Portable single port 23-gauge vitrectomy in postoperative endophthalmitis.

AIM: To evaluate the safety and effectiveness of the Intrector(®) for treating postoperative endophthalmitis. MATERIALS AND METHODS: In a retrospective multicenter study, patients who received a single port 23-gauge core pars plana vitrectomy and isovolumetric injection of vancomycin, ceftazidime, and dexamethasone/amphotericin B using the Intrector(®) for postoperative endophthalmitis of intermediate severity (grade II or III vitreous inflammation and best-corrected visual acuity between hand movements and 0.3 logMAR [logarithm of the minimum angle of resolution]) were evaluated. Improvement in visual acuity, resolution of intraocular inflammation, the need for additional surgical procedures, and the development of complications were evaluated at a 1-month follow-up examination. RESULTS: Fifteen patients (mean age 55.6±7.2 years) underwent treatment with the Intrector(®). The mean vitreous volume aspirated was 0.78±0.22 mL. The vitreous samples indicated positive microorganism culture results in six of the 15 cases, but the samples were positive when analyzed by real-time polymerase chain reaction in all cases (15/15). The mean best-corrected visual acuity improved significantly (P=0.01) from 0.88±0.29 (logMAR) to 0.32±0.28. Each patient demonstrated at least three lines of visual improvement. No additional medical or surgical interventions were required, and the complete resolution of intraocular inflammation was noted in all patients at the 1-month follow-up examination. No procedure-related complications were observed. CONCLUSION: The Intrector(®) may be a safe and effective treatment option for infectious postoperative endophthalmitis. Larger studies comparing the outcomes of the Intrector(®) to the traditional treatments for postoperative endophthalmitis need to be conducted before its role in the treatment of postoperative endophthalmitis can be properly defined.

23-Gauge Pars Plana Vitrectomy Versus Scleral Buckling Versus Combined Pars Plana Vitrectomy-Scleral Buckling for Medium-Complexity Retinal Detachment Repair.

PURPOSE: To compare the anatomic and visual outcomes of 23-gauge pars plana vitrectomy (PPV), scleral buckling (SB), and combined 23-gauge PPV/SB in the treatment of primary medium-complexity rhegmatogenous retinal detachment (RRD). DESIGN: A retrospective, consecutive case series. METHODS: A consecutive chart review of patients with medium-complexity RRD treated with PPV, SB, and combined PPV/SB was conducted. The primary outcome measure was retinal reattachment at 6 months' follow-up. The secondary outcome measure was Snellen best-corrected visual acuity (BCVA) of 20/40 or better at 6 months' follow-up. RESULTS: Five hundred sixty-five cases met inclusion criteria. The overall primary anatomic success rate was 83.6% (95% confidence interval, 80.3%-86.5%). Logistic regression analysis did not demonstrate a significant difference between the 3 techniques in terms of likelihood of anatomic success or likelihood of achieving a Snellen BCVA of 20/40 or better. Patients with multiple breaks in 2 or more quadrants or inferior breaks were more likely to undergo SB/PPV, whereas patients with phakic lens status with breaks confined to 1 quadrant were more likely to undergo SB. Patients with macula-off detachments and those with postoperative proliferative vitreoretinopathy were less likely to achieve a Snellen BCVA of 20/40 or better. CONCLUSIONS: Although there was not a statistically significant difference in the anatomic and visual outcomes between the repair techniques analyzed, SB/PPV was performed on the more complicated spectrum of medium-complexity RRDs with the overall highest anatomic success rate and therefore may be the most effective repair technique for this patient population.

Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for secondary repair of retinal detachment.

BACKGROUND AND OBJECTIVE: To investigate the optimal technique for repairing recurrent rhegmatogenous retinal detachments. PATIENTS AND METHODS: A 2-year retrospective review of recurrent rhegmatogenous retinal detachments by 23-gauge pars plana vitrectomy (PPV) or combined 23-gauge PPV with encircling scleral buckling was performed. The primary outcome was anatomical success. The secondary outcome was the likelihood of achieving a final best corrected visual acuity of 6/12 or better at 6-month follow-up. RESULTS: Anatomical success was achieved in 65.2% (95% CI, 53.4% to 75.4%) of the PPV group versus 74.3% (95% CI, 57.9% to 85.8%) of the PPV-scleral buckling group with one additional procedure (not statistically significant). There was no significant difference in the likelihood of achieving a final acuity of at least 6/12 between groups at 6-month follow-up. CONCLUSION: The results of our study do not demonstrate a superiority of method of primary repair, or of one method of secondary repair, over another.

