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Macular Edema (macular + edema)
Selected Abstracts3414: Macular edema in ocular oncologyACTA OPHTHALMOLOGICA, Issue 2010L ZOGRAFOS To present various causes of Macular edema before and after therapy of in occular tumours. [source] Macular edema in epiretinal membrane and vitreomacular tractionACTA OPHTHALMOLOGICA, Issue 2009C CREUZOT Purpose Macular edema occuring during macular diseases is a frequent situation. The purpose of this course is to highlight the clinical signs and the different treatments which can be used to treat macular edema occuring during epiretinal membrane and vitreomacular traction syndrome. Methods Macular edema is frequently associated with epiretinal membranes and vitreomacular traction. Up to now, no specific preoperative macular edema phenotype can predict the postoperative recovery. Different methods were proposed to improve functional results: ILM peeling, intravitreal steroid injection, intravitreal antiangiogenic injections, Results The widespread use of transconjunctival vitrectomy, the combination of cataract and macular surgeries will probably change the indication of macular surgery leading to sooner surgical indications for better recovery. By contrast, vitreomacular traction often leads to a rapidly progressive visual loss. The analysis should distinguish diffuse diabetic macular edema which remains the only validated surgical indication of macular edema in diabetes and the vitreomacular traction without diabetes. This latter needs a rapid surgical management as macular edema is often severe. Conclusion Macular edema is a frequent situation associated to macular disease. It can compromise the outcomes after macular surgeriy. Attempts to define the best moment to consider surgery should improve the functional results. [source] Macular edema and uveitis: may we find a place for surgeryACTA OPHTHALMOLOGICA, Issue 2009M DE SMET [source] Vascular endothelial growth factor and diabetic retinopathy: pathophysiological mechanisms and treatment perspectivesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2003Ruth B. Caldwell Abstract Retinal neovascularization and macular edema are central features of diabetic retinopathy, the major cause of blindness in the developed world. Current treatments are limited in their efficacy and are associated with significant adverse effects. Characterization of the molecular and cellular processes involved in vascular growth and permeability has led to the recognition that the angiogenic growth factor and vascular permeability factor vascular endothelial growth factor (VEGF) plays a pivotal role in the retinal microvascular complications of diabetes. Therefore, VEGF represents an exciting target for therapeutic intervention in diabetic retinopathy. This review highlights the current understanding of the mechanisms that regulate VEGF gene expression and mediate its biological effects and how these processes may become altered during diabetes. The cellular and molecular alterations that characterize experimental models of diabetes are considered in relation to the influence of high glucose-mediated oxidative stress on VEGF expression and on the mechanisms of VEGF's actions under hyperglycemic induction. Finally, potential therapeutic strategies for preventing VEGF overexpression or blocking its pathological effects in the diabetic retina are considered. Copyright © 2003 John Wiley & Sons, Ltd. [source] 1263: Symptoms and signs of posterior uveitisACTA OPHTHALMOLOGICA, Issue 2010M KHAIRALLAH Purpose Posterior uveitis (PU) is an important anatomic form of uveitis in which the primary site of inflammation is the choroid or retina, with or without subsequent vitreous involvement. Methods Review of symptoms and signs of PU. Results The onset of PU can be sudden or less frequently insidious. Most common ocular symptoms include blurred vision, loss of vision, and floaters. Some patients with PU may have no symptoms, especially if inflammatory process is asymmetric. PU is usually associated with vitritis that can vary from mild to severe. Vitritis should be graded according to standardized grading systems. Other vitreous changes may include vitreous strands, vitreous hemorrhage, vitreous traction, and posterior vitreous detachment. Retinal and/or choroidal inflammation can be focal, multifocal, or more diffuse. It is important to distinguish between active and inactive chorioretinal disease. Retinal vasculitis can occur in the setting of several PU entities. It can involve retinal veins or arteries. It appears as focal, multifocal, or diffuse vascular cuffing or sheathing. Other retinal vasculitic changes include retinal hemorrhages, retinal vascular