Karin Mimouni

Outcomes and complications of rhegmatogenous retinal detachment repair with selective sutureless 25-gauge pars plana vitrectomy.

PURPOSE To evaluate the outcomes and complications associated with the repair of rhegmatogenous retinal detachment (RRD) using 25-gauge pars plana vitrectomy (PPV) with selective sclerotomy suturing. DESIGN Retrospective case series. METHODS Analysis of consecutive 25-gauge pars plana vitrectomy cases performed for treating RRD was conducted. Reviewed parameters included demographics, ophthalmic history, results of ocular examinations, and intraoperative as well as postoperative complications. Analysis of the surgery digital video disc recordings revealed complications such as iatrogenic retinal breaks and retinal or subretinal tugging by the soft-tip cannula. RESULTS Forty-two eyes with RRD were evaluated with a follow-up of at least 3 months. The preoperative best-corrected visual acuity (BCVA) of 20 eyes with macula-on RRD ranged between 20/20 and 20/40 (mean, 20/30). Twenty-two eyes with macula-off RRD had preoperative BCVA ranging between 20/70 and hand movements (mean, 20/400). The single-surgery success rate was 97.4%. The final BCVA of the macula-on eyes ranged between 20/20 and 20/40 (mean, 20/30). In the eyes with macula-off RRD, the postoperative BCVA ranged between 20/30 and 20/400 (mean, 20/73). Sutures were placed on at least 1 scleral wound because of intraoperative gas leakage in 36.4% of the eyes. On the first postoperative day, all the eyes receiving gas tamponade had a 100% fill. None of the eyes in the study had postoperative hypotony, ciliochoroidal effusion, or choroidal hemorrhage. No cases of postoperative subconjunctival gas or oil leakage were noted. CONCLUSIONS Modification of the standard 25-gauge sutureless technique with selective scleral wound suturing may contribute to preventing wound leakage and possible postoperative complications of hypotony or partial tamponade.

Intravitreal bevacizumab as an adjunct treatment for neovascular glaucoma

Purpose To assess the effect of adjunctive intravitreal bevacizumab treatment on neovascular glaucoma (NVG). Methods The medical records of all consecutive patients with NVG treated with intravitreal bevacizumab at our center from May 2006 to February 2008 were reviewed. The data collected included background features, findings on full ophthalmologic examination (including visual acuity, gonioscopy, and intraocular pressure), glaucoma medications prescribed, and additional procedures for glaucoma performed before and after bevacizumab injection. The interval between the diagnosis of NVG and intravitreal bevacizumab treatment was calculated. Results Eighteen patients (6 male, 12 female; mean age 63±13.2 years) met the study criteria. Causes of NVG were proliferative diabetic retinopathy (n=14), central retinal vein occlusion (n=2), occlusive vasculitis (n=1), and panuveitis (n=1). The mean duration of follow-up was 52 (±12) weeks. Mean intraocular pressure decreased from 32.3 (±4.99) to 18 (±6.1) mmHg (p<0.0001) and mean number of glaucoma medications decreased from 3.16 (±1.2) to 2.55 (±1.46) (p=0.1938). An interval of less than 6 months between the start of bevacizumab treatment and diagnosis was associated with better final visual acuity than delayed treatment (0.82±0.4 logMAR vs 1.88±1.1 logMAR, p=0.002) and a better regression of iris neovascularization (22% vs 89%; p=0.015). Conclusions Intravitreal bevacizumab is beneficial for the treatment of anterior segment neovascularization and NVG when used as an adjunct, making the administration of additional treatment for the underlying cause possible. Bevacizumab should be instituted promptly after diagnosis, before irreversible anatomic and functional damage occurs.

