Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year results.

PURPOSE: To evaluate the 3-year results of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in keratoconus patients with previous corneal collagen crosslinking (CXL) treatment. METHODS: Twenty eyes of 20 keratoconus patients who underwent DALK surgery using the big-bubble technique after CXL treatment between January 2011 and September 2015 were retrospectively reviewed. All patients completed 3 years follow-up. Intraoperative and postoperative complications were recorded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), maximum keratometry, keratometric astigmatism and endothelial cell density (ECD) were analysed. RESULTS: The mean interval between CXL and DALK surgery was 47.5 ± 24.0 months (mean ± SD). DALK was completed in all eyes. Big-bubble was successfully achieved in 16 eyes (80%), and manual dissection was performed in four eyes (20%). Microperforation occurred in three eyes (15%). Postoperatively, persistent epithelial defect occurred in three eyes (15%). The mean UCVA and mean BSCVA values were significantly improved preoperatively to all postoperative visits (p < 0.001). UCVA was 20/100 or lower in all eyes preoperatively and 20/100 or better in 18 eyes (80%) at 3 years; BSCVA was 20/40 or better in all eyes (100%) and 20/20 or better in three eyes (15%), and keratometric astigmatism was lower than 4 dioptres in 14 eyes (70%) at 3 years. The mean ECD loss was 6.3 ± 4.4% at 1 year, 9.0 ± 6.3% at 2 years and 11.2 ± 7.4% at 3 years. CONCLUSION: Previous CXL treatment in keratoconus patients did not cause a negative impact on the visual, refractive and surgical outcomes of DALK surgery using the big-bubble technique. DALK surgery seems to be a safe and effective surgical approach in these patients.

Fluorescein angiography as a primary guide for reduced-fluence photodynamic therapy for the treatment of chronic central serous chorioretinopathy.

PURPOSE: The aim of this study is to investigate the results of fluorescein angiography (FA)-guided reduced-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSCR), with the hypothesis that indocyanine green angiography (ICGA) guidance is avoidable in some cases. METHODS: This retrospective study includes a consecutive nonrandomized series of chronic CSCR cases. All eyes were examined with FA and the ones that had discrete active leakage areas or points had undergone reduced-fluence PDT. RESULTS: The study included 45 eyes of 41 patients with a mean age of 48.8 ± 10.7. The main duration of last chronic CSCR episode was 13.0 ± 11.9 months. Thirty-nine (86.7%) out of 45 consecutive eyes had active leakage area(s) on FA, which enabled them to be treated with PDT. Remaining six eyes had undergone ICGA examination and had received an ICGA-guided PDT. In FA-guided eyes, the mean BCVA improved from 0.44 ± 0.25 Snellen lines to 0.63 ± 0.32 lines in the last control visit (p < 0.001). Both central macular thickness and subfoveal choroidal thickness decreased significantly in treated eyes. Thirty-eight eyes (97.4%) in FA-guided group and six eyes (100.0%) in ICGA-guided group had total resorption of subretinal fluid. CONCLUSION: This study provides basis to support the hypothesis that FA-guided half-fluence PDT may be justified as an alternative method of treatment in appropriate cases of chronic CSCR without compromising the therapeutic success.

Evaluation of xenon, light-emitting diode (LED) and halogen light toxicity on cultured retinal pigment epithelial cells.

OBJECTIVE: To compare the possible toxic effects of three light sources used in vitreoretinal endoillumination systems; halogen, xenon, and light-emitting diode (LED) on retinal pigment epithelium (RPE) cell cultures, after two different exposure times. MATERIAL AND METHODS: ARPE-19 human RPE cell cultures were exposed to halogen, xenon, and LED light sources at a distance of 1.5 cm for 30 and 60 min with equal lumen output levels. Cells in the control group were not exposed. RPE cell cultures were compared in terms of cell viability, DNA damage, apoptosis rate, and IL-1ß, IL-6, and TNF- α levels. RESULTS: The halogen light group showed significantly more DNA damage, higher TNF-α, IL-1ß, and IL-6 levels, and lower viable cell count at 30 min compared to the control group. The rates of early and late apoptosis were also significantly higher at 60 min. There were no statistically significant differences in any of the parameters between the xenon and LED light sources and the control group at 30 or 60 min. CONCLUSION: New generation lights, xenon, and LED, seem to be safe in terms of RPE cells. Halogen light may cause toxic effects on RPE cells when used for a long time with maximal power output.

