Expert recommendations for the management of diabetic macular edema with intravitreal dexamethasone implant: A Turkish Delphi study.

PURPOSE: To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. METHODS: A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. RESULTS: A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION: This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.

Evaluation of macular microvascular structure with optical coherence tomography angiography in children with history of treatment for retinopathy of prematurity.

PURPOSE: To compare macula vascular parameters in optical coherence tomography angiography (OCTA) of children with history of retinopathy of prematurity (ROP) who were treated with laser photocoagulation (LPC) or intravitreal Bevacizumab therapy. METHODS: Forty eyes of 28 ROP children treated with LPC and 36 eyes of 22 ROP children treated with intravitreal Bevacizumab and 40 eyes of 40 age-gender matched term children were included the study. Capillary plexus densities in macula, FAZ parameters, outer retina and choriocapillaris flow rates, and central foveal thickness were measured. RESULTS: Foveal superficial and deep capillary plexus densities were found significantly higher in LPC and intravitreal Bevacizumab injection (IBI) groups compared to control group. FAZ area was found significantly lower in LPC and IBI groups compared to control group (p < 0.001). Higher foveal superficial capillary plexus density, higher central foveal thickness, and lower FAZ area were found to be associated with poorer visual acuity in correlation analysis (p < 0.05). In IBI group, earlier anti-VEGF therapy was found to be associated with lower foveal superficial capillary plexus density. CONCLUSION: Microvascular characteristics such as FAZ area and capillary plexus densities of macula are deteriorated in ROP. There is no significant difference between the treatment alternatives of ROP in terms of macular microvascular parameters.

Diode laser photocoagulation posterior to the ridge in severe stage 3+ threshold retinopathy of prematurity.

PURPOSE: To evaluate the results of diode laser photocoagulation (DLP) of the retina posterior to the ridge in eyes with severe Zone II, Stage 3+ threshold retinopathy of prematurity (ROP). METHOD: DLP was applied posterior to the fibrovascular ridge for advanced Zone II, Stage 3+ threshold ROP patients, either as the primary treatment combined with DLP of the avascular retina (group 1), or as a secondary treatment in eyes that had previously undergone DLP of the avascular retina (group 2). Statistical analysis was performed using SPSS software trail version 16.0. Values are presented as mean ± SD. RESULTS: A total of 50 eyes of 29 premature infants were treated (14 [48%] male, 15 [52%] female). The mean gestational age was 29.5 ± 2.2 weeks (range: 26-34 weeks). The mean birth weight was 1259 0.72 ± 409.15 g (range: 500-2050 g). The mean gestational age for DLP of the avascular region anterior to the ridge and DLP posterior to the ridge was 37 ± 3 weeks and 38 ± 3 weeks, respectively. The mean follow-up was 26 ± 5 weeks (18-38 weeks). In 48 eyes, the tractional fibrovascular ridge had regressed. Transient retinal hemorrhage was the most common complication. Three eyes exhibited optic-disc dragging; two eyes progressed to Stage 4a ROP; two eyes presented with macular traction, without any detachment; and one eye developed a vitreous hemorrhage, which resolved spontaneously. There were no statistically significant differences between complicated and uncomplicated eyes regarding gestational age, birth weight and applied laser spot numbers (p > 0.05 for all, Mann-Whitney U test). CONCLUSION: DLP, posterior to the ridge as an additive treatment in the management of severe Zone II, Stage 3+ threshold ROP patients, is safe and effective; this approach could be used as either the primary treatment, or as the follow-up to failed laser treatment of the avascular retina to halt the progression of the disease.

Combined excision, cryotherapy, and intraoperative mitomycin C (EXCRIM) for localized intraepithelial and squamous cell carcinoma of the conjunctiva.

BACKGROUND: To report the results of patients undergoing combined excision, cryotherapy, and intraoperative mitomycin-C (EXCRIM) for primary ocular surface squamous neoplasia (OSSN) METHODS: A retrospective review of a non-comparative interventional case series. Histopathologically confirmed primary localized (less than four clock hours) OSSN treated with EXCRIM using adjuvant 0.02 % mitomycin-C (MMC) were included in the study. The main outcome measures were recurrence and complications related to MMC. RESULTS: The study enrolled 28 eyes of 28 patients with OSSN with a median age of 64.5 (range 43 to 84) years. The mean tumor size was 6.9 × 4.35 mm. There was corneal involvement in 23 of 28 (82 %). Seven patients (21 %) had delayed epithelial healing. Two of eight patients (25 %) with squamous cell carcinoma (SCC) had positive lateral margins. There were no recurrences over a mean follow-up of 49 months (range 24 to 96). CONCLUSION: The excision of OSSN combined with cryotherapy and intraoperative MMC is effective with a low recurrence rate. Long-term follow-up yielded favorable results.

Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation.

BACKGROUND: To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. METHODS: This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher's Exact test, Pearson Chi-square test, independent t-test, Mann-Whitney U-test, and a repeated ANOVA. RESULTS: The mean age of patients was 52.7 +/- 12.6 years in group 1 and 53.2 +/- 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 +/- 7.6 weeks in group 1 and 34.1 +/- 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 +/- 0.30 in group 1 and 0.72 +/- 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). CONCLUSION: ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity.

The capillary blood flow in ischaemic type central retinal vein occlusion: the effect of laser photocoagulation.

PURPOSE: To determine the effect of photocoagulation on retinal blood flow (RBF) in eyes with ischaemic type central retinal vein occlusion (CRVO). PATIENTS AND METHODS: Retinal blood flow was measured in 12 eyes with CRVO, 12 fellow eyes and 12 eyes of 12 age-matched healthy subjects using the Heidelberg retinal flowmeter (HRF). Microvascular blood flow values (volume, flow, velocity) were recorded from the upper temporal retina and macula. Eyes were re-examined 1 month after photocoagulation. We investigated whether there was a difference in RBF measurements before and after photocoagulation treatment. RESULTS: In eyes with CRVO, mean RBF values (volume, flow and velocity) obtained from the upper temporal retina increased significantly after treatment (paired t-test, p < 0.05). In contrast, mean RBF values from the macula were unaffected by photocoagulation (paired t-test, p > 0.05). Retinal blood flow values from the upper temporal retina obtained from control subjects were significantly higher than the values in eyes with CRVO before and after photocoagulation (unpaired t-test, p < 0.05), but there was no significant difference between control subjects and CRVO patients in RBF values from the macula (unpaired t-test, p > 0.05). Mean RBF values were significantly higher in CRVO patients' fellow-eyes before photocoagulation in the eyes with CRVO (paired t-test, p < 0.05) but were lower than in age-matched healthy control eyes (unpaired t-test, p < 0.05). Macular blood flow did not differ between the eyes with CRVO and fellow eyes (paired t-test, p > 0.05). CONCLUSION: Laser photocoagulation increased retinal blood flow in eyes with CRVO, but RBF did not reach normal values. Photocoagulation was found to have no effect on RBF in the macular area.

Consecutive exotropia following strabismus surgery.

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.