Visual outcomes of early and late vitrectomy for breakthrough vitreous hemorrhage associated with exudative age-related macular degeneration and polypoidal choroidal vasculopathy.

To compare the visual outcomes of early and late vitrectomy for breakthrough vitreous hemorrhage (VH) associated with exudative age-related macular degeneration (exudative AMD) and polypoidal choroidal vasculopathy (PCV). A retrospective chart review was performed with data of all patients diagnosed with exudative AMD and PCV-related breakthrough VH who underwent early or late vitrectomy (within or after 3 months, respectively). Demographic data and best-corrected visual acuity (BCVA) at baseline, and 1, 3, 6, and 12 months postoperatively were recorded and analyzed. Overall, 105 eyes with breakthrough VH were examined and categorized in either the early or late vitrectomy group. In the early and late vitrectomy group, LogMAR BCVA improved from 2.15 ±â€…0.08 and 2.07 ±â€…0.14 at baseline to 1.26 ±â€…0.09 and 1.27 ±â€…0.14 at 12 months, respectively (P < .001). Between early and late vitrectomy, the PCV subgroup demonstrated improved LogMAR BCVA at 1 year, but there was no statistically significant (P = .754). Conversely, the LogMAR BCVA improvement at 1 year in the early vitrectomy group demonstrated statistically significant differences from the late vitrectomy group (P = .025) in the exudative AMD subgroup. Both, early and late vitrectomy can improve visual acuity in patients with breakthrough VH secondary to exudative AMD and PCV. However, early vitrectomy is more beneficial for breakthrough VH-associated exudative AMD.

Results of intravitreal dexamethasone implant (Ozurdex®) for retinal vascular diseases with macular edema: An observational study of real-life situations.

To evaluate the efficacy of intravitreal dexamethasone implants (Ozurdex®) for the treatment of macular edema (ME) associated with retinal vascular diseases in real-life situations. This retrospective study included patients with ME associated with retinal vascular occlusion (RVO) or diabetic macular edema (DME) treated with dexamethasone implants. Demographic data, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) at baseline and at 1, 3, and 6 months postoperatively were collected and analyzed, and the adverse events were recorded. Forty-four eyes, 42 patients were included in the study. The mean logMAR BCVA improved from 0.79 ± 0.38 at baseline to 0.60 ± 0.34 (P < 0.001), 0.72 ± 0.38 (P = .002), and 0.72 ± 0.37 (P = .002) at 1, 3, and 6 months, respectively. The CRT decreased from 526.70 ± 159.58 µm at baseline to 279 ± 66.23, 422.91 ± 206.99, and 350.23 ± 151.51 µm at 1, 3, and 6 months, respectively (P < 0.001, all visits). The average number of injections was 1.43 ± 0.5. Nineteen eyes (43.18%) received second injections at an interval of 4.20 ± 0.61 months. The mean logMAR BCVA was greater in RVO than in DME patients and in treatment-naïve eyes than in previously treated ones. The baseline CRT of the reinjection group was significantly higher than that of the single-injection group for both the RVO (P < 0.001) and DME groups (P = .002). Nine eyes (20.45%) with increasing intraocular pressure (IOP) were well controlled with medication, and cataract progression was observed in five eyes (21.73%) during follow-up. The dexamethasone implant was effective for the treatment of macular edema secondary to RVO and DME in terms of visual acuity and CRT improvement over 6 months. The visual acuity was greater in the RVO and treatment-naïve eyes. Reinjection may be associated with a high baseline CRT. The increase in the occurrence of IOP and cataract progression was similar to that reported in previous studies.

Timing of Complete Polypoidal Regression after Intravitreous Aflibercept Treatments in Polypoidal Choroidal Vasculopathy.

