BackgroundTo assess closure rate after a single surgery of large macular holes and their visual recovery in the short term with three different surgical techniques.MethodsProspective multicenter randomized controlled trial. We included treatment-naïve patients with diagnosis of large macular hole (minimum diameter of > 400 µm). All patients underwent a comprehensive ophthalmological examination. Before surgery, the patients were randomized into three groups: group A: conventional internal limiting membrane peeling, group B: inverted-flap technique and group C: free-flap technique. All study measurements were repeated within the period of 1 and 3 months after surgery. Continuous variables were assessed with a Kruskal–Wallis test, change in visual acuity was assessed with analysis of variance for repeated measurements with a Bonferroni correction for statistical significance.ResultsThirty-eight patients were enrolled (group A: 12, group B: 12, group C: 14). The closure rate was in group A and B: 91.6%; 95% CI 61.52–99.79%. In group C: 85.71%; 95% CI 57.19–98.22%. There were no differences in the macular hole closure rate between groups (p = 0.85). All groups improved ≈ 0.2 logMAR, but only group B reached statistical significance (p < 0.007).ConclusionsDespite all techniques displayed a trend toward visual improvement, the inverted-flap technique seems to induce a faster and more significant recovery in the short term.
Purpose: To report ultraviolet-A (UV-A) light treatment in a patient with Acanthamoeba keratitis (AK). Methods: Interventional case report. A standard protocol for ultraviolet corneal therapy, with a power emission of 3 mW/cm2 and a wavelength of 370 nm, was used. The protocol included an 8-nm bandwidth at a 54-mm distance measured with a collimation system of diodes as well as a protective shield of riboflavin in a case of documented AK. Results: A 54-year-old female patient with AK, showing no therapeutic response to a wide variety of topical antimicrobial agents and with a visual acuity of 20/400, was treated with UV-A therapy. The patient displayed a favourable response in the first 24 h after treatment, with improvement of symptoms, visual acuity (to 20/200) and biomicroscopy cornea with haze degree I. By the third week post-treatment, the patient was symptom-free. Her visual acuity was 20/30, and the affected cornea was clear. Five months after treatment, there had been no recurrence, and her vision was 20/20. Conclusions: Treatment with UV-A light was an effective therapy in this case of AK.
Purpose: The aim of this study was to evaluate the correlations between fundus autofluorescence and morphologic parameters as well as visual function in patients with diabetic macular oedema treated with intravitreal ziv-aflibercept. Methods: A total of 34 eyes of 20 patients with untreated diabetic macular oedema received an intravitreal injection of ziv-aflibercept at baseline, and 1 and 2 months later. The baseline, 1-month, and two-month best corrected visual acuity determination, contrast sensitivity, spectral domain optical coherence tomography, mean central macular thickness, mean macular cube volume, mean macular cube average thickness, and fundus autofluorescence (decreased, normal, or increased; and single or multiple spots) were measured. Correlation analysis with a determination of Spearman’s rank correlation coefficient, regression analysis, agreement between investigators, and Friedman’s test were used for statistical analyses. Results: A direct correlation was observed between baseline fundus autofluorescence and macular cube average thickness at 1 month (r = 0.51, p = 0.020) and between fundus autofluorescence at 1 month and baseline macular cube average thickness (r = 0.50, p = 0.021). Regression analysis showed a coefficient of determination of 0.29 (p = 0.016) between baseline fundus autofluorescence and macular cube average thickness at 1 month. Conclusion: In patients with diabetic macular oedema, the pretreatment baseline degree of foveal fundus autofluorescence might be helpful in predicting macular cube average thickness in patients undergoing treatment with intravitreal ziv-aflibercept in the short term.
To evaluate the safety and efficacy of intravitreal injection of bevacizumab before vitrectomy in advanced proliferative diabetic retinopathy.
A randomized clinical trial was performed on 40 eyes of 40 patients. Inclusion criteria were advanced proliferative diabetic retinopathy with fractional retinal detachment and HbA1c <7%. Patients were randomly assigned into 2 groups. Patients in one group had an intravitreal injection (1.25 mg) of bevacizumab 48 hours before 23-G pars plana vitrectomy surgery was performed, whereas the other group did not. Best-corrected visual acuity, intraocular pressure, and fundus photographs were taken prior to surgery 1 week and 3 and 6 months postoperatively.
Effective vitrectomy time was 8.05 minutes in the bevacizumab group vs 16.8 minutes in the non-bevacizumab group. Statistically significant differences were observed in visual acuity at 1 week and 3 and 6 months follow-up between the 2 groups (p<0.05 for each visit). Also, there was less bleeding intraoperatively in the bevacizumab group. Mean final visual acuity in the bevacizumab group was 0.82 logMAR and 2.01 logMAR in the non-bevacizumab group.
Adjuvant intravitreal injection of bevacizumab prior to vitrectomy in diabetic retinopathy with fractional retinal detachment significantly eases the procedure, diminishing intraoperative complications, and leads to a better visual outcome.
Purpose: To evaluate the combination of fundus autofluorescence results with several clinical and structural variables into mathematical indexes to enhance their ability to predict visual and anatomical changes after the antivascular endothelial growth factor loading dose. Methods: Patients with diabetic macular edema were enrolled. Each patient had a comprehensive ophthalmological examination, contrast sensitivity, optical coherence tomography, and fundus autofluorescence assessment. All patients received three monthly doses of ziv-aflibercept and were followed each month for response assessment. Autofluorescence was classified according to its level into five grades. The grades were combined with other variables (best-corrected visual acuity, contrast sensitivity, central macular thickness, macular cube volume, and macular cube average thickness) into normalized indexes. Statistical assessment was done using a Spearman’s rank correlation coefficient, linear regression, and interobserver-agreement analysis. Results: There was a strong correlation between the fundus autofluorescence/baseline best-corrected visual acuity index and the fundus autofluorescence/contrast-sensitivity index at baseline with the best-corrected visual acuity after the third dose of ziv-aflibercept ( rs = −0.78, p = .000 and rs = −0.68, p = .0009 respectively). The fundus autofluorescence/baseline best-corrected visual acuity index and the fundus autofluorescence/contrast-sensitivity index, both at baseline had a mild correlation with the macular volume at 1 month of follow-up ( rs = 0.56, p = .008 and ( rs = 0.64, p = .002, respectively). Conclusion: This study suggests that it is possible to combine fundus autofluorescence results with functional and structural variables into normalized indexes that could potentially predict outcomes after antivascular endothelial growth factor loading dose in patients with diabetic macular edema.
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