Vincent Y.W. Lee

Efficacy of 1.25 MG versus 2.5 MG intravitreal bevacizumab for diabetic macular edema: six-month results of a randomized controlled trial.

Purpose: To evaluate the efficacy of intravitreal injections of two different dosages of bevacizumab (Avastin) for treating diffuse diabetic macular edema. Methods: Fifty-two eyes of 52 patients with diabetic macular edema were randomized to receive three monthly intravitreal injections of 1.25 mg or 2.5 mg bevacizumab. Patients were observed for 6 months and optical coherence tomography central foveal thickness, logMAR best-corrected visual acuity (BCVA), and adverse events were assessed. Results: Forty-eight eyes of 48 patients completed the 6-month follow-up and were analyzed. Significant mean central foveal thickness reductions were observed in both groups at all follow-up visits (P < 0.013). Significant improvements between baseline and 6-month mean logMAR BCVAs were seen, with the mean logMAR BCVA improved from 0.63 to 0.52 in the 1.25 mg group and 0.60 to 0.47 in the 2.5 mg group. No significant difference in BCVA was observed between the two groups at any time point (P > 0.56). Subgroup analysis showed that intravitreal bevacizumab seemed to be more effective in eyes without any previous diabetic macular edema treatment. Conclusions: Three monthly intravitreal bevacizumab injections resulted in significant reduction in central foveal thickness and improvements in BCVA in diabetic macular edema patients. Both 1.25 mg and 2.5 mg seemed to have similar treatment efficacy.

Combined photodynamic therapy and intravitreal triamcinolone for choroidal neovascularization secondary to punctate inner choroidopathy or of idiopathic origin: one-year results of a prospective series.

Purpose: To evaluate the efficacy and safety of combined intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT) with verteporfin in the treatment of subfoveal choroidal neovascularization (CNV) due to punctate inner choroidopathy (PIC) or of idiopathic cause. Methods: Consecutive patients with subfoveal idiopathic and PIC CNV were prospectively recruited and received combined PDT and 4 mg IVTA injection. Patients were observed every 3 months for 1 year and retreatment was performed in the presence of angiographic leakage. Outcome measures included changes in the mean best-corrected visual acuity (BCVA), the proportion of patients who had stable or improved vision, and the mean number of treatments required during the 1-year period. Results: Fourteen patients (14 eyes) were recruited and all completed the 1-year follow-up. The mean age of the patients was 34.7 years. The mean logMAR BCVA improved significantly from 0.52 at baseline to 0.20 at 1 year (Wilcoxon signed-ranks test, P = 0.003). For the entire group, 13 (92.9%) eyes had stable or improved vision with a mean improvement of 3.2 lines (range, –3–7 lines). The mean number of treatments during the 1-year study period was 1.1 sessions. No serious ocular or systemic complications were encountered. Conclusions: Combined PDT with IVTA seems to be a promising treatment strategy in the treatment of idiopathic CNV and CNV secondary to PIC as it resulted in fewer treatment sessions and superior visual improvement. Further study to assess its long-term safety and efficacy as the first line treatment is warranted.

Surgical treatment for diabetic vitreoretinal diseases: a review.

Over the past four decades, advancements in surgical instrumentations and techniques have significantly improved the postoperative anatomical and visual outcomes of patients with various diabetic vitreoretinal diseases. In particular, surgical interventions for previously serious and untreatable blinding proliferative diabetic retinopathy can now be performed, with much better results. The advents of micro incisional vitrectomy system with better visualization system like binocular indirect ophthalmomicroscope and state‐of‐the‐art instrumentation revolutionized the era of diabetic vitrectomy. High‐speed vitrectors, finer instruments, chromo‐assisted vitrectomy and use of anti‐vascular endothelial growth factors not only change the paradigm but also help achieve much better outcome after diabetic vitrectomies. In this review, we will discuss and summarize the indications, surgical considerations, surgical techniques, potential complications and outcomes of vitreoretinal surgery for diabetic eye diseases.

Central serous chorioretinopathy after sequential argon-neodymium: YAG laser iridotomies.

Laser peripheral iridotomy is the standard treatment for acute angle-closure glaucoma. A patient with acute angle-closure glaucoma who developed central serous chorioretinopathy after uneventful laser iridotomies is described. Central serous chorioretinopathy occurring after sequential argon-neodymium:YAG laser peripheral iridotomy is a novel complication in the English literature and is related to the stress induced by both the initial disease and the subsequent procedure, particularly in psychologically susceptible individuals.