Comparative study of conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular hole treatment.

Purpose: To compare the anatomical, morphological, and functional outcomes of the conventional internal limiting membrane (ILM) peeling versus temporal inverted ILM flap technique for large full-thickness macular holes (FTMHs). Methods: Sixty eyes of 60 patients with a minimum base diameter >600 µm were included in this retrospective interventional study. Patients were divided into conventional ILM peeling (Group 1) and temporal inverted ILM flap (Group 2) groups. The hole closure rate, best-corrected visual acuity (BCVA), ellipsoid zone (EZ), and external limiting membrane (ELM) defects were analyzed at baseline and 6 months after surgery. Results: Hole closure was achieved in 24/32 (75.0%) cases of Group 1 and 27/28 (96.4%) cases of Group 2 (P = 0.029). The mean BCVA (logMAR) changed from 1.23 ± 0.47 to 0.70 ± 0.29 logMAR in Group 1 and from 1.03 ± 0.36 to 0.49 ± 0.24 logMAR in Group 2 at 6 months (P < 0.001 in both cases). U-shaped closure was observed in 5 (15.6%) eyes in Group 1 and 19 (67.9%) eyes in Group 2 (P < 0.001). The total restoration rates of ELM and EZ were significantly higher in the temporal inverted ILM flap group (P = 0.002, P = 0.001, respectively). Conclusion: The study results suggested that the FTMH closure rate, recovery of the outer retinal layers, and, consequently, the post-operative BCVA were better with the temporal inverted ILM flap technique than with the conventional ILM peeling for larger than 600 µm macular holes.

The comparison of spectral domain optical coherence tomography and indocyanine green angiography in the diagnosis of polypoidal choroidal vasculopathy.

OBJECTIVES: To evaluate the diagnostic capability of spectral domain optical coherence tomography (SD-OCT) in patients with potential diagnostic findings for polypoidal choroidal vasculopathy (PCV). MATERIALS AND METHODS: Ninety-three eyes with potential diagnostic findings for PCV were prospectively evaluated. Patients with multiple retinal pigment epithelial detachment (RPED), sharp RPED peak, RPED notch, hyporeflective lumen representing polyps, double-layer sign and the presence of hyperreflective intraretinal hard exudate were considered as PCV in SD-OCT. The sensitivity and specificity of SD-OCT in the diagnosis of PCV were determined by comparing SD-OCT-based diagnosis with indocyanine green angiography (ICGA). RESULTS: Sixty-nine (74.2%) of 93 eyes included in the study were confirmed with ICGA and diagnosed as PCV. The sensitivity and specificity of SD-OCT for the diagnosis of PCV were 75.3% and 75%, respectively. CONCLUSION: The SD-OCT-based method helps clinicians to develop appropriate diagnostic and treatment strategies for patients in whom ICGA cannot be used.

The Short-Term Efficacy of Biweekly Subconjunctival Bevacizumab in Diabetic Macular Edema.

Purpose: To assess the effectiveness of subconjunctival bevacizumab (SB) injection every 2 weeks (biweekly) for diabetic macular edema (DME).Materials and Methods: In this prospective, non-randomized study; patients with clinically significant DME, who had central macular thickness (CMT) >300 µm, were included. They received three consecutive subconjunctival injections of 0.2 ml (5 mg) bevacizumab in biweekly intervals. Macular measurements were obtained by spectral-domain optical coherence tomography. The changes in CMT, and volumes of foveal (central 1 mm), parafoveal (between 1-3 mm), and perifoveal (3-6 mm) areas were followed.Results: Totally, 35 eyes of 26 patients with DME were included in the study. Five eyes were treatment-naive and 30 eyes were treatment non-naive. The means of CMT were 440.82 ± 101.22 µm at baseline, 380.11 ± 79.76 µm at second week, 338.34 ± 69.24 µm at first month, and 330.46 ± 74.16 µm at second month. Best-corrected visual acuity (BCVA) at baseline and second month were 0.56 ± 0.38 Log MAR (20/80) and 0.38 ± 0.35 Log MAR (20/50), respectively. While CMT, foveal, parafoveal, and perifoveal volumes significantly decreased after SB injections, a significant improvement in BCVA was found (p < .01 for all). No significant ocular or systemic adverse events were observed.Conclusions: Subconjunctival injection of bevacizumab every 2 weeks appears to be beneficial in the treatment of DME and it may provide significant anatomic and visual improvement, without ocular or systemic side effects.