Comparison of serum thiol-disulphide homeostasis and total antioxidant-oxidant levels between exudative age-related macular degeneration patients and healthy subjects.

PURPOSE: The purpose of the study was to calculate serum total oxidant status (TOS), total antioxidant status (TAS), and dynamic thiol-disulphide (T-D) homeostasis in patients with age-related macular degeneration (AMD), and compare the results with healthy individuals. METHODS: Thirty-three exudative AMD patients and 33 healthy controls were included in this case-control study. Participants' serum TAS and TOS levels were measured. In addition, total thiol (TT), native thiol (NT), and disulphide (DS) concentrations were assessed using a novel automated method of measurement. RESULTS: In comparison with the control group, serum TAS, TT, and NT levels were found to be significantly lower (p < 0.0001, p = 0.004, p = 0.003, respectively) and TOS levels were detected higher (p = 0.032) in AMD patients. Serum DS levels were elevated in the AMD patient group, but the difference was not statistically significant (p = 0.219). DS/TT and DS/NT ratios were significantly higher (p = 0.012, p = 0.013, respectively) in AMD patients. A positive correlation was found between TT and NT (p < 0.0001) in AMD group. CONCLUSIONS: Serum TOS levels are higher, TAS levels are lower, and the T-D balance is shifted to the DS bond side in AMD patients. These results suggest that increased oxidative stress and decreased antioxidant levels may play a role in AMD progression. Further studies are needed to confirm the pathophysiologic role of T-D homeostasis in AMD.

The effect of intracameral anesthesia on macular thickness and ganglion cell-inner plexiform layer thickness after uneventful phacoemulsification surgery: prospective and randomized controlled trial.

BACKGROUND: To evaluate the effect of intracameral lidocaine anesthesia on macular thickness and macular ganglion cell-inner plexiform layer (GC-IPL) thickness following uneventful phacoemusification in healthy subjects. METHODS: This is a prospective, randomized and double- masked study. One hundred eyes of 74 consecutive patients were randomized to receive intracameral preservative-free lidocaine 1 % (intracameral lidocaine group) or intracameral injection of balanced salt solution (sham injection group) at the time of the phacoemulsification surgery. Preoperative and postoperative macular thickness analyses with spectral domain optical coherence tomography (SD-ODT) were performed and the results between the two groups were compared. RESULTS: Postoperatively, both the central foveal thickness (CFT) and the thickness of perifoveal macula were significantly improved in both groups (p < 0.001). There was no statistically significant difference between CFT and the inner and outer macular zone thicknesses of the two groups at any follow-up time. In both groups, GC-IPL thickness was significantly increased at the first week and first month visits (p < 0.001). There was no statistically significant difference between GC-IPL thickness measurements of the two groups at any follow-up time. CONCLUSION: The current study demonstrated that supplementary intracameral lidocaine 1 % did not cause more macular thickening than the intracameral sham injection during a follow-up period of 3 months. The present study also showed a tendency for a transient increase in high definition SD-OCT-based GC-IPL thickness measurements within a few months following cataract surgery under both intracameral lidocaine anesthesia and intracameral sham injection.

The prevalence of 4G/5G polymorphism of plasminogen activator inhibitor-1 (PAI-1) gene in central serous chorioretinopathy and its association with plasma PAI-1 levels.