PURPOSE: To understand timing of complete polypoidal regression on indocyanine green angiography (ICGA) after aflibercept injections for polypoidal choroidal vasculopathy (PCV). DESIGN: Multicenter prospective study. PARTICIPANTS: Adults with treatment-naïve PCV. METHODS: After institutional review board approval, participants were enrolled and followed up for 1 year, from Apr 1, 2016, through Dec 30, 2018, at 2 university-based centers in Thailand. Diagnosis of PCV was based on the Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy criteria. Eligible eyes received fixed-dose aflibercept injections (3 monthly then every 8 weeks), or monthly if fluid persisted on OCT. Photodynamic therapy (PDT) was administered when fluid persisted despite 6 consecutive injections. Indocyanine green angiography was performed at baseline and then every 8 weeks. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline, 6 months, and 1 year. Two retina specialists reviewed posttreatment ICGA, categorized into: complete regression (complete disappearance of polypoidal lesions), partial regression (reduced in size or number), or no regression. Disagreements were resolved through open adjudication. MAIN OUTCOME MEASURES: Timing of complete regression over 1 year. RESULTS: Final analysis included 40 eyes (39 participants; 100% Thai, 59% women; mean age±standard deviation, 64 ± 8.3 years). At baseline, 90% had 5 or more polypoidal lesions. Ninety-five percent received aflibercept monotherapy, and 5% received rescue PDT per protocol. Polypoidal statuses at 1 year were 55% complete, 40% partial, and 5% no regression. Cumulative rates of complete regression at 2, 4, 6, and 12 months were 28%, 33%, 43%, and 55%. Of 22 eyes with complete regression at 1 year, complete regression was identified first at 2, 4, 6, 8, 10, 12 months in 50%, 9%, 18%, 5%, 9%, and 9%, respectively. Cumulative rates of complete regression among these eyes at 2, 6, and 12 months were 50%, 77%, and 100%, respectively. Median duration of complete regression was 3 months (interquartile range, 2-6 months). Median visual acuity improved from 20/125 (Snellen equivalent) to 20/50; median NEI VFQ-25 scores improved from 80 to 93 from baseline to 1 year. CONCLUSIONS: Complete polypoidal regression could occur as early as 2 months after aflibercept injections. Most PCV eyes with complete polypoidal regression at 1 year already showed complete regression within the first 6 months. These findings support consideration of aflibercept for PCV to achieve both anatomic and visual outcomes.

Surgical outcomes and prognostic factors following vitrectomy in acquired immune deficiency syndrome patients with cytomegalovirus retinitis-related retinal detachment.

To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy.A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan-Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success.Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success.Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.

Outcomes of a postoperative perfluorocarbon liquid tamponade for complex retinal detachments: 12 years of experience in southern Thailand.

BACKGROUND: The study evaluates both functional and anatomical outcomes of retinal detachment (RD) repair by vitrectomy and perfluorocarbon liquid (PFCL) tamponade. METHODS: A retrospective chart review of patients who underwent vitrectomy using PFCL tamponade for RD repair from causes such as giant tear, chronic RD, or RD with previously failed surgery. RESULTS: This study included 122 eyes from 121 patients. One-hundred fourteen eyes (93.5%) had baseline vision worse than 20/200. The median duration of intraocular PFCL retainment was 14 days before gas or silicone oil replacement. The retinal reattachment rate was 80.3%. At 1 year, the retention probability of retinal reattachment was 0.84 (95% confidence interval, 0.77-0.91). Although visual improvement was found in 45.9% of patients, the median of final vision was not different between baseline and the last visit. CONCLUSION: The rate of retinal reattachment operated with a short- to medium-term PFCL tamponade achieved a high satisfaction rate. However, postoperative hypotony was a predictor for unfavorable visual and anatomical outcomes.

A 14-Year Retrospective Analysis of Endogenous Endophthalmitis in a Tertiary Referral Center of Southern Thailand.

