Mesenchymal stem cells derived-exosomes enhanced amniotic membrane extract promotes corneal keratocyte proliferation.

Amniotic membrane extract (AME) and Wharton's jelly mesenchymal stem cells derived-exosomes (WJ-MSC-Exos) are promising therapeutic solutions explored for their potential in tissue engineering and regenerative medicine, particularly in skin and corneal wound healing applications. AME is an extract form of human amniotic membrane and known to contain a plethora of cytokines and growth factors, making it a highly attractive option for topical applications. Similarly, WJ-MSC-Exos have garnered significant interest for their wound healing properties. Although WJ-MSC-Exos and AME have been used separately for wound healing research, their combined synergistic effects have not been studied extensively. In this study, we evaluated the effects of both AME and WJ-MSC-Exos, individually and together, on the proliferation of corneal keratocytes as well as their ability to promote in vitro cell migration, wound healing, and their impact on cellular morphology. Our findings indicated that the presence of both exosomes (3 × 105 Exo/mL) and AME (50 µg/mL) synergistically enhance the proliferation of corneal keratocytes. Combined use of these solutions (3 × 105 Exo/mL + 50 µg/mL) increased cell proliferation compared to only 50 µg/mL AME treatment on day 3 (**** p < 0.0001). This mixture treatment (3 × 105 Exo/mL + 50 µg/mL) increased wound closure rate compared to isolated WJ-MSC-Exo treatment (3 × 105 Exo/mL) (*p < 0.05). Overall, corneal keratocytes treated with AME and WJ-MSC-Exo (3 × 105 Exo/mL + 50 µg/mL) mixture resulted in enhanced proliferation and wound healing tendency. Utilization of combined use of AME and WJ-MSC-Exo can pave the way for a promising foundation for corneal repair research.

Rose petal topography mimicked poly(dimethylsiloxane) substrates for enhanced corneal endothelial cell behavior.

Low proliferation capacity of corneal endothelial cells (CECs) and worldwide limitations in transplantable donor tissues reveal the critical need of a robust approach for in vitro CEC growth. However, preservation of CEC-specific phenotype with increased proliferation has been a great challenge. Here we offer a biomimetic cell substrate design, by optimizing mechanical, topographical and biochemical characteristics of materials with CEC microenvironment. We showed the surprising similarity between topographical features of white rose petals and corneal endothelium due to hexagonal cell shapes and physiologically relevant cell density (≈ 2000 cells/mm2). Polydimethylsiloxane (PDMS) substrates with replica of white rose petal topography and cornea-friendly Young's modulus (211.85 ± 74.9 kPa) were functionalized with two of the important corneal extracellular matrix (ECM) components, collagen IV (COL 4) and hyaluronic acid (HA). White rose petal patterned and COL 4 modified PDMS with optimized stiffness provided enhanced bovine CEC response with higher density monolayers and increased phenotypic marker expression. This biomimetic approach demonstrates a successful platform to improve in vitro cell substrate properties of PDMS for corneal applications, suggesting an alternative environment for CEC-based therapies, drug toxicity investigations, microfluidics and organ-on-chip applications.

Bioinspired hydrogel surfaces to augment corneal endothelial cell monolayer formation.

Corneal endothelial cells (CECs) have limited proliferation ability leading to corneal endothelium (CE) dysfunction and eventually vision loss when cell number decreases below a critical level. Although transplantation is the main treatment method, donor shortage problem is a major bottleneck. The transplantation of in vitro developed endothelial cells with desirable density is a promising idea. Designing cell substrates that mimic the native CE microenvironment is a substantial step to achieve this goal. In the presented study, we prepared polyacrylamide (PA) cell substrates that have a microfabricated topography inspired by the dimensions of CECs. Hydrogel surfaces were prepared via two different designs with small and large patterns. Small patterned hydrogels have physiologically relevant hexagon densities (∼2000 hexagons/mm2 ), whereas large patterned hydrogels have sparsely populated hexagons (∼400 hexagons/mm2 ). These substrates have similar elastic modulus of native Descemet's membrane (DM; ∼50 kPa) and were modified with Collagen IV (Col IV) to have biochemical content similar to native DM. The behavior of bovine corneal endothelial cells on these substrates was investigated and results show that cell proliferation on small patterned substrates was significantly (p = 0.0004) higher than the large patterned substrates. Small patterned substrates enabled a more densely populated cell monolayer compared to other groups (p = 0.001 vs. flat and p < 0.0001 vs. large patterned substrates). These results suggest that generating bioinspired surface topographies augments the formation of CE monolayers with the desired cell density, addressing the in vitro development of CE layers.