CONTEXT: Central serous chorioretinopathy (CSCR) is a poorly understood disease and the choroidal circulation abnormality induced by the plasminogen activator inhibitor type 1 (PAI-1) seems to be associated with the pathogenesis. There are many reports indicating that 4 G/5 G polymorphism of the PAI-1 gene is a risk factor for several diseases related to the elevated serum levels of PAI-1. OBJECTIVE: To evaluate the 4 G/5 G polymorphism of the PAI-1 gene and its association with serum levels of PAI-1 in acute CSCR patients. MATERIALS AND METHODS: Sixty CSCR patients and 50 healthy control patients were included. The PAI-1 4 G/5 G was genotyped using the polymerase chain reaction-restriction technique. Serum PAI-1 level was measured using enzyme-linked immunosorbent assay. Demographic data consisting of age, sex, body mass index (BMI) as well as genotype disturbances and serum PAI-1 levels were compared between the groups. Statistical significance for differences in the serum PAI-1 levels of each group with different genotypes was also analyzed. RESULTS: The CSCR group consisted of 40 male (66.7%) and 20 female (33.3%) patients with a mean age of 46.7 ± 8.39 years. The control group consisted of 32 male (64%) and 18 female (36%) healthy subjects with a mean age of 45.8 ± 8.39 years. There was no statistically significant difference between the groups in terms of age, sex and BMI. In the CSCR group the genotype frequencies were 4 G/4G: 30% (n = 18), 4G/5 G: 50% (n = 30), 5 G/5G: 20% (n = 12) and in the control group genotype frequencies were 34% (n = 17), 42% (n = 21) and 24% (n = 12), respectively. There was no statistically significant difference in the distribution of genotypes among the groups (chi-squared, p = 0.70). The CSCR group had a significantly higher serum PAI-1 concentration than the control group (p = 0.001). In both groups the mean plasma PAI-1 concentration did not vary significantly among the different genotypes (p > 0.05). DISCUSSION AND CONCLUSION: Although our results demonstrated that the patients with acute CSCR have higher serum PAI-1 concentrations than the controls, no significant difference was found in the genotype disturbances of the PAI-1 gene between the groups. The current study indicates that 4 G/5 G polymorphism in the promoter of the PAI-1 gene cannot be considered a risk factor for the elevated serum PAI-1 levels and consequent development of CSCR.

Scleral fixation underneath an intact conjunctiva.

PURPOSE: To describe a technique for the fixation of intraocular lenses or capsular tension rings through the ciliary sulcus or pars plana. METHODS: This alternative technique allows burial of the knot and the free suture ends within the sclera, without using a scleral flap or pocket or even a conjunctival opening. RESULTS: No suture exposure has occurred with the use of the suture burial technique in approximately 25 eyes in 4 years. Additional benefits include less patient discomfort and an improved anatomic and cosmetic outcome starting from the first postoperative day. CONCLUSIONS: This technique causes minimal tissue damage and scarring with almost no postoperative discomfort.

Toric implantable collamer lens for moderate to high myopic astigmatism: 3-year follow-up.

BACKGROUND: To evaluate the 3-year clinical outcomes after toric implantable collamer lens (ICL) implantation for the management of moderate to high myopic astigmatism. METHODS: Thirty-four eyes of 20 patients who underwent toric ICL implantation were reviewed. All eyes completed 3-year follow-up. Uncorrected (UDVA) and corrected (CDVA) distance LogMAR visual acuities, refraction, endothelial cell density (ECD), and surgical complications were evaluated. Vectorial analysis of astigmatic correction was also done. RESULTS: A significant improvement in UDVA, CDVA, manifest spherical and cylindrical refraction was observed at 1 week and remained stable after 3 years. Twenty-six eyes (76.5%) gained lines of CDVA, and two eyes (5.9%) showed a loss of 1 line of CDVA. The spherical equivalent (SE) was within ±0.50 D of emmetropia in 18 eyes (52.9%) and within ±1.00 D in 28 eyes (82.4%). Differences between target-induced astigmatism (TIA) and surgically-induced astigmatism (SIA) were statistically significant (p < 0.01), and a trend to undercorrection of the refractive astigmatism was present after 3 years. The magnitude of flattening effect (FE) was found to be significantly lower than the magnitude of TIA (p < 0.01). The magnitude of the torque vector was always positive, with a value below 0.50 D in all cases. No vision-threatening complications were observed during the follow-up. CONCLUSION: Toric ICL implantation is an effective and safe surgical option that provides a relatively predictable and stable refractive correction of myopic astigmatism. Further improvements are needed to minimize the degree of undercorrection.

Detection and Classification of Diabetic Macular Edema with a Desktop-Based Code-Free Machine Learning Tool.

