Intravitreal Aflibercept injection with Panretinal photocoagulation versus early Vitrectomy for diabetic vitreous hemorrhage: randomized clinical trial.

BACKGROUND: To compare efficacy and safety of intravitreal aflibercept (IVA) injection with panretinal photocoagulation (PRP) versus early vitrectomy for diabetic vitreous hemorrhage (VH). METHODS: Prospective, randomized study that included 34 eyes with diabetic VH. They were divided into two groups, Group Ι (17 eyes) received three successive IVA injections followed by PRP and group ΙΙ (17 eyes) for whom early vitrectomy was done. Follow up was carried out after one, two, three, six and nine months. The primary outcome measure was change in the mean best corrected visual acuity (BCVA) after nine months, secondary outcome measures were mean duration of clearance of VH and rate of recurrent hemorrhage with any additional treatment in both groups. Complications were reported. RESULTS: There was no statistically significant difference regarding initial demographic criteria between both groups. The mean final log MAR BCVA was statistically better than the initial BCVA in both groups (0.51 ± 0.20, 1.17 ± 0.48 for group I and 0.48 ± 0.18, 1.44 ± 0.44 for group II, P < 0.001). There was no statistically significant difference between both groups regarding the mean final Log Mar BCVA (0.51 ± 0.20 for group I, 0.48 ± 0.18 for group II, p ≥ 0.05), the mean duration of clearance of VH was 7.8 ± 1.8 weeks, 5 days for group I and II respectively. PRP was completely done for all eyes in group I after three months. The difference in the recurrence rate between group I (29.4%) and group II (11.8%) was statistically significant (p < 0.05). Vitrectomy was done for three eyes (17.6%) due to recurrent non-resolving VH in group I. late recurrent VH occurred in two eyes (11.8%) in group II, IVA was given with complete clearance of the hemorrhage. No vision threatening complications were reported in both groups. CONCLUSION: Both intravitreal injection of aflibercept followed by PRP and early vitrectomy are effective and safe modalities for treatment of diabetic vitreous hemorrhage. Early vitrectomy leads to faster vision gain with less incidence of recurrence than intravitreal injection. TRIAL REGISTRATION: Randomized clinical trial under the number of NCT04153253 on November 6, 2019 "Retrospectively registered".

Quantitative Assessment of Outer Retinal Layer and Photoreceptor Outer Segment Layer and Their Relation to Visual Acuity in Diabetic Macular Edema.

PURPOSE: To compare outer retinal layer (ORL) thickness and photoreceptor outer segment (PROS) length between normal eyes and eyes with diabetic macular edema (DME), and also, to study the correlation between central macular thicknesses (CMT), ORL, and PROS length with best corrected visual acuity (BCVA) in DME. METHODS: 80 eyes were included in the study; they were divided into two groups, group Ι (40 normal eyes) and group ΙΙ (40 eyes) with DME. Complete ophthalmic examination and OCT were done for all eyes. Comparison between ORL and PROS was done between both groups; also, correlation between ORL thickness, PROS length, and CMT with BCVA in group ΙΙ was studied. RESULTS: CMT was greater in group ΙΙ than group Ι (392.70 ± 62.91 and 265.73 ± 17.17, respectively) (SS, p < 0.001). ORL thickness was statistically significantly greater in group Ι than group ΙΙ (104.80 ± 4.94, 93.68 ± 6.34, p < 0.001). Regarding PROS length, it was statistically significantly greater in group Ι than group ΙΙ (31.38 ± 3.4 and 26.65 ± 3.39, respectively, p < 0.001). There was moderate correlation between BCVA and ORL thickness (r = -0.440, p=0.004) and strong correlation between BCVA and PROS length in group ΙΙ (r = - 0.690, p < 0.001), while there was weak correlation between BCVA and CMT (r = 0.198, p=0.220). CONCLUSION: Both ORL thickness and PROS length were greater in healthy normal eyes than eyes with DME. BCVA was correlated better with PROS length and ORL thickness than CMT.

Subthreshold micropulse yellow laser treatment for nonresolving central serous chorioretinopathy.

PURPOSE: To report the efficacy and safety of micropulse 577 nm yellow laser in the treatment of nonresolving central serous chorioretinopathy (CSC) cases. PATIENTS AND METHODS: The study included 15 eyes with nonresolving CSC lasting more than 3 months. All the patients were subjected to complete ophthalmic examination, in addition to contrast sensitivity measurement, fundus fluorescein angiography, and optical coherence tomography. All eyes were subjected to 577 nm subthreshold micropulse laser treatment, using the IQ 577 device, and followed up after 4 weeks, 2 months, 3 months, and 6 months. The outcome measures were change in best-corrected visual acuity, contrast sensitivity, subretinal fluid height, and change in macular thickness measured by optical coherence tomography. RESULTS: The average age of the patients was 36.4 years; eleven were males and four were females. Average duration of the leakage was 4.6 months. The mean best-corrected visual acuity measured 6 months after laser treatment was 0.85±0.097, in comparison to 0.67±0.097 before laser treatment (statistically significant [SS], P<0.05). The mean central macular thickness before laser was 389.6±46.4 µm, in comparison to 263.6±24 µm after 6 months (SS, P<0.05). The mean post-laser log contrast sensitivity measured using the Pelli-Robson contrast sensitivity chart was 1.73±0.14, while the initial log contrast sensitivity was 1.48±0.28 (SS, P<0.05). CONCLUSION: Subthreshold micropulse laser treatment is an effective and safe treatment option for patients with nonresolving CSC.