Pharmacogenetic Aspect of Intravitreal Ranibizumab Treatment in Neovascular Age-Related Macular Degeneration: A Five-Year Follow-Up.

PURPOSE: This study aims to evaluate the role of complement factor H (CFH) in response to intravitreal ranibizumab (IVR) treatment, which is administered to patients with neovascular age-related macular degeneration (nAMD). METHODS: In this retrospective study, 90 nAMD patients' 90 eyes were evaluated. IVR was injected once a month for three consecutive months, and then, patients were followed up for five years by using pro re nata method. RESULTS: Average visual acuity (BCVA) values in TT group for the third, fourth and fifth years were found to be significantly higher than those in TC and CC groups, while average BCVA values in TC group were significantly higher than those in CC group (all p = .000 < .0167). CONCLUSION: Patients with CFH TT genotype responded significantly better to treatment after third year, while patients with CC genotype had a poorer response to IVR.

Correlation of neutrophil/lymphocyte and platelet/lymphocyte ratio with visual acuity and macular thickness in age-related macular degeneration.

AIM: To investigate the place of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in the diagnosis of and prognosis for neovascular age-related macular degeneration (AMD). METHODS: One hundred AMD patients and 100 healthy controls were included in the study. Blood samples were obtained from the venous blood, which is used for routine analysis, and these samples were subjected to complete blood count. NLR was defined as the neutrophil count divided by the number of lymphocytes, and PLR was defined as the platelet count divided by the number of lymphocytes. RESULTS: No statistically significant difference was observed between the two groups under consideration in terms of demographic features (P>0.05). The average NLR in the patient group was found to be significantly higher than that in the healthy control group (P<0.05). The average PLR was significantly higher in the patient group as compared to the control group (P<0.05). As best corrected visual acuity (BCVA) increased, both NLR and PLR decreased (significant negative correlations at 49.8% and 63.0%, respectively), whereas as central macular thickness (CMT) increased, both NLR and PLR increased (significant positive correlations at 59.3% and 70.0%, respectively). CONCLUSION: NLR and PLR levels are higher among neovascular AMD patients as compared to healthy control group. NLR and PLR levels were found to be inversely proportional to BCVA and directly proportional to CMT.

Retinal Nerve Fiber Layer Thickness Changes in Age-Related Macular Degeneration Treated with Multiple Intravitreal Ranibizumab.

PURPOSE: The objective of this study was to investigate the effect of multiple intravitreal ranibizumab (IVR) injections on the retinal nerve fiber layer (RNFL) in neovascular age-related macular degeneration (nAMD). METHODS: One hundred sixty-eight eyes of 168 patients with nAMD who received an IVR at least 3 times were included in this prospective interventional case series. The RNFL thickness data on 80 healthy eyes, used as the control group, were obtained. The patients were grouped as follows: 3-10 injections (group 1, 62 eyes, 37%), 10-20 injections (group 2, 62 eyes, 37%), and ≥20 injections (group 3, 44 eyes, 26%). The RNFL thickness was measured by spectral domain optical coherence tomography. RESULTS: The mean baseline measurement of the RNFL thickness was 97.4 ± 6.4 µm in the control group, 96.4 ± 5.6 µm in group 1, 93.8 ± 4.6 µm in group 2, and 93.2 ± 5.3 µm in group 3. At the last follow-up, it was 95.1 ± 2.4 µm in the control group, 93.4 ± 7.3 µm in group 1, 90.5 ± 3.6 µm in group 2, and 89.2 ± 4.9 µm in group 3 (all P values >0.050). A statistically significant difference was not found between the mean total RNFL thickness of the eyes that received injections and that of the eyes in the healthy control group (P value >0.050). A statistically significant difference was not found in all the treatment groups between the intraocular pressure level taken 1 day after the administration of the injections and that recorded preintervention (all P values >0.050). CONCLUSION: Repeated IVR did not lead to a significant change in RNFL thickness in patients with nAMD.

The decrease in aqueous tear production associated with pepper spray.

