Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behçet Disease.

PURPOSE: Investigation of the efficacy of intravitreal dexamethasone implants (0.7 mg) in patients with Behçet disease (BD) who had cystoid macular edema (CME) despite immunomodulatory treatment. MATERIALS AND METHODS: Twenty-seven eyes of 20 patients who had intravitreal dexameth-asone implant injections and follow-up for more than 6 months were included in this study. Best corrected visual acuities (BCVA), intraocular pressures (IOP), and central macular thicknesses (CMT) were recorded. Systemic immunomodulatory treatment was noted. Injection-related complications and the need for recurrent injections were recorded. RESULTS: Statistically significant anatomical and functional success was achieved with a single injection. BCVA increased from 0.85 ± 0.72 to 0.45 ± 0.52 logMAR, while the mean CMT decreased from 406 ± 190 to 243 ± 101 µm at the sixth month. The peak of visual acuity gain was reached within the first 2 months and a substantial proportion of the patients gained 3 or more lines. There was no complication other than transient IOP elevation in 4 eyes and cataract surgery in 2 eyes. CONCLUSION: Adjuvant intravitreal dexamethasone implant injections offer promising results in cases of BD with CME. It is effective in preserving the macular anatomy and vision particularly in transition to biological agents.

VITREORETINAL SURGERY FOR PATIENTS WITH SEVERE EXUDATIVE AND PROLIFERATIVE MANIFESTATIONS OF RETINAL CAPILLARY HEMANGIOBLASTOMA BECAUSE OF VON HIPPEL-LINDAU DISEASE.

PURPOSE: The evaluation of long-term results of vitreoretinal surgery and retinal capillary hemangioblastoma (RCH) resection in patients with complicated retinal detachment (RD) secondary to RCHs. METHODS: Twelve eyes of 12 patients were operated on with vitreoretinal surgery, including occlusion of afferent and efferent feeder vessels with endodiathermy and endolaser photocoagulation, and subsequent resection of RCHs. The long-term anatomical and visual outcomes were retrospectively evaluated. RESULTS: Total exudative RD was detected in six eyes and subtotal exudative RD was found in the remaining six eyes. A tractional component was present in eight eyes, and four eyes had pure exudative RD. Laser treatment had been previously applied to four eyes but vitreoretinal surgery was the primary treatment in eight eyes. A total of 19 RCHs were resected. The quadrant location of RCHs was superior temporal in six, superior nasal in five, inferior nasal in five, and inferior temporal in three. The dimensions of the RCHs ranged between 1 and 4 disk diameters (DD) (1-DD in 1 eye, 1.5-DD in 3, 2-DD in 10, 2.5-DD in 3, 3-DD in 1, and 4-DD in 1). Preoperative mean logarithm of the minimum angle of resolution visual acuity was 1.9 ± 1.0 (3.0-0.7) (20/1,588 ± 20/200 [20/20,000-20/100]). Silicone oil and C3F8 was applied to four and eight eyes, respectively. The median postoperative follow-up was 30.5 (18-48) months. Single operation and final anatomical success was obtained in 9 and 11 eyes, respectively. Mean logarithm of the minimum angle of resolution visual acuity in the postoperative 18th month and at the final visit were 1.05 ± 0.8 (3.0-0.2) (20/224 ± 20/125 [20/20,000-20/32]) and 0.96 ± 0.8 (3.0-0.2) (20/182 ± 20/125 [20/20,000-20/32]), respectively. New RCHs occurred in eight eyes. Rubeosis iridis was not present in any of the eyes. CONCLUSION: Promising anatomical and visual outcomes were obtained after vitreoretinal surgery and resection of RCHs in eyes with complicated RD secondary to RCH. However, life-long follow-up is needed to recognize recurrent RD seen even in the early period or recurrences of RCHs seen in the long-term period.

Myocardial performance is impaired in patients with branch retinal vein occlusion.

