INTRAVITREAL DEXAMETHASONE IMPLANT FOR THE TREATMENT OF REFRACTORY MACULAR EDEMA IN RETINAL VASCULAR DISEASES: Results of the KKESH International Collaborative Retina Study Group.

PURPOSE: To evaluate the safety and efficacy of intravitreal dexamethasone implant (Ozurdex) for treating refractory macular edema in retinal vascular diseases. METHODS: This is a retrospective consecutive series of 53 eyes with refractory macular edema secondary to central retinal vein occlusion (13 eyes), branch retinal vein occlusion (14 eyes), and diabetic macular edema (26 eyes) treated with a single 0.7 mg dexamethasone implant. Data were collected on best-corrected visual acuity, intraocular pressure, and central macular thickness preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: Baseline best-corrected visual acuity was 20/160 and improved statistically significantly to 20/80 and 20/60 at 1 months and 3 months, respectively (P < 0.05, both postoperative visits), and 20/100 at 6 months (P > 0.05). The central macular thickness at baseline was 569.96 ± 178.11 µm, and it decreased statistically significantly to 305.81 ± 155.94 µm, 386 ± 210.79 µm, and 446.41 ± 221.21 µm at 1, 3 and 6 months, respectively (P < 0.05, all visits compared with baseline). Fourteen (26%) eyes developed high intraocular pressure after implantation and was successfully controlled with topical medications, and cataract progressed in 1 (1.8%) eye. CONCLUSION: The dexamethasone implant improved macular edema in refractory cases resulting in statistically significant improvements in best-corrected visual acuity and central macular thickness that remained stable to 3 months and 6 months, respectively.

Epiretinal membrane after branch retinal vein occlusion: Separation after dexamethasone implant injection.

PURPOSE: The authors report a case of epiretinal membrane after branch retinal vein occlusion with macular wrinkling that was successfully managed without surgical treatment. OBSERVATIONS: A patient presented with complaints of a gradual decrease in vision, with metamorphopsia over the previous 2 years in the right eye. The patient was diagnosed with a grade 2 epiretinal membrane (ERM) with macular wrinkling in the right eye that was confirmed with optical coherence tomography (OCT) demonstrating significant macular thickening. The patient refused surgical intervention, and was managed with a dexamethasone implant to decrease macular edema. Six months later, the patient presented with resolution of macular edema, separation of the ERM from the retina as confirmed with OCT, and excellent visual recovery. CONCLUSIONS AND IMPORTANCE: A dexamethasone implant injection can be an alternative treatment for ERM resulting in excellent visual recovery and possibly, separation of ERM.

Giant coronary artery aneurysm associated with familial retinal artery macroaneurysm: a case report.

Background: The term 'Giant' coronary aneurysm is usually defined as any coronary aneurysm more than 8 mm in maximum diameter. The form of familial retinal arterial macroaneurysms (FRAMs) is a rare autosomal recessive disease that is described by arterial aneurysm formation in the retina. Here, we report an association of coronary artery aneurysms with FRAM in a young male who presented with the acute coronary syndrome. Case summary: A 31-year-old male smoker presented to the emergency department with atypical chest pain for 5 days. Blood investigations showed raised troponin enzymes. Review of his past medical history revealed decreased vision in the left eye, starting at the age of 10 years which progressed to blindness. He was diagnosed to have IGFBP7 mutation which causes eye manifestations in the form of FRAM. Fundoscopy showed bleeding retinal artery macroaneurysms in the right retina and sub-retinal gliosis suggesting laser treatment for the prior retinal arterial aneurysm. Coronary angiogram revealed a large aneurysm in the proximal segment of the left anterior descending (LAD) artery. Cardiac computed tomography scan with contrast was done which showed a 2.28 × 1.64 cm coronary aneurysm at the proximal segment of the LAD artery with peripheral calcification with a narrow neck of about 0.6 cm. After the heart team discussion, he underwent surgical ligation of the LAD and coronary aneurysm with implantation of the saphenous venous graft to distal LAD. Discussion: Coronary artery aneurysms can be a part of multisystem diseases like FRAM. The management should be individualized based on symptoms at presentation, size of coronary aneurysms, and local expertise.

Reflux, Intraocular Pressure Variation and Pain Following Intravitreal Ranibizumab Injections Using 30-Gauge or 32-Gauge Needles for Patients With Retinal Pathologies: A Randomized Clinical Trial.

PURPOSE: To compare reflux, intraocular pressure (IOP) variation and pain following intravitreal (IV) injections using 30-gauge and 32-gauge needles in patients with retinal pathologies in Saudi Arabia. METHODS: A double-blind randomized clinical trial was conducted in 2018. Participants were randomized to receive IV injections of Ranibizumab using 30-gauge (Gr1) or 32-gauge (Gr2) needles. The amount of reflux of injected material, IOP before (IOP1) and five minutes after injection (IOP2) were measured. The patient-perceived pain score was assessed using a visual analogue score (VAS). Outcome variables were compared. RESULTS: The study sample was comprised of 86 eyes (86 patients) in each group. Gender (P=0.76), laterality (P=0.55) and age (P=1.0) were not different between groups. The reflux in Gr1 [34.9% (95% confidence interval {CI}, 24.8; 45.0)] was significantly higher compared to Gr2 [22.1% (95% CI, 13.3; 30.9)] (P=0.007). The median pain score was 1 in both Gr1 [interquartile range (IQR) 1.0: 3.0] and Gr2 (IQR 0.0; 2.0) (P=0.04). Among 56 eyes without reflux in Gr1, the IOP1 and IOP2 were 13.6±2.7 mmHg and 16.4±5.0 mmHg, respectively. Among 67 eyes without reflux in Gr2, the IOP1 and IOP2 were 13.6±2.9 mmHg and 17.0±5.2 mmHg, respectively. The change in percentage in IOP in Gr1 and Gr2 was not significantly different (Mann Whiney P=0.3). CONCLUSIONS: IV injection given by 30-gauge needle compared to 32-gauge needle resulted in greater patient-perceived pain and more reflux of injected material from the injection site. An increase in IOP was not associated with the gauge of the needle used for IV injection.

