Observational outcomes in proliferative diabetic retinopathy patients following treatment with ranibizumab, panretinal laser photocoagulation or combination therapy - The non-interventional second year follow-up to the PRIDE study.

PURPOSE: Ranibizumab monotherapy showed stronger effects on area of retinal neovascularization (NV) reduction while offering better visual acuity (VA) results than panretinal laser photocoagulation (PRP) monotherapy during the first 12 months of the PRIDE study. The second year of PRIDE was an observational, non-interventional follow-up, performed to evaluate long-term anatomical and functional outcomes in proliferative diabetic retinopathy (PDR) patients under real-life conditions, prior to the approval of ranibizumab for PDR. METHODS: Seventy-three PDR patients (28 from the ranibizumab group; 20 from the PRP group; 25 from the combination group) were included in the observational follow-up phase and treated at the investigators discretion. Visual acuity (VA) measurements and retinal imaging were performed at Months 12, 18 and 24. RESULTS: Mean (± SD) NV area in the ranibizumab monotherapy and combination follow-up groups increased from 3.16 ± 4.30 mm2 and 1.13 ± 2.78 mm2 at Month 12 to 6.09 ± 10.79 mm2 and 2.14 ± 4.41 mm2 at Month 18 and 10.00 ± 17.63 mm2 and 3.26 ± 7.05 mm2 at Month 24, respectively. In the PRP follow-up group, NV area declined from 5.44 ± 14.55 mm2 at Month 12 to 1.22 ± 1.67 mm2 at Month 18, but increased again to 4.05 ± 11.66 mm2 at Month 24. During the observational phase, only 2 (6;8) patients in the ranibizumab (PRP;combination) follow-up group were treated with anti-VEGF medications, while 17 (6;10) patients received PRP laser therapy. CONCLUSION: Discontinuation of ranibizumab treatment in PDR patients may result in an increase of NV area and VA loss. Tight monitoring of disease activity and continued treatment beyond the first year is needed to maintain disease control.

Clinical efficacy and acceptability of panretinal photocoagulation combined with conbercept for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis.

BACKGROUND: Although conbercept has been used for other diseases associated with new vascular formation, the effect of single-dose conbercept in combination with proliferative diabetic retinopathy (PDR) have not been established. We thus conducted this protocol for systematic review and meta-analysis to compare the efficacy and acceptability of panretinal photocoagulation (PRP) associated with intravitreal conbercept injections versus PRP alone in the treatment of patients with PDR. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines and the recommendations of the Cochrane Collaboration were followed to conduct this study. Reviewers will search the PubMed, Cochrane Library, Web of Science, and EMBASE online databases using the key phrases "panretinal photocoagulation," "conbercept," and "proliferative diabetic retinopathy" for all cohort studies published up to May 2021. The studies on cohort study focusing on PRP + conbercept and PRP alone for PDR patients will be included in our meta-analysis. At least one of the following outcomes should have been measured: PRP completion rate, proportion of eyes with visual gain/loss, central macular thickness, and incidence of complication. Review Manager software (v 5.4; Cochrane Collaboration) is used for the meta-analysis. RESULTS: It was hypothesized that intravitreal conbercept plus PRP was more effective than PRP alone. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/HCQ2S.

Clinical efficacy of anti-vascular endothelial growth factor versus panretinal photocoagulation for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis.

