Marialucia Cascavilla

Compassionate use of dexamethasone implant for the treatment of macular edema secondary to central retinal vein occlusion in a clinical setting

to be involved in photoreceptor degeneration in retinal detachment (Nakazawa et al. 2011). Improved visual function and absence of malaise during repeated anti-thymocyte therapy are compatible with only the first infusion of anti-thymocyte globulin resulting in significant cytokine release (Guttmann et al. 1997). In conclusion, our observation suggests that cytokines released from T cells that disintegrated as a result of anti-thymocyte globulin infusion may have been be involved in the development of AMN.

Intravitreal Bevacizumab for Subfoveal Choroidal Neovascularization Associated with Pattern Dystrophy

PURPOSE To assess the effects of intravitreal bevacizumab injections in the treatment of subfoveal choroidal neovascularization (CNV) associated with pattern dystrophy (PD) of the retinal pigment epithelium. METHODS The study was a prospective, nonrandomized, open-label, interventional clinical trial in which 12 patients were prospectively enrolled. Patients with a diagnosis of PD complicated by subfoveal CNV were considered for the study. All patients underwent a complete ophthalmic examination, including ETDRS visual acuity measurement, electroretinogram, electrooculogram, optical coherence tomography, and fluorescein angiography. The treatment protocol began with a loading dose of three consecutive injections at 1-month intervals, followed by injections administered as needed, according to OCT parameters and angiographic features observed during a 24-month follow-up period. The number of eyes with a visual acuity loss of fewer than 15 letters (<3 ETDRS lines), compared with baseline measures, was recorded at the 6-, 12-, and 24-month examinations. RESULTS Twelve patients completed the planned visits and were included in the study. A visual acuity loss of fewer than 15 letters was not registered in any case at the 6- and 12-month examinations and was found in only one (8%) patient at the 24-month examination. The mean best corrected visual acuity (BCVA) and the mean central macular thickness (CMT) at baseline were 0.73+/-0.34 (logMAR+/-SD) and 276+/-95 microm (SD), respectively. At the 3-month examination, the mean BCVA significantly improved to 0.48+/-0.27, whereas the mean CMT decreased to 220+/-71 microm. At the 12-month examination, the mean BCVA was 0.45+/-0.24, and the mean CMT was 209+/-53 microm. At the 24-month (last) follow-up, the BCVA showed substantial stabilization and the CMT decreased to 199+/-34 microm. No side effects or complications were registered. CONCLUSIONS Intravitreal bevacizumab injection is a beneficial treatment for subfoveal CNV associated with PD. Further studies are warranted to confirm these initial results and to analyze the morphofunctional changes during the follow-up. (ClinicalTrials.gov number, NCT00391144.).

Rebound Effect After Intravitreal Dexamethasone Implant for the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion

AIM To report on the rebound macular edema (ME) effect following dexamethasone implant for the treatment of nonischemic central retinal vein occlusion (CRVO). METHODS Twenty-one patients affected by ME secondary to central retinal vein occlusion (CRVO) underwent an implant of dexamethasone (700 μg) in a compassionate use program. The patients were followed up monthly. The Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), central retinal thickness (CRT) on optical coherence tomography (OCT), and intraocular pressure were registered at monthly intervals. Retreatments were carried out on a pro-re-nata (PRN) basis starting from the third month. RESULTS Both BCVA and CRT improved in all cases. A rebound effect, characterized by a recurrence of ME in excess of the baseline value, occurred in 3 cases (13%) at months 3 and 4. Visual acuity accordingly dropped at the higher CRT values in the 3 cases displaying the rebound effect. Additional treatment with dexamethasone implant led to both a recovery in visual acuity and reduction in CRT. CONCLUSIONS A rebound effect can occur after dexamethasone implant for the treatment of ME related to CRVO, but does not affect functional or anatomical recovery when retreatment is provided. The retreatment rate with dexamethasone implant should be adapted to suit the patients response.

Intravitreal Bevacizumab in Advanced-Stage Neovascular Age-Related Macular Degeneration With Visual Acuity Lower Than 20/200

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Microperimetric assessment of the two optical coherence tomography subtypes of acute macular neuroretinopathy

This study evaluates the morpho‐functional alterations associated with acute macular neuroretinopathy (AMNR).

A Pathogenetic Classification of Diabetic Macular Edema

Purpose: The aim of this study was to define a new pathogenetic classification of diabetic macular edema (DME) and to present the results of its application in common clinical practice. Methods: One hundred and seventy-seven consecutive patients with center-involving DME, central retinal thickness (CRT) ≥250 µm, were prospectively enrolled. A complete ophthalmological examination included best-corrected visual acuity (BCVA) assessment, fundus photography, and spectral-domain optical coherence tomography (OCT). The DME classification was broken down into 4 categories, combining the presence of retinal thickening with the presence/absence of visible vascular dilations and OCT-detectable macular traction. The OCT parameters included were as follows: CRT, subretinal fluid, intraretinal cysts, and hyper- reflective foci (HF). Results: Four subtypes of DME were identified: vasogenic (131 eyes, DME with vascular dilation), nonvasogenic (46 eyes, DME without vascular dilation), tractional (11 eyes), and mixed DME (13 eyes). Vasogenic DME was the pattern mainly represented in each subclass of CRT (< 300, 300–400, and > 400 µm), with tractional DME observed especially with CRT > 400 µm. Internal and external cysts and a greater presence of hard exudates were predominantly found in vasogenic DME, whereas HF was equally distributed in the 4 DME subgroups. Conclusion: The study offers a new pathogenetic classification able to detect significant differences among DME subtypes. A tailored therapeutic approach could take into consideration specific changes associated with the different DME subtypes.