OBJECTIVE: To investigate whether the Tei index, which is an indicator of global myocardial function and an independent predictor of cardiac death, is increased in patients with branch retinal vein occlusion (BRVO). METHODS: The Tei index was used to evaluate myocardial performance, in addition to conventional echocardiographic evaluation of myocardial structural and functional changes, in patients with BRVO, patients with hypertension and healthy controls. RESULTS: Out of 36 patients with BRVO (18 female, 18 male; 17 hypertensive, 19 normotensive), 29 patients with hypertension (15 female, 14 male) and 28 healthy controls (15 female, 13 male), there were no significant between-group differences in age and sex. The mitral A wave was higher and mitral E/A ratio, mitral E wave and ejection time were lower, in patients with BRVO than in healthy controls. Mean Tei index was significantly higher in the BRVO group than in patients with hypertension or healthy controls. Compared with healthy controls, the Tei index was significantly higher in hypertensive and normotensive patients with BRVO. CONCLUSION: Myocardial performance is decreased in patients with BRVO, independent of whether or not they have hypertension.

Intravitreal versus sub-tenon posterior triamcinolone injection in bilateral diffuse diabetic macular edema.

PURPOSE: To compare the efficacy of intravitreal and sub-Tenon (ST) posterior triamcinolone injection in the treatment of bilateral diabetic diffuse macular edema (DDME). METHODS: 28 eyes of 14 diabetic patients with bilateral DDME were included in this prospective randomized study. One eye of each individual received a sub-Tenon (ST) posterior triamcinolone injection (ST group), whereas the fellow eye received an intravitreal triamcinolone injection (IV group). All eyes were treated with supplementary focal laser after the injections. Cases were evaluated 1, 2, 3 and 6 months after the initial treatment. RESULTS: Both groups had visual improvement and macular edema reduction following the injections. This temporary effect was prominent for 24 weeks in the IV group and for 8 weeks in the ST group. Edema resorption and visual improvement were more pronounced in the IV group, although this difference was not statistically significant. No major complications were observed except for moderate and reversible intraocular pressure elevation in some cases. CONCLUSION: Both intravitreal and ST injections of triamcinolone appear to yield a significant visual recovery and prompt resolution of DDME. The beneficial outcome appears to be more longstanding with intravitreal injection.

Impaired aortic stiffness and pulse wave velocity in patients with branch retinal vein occlusion.

BACKGROUND: Aortic distensibility (AD) and pulse wave velocity (PWV) reflect arterial stiffness, which is linked to increased cardiovascular morbidity and mortality in different diseases such as atherosclerosis, hypertension, and diabetes mellitus, all of which are also common risk factors in patients with branch retinal vein occlusion (BRVO). In the present study, we aimed to determine whether arterial stiffness in different segments of the arterial tree is increased in patients with BRVO. METHODS: The study group consisted of 35 patients with BRVO (20 female, 15 male, mean age: 55.9+/-6.8) and the age-matched control groups consisted of 19 patients with hypertension (9 female, 10 male, mean age: 55.2+/7.6) and 17 healthy subjects (9 female, 8 male, mean age: 53.4+/-9.6). Radial artery PWV was measured using a Pulse Wave Sensor HDI system, which measures non-invasively the radial pulse-wave recording with computer analysis of the diastolic decay, and provides separate assessment of the large arterial elasticity index (LAEI) and small artery elasticity index (SAEI). Aortic strain and AD was determined echocardiographically based on the relationship between changes in aortic diameter and pressure with each cardiac pulse. Patients with diabetes mellitus or inflammatory BRVO, and control patients with any occlusive vascular eye disease, were excluded. The results of the three groups were compared. RESULTS: Compared to the subjects of the healthy control group, those with BRVO had lower LAEI (p<0.05). Both AD and aortic strain were significantly lower in the BRVO group than in both control groups (p<0.05 for both) and in the hypertensive control group than the healthy controls (p<0.05). The AD, LAEI and SAEI were positively correlated (p=0.021, r=0.307 and p=0.041, r=0.269 respectively). CONCLUSIONS: The results of this study show that the arterial stiffness indices (large arterial elasticity index and aortic distensibility) are abnormal in patients with BRVO compared to the healthy and hypertensive controls. Arterial stiffness may play a role in the onset or progression of BRVO. Further studies are needed to determine the exact role of AS in the pathogenesis of BRVO, and to reveal its value in predicting systemic morbidity and mortality in patients with BRVO.

Comparative evaluation of apoptotic activity in photoreceptor cells after intravitreal injection of bevacizumab and pegaptanib sodium in rabbits.

