Short-term efficacy of intravitreal bevacizumab for the treatment of macular edema due to diabetic retinopathy and retinal vein occlusion.

PURPOSE: To evaluate the short-term efficacy of intravitreal bevacizumab injection for the management of macular edema due to diabetic retinopathy and retinal vein occlusion. METHODS: Patients with macular edema due to diabetic retinopathy, and retinal vein occlusion were treated with intravitreal bevacizumab and evaluated retrospectively. Standardized ophthalmic evaluation, ETDRS visual acuity measurement, and central macular thickness were performed at baseline and 1 month intervals after injection. RESULTS: There were 23 eyes of 21 patients with macular edema due to diabetic retinopathy (14 eyes of 12 patients), and retinal vein occlusion (9 eyes of 9 patients). The mean baseline logMAR visual acuity and central macular thickness were 0.82 +/- 0.27 and 604.71 +/- 123.62 microm, respectively, in patients with diabetic retinopathy. There was no statistically significant difference between the mean logMAR visual acuity (P = 0.22) and central retinal thickness (P = 0.16) measurements at baseline and 3 months follow-up. The mean baseline logMAR visual acuity and central macular thickness were 0.94 +/- 0.48 and 557 +/- 113.9 microm, respectively, in patients with retinal vein occlusion. There was a statistically significant difference between the mean logMAR visual acuity and central retinal thickness measurements at baseline and 3 months follow-up (P < 0.01). Almost all of the eyes (88.8%) regained normal foveal configuration. CONCLUSIONS: Although our follow-up period was short and the number of patients were limited to provide specific treatment recommendations, intravitreal bevacizumab seems to be more effective for macular edema due to retinal vein occlusion than diabetic macular edema. The favorable short-term results suggest further study is needed.

Conjunctival flora in patients with type 1 or type 2 diabetes mellitus.

Patients with diabetes mellitus (DM) are prone to infection because glucose in the skin, urine, mucous membranes, and tears promotes growth of microorganisms. Conjunctival flora develops soon after birth, and some saprophytic conjunctival flora play a pathogenic role when immune function is compromised, which can lead to serious infection. DM is one condition that may compromise immune status. In lacrimal function tests of DM patients, a decrease in breakup time (BUT) of lacrimal film and a decrease in Schirmer's test results were seen. In the present study, conjunctival flora in patients with DM was compared with that in controls with regard to type and duration of diabetes and results of lacrimal function tests. Seventeen patients with type 1 DM (n=34 eyes), 66 patients with type 2 DM (n=132 eyes), and 50 control subjects (n=100 eyes) were included. The control group consisted of age-matched patients with no ophthalmologic problems other than refractive error. Glycosylated hemoglobin values were measured with highpressure liquid chromatography with the Hi-AUTOA1c analyzer (Kyoto Daiichi Kagatu Co., Ltd., Kyoto, Japan). Type and duration of diabetes and demographic data were recorded, and routine ophthalmologic examinations were performed; the BUT of lacrimal film was determined, and the results of Schirmer's test were assessed. Microbiologic sampling was performed twice for both eyes with sterile cotton swabs. One sample was incubated in 2 mL of brain-heart infusion broth agar; the other was incubated for the presence of fungi in Sabouraud dextrose agar. Colony morphology, hemolysis, and Gram's stain, as well as catalase, oxidase, and coagulase tests were performed. No growth was observed in 12 of 17 patients (35.4%) with type 1 DM, 28 of 66 patients (21.2%) with type 2 DM, and 25 of 50 control subjects (50%). Staphylococcus epidermidis (11.79%) and Staphylococcus aureus (11.7%) were the most frequently isolated organisms in the type 1 DM group, and S epidermidis (24.2%) and S aureus (21.2%) were the predominant organisms in the type 2 DM group. In control subjects, S epidermidis (22%), S aureus (12%), and Corynebacterium spp (10%) were the most frequently isolated organisms, and the number of eyes with growth of S aureus was significantly higher in the type 2 DM group than in the other groups (P<.01). Patients with diabetes are more prone to postoperative endophthalmitis than are nondiabetics, and preoperative application of antiseptic or antimicrobial agents to the conjunctiva may not sterilize the area. Impaired integrity of the posterior capsule may also increase the risk of endophthalmitis. Postoperative endophthalmitis is usually associated with gram-positive organisms (75%-80%); gram-negative organisms (15%-29%) and fungi (3%-13%) account for a smaller number of cases. A high rate of resistance to penicillin, ampicillin, and tetracycline was observed in S aureus isolates, although resistance to vancomycin was absent, rendering this molecule the most effective therapeutic option. In this study, S epidermidis and S aureus were the 2 most frequently isolated organisms in patients with DM. It is concluded that the conjunctival flora in diabetic subjects differs from that in nondiabetic subjects. This should be considered preoperatively and postoperatively, and prophylactic and postoperative treatment should be administered accordingly to diabetic patients.

Chromosome and sister chromatid exchange studies in Behcet's patients.

Behcet's disease is a chronic multisystemic disease of unknown pathogenesis characterized by four major symptoms: oral aphthous ulcers, skin lesions, ocular symptoms and genital ulcerations. The disease is spread throughout the world, but it is most frequent in Turkey, Japan, Korea and China. Although HLA-Bw51 has been found to predominate in Behcet's cases, the genetic etiology has not yet been clarified. In this study, we investigated the chromosomal abnormalities and sister chromatid exchange rates in patients with Behcet's diseases. Thirty-eight patients with Behcet's disease (diagnosed for the first time) and 30 healthy subjects (as controls) were included in this study. Although numerical and structural chromosomal abnormalities were not detected in our patients, we found an increased rate of sister chromatid exchange in patients over the control groups (P < 0.01). On the basis of these results, we discuss the genetic etiology of Behcet's disease.

Rapid improvement of retinal and iris neovascularization after a single intravitreal bevacizumab injection in a patient with central retinal vein occlusion and neovascular glaucoma.

BACKGROUND: Intravitreal injections of bevacizumab have been reported to have anatomical and functional success in treating choroidal neovascularization, macular edema and neovascular glaucoma. We report a case with neovascular glaucoma due to central retinal vein occlusion who demonstrates rapid resolution of anterior and posterior segment neovascularization after a single intravitreal bevacizumab injection. CASE: A 46-year old man with a 6-month history of central retinal vein occlusion presented with neovascular glaucoma. Fluorescein angiography revealed marked leakage from new vessels on the iris, disc and retina. Bevacizumab was used after incomplete panretinal photocoagulation because of inadequate fundus visualization. About a week after intravitreal bevacizumab injection, new vessels were no longer visible. IOP improved and additional laser photocoagulation was performed. CONCLUSION: Intravitreal bevacizumab injection may be a useful alternative or adjuvant treatment for patients with neovascular glaucoma in whom inadequate visualization precludes adequate panretinal photocoagulation.

Corneal degeneration following bicanalicular silicone intubation.

PURPOSE: A case of bilateral arcus-like corneal degeneration in the medial limbal regions following bilateral bicanalicular silicone intubation is reported. METHODS: Case report. RESULTS: Bilateral arcus-like corneal opacifications were observed in the medial limbal regions of a 33-year-old woman 3 months after the bilateral silicone intubation with dacryocystorhinostomy. No clinical signs of infection and direct contact of the silicone tubes with those regions of the corneas were observed. Routine laboratory tests revealed no abnormalities, and serum lipoprotein composition was normal. CONCLUSIONS: Silicone tubing appeared to be the precipitating factor of the corneal opacifications that occurred in this patient.