Erdal Yuzbasioglu

Intravitreal Bevacizumab in Treatment of Idiopathic Persistent Central Serous Chorioretinopathy: A Prospective, Controlled Clinical Study

Purpose: To evaluate and determine the effect of intravitreal bevacizumab in treatment of persistent central serous chorioretinopathy. Methods: This prospective, comparative clinical study included 30 eyes of 30 patients with persistent, symptomatic central serous chorioretinopathy of 3 months’ duration or more. Fifteen eyes of 15 patients were treated with intravitreal injections of 2.5 mg (0.1 ml) bevacizumab (treatment group). Fifteen eyes of 15 patients with the same characteristics who declined treatment were an acceptable control group. The visual and anatomic responses were observed with best-corrected visual acuity and central foveal thickness measured by optic coherence tomography at baseline,1, 3, and 6 months after treatment. Results: Twelve (80%) eyes in the treatment group compared with 8 (53.3%) eyes in the control group showed morphologic restitution at 6 months (P < 0.01). All 15 (100%) treated eyes had stable or improved vision, compared with 10 (66.6%) eyes in the control group (P < 0.01). At 6 months, the mean ± SD central foveal thickness for the treatment group remained significantly lower compared to the control group, with 174 ± 68 µm and 297 ± 172 µm, respectively (P < 0.001). Injection-related complications were not encountered. Conclusions: Our results indicate that intravitreal bevacizumab injection may be a new, promising treatment option for select patients with idiopathic persistent central serous chorioretinopathy. Continued studies with intravitreal bevacizumab in this population will help to establish its long-term efficacy.

Intravitreal Bevacizumab (Avastin) Injection in Retinitis Pigmentosa

Purpose: To evaluate and report the effectiveness, visual, anatomical, and clinical outcome of intravitreal bevacizumab (Avastin) injection in patients with retinitis pigmentosa (RP). Methods: Our prospective study included 13 eyes of 7 patients (4 women and 3 men) in the age range of 25–69 years (mean 44.14 years) with cystoid macular edema (CME) secondary to RP. Intravitreal bevacizumab at a dose of 1.25 mg/0.05 ml was injected via a 28-gauge needle. The response rate to treatment was monitored functionally by visual acuity assessment and anatomically using the optical coherence tomography. Results: The baseline mean central macular thickness was 370.15 μ m (range 245–603 μ m. The central macular thickness decreased to 142.53 μ m (range 124–168 μ m) after bevacizumab injections. The pre- and post-treatment visual acuity ranges were 5/400–20/100 and 20/200–20/63, respectively. Conclusions: Our data reveal that intravitreal bevacizumab administration is effective for the treatment of CME in RP. Further studies with a larger population and longer follow-up period are warranted to assess the efficacy of the treatment.

Intravitreal Ranibizumab in the Treatment of Cystoid Macular Edema Associated With Retinitis Pigmentosa

PURPOSE To report and evaluate the anatomic, clinical, and visual acuity response after intravitreal ranibizumab (IVR) injection in patients with cystoid macular edema (CME) due to retinitis pigmentosa (RP). METHODS This study included 30 eyes of 30 patients with RP who had persistent CME at least 6 months despite medication with acetazolamide. Fifteen eyes of 15 eligible patients were treated with 0.5 mg IVR injection (treatment group). Fifteen eyes of 15 patients with the same characteristics who refused treatment were accepted as control group. The primary outcome of the study (morphologic restitution) was the complete or significant resolution of cystoid space on optic coherence tomography (OCT) without relapse or complication at 6 months. The serial changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured. RESULTS Thirteen eyes (86.6%) in the treatment group had significant resolution of CME at 6 months after single IVR injection. The difference between the 2 groups in BCVA was not statistically significant (P > 0.05). The baseline mean +/- SD CFT for the treatment and control groups were 478 +/- 88 microm and 469 +/- 75 microm, respectively (P > 0.05). At 6 months after treatment, the mean +/- SD CFT of the treatment group improved to 272 +/- 65 microm whereas that in the control group was 480 +/- 92 microm (P < 0.001). CONCLUSIONS This investigation indicated that IVR may provide a new therapeutic approach for the treatment of CME secondary to RP. No adverse event was found to be associated with the treatment. Continued experience with IVR in this population will help establish its longer-term efficacy.