Objectives: To evaluate the effectiveness of the Lobe application, a machine learning (ML) tool that can be used on a personal computer without requiring coding expertise, in the recognition and classification of diabetic macular edema (DME) in spectral-domain optical coherence tomography (SD-OCT) scans. Materials and Methods: A total of 695 cross-sectional SD-OCT images from 336 patients with DME and 200 OCT images of 200 healthy controls were included. Images with DME were classified into three main types: diffuse retinal edema (DRE), cystoid macular edema (CME), and cystoid macular degeneration (CMD). To develop the ML model, we used the desktop-based code-free Lobe application, which includes a pre-trained ResNet-50 V2 convolutional neural network and is available free of charge. The performance of the trained model in recognizing and classifying DME was evaluated with 41 DRE, 28 CMD, 70 CME, and 40 normal SD-OCT images that were not used in the training. Results: The developed model showed 99.28% sensitivity and 100% specificity for class-independent detection of DME. Sensitivity and specificity by labels were 87.80% and 98.57% for DRE, 96.43% and 99.29% for CME, and 95.71% and 95.41% for CMD, respectively. Conclusion: To our knowledge, this is the first evaluation of the effectiveness of Lobe with ophthalmological images, and the results indicate that it can be used with high efficiency in the recognition and classification of DME from SD-OCT images by ophthalmologists without coding expertise.

Scleral buckling with a non-contact wide-angle viewing system.

PURPOSE: To assess the outcome of scleral buckling surgery using a non-contact wide-angle viewing system for fundus visualization in patients with rhegmatogenous retinal detachment without proliferative vitreoretinopathy. PATIENTS AND METHODS: Sixteen eyes of 16 patients underwent scleral buckling using a non-contact wide-angle viewing system combined with a 25-gauge illumination fibre inserted into the sclera at the pars plana. RESULTS: The mean age of the patients was 53.6 ± 13.7 years and the mean follow-up time was 13.4 ± 2.8 months. Retinal reattachment was achieved in 13 of the 16 eyes (81%). Three eyes underwent vitrectomy with silicone oil injection because of development of proliferative vitreoretinopathy in 2 eyes and scleral perforation due to excessive indentation during cryoretinopexy in 1 eye. Two eyes developed limited subretinal haemorrhage during subretinal fluid drainage. CONCLUSION: Simultaneous use of a non-contact wide-angle viewing system combined with a 25-gauge light fibre illumination for fundus visualization brings the advantages of microsurgery and indirect ophthalmoscopy into scleral buckling surgery.

In vivo generated autologous plasmin assisted vitrectomy in young patients.

BACKGROUND: Autologous plasmin enzyme facilitates the induction of posterior vitreous detachment(PVD) during vitrectomy in young patients. We proposed the concept of in-vivo generated plasmin which is based on the injection of tissue plasminogen activator(t-PA) and autologous whole blood(AWB) into the vitreous cavity. The purpose of this pilot study is to report the efficacy of preoperative simultaneous intravitreal injection of(t-PA) and autologous whole blood in facilitating the intraoperative induction of PVD in young patients with various vitreoretinal pathologies. METHODS: Seventeen eyes of 16 young patients with various vitreoretinal pathologies requiring vitrectomy, who received simultaneous intravitreal injection of 0.1 ml of AWB and 25 µg of t-PA, 3 days prior to surgery were retrospectively reviewed. Outcome measures were the number of attempts required to achieve successful intraoperative separation of the posterior hyaloid; the postoperative visual acuity; and intraoperative and postoperative complications. RESULTS: The mean age of the patients was 23.87 ± 10.09 years, ranging from 10 to 39 years. Eight of 16 patients were men. The mean follow-up time was 19.35 ± 5.04 months, ranging from 12 to 26 months. Surgical indications for vitrectomy were chronic retinal detachment (n = 7), traumatic retinal detachment without proliferative vitreoretinopathy(n = 3), traumatic macular hole(n = 1), secondary vasoproliferative tumor(n = 4) and optic pit maculopathy(n = 2). Patients with retinal detachment complicated with PVR and those who were older than 40 years of age were excluded from the study. Separation of the Weiss ring from the optic nerve head was achieved intraoperatively in all cases, with a mean number of 2.86 ± 1.4 attempts. While the mean preoperative LogMAR visual acuity was 1.38 ± 0.59, ranging from 2.40 to 0.50, it was a mean of 0.51 ± 0.29, ranging from 1.00 to 0.10 at final postoperative exam(p < 0.001; paired samples t-test). No preoperative or intraoperative complications were noted. CONCLUSION: Preoperative simultaneous intravitreal injection of 25 µg t-PA with 0.1 ml of AWB facilitates the intraoperative induction of posterior vitreous detachment in young patients.

