Evaluation of the results of contact lens assisted corneal cross-linking treatment in keratoconus patients with thin corneas.

PURPOSE: We aimed to compare the efficacy and safety of accelerated contact lens-assisted cross-linking (CA-CXL) with Lotrafilcon B and Comfilcon A lenses in keratoconus (KC) patients with thin corneas. STUDY DESIGN: Retrospective, single-center study. MATERIALS AND METHODS: We retrospectively included 51 eyes of 39 KC patients with corneal thickness <400µm after epithelial scraping (Epi-off), who underwent accelerated CA-CXL treatment with Lotrafilcon B (n=20) and Comfilcon A (n=31). Uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest refraction values, corneal topographic data and endothelial cell density were recorded at preoperative and postoperative 1st, 3rd and 6th month controls. RESULTS: CDVA in the Comfilcon A group was higher than CDVA before surgery at 6 months postoperatively (p<0.001). When the two lenses were compared, CDVA was found to be significantly higher in the Lotrafilcon B group in the preoperative, postoperative 1st month and 3rd month values, but there was no significant difference between the postoperative 6th month values (p=0.028, p=0.018, p=0.044, p=0.181, respectively). The maximum keratometry (Kmax) value at the 6th month after surgery in the Comfilcon A group was significantly lower than in the Lotrafilcon B group (p=0,009). There was no significant difference between the endothelial cell density values between the groups (p=0.623, p=0.609, p=0.794, p=0.458, respectively). There was no significant difference between the progression, regression, and stability rates of the two groups (p=0.714). CONCLUSIONS: Accelerated CA-CXL with Lotrafilcon B and Comfilcon A silicone hydrogel lenses is a safe and effective method to stop progression in patients with thin corneas.

Investigation of the safety and effectiveness of accelerated contact lens-assisted corneal cross-linking (A-CACXL) in thin corneas.

PURPOSE: To determine the safety and effectiveness of accelerated contact lens-assisted corneal crosslinking (A-CACXL) as an alternative method in progressive keratoconus patients with thin corneas. METHODS: In our retrospective study, 31 eyes from 25 patients with progressive keratoconus that with a minimum corneal thickness of 400 µm or less after epithelial debridement underwent A-CACXL with a follow-up 6 months or more were included. The main outcome measures were uncorrected distance(UDVA) and corrected distance(CDVA) visual acuities, manifest sphere(D) and manifest cylinder(D) refraction values, K1(D), K2(D), Kmax(D), mean keratometry(D) values, minimum corneal thickness(µm) and endothelial cell count(cells/mm2). These outcome measurements were statistically analyzed at preoperative and postoperative 1 month, 3 months, and 6 months follow-ups. RESULTS: 31 eyes from 25 patients with the mean follow-up period of 7.7 ± 2.7 months were included. Data revealed a significant increase in CDVA(p = 0.053). There is no statistically significant change in UDVA, K1, mean keratometry, mean manifest sphere value, minimum corneal thickness and endothelial cell count .(respectively p:0.053, p: 0.333, p: 0,129, p:0.490, p: 0,467, p:0.035, p:0.102). There is a statistically significant decrease in the K2, Kmax and mean manifest cylinder values.(respectively p: 0,030, p < 0,001, p < 0,001). CONCLUSION: A-CACXL method is a safe and effective method to stop keratoconic progression and improve functional vision in patients with thin corneas. However, larger randomised controlled studies are needed to validate these findings.

Three versus five intravitreal aflibercept injections as the initial loading phase in the treatment of diabetic macular edema: one-year results.

PURPOSE: To compare the efficacy of three initial monthly intravitreal aflibercept injections followed by pro re nata (3+PRN) dosing versus five initial monthly intravitreal aflibercept injections followed by pro re nata (5+PRN) dosing in patients with diabetic macular edema. METHODS: A total of 60 treatment-naïve patients with macular edema who underwent intravitreal aflibercept injections (2 mg/0.05 mL) with at least one year of follow-up were analyzed in this retrospective and comparative study. The patients were divided into two groups according to the number of intravitreal aflibercept injections administered in the loading phase. The 3+PRN group comprised 27 patients, whereas the 5+PRN group comprised 33 patients. The visual and anatomical outcomes were compared between the two groups at baseline and at 3, 6, 9, and 12 months. RESULTS: Both 3+PRN and 5+PRN, showed statistically significant improvements in the best-corrected visual acuity and central macular thicknesse throughout the study period (p<0.001 and, p<0.001, respectively). There were no significant differences between the two groups in terms of changes in the best-corrected visual acuity and central macular thickness (p=0.453 and, p=0.784, respectively). The mean number of intravitreal aflibercept injections was significantly greater in the 5+PRN group (6.1 ± 0.8) than in the 3+PRN group (3.9 ± 0.8) (p<0.001). CONCLUSION: The 3+PRN and 5+PRN regimens showed similar 12-month visual and anatomical outcomes following treatment with intravitreal aflibercept injections in patients with macular edema.