Comparison of fluorescein angiography and indocyanine green angiography for imaging of choroidal neovascularization in hemorrhagic age-related macular degeneration

PURPOSE To compare fluorescein angiography and indocyanine green angiography for imaging of choroidal neovascularization located under subretinal hemorrhage, in age-related macular degeneration. METHODS In a retrospective study, 30 eyes of 30 consecutive patients with hemorrhagic age-related macular degeneration were evaluated with fluorescein angiography and indocyanine green angiography. In each eye, areas of macular hemorrhage, choroidal neovascularization, and total lesion (hemorrhage plus choroidal neovascularization) were measured, and the choroidal neovascularization was categorized as classic, occult, or mixed on fluorescein angiography, and as hot spot, plaque, or combined lesion on indocyanine green angiography. Results of the two techniques were compared for the ability to identify a laser-treatable lesion. RESULTS Fluorescein angiography showed fluorescence in most cases (28, 93.3%). In 23 cases (76.6%), the fluorescence pattern was compatible with occult choroidal neovascularization. Indocyanine green angiography revealed defined patterns of fluorescence in 27 cases (90%): 12 hot spots, seven plaques, and eight combined hot spots and plaques. Twenty lesions (66.6%) detected by indocyanine green angiography were considered eligible for laser therapy. Nine of them (45%) were extrafoveal. CONCLUSIONS Indocyanine green angiography is beneficial for imaging choroidal neovascularization located under subretinal hemorrhage. Choroidal neovascularization demonstrated on indocyanine green angiography may be considered eligible for laser treatment. Therefore, indocyanine green angiography should be considered in cases of hemorrhagic age-related macular degeneration.

Intravitreal Bevacizumab Treatment for Macular Edema due to Branch Retinal Vein Occlusion in a Clinical Setting

Purpose: To report the functional and anatomical outcome of intravitreal bevacizumab (IVB) treatment for macular edema due to branch retinal vein occlusion (BRVO) in a clinical setting. Methods: The files of 45 patients treated with IVB for BRVO-induced macular edema at a tertiary medical center in 2007–2010 were reviewed. All received three loading doses (1.25 mg) and were followed every 6 weeks. Treatment was repeated for persistent or recurrent edema. If the edema did not resolve after 4–6 injections, grid laser photocoagulation was performed. Results: Mean patient age was 70.7 years (SD 8.5); mean follow-up time, 18.8 months (SD 8.3); mean number of injections, 8.8 (SD 3.8). Fourteen patients (33%) received grid laser treatment before bevacizumab and 23 (51%) after. Mean logMAR visual acuity (VA) was 0.63 (SD 0.43) before treatment (Snellen, 20/140) and 0.4 (SD 0.43) (Snellen, 20/70) after (p < 0.0005). Corresponding central macular thickness (CMT) values were 382.2 microns (SD 155.6) and 320.5 microns (SD 172.8) (p= 0.028). Positive correlations were found between initial VA and initial and final CMT (p = 0.004) and between gain in VA and reduction in CMT (p = 0.03). There was no statistically significant difference in mean initial or final VA and CMT between patients who received grid laser treatment before or during the study and those who did not. Conclusions: IVB treatment improves visual function and reduces CMT in patients with BRVO-induced macular edema.

Intravitreous Bevacizumab Treatment for Macular Edema due to Central Retinal Vein Occlusion

Purpose: To investigate the visual and anatomical effects of intravitreal bevacizumab treatment of macular edema due to central retinal vein occlusion (CRVO). Methods: Data were collected by medical chart review for 35 consecutive patients (35 eyes) with CRVO-induced macular edema treated with intravitreal bevacizumab in 2007–2010 and followed for at least 6 months. All patients received 3–4 loading doses (1.25 mg) with follow-up every 6–8 weeks and repeated injections as necessary. Results: Mean patient age was 65.5 years (SD 13.5); mean follow-up time, 17.7 months (SD 10.8); mean number of injections, 9.3 (SD 5). Mean logMAR visual acuity (VA) improved from 0.9 (SD 0.49) at baseline to 0.7 (SD 0.5) at the last visit; corresponding Snellen values were 6/98 and 6/15 (p = 0.009). Four patients (11%) lost ≥3 lines, and 13 patients (37%) gained ≥3 lines. There was a positive correlation between initial and final VA (p < 0.0005). Central macular thickness (CMT) measured 489.5 microns (SD 175) at baseline and 395 microns (SD 223) at the last visit (p = 0.24). VA gain was positively correlated with CMT reduction (p < 0.0001). Conclusions: Intravitreal bevacizumab treatment of CRVO-induced macular edema improves vision, especially in patients with good initial VA.

