Influence of intravitreal triamcinolone acetonide injection in scleral buckling surgery for macula-off retinal detachment.

PURPOSE: To investigate the effect of intravitreal triamcinolone acetonide injection on the resolution of subretinal fluid (SRF), and its correlation with visual outcome after scleral buckle (SB) surgery. METHODS: A prospective consecutive case series was conducted in patients who underwent SB surgery for macula-off rhegmatogenous retinal detachment (RRD) at Farabi Eye Hospital from February 1, 2012 to August 30, 2013. Exclusion criteria included previous ocular surgery (e.g. primary surgical failure) except cataract surgery, recurrent retinal detachment, macular hole, epiretinal membrane, proliferative vitreoretinopathy grade C, history of trauma, other retinal diseases, and diabetes mellitus. Patients were assigned to two groups. In group 1, patients received 2 mg of intravitreal triamcinolone acetonide injection at the end of surgery while patients in group 2 received intravitreal balanced saline solution for balancing the intraocular pressure (IOP). Patients were followed up at 1 day, 1 week, 1 month, 2 months and 3 months after the surgery by best-corrected visual acuity (BCVA), slitlamp examination, indirect ophthalmoscopy and optical coherence tomography (OCT). OCT (Heidelberg Engineering, Heidelberg, Germany) was used at all visits except day 1 after the surgery. Student's t test and χ(2) tests were used for comparisons; p value ≤ 0.05 was considered significant. RESULTS: Sixty-two eyes of 62 patients were enrolled in the study. There were 33 male patients (53%) and 29 female patients (47%). The average age was 43.8 years (18-72 years). The mean duration of symptoms was 34.7 ± 46.8 days. There were 29 eyes in group 1 and 33 eyes in group 2. Twelve weeks after the operation, 25 patients (40%) had SRF beneath the macula, but there was no significant difference (p = 0.24, χ(2) test) between the two groups. Improvement in BCVA in both groups was statistically significant (p ≤ 0.001) but did not differ between the two groups (p = 0.09) apart from week 12, in which the improvement in group 1 was significantly higher (p = 0.03). The incidence of cystoid macular edema did not differ in a statistically significant way between the groups (p = 0.19). IOP in 4 (15%) patients in group 1 rose above 21 mm Hg but responded quickly to 2 weeks of topical antiglaucoma medication. There was no cataract progression in either group. There was no correlation between the incidence of persistent SRF and the extent of detachment in both groups (p = 0.83). There was no surgical failure or redetachment in either group during the study period. CONCLUSION: Single-dose intravitreal triamcinolone may increase the final BCVA in macula-off RRD patients despite persistent SRF, suggesting the anti-inflammatory role of this drug.

Evaluating the Efficacy and Safety of Aflibercept Biosimilar (P041) Compared with Originator Product in Patients with Neovascular Age-Related Macular Degeneration.

OBJECTIVE: To assess the noninferiority of biosimilar aflibercept (P041, CinnaGen) to the originator aflibercept (AFL, Regeneron) in terms of efficacy, safety, and immunogenicity. DESIGN: This was a phase Ш, 52-week, multicenter, randomized, double-masked, and active control trial involving eyes in a 1:1 ratio. SUBJECTS: Patients with active subfoveal choroidal neovascularization secondary to age-related macular degeneration randomized into the 2 groups of P041 and AFL. METHODS: Patients received an injection of aflibercept every 4 weeks for 3 doses, followed by administration every 8 weeks up to week 48. MAIN OUTCOME MEASURES: The primary outcome was the noninferiority analysis of eyes maintaining vision at week 52. Secondary outcomes included the changes in visual acuity and retinal thickness, safety evaluation, and immunogenicity during the study. RESULTS: In total, 168 eyes of 168 patients were included. At week 52, the proportion of patients maintaining vision was 94.44% in the P041 group compared with 94.52% in the AFL group. The 95% confidence interval (CI) for the difference of maintaining vision from baseline did not exceed the predefined noninferiority margin of 10% (difference, -0.0008; 95% CI, -0.074 to 0.074; P = 0.98). Secondary outcomes indicated similar results in both arms (all P > 0.05). Safety measured outcomes and immunogenicity were similar between the 2 study groups. CONCLUSIONS: Biosimilar aflibercept was noninferior to AFL in eyes with neovascular age-related macular degeneration. Other efficacy and safety findings also indicated the similarity of 2 products. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The value of the visual evoked potentials test in the assessment of the visual pathway in head trauma.