Outcome and Predictors for 2-Year Visual Acuity in Eyes with Diabetic Macular Edema Treated with Ranibizumab.

Purpose: To determine the role of baseline characteristics in predicting visual outcome in patients with diabetic macular edema (DME) treated with ranibizumab. Methods: A review was carried out of the charts of 97 eyes that received pro re nata (PRN) intravitreal ranibizumab (IR) 0.5 mg treatment for DME. The change in the mean best-corrected visual acuity (BCVA) was analyzed. The baseline demographics and ocular and optic coherence tomography findings were analyzed to determine the association with the 2-year visual acuity (VA). Results: BCVA increased from 0.54 ± 0.2 (0.05-1.0) to 0.41 ± 0.3 (0.0-1.0) log of the minimum angle of resolution (P < 0.001). Age (P = 0.012), gender (P = 0.018), baseline BCVA (P < 0.001), presence of leaking microaneurysms (MA) (P = 0.018), development of vitreomacular traction (VMT) (P = 0.001), development of posterior vitreous detachment (PVD) (P = 0.040), and disruption of ellipsoid zone (EZ) (P = 0.007) were found as predictors of 2-year VA. There was no association between visual outcome and the other characteristics. Conclusions: PRN treatment of IR provides significant benefits in VA gain and anatomic improvement in eyes with DME. Older age, female sex, lower baseline VA, VMT development, and EZ disruption are predictors for the poor final VA. Development of PVD and leaking MA are predictors for the good final VA.

The short-term efficacy of intravitreal ranibizumab, aflibercept and dexamethasone implant in the treatment of macular edema due to non-ischemic central retinal vein occlusion.

PURPOSE: To assess and compare the efficacy over 6 months of intravitreal ranibizumab (IR), aflibercept (IA) and dexamethasone implant (IDI) in eyes with macular edema (ME) secondary to non-ischemic central retinal vein occlusion (CRVO). METHODS: This is a retrospective single-center study. Patients who received pro re nata treatment of IR 0.5 mg, IA 2 mg or IDI 0.7 mg (as Group 1, Group 2, and Group 3, respectively) for the treatment of ME due to non-ischemic CRVO were included in the study. Efficacy outcomes were considered as the changes in mean best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline over 6 months. RESULTS: Eighteen patients (Group 1) received IR, 16 patients received (Group 2) IA, and 24 patients (Group 3) received IDI. The mean numbers of injections were 2.56 ± 1.0, 2.68 ± 0.9, and 1.62 ± 0.5 in Group 1, 2, and 3, respectively (p = 0.000). In Groups 1 and 2, the mean BCVA values increased significantly after the treatment (p < 0.001). However, in Group 3, no increase in mean BCVA was statistically significant in any month (p = 0.061). The proportion of eyes gaining at least three lines in BCVA was 33.3% in Group 1, 43.8% in Group 2, and 33.3% in Group 3 (p = 0.762). In all groups, significant improvements were observed in CMT after treatment (p < 0.001). At month 6, the mean changes in CMT were - 162.7 ± 186.5 µm in Group 1, - 310.1 ± 345.9 µm in Group 2, and - 193.8 ± 228.3 µm in Group 3, with no significant difference among groups (p = 0.474). Cataract formation and IOP increase were higher in the IDI group, but the differences were not statistically significant (p = 0.054 and p = 0.392, respectively). CONCLUSIONS: IR and IA may be preferred treatment for ME due to non-ischemic CRVO as visual improvement remains the primary ophthalmological objective. The most important advantages of IDI are its effect on CMT and the need for fewer injections. The increase in IOP and the formation of cataract may be observed more in IDI-treated eyes.

Dexamethasone Implant in Chronic Diabetic Macular Edema Resistant to Intravitreal Ranibizumab Treatment.