Three versus five intravitreal aflibercept injections as the initial loading phase in the treatment of diabetic macular edema: one-year results / Três versus cinco injeções intravítreas de aflibercept como carga inicial do tratamento de edema macular diabético: resultados de um ano

ABSTRACT Purpose: To compare the efficacy of three initial monthly intravitreal aflibercept injections followed by pro re nata (3+PRN) dosing versus five initial monthly intravitreal aflibercept injections followed by pro re nata (5+PRN) dosing in patients with diabetic macular edema. Methods: A total of 60 treatment-naïve patients with macular edema who underwent intravitreal aflibercept injections (2 mg/0.05 mL) with at least one year of follow-up were analyzed in this retrospective and comparative study. The patients were divided into two groups according to the number of intravitreal aflibercept injections administered in the loading phase. The 3+PRN group comprised 27 patients, whereas the 5+PRN group comprised 33 patients. The visual and anatomical outcomes were compared between the two groups at baseline and at 3, 6, 9, and 12 months. Results: Both 3+PRN and 5+PRN, showed statistically significant improvements in the best-corrected visual acuity and central macular thicknesse throughout the study period (p<0.001 and, p<0.001, respectively). There were no significant differences between the two groups in terms of changes in the best-corrected visual acuity and central macular thickness (p=0.453 and, p=0.784, respectively). The mean number of intravitreal aflibercept injections was significantly greater in the 5+PRN group (6.1 ± 0.8) than in the 3+PRN group (3.9 ± 0.8) (p<0.001). Conclusion: The 3+PRN and 5+PRN regimens showed similar 12-month visual and anatomical outcomes following treatment with intravitreal aflibercept injections in patients with macular edema.

RESUMO Objetivo: Comparar a eficácia de três injeções intravítreas mensais iniciais de aflibercept, seguidas de dosagem de pro re nata (3+PRN) versus cinco injeções mensais iniciais intravítreas de aflibercept, seguidas de doses de pro re nata (5 + PRN) em pacientes com edema macular diabético. Métodos: Foram analisados neste estudo retrospectivo e comparativo 60 pacientes que não receberam tratamento prévio com edema macular e foram submetidos a injeções intravítreas de aflibercept (2 mg/0,05 mL) com pelo menos um ano de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com o número de injeções intravítreas de aflibercept administradas na fase inicial. O grupo 3+PRN compreendeu 27 pacientes, enquanto o grupo 5+PRN compreendeu 33 pacientes. Os resultados visuais e anatômicos foram comparados entre os dois grupos no período inicial e aos 3, 6, 9 e 12 meses. Resultados: Tanto os grupos 3+PRN quanto 5+PRN mostraram melhoras estatisticamente significativas na acuidade visual melhor corrigida e na espessura macular central ao longo do período de estudo (p<0,001 e p <0,001, respectivamente). Não houve diferenças significativas entre os dois grupos em termos de alterações na acuidade visual melhor corrigida e na espessura macular central (p=0,453 e p=0,784, respectivamente). O número médio de injeções intravítreas de aflibercept foi significativamente maior no grupo 5+PRN (6,1 ± 0,8) do que no grupo 3+PRN (3,9 ± 0,8) (p <0,001). Conclusão: Os regimes 3+PRN e 5+PRN mostraram resultados visuais e anatômicos semelhantes em 12 meses após o tratamento com injeções intravítreas de aflibercept em pacientes com edema macular.

Comparison of the short-term effect of aflibercept and dexamethasone implant on serous retinal detachment in the treatment of naive diabetic macular edema.

Purpose: The aim of this study is to compare the efficacy of intravitreal injection of aflibercept and dexamethasone implant in the early treatment period of naive diabetic macular edema (DME) with serous retinal detachment (SRD). Materials and methods: In this retrospective comparative study, medical records of patients who received treatment for naive DME with SRD and underwent three monthly intravitreal aflibercept (IVA) injections (2 mg) or one intravitreal dexamethasone implant (IDI) injection (0.7 mg) were reviewed. The best corrected visual acuity (BCVA), central macular thickness (CMT), and presence and height of SRD were compared three months after IDI injection and one month after the third IVA injection. Results: A total of 57 eyes of 49 patients were included in the study. The IVA group consisted of 32 eyes of 27 patients, whereas the IDI group consisted of 25 eyes of 22 patients. Both groups were similar in terms of gender, baseline intraocular pressure, HbA1c levels, types of diabetes, BCVA, CMT, and height of SRD (p = 0.469, p = 0.089, p = 0.889, p = 0.461, p = 0.072, p = 0.073, and p = 0.064, respectively). The mean CMT changes were 228.6 ± 109.8 µm and 168.5 ± 106.4 µm in the IDI and IVA groups, respectively (p < 0.001 for both groups). The change in CMT was statistically significantly greater in IDI group than in IVA group (p = 0.041). The mean SRD changes were 162.7 ± 106.9 µm and 110.7 ± 51.9 µm in the IDI and IVA groups, respectively (p < 0.001 for both groups), and the change in SRD height was statistically significantly greater in IDI group than in IVA group (p = 0.019). SRD completely resolved in 92% and 91.2% of the patients in IDI and IVA groups, respectively (p = 0.856). Moreover, BCVA was significantly increased after the injections in both groups (p < 0.001 for both groups), and the change in BCVA was comparable between the groups (p = 0.245). Conclusions: Fewer injections of dexamethasone implant demonstrated better morphological results than aflibercept in the early treatment period of naive diabetic macular edema (DME) with serous retinal detachment (SRD).