Effect of Previous Crosslinking on Intraoperative and Postoperative Outcomes and Complication Rates of Big-Bubble Deep Anterior Lamellar Keratoplasty for Keratoconus: A Comparative Study.

PURPOSE: To compare surgical outcomes and intraoperative and postoperative complications of big-bubble deep anterior lamellar keratoplasty (DALK) in patients with and without a history of previous corneal collagen crosslinking (CXL) for keratoconus. METHODS: Patients with keratoconus who underwent DALK surgery with big-bubble technique between January 2013 and January 2018 were retrospectively reviewed. Operative findings, intraoperative and postoperative complications, and visual and refractive outcomes were recorded. Patients were divided into 2 groups: with previous CXL (CXL-DALK group: 27 eyes) and without previous CXL (DALK group: 50 eyes). All parameters were compared between groups. RESULTS: Big bubble was successfully achieved in 24 eyes (88.9%) in the CXL-DALK group and in 45 eyes (90.0%) in the DALK group (P = 0.87). Type 1 bubble was obtained in 22 eyes (91.7%) in the CXL-DALK group and in 42 eyes (93.3%) in the DALK group (P = 0.79). Intraoperative microperforation occurred in 3 eyes (11.1%) in the CXL-DALK group and in 5 eyes (10.0%) in the DALK group (P = 1). Visual and refractive outcomes were similar between groups. The mean endothelial cell loss rates were 5.7% ± 2.3 at 1 year and 10.2 ± 3.1 at 2 years in the CXL-DALK group and 6.4% ± 4.7 at 1 year and 10.9% ± 5.4 at 2 years in the DALK group. Postoperatively, persistent epithelial defect was the most common complication in both groups, and postoperative complication rates were similar between groups. CONCLUSIONS: Our results have shown that previous CXL treatment does not influence the success of bubble formation and does not increase intraoperative or postoperative complication rates of DALK surgery for keratoconus. The improvement in visual acuity and refractive errors and endothelial cell loss rates were similar between CXL treated and untreated eyes after 2 years of follow-up.

Fluorescein angiography-guided photodynamic therapy with half-dose verteporfin for chronic central serous chorioretinopathy.

PURPOSE: The purpose of this study was to evaluate the results of fluorescein angiography-guided photodynamic therapy with half-dose verteporfin in the treatment of chronic central serous chorioretinopathy with focal leakage areas. METHODS: Eight cases with a history of central serous chorioretinopathy of ≥6 months were included. All eyes had one or more focal areas of active retinal pigment epithelial leak. Photodynamic therapy was applied with half-dose verteporfin (3 mg/m²), and the spot size was set limited to the area of active leakage shown on fluorescein angiography. RESULTS: The mean duration of the last central serous chorioretinopathy episode was 12.50 months. The mean best-corrected visual acuity improved from 20/122 to 20/60 the first month (P = 0.017) and to 20/55 the first year after treatment (P = 0.018). Seven eyes (87.5%) had improved vision 1 year after treatment, and 1 eye (12.5%) had stable vision with a mean number of 3.61 gained lines. The mean central macular thickness was reduced from 366 ± 95 µm to 217 ± 32 µm the first month (P = 0.006). CONCLUSION: Fluorescein angiography-guided photodynamic therapy with half-dose verteporfin seems to be a rational and effective alternative to other methods in the treatment of chronic central serous chorioretinopathy with focal leakage on fluorescein angiography.

Penetrating keratoplasty in keratoconic eyes with prior radial keratotomy.