PURPOSE: The aim of this study was to assess the efficacy of a single intravitreal dexamethasone implant (IDI) over 6 months in eyes with chronic diabetic macular edema (DME) that were resistant to intravitreal ranibizumab (IR) treatment. METHODS: This retrospective study was conducted at the Ondokuz Mayis University Hospital, Samsun, Turkey. Efficacy outcomes were considered as the change from baseline in best corrected visual acuity (BCVA) and central macular thickness (CMT). RESULTS: Thirty eyes of 20 patients with a mean age of 61.6 ± 8.8 (45-85) years were included in the study. The mean BCVA significantly increased from 0.68 ± 0.27 to 0.56 ± 0.30 logMAR (p = 0.001) and 0.57 ± 0.30 logMAR (p = 0.002) at months 1 and 2, respectively. The proportion of patients who gained 3 or more lines in BCVA was 20%. The mean CMT significantly decreased from 578.93 ± 17.95 µm at baseline to 282.10 ± 21.42, 292.26 ± 19.69, 371.70 ± 21.23, and 463.60 ± 23.16 µm at months 1, 2, 3, and 4, respectively (p = 0.001). Intraocular pressure (IOP) increase occurred in 5 (16.7%) eyes. Cataract surgery was required in 3 (13%) out of 23 phakic eyes. CONCLUSION: IDI provides significant benefits in visual acuity gains and anatomic improvements in eyes with chronic DME that are resistant to IR treatment. Increases in IOP and cataract progression can be observed in IDI-treated patients. However, its safety profile is acceptable.

A safe method of ciliary sulcus fixation of foldable intraocular lens using a ciliary sulcus guide.

To describe a novel technique for implantation of intraocular lens in the absence of capsular support using a ciliary sulcus guide. Based on the anatomic knowledge of the ciliary sulcus and the sclera, a new instrument was developed to pierce the needle safely through the ciliary sulcus and sclera. While the foldable lens is stored inside the cartridge, the leading haptic is sutured with a cow-hitch knot. The needle is then inserted into the ciliary sulcus guide. The tip of the guide is inserted from the corneal incision and proceeded under the iris to touch and fit the ciliary sulcus. The needle is pushed from back side. The needle comes out at precise point at the sclera. Implantation of the lens was performed through a 2.8 mm clear cornea incision using the injector. The trailing haptic is tied after implantation, and then the same procedure is performed at the opposite side. We performed this technique to 15 aphakic eyes without sufficient capsular support. There was no bleeding or other intraoperative complication. All the points coming out the sclera were between 2 and 2.5 mm from the limbus. The ab interno technique for scleral fixation of IOL is quicker, easier and less traumatic then ab externo techniques. A new ciliary sulcus guide which is usable with both straight and curved needles eliminates the blind maneuvers of ab interno technique and makes this technique more safe and precise.

Effects of Birth Weight on Anterior Segment Measurements in Full-Term Children Without Low Birth Weight by Dual-Scheimpflug Analyzer.

PURPOSE: To evaluate the effects of birth weight on ocular anterior segment parameters in full-term children without low birth weight using the Galilei Dual-Scheimpflug Analyzer. DESIGN: Retrospective cohort study. METHODS: The right eyes from 110 healthy children, 3-6 years of age, were scanned with the Galilei Dual-Scheimpflug Analyzer. A total of 78 eyes were measured in full-term children with birth weight of >2500 g. Central, paracentral, pericentral, and the thinnest corneal thicknesses; anterior and posterior keratometry (average, steep, flat); axial curvatures; asphericity of cornea; anterior chamber depth and volume; and iridocorneal angle values were measured. Axial length, lens thickness, and vitreous length were obtained by ultrasound biometry. RESULTS: The mean age of children was 55.86 ± 12.52 (mean ± SD) months. Mean birth weight and gestational age were 3426.3 ± 545 g and 39.4 ± 1.2 weeks, respectively. Although lens thickness, vitreous length, axial length, and anterior chamber volume were moderately correlated with birth weight (P < .05), there was no relationship between birth weight and anterior chamber depth. With the exception of pericentral corneal thickness, all regions of corneal thicknesses were correlated with birth weight (P < .05). Birth weight was negatively correlated with anterior curvature (P < .05) and had no relationship to posterior curvature. While central and paracentral axial curvatures correlated with birth weight (P < .05), pericentral axial curvature did not. CONCLUSION: Preschoolers who were born heavier had thicker cornea and lens, longer axial length, and flatter corneal curve. The thicknesses and axial curves of central cornea within 7 mm may be particularly associated with birth weight.