PURPOSE: To evaluate quantitatively the apoptotic activity after intravitreal injections of pegaptanib sodium and bevacizumab in the rabbit retina. METHODS: Different doses of bevacizumab (0.25, 0.625, 1.25, and 2.5 mg) and pegaptanib sodium (0.15, 0.3, and 0.6 mg) were injected intravitreally in 48 rabbits. The eyes were enucleated at different times for early studies at day 14 and for late studies at 3 months after a single injection or at 3 months, with 1 injection in each of the 3 months (day 90). The time course and dose-response of photoreceptor cells in the rabbit retina after intravitreal injection of bevacizumab or pegaptanib sodium were examined by histologic analysis with hematoxylin and eosin (H&E) staining, caspase-3 and -9 immunostaining, and in situ terminal-deoxynucleotidyl transferase-mediated biotin-deoxyuridine triphosphate nick-end labeling (TUNEL) of DNA fragments of paraffin-embedded sections. RESULTS: No sign of retinal toxicity was seen in H&E stained histologic sections of eyes that had received bevacizumab or pegaptanib sodium. Nuclear DNA fragmentation in the outer retinal layers shown by the TUNEL method was evident in the high-dose groups (55.3% with 1.25 mg and 64.5% with 2.5 mg bevacizumab, and 48.5% with 0.6 mg pegaptanib sodium) at 14 days and also in the clinical dose groups (49.8% with three injections [1 each month] of 0.625 mg bevacizumab and 44.3% with 0.15 mg pegaptanib sodium) at 90 days. The ratios of TUNEL-positive cells in physiologic saline and the sham-control groups were 32.3% and 21%, respectively. CONCLUSIONS: Intravitreal injection of bevacizumab and pegaptanib sodium caused a significant increase in apoptotic activity in rabbit photoreceptor cells. However, although bevacizumab caused increasing apoptotic activity at higher doses, similar dose-dependent adverse effects were not evident for pegaptanib sodium.

SUBCONJUNCTIVAL INTERFERON α-2A APPLICATION IN A CASE WITH SERPIGINOUS CHOROIDOPATHY.

BACKGROUND: Serpiginous choroidopathy (SC) is a chronic, inflammatory disease which progresses with recurrences leading to visual loss. Diverse immunosuppressive regimens have been used for treatment. In case of an unanticipated side effect with immunosuppressive agents, alternative modalities in SC are limited. METHODS: A 38-year-old woman presented with slight deterioration in visual acuity in her right eye. She had had a visually devastating episode of SC in the left eye 8 months previously. She received combination therapy of prednisone, cyclosporine, and intravitreal triamcinolone for the left eye. With that treatment, vision in her left eye declined to light perception due to macular involvement and renal functions were impaired. Eight months later, she was hospitalized with the diagnosis of SC in the right eye. In the quest for an alternative modality, a combination of antituberculosis medications was given initially, because of the high PPD reading. Despite 10 days of treatment, the lesion persistently progressed. Subsequently, interferon (INF) α-2a therapy was initiated solely as daily injections of 1 million unit (MIU) subconjunctivally. The frequency of injections was tapered within the course. Currently, injections are still being dispensed once a month. RESULTS: Throughout the 12 months of follow-up, the patient had no major side effects due to INF α-2a therapy. At present, SC in the right eye is inactive and the macula is safe in terms of incurring. The vision is 20/20 in the right eye, whereas it is light perception in the left eye. CONCLUSION: Interferon α-2a administration in SC can be an efficient modality and is free of immunosuppression related side effects. Subconjunctival application seems to be a promising and safe tool for treatment.

Intravitreal triamcinolone improves recovery of visual acuity in nonarteritic anterior ischemic optic neuropathy.

BACKGROUND: The visual outcome in untreated nonarteritic anterior ischemic optic neuropathy (NAION) is dismal. Because intravitreal triamcinolone (IVTA) has shown promise in improving edematous retinal disorders, a pilot trial of this therapy in NAION was considered reasonable. METHODS: Four eyes of 4 patients with severe visual loss due to NAION were treated with 4 mg IVTA (study group). The control group consisted of 6 consecutive patients with NAION who received no treatment. Patients were evaluated by the visual acuity and visual field measurements of the Early Treatment Diabetic Retinopathy Study (ETDRS) and fluorescein angiography. RESULTS: All patients completed at least 9 months of follow-up. In the study group, the mean improvement in visual acuity were 4, 5.8, and 6.2 ETDRS lines at the first and third weeks and final visit, respectively. Optic disc swelling and leakage had markedly decreased at the first postinjection week and had disappeared by the third week examination in all eyes. In the control group, the mean improvements in visual acuity were 0, 0.7, and 1.3 ETDRS lines at the first and third weeks and final visit, respectively. Control eyes showed resolution of the optic disc swelling between the fourth week and third month visits. No marked change in visual field defects was observed in either group. CONCLUSIONS: IVTA provided relatively improved recovery of visual acuity and relatively rapid resolution of optic disc swelling in a small sample of patients with acute NAION. It did not provide visual field improvement. A larger trial is merited by the results of this small pilot study.

