Comparison of intravitreal ranibizumab and aflibercept for the treatment of diabetic macular edema: a real-world study.

PURPOSE: To compare the visual and anatomic outcomes of intravitreal ranibizumab versus aflibercept in patients with diabetic macular edema (DME) in a real-world study. METHODS: This is a single-center retrospective comparative study of treatment-naïve patients who received intravitreal ranibizumab or aflibercept administration for DME for at least 12 months on an as needed regimen following three-monthly loading doses. The primary outcomes of the study were the mean change in best-corrected visual acuity (BCVA), central macular thickness (CMT), and central macular volume (CMV). Factors to potentially affect these parameters were also analyzed. RESULTS: A total of 100 eyes (66 patients) were included in the study. Fifty two eyes received ranibizumab and 48 eyes in aflibercept injections. At the end of follow-up, the improvement in mean BCVA was similar in both groups (p = 0.38). While the decrease in mean CMT at the 4th-month visit was significantly higher in the aflibercept-treated group than in the ranibizumab-treated group (p = 0.02), there was no difference between the two groups at the end of the 1-year follow-up (p = 0.25). There was no significant difference between the two groups in terms of change in mean CMV during the follow-up (p = 0.26, p = 0.27 at 4 and 12 months, respectively). The mean number of injections were also similar between groups (4.5 ± 1 vs. 4.6 ± 1.1 respectively, p = 0.63). CONCLUSION: In a real-world setting, ranibizumab and aflibercept were both found to be effective in the first-line treatment of DME. Patients with DME who received fewer injections in the real-world could achieve visual and anatomical results comparable to randomized controlled trials participants.

Clinical features of childhood uveitis at a tertiary referral center in Southern Turkey.

PURPOSE: To report the epidemiology, etiology, ocular characteristics, management, and visual outcomes of pediatric uveitis patients in Southern Turkey. METHODS: The clinical records of pediatric patients with a diagnosis of uveitis under the age of 16 years and followed up longer than 6 months were analyzed retrospectively. RESULTS: The study included 102 patients and 173 affected eyes. The mean age at presentation was 11.4 ± 3.7 years. Uveitis was predominantly bilateral (69.6%), anterior (45.1%), and chronic (58.8%). The leading diagnoses were idiopathic uveitis (38.2%), pars planitis (19.6%), and juvenile idiopathic arthritis-associated uveitis (14.7%). Infectious uveitis accounted for 12.7%, and toxoplasmosis was the most common cause (10.8%). At least one complication was observed in 76.3% of the eyes, and optic disk edema (37%) was the most frequent. Corticosteroids were used in 97.1% and systemic immunomodulatory agents in 49% of the patients. Ocular surgery was performed in 17.3% of the eyes, and cataract extraction was the most common (8.7%). The mean BCVA was 0.39 ± 0.66 LogMAR at baseline and 0.25 ± 0.53 LogMAR at the last recorded visit. CONCLUSION: Pediatric uveitis is a challenging disease that requires meticulous management. Anterior uveitis is the most frequent form. Despite a changing trend for an increase in diagnostic variety, idiopathic cases still constitute the majority. A significant number of patients receive systemic therapy, develop complications, and require surgical intervention. Early diagnosis and appropriate treatment might improve visual outcomes and reduce the risk of visual loss.

The effect of epiretinal membrane surgery on macular microvasculature: an optical coherence tomography angiography study.

PURPOSE: To investigate both the possible effects of both idiopathic epiretinal membrane (IERM) itself and surgery on macular microvascular structure using optical coherence tomography angiography (OCT-A) and to determine the associations with structural and visual outcomes. METHODS: Twenty-four eyes of 24 patients with IERM and 24 eyes of 12 healthy controls were included. Vascular parameters, including the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were evaluated by OCT-A prior to and 6 months after ERM removal. The foveal avascular zone (FAZ, mm2) area, parafoveal vascular density (VD, %) and flow area (mm2) measurements were used to evaluate the macular vascular integrity. RESULTS: The mean preoperative vascular density (VD) of both plexuses was lower in eyes with IERM than in healthy eyes (both p = 0.0001). The mean preoperative flow area of the DCP in eyes with IERM was significantly lower than that in the control eyes (p = 0.016). There was no significant difference in the VD or flow area in either superficial or deep capillary plexuses as a result of surgery (SCP; p = 0.957, p = 0.97, DCP; p = 0.861, p = 0.6, respectively). Both the parafoveal DCP-VD and flow area in DCP were negatively correlated with best-corrected visual acuity (logMAR) at 6 months postoperatively (r = -0.46, p = 0.03; r = -0.52, p = 0.01, respectively). CONCLUSION: Epiretinal membranes may cause dynamic microvascular changes at the macula. However, the effect of surgery on microvasculature may be more limited than that on anatomical and visual recovery. OCT-A may serve as a useful tool in understanding the pathophysiological basis of diseases.

