PurposeWe aimed to investigate biomarkers and predictive factors for visual and anatomical outcome in patients with naïve diabetic macular edema (DME) who underwent small gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling as a first line treatment.DesignMulticenter, retrospective, interventional study.Participants120 eyes from 120 patients with naïve DME treated with PPV and ILM peeling with a follow up of 24 months.MethodsChange in baseline best corrected visual acuity (BCVA) and central subfoveal thickness (CST) 1, 6, 12 and 24 months after surgery. Predictive value of baseline BCVA, CST, optical coherence tomography (OCT) features (presence of subretinal fluid (SRF) and photoreceptor damage), and time between DME diagnosis and surgery. Additional treatment for DME needed. Intra- and post-operative complications (cataract rate formation, increased intraocular pressure).Main outcome measuresThe correlation between baseline characteristics and BCVA response (mean change from baseline; categorized improvement ≥5 or ≥10; Early Treatment Diabetic Retinopathy Study (ETDRS) letters) 12 and 24 months after surgery.ResultsMean BCVA was 0.66 ± 0.14 logMAR, 0.52 ± 0.21 logMAR, and 0.53 ± 0.21 logMAR (p<0.001) at baseline, 12 and 24 months, respectively. Shorter time from DME diagnosis until PPV (OR: 0.98, 95% CI: 0.97–0.99, p<0.001) was a predictor for good functional treatment response (area under the curve 0.828). For every day PPV is postponed, the patient’s chances to gain ≥5 letters at 24 months decrease by 1.8%.Presence of SRF was identified as an anatomical predictor of a better visual outcome, (OR: 6.29, 95% CI: 1.16–34.08, p = 0.033). Safety profile was acceptable.ConclusionsOur results reveal a significant functional and anatomical improvement of DME 24 months after primary PPV, without the need for additional treatment. Early surgical intervention and presence of SRF predict good visual outcome. These biomarkers should be considered when treatment is chosen.
* BACKGROUND AND OBJECTIVE: To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery. * PATIENTS AND METHODS: Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated. * RESULTS: Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis; aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%). * CONCLUSIONS: Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes. [Ophthalmic Surg Lasers Imaging 2005;36:205210.]
* BACKGROUND AND OBJECTIVE: To evaluate whether the combination of simultaneous hyperthermia by transpupillary thermotherapy and indocyanine green-based photodynamic therapy is an effective treatment for small and medium choroidal melanomas. * PATIENTS AND METHODS: Twenty-five patients with small and medium choroidal melanomas were treated with combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy. * RESULTS : The median age of the 25 patients was 64 years (range, 35 to 88 years). The pretreatment volume of the tumors ranged from 1 5.9 to 653.5 mm3 (mean, 1 1 8.7 ± 146.6 mm3). After a mean of 2.4 treatments (range, 1 to 5 treatments), all of the tumors but one showed a significant volume reduction without clinical evidence of recurrences. The follow-up ranged from 6 to 59 months (mean, 12 ± 14 months). Complications included retinal vascular occlusions, edema and superficial scarring of the macula, and rhegmatogenous retinal detachment. * CONCLUSIONS: The effects of combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy appears to be effective in achieving local tumor control in selected small and medium choroidal melanomas. [Ophthalmic Surg Lasers Imaging 2005;36:463-470.]
To evaluate the effect of radial optic neurotomy on visual acuity (VA) and foveal thickness in patients with hemicentral retinal vein occlusion. Methods: A prospective noncomparative case series of 13 eyes in 13 patients with hemicentral retinal vein occlusion and a preoperative VA of 20/60 or less from a total of 232 retinal vein occlusions diagnosed. All patients underwent pars plana vitrectomy, posterior hyaloid dissection, and radial optic neurotomy at the nasal border of the optic disc. Results: Visual acuity and macular thickness were measured with optical coherence tomography. Nine patients (69.2%) gained 2 or more Snellen lines of vision, and in 4 patients (30.8%) VA improved by 4 or more Snellen lines (median visual acuity, 20/50; mean VA, 20/45; PϽ.01) (average gain, 2.7 Snellen lines). The decrease in foveal thickness was statistically significant (PϽ.01) (median decrease, 297 µm). Final VA was statistically related to decreased macular thickness at optical coherence tomography (P = .03; = −0.62). Retinochoroidal shunts developed in 6 patients (46.1%) at the radial optic neurotomy site. No surgical complications were observed. Conclusions: Radial optic neurotomy seems to be a potential treatment in selected patients with hemicentral retinal vein occlusion, probably because of the more rapid appearance of retinochorioretinal collateral vessels, which promote faster resolution of macular edema.
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