BACKGROUND: The research was done to evaluate the value of the visual evoked potentials test in the assessment of visual pathways function in cases with head trauma and minimal findings on routine testing. METHODS: A prospective case series evaluating use of visual evoked potentials testing in patients with a history of head trauma and suffering from visual symptoms with no significant clinical and neuroimaging findings, referred for further work up. RESULTS: Thirty-four patients with a history of head trauma and subsequent visual complaints were included. 27 cases (79.4%) were male and 7 cases (20.6%) were female. The mean elapsed time after the trauma was 47.6 weeks (range: 3.5 to 320 weeks). Twenty-five cases had unilateral and 9 cases had bilateral visual complaints. History of coma with mean duration of 12 days was present in 4 cases. The best-corrected visual acuity was less than 1 Log MAR (legally blind) in 21 eyes. In 4 eyes (12%) the relative afferent papillary defect test was positive. Mild to moderate optic disc pallor was present bilaterally in 4 cases and unilaterally in 3 cases. Hemorrhagic patches were reported on MRI in 2 cases; no other cases had pathologic MRI findings. In unilateral cases, there was a statistically significant difference between the involved eye-sided lobe and the sound eye-sided lobe implicit time and amplitude. In patients with bilateral complaints, by testing each eye, the VEP amplitudes of both eyes showed significant differences with the International Society for Clinical Electrophysiology of Vision standards, whereas the implicit times showed not-statistically significant differences. CONCLUSIONS: The visual evoked potentials test shows not only additional diagnostic value, not seen on routine clinical and neuroimaging testing, but also rather a high validity in tracing visual disability in traumatic brain injury.

Determining corneal power using Pentacam after myopic photorefractive keratectomy.

PURPOSE: To assess the accuracy of Pentacam Scheimpflug camera for corneal power measurement in eyes with previous photorefractive keratectomy for myopia. METHODS: In this comparative interventional case series, 35 eyes of 35 patients who had myopic photorefractive keratectomy were studied. Corneal power was measured by conventional topography and Pentacam Scheimpflug camera, and equivalent keratometry readings (EKR) in different central corneal rings (0.5 to 4.5 mm), true net power and simulated keratometry (K) measurements as well as those obtained using Shammas no-history, Koch-Maloney and Haigis methods were compared with clinical history method. RESULTS: All corneal power measurements except for the topography simulated K and true net power values were statistically similar to the clinical history values. Simulated keratometry and 4.5-mm EKR values were more closely correlated with clinical history method. Shammas formula, Pentacam simulated K and 3-, 4- and 4.5-mm EKR provided a 95% confidence interval within +/-0.50 D of the mean clinical history method value, among these, the width of the 95% limits of agreement (LoA) was narrower for Shammas and Pentacam simulated K and 4.5-mm EKR values; however, considerably large 95% LoA were found between each of these values and those obtained with the clinical history method. Estimated preoperative keratometry was statistically similar to the preoperative measurement; however, estimated refractive change was different from actual value. CONCLUSIONS: The Pentacam 4.5-mm EKR and simulated keratometry may be used as an alternative to clinical history method to predict corneal power when pre-keratorefractive surgery data are unavailable; however, wide LoA should be considered in the calculations.

Bilateral Multiple Serous Retinal Detachments Following Bone Marrow Transplantation.

PURPOSE: To describe a case of bilateral multiple serous retinal detachments (SRD) following bone marrow transplantation (BMT), which showed bilateral response to a single unilateral intravitreal bevacizumab injection. CASE REPORT: A 37-year-old man with acute myelogenous leukemia who had received bone marrow transplantation four months prior was referred to our clinic with the chief complaint of gradually decreasing vision in both eyes for three months. During the funduscopic examination, multiple serous retinal detachments (SRD) were observed bilaterally, and he was diagnosed with multiple foci of central serous chorioretinopathy (CSCR). He was advised to discontinue the steroid dosage, which did not make significant improvement, and he was treated with intravitreal bevacizumab injection in the more severely affected eye. One month later, significant improvement was noticed in both eyes. CONCLUSION: Serous retinal detachment is a rare complication following BMT. Significant bilateral improvement after single unilateral intravitreal bevacizumab injection shows not only the possible role of increased level of vascular endothelial growth factor (VEGF) in this case, but also the systemic diffusion of the drug and effect on the contralateral eye following unilateral injection.