BACKGROUND: The argument on the optimal treatment for patients with proliferative diabetic retinopathy (PDR) remains to be resolved. Therefore, the primary objective of the present study was to evaluate the clinical efficacy of anti-vascular endothelial growth factor (anti-VEGF) therapy versus panretinal photocoagulation (PRP) for patients with PDR. METHODS: Two independent investigators followed The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and the recommendations of the Cochrane Collaboration to conduct this meta-analysis. The electronic databases of EMBASE, PubMed, Cochrane Library, and Web of Science were searched from the inception to April 2021 using the following key terms: "proliferative diabetic retinopathy," "anti-vascular endothelial growth factor," and "panretinal photocoagulation," for all relevant studies. We identified literature that met the following inclusion criteria: patients with PDR; studies focusing on assessing anti-VEGF therapy and PRP; the following outcome measures must be shown: anatomical outcomes, including complete regression and recurrence of neovascularization, mean change in best corrected vision acuity from baseline to the end of follow-up period. The Cochrane risk of bias tool was used to evaluate the risk of bias of included randomized clinical trials by 2 independent reviewers. RESULTS: This protocol will provide a reliable theoretical basis for the following research. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/UHYDR.

Clinical efficacy of intravitreal aflibercept injection versus vitrectomy with panretinal photocoagulation for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis.

BACKGROUND: In the current literature, it is still controversial whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) patients. Given that there is no high-quality meta-analysis or review to incorporate existing evidence, the purpose of this study is to systematically review the level I evidence in the literature to ascertain whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with PRP for PDR patients. METHODS: The systematic literature review is structured to adhere to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), which include requirements deemed essential for the transparent reporting of results. A systematic search will be performed in Web of Science, Embase, Scopus, Science Direct, Cochrane Library up to and inclusive of March 19, 2021. The method of data extraction will follow the approach outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome is change in best-corrected visual acuity. The secondary outcomes are change in area of neovascularization and change in area of retinal nonperfusion. Where disagreement occurs, this will be resolved through discussion. All outcomes are pooled on random-effect model. A P value of < .05 is considered to be statistically significant. RESULTS: The results of our review will be reported strictly following the PRISMA criteria. CONCLUSIONS: The hypothesis of the study was that visual acuity recovery would be faster with vitrectomy because the blood is mechanically cleared during surgery. REGISTRATION NUMBER: 10.17605/OSF.IO/NCAXW.

Diode-side-pumped, intracavity Nd:YLF/KGW/LBO Raman laser at 573 nm for retinal photocoagulation.

Wavelengths in the yellow-orange range are of significant interest for retinal photocoagulation and are especially important in the case of diabetic retinopathy, which can cause blindness and affects 3.3% of all working-age adults. This work presents a highly-efficient, compact, and cost-efficient side-pumped, intracavity Raman configuration to achieve this objective. A side-pumped Nd:YLF/KGW/LBO frequency-doubled Raman laser producing 11.7 W of output power at 1147 nm with 21% of slope efficiency and 6 W of output power at 573.5 nm with 12% slope efficiency is demonstrated.

Anti-VEGF Therapy and Retinal Photocoagulation to Prevent Recurrence of Central Retinal Vein Occlusion: Two Case Reports of Young Patients.

Case 1: An 18-year-old man. On initial examination, he was diagnosed with central retinal vein occlusion (CRVO) due to optic papillitis. He had no previous systemic and ocular medical history. His best corrected visual acuity was 20/20 for the right eye, but macular edema accompanied by serous retinal detachment was observed about 2 months after the initial examination. Intravitreal anti-VEGF injection was performed, and the symptoms improved. Then, additional photocoagulation was applied to the retinal nonperfusion area, to maintain its normal state. Case 2: A 36-year-old man. He was diagnosed with neovascular glaucoma associated with CRVO in the right eye by his previous physician. Panretinal photocoagulation and intravitreal anti-VEGF injection were performed under maximum-tolerated medical therapy for the right eye. He had diabetes. On initial examination, his visual acuity was 20/100 and his intraocular pressure was 19mmHg. Macular edema and iris neovascularization recurred half a year later, so intravitreal anti-VEGF injection and additional photocoagulation were applied to nonperfusion area. After that, both macular edema and iris neovascularization have settled down. Conclusions: Intravitreal anti-VEGF injection is effective in young patients with CRVO. Also, photocoagulation to nonperfusion area in addition to the continuous treatment with intravitreal anti-VEGF injection seems effective for preventing recurrence.