PURPOSE: Pepper spray is used both by civilians and by law enforcement. Burning sensation occurs when exposed to skin, pain and temporary blindness occurs when exposed to the eyes. This study focused on the effect of pepper spray on lacrimal tear production and subsequently on corneal sensitivity in a large group after an intense exposure. METHODS: Ninety-six people who were exposed to pepper spray during the Gezi park protests volunteered. Subjects were asked if they wore any protective goggles and if they irrigated their eyes after exposure. They were asked to record their symptoms regarding dry eye in a standardized questionnaire. Schirmer I and II tests were performed. RESULTS: Eighty-two people wore protective goggles during exposure, whereas 14 people did not have any protection. Both Schirmer results in unprotected subjects were significantly lower than that in protected subjects. Schirmer I and II results of unprotected subjects were not statistically different, whereas they were statistically different in protected subjects. Thirty-five percent of unprotected subjects and 24% of protected subjects expressed symptoms of dry eye. DISCUSSION: The active ingredient of pepper spray is oleoresin capsicum. It is randomly diffused to polymodal nerve terminals, leading to opening of non-selective cationic channels and block neuronal transmission. The lower results of both Schirmer in unprotected group emphasize the importance of a protective Google glass around the eyes during exposal, serving as a barrier minimalizing the contact of the spray with the eyes. The combination of the low results and lack of symptoms could suggest that corneal reflex lacrimation in our subjects was not abundant enough. The findings of this study could not fully represent long term findings but it could be assumed that our findings could be indicative of the sensory denervation and alterations demonstrated in studies investigating the long term effects of oleoresin capsicum.

Amniotic membrane welded to contact lens by 1470-nm diode laser: a novel method for sutureless amniotic membrane transplantation.

AIM: To avoid the side effects of the suture usage by welding amniotic membrane (AM) to contact lens (CL) with laser. METHODS: AM was taken from pregnant women and cleaned from blood clots with sterile phosphate-buffered physiological saline solution which included antibiotics. Stromal side of the AM was spread inside of the CL and it was welded to CL by 1470 nm diode laser. 600 µm diameter fiber tip of the laser was contacted with the epithelial side of the AM from 4 separate points. After welding excess amniotic membrane around the CL was cut with a scalpel. RESULTS: Stromal side of the AM was spread inside of the CL and then with laser fiber, different power levels and exposure times were applied on the epithelium of AM and 340 mW for seven seconds was found optimal. CL and AM attached with the spot welding effect in 4 points by touching fiber tip. CL-AM welded complex did not separated from each other while holding AM that extend beyond the CL with the help of two forceps. CONCLUSION: As a conclusion, it was aimed in this study to achieve the success of the conventional amniotic membrane transplantation (AMT)with the easiness of applying a CL and to avoid risks and side effects of corneal or conjunctival suturing. The results showed that the application of the CL-AM complex will be as easy as the application of a CL and lasts shortly.

Central serous chorioretinopathy associated with topical latanoprost therapy.

PURPOSE: To report a case of central serous chorioretinopathy (CSC) as a possible complication of latanoprost treatment. METHODS: A 65-year-old woman presented with a 1-week history of blurred vision and metamorphopsia in her right eye. She was previously diagnosed with unilateral glaucoma, and treatment was initiated with topical latanoprost 0.005% for the right eye. The symptoms occurred 1 month after initiation of glaucoma treatment. RESULTS: Visual acuity (VA) of the patient had reduced to 20/50 in right eye. Fluorescein angiography revealed a focal RPE leak near to the fovea with neurosensory detachment due to CSC, which was confirmed by optical coherence tomography. After cessation of the therapy, her clinical and morphological status improved spontaneously. The neurosensory detachment resolved almost completely and VA improved to 20/20 simultaneously. CONCLUSIONS: The authors report the first case of CSC associated with latonoprost therapy. This case demonstrates that topical latanoprost may lead to the development of CSC.

Combination treatment with intravitreal injection of ranibizumab and reduced fluence photodynamic therapy for choroidal neovascularization secondary to angioid streaks: preliminary clinical results of 12-month follow-up.

BACKGROUND: To evaluate combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks. METHODS: This is an interventional case series of 10 previously untreated eyes of 10 patients with choroidal neovascularization secondary to angioid streaks. All eyes were treated with reduced fluence photodynamic therapy using 25 J/cm, immediately followed by intravitreal ranibizumab injection at baseline, and subsequent injections were performed on an as-needed basis thereafter. Treatment efficacy was assessed based on best-corrected visual acuity and optical coherence tomography findings. RESULTS: After 12 months of follow-up, the best-corrected visual acuity improved by >2 lines in 6 eyes (60%), remained within 2 lines of baseline in 3 eyes (30%), and decreased by ≥ 3 lines in only 1 eye (10%). The mean central foveal thickness decreased significantly from 332.2 µm at baseline to 235.7 µm at the last follow-up (P < 0.001), as measured by optical coherence tomography. CONCLUSION: The preliminary results of this prospective study indicate that combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks seems to be effective in reducing or eliminating retinal edema, regression of neovascularization, and improving or stabilizing visual acuity without any complications. Large controlled studies are needed to evaluate the long-term effects of this combination regimen.