Retinal nerve fibre layer imaging: comparison of Cirrus optical coherence tomography and Heidelberg retinal tomograph 3.

BACKGROUND: The purpose of this study was to analyze the relationship between retinal nerve fibre layer thickness measured by spectral domain optical coherence tomography and confocal scanning laser ophthalmoscope. DESIGN: Prospective, cross-sectional study. Hospital setting. PARTICIPANTS: One hundred seventy-three subjects (85 glaucoma and 88 normal subjects). METHODS: One eye from each individual was selected randomly for imaging by the spectral domain Cirrus optical coherence tomography and Heidelberg retinal tomograph 3. MAIN OUTCOME MEASURES: Global thickness and measurements at the four quadrants around the optic disc. RESULTS: Measurements as determined by Heidelberg retinal tomograph 3 were significantly larger than measurements done by Cirrus optical coherence tomography (respectively in mm, for global thickness: 200.0 ± 87.2 and 80.7 ± 14.7; for temporal quadrant: 75.3 ± 31.9 and 59.1 ± 13.8; for superior quadrant: 223.2 ± 128.4 and 97.7 ± 20.9; for nasal quadrant: 208.0 ± 102.9 and 66.8 ± 11.8; and for inferior quadrant: 224.4 ± 116.9 and 99.1 ± 26.6, for all P < 0.01). Significant correlation was found for all measurements (P ≤ 0.009), but a pattern of proportional bias was demonstrated. The agreement of categorical classification (within normal limits, borderline or outside normal limits) ranged between poor and fair. CONCLUSIONS: The thickness easurements by the two technologies are strongly correlated but significantly different. The differences are substantial and proportional to the retinal nerve fibre layer thickness. The normative diagnostic classification of the two technologies may not agree. The results preclude interchangeable use of these measurements in clinical practice.

Intravitreal bevacizumab versus ranibizumab for the treatment of retinal angiomatous proliferation.

PURPOSE: To evaluate the effects of intravitreal bevacizumab and ranibizumab treatments in retinal angiomatous proliferation (RAP). METHODS: Fifty patients affected by RAP were randomly assigned either to intravitreal bevacizumab injection (IVBI) or intravitreal ranibizumab injection (IVRI). After a loading phase including three consecutive monthly injections, the retreatment was administered in cases of persistent RAP. The primary outcome measures were the mean changes in BCVA between the two treatment groups, and the proportion of eyes gaining 1 and 3 lines at the end of the follow-up. Secondary outcomes included central macular thickness (CMT) changes and progression to more advanced stages of RAP. RESULTS: Fifty patients affected by stage 1 and 2 RAP were recruited. Twenty-six and 24 patients received IVBI and IVRI, respectively. At the baseline, mean best corrected visual acuity (BCVA) values were 0.59 ± 0.21 (LogMAR ± SD, approximately corresponding to 20/80 Snellen Equivalent-SE) in IVBI group and 0.66 ± 0.33 (approximately 20/90 SE) in IVRI group with no statistical difference. At 12-month examination, both groups showed a statistically significant improvement in the BCVA, with a final mean value of 0.43 ± 0.24 (approximately 20/54 SE) in IVBI group and 0.50 ± 0.32 (approximately 20/63 SE) in the IVRI group. A BCVA gain of 1 and 3 lines was registered in 20 and 8 eyes, respectively, in the IVBI group. Similarly, 17 and 7 eyes showed an improvement of 1 or 3 lines, respectively, in the IVRI group. The CMT reduced significantly from baseline to 12-month examination in both groups. A lower proportion of eyes with complete pigment epithelium detachment resolution was noted in the IVBI group than in the IVRI group (40% versus 90%). CONCLUSIONS: Our study shows that both IVBI and IVRI are equally effective in improving the BCVA over a 1-year follow-up in eyes affected by stage 1 and 2 RAP.

Intravitreal ranibizumab versus bevacizumab for treatment of myopic choroidal neovascularization.