Efficacy of dexamethasone intravitreal implant for the treatment of persistent diffuse diabetic macular edema.

To investigate the efficiency and safety of a single injection of intravitreal dexamethasone implant in eyes with persistent diffuse diabetic macular edema (DME). In this retrospective study, 25 eyes of 20 patients, who underwent a single injection of intravitreal dexamethasone implant for the treatment of persistent diffuse DME, were reviewed. Main outcome measures included the changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline at scheduled visits following injection. The mean BCVA showed improvement from baseline (0.97 ± 0.26 logMAR) at every visit; the difference was significant at day 7 (0.85 ± 0.3 logMAR, p = 0.003), month 1 (0.77 ± 0.32 logMAR, p < 0.001), month 3 (0.77 ± 0.34 logMAR, p = 0.001), and month 4 (0.85 ± 0.31 logMAR, p = 0.014). The mean CMT was significantly lower than baseline (616 ± 132 µm) at day 1 (518 ± 144 µm), day 7 (414 ± 134 µm), month 1 (306 ± 95 µm), month 3 (339 ± 88 µm), month 4 (420 ± 116 µm), and month 6 (494 ± 128 µm) following the injection (p < 0.001, for all). Thirteen eyes on the 4-month follow-up and ten eyes on the 6-month follow-up experienced recurrence of macular edema requiring retreatment. No serious ocular and systemic adverse events were observed. In patients with persistent DME, switching to intravitreal dexamethasone implant injection provides functional and anatomical improvement, and might be an effective therapeutic option for long-standing diffuse DME.

CHOROIDAL THICKNESS CHANGES AFTER INTRAVITREAL DEXAMETHASONE IMPLANT INJECTION FOR THE TREATMENT OF MACULAR EDEMA DUE TO RETINAL VEIN OCCLUSION.

PURPOSE: To investigate changes in choroidal thickness after intravitreal injection of a dexamethasone implant for macular edema due to retinal vein occlusion. METHODS: Thirty-one eyes of 31 patients, treated with a single dose of a dexamethasone implant for retinal vein occlusion-associated macular edema, were included. Subfoveal choroidal thickness (SFCT) and central macular thickness of the affected eyes were compared with those of the normal contralateral eyes at baseline and 1, 3, and 5 months after injection. RESULTS: The mean SFCT of the affected eyes (296.3 µm ± 61.6 µm) was significantly higher than that of the contralateral eyes (251.2 µm ± 57.7 µm; P < 0.001) at baseline. After injection, the mean SFCT was decreased compared with baseline in the treated eyes at months 1, 3, and 5. There was a correlation between SFCT and central macular thickness in the affected eyes at baseline (r = 0.397, P = 0.027). The change in SFCT was not correlated with the change in central macular thickness after injection. In the contralateral eyes, the mean SFCT did not change significantly. CONCLUSION: Subfoveal choroidal thickness in eyes with macular edema due to retinal vein occlusion was higher than that of the contralateral eyes. Intravitreal injection of a dexamethasone implant was associated with a reduction in the choroidal thickness of the treated eye.

Evaluation of Choroidal Vascular Changes in Patients with Multiple Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography.