PURPOSE: The aim of this study is to evaluate the long-term therapeutic outcomes and potential intraoperative and postoperative complications of penetrating keratoplasty in keratoconic eyes with prior radial keratotomy. METHODS: In this retrospective study, we reviewed the clinical data for keratoconic eyes with prior radial keratotomy that underwent penetrating keratoplasty between 1995 and 2007. RESULTS: Data were obtained from 16 patients (24 eyes). The mean time interval between radial keratotomy and penetrating keratoplasty was 50.2 months. The mean postoperative follow-up period was 33.7 months. The mean best spectacle-corrected visual acuity (BSCVA) improved from 20/342 (range: 20/1200 to 20/100) preoperatively to 20/32 (range: 20/100 to 20/16) at the last control visit (p<0.05). None of the eyes had a preoperative BSCVA better than 20/100, while 91.7% of the eyes had a BSCVA of 20/40 or better at the end of the follow-up period. The mean keratometric astigmatism was 8.03 diopters preoperatively as compared with 3.63 diopters at the end of the follow-up period. There were no intraoperative complications. Six eyes (25.0%) experienced at least one episode of immunologic graft rejection during the follow-up period. One eye required a new corneal transplantation because of graft failure. CONCLUSIONS: Penetrating keratoplasty for treating keratoconic eyes with previous radial keratotomy provides good visual outcomes and low graft rejection rates. We did not encounter any intraoperative difficulty related to the previous radial keratotomy. However, more caution during the keratoplasty is needed to overcome possible incision-related complications that may negatively affect the surgery and its outcome.

Comparison of postoperative anterior segment changes associated with pars plana vitrectomy with and without vitreous base shaving.

AIM: To compare changes in anterior segment topography and axial length (AL) evaluated with Pentacam and IOL Master after pars plana vitrectomy (PPV) performed with and without vitreous base shaving. METHODS: This prospective study included patients who underwent PPV or phacoemulsification+PPV (Phaco+PPV) for various indications. Patients who underwent total posterior hyaloid detachment and excessive vitreous base shaving with scleral indentation were referred to as complete PPV (c-PPV). The patients whom posterior hyaloid was separated as far as the posterior arcades and vitreous base shaving with scleral depression was not performed were classified as the partial PPV (p-PPV) group. All patients underwent detailed ophthalmologic examinations preoperatively and 1wk, 1, and 3mo postoperatively. Changes in the anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), central corneal thickness (CCT), and keratometric measurements (K1 and K2) were evaluated with Pentacam HR. Changes in the AL measurements were analyzed with IOL Master. RESULTS: A significant increase in ACD was observed in c-PPV cases (P=0.02), but this increase was not significant in the p-PPV group (P=0.053). In contrast, ICA increased significantly in the c-PPV group (P=0.02) but decreased in the p-PPV group (P=0.09). BCVA was significantly improved in the c-PPV group from week 1 (P<0.001) while the increase in the p-PPV group reached significance at 3mo (P=0.035). CCT increased in the first week and later returned to baseline in both groups. No significant differences in the other parameters were observed between the groups, and there were no significant changes in intraocular pressure, ACV, AL, K1 or K2 values (P>0.05 for all). CONCLUSION: Incomplete posterior hyaloid excision and not removing the vitreous base in PPV surgeries may create a more stable anterior chamber, thus preventing the downward movement of the lens-iris diaphragm, and may cause ciliary body retraction, thereby reducing ICA. Awareness of these effects can provide some amount of guidance to physicians in selecting the appropriate PPV procedure and preempting surgical complications.

Autologous Platelet-Rich Fibrin in the Treatment of Refractory Macular Holes.

PURPOSE: To describe a novel method for the treatment of refractory macular holes. METHODS: Two case reports on the use of autologous platelet rich fibrin (PRF), followed by sulfur hexafluoride gas tamponade to facilitate closure of refractory macular holes. RESULTS: Macular holes were succesfully closed within a week in both cases. Best corrected Snellen visual acuities improved from counting fingers to 0.16 in the first case, and from 0.05 to 0.2 in the second case. No complication occurred during or after the procedures. CONCLUSION: The use of autologous PRF seems to be a safe and effective alternative method for the treatment of refractory macular holes. Further experience and studies are required to assess the value of autologous PRF in the management of challenging macular hole cases of different etiologies. To the best of our knowledge, this is the first use of autologous PRF in the treatment of macular holes.