Phacoemulsification in patients with nanophthalmos

OBJECTIVE To evaluate phacoemulsification surgery and its possible risks in patients with nanophthalmos. DESIGN The surgical procedure, corneal diameter, keratometry, axial length, visual acuity, and intraoperative and postoperative complications were reviewed. Scleral thickness was determined by echography. PARTICIPANTS 5 patients, 8 eyes. METHODS The results of cataract surgery in nanophthalmic eyes were reviewed. Inclusion criteria was based on a clinical diagnosis of nanophthalmos and ocular surgery for cataract. Nanophthalmos was diagnosed according to a shorter than average axial length (usually less than 20.0 mm), typically a shallow anterior chamber, hyperopia, and scleral thickening greater than 1.5 mm. The procedure was planned as phacoemulsification, and foldable acrylic PCIOL implantation via a clear corneal tunnel. RESULTS The procedure was planned as phacoemulsification. Six eyes had cataract extraction with posterior chamber intraocular lens implantation by phacoemulsification. It was necessary to change the procedure to extracapsular cataract surgery in 2 cases because of uncontrolled shallowing of the anterior chamber. Postoperative trabeculectomy was needed in 1 eye, and Nd:YAG laser capsulotomy was performed on 4 eyes. No postoperative uveal effusion or infections were seen in any of the eyes. Complications included iritis with posterior synechia (n = 1), transient choroidal hemorrhage (n = 1), vitreous loss (n = 1), posterior capsule opacity (n = 4), and glaucoma (n = 1). In 1 case retinal detachment developed 3 weeks postoperatively. Prophylactic laser iridoplasty or iridotomy was not performed for surgery. CONCLUSIONS Although phacoemulsification seems to be relatively safe in nanophthalmic patients without performing any prophylactic surgical procedure, surgeons need to be attentive of the challenges of working through them when performing phacoemulsification in these high-risk eyes. However, with careful preoperative evaluation and planning, complications can be avoided.

Vitreous Levels of VEGF, IL-8, and TNF-α in Retinal Detachment

Purpose: To determine intravitreal levels of interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF) in patients with rhegmatogenous retinal detachment (RD). Methods: Vitreous samples were collected from 22 eyes of 22 patients during vitrectomy procedures for RD. For controls, vitreous samples were obtained from 12 eyes of 12 patients without RDs during pars plana vitrectomies. Control group patients included four with macular holes and eight with epiretinal membranes; none had any associated vitreoretinopathy. All vitreous samples were immediately frozen at −80°C until assayed. Results: VEGF concentrations were significantly elevated in samples from patients with RDs compared to samples from control patients (p < 0.001). Vitreous concentrations of IL-8 were also significantly elevated in patients with macular edema when compared to control patients (p < 0.05). However, no significant difference was observed in vitreous concentrations of TNF-α in subjects with RDs compared to control subjects (p > 0.05). Conclusions: Increases in IL-8 (an inflammatory angiogenic mediator) and VEGF (a regulatory mediator of cellular proliferation and permeability) may be related to development of proliferative vitreoretinopathy.

Posterior Reversible Encephalopathy Syndrome After Intravitreal Bevacizumab Injection in Patient with Choroidal Neovascular Membrane Secondary to Age-Related Maculopathy

The posterior reversible encephalopathy syndrome (PRES), a complex of cerebral disorders including headache, seizures, visual disturbances, is associated with a variety of conditions in which blood pressure rises acutely. Arterial hypertension can occur in systemic administration of bevacizumab. A few cases of systemic injection of bevazicumab-induced PRES have been reported. In this article, we first report on a patient who developed PRES following intravitreal bevazicumab.