OBJECTIVE: To evaluate the choroidal thickness in patients with multiple sclerosis (MS) using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: In this observational comparative study, 68 eyes of 34 MS patients and 60 eyes of 30 healthy subjects were evaluated. All participants underwent complete ophthalmologic examination and OCT scanning. Choroidal thickness measurements were performed at seven points. RESULTS: The mean subfoveal choroidal thickness was reduced significantly in MS patients (310.71 ± 61.85 µm) versus healthy controls (364.85 ± 41.81 µm) (p < 0.001). The difference was also significant at all six measurement points (p < 0.001 for all). Choroidal thickness measurements revealed no significant difference between MS eyes with a prior optic neuritis (ON) history (MS ON) and those without ON history (MS non-ON). Subfoveal choroidal thickness did not correlate with retinal nerve fiber layer and Expanded Disability Status Scale score, but reduced choroidal thickness was associated with longer disease duration (r = -0.28, p = 0.019) in MS patients. CONCLUSION: In MS patients, choroidal structural changes occur both in MS ON and MS non-ON eyes. The decreased choroidal thickness might provide evidence to support a potential role of vascular dysregulation in the pathophysiology of MS.

Management and Clinical Outcomes of Eyes With Posterior Segment Intraocular Foreign Bodies Seen at a Tertiary Referral Center.

BACKGROUND AND OBJECTIVE: This study aimed to identify the prognostic factors regarding the visual and anatomic outcomes of eyes with posterior segment intraocular foreign body (PS-IOFB). PATIENTS AND METHODS: The medical records of 95 patients who underwent pars plana vitrectomy and PS-IOFB removal between 2004 and 2021 were retrospectively reviewed. Data on anatomical and visual outcomes, as well as preoperative, intraoperative, and postoperative variables were statistically analyzed. RESULTS: The mean age of the patients was 31.9 ± 12.3 years. The mean follow-up time was 21.9 ± 28.3 months. The median time interval from trauma to IOFB removal was 9 days. In univariate analysis, there was a positive correlation between initial visual acuity (VA) and final VA (P < 0.001). A higher ocular trauma score (OTS) was significantly associated with both anatomical and functional success (P < 0.001). Linear regression analysis showed that OTS was not superior to initial VA in predicting final VA (r = 0.625 vs r = -0.601). Anatomic and functional outcomes were not affected by the injury site, nature of PS-IOFB, or timing of PS-IOFB removal (P > 0.05 for all). Subretinal IOFB location, the need for silicone oil tamponade, and endophthalmitis (P = 0.005, P < 0.001, P = 0.044, respectively) were risk factors for poor visual outcome. CONCLUSIONS: The initial VA, the extent of the initial ocular damage, and the presence of endophthalmitis are important prognostic factors for functional success. [Ophthalmic Surg Lasers Imaging Retina 2024;55:434-442.].

Analysis of Macular Microvasculature in Human Immunodeficiency Virus Infection.

PURPOSE: To evaluate the retinal and choroidal microvascular blood flow in patients with human immunodeficiency virus (HIV) infection using optical coherence tomography angiography (OCTA). METHODS: Macular OCTA parameters including vessel density (VD) of parafoveal superficial capillary plexus (SCP-VD) and deep capillary plexus (DCP-VD), foveal vessel density (FD), foveal avascular zone area, and flow area of choriocapillaris were analyzed in 42 HIV-positive patients, and compared with 42 healthy controls. RESULTS: The mean SCP-VD, DCP-VD and FD were significantly lower in HIV-positive group compared with controls (p < .001, p = .014, p = .026; respectively). Reduced SCP-VD was associated with higher HIV RNA plasma level (r = -0.400, p = .021) and lower CD4 + T cell count (r = 0.314, p = .046) in HIV-positive patients. CONCLUSIONS: Macular microvascular blood flow is affected by HIV infection. OCTA can detect microvascular flow abnormalities in retinal capillary plexus in HIV-positive patients.

Expert recommendations for the management of diabetic macular edema with intravitreal dexamethasone implant: A Turkish Delphi study.

PURPOSE: To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. METHODS: A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. RESULTS: A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION: This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.

Comparison of intravitreal injections of Ranibizumab and Aflibercept in neovascular age related macular degeneration.

