Nanorheology and Nanoindentation Revealed a Softening and an Increased Viscous Fluidity of Adherent Mammalian Cells upon Increasing the Frequency.

The nanomechanical response of a cell depends on the frequency at which the cell is probed. The components of the cell that contribute to this property and their interplay are not well understood. Here, two force microscopy methods are integrated to characterize the frequency and/or the velocity-dependent properties of living cells. It is shown on HeLa and fibroblasts, that cells soften and fluidize upon increasing the frequency or the velocity of the deformation. This property was independent of the type and values (25 or 1000 nm) of the deformation. At low frequencies (2-10 Hz) or velocities (1-10 µm s-1 ), the response is dominated by the mechanical properties of the cell surface. At higher frequencies (>10 Hz) or velocities (>10 µm s-1 ), the response is dominated by the hydrodynamic drag of the cytosol. Softening and fluidization does not seem to involve any structural remodeling. It reflects a redistribution of the applied stress between the solid and liquid-like elements of the cell as the frequency or the velocity is changed. The data indicates that the quasistatic mechanical properties of a cell featuring a cytoskeleton pathology might be mimicked by the response of a non-pathological cell which is probed at a high frequency.

The viscoelasticity of adherent cells follows a single power-law with distinct local variations within a single cell and across cell lines.

AFM-based force-distance curves are commonly used to characterize the nanomechanical properties of live cells. The transformation of these curves into nanomechanical properties requires the development of contact mechanics models. Spatially-resolved force-distance curves involving 1 to 2 µm deformations were obtained on HeLa and NIH 3T3 (fibroblast) cells. An elastic and two viscoelastic models were used to describe the experimental force-distance curves. The best agreement was obtained by applying a contact mechanics model that accounts for the geometry of the contact and the finite-thickness of the cell and assumes a single power-law dependence with time. Our findings show the shortcomings of elastic and semi-infinite viscoelastic models to characterize the mechanical response of a mammalian cell under micrometer-scale deformations. The parameters of the 3D power-law viscoelastic model, compressive modulus and fluidity exponent showed local variations within a single cell and across the two cell lines. The corresponding nanomechanical maps revealed structures that were not visible in the AFM topographic maps.

Intravitreal bevacizumab for subfoveal choroidal neovascularization in age-related macular degeneration at twenty-four months: the Pan-American Collaborative Retina Study.

PURPOSE: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (IVB) (Avastin; Genentech Inc., San Francisco, CA) (1.25 or 2.5 mg) in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Retrospective, multicenter, interventional, comparative case series. PARTICIPANTS: We reviewed the clinical records of 180 consecutive patients (207 eyes) with subfoveal CNV secondary to AMD at 9 centers from 8 countries. METHODS: Patients were treated with at least 1 injection of IVB 1.25 mg (124 eyes [59.9%]) or 2.5 mg (83 eyes [40.1%]). Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and 1-, 3-, 6-, 12-, and 24-month visits. MAIN OUTCOME MEASURES: Changes in BCVA and OCT. RESULTS: The mean age of our patients was 74.3±7.5 years. The mean number of IVB injections per eye was 5.1 (range, 1-24 injections). In the 1.25 mg group, baseline BCVA improved from 20/235 (logarithm of the minimum angle of resolution [logMAR] 1.07) to 20/172 (logMAR 0.92) at 24 months (P<0.0001). Similar BCVA changes were observed in the 2.5 mg group. At baseline, the mean central macular thickness (CMT) by OCT in the 1.25 mg group was 308.4±127.52 µm, which was reduced to 269.35±97.92 µm, 262.1±94.81 µm, 264.03±97.06 µm, 245.91±89.52 µm, and 249.27±89.14 µm at 1, 3, 6, 12, and 24 months, respectively (P<0.0001). Similar changes were observed in the 2.5 mg group. In the 2.5 mg group, systemic complications included 2 new cases (2.6%) of arterial hypertension, 1 case (1.3%) of stroke, and 1 case (1.3%) of death. CONCLUSIONS: Primary IVB at a dose of 1.25 or 2.5 mg seems to provide stability or improvement in BCVA, OCT, and FA in subfoveal CNV secondary to AMD at 24 months. Our results show no significant difference regarding BCVA with IVB at doses of 1.25 or 2.5 mg.