PURPOSE: To compare intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) in the treatment of subfoveal choroidal neovascularization associated with pathologic myopia. METHODS: Fifty-five patients fulfilling inclusion and exclusion criteria were randomized either to IVB or to IVR. After the first injection, re-treatments were performed on a pro re nata basis in monthly examinations over an 18-month follow-up. Primary outcome measures were the change in mean best-corrected visual acuity and the proportion of eyes improving in best-corrected visual acuity by >1 and >3 lines at the 18-month examination. RESULTS: Forty-eight eyes received the treatment and were subsequently included in the analysis. At the 18-month examination, a significant improvement of 1.7 lines and 1.8 lines compared with baseline were noticed in the IVR and IVB subgroups, respectively. The difference in the final mean best-corrected visual acuity between the groups was not significant. A 3-line gain or higher was noted in 30% of eyes in the IVR subgroup and 44% of eyes in the IVB subgroup. Although both groups attained a significant improvement in central macular thickness, the IVR subgroup achieved a faster central macular thickness reduction. A significantly lower number of injections were administered in the IVR subgroup (2.5) compared with the IVB subgroup (4.7; P < 0.001). CONCLUSION: Intravitreal ranibizumab and IVB are effective in the treatment of subfoveal myopic choroidal neovascularization. Intravitreal ranibizumab achieved greater efficacy than IVB in terms of the mean number of injections administered.

Inner and outer retinal volumetric and morphologic analysis of the macula with spectral domain optical coherence tomography in retinitis pigmentosa.

PURPOSE: To use spectral domain optical coherence tomography (OCT) to assess the features of the inner and outer layers of the macula in subjects with retinitis pigmentosa (RP). DESIGN: Prospective observational comparative study. MATERIALS AND METHODS: Subjects with RP with reduced central visual acuity and central macular thinning (RP group) underwent spectral domain OCT evaluation along with age-matched healthy control subjects (control group). Using the E-MM5 raster protocol, a 5 × 5 mm central macular cut was acquired with inner and outer macular volumes serving as the primary outcome measures. A structural analysis of the inner and outer retinal layers at the macula in the RP group was also performed using the HD cross-line protocol. RESULTS: The RP group comprised six eyes of six RP subjects and control group comprised six eyes of six control subjects. The outer macular volume was significantly lower (P<0.05) in the RP group (2.01±0.44 mm(3)) compared to the control group (4.68±0.16 mm(3)). There was no difference in the mean inner macular volume between the RP group (2.46±0.24 mm(3)) and the control group (2.55±0.22 mm(3)). No significant structural alteration was noted in the inner retinal layers of the RP group. There was no significant correlation (r = -0.04, P>0.05) between best-corrected visual acuity and outer macular volume in the RP group. CONCLUSIONS: Spectral domain OCT findings confirm that RP preferentially affects the outer retinal layers in the macula. Although the number of patients included in this study was small, it demonstrated relatively well-preserved volume and morphology of the inner retinal layers using spectral domain OCT.

Fulminant toxoplasmic retinochoroiditis following intravitreal triamcinolone administration.

We report two cases of fulminant toxoplasmic retinochoroiditis following intravitreal triamcinolone acetonide (IVTA) administration. Case 1: A 42-year-old female received IVTA for presumed non-infectious panuveitis. Within 2 months, she developed diffuse macular retinochoroiditis with optic disc edema. Upon starting anti-toxoplasmic therapy (ATT), her intraocular inflammation resolved with catastrophic damage to the disc and macula. Case 2: A 30-year-old male received IVTA for presumed reactivation of previously scarred toxoplasmic retinochoroiditis. Despite simultaneous ATT, within 6 weeks, he developed extensive, multifocal macular retinochoroiditis. He continued to require ATT for 18 months and later underwent vitrectomy with silicone oil placement for severe epiretinal proliferation. Aqueous tap polymerase chain reactions were found positive for Toxoplasma gondii in both cases. In conclusion, IVTA administration can lead to fulminant toxoplasmic retinochoroiditis even when used with appropriate ATT. Extreme caution should be exercised while administering depot corticosteroids in eyes with panuveitis of unknown origin.

Postoperative perfluoro-N-octane tamponade for primary retinal detachment repair.