Clinical relevance: Pivotal studies are based on strict treatment regimens of vascular endothelial growth factor blocking drugs in neovascular age-related macular degeneration. However, looser regimens with poorer results have been reported in real-world studies with various outcomes. This results in a search of more precise data to rely on in the management of patients with neovascular age-related macular degeneration.Background: The aim of this study is to analyse the real-world outcome of vascular endothelial growth factor blocking agents in neovascular age-related macular degeneration.Methods: This is a retrospective comparative study of treatment-naïve patients who received intravitreal aflibercept or ranibizumab administration for neovascular age-related macular degeneration for at least 12 months on an as needed regimen following a loading phase of three-monthly injections. Full eye examination and optical coherence tomography scans were provided at all visits. The drugs were compared on the basis of visual acuity, central macular thickness, and subfoveal choroidal thickness. The baseline optical coherence tomography features were analysed seeking a correlation with the outcome.Results: One hundred and forty-one eyes were enrolled. The mean age was 71.7 ± 8.5 years. Sixty-eight (48.2%) patients received aflibercept and 73 (51.8%) received ranibizumab injections. The mean number of injections was 6.5 ± 2.5. The mean number of injections were also similar between groups (6.4 ± 2.5 vs. 6.5 ± 2.6, respectively, p = 0.783). At one year, both drugs caused significant increase in visual acuity and decrease in central macular thickness and subfoveal choroidal thickness.Conclusion: In a real-world setting, aflibercept and ranibizumab yielded similar results at one year in the management of neovascular age-related macular degeneration.

Microstructural changes after half-dose photodynamic therapy in patients with chronic central serous chorioretinopathy.

BACKGROUND: To evaluate the retinal and choroidal microstructural changes at fovea after half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (CSC), using optical coherence tomography (OCT). METHODS: The study included 35 eyes with unilateral chronic CSC treated with half-dose PDT. The foveal outer nuclear layer (ONL) and subfoveal choroidal thickness (SFCT) in the affected eyes were compared with baseline measurements at month 1, 3, and 6 after half-dose PDT, and those of the healthy contralateral eyes. RESULTS: The mean baseline ONL thickness of the affected eyes was thinner compared to unaffected fellow eyes (66.9 ± 16.5 µm vs 111.5 ± 11.6 µm, p<0.001), and increased significantly to 68.6 ± 17.0 µm at month 3 and 68.9 ± 17.3 µm at month 6 after treatment (p = 0.025 and p = 0.014 respectively). The mean baseline SFCT of the affected eyes was thicker compared to unaffected fellow eyes (399.9 ± 87.0 µm vs 338.2 ± 75.4 µm, p<0.001), and decreased significantly after treatment at month 1, 3, and 6 (374.0 ± 84.8 µm, 369.7 ± 81.8 µm, 367.3 ± 80.8 µm respectively, p<0.001 for all). The responder group (n = 26), in which subretinal fluid was completely resorbed, showed a significant increase in ONL thickness and decrease in SFCT after treatment, whereas in the non-responder group (n = 9) ONL thickness and SFCT did not differ after treatment. CONCLUSIONS: In CSC patients, significant changes are observed in foveal ONL thickness and SFCT after half-dose PDT. ONL thickness and SFCT are suggested to be considered in the OCT examinations of CSC patients.

Outcome of 532 nm Nd:YAG laser photocoagulation in retinopathy of prematurity from a referral center.

Clinical relevance: Retinopathy of prematurity is a preventable blinding disorder worldwide. Laser photocoagulation is said to be the gold standard care of treatment. However, various factors are known to affect the outcome.Background: The purpose of this study was to analyse the risk factors in patients with laser treatment requiring retinopathy of prematurity (ROP) and the outcome of 532 nm Nd:YAG laser photocoagulation (LP).Methods: Patients who underwent LP for ROP at a tertiary referral centre between January 2012 and January 2019 were enrolled. Those who were born and followed-up at the institution of the authors were in Group 1 and those who were born and followed-up elsewhere and referred to the authors for treatment were in Group 2. The clinical features, gestational ages, birth weights, and data regarding the treatment were retrospectively reviewed. The need for pars plana vitrectomy was taken as a poor outcome.Results: The mean gestational age and birth rate was 26.7 ± 1.9 weeks and 927.2 ± 263.5 grams, respectively, in Group 1 (57 infants, 111 eyes); and 28.5 ± 2.5 weeks and 1174.8 ± 385 grams, respectively, in Group 2 (66 infants, 131eyes) (p < 0.001 for both). The extent of the disease (p < 0.001), the zone of the disease (p = 0.002), and the timing of LP (p < 0.001) were significantly different between groups. In the whole cohort, the zone (p = 0.006) and stage (p < 0.001) of the disease, aggressive posterior disease (p = 0,009), and tunica vasculosa lentis were found to significantly interfere with the outcome.Conclusion: Eyes with more severe disease undergoing timely treatment and eyes with less severe disease undergoing delayed management had similar prognosis. A favourable outcome was obtained with 532 nm green laser in ROP.