Bimatoprost 0.03% versus brimonidine 0.2% in the prevention of intraocular pressure spike following neodymium:yttrium­aluminum­garnet laser posterior capsulotomy.

PURPOSE: The aim of this study was to compare the efficacy of bimatoprost 0.03% with brimonidine 0.2% in preventing intraocular pressure (IOP) elevations after neodymium:yttrium­aluminum­garnet (Nd:YAG) laser posterior capsulotomy. METHODS: In this prospective, randomized, double-masked study, 195 eyes of 195 consecutive patients who had YAG laser capsulotomy for posterior capsule opacification were recruited. Eyes received either 1 drop of bimatoprost 0.03% (98 patients) or brimonidine 0.2% (97 patients) at 1h before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before treatment and after treatment at 1h, 3h, 24h, and 7 days. Inflammation was evaluated after surgery. Formation of cystoid macular edema was assessed by measuring the macular thickness before and after laser surgery. RESULTS: The average peak of postoperative IOP elevation was 2.2±3.9mm Hg in the bimatoprost 0.03% and 3.6±3.1mm Hg in the brimonidine 0.2% group. The difference was statistically significant (P<0.001). Postoperative IOP elevations of 10mm Hg or more occurred in 1 eye (1.56%) in the bimatoprost 0.03% group and 5 eyes (7.35%) in the brimonidine 0.2%. This difference was statistically significant (P<0.001). Macular edema and anterior chamber reaction were not observed related to bimatoprost. No clinically significant side effects were noted in either group. CONCLUSIONS: Our results indicate that prophylactic use of bimatoprost 0.03% is more effective than brimonidine 0.2% in preventing IOP elevation immediately after YAG laser capsulotomy. Bimatoprost 0.03% as a prostamide analog may provide new option for preventing IOP elevation after YAG laser capsulotomy.

Posterior reversible encephalopathy syndrome after intravitreal bevacizumab injection in patient with choroidal neovascular membrane secondary to age-related maculopathy.

The posterior reversible encephalopathy syndrome (PRES), a complex of cerebral disorders including headache, seizures, visual disturbances, is associated with a variety of conditions in which blood pressure rises acutely. Arterial hypertension can occur in systemic administration of bevacizumab. A few cases of systemic injection of bevazicumab-induced PRES have been reported. In this article, we first report on a patient who developed PRES following intravitreal bevazicumab.

Vitreous levels of VEGF, IL-8, and TNF-alpha in retinal detachment.

PURPOSE: To determine intravitreal levels of interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), and vascular endothelial growth factor (VEGF) in patients with rhegmatogenous retinal detachment (RD). METHODS: Vitreous samples were collected from 22 eyes of 22 patients during vitrectomy procedures for RD. For controls, vitreous samples were obtained from 12 eyes of 12 patients without RDs during pars plana vitrectomies. Control group patients included four with macular holes and eight with epiretinal membranes; none had any associated vitreoretinopathy. All vitreous samples were immediately frozen at -80 degrees C until assayed. RESULTS: VEGF concentrations were significantly elevated in samples from patients with RDs compared to samples from control patients (p < 0.001). Vitreous concentrations of IL-8 were also significantly elevated in patients with macular edema when compared to control patients (p < 0.05). However, no significant difference was observed in vitreous concentrations of TNF-alpha in subjects with RDs compared to control subjects (p > 0.05). CONCLUSIONS: Increases in IL-8 (an inflammatory angiogenic mediator) and VEGF (a regulatory mediator of cellular proliferation and permeability) may be related to development of proliferative vitreoretinopathy.

Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: a prospective, controlled clinical study.