Preclinical safety evaluation of intravitreal injection of full-length humanized vascular endothelial growth factor antibody in rabbit eyes.

PURPOSE: To evaluate the preclinical safety of intravitreal bevacizumab, which is a full-length humanized monoclonal antibody against the vascular endothelial growth factor (VEGF), in rabbit eyes over a short-term period. METHODS: Twenty-four rabbits were divided into two groups, each with two subgroups. The first group (groups 1 and 2) received 1.25 mg (0.05 mL) intravitreal bevacizumab, and the second group (groups 3 and 4) received 3.00 mg (0.12 mL) intravitreal bevacizumab. The right eyes were designated as the study eyes, and the left eyes served as a control and received the same volume of saline intravitreally. Groups 1 and 3 were labeled as early groups and scheduled to be terminated at 14 days. Groups 2 and 4, labeled as late groups, were scheduled to be terminated at 28 days. Besides electroretinography (ERG) and visually evoked potentials (VEP), central corneal thickness, intraocular pressure, fundus photography, and anterior segment imaging were performed at baseline and scheduled time points. Enucleated eyes were preserved for light and electron microscopic investigation. RESULTS: No anterior segment inflammation was observed, except in one eye in group 1 which showed a uveitic reaction. No evidence of retinal toxicity was seen with intravitreal bevacizumab at doses of 1.25 and 3.00 mg, by either ERG or light microscopy. Electron microscopic assessment revealed mitochondrial damage in the inner segments of photoreceptors. Immunohistochemical staining with bax and caspase-3 and -9 showed intensive apoptotic protein expression in all study sections and minimal expression in the control eyes. CONCLUSIONS: Although electrophysiologic investigation and light microscopy showed normal retinal function and structure, mitochondrial disruption in the inner segments of photoreceptors was detected by electron microscopy, and apoptotic expression was detected after the injection of intravitreal bevacizumab.

The first Susac's syndrome case in Turkey.

Susac's syndrome is a vasospastic disease resulting from bilateral microangiopathy of the brain, cochlea and retina. It is characterized by encephalopathy, bilateral sensorineural fluctuating hearing loss and visual loss. It is very uncommon and usually affects women during young adulthood. Since all three symptoms of the triad may not be present, the clinical diagnosis is difficult. Therefore, neuroimaging, particularly magnetic resonance imaging, has an important role in establishing the diagnosis. In this case report, we present a young woman who had all the symptoms of Susac's syndrome. This is the first Susac's syndrome case reported in Turkey.

Intravitreal triamcinolone injection for chronic diffuse diabetic macular oedema.

PURPOSE: To determine the efficacy and safety of intravitreal triamcinolone in chronic diffuse diabetic macular oedema. METHODS: This prospective, interventional consecutive case series study consisted of 59 eyes (36 patients) with chronic diffuse diabetic macular oedema, which received an intravitreal injection of 4 mg triamcinolone acetonide. The results were evaluated by clinical examination and fluorescein angiography. Potential complications such as a rise in intraocular pressure, cataract progression and endophthalmitis were recorded. RESULTS: All patients completed at least 6 months follow up. The mean visual acuity improved significantly from 0.17 +/- 3.4 to a maximum of 0.30 +/- 3.3 at the third postinjection month (P < 0.01). Mean improvements in visual acuity measured were 2.15 +/- 1.66, 2.42 +/- 2.66, 1.13 +/- 2.74, 0.96 +/- 2.01 and 0.08 +/- 2.34 lines at the 1, 3, 6, 9 and 12 months follow-up intervals, respectively. In all eyes in fluorescein angiography, macular oedema was resolved (63%) or decreased (37%) during the follow up. However, the macular oedema reached the pretreatment level in 29 (49%) of the eyes at 6 months and 15 of 21 eyes (71%) at 9 months after injection. Intraocular pressure exceeded 21 mmHg in 10 eyes, which were controlled by topical medication. Four eyes showed cataract progression. Endophthalmitis was not observed in any of the eyes. CONCLUSIONS: Intravitreal injection of 4 mg triamcinolone acetonide appears to be an effective and relatively safe therapeutic method for diffuse diabetic macular oedema. Further studies are warranted to assess the long-term efficacy, safety and the need for reinjection.