Outcome and Complications of Combined Phacoemulsification and 23-Gauge Pars Plana Vitrectomy.

BACKGROUND: With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This combined surgery offers several advantages besides limitations. The aim of this study is to assess the outcome and complications of phacoemulsification combined with pars plana vitrectomy (PPV). PATIENTS AND METHODS: In this retrospective review, medical charts of patients undergoing phacovitrectomy for coexisting cataract and various vitreoretinal disorders were analyzed. Patient demographics, retinal diagnosis, visual acuities (VA) in logMAR, intraocular pressure (IOP), intraoperative and postoperative complications were assessed. Clear corneal phacoemulsification and 23-gauge transconjunctival PPV were administered in all cases. RESULTS: Eighty-four eyes of 64 (76.2%) males and 20 (23.8%) females were enrolled. The average age of patients was 59.5 ± 13.8 (18-81). The average period of follow-up was 7.2 ± 7.5 months (1-36). The vitreoretinal diagnoses were as follows: 28 (33.3%) rhegmatogenous retinal detachment, 23 (27.4%) vitreous hemorrhage, 12 (14.3%) intraocular foreign body, 12 (14.3%) epiretinal membrane, 4 (4.8%) macular hole, 4 (4.8%) tractional retinal detachment, and 1 (1.2%) vitreomacular traction. The most common intraoperative complications were miosis and rupture of the posterior capsule (92.9% and 8.3%, respectively). In 8 (9.5%) cases, there was fibrin in the anterior chamber. Posterior synechia developed in 7 (8.3%) of cases. No severe increase in intraocular pressure was evident. CONCLUSION: Phacoemulsification combined with PPV is a safe and efficient way of management in cases where cataract coexists with vitreoretinal pathologies.

A Rare Cause of Uveitis: Vemurafenib

A 25-year-old female presented with a decrease of vision and redness in both eyes. She had a history of nodular melanoma in her right shoulder, which was excised surgically and she was under oral vemurafenib treatment. She was diagnosed with moderately severe bilateral panuveitis and hospitalized for systemic investigation and workup. The laboratory test results were unremarkable and systemic workup failed to reveal an etiology. The condition was considered vemurafenib-induced uveitis, as the drug is known to be associated with uveitis. After reevaluation with the oncology department, vemurafenib was stopped and topical and systemic corticosteroid therapy was started. The uveitis resolved and her vision returned to normal. No sign of recurrence was detected at 8-month follow-up.

Evaluating Choroidal Characteristics in Systemic Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography.

PURPOSE: To evaluate choroidal thickness (CT) and investigate the involvement of choroidal circulation in patients with systemic sclerosis (SSc). METHODS: A total of 120 eyes of 60 SSc patients and 60 eyes of 30 healthy controls were evaluated. CT measurements were performed at the subfoveal region, 1000 µm nasal and 1000 µm temporal to the fovea, using enhanced depth imaging optical coherence tomography. CT measurements were compared between the patients and controls. RESULTS: The average subfoveal, parafoveal nasal and parafoveal temporal CT were significantly thinner in SSc patients when compared with healthy controls (297.77 ± 60.8 µm vs 339.8 ± 50.4 µm; 267.32 ± 51.1 µm vs 308.65 ± 49.9 µm; 270.63 ± 46.3 µm vs 309.22 ± 42.4 µm, respectively; p<0.001 for all). CONCLUSIONS: Reduced CT in SSc patients supports the hypothesis of widespread vascular injury, including the ocular microcirculation.