed improvements N1 and P1 amplitudes at months 9 and 12. There was a positive correlation between the baseline central (p < 001; r: - 0.378 and p < 0.05; r:-0.335, respectively), the second ring (p < 0.05; r: - 0.260 and p < 0.05; r: - 0.270, respectively) P1- and N1-wave amplitudes, and the BCVA at month 12. Full-field ERG recordings showed that peripheral neuroretinal responses were maintained or improved at month 12. Statistically significant improvements in BCVA and macular thickness were observed at all follow-up visits. CONCLUSION: Multifocal electroretinographic recording started to improve 6 months after the beginning of intravitreal ranibizumab treatment in eyes with DME. This improvement was significant at months 9 and 12. A significant improvement in ff-ERG was observed at month 12.

Comparison of Long-Term Automated Retinal Layer Segmentation Analysis of the Macula between Silicone Oil and Gas Tamponade after Vitrectomy for Rhegmatogenous Retinal Detachment.

PURPOSE: To identify long-term changes in individual retinal layer thickness using automated retinal layer segmentation analysis on high-resolution spectral-domain optical coherence tomography (SD-OCT) scans of eyes with macula-off rhegmatogenous retinal detachment (RRD) treated with vitreoretinal surgery (VRS) and gas or silicone oil tamponade and having single-operation success. METHODS: A total of 58 patients operated on by VRS for RRD and followed up for 12 months were imaged by SD-OCT. The patients with retinal diseases such as an epiretinal membrane or cystic macular edema in the operated and fellow eyes were excluded. The thicknesses of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor layer, and retinal pigment epithelium were compared to those of the fellow eyes after the 12-month follow-up. Thickness changes in individual layers were quantitatively analyzed in the operated and fellow eyes and correlated with the type of tamponade used in the surgery. RESULTS: Spectralis OCT automated segmentation software was used for the retinal layer analysis. There were 22 females and 36 males. Their mean age was 60.7 ± 11.2 years. The mean central macular thickness was 214.3 ± 29.5 µm in the operated and 229.7 ± 21.7 µm in the fellow eyes (p = 0.008). There was a statistically significant difference between the operated and the healthy fellow eyes in the following layers: the RNFL (p = 0.017), GCL (p = 0.02), INL (p = 0.005), and ONL (p = 0.008) in the central foveal area; the RNFL (p < 0.001), INL (p = 0.017), and ONL (p = 0.022) in the perifoveal ring; and the RNFL (p < 0.001), IPL (p = 0.042), INL (p = 0.001), and OPL (p = 0.001) in the peripheral ring. The logMAR best corrected visual acuities were 2.51 ± 0.68 and 2.69 ± 0.62 at baseline and 0.60 ± 0.38 and 0.50 ± 0.38 at month 12 in the silicone oil tamponade (n = 28) and the gas tamponade (n = 30) group (p = 0.52 and p = 0.21, respectively). The foveal GCL, OPL, and ONL and the perifoveal GCL and IPL were statistically significantly thinner in the silicone oil tamponade group (p = 0.01, p = 0.046, p = 0.024, p = 0.006, and p = 0.011, respectively). CONCLUSIONS: Significant changes were observed in the retinal layers after VRS for RRD. Individual retinal layers seem to be affected 1 year after VRS for RRD. The type of tamponade can influence the thickness of the retinal layers. The thickness of the retinal layers was significantly preserved in eyes treated with gas tamponade when compared to those treated with silicone oil tamponade in the long term. Further studies are needed to validate our results.

Comparison of navigated laser and conventional single-spot laser system for induced pain during panretinal photocoagulation.

To compare the panretinal photocoagulation (PRP)-induced pain response between novel navigated laser (Navilas) and conventional single-spot laser. The eyes were randomly assigned to Navilas or conventional laser. Contralateral eyes underwent PRP with the other system with 30 min resting interval. Pulse duration was 100 ms in conventional laser and 30 ms or 100 ms in Navilas and power setting was enough to create gray-white light burn on both devices. Pain response was evaluated by verbal scale (VS) (0-4) and visual analog scale (VAS) (0-10) after each PRP application. The mean age of 70 patients (140 eyes) was 62.52 ± 9.49 years. Mean power and spot numbers for Navilas and conventional laser were 291.9 ± 85.3 mW vs 368.4 ± 72.0 mW, and 375.4 ± 108.4 vs 374.2 ± 105.0 (p < 0.001 and p = 0.53, respectively). Pain scores for Navilas and conventional laser were 1.19 ± 0.73 and 1.99 ± 0.84 for VS and 2.41 ± 1.65 and 4.74 ± 2.17 for VAS (p < 0.001 and p < 0.001). More comfortable PRP is achieved with Navilas system in comparison with conventional single-spot laser system. However, small number of patients treated with same pulse duration and different contact lenses used for two systems should be taken into consideration. Besides, we did not report comparative clinical efficiency of either laser system.