Intravitreal bevacizumab treatment for exudative age-related macular degeneration with good visual acuity.

Purpose: To investigate the effect of intravitreal bevacizumab on the visual and anatomic outcome of patients with exudative age-related macular degeneration presenting with good visual acuity (VA). Methods: A file review was performed for all consecutive patients with newly diagnosed exudative age-related macular degeneration and initial VA of ≥20/40 treated in 2005 to 2010 and followed for at least 6 months. Treatment consisted of 3 loading doses of intravitreal bevacizumab every 6 weeks and was repeated when fluid or hemorrhage was present. Results: The cohort included 130 patients (150 eyes). Mean follow-up was 20.2 ± 13.2 months, and mean number of injections was 11.3 ± 6.2. At the last examination, VA was stable or improved in 106 eyes (70.7%); 11 eyes (7.3%) lost ≥3 lines. Mean logarithm of the minimum angle of resolution VA measured 0.22 ± 0.1 (0–0.3) at presentation and 0.22 ± 0.2 (0–1.3) at the last visit. Corresponding values for central macular thickness were 267 ± 75 &mgr;m (137–562) and 226 ± 75 &mgr;m (75–568) (P = 0.14). The most frequent complication (18 eyes, 12%) was corneal epithelial defects. Conclusion: Prompt intravitreal bevacizumab treatment for newly diagnosed exudative age-related macular degeneration in patients with good initial best-corrected visual acuity is associated with sustained or improved vision and a good safety profile. Attempts should be made to expedite the access of these patients to treatment, regardless of initial VA.

The Effectiveness of Intravitreal Ranibizumab in Patients with Diabetic Macular Edema Who Have Failed to Respond to Intravitreal Bevacizumab

Purpose: To investigate the response to intravitreal ranibizumab after failure of intravitreal bevacizumab in patients with diabetic macular edema (DME). Methods: Demographics, visual acuity (VA), central macular thickness (CMT), and HbA1C were retrospectively collected from DME patients treated with second-line intravitreal ranibizumab at a tertiary hospital in 2012-2013 and followed for at least 3 months. Results: Twenty-two patients (26 eyes) were included in the study, with a mean (±SD) age of 66 ± 8.1 years and followed for an average of 28.36 months. The mean number of intravitreal bevacizumab injections was 7.3 ± 2.8, and of intravitreal ranibizumab injections 5.11 ± 2.4. After 3 ranibizumab injections, 57% of eyes showed improvement in VA. The change in VA was statistically significant (p = 0.044) in those eyes where the pretreatment acuity for the second-line therapy was <20/40 (logMAR 0.3). CMT decreased from 435.95 ± 83.28 to 373.69 ± 44.39 µm (p = 0.01). The number of ranibizumab injections was significantly correlated with the change in CMT (p = 0.037). Conclusion: Intravitreal treatment with ranibizumab can be efficacious in eyes with DME that have failed to respond to bevacizumab.

Photodynamic Therapy for Pseudophakic Eyes Compared to Eyes With Cataract

BACKGROUND AND OBJECTIVE Verteporfin photodynamic therapy (vPDT) plays a role in the treatment of chorioretinal conditions. The purpose of this study was to compare vPDT outcomes between cataractous and pseudophakic eyes. PATIENTS AND METHODS In this prospective study of consecutive patients with choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration (nAMD) treated with vPDT, cataract and pseudophakic eyes were compared for number and timing of vPDT treatments, duration of follow-up, angiographic features, and changes in best-corrected visual acuity (BCVA). RESULTS Overall, 103 eyes (n = 95) were included in the final analysis; 44 eyes in the cataract group and 59 eyes in the pseudophakic group. No significant difference in change in BCVA (P = .19) or leakage-free CNV lesions (P = .58) was found between the groups. CONCLUSIONS In this study of vPDT for nAMD, there was no significant difference between eyes with cataract and pseudophakic eyes. It seems that cataract does not clinically alter the effect of vPDT. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1132-1136.].