PURPOSE: To investigate patient characteristics, clinical features, common causative organisms, and visual acuity outcomes in endogenous endophthalmitis. METHODS: This was a retrospective chart analysis of patients with endogenous endophthalmitis between January 2006 and December 2019. Collected data included basic patient characteristics, presenting symptoms, causative organisms, treatments, and 3-month and 1-year visual outcomes. RESULTS: Twenty-nine eyes of 27 patients were included in the study. The mean age of the patients was 45.4 ± 19.9 years, and 63% were female. Visual acuity at presentation ranged from counting fingers to no light perception. Systemic comorbidities presented in 66.7% of the patients, the majority of which were related to diabetes mellitus (48.1%). The most common primary infection was a urinary tract infection. Positive blood cultures were identified in 48.1% of patients, and positive cultures from vitreous and aqueous samples were identified in 59.3% and 31.6% of eyes, respectively. Among all the specimens, Gram-positive bacteria were identified in 55.5%, Gram-negative bacteria in 22.2%, fungi in 14.8%, and mixed organisms in 7.4%. Among ocular specimens, 61.1% contained Gram-positive organisms, 16.7% contained Gram-negative organisms, and 22.2% contained fungi. Streptococcus spp. was the most common causative organism. From 29 eyes, 18 (62.1%) underwent vitrectomy, and 12 (42.9%) underwent either evisceration or enucleation. Positive vitreous culture was significantly associated with unfavorable final visual outcome. Final visual acuity ranged from 20/125 to no light perception. Although visual improvement at 3 months was significantly better in younger patients, this had no impact on final visual outcome at 1 year. CONCLUSION: Eyes with positive vitreous cultures had significantly poorer visual outcomes. Despite full treatment coverage, visual prognosis was extremely poor and the rates of blindness and evisceration/enucleation were still high.

Polypoidal choroidal vasculopathy (PCV): the 4-year review of the real-life treatment experiences.

PURPOSE: The purpose of this article was to study the real-life treatment results of polypoidal choroidal vasculopathy (PCV). DESIGN: This was a retrospective study. METHODS: Patients with presumed age-related macular degeneration were reviewed, and PCV diagnosis was made using the EVEREST study criteria. Outcomes were changes in visual acuity (VA) and central retinal thickness, time between treatments, follow-up time, and number of treatments. RESULTS: The prevalence of PCV was 30.8%. At the beginning, 195 eyes received monotherapy of anti-vascular endothelial growth factor (anti-VEGF) injections, either bevacizumab or ranibizumab, and only six eyes received the combination of anti-VEGF injection and photodynamic therapy (PDT) at the time of the first treatment. During the follow-up, some patients received "rescue or add-on" PDT when they had a poor response after anti-VEGF injections. After 4 years, the average number of injections was 8.25 and 9.15 for the anti-VEGF monotherapy and the combination groups, respectively. The average time between the first anti-VEGF injections and the first PDT was 21.4 months. The average VA in the anti-VEGF monotherapy group increased by 1.5 letters, whereas it decreased by 0.95 letters in the combination group (P=0.48). CONCLUSION: The review demonstrated the same visual outcomes between the combination therapy of anti-VEGF injections and rescue or add-on PDT vs monotherapy anti-VEGF injections in PCV treatment. When compared with EVEREST II and Planet studies, the "initial" or "rescue or add-on PDT" might have different effects on the final visual outcomes.

Efficacy of an eye drop mixture for pupillary dilatation: A randomized comparative study / Eficacia de la mezcla de gotas oculares para la dilatación de la pupila: estudio aleatorizado y comparativo