Long-term changes in retinal layers in patients undergoing intravitreal ranibizumab for neovascular age-related macular degeneration : Retinal layers after anti-VEGF therapy.

PURPOSE: To analyze long-term changes in individual retinal layers (RLs) after intravitreal injections of ranibizumab (IVRs) in patients with neovascular age-related macular degeneration (n-AMD). METHODS: The patients were treated with 0.5-mg IVRs based on an as-needed protocol after the first three monthly doses over a 12-month follow-up period. Patients underwent optical coherence tomography and best-corrected visual acuity (BCVA) evaluation at each visit. The ETDRS grid with central subfield (R1) (r 0.5 mm) and the inner ring (R2) (r 0.5-1.5 mm) was used for calculation of the mean thickness of each RL. Changes in the thickness of segmented RLs within the R1 and R2 of ETDRS circles at months-3, -6, and -12 were compared to baseline. RESULTS: The mean age was 72 ± 7.4 years. The mean number of injections was 9.08 (range 6-11). Mean BCVA improved from 49.7 ± 22.1 to 60.1 ± 19.8 letters. Central macular thickness decreased from 390.25 ± 149.6 to 312.74 ± 118.4 µm. Thicknesses of GCL (from 23.93 ± 13.73 to 19.50 ± 9.50 µm in R1; p 0.001, and from 44.5 ± 12.6 to 39.6 ± 10.6 µm in R2; p 0.005), IPL (from 28.90 ± 14.36 to 22.35 ± 6.23 µm in R1; p 0.001, and from 39.34 ± 8.53 to 35.58 ± 7.93 µm in R2; p 0.004), and total inner RL (ILM to ELM) (from 222.93 ± 93.09 to 180 ± 53 µm in R1; p 0.001, and from 255.06 ± 42.74 to 240.25 ± 40.37 µm in R2; p 0.003) in the central and parafoveal rings decreased statistically at month-12. Decrease in INL was limited to month-6 (from 34.80 ± 15.33 to 27.60 ± 12.59 µm in R1; p 0.001), while decreases in total outer RLs (ELM to RPE) (from 128.32 ± 26.92 to 115.54 ± 43.98 µm in R1; p 0.001, and 103.81 ± 16.73 to 96.38 ± 16.22 µm in R2; p 0.014) and RPE (from 39.12 ± 22.33 to 29.70 ± 22.05 µm in R1; p 0.001, and from 31.27 ± 13.11 to 24.40 ± 9.99 µm in R2; p 0.001) were limited to month-3. CONCLUSIONS: Significant changes were observed in the thickness of the inner RLs after 1-year treatment with IVRs for n-AMD. A significant decrease in RPE thickness confined to the first months disappeared at month-12.

VITREORETINAL SURGERY FOR PATIENTS WITH SEVERE EXUDATIVE AND PROLIFERATIVE MANIFESTATIONS OF RETINAL CAPILLARY HEMANGIOBLASTOMA BECAUSE OF VON HIPPEL-LINDAU DISEASE.

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.

A review of unilateral acute idiopatic maculopathy related to hand-foot-mouth disease with a representative case.

