Evaluating the Effect of Intravitreal Ranibizumab on Retrobulbar Hemodynamics by Color Doppler Ultrasonography in Neovascular AMD.

BACKGROUND AND OBJECTIVE: To evaluate changes in retrobulbar blood flow by using color Doppler ultrasonography (CDUS) after intravitreal ranibizumab injection in patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: Eighteen patients who had undergone intravitreal ranibizumab (0.05 mg/0.05 mL) injection due to choroidal neovascular membrane (CNVM) were included in the study. Contralateral eyes of the patients were also analyzed. Peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) were measured from the ophthalmic artery (OA), central retinal artery (CRA), lateral posterior ciliary artery (LPCA), and medial posterior ciliary artery (MPCA) for all patients pre-injection, and at 1 day, 1 week, and 1 month after ranibizumab injection. RESULTS: The mean age of the 18 patients included in the study was 66.94 years (± 8.3 years). Of these 18 patients, eight were female and 10 were male. After Bonferroni's correction for multiple comparisons was carried out, there were significant differences only in some values of LPCA; these included the decrease in EDV and an increase in PI values of LPCA between the pre-injection and post-injection of the first month measurements in uninjected eyes (P = .002, P = .002), and a decrease in PI value of LPCA between post-injection first day and first week measurements in injected eyes (P = .004). There were no statistically significant differences in other parameters. CONCLUSION: Ocular blood flow velocities may change after intravitreal ranibizumab injection in patients with CNVM. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:437-443.].

The effect of intravitreal bevacizumab as a pretreatment of vitrectomy for diabetic vitreous hemorrhage on recurrent hemorrhage.

PURPOSE: This study was constructed to compare the rate of rehemorrhage in patients with diabetic vitreous hemorrhage (VH) undergoing pars plana vitrectomy (PPV) with versus without preoperative intravitreal bevacizumab (IVB) injection. METHODS: It is a retrospective chart review of all patients who had undergone PPV for diabetic VH from January 2008 to January 2011. Patients who had undergone IVB injection before PPV were assigned to Group 1; the others were assigned to Group 2. Postoperative VH was the main outcome. RESULTS: A total of 65 eyes of 60 patients (19 eyes in Group 1 and 46 eyes in Group 2) were examined. Postoperative VH occured in three eyes (15.8%) in Group 1 and in 13 eyes (28.3%) in Group 2, but this was not statistically significant (p: 0.347). CONCLUSION: Further studies to evaluate the effect of IVB on postoperative VH are needed.

Fuchs endothelial corneal dystrophy: clinical characteristics of surgical and nonsurgical patients.

PURPOSE: To review the patient and clinical characteristics of patients with Fuchs endothelial corneal dystrophy (FECD). METHODS: Review of records for every patient who presented to the Bascom Palmer Eye Institute between 2003 and 2009 whose visit was coded for endothelial corneal dystrophy (International Classification of Diseases, Ninth Revision [ICD9] 371.57), bullous keratopathy (ICD9 371.23), or who underwent a corneal surgery with or without cataract extraction. Demographic, clinical, and ancillary testing data were collected from the time of presentation, diagnosis, and follow-up, and the use, timing, and type of surgical interventions was documented, with 6-month and final visual acuities recorded. RESULTS: A total of 2,370 charts were included in this study, of which 966 patients had a diagnosis of FECD. Of these, 197 patients (21%) received a corneal transplantation procedure. The surgery most often performed was penetrating keratoplasty with or without cataract extraction (66%), followed by endothelial keratoplasty with or without cataract extraction (34%). The risk factors for surgery include worse visual acuity at presentation (20/60 Snellen visual acuity in surgical patients versus 20/40 Snellen visual acuity in nonsurgical patients, P<0.001), greater average central corneal thickness (635 µm versus 592 µm, P<0.001), loss of visual acuity over time (two lines lost versus zero lines lost, P<0.001), increasing age (P<0.001), and male sex (P=0.008). Over half of patients (52%) did not receive surgery despite poor vision. CONCLUSION: During this time period, FECD did not have a consistent pattern for management or treatment, and despite advances in surgical techniques, most patients were still managed without surgery.