Simultaneous Intravitreal and Intracameral Injection of Bevacizumab (Avastin) in Neovascular Glaucoma

PURPOSE To report the effects of simultaneous intravitreal and intracameral injection of 1.25 mg bevacizumab (Avastin) in 15 neovascular glaucoma (NVG) cases secondary to iris and/or angle neovascularization. PATIENTS AND METHODS The study included 15 eyes of 15 patients (seven women, eight men) with NVG secondary to central retinal vein occlusions (CRVO) or proliferative diabetic retinopathy (PDR). Eight eyes had had CRVO and seven PDR prior to NVG. The severity of neovascularization and peripheric anterior synechiae (PAS) was scored from mild (+) to severe (+++). A total dose of 1.25 mg bevacizumab in 0.05 mL was injected into the vitreous cavity and the same dose of bevacizumab into anterior chamber by sterile 30-gauge needle. RESULTS After treatment neovascularizations on iris and angle were completely resolved 36 h after injection in all patients. Intraocular pressure (IOP) was decreased under 22 mmHg in six cases without any medication. Six cases need medical treatment to achieve appropriate IOP level. Surgical procedure was necessary in three patients who persist high IOP levels despite completely resolved neovascularizations. CONCLUSIONS Simultaneous intravitreal and intracameral injection of bevacizumab can cause an immediate regression of neovascularization secondary to PDR or CRVO and could be an useful adjuvant to prevent dense PAS formation that lead to persistent IOP increasing.

Combination treatment with intravitreal injection of ranibizumab and reduced fluence photodynamic therapy for choroidal neovascularization secondary to angioid streaks: preliminary clinical results of 12-month follow-up.

Background: To evaluate combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks. Methods: This is an interventional case series of 10 previously untreated eyes of 10 patients with choroidal neovascularization secondary to angioid streaks. All eyes were treated with reduced fluence photodynamic therapy using 25 J/cm2, immediately followed by intravitreal ranibizumab injection at baseline, and subsequent injections were performed on an as-needed basis thereafter. Treatment efficacy was assessed based on best-corrected visual acuity and optical coherence tomography findings. Results: After 12 months of follow-up, the best-corrected visual acuity improved by >2 lines in 6 eyes (60%), remained within 2 lines of baseline in 3 eyes (30%), and decreased by ≥3 lines in only 1 eye (10%). The mean central foveal thickness decreased significantly from 332.2 μm at baseline to 235.7 μm at the last follow-up (P < 0.001), as measured by optical coherence tomography. Conclusion: The preliminary results of this prospective study indicate that combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks seems to be effective in reducing or eliminating retinal edema, regression of neovascularization, and improving or stabilizing visual acuity without any complications. Large controlled studies are needed to evaluate the long-term effects of this combination regimen.

Pharmacogenetic Aspect of Intravitreal Ranibizumab Treatment in Neovascular Age-Related Macular Degeneration: A Five-Year Follow-Up

ABSTRACT Purpose: This study aims to evaluate the role of complement factor H (CFH) in response to intravitreal ranibizumab (IVR) treatment, which is administered to patients with neovascular age-related macular degeneration (nAMD). Methods: In this retrospective study, 90 nAMD patients’ 90 eyes were evaluated. IVR was injected once a month for three consecutive months, and then, patients were followed up for five years by using pro re nata method. Results: Average visual acuity (BCVA) values in TT group for the third, fourth and fifth years were found to be significantly higher than those in TC and CC groups, while average BCVA values in TC group were significantly higher than those in CC group (all p = .000 < .0167). Conclusion: Patients with CFH TT genotype responded significantly better to treatment after third year, while patients with CC genotype had a poorer response to IVR.

The Use of Amniotic Membrane in the Management of Strabismus Reoperation Cases

Objective: To describe the use of amniotic membrane (AM) in reoperations to decrease scar formation and to improve ductions. Design: Prospective interventional case series. Participants: Four previously operated cases with restrictive strabismus. Methods: Objective clinical findings were recorded during both pre and post-operative periods. Excision of adhesions and scar tissue, repositioning of extraocular muscles and placement of AM between muscle, sclera and tenon tissue were performed. Results: Orthophoria with no duction deficits was achieved in 2 patients. One patient with fat adherence syndrome had orthophoria with -1 adduction deficit. Only one patient with congenital fibrosis syndrome had 25 PD of esotropia with abduction deficit (-2). Conclusions: We believe that AM placement between the extra ocular muscle, sclera and tenon tissue improves the ductions by inhibiting post-operative scar formation.