Purpose: Pupillary dilatation with three types of eye drops is used regularly in the clinic; however, a mixture of these drops in a single bottle may be more beneficial in reducing workloads and resources. This study compared the efficacy in pupillary dilatation between two protocols of dilating drop instillation. Methods: This prospective, randomized, comparative study included 30 eligible Thai patients. The patients randomly received preoperative pupillary dilatations by either the conventional protocol (1% tropicamide (T), 10% phenylephrine (P) and 0.1% diclofenac (D) in three separate bottles) or the fixed combination (TPD) protocol which had the three types of eye drops mixed in a single bottle in a ratio of 4:3:3. The chi-square test and independent t-test were used to analyze the data. Results: The conventional protocol group and TPD protocol group each had 15 patients. Sixty minutes after the initial instillation, all patients in the TPD protocol and 13 patients (86.7%) in conventional protocol achieved at least 6mm in the shortest diameter. The mydriatic rate between protocols showed no difference. In patients who received the TPD protocol, the systemic effects on the mean arterial blood pressure and pulse rate decreased over time. Conclusion: The mixture of tropicamide, phenylephrine and diclofenac had a comparable efficacy for a pupillary dilatation to the conventional dilating drops in separate bottles. The systemic complications on blood pressure and arterial pulse of the TPD mixture were less than the conventional protocol (AU)

Objetivo: La dilatación de la pupila con tres tipos de gotas oculares se utiliza normalmente en la práctica clínica; sin embargo, la mezcla de dichas gotas en un único envase puede resultar más beneficiosa a la hora de reducir las cargas de trabajo y los recursos. Este estudio comparó la eficacia entre dos protocolos de dilatación de pupilas. Métodos: Este estudio prospectivo, aleatorizado y comparativo incluyó a 30 pacientes tailandeses elegibles. A dichos pacientes se les dilató aleatoria y preoperatoriamente la pupila utilizando el protocolo convencional (1% tropicamida (T), 10% fenilefrina (P) y 0,1% diclofenaco (D) en tres envases separados), o el protocolo de combinación fija (TPD), que contenía los tres tipos de gotas oculares mezclados en un único envase, a un ratio de 4:3:3. Se utilizaron las pruebas de χ2 y la prueba independiente t para analizar los datos. Resultados: Tanto el grupo de protocolo convencional como el grupo TPD incluyeron a 15 pacientes. A los sesenta minutos de la instilación inicial, todos los pacientes del protocolo TPD y 13 pacientes (86,7%) del protocolo convencional lograron un mínimo de 6mm en el diámetro menor. La tasa midriática entre ambos protocolos no reflejó diferencia alguna. En los pacientes del protocolo TPD, los efectos sistémicos sobre la presión sanguínea media y el índice de pulso disminuyeron con el tiempo. Conclusión: La mezcla de tropicamida, fenilefrina y diclofenaco mostró una eficacia comparable a la de las gotas para dilatación de pupilas suministradas en envases separados. Las complicaciones sistémicas sobre la presión sanguínea y la presión arterial de la mezcla de TPD fueron menores a las del protocolo convencional (AU)

Efficacy of an eye drop mixture for pupillary dilatation: A randomized comparative study.

PURPOSE: Pupillary dilatation with three types of eye drops is used regularly in the clinic; however, a mixture of these drops in a single bottle may be more beneficial in reducing workloads and resources. This study compared the efficacy in pupillary dilatation between two protocols of dilating drop instillation. METHODS: This prospective, randomized, comparative study included 30 eligible Thai patients. The patients randomly received preoperative pupillary dilatations by either the conventional protocol (1% tropicamide (T), 10% phenylephrine (P) and 0.1% diclofenac (D) in three separate bottles) or the fixed combination (TPD) protocol which had the three types of eye drops mixed in a single bottle in a ratio of 4:3:3. The chi-square test and independent t-test were used to analyze the data. RESULTS: The conventional protocol group and TPD protocol group each had 15 patients. Sixty minutes after the initial instillation, all patients in the TPD protocol and 13 patients (86.7%) in conventional protocol achieved at least 6mm in the shortest diameter. The mydriatic rate between protocols showed no difference. In patients who received the TPD protocol, the systemic effects on the mean arterial blood pressure and pulse rate decreased over time. CONCLUSION: The mixture of tropicamide, phenylephrine and diclofenac had a comparable efficacy for a pupillary dilatation to the conventional dilating drops in separate bottles. The systemic complications on blood pressure and arterial pulse of the TPD mixture were less than the conventional protocol. TRIAL REGISTRATION: TCTR20130325001.

