Real-world experience with fluocinolone acetonide intravitreal implant in patients with diabetic macular edema.

OBJECTIVES: to evaluate long-term effectiveness and safety of fluocinolone acetonide (FAc) implant used as second-line treatment in patients with persistent diabetic macular edema (DME). METHODS: retrospective data chart review of 241 pseudophakic eyes of 178 patients treated with FAc from July 2017 to December 2021 in 10 medical retinal units in Italy. The primary endpoint was the change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 2 years. A Student's paired t-test was used. Additional therapies for DME and intraocular pressure (IOP)-related events were also evaluated. RESULTS: efficacy of FAc was assessed in a subset of 111 eyes with at least 24 months of follow-up. Mean BCVA increased at 2 years by 5.1 ETDRS letters (95%CI = 2.6-7.5; p < 0.001) while mean CMT decreased by 189 µm (95% CI 151-227; p < 0.001). Thirty-eight of these eyes (34.2%) needed additional intravitreal treatments, mainly anti-VEGF. Safety was evaluated on the entire cohort of 241 eyes treated with FAc. Overall, 66 eyes (27.4%) required emergent IOP-lowering medications (typically within the first-year post FAc) while 14 eyes (5.8%) underwent trabeculectomy, mostly during the second year of follow-up. CONCLUSION: FAc implant provides a substantial long-term functional and anatomical benefit when used as second-line treatment in eyes with DME. IOP rise can be adequately managed with topical agents although some eyes may require IOP-lowering surgery.

Simultaneous bilateral acute angle-closure glaucoma in a patient with subarachnoid hemorrhage.

PURPOSE: To present an unusual case of simultaneous bilateral acute angle-closure (AAC) glaucoma in a patient with subarachnoid hemorrhage due to an aneurysm involving the right middle cerebral artery. METHODS: A 60-year-old woman with a clinically inexplicable bilateral nonreacting mydriasis after brain surgery underwent an ophthalmologic consultancy. The bilateral mydriasis was diagnosed as an unusual clinical presentation of simultaneous bilateral AAC glaucoma. One week after the AAC was bilaterally resolved, the patient underwent echographic examination because of the outbreak of a unilateral relapsed ocular hypertensive attack that required an ultrasound biomicroscopy (UBM) to be accurately diagnosed and treated. RESULTS: The bilateral AAC regressed completely after pharmacologic therapy. UBM evaluation of the eye with recurrence of the angle-closure glaucoma attack was necessary to confirm the diagnosis of unilateral relapsed angle-closure glaucoma due to an unresolved pupillary block. A viscoelastic-aided opening of the angle and peripheral surgical iridectomy were performed. UBM and tonometry were performed intraoperatively to confirm the success of the surgical treatment. CONCLUSIONS: The UBM allowed us to identify the pupillary block as the main mechanism involved in the pathogenesis of this unusual case of simultaneous bilateral AAC glaucoma. Despite the fact that drug-induced supraciliary uveal effusion and mydriasis due to surgical anesthesia have been frequently reported to contribute to this complication, we presumed that simultaneous intravenous administration of sedative drugs and adrenergic agonists, in a patient with individual biometric predisposing factors to the angle-closure, created the anatomic conditions which induced the pupillary block with obliteration of the trabeculum.

Comparison of dynamic contour tonometry and goldmann applanation tonometry in deep lamellar and penetrating keratoplasties.

PURPOSE: To compare the measurements of intraocular pressure (IOP) with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in eyes with corneal graft and to evaluate the influence of corneal thickness (CCT), corneal curvature (CC), and astigmatism on these methods. DESIGN: Prospective, observational cross-sectional study. METHODS: Eighteen eyes of 18 patients after penetrating keratoplasty (PKP) and 14 eyes of 14 patients after deep lamellar keratoplasty (DLKP) underwent IOP evaluation with DCT and GAT, and measurements of CCT, CC, and astigmatism. Bland-Altman plots were used to evaluate the agreement between tonometers. Multivariate regression analysis was used to evaluate the influence of ocular structural factors and running suture on IOP measurements obtained with both tonometers. RESULTS: IOP values obtained by DCT and GAT were strongly correlated in all eyes (r = .91; P < .001). DCT values measured 2.5 +/- 1.7 mm Hg higher than GAT readings (P < .001). A reduction of the mean IOP difference between DCT and GAT with an increase in IOP values (P < .001) was found. Regression analysis showed no effect of CCT, CC, astigmatism, and running suture on both DCT and GAT readings, either in DLKP or in PKP eyes. CONCLUSIONS: We found a good overall correlation between both tonometers but the agreement between instruments differs in high or low IOP ranges. The wide and varying 95% limits of agreement between DCT and GAT indicates that DCT provides IOP measurements on deep lamellar and penetrating keratoplasties which can be used in the clinical practice.