The purpose of this study was to review unilateral acute maculopathy associated with hand-foot-mouth disease with a representative case. Clinical course of a 24-year-old male case with unilateral acute idiopatic maculopathy documented by multimodal imaging is presented, and a review of similar cases is given. On initial examination, best-corrected visual acuity was 20/200 in the left eye. Fundoscopy revealed grayish-yellowish subretinal exudate, and fluorescein angiography demonstrated irregular mottled hyperfluorescence at the central macula. Spectral domain optical coherence tomography demonstrated disruption of ellipsoid layer, which partially resolved on follow-up examinations. Best-corrected visual acuity increased to 20/20 at 3 months, with persistent retinal changes, and mild disruption of ellipsoid layer and persistent mild metamorphopsia. Although hand-foot-mouth disease is usually benign and self-limited in childhood, it may be rarely associated with unilateral vision loss due to maculopathy, especially at early adulthood in both sexes. Vision loss associated with this eruption is acute and reversible in most cases, despite some residual pigmentary and scarring changes in all cases and persistent mild visual loss in some cases. Exact pathophysiology, the causes of variability of clinical features, adulthood onset, unilateral involvement, and role of multimodal imaging are issues which need to be clarified with further research.

Multifocal electroretinography in subjects with age-related macular degeneration.

PURPOSE: To evaluate retinal function objectively in subjects with different stages of age-related macular degeneration (AMD) using multifocal electroretinography (mfERG) and compare it with age-matched control group. METHODS: A total of 42 subjects with AMD and 37 age-matched healthy control group aged over 55 years were included in this prospective study. mfERG test was performed to all subjects. Average values in concentric ring analysis in four rings (ring 1, from 0° to 5° of eccentricity relative to fixation; ring 2, from 5° to 10°; ring 3, from 10° to 15°; ring 4, over 15°) and in quadrant analysis (superior nasal quadrant, superior temporal quadrant, inferior nasal quadrant and inferior temporal quadrant) were recorded. Test results were evaluated by one-way ANOVA test and independent samples t test. RESULTS: In mfERG concentric ring analysis, N1 amplitude, P1 amplitude and N2 amplitude were found to be lower and N1 implicit time, P1 implicit time and N2 implicit time were found to be delayed in subjects with AMD compared to control group. In quadrant analysis, N1, P1 and N2 amplitude was lower in all quadrants, whereas N1 implicit time was normal and P1 and N2 implicit times were prolonged in subjects with AMD. CONCLUSION: mfERG is a useful test in evaluating retinal function in subjects with AMD. AMD affects both photoreceptors and inner retinal function at late stages.

Long-Term Changes in Submacular Choroidal Thickness after Intravitreal Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration: 14-Mo Follow-Up.

Purpose: To study (i) the long-term effects of intravitreal ranibizumab treatment on changes in submacular choroidal thickness and (ii) the relationship between any resulting changes in choroidal thickness and visual outcomes following such treatment in patients with neovascular age-related macular degeneration (n-AMD). Methods: Reviewed were medical records of 30 consecutive, treatment-naïve, patients with unilateral n-AMD (n = 30 eyes) and unaffected fellow eyes (n = 26 eyes) (controls). Monthly injections of 0.5 mg ranibizumab were administered until stabilization of n-AMD, with additional injections as needed over the following 14-mo. Choroidal thickness was determined using enhanced-depth imaging-optical coherence tomography (EDI-OCT) before and after initiation of ranibizumab therapy. Choroidal thickness measurements were generated via manual segmentation. Results: The mean age of patients was 71.9 ± 7.4 (56-83) years; the mean best-corrected visual acuity (BCVA) of affected eyes improved from 51.1 to 59.4 letters (p < 0.001); and the mean number of injections was 9.16 ± 1.75. Subfoveal choroidal thickness decreased from 208.3 ± 73.7 µm at baseline to 185.3 ± 70.1 µm at mo-14 (p < 0.001), with significant (p < 0.001) decreases at all measured time points. Choroidal thickness also tended to decline in fellow eyes but was only statistically significant nasally 1,000 µm (p =0.04). Mean changes in choroidal thickness did not correlate with BCVA at mo-14 (p = 0.76). Disciform scars and geographic atrophy (p = 0.017), and BCVA (p < 001) at baseline were predictive of visual outcome. Age (p = 0.001), reticular drusen (p = 0.004), and size of choroidal neovascularized area (p = 0.042) were predictive of decreases in choroidal thickness. Conclusions: Submacular choroidal thickness appeared to decrease significantly in eyes with n-AMD over a 14-mo period of ranibizumab treatment. No corresponding decrease in choroidal thickness occurred in fellow eyes.

Multimodal imaging in a child with severe posterior scleritis.