Pattern of Contrast Sensitivity Changes in Acute Central Serous Chorioretinopathy.

PURPOSE: To evaluate contrast sensitivity (CS) changes in acute central serous chorioretinopathy (CSC). METHODS: Visual acuity (VA), CS, and subretinal fluid (SRF) were evaluated monthly for 6 months. Treatment was considered at 3 months in case of persistent SRF. RESULTS: Twelve of 20 eyes (60%) had spontaneous SRF resolution within 4 months. Five of 8 patients with delayed SRF resolution received either focal laser or photodynamic therapy. The CS was impaired in all spatial frequencies at baseline. There was a negative correlation between the baseline SRF thickness and CS at 3 and 6 cycles per degree (cpd). The CS improved significantly at the time of fluid resolution (p = 0.001) and continued to improve in 3 and 6 cpd. The CS at 6 cpd did not recover if compared to a normal fellow eye at 6 months (p = 0.018). The CS of 12 cpd at 6 months was superior in the spontaneous resolution group. CONCLUSION: The impaired CS gradually improved as the SRF reduced at all spatial frequencies. CS at 3 and 12 cpd continued to improve after complete fluid resolution. Despite an excellent final VA, the CS at 6 months did not regain its normal value.

The Impact of Vision Impairment (IVI) Questionnaire; Validation of the Thai-Version and the Implementation on Vision-Related Quality of Life in Thai Rural Community.

The objective of this study is to validate the Thai-version of the impact of vision impairment (IVI) questionnaire and to evaluate its impact on vision-related quality of life (VRQoL) in southern Thailand. The IVI questionnaire was translated into Thai according to WHO translation guidelines. In addition to the routine ophthalmological examinations, a Thai version of the IVI questionnaire was administered to all participants. A total of 120 patients with visual impairment who presented at Songklanagarind hospital, Songkhla province, were enrolled in the study; 30 had age-related macular degeneration (AMD), 30 had cataract, 30 had diabetic retinopathy, 30 had glaucoma, and 30 non-visually impaired individuals comprised the control group. Statistical analysis demonstrated the Thai-version IVI questionnaire is valid and reliable to evaluate the VRQoL of the Thai patients through three subscales: (i) mobility and independence, (ii) reading and accessing information, and (iii) emotional well-being. The results demonstrated high consistency in all subscales with Cronbach's alpha ranging from 0.787 to 0.849. Rasch analysis revealed the validity of the Thai-version IVI to assess VRQoL through all three subscales. Test-retest reliability was also high (intraclass correlation coefficient = 0.96). The composite score of the IVI was significantly higher in participants with visual impairment compared with healthy participants. Moreover, the subscale scores of reading and accessing information, and emotional well-being were highest in participants with AMD. While the subscale scores of mobility and independence were highest among those with either cataracts or diabetic retinopathy. The symptoms of the common vision impairment diseases are associated with an adverse impact on VRQoL in a clinic-based population as demonstrated in this study.

The normal choroidal thickness in southern Thailand.

OBJECTIVE: To investigate the association between subfoveal choroidal thickness in healthy southern Thailand volunteers and age, axial length, and refractive error. SUBJECTS AND METHODS: This was a prospective cross-sectional case series. A total of 210 eyes of 105 healthy volunteers (86 women, age 23-83 years) in southern Thailand were examined with enhanced depth-imaging optical coherence tomography. Subjects with systemic diseases that may affect the choroidal vascular blood vessels, such as diabetes, impaired renal function, and hypertension, were excluded. Refractive error and axial length were measured by autorefractometry and an IOLMaster, respectively. Subfoveal choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border in the subfoveal area. RESULTS: The mean subfoveal choroidal thickness was 279.4±75.49 µm, and the mean age was 46.4±16.45 years. Subfoveal choroidal thickness was negatively correlated with age (r (2)=0.33, P<0.0001) and axial length (r (2)=0.02, P<0.02). Multivariable regression analysis showed subfoveal choroidal thickness was positively and negatively correlated with a spherical equivalent refractive error and axial length, respectively, when adjusted for age. CONCLUSION: Age is the most important factor in choroidal thickness rather than axial length and refractive error. Subfoval choroidal thickness was decreased 2.67 µm every year and 14.59 µm with 1 mm increase in axial length.