Intravitreal triamcinolone injection for chronic diabetic macular oedema with severe hard exudates.

BACKGROUND: The purpose of the study was to determine the efficacy and safety of intravitreal triamcinolone acetonide (TA) in chronic diabetic macular oedema with severe hard exudates. METHODS: This prospective, interventional consecutive case series study consisted of 33 eyes of 28 patients with chronic diabetic macular oedema and severe foveal hard exudates who received an intravitreal injection of 4 mg of TA. The patients were divided into two groups according to the type of foveal hard exudates: group I, plaque-like (17 eyes) and group II, dot-like scattered hard exudates (16 eyes). The results of both groups, evaluated by colour fundus photography and fluorescein angiography, were compared and complications were recorded. RESULTS: All patients completed at least 6 months of follow-up. In all eyes, the hard exudates were completely resolved (24% in group I and 50% in group II) or decreased (76% in group I and 50% in group II). In group I, the mean diameter of the exudates plaques significantly decreased from 5.5+/-3.8 mm(2) in the pre-treatment period to 2.2+/-2.7 mm(2) at the end of the follow-up period. There was no recurrence of the hard exudates in either of the groups. The mean +/- SD visual acuity (VA) improved from 0.07+/-2.5 at the baseline to a maximum of 0.09+/-2.1 lines in group I (P<0.01) and from 0.13+/-3.9 to a maximum of 0.27+/-2.7 lines in group II (P<0.01). The mean VA improvement in group II was better than group I (3.2+/-2.5 vs. 1.4+/-1.0 lines, P<0.05). Intraocular pressure exceeded 21 mmHg in 10 eyes (30%), which was then controlled by topical medication. Three eyes (9%) exhibited signs of subcapsular cataract progression. CONCLUSIONS: Intravitreal TA appears to be a valuable treatment in chronic diabetic macular oedema with severe foveal hard exudates. In all eyes in this study the hard exudates were completely resolved or decreased, and the mean VA improved significantly in both groups. However, the VA improvement was significantly worse in eyes with plaque-like exudates suggesting the possible value of earlier treatment. Further studies would enable the assessment of the universal effectiveness of this treatment.

Dilute triamcinolone-assisted peeling of the internal limiting membrane in cases of diffuse diabetic macular oedema.

PURPOSE: In this study we evaluated the efficiency of diluted triamcinolone particles in peeling of the internal limiting membrane (ILM) in cases of diffuse diabetic macular oedema. METHODS: A prospective observational study of thirteen consecutive patients with diffuse diabetic macular oedema who had undergone ILM peeling aided by use of a diluted (1 mg mL(-1)) suspension of triamcinolone particles (0.05 mg). The results were assessed by measurement of visual acuity and intraocular pressure, by ophthalmoscopy, and by fluorescein angiography. RESULTS: ILM peeling in all eyes could be performed easily and completely with the aid of triamcinolone particles homogeneously dispersed over the macular ILM. During the peeling procedure, triamcinolone particles resulted in clear contrast between the peeled and unpeeled ILM thus enabling us to easily find the edge of the ILM and to be able to continue peeling at further attempts. In twelve of the thirteen eyes the macular oedema was completely resolved or reduced. Visual acuity improved by at least two lines in nine eyes (70%). The intraocular pressure increase did not exceed 21 mmHg in any of the patients. CONCLUSIONS: The diluted triamcinolone suspension enables good visualisation of the ILM during the ILM peeling procedure in cases of diffuse diabetic macular oedema. Use of a diluted suspension may reduce the risk of intraocular pressure increase and the potential toxicity of triamcinolone.

Intravitreal triamcinolone as an adjunct in the treatment of concomitant proliferative diabetic retinopathy and diffuse diabetic macular oedema. Combined IVTA and laser treatment for PDR with CSMO.