Short-term effects of intravitreal triamcinolone acetonide injection on ocular blood flow evaluated with color Doppler ultrasonography.

AIM: To evaluate the changes in ocular blood flow with color Doppler ultrasonography (CDU) after intravitreal triamcinolone acetonide (IVTA) injection. METHODS: A total of 46 patients who underwent IVTA (4 mg/0.1 mL) injection for diabetic macular edema (DME) (n=22), central retinal vein occlusion (CRVO) (n=12) and choroidal neovascular membrane (CNVM) (n=12) were included in the study. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI) were measured from the ophthalmic artery (OA), the central retinal artery (CRA) and the posterior ciliary artery (PCA) of each patient with CDU before, at the end of the first week and at the end of the first month following IVTA injection. RESULTS: In the DME group, PSV of OA at the first of the first month (mean±SD) (37.48±10.87 cm/s) increased compared to pre-injection value (31.39±10.84 cm/s) (P=0.048). There was a statistically significant decrease (P=0.049) in PSV of CRA at the end of the first month (7.97±2.67 cm/s) compared to the pre-injection (9.47±3.37 cm/s). There was not any statistically significant difference on the other parameters in the DME group. Also, there was not any statistically significant difference on the ocular blood flow values in the CRVO and CNVM groups. CONCLUSION: We observed that 4 mg/0.1 mL IVTA increased PSV of OA and decreased PSV of CRA in DME patients and did not have any effect on ocular blood flow values of CRVO and CNVM patients.

Free-floating vitreous cyst in an adult male.

A 50 year-old male patient was referred to our clinic due to a floating mass in the right eye. The uncorrected visual aquity was 10 / 10 in both eyes.The patient did not have any systemic disorder and trauma history. His ophthalmological examination revealed an unremarkable anterior segment with no signs of inflammation. Indirect opthalmoscopy and posterior segment biomicroscopy performed with 90D lens was unremarkable in the left eye, while in the right eye a single oval cyst was identified floating freely in the vitreous. The cyst was partially masking the underlying retinal vasculature. B-scan ultrasound revealed an echo-free, round-shaped cyst that was free from surrounding vitreous strands or retina localised at the posterior vitreous. Fluorescein angiography (FA) ruled out the presence of intra and overlying vascularisation of the cyst. Indeed, FA showed a clear-edged hypofluorescence due to a pre-retinal masking effect. The indirect hemaglutinin tests of the patient for ecinococcus and cysticercosis were negative. Eosinophilia was not detected in the preripheral blood smear. Based on these findings the patient was diagnosed as primary vitreal cyst. The presented case was mild symptomatic so the patient was decided to be followed up without any treatment.

Corneal white-to-white distance and mesopic pupil diameter.

AIM: To study the relationship between corneal white-to-white (WTW) distance and mesopic pupil diameter. METHODS: This study is composed of 30 cases that underwent photorefractive keratotomy (PRK). Pupil size measurements were performed with Schwind ORK wavefront analyzer in mesopic conditions. WTW distance was measured with a measuring caliper. Also, A-scan ultrasound examination was performed in all patients. The relationship among the mesopic pupil diameter and age, sex, axial length, lens thickness, anterior chamber depth(ACD), horizontal WTW distance, vertical WTW distance, spherical equivalent, and average keratometry were analyzed with univariate and multivariate regression analysis. RESULTS: Mean pupil diameter was (6.39±0.80)mm (range: 3.70mm-7.73mm). Horizontal WTW distance measurements were between 11.00mm and 12.50mm and mean horizontal WTW distance was (11.79±0.43)mm. On the other hand, vertical WTW distances ranged between 10.00mm and 13.00mm, and their mean was (11.42±0.72)mm. Bivariate correlation between pupil diameter and other variables showed that the axial length, ACD, spherical equivalent, and horizontal WTW distance had a moderate correlation with mesopic pupil diameter. Multiple regression analysis revealed that spherical equivalent and horizontal WTW distances were significantly associated with mesopic pupil diameter (R=0.598, R(2)=0.358 P=0.02). CONCLUSION: This study shows that mesopic pupil diameter is closely related to horizontal WTW distance. These two factors must be taken in consideration together in preoperative ablation zone planning.