Chronic Endophthalmitis Caused by Pseudomonas stutzeri.

A patient presented with complaints of a sudden decrease in vision, ocular redness, and pain in the right eye. The patient had a history of clear lens extraction with intraocular lens (IOL) implantation for myopia 2 years previously. He had been prescribed topical steroids for episodes of inflammation that occurred repeatedly every 1-2 months. With a presumptive diagnosis of chronic endophthalmitis, a 23-G transconjunctival sutureless pars plana vitrectomy (PPV) with delivery of intravitreal antibiotics was performed the next day. Culture sensitivity testing of the vitreous sample indicated Pseudomonas stutzeri that was sensitive to ceftazidime and gentamicin. Two weeks later, the patient presented with sudden loss of vision and all the signs of recurrent endophthalmitis. 23-G transconjunctival sutureless PPV was performed along with removal of the posterior chamber IOL through a corneal incision. Complete resolution was only achieved after removal of the IOL, resulting in excellent visual recovery. Due to its chronic and fulminating nature, P. stutzeri can induce endophthalmitis and should be considered in the differential diagnosis. Aseptic measures are the best prevention.

Rhegmatogenous retinal detachments associated to Stickler syndrome in a tertiary eye care center in Saudi Arabia.

PURPOSE: To investigate the clinical findings and outcomes of rhegmatogenous retinal detachment (RRD) in Stickler syndrome on affected and fellow eyes that underwent prophylactic retinopexy. PATIENTS AND METHODS: Chart review of 70 eyes (62 patients). Incidence of RRD, postoperative visual acuity, and risk factors were evaluated. RESULTS: Twenty-two patients (35%) had RRD in the fellow eye, 37% of the eyes had cataract, 93% had macular detachment, 50% had proliferative vitreoretinopathy, and 41% had posterior vitreous detachment. Success rates were: 60% of patients after scleral buckling; 57.1% after pars plana vitrectomy; and 75% after combined scleral buckling and pars plana vitrectomy. Sixty-one (93.8%) of patients had successful surgery (including second surgery). Silicone oil tamponade was significantly associated with final anatomic outcome, with a protective odds ratio of 0.11 (P=0.027). Visual acuity improved in 54% of eyes and decreased in 5%. Statistically significant associations were present for eyes with final visual acuity ≥20/200, and total retinal detachment (P<0.001); preoperative cataract (P=0.023); and proliferative vitreoretinopathy (P<0.001). RRD developed in 16/44 eyes despite laser prophylaxis. CONCLUSION: Prophylactic retinopexy was not beneficial for Stickler syndrome patients. Success of primary surgery for RRD remains low. The primary surgery should be vitrectomy combined with scleral buckling and silicone oil tamponade.

Navigated laser (navilas) therapy for choroidal neovascular and hyperpermeability pathologies.

PURPOSE: To report the utility of navigated laser (NAVILAS) in the treatment of leaking areas in central serous chorioretinopathy and a feeder vessel in choroidal neovascular membrane. METHODS: Two patients with choroidal lesions were treated with NAVILAS. The first patient had central serous chorioretinopathy with visible leaking angiographic spots, and the second had choroidal neovascular membrane with a well-defined feeder vessel on angiography. Both patients underwent NAVILAS treatment. RESULTS: Both patients were successfully treated with resolution of clinical symptoms after a single session of NAVILAS. In addition, complete resolution of the subretinal fluid and leakage, and the subretinal blood and feeder vessel, were noted in the central serous chorioretinopathy and feeder vessel cases, respectively. CONCLUSION: NAVILAS may be of utility in targeting choroidal vascular pathologies with laser.

Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a type 1 neovascular growth pattern.

PURPOSE: To report spectral-domain optical coherence tomography (SD-OCT) findings in polypoidal choroidal vasculopathy (PCV). PATIENTS AND METHODS: Seventeen eyes of 15 consecutive patients diagnosed with PCV based on typical clinical and angiographic findings were imaged with macular SD-OCT including line scans passing through the polyps. RESULTS: SD-OCT findings included typical and atypical retinal pigment epithelial (RPE) detachments and subretinal and intraretinal fluid in all eyes. In the areas corresponding to the polypoidal lesions, well-delineated round-oval, sub-RPE cavities were present and were adherent to the posterior surface of the detached RPE above Bruch membrane. No retinal or choroidal connections to the cavities were noted. CONCLUSION: These SD-OCT findings document that the vascular lesions in PCV are not located in the inner choroid, but in the sub-RPE space, suggesting that PCV is a variant of type 1 choroidal neovascularization rather than a distinct clinical entity as initially thought.