PURPOSE: To investigate if triamcinolone acetonide (TA) can be an adjunct to laser treatment in patients with concomitant non-high-risk proliferative diabetic retinopathy (PDR) and diffuse clinically significant diabetic macular oedema (CSMO). METHODS: This prospective, interventional and comparative clinical study included 32 eyes of 16 patients with bilateral concomitant non-high-risk PDR and diffuse CSMO. Each patient received 4 mg intravitreal TA for the eye with worse visual acuity (study group) and macular focal and grid laser photocoagulation (MP) for the other eye (control group). One month later, each patient received four sessions of panretinal photocoagulation for both eyes plus MP for the eyes in the study group. The visual and angiographic results of both groups were compared. RESULTS: In the study group, the mean visual acuity (VA) improved from 0.12 +/- 2.3 lines at the baseline to 0.19 +/- 3.1 (P = 0.004), 0.20 +/- 3.2 (P = 0.004), 0.19 +/- 3.6 (P = 0.009) and 0.19 +/- 3.3 lines (P = 0.091) at the 1-, 3-, 6- and 9-month follow-up intervals, respectively. The macular oedema was found to be resolved in 11 eyes (69%) and decreased in five eyes (31%). In the control group, the mean VA deteriorated progressively from 0.41 +/- 3.1 lines at the baseline to 0.20 +/- 3.1 lines (P = 0.026) at the end of the study and the macular oedema decreased only in three eyes (19%) at the sixth follow-up month. CONCLUSIONS: During the follow-up period of the study, intravitreal TA as an adjunct in the treatment of concomitant non-high-risk PDR and diffuse CSMO led to a more-favourable clinical outcome than conventional laser treatment.

Small-incision manual extracapsular cataract extraction using deep-topical, nerve-block anesthesia.

BACKGROUND AND OBJECTIVE: To determine whether deep-topical anesthesia is suitable for small-incision manual extracapsular cataract extraction (ECCE). PATIENTS AND METHODS: Three hundred twenty-six eyes of 253 patients had small-incision manual ECCE under topical anesthesia with a 4% lidocaine-soaked sponge. The severity of the pain, eye movements, blepharospasm, and intraoperative complications were recorded. Patient and surgeon satisfaction levels were assessed. RESULTS: Operations on 323 eyes (99%) were completed with topical anesthesia. Intraoperatively, topical anesthesia was converted to peribulbar anesthesia in 3 eyes (0.9%) because of excessive eye movements. The cauterization of the scleral vessels and conjunctiva and the subconjunctival injection were the stages causing severe pain. The most frequent intraoperative complication was posterior capsule rupture in 6 eyes (1.8%). The satisfaction level was 95% for the patients and 90% for the surgeon. CONCLUSION: Deep-topical, nerve-block anesthesia provides anesthesia with sufficient quality for small-incision manual ECCE.

Ocular surface changes with applanation contact lens and coupling fluid use after argon laser photocoagulation in noninsulin-dependent diabetes mellitus.

PURPOSE: To describe the effect of coupling solutions used during laser photocoagulation on the ocular surface of patients with noninsulin-dependent diabetes mellitus (NIDDM). DESIGN: A prospective case-controlled study. METHODS: Ninety-two eyes of 46 NIDDM patients with clinically significant macular edema, poor metabolic control of diabetes, and peripheral neuropathy and 100 eyes of 50 normal control subjects were studied. The patients' eyes were assigned to argon green focal/grid laser photocoagulation using an applanation contact lens and one of the coupling fluids; 2% methocel, Thilo-Tears Gel, 1.4% sodium hyaluronate, or 0.9% simple saline. The control subjects received time-matched three-mirror contact lens fundus examinations. All subjects underwent corneal sensitivity measurements, Schirmer test, tear film breakup time, and corneal fluorescein staining before as well as 3 and 8 days after the laser procedures and contact lens examinations. Patients with corneal problems persisting after 8 days were followed longer. RESULTS: Diabetic eyes assigned to 2% methocel and 1.4% sodium hyaluronate had significantly lower mean corneal sensitivities and break-up time values as well as significantly higher mean fluorescein staining scores at all examination points after laser photocoagulation. All diabetic eyes with aqueous deficiency assigned to 2% methocel and 1.4% sodium hyaluronate developed delayed corneal epithelial healing. CONCLUSION: The use of viscous coupling solutions during applanation contact lens-aided laser procedures may be detrimental for the corneal epithelium in poorly controlled NIDDM patients with peripheral neuropathy and coexisting aqueous deficiency.