Sedoanalgesia modality during laser photocoagulation for retinopathy of prematurity: Intraoperative complications and early postoperative follow-up.

BACKGROUND: Laser photocoagulation (LPC) is a surgical procedure used in the treatment of premature retinopathy that may cause retinal detachment and blindness if not diagnosed and treated early. The anesthesia method used in LPC varies from sedoanalgesia to general anesthesia and airway management varies from spontaneous ventilation to endotracheal intubation. In this study, we aimed to evaluate the effectiveness of sedoanalgesia applications and this anesthesia procedure concerning intraoperative and postoperative complications by avoiding intubation and mechanical ventilation in premature infants with a fragile population. METHODS: This retrospective study included 89 patients who underwent laser photocoagulation under anesthesia for premature retinopathy. Patients' demographic characteristics, preoperative risk factors, anesthesia technique, especially airway management, changes in ventilation status during surgery, intraoperative complications, postoperative complications, and intensive care follow-up, were recorded and analyzed statistically. RESULTS: Two of the 89 patients who underwent laser photocoagulation were excluded from this study because they were followed up intubated. The number of patients who received mask ventilation due to intraoperative complications was 12 (13.8%). The mean operation time was 36.2±10.1 minutes. In 86.2% (n=75) of the patients, the surgical procedure was completed with sedoanalgesia while maintaining spontaneous ventilation. CONCLUSION: Sedoanalgesia application during the surgical intervention of patients with Retinopathy of Prematurity (ROP) requiring early diagnosis and emergency treatment will minimize intraoperative and postoperative complications. We believe that sedoanalgesia as an anesthetic method can be applied as an effective alternative method while preserving spontaneous ventilation.

A systematic review and meta-analysis to compare the efficacy of conbercept with ranibizumab in patients with macular edema secondary to retinal vein occlusion.

BACKGROUND: The objective of this review and meta-analysis is to investigate the efficacy of conbercept and ranibizumab, combined with or without laser photocoagulation, in patients with macular edema secondary to retinal vein occlusion (RVO-ME). METHODS: Several databases have been used to identify relevant publications. After screening, a meta-analysis was conducted to compare conbercept and ranibizumab with the support of RevMan 5.3 (Cochrane Library Software, Oxford, UK). RESULTS: In this study, 9 randomized controlled trials and 6 retrospective trials were included with a total of 1180 patients. No significant difference was found in best corrected visual acuity (BCVA) or central macular thickness (CMT) in the baseline parameters [BCVA (weighted mean difference (WMD): -0.01; 95% confidence interval CI: -0.03 to 0.01; P = .17), CMT (WMD: 20.14; 95% CI: -26.70 to 66.97; P = .40). No significant differences were found in the improvements of BCVA and adverse events (AEs) between the 2 groups after injection of loading dosage [the 1st month BCVA (WMD: -0.01; 95% CI: -0.04 to 0.02; P = .54),the 3rd month BCVA (WMD: -0.02; 95% CI: --0.05 to 0.01; P = .23), the 6th month BCVA (WMD: -0.02; 95% CI: -0.05 to 0.01; P = .27), AEs (odds ratio: 0.84; 95% CI: 0.38 to 1.84; P = .66)]. However, there were significant differences between conbercept and ranibizumab treatment in terms of CMT [1st month CMT (WMD: -11.70; 95% CI: -19.71 to -3.68; P < .01), 3rd month CMT (WMD: -10.08; 95% CI: -15.62 to -4.53; P < .01), 6th month CMT (WMD: -15.83; 95% CI: -22.88 to -8.78; P < .01)] and the number of injections (WMD, -0.36; 95% CI: -0.68 to -0.04; P = .03). CONCLUSION: The current pooled evidence suggested that both therapies of intravitreal conbercept and intravitreal ranibizumab with or without laser photocoagulation are effective in vision function in RVO-ME patients, and confirmed that conbercept has advantages over ranibizumab in terms of CMT and the number of injections for treating RVO-ME. In addition, conbercept has the statistically same visual gains and safety as ranibizumab in RVO-ME patients. Longer-term follow-up surveys on the safety and effectiveness of these 2 treatment regimens are required.