Regression of Serous Macular Detachment After Intravitreal Dexamethasone Implant in Patients with Diabetic Macular Edema.

Purpose: To assess the effect of intravitreal dexamethasone (Ozurdex®) implant in eyes with serous macular detachment (SMD) secondary to diabetic retinopathy (DRP) with diabetic macular edema (DME). Methods: Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP were included in this study. Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP, which was documented by optical coherence tomography, were included in this study. Intravitreal dexamethasone implantation was performed for treatment to all eyes. Main outcome measures included changes in best corrected visual acuity (BCVA), central neuroretinal thickness (CRT), and height of SMD. After intravitreal dexamethasone implantation, functional and anatomic responses were observed. Results: From the data at 3 months follow-up, we found that the Ozurdex implant was effective in treating SMD with DME, no eyes had lost vision from baseline, 22 eyes (92%) had improved visual acuity, and 22 eyes (92%) had presented SMD regression. Only two eyes had needed dexamethasone implant retreatment. Data at 6-months follow-up, no eyes had lost vision from baseline, 20 eyes (83%) had improved visual acuity, and all eyes had presented SMD regression. Also, after injections and at the end of the follow-up, mean CRT and BCVA were statistically different from the baseline. Conclusions: Intravitreal Ozurdex implantation increases BCVA and reduces SMD and CRT, in patients with SMD. In this context, intravitreal dexamethasone implantation is an effective treatment for SMD in patients with DME.

Oxidant-Antioxidant Balance in the Aqueous Humor of Patients with Retinal Vein Occlusion.

PURPOSE: To analyze oxidative stress parameters in the aqueous humor with retinal vein occlusion. MATERIALS AND METHODS: A total of 56 patients who underwent cataract surgery were enrolled in this study. The eyes with retinal vein occlusion were included in the study group. Aqueous humor was sampled from all patients and analyzed by an automated measurement method. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stres index (OSI) were calculated. RESULTS: OSI was significantly higher in the study group (p = 0.04). TAS was significantly lower (p = 0.01) and OSI was significantly higher (p = 0.01) in cases with both central retinal vein occlusion and macular edema. Previous laser photocoalugation to the retina and the duration of disease had no significant effect on the levels of oxidative stress parameters. CONCLUSION: OSI was found higher in patients with retinal vein occlusion. This increase is more significant in patients with macular edema and central retinal vein occlusion; in which TAS was also found to decrease.

Intravitreal Dexamethasone Implant for Treatment of Serous Macular Detachment in Central Retinal Vein Occlusion.

PURPOSE: To evaluate the effect of intravitreal dexamethasone implant (Ozurdex) treatment on serous macular detachment (SMD) in patients with nonischemic central retinal vein occlusion (CRVO). METHODS: Retrospective, interventional, noncomparative case series was conducted. Twenty-four eyes of 24 patients with macular edema (ME) and SMD secondary to nonischemic CRVO made up the study population. Patients who had received intravitreal triamcinolone and/or antivascular endothelial growth factor treatment and/or had undergone retinal photocoagulation were excluded from the study. After Ozurdex injection, visual and anatomical responses were observed. RESULTS: The mean follow-up time was 9.96 ± 2.44 months (minimum 7, maximum 14). After injection of Ozurdex, ME and SMD regressed except for 1 patient. Twenty cases showed relapse within a 5.45 ± 1.43 months mean time. Seventeen of them had SMD. Eight cases revealed a second relapse and 1 case revealed a third relapse after retreatments. The mean time for the second relapse was 5.50 ± 1.19 months. The height of SMD was found to be lower in all follow-up examinations-including relapses-than baseline measurements. The median SMD value decreased from 247.5 µm (minimum 80, maximum 745) at baseline to 0 µm (minimum 0, maximum 426) at the final examination (P < 0.001). No eyes lost vision at any control visit. The mean best corrected visual acuity increased from 0.89 ± 0.31 logMAR at baseline to 0.62 ± 0.31 logMAR at the final examination (P < 0.01). No local or systemic complication was observed. CONCLUSION: In this case series, Ozurdex was found as a safe and effective treatment for SMD and ME associated with nonischemic CRVO.