Objective: Posterior scleritis in a child is a rare condition. High-resolution imaging techniques in the course of posterior scleritis have not been published extensively in literature. The authors reported a case of posterior scleritis in a 12-year-old child to demonstrate multimodal imaging techniques in the course of development and improvement of the disease. Methods: Case report that included fundus photography, spectral domain optical coherence tomography with enhanced depth imaging, blue-peak autofluorescence, multicolor imaging, fluorescein angiography, indocyanine green angiography, and ultrasonography. Results: A twelve-year-old healthy boy presented with ocular pain and mild vision loss. His visual acuity was 20/ 32. There was no sign of inflammation on the ocular surface. There were no cells in the anterior chamber or vitreous. Ultrasonography revealed the diagnosis of posterior scleritis. When he was seen the next day for multimodal imaging techniques, he presented with exudative retinal detachment with visual acuity of 20/ 100. One week after the beginning of the therapy, ocular symptoms, and findings resolved and visual acuity improved to 20/ 20. Conclusion: Multimodal imaging techniques, which are important for the diagnosis of posterior scleritis, before and after the treatment, are presented in this case report.

Homocysteinemia as a cause for amaurosis fugax in a patient without an apparent embolic source.

Purpose: To report a case with monocular transient vision loss (TVL) associated with Hyperhomocysteinemia. Methods: We present a case with persistent TVL attacks and high level of homocysteine. Results: A 32-year-old male had a history of episodes of recurrent monocular TVL. Extensive ophthalmic, systemic and laboratory studies were unremarkable with the exception of high plasma homocysteine level. He never experienced TVL during the 36-month follow-up after starting folate, B12 and B6 except for one episode in which he had discontinued the treatment for three months. Conclusion: This case may suggest hyperhomocysteinemia as one of the underlying causes of recurrent attacks of TVL without any known source of emboli.

The association of exudation pattern with anatomical and functional outcomes in patients with Neovascular Age-Related Macular Degeneration.

Objective. To evaluate the correlation between visual outcomes and fluid configuration observed on spectral-domain optical coherence tomography (SD-OCT) in patients with wet age-related macular degeneration (AMD). Methods. Sixty-five eyes of 53 patients with AMD who were administered intravitreal ranibizumab treatment with 12 months of follow-up were included in this retrospective study. Presence of intraretinal cystoid fluid (IRC) and pigment epithelial detachment (PED), thickness of subretinal fluid (SRF), central macular thickness (CMT), and central macular volume (CMV) were assessed. Results. Subretinal fluid was observed in 29 eyes (45%), IRC in 36 eyes (55%), and PED in 39 eyes (60%). Baseline and final best-corrected visual acuity (BCVA) were 0.69±0.4 and 0.60±0.4 logMAR in the IRC negative group and 1.17±0.5 and 0.97±0.5 logMAR in the IRC positive group. BCVA was lower in IRC positive group (baseline p=0.001 and final=0.003); however, marked improvement was detected in both groups. Anatomic improvement and increased visual acuity were observed in groups with and without PED, IRC, and SRF. An inverse correlation was detected between pre-treatment CMT, IRC and post-treatment IRC, and final BCVA. Conclusion. Significant visual and anatomic improvement was observed after one-year of ranibizumab treatment regardless of fluid configuration. However, the presence of IRC was observed to be associated with worse visual acuity. Baseline retinal fluid configuration may have prognostic effects on functional success in patients treated with ranibizumab for wet AMD. Abbreviations. AMD = Age-related macular degeneration, VEGF = Vascular endothelial growth factor, IRC = intraretinal cystoid fluid, PED = pigment epithelial detachment, SRF = subretinal fluid, SD-OCT = spectral-domain ocular coherence tomography, IVR = intravitreal ranibizumab, BCVA = best-corrected visual acuity, FFA = fundus fluorescein angiography, CMT = central macular thickness, CMV = central macular volume.

Bilateral serous retinal detachment accompanied by a rare intraretinal fluid configuration in preeclampsia and PRES Syndrome.