Efficacy of conbercept combined with panretinal photocoagulation in the treatment of proliferative diabetic retinopathy.

This prospective clinical study was to compare the effect of panretinal photocoagulation (PRP) associated with intravitreal conbercept injections versus PRP alone in the treatment of proliferative diabetic retinopathy (PDR). For each of 15 patients included, one eye was randomly assigned to receive treatment with PRP, and the other eye received conbercept combined PRP. Ophthalmic examinations, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) were performed at baseline and at each monthly visit until 6 months. Fluorescein angiography (FA) was acquired at baseline, 3 months and 6 months. Between group and within group analysis was done by using generalized estimating equations (GEE). The combination group had a significant decrease of neovascularization (NV) leakage area than the PRP group at month 3 and month 6 after treatment, and a better best-corrected visual acuity (BCVA) during the first three months. Within-group analysis indicated a significant decrease in NV leakage at month 3 and month 6 in both groups, and a significant increase in BCVA at 1 month in the combination group. In summary, the combination of intravitreal injection of conbercept and PRP can significantly reduce the NV of PDR patients and achieve better BCVA during the drug's lifespan compared with PRP alone.

Crossover to Photodynamic Therapy or Micropulse Laser After Failure of Primary Treatment of Chronic Central Serous Chorioretinopathy: The REPLACE Trial.

PURPOSE: To assess whether chronic central serous chorioretinopathy (cCSC) patients without a complete resolution of subretinal fluid (SRF) after either half-dose photodynamic therapy (PDT) or high-density subthreshold micropulse laser (HSML) treatment may benefit from crossover treatment. DESIGN: Multicenter prospective interventional case series. METHODS: cCSC patients with persistent SRF at the final visit of the PLACE trial were included. Patients received crossover treatment with either half-dose PDT or HSML. RESULTS: Thirty-two patients received PDT and 10 patients received HSML. At the first evaluation visit (6-8 weeks after treatment), 81% of patients in the PDT group had complete resolution of SRF, while none of the HSML-treated patients had complete resolution of SRF. At final visit (1 year after baseline), 78% (P = .030) and 67% (P = .109) of the patients, respectively, had a complete resolution of SRF. The mean retinal sensitivity in the PDT group increased from 21.7 dB (standard error [SE]: 0.9) to 23.4 dB (SE: 0.8) at evaluation visit 1 (P = .003), to 24.7dB (SE: 0.8) at final visit (P < .001), while there were no significant changes in the HSML group (23.7 dB [SE: 1.6] at baseline, 23.8 dB [SE: 1.4] at evaluation 1, and 23.3 dB [SE: 1.4] at final visit). The mean visual acuity and mean visual quality-of-life questionnaire score did not change significantly in both groups. CONCLUSIONS: Crossover to half-dose PDT after previous unsuccessful HSML treatment for cCSC may lead to improved anatomic and functional endpoints, while crossover to HSML after half-dose PDT does not seem to significantly affect these endpoints.

Diode laser photocoagulation of sublingual varices in 706 patients on antithrombotic therapy without drug discontinuation.

Several conditions such as age, gender, systemic diseases, smoking, consuming vitamin rich foods, denture wearing may play a role in aetiology of sublingual varices. However, few studies investigating these associations. Nevertheless, prevention of potential bleeding of sublingual varices especially in patients in antithrombotic therapy should led clinicians to treat them by diode laser, since it allows a minimally invasive treatment of photocoagulation. We report on a large sample of patients (706) showing single or multiple SVs on antithrombotic therapy, highlighting the possibility to treat lesions without drug discontinuation and without intra- and post -operative complications. KEY WORDS: Antithrombotic therapy, Bleeding, Diode laser photocoagulation, Sublingual varices.