Bilateral choroidal osteoma associated with langerhans cell histiocytosis, a coincidence?

PURPOSE: To describe a case of bilateral choroidal osteoma (CO) in a patient with a history of langerhans cell histiocytosis (LCH). METHODS: A 24-year-old man complaining of gradually decreasing visual acuity in both eyes is presented. He had a history of lymphadenopathy, respiratory symptoms, and pathology-proven diagnosis of LCH. RESULTS: Ophthalmic clinical and imaging studies revealed bilateral CO. CONCLUSION: In this patient, we suggest a possible relationship between LCH and CO.

Effect of Photorefractive Keratectomy on Optic Nerve Head Topography and Retinal Nerve Fiber Layer Thickness Measured by Heidelberg Retina Tomograph 3.

PURPOSE: To determine whether photorefractive keratectomy (PRK) has a significant effect on optic nerve head (ONH) parameters and peripapillary retinal nerve fiber layer (RNFL) thickness measured by the Heidelberg Retina Tomograph 3 (Heidelberg Engineering GmbH, Heidelberg, Germany) in eyes with low to moderate myopia. METHODS: This prospective, interventional case series, includes 43 consecutive myopic eyes which were assessed on the day of PRK and 3 months postoperatively using the HRT3. Among the stereometric parameters, we compared disc area, linear cup disc ratio, cup shape measure, global rim area, global rim volume, RNFL height variation contour and mean RNFL thickness; out of the Glaucoma Probability Score (GPS) we assessed changes in global value, rim steepness temporal/superior, and temporal/inferior, as well as cup size and cup depth before and after PRK. RESULTS: Mean refractive error before and after PRK were -3.24 ± 1.31 and -0.20 ± 0.42 diopters, respectively. No significant change occurred in disc area, linear cup disc ratio, cup shape measure, rim area and rim volume among the stereometric parameters; and in rim steepness temporal/superior and rim steepness temporal/inferior in the GPS before and after PRK using the default average keratometry. However, RNFL height variation contour, mean RNFL thickness, and cup size and depth were significantly altered after PRK (P < 0.05). CONCLUSION: PRK can affect some HRT3 parameters. Although the most important stereometric parameters for differentiating normal, suspect or glaucomatous patients such as rim and cup measurements in stereometric parameters were not changed.

Interocular differences of the Pentacam measurements in normal subjects.

PURPOSE: The aim of this study was to determine the interocular differences of the Pentacam corneal measurements in a normal population. METHODS: A retrospective analysis was performed on 550 eyes of 275 consecutive subjects evaluated for refractive surgery at the Rassoul Akram Hospital, Iran University of Medical Sciences. A Pentacam Scheimpflug camera was used for corneal measurements. Statistical analysis was performed to determine the normal levels of the difference between the two eyes. RESULTS: One hundred and four men and 171 women with a mean age of 29.1 +/- 7.73 years were evaluated. The mean (range) interocular difference was 2.17 (zero to 21) microm for maximum anterior elevation (AEmax), 3.62 (zero to 31) microm for maximum posterior elevation (PEmax), 8.42 (zero to 30) microm for minimum corneal thickness (CTmin), 0.06 (zero to 0.4) mm(3) for three millimetre corneal volume (CV3), 0.19 (zero to 1.2) mm(3) for five millimetre corneal volume (CV5), 0.44 (zero to 2.9) mm(3) for seven millimetre corneal volume (CV7), 0.24 (zero to 2.5) dioptres for the mean keratometry (Km) and 0.39 (zero to 2.5) D for measurements of the corneal dioptric power in the steepest meridian (Kmax). CONCLUSIONS: Individuals with differences greater than 17.4 microm in AEmax, 29.1 microm in PEmax, 29.6 microm in CTmin, 2 D in Km, 2.27 D in Kmax, 0.32 in CV3, 1.05 in CV5, and 2.6 in CV7 between eyes represent less than 0.5 per cent of the population. An interocular difference outside the normal range should alert the clinician to examine for other parameters that are more predictive of post-refractive surgical ectasia.