Photoreceptor disruption in central serous chorioretinopathy treated by half-dose photodynamic therapy.

BACKGROUND: To evaluate photoreceptor disruption in patients with central serous chorioretinopathy (CSC) treated by half-dose photodynamic therapy (PDT). METHODS: A total of 29 patients with symptomatic CSC were recruited and underwent half-dose verteporfin PDT covering the leakage sites as observed via fundus fluorescein angiography. The primary outcome was the percentage of patients with the presence of photoreceptor disruption, and the secondary outcome was the correlation between photoreceptor disruption and visual results at the 1-year follow-up. RESULTS: Photoreceptor disruption was identified in 13 eyes (44.8%) 12 months after treatment. Twenty-seven patients experienced best-corrected visual acuity (BCVA) improvement after PDT, while two patients showed stable BCVA. The mean BCVA in patients with photoreceptor disruption at the baseline and every follow-up visit was significantly lower than that of patients without photoreceptor disruption. However, there was no correlation between the presence or absence of photoreceptor disruption and the improvement of visual acuity because the BCVA gain at the last follow-up visit between the two groups was not significant (P = 0.69). No potential ocular complication was encountered in the study. CONCLUSION: Photoreceptor disruption was found in about 45% of CSC patients treated by PDT, which ultimately resulted in poor visual outcomes. However, a half-dose PDT might not affect or modify the photoreceptor function because it gave the same pattern of visual recovery in patients with and without photoreceptor cell loss.

Pattern of uveitis in a university-based referral center in southern Thailand.

PURPOSE: To identify the characteristics (demographics, anatomical classification, diagnoses, and treatment) of all uveitis patients who were seen at our newly started Uveitis and Ocular Inflammatory Disease Clinic over a two-year period. METHODS: The computerized uveitis database files and medical records for all new consecutive patients seen at our Uveitis and Ocular Inflammatory Disease Clinic from January 2010 through December 2011 were included. RESULTS: A total of 254 patients were seen during the study period. Anterior uveitis and panuveitis were most frequently found, each accounting for around 35% of cases. Specific diagnoses were established in 70.9% of patients and the top five most common specific diagnoses were VKH (11%), HLA-B27-associated anterior uveitis (7.9%), Behçet disease (7.1%), toxoplasmosis (7.1%), and herpetic anterior uveitis (4.7%). CONCLUSION: In this setting, the authors found VKH to be the most common diagnosis in the noninfectious uveitis group. Regarding infectious uveitis, toxoplasmosis ranked the most common diagnosis.

High-dose antioxidants for central serous chorioretinopathy; the randomized placebo-controlled study.

BACKGROUND: To determine the efficacy of high-dose antioxidants in the acute stage of central serous chorioretinopathy (CSC). METHODS: This was a randomized placebo-controlled study. The patients with acute CSC (onset within 6 weeks) were randomized to receive either high-dose antioxidant tablets (study group A) or placebo tablets (control group B) for 3 months or until the complete resolution of subretinal fluid. After 3 months, additional treatment with laser or photodynamic therapy (PDT) was considered if any fluorescein leakage persisted. The outcomes measured were the changes in visual acuity (VA) and central macular thickness (CMT), the number of patients with subretinal fluid at each follow-up time, the number of patients with fluorescein leakage at the end of the 3rd month and patients who received additional treatments. RESULTS: Fifty-one of 58 patients (88%) completed the follow-up criteria. The baseline demographic data were comparable in both groups. At the end of the 3rd month, the VA and CMT showed no statistical difference between the groups but the patients in group A has less fluorescein leakage and additional treatments than in group B (p = 0.027 and 0.03). CONCLUSION: The high-dose antioxidants for acute CSC did not show any benefits in VA and CMT. However, the drugs might decrease the chance for fluorescein leakage and additional treatments at the end of the 3rd month.