Visual Outcomes in the Management of Diabetic Maculopathy in Central Australia.

PURPOSE: In major urban centres and high-resource settings, treatment of diabetic maculopathy with anti-Vascular Endothelial Growth Factor (VEGF) injections has largely displaced laser treatment. However, intravitreal therapy alone requires frequent follow-up, a barrier to adherence in remote Australia. We report vision outcomes of phased diabetic maculopathy treatment in remote Central Australia for maculopathy using laser and, in a subset, supplementary injection treatment. METHODS: We audited clinical records of patients undergoing laser treatment for diabetic maculopathy between 2001 and 2013 at an ophthalmology service based at Alice Springs Hospital, a regional hub in remote Australia. All patients receiving macular laser treatment were included, and some required supplementary injection(s). The primary outcome measure was change in best-corrected visual acuity [BCVA] from baseline treatment. RESULTS: Of 338 maculopathy-treated patients, 88% were indigenous and 39% were male. Of 554 maculopathy laser-treated eyes, 118 (21%) received supplementary injection/s. In the laser treatment phase, median BCVA was 78 letters at baseline (interquartile range 62-80) and decreased by a median of two letters at final visit. In the subset who underwent subsequentinjection treatment, BCVA was 60 letters at first injection, with a median five-letter increase by final visit. Overall outcomes were similar in Indigenous and non-Indigenous Australians. Predictors of reduction in BCVA in the macular laser treatment phase were better baseline BCVA, older age, and PRP treatment (all p < .005). CONCLUSION: Laser treatment for diabetic maculopathy preserved vision in Central Australia, where barriers to follow-up can preclude regular injections. Supplementary injections stabilized vision in the laser-resistant subset.

Early-scatter laser photocoagulation promotes the formation of collateral vessels in branch retinal vein occlusion.

PURPOSE: To investigate the effect of early-scatter laser photocoagulation on the formation of collateral vessels in branch retinal vein occlusion. METHODS: The medical records of 40 cases (40 patients) of branch retinal vein occlusion with macular edema were retrospectively reviewed. Of them, 23 patients were treated with intravitreal bevacizumab injection and 17 patients underwent intravitreal bevacizumab injection with additional laser treatment. Early-scatter laser photocoagulation was applied for capillary non-perfusion areas, regardless of retinal neovascularization. Collateral vessel presence, recurrence rate of macular edema, and number of intravitreal bevacizumab injections were compared between the groups. RESULTS: During the follow-up period, collateral vessel formation was noted in 10/23 eyes (43.5%) in the intravitreal bevacizumab injection group and 15/17 eyes (88.2%) in the laser combined treatment group (p = 0.004). The recurrence rate of macular edema was lower in the laser combined treatment group (29.4%) than in the intravitreal bevacizumab injection group (65.2%); this difference was statistically significant (p = 0.025). The average numbers of intravitreal bevacizumab injections were 3.57 ± 3.23 in the intravitreal bevacizumab group and 2.14 ± 2.26 in the laser combined treatment group (p = 0.044). CONCLUSION: Early-scatter laser photocoagulation promotes collateral vessel formation; the presence of collateral vessels seemed to affect the course of macular edema in branch retinal vein occlusion. Combined early-scatter laser photocoagulation treatment after intravitreal bevacizumab injection lowered the recurrence rate of macular edema and number of intravitreal bevacizumab injections in the cases of branch retinal vein occlusion.

Laser photocoagulation therapy for thyroid nodules: long-term outcome and predictors of efficacy.