Purpose: To present the association between posterior reversible encephalopathy (PRES) syndrome due to preeclampsia and bilateral serous retinal detachment (SRD) accompanied by intraretinal fluid configuration. Methods: A 24-year-old woman, at 28 weeks of gestation presented with blurred vision bilaterally related to bilateral SRD involving the center of the macula accompanied by intraretinal fluid. The patient was diagnosed as pre-eclampsia accompanied by PRES syndrome. The patient approved and underwent delivery the same day. On day 9, ophthalmologic examination revealed complete resolution of SRD and normal visual acuity bilaterally and cranial MRI showed complete resolution of the vasogenic edema with medical treatment. Conclusion: SRD and accompanying retinal edema must be considered among etiological factors leading to sudden vision loss in patients with preeclampsia and PRES syndrome. Abbreviations: PRES = Posterior reversible encephalopathy, SRD = Serous retinal detachment, SD-OCT = Spectral-domain optical coherence tomography, RPE = Retinal pigment epithelium, CSC = Central serous chorioretinopathy, ONL = Outer nuclear layer, INL = Inner nuclear layer, IPL = Inner plexiform layer, RNFL = retinal nerve fiber layer.

Choroidal Thickness and its Correlations with Ocular Parameters in Primary Open-angle Glaucoma.

OBJECTIVES: To evaluate the relationships between macular choroidal thickness (mCT) and ocular parameters, such as optic nerve head (ONH) and multifocal electroretinogram (mf-ERG) parameters, in cases with primary open-angle glaucoma (POAG). METHODS: This controlled and prospective clinical trial included 49 patients with POAG diagnosed for the first time and 47 healthy participants. Macular CTs, ONH and mf-ERG parameters were measured, and the examination findings were recorded at baseline and follow-ups. RESULTS: In the POAG group, the mean mCT was 254.92±37.65 µm at baseline, and it was 235.6±38.48 µm at 3-month and was 237.55±37.27 µm at 6-month. In the glaucoma group, there was a significant decrease in the first three months despite the treatment, but no significant change was observed in the next three months. In the healthy group, the mean mCTs were 287.78±26.77 µm, 285.48±25.58 µm and 285.02±27.44 µm at baseline, at 3-month and at 6-month, respectively. No significant change was observed in the control group throughout the process. However, the mean mCT values in the glaucoma group were significantly thinner in all controls compared to the healthy group (p<0.05). Furthermore, significant correlations were found between CT and some ONH, as well as mf-ERG parameters. CONCLUSION: The choroid can play an important role in the pathogenesis of glaucoma. Significant correlations in parameters support this relationship. We have observed that the glaucomatous effect initiated first in the inferior quadrant of ONH.

Quality of life among patients with age-related severe macular degeneration assessed using the NEI-VFQ, HADS-A, HADS-D and SF-36 tests. A cross-sectional study.

BACKGROUND: Exudative age-related macular degeneration (e-AMD) may cause severe central vision loss. Patients with e-AMD can experience difficulties in daily basic activities and suffer from psychological problems. Our aim was to assess quality of life (QoL) and anxiety and depression status among patients with e-AMD. DESIGN AND SETTING: Cross-sectional study in a state university. METHODS: We included 200 e-AMD patients and 120 age and gender-matched controls. We assessed QoL using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and the Short Form (SF)-36 test; and anxiety and depression status using the Hospital Anxiety Depression Scales A and D (HADS-A and HADS-D). RESULTS: The mean ages in the e-AMD and control groups were 68.40 ± 9.8 and 66.31 ± 8.98, respectively. Visual acuity among e-AMD patients was 0.37 ± 0.31 and 0.39 ± 0.32 in the right and left eyes, respectively. The e-AMD patients performed significantly worse than the controls in NEI-VFQ-25 (P < 0.05 for all items). The proportions of e-AMD patients scoring higher than the cutoffs in HADS-A and HADS-D were significantly higher than among the controls (41.5% versus 12.5% and 63.5% versus 27.5%; P < 0.001). The e-AMD patients had significantly lower mean scores than the controls for each of the SF-36 QoL items (P < 0.001). The NEI-VFQ-25 scores were significantly lower among patients with bilateral e-AMD than among those with unilateral disease (P < 0.05 for all). The HADS scores were positively correlated with duration of e-AMD and patient age, but negatively with vision levels (P < 0.05 for all items). CONCLUSION: The e-AMD patients had higher depression and anxiety scores and lower QoL scores.

PASCAL laser platform produces less pain responses compared to conventional laser system during the panretinal photocoagulation: a randomized clinical trial.