The one-year results of half-dose photodynamic therapy with verteporfin in chronic or recurrent central serous chorioretinopathy.

OBJECTIVE: To evaluate the one-year results of half-dose photodynamic therapy with verteporfin in chronic or recurrent central serous chorioretinopathy (CSC). MATERIAL AND METHOD: A Retrospective, consecutive case series. Twenty-seven eyes of 27 patients with chronic symptomatic CSC or recurrent CSC underwent photodynamic therapy (PDT) with half-dose (3 mg/m2) verteporfin. The demographic data such as age, side, gender spot sizes of laser photodynamic therapy (PDT) were recorded. The primary outcomes were the best correct visual acuity (BCVA), central foveal thickness using the optical coherence tomography (OCT) and complication were recorded as secondary outcome at baseline, month 1,3,6 and 12 post PDT RESULTS: At 12 months after half-dose PDT the mean logMAR BCVA improved from 0.32 to 0.18 (p = 0.001), the mean central foveal thickness decreased from 375.52 microm to 186.52 mirom (p < 0.001). The results also showed significant improvement of logMAR BCVA and decreased central foveal thickness after 1 month (0.32 to 0.22, p = 0.003 and 375.52 microm to 175.41 microm, p < 0.001) and maintained the results until one-year follow-up. Twenty-five eyes (92.59%) showed complete resolution of subretinal fluid at 1 month, 27 patients (100%) showed complete resolution at 3 month and all sustained the complete resolution until the last visit. No serious complications were recorded during and after the treatment. CONCLUSION: The half-dose PDT in area of fluorescein leakage is one of the effective treatment options for chronic or recurrent CSC, especially in patients who cannot be performed by focal laser photocoagulation. The treatment sustained the good visual results and has no serious complications up to one-year.

Validity of the Watzke-Allen test after a surgery for idiopathic full thickness macular hole.

OBJECTIVE: To evaluate the role and validity of the Watzke-Allen test in following up patients after surgeries for an idiopathic full-thickness macular hole (FTMH). DESIGN: A prospective interventional analytical study MATERIAL AND METHOD: Patients with idiopathic FTMH were consecutively recruited. A comparative analysis between preoperative and post operative visual acuity, macular hole status and Watzke-Allen slit beam test results was performed using a Chi-square test and a random intercept mixed model. RESULTS: Twenty-one patients with an average age of 65.90 +/- 6.05 years were included in the present study. Three months after surgery, macular holes were surgically closed in 13 eyes (61.9%) and still open in eight eyes (38.1%). An improvement in metamorphopsia, according to Watzke-Allen test results, was found in 61.53% of patients with closed holes and 87.5% of those with open holes. There was no statistically significant correlation between the Watzke-Allen test and the restorative status of a macular hole post surgery CONCLUSION: The Watzke-Allen test is a useful subjective assessment of visual function for diagnosis in patients with idiopathic FTMH. However the test is not beneficial in the post operative follow-up of patients.

Electrophysiologic changes after intravitreal ranibizumab injection for the treatment of choroidal neovascular membrane (CNVM).