PURPOSE: The aim of the present study was to retrospectively evaluate the efficacy of interstitial laser photocoagulation (ILP) ablation of thyroid nodules during a 6-year follow-up period and to identify possible predictors of the final outcome. METHODS: Forty-three outpatients (38 women) were assigned to ILP therapy. The study group included euthyroid patients with benign thyroid nodules. Thyroid size, nodule volume and features, and autoimmune test were collected at baseline. Patients underwent US control after the ILP procedure and 1 month, 6 months, 12 months later and then annually. RESULTS: During the follow-up, two distinct groups of patients emerged: the responders (N = 33) and the non-responder (N = 10) ones to ILP. In the responder group, the nodule volume significantly decreased during the follow-up, but a trend toward a slight increase in nodule volume was recorded up to the end of follow-up. No significant decrease in nodule volume was observed in the non-responder group. Neither baseline clinical nor demographic features were significantly different between responders and non-responders groups. In the whole group of patients, the energy delivered per mL of nodule tissue was significantly correlated with the percent volume decrease at the end of follow-up. CONCLUSIONS: Interstitial laser photocoagulation is a safe technique able to reduce byabout 50% the volume of benign thyroid nodules in the majority of treated patients. However, due to the great variability of results, an active follow-up is required. The only independent predictor of ILP outcome is the energy delivered per mL of nodule tissue.

Long Term Follow-up of Intralesional Laser Photocoagulation for Head and Neck Lymphatic Malformations Using Neodymium-Yttrium-Aluminium-Garnet Laser.

BACKGROUND: Lymphatic malformations remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional laser photocoagulation (ILP) for treating vascular anomalies. BACKGROUND DATA: The objective of our study is to review the long-term results of a large series of lymphatic malformations in patients treated with ILP. MATERIALS AND METHODS: A retrospective review of 190 head and neck lymphatic malformations in patients were treated by ILP with an neodymium-yttrium-aluminum-garnet (Nd:YAG) laser (1064 nm) over a period of 20 years (January 1997-January 2016). Patients' ages ranged from 10 months to 12 years and 6 months (mean, 1 year and 11 months). The patient group consisted of 98 female and 92 male patients. RESULTS: Patients were treated with an Nd:YAG laser (Sharplan Inc, Allendale, New Jersey) delivered through a 600-µm optical fiber. Laser power was set at 7 to 15 W and delivered with a pulse duration of 7 to 15 seconds. All patients demonstrated improvement as judged by clinical assessment of the reduction in lesion size (range, 65%-100%; mean reduction, 85%). One hundred fifty-two (80%) patients had a more than 65% reduction of the volume in lymphatic malformations at 3 months after 1 treatment, and 171 (90%) patients had a more than 85% reduction of the volume after 2 treatments. Excellent results were seen in 19 (10%) patients after 3 treatments. Postoperative complications were related to photocoagulation that was delivered too extensively or superficially, with resultant ulceration, infection, induration, and scarring. CONCLUSIONS: Throughout the course of our long-term study, ILP using an Nd:YAG laser is an effective treatment modality for lymphatic malformations. Complications can be avoided if the potential for harm is kept in mind.

Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study.

Neovascular glaucoma (NVG) is a terminal severe complication in eyes with proliferative diabetic retinopathy (PDR), and PDR eyes with vitreous hemorrhage (VH) which undergo vitrectomy may have higher risk of postoperative NVG. The incidence and the prognostic factor of postoperative NVG after 25-gauge vitrectomy with advanced surgical options remain unclear. We retrospectively reviewed medical records of 268 eyes of 268 consecutive PDR patients with VH who underwent 25-gauge vitrectomy and 12 months follow-up at seven centers. Preoperative ocular factors (visual acuity, tractional retinal detachment, panretinal photocoagulation [PRP]), demographics and clinical factors (sex, age, diabetic duration, HbA1c, hypertension, anticoagulant medication, and kidney function), surgical procedures, and postoperative complications were compared between patients who developed postoperative NVG (9.3%) and those who did not. NVG eyes was significantly younger (P = 0.026), had shorter diabetic duration (P = 0.022), higher HbA1c (P = 0.028), absence of PRP (P = 0.039) and higher frequency of postoperative VH (P = 0.0075) than non-NVG eyes. Logistic regression analysis identified postoperative VH (P = 0.014), shorter diabetic duration (P = 0.029), and no PRP (P = 0.028) as prognostic factors for postoperative NVG. This multicenter study indicates that younger age, uncontrolled diabetes, no PRP, and postoperative VH are risk factors of post-vitrectomy NVG.

