Dexamethasone intravitreal implant may present an alternative option in the treatment of chronic diabetic macular edema nonresponsive to three consecutive monthly bevacizumab injections administered previously. However, IOP measures were only slightly increased. It seems that the effect of dexamethasone may last till 4 months after initial injection.

ABSTRACT.Purpose: To discuss treatment modalities for aggressive posterior retinopathy of prematurity (AP-ROP). Methods: The medical charts of all infants with AP-ROP at Uppsala University Hospital, Sweden, during a 2-year period (2009 and 2010) were reviewed. Eight infants (16 eyes) with a mean gestational age of 23.8 weeks and a mean birth weight of 592 g were treated with laser and ⁄ or intravitreal injections of bevacizumab (0.4 and 0.625 mg). RetCam photography was used to document the retinal appearance before and after treatment. Results: All infants (16 eyes) had AP-ROP in zone I. Mean time at initial treatment was 34 weeks postmenstrual age. Two eyes (one infant) were only treated with laser, and six eyes (three infants) were treated with laser therapy or cryopexy and, because of lack of regression, with bevacizumab as salvage therapy. Eight eyes (four infants) were treated with a first-line bevacizumab injection and four of these eyes (two infants) with additional laser ablation for continued disease progression in zone II. Macular dragging occurred in one eye of one infant primarily treated with laser. Conclusions: Given the high complication rate of the extensive laser treatment for zone I ROP, it is worth considering anti-vascular endothelial growth factor treatment as an alternative therapy. Further knowledge concerning side effects and long-term ocular and systemic outcome is warranted before this drug becomes general clinical practice.

In order to study long-term anatomical and functional results the authors evaluated the data from 260 patients who underwent pars plana vitrectomy for proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 68 eyes (26.2%); vitreous hemorrhage & tractional retinal detachment, 84 eyes (32.3%); tractional retinal detachment, 82 eyes (31.5%); and combined tractional-rhegmatogenous retinal detachment, 26 eyes (10%). In 118 eyes vitreoretinal surgery was combined with silicone-oil tamponade. The retina was completely attached posterior to a scleral buckle in 251 eyes (96%) at the time of the last examination. After a follow-up period of at least 12 months in a group of patients with vitreous hemorrhage, visual acuity improved in 88% of the eyes. Visual acuity was better than 0.5 in 31% of eyes. In group of eyes with nonresorbing vitreous hemorrhage & tractional retinal detachment visual acuity improved in 52% of eyes. Visual acuity improved in 76% of eyes with tractional retinal detachment and in 81% of eyes with combined tractional & rhegmatogenous retinal detachment. When comparing the latest postoperative visual acuity to visual acuity after three months postoperatively, visual acuity was unchanged in 88%, in 10% it became worse and in 3 cases (1%) became better. In the postoperative period, recurrent vitreous hemorrhage occurred in 33 (13%) eyes, reproliferation in 12 eyes. Cataract developed in 45 of 168 phakic eyes. If postoperative visual acuity before cataract formation was good, extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed. Otherwise simple intra or extracapsular cataract extraction was performed. In 19 cases cataract operation was performed together with silicone oil extraction. Neovascular glaucoma developed postoperatively in 15 eyes (6%). Retinal detachment occurred postoperatively in 21 eyes (8%). In 15 eyes the retina was successfully reattached after additional operations.

Lidocaine 2% jelly with or without peroral preoperative morphine and dixyrazine offers adequate analgesia to perform sutureless vitrectomy. Lack of akinesia does not prevent a successful surgical result.

ABSTRACT.Purpose: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens (IOL) implantation in eyes with macular hole. Methods: A retrospective study was conducted in 38 eyes (36 patients) after combined phacoemulsification, insertion of a posterior capsule IOL and pars plana vitrectomy. Results: The macular hole was successfully closed in 32 of the 38 eyes (84%). In six eyes (16%) the hole failed to close and one eye underwent a second operation. Vision improved by two or more Snellen lines in 29 eyes (73%), there was no change in seven eyes (18%), and visual acuity decreased in two eyes (5%). Intraoperative and postoperative complications included retinal tears in nine eyes (24%), posterior capsule rupture in two eyes (5%), transient postoperative increase of intraocular pressure in eight eyes (21%), and posterior capsule opacification in five eyes (13%). Conclusion: Combining phacoemulsification, IOL insertion and pars plana vitrectomy for macular hole repair can reduce the need for cataract surgery in the future, decrease costs, shorten postoperative recovery time and allow for clearer intraoperative visualization, making the procedure safer and more effective.