Scleral fixation of one piece intraocular lens by injector implantation.

AIM OF STUDY: With an ab-interno technique of transscleral suturing of current one-piece posterior chamber intraocular lenses (PC IOLs) by injector implantation in the absence of capsular support, we aimed to demonstrate the possibility of the implantation of one-piece acrylic PC IOLs that might be produced in the future for only scleral fixation through small clear corneal incision. MATERIALS AND METHODS: Case report and literature review. RESULTS: This procedure has been performed in eight aphakic eyes with four different types of IOLs. Good centration was achieved with minimal technical effort. All patients had well-centered and stable lenses postoperatively during 9-18 months follow-up. CONCLUSION: We managed to decrease the risks of surgical trauma and intricate surgical maneuvers requirement. With this technique, excessive fluid leakage and consecutive hypotony can be minimized.

Surgical results of triamcinolone assisted pars plana vitrectomy combined with phacoemulsification in diabetic patients.

PURPOSE: It is aimed to evaluate the technical feasibility, safety, outcome, and incidence of complications after clear corneal phacoemulsification with foldable intraocular lens implantation (IOL) and triamcinolone assisted pars plana vitrectomy in patients with proliferative diabetic retinopathy. METHODS: The results of combined phacoemulsification, in the capsular bag foldable intraocular lens implantation and triamcinolone assisted pars plana vitrectomy in 75 eyes of 72 patients, were retrospectively evaluated. Surgery was performed using general anesthesia in 9 cases, and monitored retrobulbar block in 66 cases. In all cases, phacoemulsification with clear corneal incision and foldable acrylic IOL implantation were performed before vitreoretinal surgery. The main investigation points were preoperative and postoperative best corrected visual acuity (BCVA), and intraoperative and postoperative complications. RESULTS: The mean age at surgery was 62.07 ± 9.51 years (range 22 to 78 years) and the postoperative follow-up time was 17.17 ± 7.25 months. All eyes had clinically significant cataract that interfered with visualization of the retina preoperatively. All eyes had proliferative diabetic retinopathy. Postoperatively, visual acuity improved in 65 eyes (86.7%), was unchanged in 9 eyes (12.0%), and decreased in 1 eye (1.3%). The most postoperative complications consisted of a mild iritis in 8 eyes (10.7%), recurrent vitreous hemorrhage in 8 eyes (10.7%), posterior capsule opacification in 7 eyes (9.3%), transient intraocular pressure increase in 6 (8.0%), iatrogenic retinal tear in 6 (8.0%), epiretinal membrane in 5 (6.7%). CONCLUSION: The results of combined phacoemulsification in the capsular bag foldable IOL implantation and triamcinolone assisted pars plana vitrectomy show that visual acuity outcomes are generally favorable and complications are acceptable in diabetic patients. Visual results and complications depend primarily on the underlying posterior segment pathology. The use of triamcinolone acetonide may simplify surgery and decreases the postoperative inflammation.

Ocular blood flow in healthy and primary open-angle glaucomatous eyes.

PURPOSE: To evaluate blood flow parameters in the ophthalmic artery, in the posterior ciliary arteries and in the central retinal artery in eyes with primary open-angle glaucoma. METHODS: Hemodynamic parameters were evaluated by color Doppler imaging in 48 patients with primary open-angle glaucoma and 42 age-matched normal control subjects. Peak systolic velocity (Pv), end-diastolic velocity (Ev), and resistive index (RI) were calculated in the central retinal artery, short posterior ciliary arteries and the ophthalmic artery. RESULTS: The analysis of the ocular blood flow velocities in the central retinal artery, short posterior ciliary arteries and the ophthalmic artery revealed a significant reduction in peak systolic velocity and end-diastolic velocity with an increase in resistive index in primary open-angle glaucoma compared with controls (p < 0.05). CONCLUSION: Our data indicate primary open-angle glaucoma to be associated with a decreased flow velocity and increased resistive index in the ocular vasculature.