Ocular ischemic syndrome; A case report.

BACKGROUND: Ocular ischemic syndrome is not a common condition so most of these cases are often misdiagnosed or treated as a different entity. Therefore, it is very important for the ophthalmologists to have this condition in mind as a differential so that the patients can be diagnosed and treated as early as possible. A 42 years female presented with painless, progressive diminution of vision in right eye over the period of 1 month. She doesn't give any history of redness of eyes, fever or trauma. There is no history of diabetes mellitus or hypertension as well. On examination, vision in right and left eyes was 1.78 and 0.30 Log Mar Units respectively. On anterior segment examination, revascularization of iris (1o 4 'o'clock hrs) in right eye was noted. On dilated fund us copy, revascularization of disc (1/3rd) was present in right eye. Cotton wool spots blot hemorrhages and micro aneurysms were also noted in right eye. Likewise, attenuation of arteries were noted on both sides. Fund us fluorescent angiography revealed delayed artery covetous and venous phase. Carotid Doppler was done which showed complete occlusion of right common carotid and bilateral internal carotid artery. These findings lead to the diagnosis as ocular ischemic syndrome so she was then referred to the cardiologist who further confirmed that no active intervention was required at present. The patient was planned for right eye pan retinal photocoagulation (PRP) and was completed in 2 sittings and was asked to follow up regularly. CONCLUSION: Early diagnosis and management is very important for uncommon conditions such as ocular ischemic syndrome to prevent further complications.

Intravitreal Ranibizumab With Panretinal Photocoagulation Followed by Trabeculectomy Versus Visco-Trabeculotomy in Management of Neovascular Glaucoma.

PURPOSE: The aim of the current study was to compare visco-trabeculotomy (VT) with standard trabeculectomy with mitomycin C (Trab-MMC) in the treatment of quiescent neovascular glaucoma (NVG). METHODS: The study was conducted on 51 eyes of 51 patients presenting with NVG and treated at an Ophthalmic Center in Egypt between March 2014 and April 2017. All study eyes were subjected to a standard protocol of intravitreal injection of ranibizumab followed by panretinal photocoagulation. Eyes were then randomized to either VT or Trab-MMC. Study eyes were followed up for at least 18 months. Success was defined as an intraocular pressure of ≤21 mm Hg and without vision-threatening complications. Complications were noted. RESULTS: The mean ±â€ŠSD (range, median) age of the study patients was 54.1 ±â€Š6.4 (40-67, 54.5) and 52.4 ±â€Š8.8 (38-66, 53) years in the VT (26 eyes) and Trab-MMC (25 eyes) groups, respectively (P = 0.45). The mean ±â€ŠSD (range, median) intraocular pressure (IOP) of the study eyes was 45.19 ±â€Š2.97 (39-52, 45.5) and 45.64 ±â€Š3.56 (3-53, 45) mm Hg on maximal medical therapy in the VT and Trab-MMC groups, respectively (P = 0.61). At 18 months' follow-up, the mean ±â€ŠSD (range, median) IOP of the study eyes was 18.19 ±â€Š2.0 (16-23, 17) and 19.92 ±â€Š2.6 (18-26, 19) mm Hg in the VT and Trab-MMC groups, respectively (P = 0.004). There was no difference in postoperative antiglaucoma medication between the 2 groups (P = 0.62). Complications included hyphema and Descemet split in the VT group and an IOP spike in the Trab-MMC group. Success rates were 84.6% and 80% in the VT and Trab-MMC groups, respectively (P = 0.726). CONCLUSIONS: Both VT and Trab-MMC groups are effective in reducing the IOP in cases of NVG after control of neovascularization with anti-vascular endothelial growth factor and pan retinal photocoagulation.