AIM: To study outcomes after using perfluoro-n-octane (PFO) as a short-term postoperative vitreous substitute in eyes undergoing primary vitrectomy with or without scleral buckling for rhegmatogenous retinal detachments with inferior/multiple breaks or giant retinal tears (GRTs). METHODS: Charts of 39 eyes at 3-24 months after primary PFO retention and secondary replacement were retrospectively analyzed for anatomical attachment rates, visual acuity gain, and postoperative complications. RESULTS: Intraoperatively, 33 of 39 eyes showed ≥ 4 retinal breaks, with 31 of 39 eyes having at least 1 inferior break, 10 of 39 eyes having GRT, and 12 of 39 eyes showing preoperative proliferative vitreoretinopathy. All eyes showed complete anatomical retinal attachment after primary vitrectomy for at least 7-17 days when PFO was retained without any specific posturing. With sulfur hexafluoride (SF6) gas PFO exchange, 3 cases redetached. With perfluoropropane (C3F8) gas or silicone oil PFO exchange, no cases redetached, resulting in a final anatomical success rate of 92.4%. Visual acuity improved from 2.07 ± 0.86 to 0.76 ± 0.79 logarithm of the minimum angle of resolution (P < 0.0004) among macula-off and from 0.11 ± 0.08 to 0.12 ± 0.09 logarithm of the minimum angle of resolution (P > 0.05) among macula-on rhegmatogenous retinal detachment eyes. Perfluoro-n-octane retention ≥ 10 days significantly increased posterior capsular opacification (28 of 39 eyes) and cataract extraction rates (21 of 25 eyes) without affecting the final retinal attachment success rate. CONCLUSION: Perfluoro-n-octane is efficacious and safe as a short-term vitreous substitute in primary rhegmatogenous retinal detachment repair cases with inferior/multiple breaks or GRTs. Perfluoro-n-octane removal within 10 days reduces its side effect profile considerably. The highest anatomical retinal reattachment rates were observed when C3F8 or silicone oil was exchanged for PFO.

Bilateral central retinal artery occlusions and hughes syndrome.

PURPOSE: The purpose of this study to report a case of bilateral retinal artery occlusions in a patient with systemic lupus erythematosus and antiphospholipid antibodies. METHODS: A 28-year-old woman with systemic lupus erythematosus presented with sudden painless bilateral vision loss. Clinical examination and flourescein angiography were performed, and a diagnosis of bilateral central retinal artery occlusions was made. Laboratory evaluations were ordered. RESULTS: Laboratory evaluation revealed the presence of antiphospholipid antibodies.The patient was treated with corticosteroids, azathioprine, aspirin, and warfarin. The patient's visual acuity gradually improved over 2 weeks and then remained stable for 6 months without any further thrombotic events. CONCLUSION: The presence of bilateral retinal artery occlusions in a young patient should prompt an immediate evaluation for antiphospholipid antibodies, especially if the patient has been previously diagnosed with systemic lupus erythematosus. Correctly diagnosing patients with antiphospholipid antibodies is important because it implies the need for long-term anticoagulative and antiaggregative therapies to reduce the patient's risk of recurrent, life-threatening, thrombotic events.

Intravitreal bevacizumab therapy on an as-per-needed basis in subfoveal choroidal neovascularization secondary to pathological myopia: 2-year outcomes of a prospective case series.

PURPOSE: To evaluate the effects of intravitreal bevacizumab in the treatment of subfoveal choroidal neovascularization (CNV) related to pathological myopia. METHODS: Thirty eyes with treatment-naive CNV were included. Best-corrected visual acuity on Early Treatment Diabetic Retinopathy Study chart, optical coherence tomography (OCT), and fluorescein angiography assessment was performed at baseline and thereafter monthly for more than 24 months. Intravitreal bevacizumab on an as-per-needed basis was administered if either persistent intraretinal/subretinal fluid was detected on OCT or the presence of leakage was noted on fluorescein angiography. Primary outcome measures included the change in mean best-corrected visual acuity and the proportion of eyes improving by three lines or greater. Secondary outcome measures included the change in mean central macular thickness on OCT. The proportion of eyes with resolution of intraretinal/subretinal fluid on OCT and leakage on fluorescein angiography over the follow-up was also noted. RESULTS: Mean best-corrected visual acuity improved from 54.8 ± 14.8 (Early Treatment Diabetic Retinopathy Study letters ± SD) to 59.03 ± 17.0 at 3 months, subsequently stabilizing to 58.63 ± 18.52 at 12 months and 59.25 ± 20 at 24 months. A statistically significant difference was detected only at the 1-month examination. Best-corrected visual acuity at 24 months showed a 3-line improvement in 36.6% of cases and at least a 1-line increment in 43.3% of cases. Mean central macular thickness showed no significant reduction from baseline (216.8 ± 86 µm) up to the end of 24 months (205 ± 77.8 µm). At the last visit, a complete CNV closure was obtained in 93% of cases while intraretinal/subretinal fluid was detected on OCT in 13% of cases. The mean number of intravitreal bevacizumab injections was 4.73 (range, 1-10) at the end of 12 months and 5.9 (range, 1-13) at the end of the 24 months. CONCLUSION: Intravitreal bevacizumab injection for myopic subfoveal CNV administered on an as-per-needed basis over 24 months of follow-up achieved stabilization of vision with >90% CNV closure rate.