Intravitreal bevacizumab for refractory pseudophakic cystoid macular edema: the Pan-American Collaborative Retina Study Group results.

OBJECTIVE: To determine the feasibility, safety, and clinical effect of intravitreal (IVT) bevacizumab (Avastin; Genentech, Inc., San Francisco, CA) in patients with refractory cystoid macular edema (CME) after cataract surgery. DESIGN: Interventional, retrospective, multicenter study. PARTICIPANTS: Thirty-six eyes of 31 patients with refractory CME after cataract surgery and with a mean age of 68.2 years (range, 67-87 years). METHODS: Patients were treated with at least 1 IVT injection of 1.25 or 2.5 mg bevacizumab. Patients were followed up for 12 months. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA) and central macular thickness (CMT) by optical coherence tomography (OCT). RESULTS: Twenty-six eyes (72.2%) demonstrated improvement of BCVA (> or =2 Early Treatment Diabetic Retinopathy Study [ETDRS] lines), and no eye experienced worsening of visual acuity (> or =2 ETDRS lines). Mean baseline BCVA was 20/200 (0.96 logarithm of the minimum angle of resolution [logMAR] units), and the mean 12-month BCVA was 20/80 (0.62 logMAR units; P<0.0001). Optical coherence tomography demonstrated that mean CMT at baseline was 499.9 microm (range, 298-784 microm) and decreased to a mean of 286.1 microm (range, 168-499 microm) at 12 months (P<0.0001). Four (11%) eyes received 2 injections, 10 (27.8%) eyes received 3 injections, 10 (27.8%) eyes received 4 injections, 1 (2.8%) eye received 5 injections, and 1 (2.8%) eye received 6 injections. The mean number of injections was 2.7 (range, 1-6), and the mean interval between injections was 15.1 weeks (range, 4-45 weeks). No ocular or systemic adverse events were observed. CONCLUSIONS: Short-term results suggest that IVT bevacizumab is well tolerated in patients with refractory pseudophakic CME. Treated eyes had a significant improvement in BCVA and decrease in macular thickness by OCT at 12 months.

Primary intravitreal bevacizumab for diffuse diabetic macular edema: the Pan-American Collaborative Retina Study Group at 24 months.

PURPOSE: To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin; Genentech, Inc., San Francisco, CA; 1.25 or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the 2 different doses of intravitreal bevacizumab (IVB) used is presented. DESIGN: Retrospective, multicenter, interventional, comparative case series. PARTICIPANTS: The clinical records of 115 consecutive patients (139 eyes) with DDME at 11 centers from 8 countries were reviewed. METHODS: Patients were treated with at least 1 intravitreal injection of 1.25 or 2.5 mg of bevacizumab. All patients were followed up for 24 months. Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at the baseline, 1-, 3-, 6-, 12-, and 24-month visits. MAIN OUTCOME MEASURES: Changes in BCVA and OCT results. RESULTS: The mean age of the patients was 59.4+/-11.1 years. The mean number of IVB injections per eye was 5.8 (range, 1-15 injections). In the 1.25-mg group at 1 month, BCVA improved from 20/150 (0.88 logarithm of the minimum angle of resolution [logMAR] units) to 20/107, 0.76 logMAR units (P<0.0001). The mean BCVA at 24 months was 20/75 (0.57 logMAR units; P<0.0001). Similar BCVA changes were observed in the 2.5-mg group: at 1 month, BCVA improved from 20/168 (0.92 logMAR units) to 20/118 (0.78 logMAR units; P = 0.02). The mean BCVA at 24 months was 20/114 (0.76 logMAR units; P<0.0001). In the 1.25-mg group, the mean central macular thickness (CMT) decreased from 466.5+/-145.2 microm at baseline to 332.2+/-129.6 microm at 1 month and 286.6+/-81.5 microm at 24 months (P<0.0001). Similar results were obtained in the 2.5-mg group. CONCLUSIONS: Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 24 months. The results show no evident difference between IVB at doses of 1.25 or 2.5 mg.

Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up.

BACKGROUND: To report the 12-month anatomic and ETDRS best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) (1.25 mg or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the two different doses of intravitreal bevacizumab (IVB) utilized was made. METHODS: We reviewed the clinical records of 82 consecutive patients (101 eyes) with DDME in this interventional retrospective multicenter study. All patients with a minimum follow-up of 12 months (mean 57.6 +/- 8.4 weeks) were included in this analysis. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. RESULTS: The mean age of our patients was 59.7 +/- 9.3 years. The mean number of IVB injections per eye was three (range: one to six injections) at a mean interval of 14.1 +/- 10.5 weeks. In the 1.25 mg group at 1 month BCVA improved from 20/190, logMAR = 0.97 to 20/85, logMAR 0.62, a difference that was statistically significant (p = 0.0001). This improvement was maintained throughout the 3-, 6-, and 12-month follow-up. The mean final BCVA at 12 months was 20/76, logMAR = 0.58 (p < 0.001), a statistically significant difference from baseline BCVA. Similar BCVA changes were observed in the 2.5 mg group. In the 1.25 mg group, the mean central macular thickness (CMT) decreased from 419.1 +/- 201.1 microm at baseline to 295.11 +/- 91.5 microm at 1 month, 302.1 +/- 124.2 microm at 3 months, 313.4.1 +/- 96.3 microm at 6 months, and 268.2 +/- 95.5 microm at 12 months (p < 0.0001). Similar CMT changes were observed in the 2.5 mg group. Adverse events included transient high blood pressure in one patient (1.2%), transient increased intraocular pressure in one eye (1%), and tractional retinal detachment in one eye (1%). CONCLUSIONS: Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 12 months. There seems to be no difference in our results between intravitreal bevacizumab at doses of 1.25 mg or 2.5 mg. In addition, our results suggest the need for at least three injections a year to maintain the BCVA results.

Primary intravitreal bevacizumab for subfoveal choroidal neovascularization in age-related macular degeneration: results of the Pan-American Collaborative Retina Study Group at 12 months follow-up.

PURPOSE: To report the 12-month anatomic and Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA) (1.25 mg or 2.5 mg) in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: Sixty-three eyes of 63 consecutive patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration, a mean age of 73.7 +/- 7.5 years and a minimum of 12 months (mean 55.5 +/- 6.2 weeks) of follow-up participated in this interventional retrospective multicenter case series in 7 centers from 6 countries. Patients were treated with at least 1 intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab. Patients underwent Early Treatment Diabetic Retinopathy Study BCVA testing, ophthalmoscopic examination, optical coherence tomography, and fluorescein angiography at baseline and follow-up visits. Repeated measures analysis of variance was used to compare mean values. RESULTS: The mean number of intravitreal bevacizumab injections per eye was 3.5 (range, 1-8). Mean baseline BCVA was 20/320, logarithm of the minimum angle of resolution = 1.2, and mean final BCVA was 20/200, logarithm of the minimum angle of resolution = 1.0 (P < 0.001). Central macular thickness at baseline by optical coherence tomography had a mean of 389.2 +/- 149.6 microm which was significantly reduced to a mean of 281.0 +/- 96.1 microm, 268.2 +/- 82.6 microm, 262.6 +/- 92.3 microm, and 241.3 +/- 76.7 microm at 1, 3, 6, and 12 months after initial treatment, respectively (P < 0.0001). Ocular adverse events included transient increased intraocular pressure in 2 (3.1%) eyes, endophthalmitis in 2 (3.1%) eyes, and transient hypotony in 1 eye (1.1%). No systemic adverse events were observed. CONCLUSION: Primary intravitreal bevacizumab at doses of 1.25 mg or 2.5 mg seems to provide stability or improvement in BCVA, optical coherence tomography, and fluorescein angiography in subfoveal choroidal neovascularization secondary to age-related macular degeneration at 12 months.

Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: results from the Pan-American Collaborative Retina Study Group at 6-month follow-up.

PURPOSE: To report the 6-month anatomic and best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) in patients with diabetic macular edema (DME). DESIGN: Interventional retrospective multicenter study at 6 centers from 6 countries of patients with DME. PARTICIPANTS: We reviewed the clinical records of 88 consecutive patients (110 eyes) with DME. Seventy-eight eyes of 64 consecutive patients with a minimum follow-up of 6 months and mean age of 59.7+/-9.3 years were included in this analysis. INTERVENTION: Patients were treated with at least one intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab and underwent Early Treatment Diabetic Retinopathy Study (ETDRS) BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. Repeated-measures analysis of variance was used to compare mean values. MAIN OUTCOME MEASURES: Changes in BCVA, OCT, and FA. RESULTS: Mean follow-up was 6.31+/-0.81 months (range, 6-9). Sixteen (20.5%) eyes needed a second injection at a mean of 13.8 weeks (range, 4-28), and 6 eyes needed a third injection (7.7%) at a mean of 11.5 weeks (range, 5-20). The mean baseline BCVA was 0.87 (logarithm of the minimum angle of resolution), and the final mean BCVA was 0.6, a difference that was statistically significant (P<0.0001). Final BCVA analysis by subgroups demonstrated that 32 (41.1%) eyes remained stable, 43 (55.1%) improved > or =2 ETDRS lines of BCVA, and 3 (3.8%) decreased > or =2 ETDRS lines of BCVA. Mean central macular thickness at baseline by OCT was 387.0+/-182.8 mum and decreased to a mean of 275.7+/-108.3 at end of follow-up (P<0.0001). No ocular or systemic adverse events were observed. CONCLUSIONS: Primary intravitreal bevacizumab at doses of 1.25 to 2.5 mg seem to provide stability or improvement in VA, OCT, and FA in DME at 6 months. Follow-up is still short to make any specific treatment recommendations; however, the results appear promising. Evaluation in a multicenter randomized controlled clinical trial with longer follow-up is needed.

Primary intravitreal bevacizumab for the management of pseudophakic cystoid macular edema: pilot study of the Pan-American Collaborative Retina Study Group.

PURPOSE: To determine the feasibility, safety, and clinical effect of primary intravitreal bevacizumab (Avastin) in patients with cystoid macular edema (CME) after cataract surgery. SETTING: Five institutions in Venezuela, Costa Rica, Puerto Rico, Peru, and Brazil. METHODS: Twenty-eight eyes of 25 patients treated with at least 1 intravitreal injection of 1.25 mg or 2.50 mg of Avastin participated in this interventional retrospective multicenter study at 5 institutions from 5 countries. Baseline and follow-up visits included Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing, optical coherence tomography (OCT) imaging, and ophthalmoscopic examination. RESULTS: The mean follow-up was 32 weeks (range 24 to 52 weeks). Twenty eyes (71.4%) had improved best corrected visual acuity (BCVA) (> or =2 ETDRS lines), and no eye had worse visual acuity (> or =2 ETDRS lines). The BCVA remained stable in 8 eyes (28.6%). The mean baseline BCVA was 20/160 (logMAR = 0.92) and the mean final BCVA, 20/63 (logMAR = 0.50); the difference was statistically significant (P<.0001). The mean central macular thickness at baseline (466.3 microm; range 208 to 784 microm) decreased significantly (264.5 microm; range 176 to 513 microm) by the end of follow-up (P<.0001). Eight eyes (28.6%) required a second injection and 4 (14.3%), a third injection. The mean interval between injections was 13 weeks (range 5 to 26 weeks). No ocular or systemic adverse events were observed. CONCLUSIONS: Short-term results suggest that primary intravitreal Avastin is well tolerated in patients with pseudophakic CME. Treated eyes had a significant improvement in BCVA and decrease in macular thickness by OCT.