BACKGROUND: Most of patients experience pain during the panretinal photocoagulation(PRP). Laser photocoagulation delivery has advanced with the introduction of pattern-scanning laser systems (PASCAL). Shorter pulse duration and less choroidal penetration believed to reduce pain during the laser treatment. OBJECTIVES: To compare the severity of expressed pain scores in patients with PDR who underwent PRP either with PASCAL laser or conventional laser. METHODS: A total of 28 patients with a diagnosis of PDR who were scheduled for bilateral PRP therapy were enrolled into the prospective study. Both eyes were treated within the same session and while one eye was treated with PASCAL the other was treated with conventional laser randomly. Pulse duration was adjusted to 100-ms in conventional laser and 30 ms in PASCAL. The severity of pain was graded using a verbal scale and a visual analog scale (VAS). RESULTS: Mean age was 61.36±9.10 years. Mean verbal and VAS scores were 1.32±0.47 and 2.86±1.21 in the PASCAL laser and 2.39±0.49 and 5.75±1.35 in the conventional laser group, respectively. Differences between expressed pain scores obtained by both two scales were statistically significant (p<0.001). CONCLUSION: PASCAL laser significantly alleviates pain levels possibly due to the shorter laser pulse duration and lower intensity.

Preclinical safety evaluation of intravitreal injection of full-length humanized vascular endothelial growth factor antibody in rabbit eyes.

PURPOSE: To evaluate the preclinical safety of intravitreal bevacizumab, which is a full-length humanized monoclonal antibody against the vascular endothelial growth factor (VEGF), in rabbit eyes over a short-term period. METHODS: Twenty-four rabbits were divided into two groups, each with two subgroups. The first group (groups 1 and 2) received 1.25 mg (0.05 mL) intravitreal bevacizumab, and the second group (groups 3 and 4) received 3.00 mg (0.12 mL) intravitreal bevacizumab. The right eyes were designated as the study eyes, and the left eyes served as a control and received the same volume of saline intravitreally. Groups 1 and 3 were labeled as early groups and scheduled to be terminated at 14 days. Groups 2 and 4, labeled as late groups, were scheduled to be terminated at 28 days. Besides electroretinography (ERG) and visually evoked potentials (VEP), central corneal thickness, intraocular pressure, fundus photography, and anterior segment imaging were performed at baseline and scheduled time points. Enucleated eyes were preserved for light and electron microscopic investigation. RESULTS: No anterior segment inflammation was observed, except in one eye in group 1 which showed a uveitic reaction. No evidence of retinal toxicity was seen with intravitreal bevacizumab at doses of 1.25 and 3.00 mg, by either ERG or light microscopy. Electron microscopic assessment revealed mitochondrial damage in the inner segments of photoreceptors. Immunohistochemical staining with bax and caspase-3 and -9 showed intensive apoptotic protein expression in all study sections and minimal expression in the control eyes. CONCLUSIONS: Although electrophysiologic investigation and light microscopy showed normal retinal function and structure, mitochondrial disruption in the inner segments of photoreceptors was detected by electron microscopy, and apoptotic expression was detected after the injection of intravitreal bevacizumab.

Efficacy of topical caspofungin in experimental fusarium keratitis.

PURPOSE: To evaluate the efficacy of caspofungin in an experimental rabbit model of Fusarium keratitis and to compare it with amphotericin B. METHODS: Eighteen New Zealand white rabbits were randomly divided into 2 treatment groups and 1 control group. One cornea of each rabbit was inoculated with Fusarium solani spores. The first group received topical amphotericin B 0.15%, the second group received topical caspofungin 1%, and the control group received topical balanced salt solution hourly for 2 days and then 4 times daily for 3 additional days. Treatment effects were evaluated by clinical assessment at days 3 and 5 and by fungal culture after 5 days of treatment. RESULTS: In the treatment groups, progression of keratitis was inhibited, and cultures were sterile at the end of the study. In the control group, keratitis progressed, and cultures were positive for F. solani. CONCLUSIONS: Topical caspofungin is effective in Fusarium keratitis, and clinical efficacy studies seem justified.

Effects of intravitreal moxifloxacin and dexamethasone in experimental Staphylococcus aureus endophthalmitis.