Experience with the Pascal® photocoagulator: an analysis of over 1,200 laser procedures with regard to parameter refinement.

AIM: To systematically refine and recommend parameter settings of spot size, power, and treatment duration using the Pascal® photocoagulator, a multi-spot, semi-automated, short-duration laser system. MATERIALS AND METHODS: A retrospective consecutive series with 752 Caucasian eyes and 1242 laser procedures over two years were grouped into, (1) 374 macular focal / grid photocoagulation (FP), (2), 666 panretinal photocoagulation (PRP), and (3) 202 barrage photocoagulation (BP). Parameters for power, duration, spot number, and spot size were recorded for every group. RESULTS: Power parameters for all groups showed a non-gaussian distribution; FP group, median 190 mW, range 100 - 950 mW, and PRP group, median 800 mW, range 100 - 2000 mW. On subgroup comparison, for similar spot size, as treatment duration decreased, the power required increased, albeit in a much lesser proportion than that given by energy = power x time. Most frequently used patterns were single spot (89% of cases) in FP, 5 Χ 5 box (72%) in PRP, and 2 Χ 2 box (78%) in BP. Spot diameters as high as ≈ 700 µm on retina were given in the PRP group. Single session PRP was attempted in six eyes with a median spot count of 3500. CONCLUSION: Overall, due to the small duration of its pulse, the Pascal® photocoagulator tends to use higher powers, although much lower cumulative energies, than those used in a conventional laser. The consequent lesser heat dissipation, especially lateral, can allow one to use relatively larger spot sizes and give more closely spaced burns, without incurring significant side effects.

Retinitis pigmentosa inversa with unilateral high myopia with fellow eye optic disc pitting.

PURPOSE: To report a possible rare association of bilateral retinitis pigmentosa inversa (RPI) with unilateral high myopia with fellow eye optic disc pitting. METHODS: A 55-year-old man with a history of reduced vision in the right eye since childhood presented with gradually decreasing vision in the left eye. On examination, a -23.00 diopter refractive error and diffuse chorioretinal atrophy consistent with pathologic myopia was found in the right eye. An optic disc pit with posterior pole pigmentary alterations thought to be consequent to a previous neurosensory detachment was found in the left eye. Though the retinal arteriolar attenuation seen in both eyes with an inconsistent history of night blindness since childhood pointed towards the possibility of a concurrently existing rod or rod-cone dystrophy, the posterior pole pigmentary alterations characteristic of RPI were clearly masked by the above pathologies. RESULTS: Optical coherence tomography demonstrated prominent foveal atrophy and an optic disc pit in the left eye. Electroretinography (ERG) demonstrated moderately attenuated amplitudes with prolonged implicit times of rod and cone responses bilaterally. The patient was diagnosed with bilateral RPI and anisometropic amblyopia in the right eye. CONCLUSIONS: This report documents a unique constellation of findings which include bilateral RPI and unilateral high myopia with an optic disc pit in the fellow eye. An ERG confirmation of a dystrophic etiology should be sought in suspicious cases, especially when findings are masked by the concurrent presence of other pathologies.

Intravitreal triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema.

BACKGROUND: To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema. DESIGN: Prospective, non-randomized, masked, interventional case series. PARTICIPANTS: Twenty-four eyes of 24 subjects with centre-involved diabetic macular oedema extending over two disc-areas with predominant cystic changes on spectral domain optical coherence tomography were selected. METHODS: Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide. MAIN OUTCOME MEASURES: Change in central macular volume on spectral domain optical coherence tomography and best-corrected visual acuity were measured at 6-week follow-up. RESULTS: Baseline data were matched in both groups. Post-injection central macular volume (7.46 ± 0.73 mm(3)) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre-injection central macular volume (9.11 ± 1.0 mm(3)) or when compared with the post-injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm(3)). However, post-injection best-corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best-corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre-injection central macular volume (r = 0.55, P = 0.005). CONCLUSIONS: Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best-corrected visual acuity.