Combined 5-fluorouracil, low-molecular-weight heparin, and silicone oil in the management of complicated retinal detachment with proliferative vitreoretinopathy grade C.

BACKGROUND AND OBJECTIVE: To determine whether combined 5-fluorouracil (5-FU) and low-molecular-weight heparin (LMWH) could improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR) grade C. PATIENTS AND METHODS: In an interventional, controlled, nonrandomized clinical trial, 33 eyes with complicated retinal detachment and PVR underwent vitrectomy with silicone oil and perioperative infusion of 5-FU and LMWH (study group) and 31 eyes underwent vitrectomy with silicone oil without adjunctive medication (control group). RESULTS: In the study group, 24 eyes (72.7%) had the retina attached and 9 had a retinal redetachment (27.3%) at 6 months. In the control group, 25 eyes (80.6%) had the retina attached and 6 eyes (19.4%) had a retinal redetachment at 6 months (chi-square: 0.53, P > .05). One-year postoperative data were available for 17 eyes in the study group and 19 eyes in the control group. Four eyes in each group (23.5% and 21%, respectively) developed retinal redetachment (chi-square: 0.03, P > .05). CONCLUSIONS: Combined 5-FU and LMWH does not seem to improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with PVR grade C.

Management of primary pterygia using free conjunctival and limbal-conjunctival autografts without antimetabolites.

PURPOSE: To report the incidence of recurrence after primary pterygium surgery using either a free conjunctival or limbal-conjunctival autograft without antimetabolites. METHODS: One hundred eleven eyes of 90 patients underwent pterygium resection; a free conjunctival autograft was used in 88 surgeries and a free limbal-conjunctival autograft in 24; the latter technique was reserved for dark-skinned patients, under age 30, and with a history of recurrent pterygium in the contralateral eye. RESULTS: Mean age was 42.5 years (range, 23-75), and 50% of the patients were male. Mean follow-up was 9 months (range, 3-12). There were 2 recurrences (1.8%), both observed in the third postoperative month. CONCLUSIONS: With a good surgical technique, the incidence of recurrence after primary pterygium surgery is very low, making the use of antimetabolites unnecessary.

Simultaneous surgery for corneal edema and aphakia: DSEK and placement of a retropupillary iris claw lens.

PURPOSE: The aim was to report the surgical outcomes of simultaneous Descemet stripping endothelial keratoplasty (DSEK) with a retropupillary fixated iris claw lens in patients with aphakic corneal edema without capsular support. METHODS: The clinical records of aphakic patients with corneal edema and no capsular support who underwent a combined DSEK and implantation of a retropupillary fixated iris claw lens (Artisan) were evaluated. Presurgical and postsurgical best-corrected visual acuity, postsurgical refraction, and endothelial cell count were analyzed at the first and sixth months after the surgery and were imaged with anterior segment ultrasound biomicroscopy. RESULTS: A total of 9 eyes from 7 females and 2 males were analyzed. The average age was 72.1 years. The mean duration of the postoperative follow-up was 7.7 months. All the patients achieved corrected visual acuities over 0.60 logarithm of the minimum angle of resolution. There was no significant variation in the endothelial count between the first and sixth months. Astigmatism >1 D was induced in all the patients, with 7 patients having against the rule, and 2 patients having oblique astigmatism. CONCLUSIONS: DSEK combined with a retropupillary fixated iris claw lens was shown to be a safe surgical technique in patients with aphakia without capsular support and corneal swelling. This surgery resulted in stable endothelial cell counts during the first 6 months after the surgery and an improvement in visual acuity.

Update on sympathetic ophthalmia.

Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous intraocular inflammation that occurs in most cases within days or months after surgery or penetrating trauma to one eye. The incidence of SO ranges from 0.2 to 0.5% after penetrating ocular injuries and 0.01% after intraocular surgery. Vitreoretinal surgery and cyclodestructive procedures are considered risk factors. The time from ocular injury to onset of SO varies greatly, ranging from a few days to decades, with 80% of the cases occurring within 3 months after injury to the exciting eye and 90% within 1 year. The diagnosis is based on clinical findings rather than on serological testing or pathological studies. It presents as a bilateral diffuse uveitis. Patients report an insidious onset of blurry vision, pain, epiphora, and photophobia in the sympathizing, non-injured eye. Classically this is accompanied by conjunctival injection and a granulomatous anterior chamber reaction with mutton-fat keratic precipitates (KPs) on the corneal endothelium. In the posterior segment, the extent of inflammation can vary. Systemic corticosteroids are the first line therapy for SO. If patients are non-responsive to steroid therapy or have clinically significant side effects, cyclosporine, azathioprine or other immunosuppressive agents can be used for long-term immunomodulatory therapy.

Intravitreal Bevacizumab (Avastin) for Diabetic Retinopathy: The 2010 GLADAOF Lecture.

This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy.

Intravitreal Bevacizumab (Avastin(®)) for Diabetic Retinopathy at 24-months: The 2008 Juan Verdaguer-Planas Lecture.

Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab (IVB) on DR including DME and PDR at 24 months of follow up. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse diabetic macular edema. Therefore, in the future this new therapy could replace or complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to pan-retina photocoagulation so that more selective therapy may be applied. In addition, we report a series of patients in which tractional retinal detachment developed or progressed after adjuvant preoperative IVB in severe PDR.

Long-term effect of intravitreal triamcinolone in the nonproliferative stage of type II idiopathic parafoveal telangiectasia.

PURPOSE: To report the visual outcomes and ocular complications of intravitreal triamcinolone acetonide (IVTA) in the treatment of the nonproliferative stage of type II idiopathic parafoveal telangiectasia (IPT). METHODS: Retrospective, multicenter, uncontrolled interventional case series of 19 eyes of 14 consecutive patients with the nonproliferative stage of IPT that had undergone at least one intravitreal injection of 4 mg of triamcinolone acetonide. Demographic, medical, and ocular data were obtained through chart review. The main outcome measures included best-corrected visual acuity at several timepoints of follow up and ocular complications. RESULTS: At baseline the mean logMAR visual acuity was 0.83 +/- 0.41 (Snellen 20/135, range 0.3-2). After an average follow-up of 21.2 months (range 6-44 months), the mean logMAR visual acuity remained essentially unchanged from baseline. At 3 months, the logMAR visual acuity was 0.86 +/- 0.44 (Snellen 20/145, P = 0.8378), at 6 months 0.86 +/- 0.42 (Snellen 20/145, P = 0.8149), at 12 months 0.87 +/- 0.46 (Snellen 20/148, P > 0.9999), at 18 months 0.84 +/- 0.35 (Snellen 20/138, P = 0.8385), and at the last follow-up 0.82 +/- 0.44 (Snellen 20/132, P = 0.9301). Seven eyes were reinjected once. Ten of 19 eyes (53%) developed cataract (3 eyes underwent phacoemulsification and intraocular lens implantation) and 7 of 19 eyes (37%) had an elevated intraocular pressure, none of which required surgical treatment. CONCLUSION: IVTA does not seem to improve visual acuity in most eyes with the nonproliferative stage of IPT.

Indocyanine-green-mediated photothrombosis (IMP) with intravitreal triamcinolone acetonide for macular edema secondary to group 2A idiopathic parafoveal telangiectasis without choroidal neovascularization: a pilot study.