PURPOSE: To evaluate the effects of intravitreal moxifloxacin and moxifloxacin and dexamethasone combination in an experimental rabbit model of Staphylococcus aureus endophthalmitis. METHODS: The right eyes of 24 rabbits weighing 2 to 3 kg were used. Ten thousand colony-forming units (CFU) of S. aureus in 0.1 ml saline solution were inoculated into the vitreous cavity. The eyes were randomly assigned to one of the four groups equally. Twenty-four hours after the inoculation of S. aureus, group 1 received 50 microg moxifloxacin, group 2 received 50 microg moxifloxacin plus 400 microg dexamethasone, and group 3 received 1 mg vancomycin intravitreally. No treatment was given to group 4. Clinical examination scores were recorded. Vitreous aspirates were obtained for microbiological analysis just before sacrifice, and the eyes were enucleated for histopathologic examination. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: In all treatment groups, mean number of CFU and histopathologic score were significantly lower compared with control group (p<0.05), and the difference between treatment groups was not statistically significant (p>0.05). The clinical score was not significantly different between groups (p>0.05). CONCLUSIONS: Intravitreal injection of 50 microg moxifloxacin was effective in the treatment of S. aureus endophthalmitis. Bacteriological, histopathologic, and clinical outcomes after treatment using moxifloxacin, moxifloxacin and dexamethasone combination, and vancomycin were comparable. Intravitreal moxifloxacin may be an option in the treatment of S. aureus endophthalmitis.

The effects of caspofungin and voriconazole in experimental Candida endophthalmitis.

PURPOSE: To evaluate the efficacy of newly developed antifungal agents caspofungin and voriconazole in Candida albicans endophthalmitis in rabbit eyes. METHODS: Thirty New Zealand white rabbits were divided into four treatment groups and one control group. One eye of each rabbit was infected by inoculation of 1 x 10(4) CFU/ml of C. albicans. Seventy-two hours after the inoculation, caspofungin 100 microg/0.1 ml in group 1 (n = 6), voriconazole 50 microg/0.1 ml in group 2 (n = 6), amphotericin B 10 microg/0.1 ml in group 3 (n = 6), itraconazole 10 microg/0.1 ml in group 4 (n = 6), and 0.1 ml NaCl 0.9% in control group (n = 6) were injected into the vitreous cavity. Clinical and histopathologic examination scores and microbiological analysis of vitreous aspirates were compared. RESULTS: There was statistically significant difference in the clinical scores, histopathologic scores, and mean CFU/ml between the treatment and control groups (p < 0.05). In caspofungin and voriconazole groups, histopathologic scores and mean CFU were lower than other treatment groups and control group. CONCLUSIONS: Intravitreal injection of caspofungin and voriconazole was effective against C. albicans endophthalmitis in this experimental rabbit model.

Factors Affecting Compliance to Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Patients with Age-Related Macular Degeneration.

OBJECTIVES: To determine factors influencing compliance in patients with neovascular age-related macular degeneration (n-AMD) undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy. MATERIALS AND METHODS: The files of n-AMD patients recommended treatment with ranibizumab were reviewed retrospectively. The treatment regimen was 3 consecutive monthly injections followed by monthly follow-up with intravitreal injections as needed (pro re nata, PRN). Demographic and ocular characteristics were recorded. The patients were categorized into 2 groups: full compliance to treatment, or incomplete loading schedule and/or irregular maintenance treatment. All patients were interviewed by phone about factors affecting continuation of treatment. RESULTS: Mean age of the 314 patients (160 female, 154 male) included in the study was 71.6±9.1 years. A total of 246 patients (78.3%) could complete 3 consecutive injections at 1-month intervals after the start of treatment; 57 patients (18.2%) did not attend monthly follow-up during the 1-year follow-up period following the 3 consecutive monthly injections. Overall, 39.8% of the patients were not able to fully comply with the ranibizumab treatment by PRN regimen for 1 year. Better visual acuity at baseline, smaller lesion size, living closer to the hospital, higher education and sociocultural level, and better financial status were determined as factors affecting patient compliance. The most frequent reasons to discontinue treatment were fear of injection, disbelief in the benefit of the treatment, financial limitations, continuation of treatment at another center, and comorbid systemic diseases. CONCLUSION: Patient compliance and success rates of anti-VEGF therapy may be increased by determining the factors affecting patient compliance and raising awareness about n-AMD among patients and their relatives.