Transient Increase of Flicker Electroretinography Amplitudes after Cataract Surgery: Association with Postoperative Inflammation.

Purpose: To determine the characteristics and cause of the increase in the amplitude of flicker electroretinography (ERG) after cataract surgery. Design: Prospective, observational clinical study. Participants: Thirty patients who underwent cataract surgery. Methods: Flicker ERGs were recorded with the RETeval system without mydriasis. The central macular thickness (CMT) was measured by OCT and the aqueous flare value (AFV) by laser flare-cell photometry. These examinations were performed before surgery and 1 day, 1 week, 1 month, 2 months, and 3 months after surgery. Linear regression analysis through the origin was used to compare the correlations between the relative changes in flicker ERG amplitudes and the changes in the CMT and AFV at different times after the surgery. Main Outcome Measures: The amplitude of flicker ERGs, CMT, and AFV. Results: The mean amplitude of flicker ERGs increased significantly by 31% at 1 week after surgery (P < 0.001); a significant increase in the amplitudes was not present at 3 months after the surgery. The mean AFV was significantly increased at 1 day after surgery (P < 0.001), and the CMT was significantly increased at 1 to 3 months after surgery (P < 0.001). The changes in flicker ERG amplitudes at 1 week after surgery were significantly associated with the changes in the CMT at 1 to 3 months after surgery (P < 0.05), and they were weakly associated with the changes in AFV at 1 day after surgery (P = 0.05). Conclusions: These results suggest that the increase in the amplitude of flicker ERGs after cataract surgery is a transient phenomenon that has a peak at 1 week after surgery. The increase of flicker ERG amplitude was associated with measures that are frequently used to evaluate postoperative inflammation. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

Expression of vascular infarction-related molecules after anti-vascular endothelium growth factor treatment for diabetic macular edema.

To determine whether an intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in eyes with diabetic macular edema (DME) affects the vascular infarction-related molecules (VIRMs). Nineteen eyes with DME were treated with 0.5 mg of intravitreal ranibizumab (IVR), and 22 eyes with DME were treated with 2 mg of intravitreal aflibercept (IVA). Blood was collected before, 1 week and 1 month after the injections. Aqueous humor was collected before and 1 month after the injections. The concentration of the VIRMs (cardiac myoglobin, cardiac troponin, intercellular adhesion molecule, monocyte chemotactic protein-1, matrix metalloproteinase-8, placental growth factor [PlGF], tenascin-C, tissue inhibitor of metalloproteinase-1, thrombospondin-2, vascular cell adhesion molecule-1, and VEGF) were determined by the multiplex assay. After the single injection of both types of anti-VEGF agents, the concentration of aqueous VEGF decreased significantly (P < 0.01). The plasma VEGF was reduced significantly at 1 week after the IVA (93.7 ± 17.6 to 39.5 ± 11.6 pg/ml; P < 0.01) but no significant change was seen after IVR (120.2 ± 11.3 to 137.4 ± 17.7 pg/ml). No significant changes were detected for the other VIRMs in the plasma and aqueous. A single intravitreal injection of anti-VEGF for DME does not significantly affect the concentration of several VIRMs.

Short-Term Results of Intravitreal Triamcinolone Acetonide Combined with Cataract Surgery for Diabetic Macular Edema in Japan: In the Era of Anti-Vascular Endothelial Growth Factor Therapy.

PURPOSE: To evaluate the effectiveness of an intravitreal triamcinolone acetonide injection (IVTA) combined with cataract surgery for diabetic macular edema (DME) resistant to anti-vascular endothelial growth factor (anti-VEGF) therapy. PROCEDURE: IVTA combined with cataract surgery was performed on 29 eyes of patients with DME (aged 70.5 ± 6.2 years) who were refractive to anti-VEGF treatments. The visual acuity, central retinal thickness (CRT), and the central retinal sensitivity were assessed at 1, 4, 12, and 24 weeks after the treatment. RESULTS: The visual acuity improved significantly from 0.49 ± 0.30 logMAR units to 0.35 ± 0.33 logMAR units at 24 weeks after the treatment (p < 0.05; repeated ANOVA). The CRT decreased significantly from 435.1 ± 112.3 µm to 350.8 ± 123.3 µm at 12 weeks after the treatment (p < 0.05). The retinal sensitivity threshold also improved significantly from 18.2 ± 4.3 dB to 20.4 ± 3.8 dB at 4 weeks after the treatment (p < 0.05). CONCLUSIONS: IVTA combined with cataract surgery is effective for successful treatment of eyes with DME refractive to anti-VEGF therapy.

Effect of intravitreal ranibizumab on the ocular circulation of the untreated fellow eye.

PURPOSE: To evaluate the effects of unilateral intravitreal ranibizumab (IVR) on the ocular circulation of the fellow eyes. METHODS: Fifteen eyes of 15 patients with macular edema (average age 69.6 ± 11.8 years) were studied. Eleven eyes had diabetic macular edema (DME) and four eyes had macular edema associated with a branch retinal vein occlusion. Each eye received 0.5 mg of IVR. The blood circulation on the optic nerve head of the treated and untreated eyes were determined by laser speckle flowgraphy (LSFG, Softcare Co., Ltd) before, 1 day, and 1 week after the IVR. The mean blur rate (MBR) and the relative changes of the MBRs determined as dMBR(%) = 100-(MBR before/MB after) × 100) were evaluated. The central macular thickness (CMT) and the rate of reduction in the thickness (dCMT = 100-(CMT before/CMT after) × 100) were also evaluated. RESULTS: The mean dMBR was significantly higher in the treated eyes than the untreated eyes at 1 day (-16.4 ± 17.0% vs 2.31 ± 19.3%) and at 1 week (-12.0 ± 14.6% vs 4.50 ± 25.9%) after the IVR (P = 0.02, paired t tests). CONCLUSION: These findings indicate that if ranibizumab enters the systemic circulation, the concentration is not high enough to affect the ocular circulation of the fellow eyes.

Two year result of intravitreal bevacizumab for diabetic macular edema using treat and extend protocol.

To determine the efficacy of the treat and extend (TAE) protocol with intravitreal bevacizumab (IVB) for managing diabetic macular edema (DME).Retrospective, single-center study.For this retrospective study, 42 eyes of 42 patients were initially treated with 3 consecutive monthly IVB injections (loading phase), after which they were selected for different additional therapies. For the TAE protocol, the baseline treatment interval was selected to be 8 weeks and was sequentially lengthened by 2 weeks if the central macular thickness (CMT) was <300 µm at 2 consecutive examinations.Among the 42 eyes, 8 eyes (19.0%) received the TAE treatment for 2 years. The BCVA was improved significantly from 0.37 ±â€Š0.04 before treatment to 0.19 ±â€Š0.04 logMAR units at 2 years after the TAE determined IVB injections (P < .05). The ratio of eyes with a gain of the BCVA by more than 2 lines was 37.5%. The CMT was significantly reduced from 515.4 ±â€Š75.5 to 303.6 ±â€Š45.0 µm after 2 years (P < .01). The mean number of TAE injection was 8.8 and the mean injection interval was 11.0 weeks.After the loading phase, 19.0% of patients can be treated with the TAE protocol. Although significant visual improvements were obtained after the TAE protocol, it does not apply to every DME case.