PURPOSE: To evaluate and determine the effect of intravitreal bevacizumab in treatment of persistent central serous chorioretinopathy. METHODS: This prospective, comparative clinical study included 30 eyes of 30 patients with persistent, symptomatic central serous chorioretinopathy of 3 months' duration or more. Fifteen eyes of 15 patients were treated with intravitreal injections of 2.5 mg (0.1 ml) bevacizumab (treatment group). Fifteen eyes of 15 patients with the same characteristics who declined treatment were an acceptable control group. The visual and anatomic responses were observed with best-corrected visual acuity and central foveal thickness measured by optic coherence tomography at baseline,1, 3, and 6 months after treatment. RESULTS: Twelve (80%) eyes in the treatment group compared with 8 (53.3%) eyes in the control group showed morphologic restitution at 6 months (P < 0.01). All 15 (100%) treated eyes had stable or improved vision, compared with 10 (66.6%) eyes in the control group (P < 0.01). At 6 months, the mean +/- SD central foveal thickness for the treatment group remained significantly lower compared to the control group, with 174 +/- 68 microm and 297 +/- 172 microm, respectively (P < 0.001). Injection-related complications were not encountered. CONCLUSIONS: Our results indicate that intravitreal bevacizumab injection may be a new, promising treatment option for select patients with idiopathic persistent central serous chorioretinopathy. Continued studies with intravitreal bevacizumab in this population will help to establish its long-term efficacy.

Intravitreal ranibizumab in the treatment of cystoid macular edema associated with retinitis pigmentosa.

PURPOSE: To report and evaluate the anatomic, clinical, and visual acuity response after intravitreal ranibizumab (IVR) injection in patients with cystoid macular edema (CME) due to retinitis pigmentosa (RP). METHODS: This study included 30 eyes of 30 patients with RP who had persistent CME at least 6 months despite medication with acetazolamide. Fifteen eyes of 15 eligible patients were treated with 0.5 mg IVR injection (treatment group). Fifteen eyes of 15 patients with the same characteristics who refused treatment were accepted as control group. The primary outcome of the study (morphologic restitution) was the complete or significant resolution of cystoid space on optic coherence tomography (OCT) without relapse or complication at 6 months. The serial changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured. RESULTS: Thirteen eyes (86.6%) in the treatment group had significant resolution of CME at 6 months after single IVR injection. The difference between the 2 groups in BCVA was not statistically significant (P > 0.05). The baseline mean +/- SD CFT for the treatment and control groups were 478 +/- 88 microm and 469 +/- 75 microm, respectively (P > 0.05). At 6 months after treatment, the mean +/- SD CFT of the treatment group improved to 272 +/- 65 microm whereas that in the control group was 480 +/- 92 microm (P < 0.001). CONCLUSIONS: This investigation indicated that IVR may provide a new therapeutic approach for the treatment of CME secondary to RP. No adverse event was found to be associated with the treatment. Continued experience with IVR in this population will help establish its longer-term efficacy.

Simultaneous intravitreal and intracameral injection of bevacizumab (Avastin) in neovascular glaucoma.

PURPOSE: To report the effects of simultaneous intravitreal and intracameral injection of 1.25 mg bevacizumab (Avastin) in 15 neovascular glaucoma (NVG) cases secondary to iris and/or angle neovascularization. PATIENTS AND METHODS: The study included 15 eyes of 15 patients (seven women, eight men) with NVG secondary to central retinal vein occlusions (CRVO) or proliferative diabetic retinopathy (PDR). Eight eyes had had CRVO and seven PDR prior to NVG. The severity of neovascularization and peripheric anterior synechiae (PAS) was scored from mild (+) to severe (+++). A total dose of 1.25 mg bevacizumab in 0.05 mL was injected into the vitreous cavity and the same dose of bevacizumab into anterior chamber by sterile 30-gauge needle. RESULTS: After treatment neovascularizations on iris and angle were completely resolved 36 h after injection in all patients. Intraocular pressure (IOP) was decreased under 22 mmHg in six cases without any medication. Six cases need medical treatment to achieve appropriate IOP level. Surgical procedure was necessary in three patients who persist high IOP levels despite completely resolved neovascularizations. CONCLUSIONS: Simultaneous intravitreal and intracameral injection of bevacizumab can cause an immediate regression of neovascularization secondary to PDR or CRVO and could be an useful adjuvant to prevent dense PAS formation that lead to persistent IOP increasing.

Intravitreal bevacizumab (Avastin) injection in retinitis pigmentosa.