Spectral domain-optical coherence tomography study of retinas with a normal foveal contour and thickness after retinal detachment surgery.

PURPOSE: The purpose was to study the disruption of the inner segment (IS) and outer segment (OS) junction associated with suboptimal visual outcome after successful retinal detachment surgery with an otherwise normal foveal contour and thickness. MATERIALS AND METHODS: A comparative study of 2 groups, i.e., group I-suboptimal visual outcome (visual acuity <20/40) and group II-optimal visual outcome (visual acuity> or =20/40), with 7 eyes of 7 patients in each group rhegmatogenous retinal detachment surgery with an otherwise normal foveal contour and thickness on spectral domain-optical coherence tomography was evaluated for disruption of the IS and OS junction at 6 weeks using the crosshair protocol through the fovea. A 5 x 5-mm grid raster protocol (E MM5)imaged 256 squares of retina and the number of squares with IS and OS junction disruption was correlated with best-corrected visual acuity. RESULTS: Disruption of the IS and OS junction was seen in all 7 eyes of group I (100%)compared with 2 eyes in group II (28%), which was an obvious statistical difference (P =0.021). Also, a statistically significant correlation existed (r = 0.84, P < 0.05) when best-corrected visual acuity was plotted against the number of squares with IS and OS disruption. There was a statistically insignificant (P = 0.09) trend noted toward greater IS and OS junction disruption in eyes with prior macula off rhegmatogenous retinal detachments on univariate analysis. CONCLUSION: Disruption of the IS and OS junction could be a surrogate measure of the structural and functional health of the photoreceptors and can explain poor visual outcome in postsuccessful retinal detachment surgery with an otherwise normal foveal contour and thickness.

Laser photocoagulation, photodynamic therapy, and intravitreal bevacizumab for the treatment of juxtafoveal choroidal neovascularization secondary to pathologic myopia.

OBJECTIVE: To compare the effects on visual acuity of laser treatment (LT), photodynamic therapy (PDT) with verteporfin, and intravitreal bevacizumab treatment in patients with juxtafoveal choroidal neovascularization secondary to pathologic myopia. METHODS: This prospective randomized clinical investigation enrolled 54 patients, who were divided into 3 groups receiving PDT, LT, or intravitreal bevacizumab treatment. The anti-vascular endothelial growth factor group received 1.25 mg of intravitreal bevacizumab at baseline; retreatment was performed if persistent intraretinal or subretinal fluid evaluated on optical coherence tomography or if choroidal neovascularization progression was detected on fluorescein angiography. The PDT group received treatment following the Verteporfin in Photodynamic Therapy Study Group guidelines. The LT group was submitted to direct LT and received PDT treatment if subfoveal recurrence or progression was detected on fluorescein angiography. A change in best-corrected visual acuity was the primary outcome. RESULTS: The mean best-corrected visual acuity in the PDT group decreased from 0.52 logMAR (SD, 0.24 logMAR) at baseline to 0.72 logMAR (SD, 0.25 logMAR) at the end of the study (P = .002). The LT group showed substantial stabilization from mean baseline visual acuity (mean, 0.45 logMAR [SD, 0.27 logMAR]) to the 24-month (mean, 0.56 logMAR [SD, 0.34 logMAR) examination values. The mean best-corrected visual acuity in the anti-vascular endothelial growth factor group increased from 0.6 logMAR (SD, 0.3 logMAR) at baseline to 0.42 logMAR (SD, 0.35 logMAR) at the end of the study (P = .006). CONCLUSIONS: Overall, bevacizumab treatment offers the best functional results during a 2-year follow-up. In view of the small size of the sample in this study and the relatively low frequency of juxtafoveal choroidal neovascularization secondary to pathologic myopia, a multicentric clinical trial is necessary to validate our results.

Treatment of serous pigment epithelium detachment with subthreshold micropulse diode laser photocoagulation: a case report.

PURPOSE: To propose a possible treatment for symptomatic serous pigment epithelium detachment (SPED) in the setting of dry age-related macular degeneration. METHODS: A 60-year-old woman presented with a SPED, subfoveal in location, enlarging in size and with gradually worsening vision over 1 year of follow-up, without any evidence of choroidal neovascular membrane or neurosensory detachment until it was treated with subthreshold micropulse laser. RESULTS: The last follow-up showed complete resolution of the SPED with restoration of visual function. CONCLUSIONS: Subthreshold micropulse laser could serve as a useful therapeutic modality for the treatment of symptomatic SPED.