BACKGROUND: The purpose of this study was to determine the feasibility, safety and clinical effect of indocyanine green (ICG)-mediated photothrombosis (IMP) combined with intravitreal triamcinolone acetonide (IVTA) in patients with macular edema secondary to idiopathic parafoveal telangiectasis (IPFT) group 2A without choroidal neovascularization (CNV). METHODS: Nine eyes of six patients that were treated with IMP immediately followed by IVTA at a dose of 4 mg participated in the study. Patients had a mean follow-up of 23.3 months (range 12-36 months). Patients underwent one or two sessions of IMP combined with IVTA ("study group"). An IVTA-only group of 19 eyes from 14 patients with macular edema secondary to IPFT group 2A that underwent an IVTA 4 mg without IMP ("IVTA-only group") was included for comparison. In addition, a matched control group of 40 eyes from 20 patients selected retrospectively from our medical records with macular edema secondary to IPFT group 2A without any therapy was included ("observation group"). RESULTS: The best-corrected visual acuity (BCVA) remained stable in five eyes (55.5%). Four eyes (44.4%) demonstrated improvement of BCVA (> or = two ETDRS lines), and no eyes experienced worsening of visual acuity (> or = two ETDRS lines). A significant decrease in hyperfluorescence was not seen with fluorescein angiography (FA), however optical coherence tomography (OCT) showed a decrease in the size of inner intraretinal hyporeflective spaces or cystic edema. Two (22.2%) eyes developed an increase in intraocular pressure. However, it was medically controlled with topical anti-glaucoma medications. Cataract developed in five eyes (55.5%). Six of nine eyes (66.6%) required one retreatment during the study period. At the last follow-up (mean 21.1 months, range 12-30 months) in the IVTA-only group, 5 (25.3%) eyes improved BCVA, 11 (57.9%) eyes remained within two lines of baseline BCVA and 3 (15.8%) eyes lost BCVA. In the observation group, with similar follow-up, 87.5% of eyes showed either stabilization or deterioration of BCVA over time. CONCLUSIONS: Combined IMP and IVTA may provide stability or improvement in BCVA and fundus findings in eyes with macular edema secondary to IPFT group 2A without CNV at a minimum follow-up of 12 months.

Optical coherence tomography characteristics of group 2A idiopathic parafoveal telangiectasis.

PURPOSE: To describe the optical coherence tomography (OCT) characteristics of patients with group 2A idiopathic parafoveal telangiectasis (IPFT) and to correlate them with biomicroscopic and fluorescein angiographic (FA) findings based on Gass and Blodi staging classification for group 2A IPFT. METHODS: Fifty-two eyes of 26 consecutive patients with IPFT underwent biomicroscopic fundus examination, color fundus photography, FA, and OCT. Main outcome measures were OCT characteristics and their correlation with biomicroscopy and FA. RESULTS: The most common OCT findings that help differentiate between stages in group 2A IPFT are 1) highly reflective dots in the inner retina that correspond with microvessels seen by FA in Stage 1 (5 eyes [62.5%]); 2) the presence of hyporeflective intraretinal spaces in the absence of retinal thickening and highly reflective dots in the retina in Stage 2 (9 [81.8%] and 10 eyes [90.9%], respectively); 3) in Stage 3, both outer and inner retina exhibit areas of similar high reflectivity. In addition, the retinal pigment epithelium (RPE)/choriocapillaris complex is thickened or disrupted as evidenced by an area of high reflectivity (13 eyes [81.2%]); 4) a highly reflective area nasal or temporal to the fovea in the inner or outer retinal layers in Stage 4 suggesting RPE proliferation and migration (13 eyes [100%]); and 5) a fusiform thickening and duplication of the highly reflective RPE/choriocapillaris complex corresponding to choroidal neovascularization in Stage 5 (4 eyes [100%]). Our OCT characteristics correlated well with biomicroscopic and FA findings for Stages 4 and 5. However, the hyporeflective spaces that are evident on OCT could not be seen clinically at the slit lamp or on FA. In addition, our OCT findings on eyes with group 2A IPFT Stage 3 have not, to our knowledge, been previously described. CONCLUSIONS: Optical coherence tomography findings in group 2A IPFT were characteristic for each stage and may be helpful in making the diagnosis as well as defining the anatomical staging proposed by Gass and Blodi. Optical coherence tomography complements biomicroscopic and FA findings in the evaluation of group 2A IPFT.