PURPOSE: To evaluate and report the effectiveness, visual, anatomical, and clinical outcome of intravitreal bevacizumab (Avastin) injection in patients with retinitis pigmentosa (RP). METHODS: Our prospective study included 13 eyes of 7 patients (4 women and 3 men) in the age range of 25-69 years (mean 44.14 years) with cystoid macular edema (CME) secondary to RP. Intravitreal bevacizumab at a dose of 1.25 mg/0.05 ml was injected via a 28-gauge needle. The response rate to treatment was monitored functionally by visual acuity assessment and anatomically using the optical coherence tomography. RESULTS: The baseline mean central macular thickness was 370.15 microm (range 245-603 microm. The central macular thickness decreased to 142.53 microm (range 124-168 microm) after bevacizumab injections. The pre- and post-treatment visual acuity ranges were 5/400-20/100 and 20/200-20/63, respectively. CONCLUSIONS: Our data reveal that intravitreal bevacizumab administration is effective for the treatment of CME in RP. Further studies with a larger population and longer follow-up period are warranted to assess the efficacy of the treatment.

Intravitreal bevacizumab injection in patients with choroidal neovascularization due to choroid rupture after blunt-head trauma.

PURPOSE: To describe and report the effect of intravitreal bevacizumab (Avastin) as primary treatment for secondary choroidal neovascularization (CNV) after choroidal rupture due to blunt-head trauma. DESIGN: Interventional case report. METHODS: The study was of the left eye of a patient who presented with choroidal neovascularization secondary to choroidal rupture due to blunt-head trauma. The patient received single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab as treatment for CNV after informed consent was signed. The patient underwent fundus fluorescein angiography (FA) and optic coherence tomography (OCT) before the bevacizumab injection and then again three months after. Visual acuity was also measured before and after treatment. The patient was re-examined on the first day, and monthly thereafter. After intravitreal injection of bevacizumab the visual and anatomic responses were observed. RESULTS: The patient showed regression of the neovascularization three months after injection of bevacizumab. There was no loss of vision in the immediate postoperative period and at the 3rd month vision improved from 20/60 to 20/20. Central retinal thickness decreased. No cataract progression, endophthalmitis, or injection-related complications were observed. CONCLUSIONS: Our study shows that intravitreal 1.25 mg bevacizumab can be an effective alternative treatment for choroidal neovascularization (CNV) due to choroidal rupture.

Acute retinal arterial occlusion after intravenous administration of bevacizumab.

Retinal artery occlusions are usually the result of emboli, although non-embolic causes such as vasculitides, coagulopathies, and vasospasms resulting from migraines and inflammatory conditions do occur. Bevacizumab, a humanised monoclonal antibody, is designed to bind to and inhibit vascular endothelial growth factor (VEGF). VEGF is a protein that plays a critical role in tumour angiogenesis, the formation of new blood vessels to the tumour. The use of bevacizumab has spread worldwide, but the drug related adverse events associated with its use have been reported in a few retrospective reviews. We report on a previously unpublished case of retinal artery occlusion following the use of systemic bevacizumab.

Posterior vitrectomy under topical anesthesia.

BACKGROUND: To determine the safety and efficacy of topical anesthesia in posterior vitrectomy. METHODS: A total of 93 patients (93 eyes) with various vitreoretinal diseases not needing scleral buckling and with short predicted duration of surgery underwent posterior vitrectomy under topical (49 eyes) or retrobulbar (44 eyes) anesthesia. Patients in the topical group were sedated with neuroleptic anesthesia. Postoperatively, patients were shown a visual analogue pain scale (VAPS) from 0 (no pain) to 10 (unbearable pain) to rate the levels of pain. The main outcome measures were overall and worst intraoperative pain scores, duration of surgery, and pain score during the administration of the retrobulbar anesthetic agent. RESULTS: Mean surgical time was 57.9 minutes in the topical group and 56.6 minutes in the retrobulbar group (p > 0.05). The pain scores were not significantly different. Mean overall pain scores were 1.71 (SD 1.04, range 0-5) in the topical group and 1.38 (SD 1.04, range 0-3) in the retrobulbar group (p > 0.05). Mean worst pain scores were 3.20 (SD 1.30, range 1-7) and 2.95 (SD 0.73, range 1-4), respectively (p > 0.05). There was no significant correlation between duration of surgery and overall pain score in either group (r = 0.146, p = 0.356, and r = 0.174, p = 0.385, respectively). No patient required additional injection anesthesia in the topical group. INTERPRETATION: Topical anesthesia combined with systemic sedation and analgesia in posterior vitrectomy procedures provided sufficient analgesic effects in selected patients needing no scleral buckling and with short predicted surgery time.