PURPOSE: To determine the pattern of electroretinographic change after an intravitreal ranibizumab (Lucentis(®)) injection for the treatment of choroidal neovascular membrane (CNVM). PATIENTS AND METHODS: A prospective interventional case series of patients treated by intravitreal ranibizumab injection. Best corrected visual acuity, optical coherence tomography (OCT), and multifocal electroretinography (mfERG) were assessed prior to treatment, and 2 weeks, 1 and 3 months after treatment. Primary outcome was the functional change in amplitude and implicit time by mfERG and secondary outcome was the structural change in macular thickness by optical coherence tomography (OCT). RESULTS: Twenty-six eyes from 25 consecutive patients were enrolled. At 3 months after treatment, the mean visual acuity (VA) improved from 1.06 to 0.84 logMAR (P = 0.034) and the mean macular thickness decreased from 389.7 to 264.4 microns (P = 0.003). The mean implicit time of the central zone showed an improvement at 3 months after treatment when compared with the response at baseline (P = 0.024) and at 1 month (P = 0.013) but the mean amplitude showed no significant change. In subgroup analysis, the eyes with initial visual acuity (VA) ≥ 20/200 had a significant improvement in mean implicit time of the peripheral zone at 2 weeks after treatment (P = 0.028). The OCT revealed a significant decrease (P < 0.003) in macular thickness at 1 and 3 months postoperatively. CONCLUSION: The mean implicit time of the central zone improved significantly at 3 months after treatment, whereas the mean amplitude showed no significant change. The macular thickness decreased significantly after the treatment, while VA improved to a lesser extent.

The response pattern of intravitreal triamcinolone injection for non-AMD macular edema.

OBJECTIVE: To determine the pattern of functional and anatomical responses after intravitreal triamcinolone (IVTA) for macular edema in diabetic retinopathy, retinal vein occlusion, uveitis, and macular telangiectasia. MATERIAL AND METHOD: A Retrospective interventional study was carried out between January 2004 and July 2006. Thirty-eight eyes from 36 patients who had undergone an IVTA injection for macular edema from etiologies other than age-related macular degeneration (non-AMD macular edema) were included in the present study. Visual improvement and retinal thickness were the main outcomes. Potential complications, including increased intraocular pressure (IOP), intraocular bleeding, and postoperative endophthalmitis were also recorded. RESULTS: The mean pre-operative logarithm of Minimum Angle of Resolution (logMAR) visual acuity (VA) was 1.0 with an average macular thickness of 463.2 +/- 141.4 microns and mean IOP of 12.9 +/- 2.7 mmHg. The macular thickness rapidly decreased in the first week after an injection with a trough at two months (p < 0.001) and began to rise thereafter. The overall VA started to improve significantly at one month and lasted for two months. The IOP significantly increased from the mean baseline during the first two months in 31.6%, which could be controlled only by the medication. No other serious complications were observed. CONCLUSION: IVTA has the potential to improve both functional and anatomical outcomes in non-AMD macular edema. The decrease in macular thickness occurs from one week after an injection but the visual function improves more slowly and has a short-time effect.

Photodynamic therapy for AMD and non-AMD patients: two-year results in Thais.

OBJECTIVE: To determine the long-term effect of photodynamic therapy (PDT) with verteporfin for age-related macular degeneration (AMD) and non-AMD in Thailand and to compare with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study. MATERIAL AND METHOD: The data of patients who received PDT between July 2003 and December 2004 and had completed two-year follow-up were prospectively reviewed. Treated eyes were classified into two main groups, the AMD (group 1) and non-AMD (group 2) groups. The AMD group was further divided into three subgroups, group 1A, AMD with subfoveal choroidal neovascularization (CNV) and TAP/VIP compatible if they followed the recommendation guidelines characteristics, group 1B, AMD with subfoveal CNV and TAP/VIP incompatible, and group 1C, AMD with non-subfoveal CNV. The main outcomes were visual acuity change, number of treatments and the comparison with the first year results. RESULTS: Of 56 eyes, 46 eyes (82.14%) had completed 24-month follow-up. Thirty-four eyes had CNV-related AMD and 12 eyes were non-AMD. At the 24-month follow-up, mean visual acuity change in group 1A, 1B, 1C were increased 0.25 (p = 0.13), 0.05 (p = 0.52), and 0.28 (p = 0.003), respectively. The total number of treatments in the first and second year was 1.8 and 0.1 in group 1A, 2.3 and 0.1 in group 1B, 1.5 and 0.25 in group 1C. CONCLUSION: PDT was effective in Thai patients for the two-year follow-up even if they were not compatible with TAP/VIP criteria. The treatment demonstrated stabilization or less visual loss in long-term results.