Short-term effects of intravitreal bevacizumab (Avastin(®)) on retrobulbar hemodynamics in patients with neovascular age-related macular degeneration.

PURPOSE: To evaluate the short-term effects of intravitreal bevacizumab on retrobulbar hemodynamics in patients with neovascular age-related macular degeneration (AMD). METHODS: This study was carried out at Ataturk Training and Research Hospital 1st Ophthalmology Clinic, Ankara. Fourteen patients with neovascular AMD, who were treated with intravitreal injection of bevacizumab, were included in this study. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistivity index (RI) were measured with colour Doppler imaging (CDI) in the ophthalmic artery, central retinal artery (CRA) and posterior ciliary artery. RESULTS: The mean age of the 14 patients was 78 ± 9 (64-87). Of the 14 patients, eight were men and six were women. Colour Doppler imaging measurements of EDV (p = 0.015) and RI (p = 0.009) parameters of CRA revealed statistically significant difference among all three periods. End-diastolic velocity values decreased at the end of the 1st week and returned close to preoperative values at the end of the 1st month after the procedure. Also, EDV of posterior ciliary artery (PCA) decreased at the end of the 1st week and returned close to preoperative values at the end of the 1st month after the procedure. Resistivity index of PCA showed a temporary increase at the end of the 1st week and returned close to preoperative values at the end of the 1st month after the procedure. CONCLUSION: Injection of bevacizumab decreased blood velocities of CRA and PCA and increased RI of CRA and PCA in the early postoperative period and returned to preoperative values at the end of the first month.

Evaluation of efficacy of topical povidone-iodine and different types of fluoroquinolones in the sterilization of bacterial flora on the conjunctiva.

PURPOSE: To compare the sterilization effectivity of topical povidone-iodine, ciprofloxacin, and ofloxacin on the conjunctival bacterial flora. METHODS: One hundred sixty-four eyes of 164 patients scheduled for cataract surgery were prospectively analyzed. Conjunctival cultures were obtained 1 day before the surgery without any topical application in all patients. Conjunctival flora was examined in 53 eyes of 53 patients (Group I) 15 min after 5% topical povidone-iodine application on the day of the surgery. Fifty-four eyes of 54 patients (Group II) received 1 drop 0.3% ciprofloxacin at 12 pm 1 day before the operation and 4 drops at 15 min intervals on the day of the surgery. Another 57 eyes of 57 patients (Group III) received 0.3% ofloxacin in the same application mode as ciprofloxacin. Conjunctival cultures were taken in all patients 15 min after last drop of topical antibiotic application. RESULTS: Only coagulase-negative staphylococci were isolated from 75.4% in Group I, 72.2% in Group II, and 59.6% in Group III on pretreatment culture. Different types of bacteria such as Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Proteus spp., Micrococcus spp. were identified in other patients. Pretreatment conjunctival flora of Group I and Group II were similar (P>0.05), but it was significantly different in Group III (P<0.05). After topical application no bacterial growth was observed in 77.3% in Group I, 92.5% in Group II, and 66.6% in Group III. The difference between Group I and III was insignificant (P>0.05), but bacterial eradication effectiveness was significantly higher in Group II than that of other groups (P<0.05). Post-treatment cultures showed same bacterial flora as pretreatment cultures in 14.9% in Group I, 1.8% in Group II, and 19.2% in Group III. The difference between Group I and Group III was statistically insignificant (P>0.05) and the difference between Group II and other groups was statistically significant (P<0.05). Four eyes (7.5%) showed different types of bacterial growth from pretreatment flora in Group I, which were seen in 3 eyes (5.5%) in Group II and in 8 eyes (14%) in Group III. The differences between groups were statistically insignificant (P>0.05). CONCLUSION: Ciprofloxacin seems to be more effective in conjunctival sterilization. In consideration with high variety of bacterial flora in pretreatment period in ofloxacin group, ofloxacin seems to be superior to povidone-iodine on the reduction of bacterial flora on the conjunctiva.