A new surgical approach for indocyanine green-assisted internal limiting membrane peeling.

BACKGROUND AND OBJECTIVE: The efficiency of indocyanine green (ICG) dye in the removal of the internal limiting membrane (ILM) with a fluid needle using passive aspiration was evaluated. PATIENTS AND METHODS: Eighteen consecutive patients with diffuse diabetic macular edema were studied. After vitrectomy and total fluid-air exchange, 0.1 mL of ICG solution 0.25% was left in the macular area for 1 minute. Then the macular ILM was peeled with a specially designed tapered fluid needle using passive aspiration. RESULTS: In 16 of the 18 eyes, the peeling procedure could be easily performed with a tapered fluid needle using passive aspiration. In 11 eyes, partial development of spontaneous ILM detachment prior to the peeling process was also observed. CONCLUSIONS: ICG solution 0.25% appears to reduce the adhesive force of the ILM to the sensory retina, which makes the removal of the ILM much easier by passive aspiration with a fluid needle.

Pars plana vitrectomy and removal of the internal limiting membrane in the treatment of chronic macular oedema.

BACKGROUND: To evaluate the results of pars plana vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with chronic macular oedema. METHODS: PPV with indocyanine green (ICG) assisted peeling of the ILM was performed in 33 eyes with diabetic (21 eyes) or non-diabetic (12 eyes) macular oedema. Postoperatively, resolution of macular oedema, improvement of visual acuity (VA) and complications were documented. The peeled membranes were submitted for light and transmission electron microscopic evaluation. RESULTS: The mean follow-up time was 12.2 months. The macular oedema decreased or was resolved in 17 (81%) eyes in the diabetic group and in 11 (92%) eyes in the non-diabetic group. VA improved by at least 2 lines in 11 (52%) eyes in the diabetic group and in 7 (58%) eyes in the non-diabetic group. The difference between visual acuity improvements of the two groups was not statistically significant (P>0.05). However, in the diabetic group the difference of visual improvement between cystoid and diffuse type of macular oedema eyes was statistically significant (14% versus 71%, P=0.02). Light and transmission electron microscopy showed the presence of ILM in all specimens. During the follow-up period no recurrence of macular oedema or epiretinal membrane formation was observed. CONCLUSION: Pars plana vitrectomy with peeling of the ILM and epiretinal membrane leads to the resolution of macular oedema in the majority of eyes. This however, is not always associated with VA improvement. In diabetic eyes, cystoid type of macular oedema appears to be a poor prognostic factor for improved VA.

Radial optic neurotomy in central retinal vein occlusion: preliminary results.

BACKGROUND: To investigate the efficacy of radial optic neurotomy (RON) on visual prognosis and clinical findings in central retinal vein occlusion (CRVO). METHODS: Prospective, non-randomised, self-controlled comparative trial. Six patients with ischemic CRVO who had visual acuity (VA) less than or equal to 0.1 and duration of CRVO at least 1 month, and 6 patients with non-ischemic CRVO who maintained their VA less than or equal to 0.1 during the minimal follow-up of 3 months underwent pars plana vitrectomy and RON. LogMAR VA measurement and fluorescein angiography were performed before and after surgery. Automated perimetry was obtained from 4 patients at the last visit. Main outcome measures were VA and clinical changes in fundus appearance of CRVO evaluated with fundus photography and fluorescein angiography. RESULTS: Radial optic neurotomy was successfully performed in all 12 patients without serious complications. All patients were of clinical improvement of fundus findings. In 11 (92%) patients, a visual improvement of at least 2 lines was observed. After mean follow-up of 9.3 months, mean improvement in VA was 5.1 +/- 3.1 lines (range, 2-14 lines). Cystoid macular oedema and degeneration were observed in 8 (67) patients. Four patients, two of whom had preoperative ocular hypertension had raised intraocular pressure controlled with topical antiglaucoma medication. In late postoperative period, one ischemic eye developed vitreous haemorrhage necessitating vitrectomy and endolaser photocoagulation. Automated perimetry revealed segmental visual field defects in all the examined eyes. CONCLUSIONS: Radial optic neurotomy in CRVO yields clinical and visual improvement in majority of the patients. Cystoid macular oedema and degeneration are the major factors responsible for restriction of VA improvement. Further randomised and controlled studies with longer follow-up are essential to establish the appropriate timing and indications of RON in CRVO.