occlusion, retinal/optic disc neovascularization, and aneurysms. Maculopathy is common patients with PU. It may result from direct inflammatory infiltration, macular edema, serous retinal detachment, retinal ischemia, epiretinal membrane, or macular hole. Optic nerve involvement that can occur in association with PU include optic disc hyperemia/edema, optic neuritis, neuroretinitis, optic disc exudate, and optic disc granuloma. Conclusion Clinical examination is a key step in the diagnostic approach to PU. Clinician should be aware of the array of ocular symptoms of signs and their importance in orienting the differential diagnosis. [source] 1364: Complications of uveitis and their managementACTA OPHTHALMOLOGICA, Issue 2010M DE SMET Visual recovery in uveitis is hampered all too often by the onset of complications arising from the frequent recurrent episodes of inflammation. These may progress despite good control. The most frequent causes of vision loss related to uveitis are cataracts, cystoid macular edema, and glaucoma. It is important to understand the need for early recognition, appropriate and timely management as well as the treatment alternatives for these entities depending on the severity of the condition. [source] 2424: Pulsatile haemodynamics: potential for end-organ damage?ACTA OPHTHALMOLOGICA, Issue 2010C HUDSON Purpose Increases in velocity pulse wave amplitude, or max:min velocity ratio, represent early haemodynamic disturbances associated with diabetic retinopathy (DR) and age-related macular degeneration. This change reflects an increase in vessel wall rigidity that is generally accepted to occur in the central vasculature but the peripheral vasculature is also implicated in this process. This presentation will highlight the implications of these changes in terms of end-organ damage in DR. Methods The sample comprised 4 groups: Group 1: 50 non-diabetic control subjects. Group 2: 56 diabetic patients without clinically visible DR. Group 3: 54 diabetic patients with micro-aneurysms and / or hard exudates within 2 disc diameters of the fovea in the absence of clinically manifest diabetic macular edema (DME). Group 4: 40 patients with clinically manifest DME. The diabetic patients were predominantly type 2. Retinal hemodynamics were assessed in the superior temporal retinal arteriole using the Canon Laser Blood Flowmeter. Intraocular pressure, blood pressure and relevant systemic markers of diabetes control and complications were also assessed. Results The velocity pulse wave amplitude was elevated with increasing risk of DME (p<0.0001). No significant differences were found between the groups with respect to diameter, velocity or flow. Pulse wave amplitude was correlated to age, duration of diabetes, blood pressure, pulse rate, IOP and serum potassium levels. Conclusion The increase in velocity pulse wave amplitude will induce excessive pressure pulsatility in the retinal arterioles and capillaries, changes in vascular function (e.g. loss of vascular regulation) and changes in vessel structure. Commercial interest [source] 3411: Update on physiopathology of cystoid macular edemaACTA OPHTHALMOLOGICA, Issue 2010P MORA Purpose To offer an overview on the historical and most recent acquisitions about the mechanisms that have been proposed to explain how cystoid macular edema (CME) develops. Methods Review of the literature and presentation of personal evidences and imagines. Results CME represents an excessive presence of fluid within the layers of the retina. A breakdown in the blood-retinal barrier normally is the causative event for fluid to accumulate in cystoid spaces within the retina. Several mechanisms have been proposed to explain the blood-retinal barrier alteration and consequent CME formation. The intraocular diffusion of inflammatory mediators (eg, prostaglandins), following mechanical or biological insults, remains the most proven evidence. Another mechanism refers to the role of tractional forces on the macula from disruption of the normal vitreoretinal interface. According to this theory, a release of mediators that lead to a breakdown of the blood-retinal barrier, would have triggered mainly by local forces. Photic injury, finally, has been implicated in the development of pseudophakic or post-vitrectomy CME. Conclusion A full comprehension of the pathogenesis of CME will significantly help in focussing and developing an effective treatment even for the chronic form of CME. [source] 3412: Anti-VEGF and corticosteroids therapy in macular edema secondary to venous occlusionsACTA OPHTHALMOLOGICA, Issue 2010JAC POURNARAS Purpose To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema (ME) secondary to central (CRVO) and branch retinal vein occlusion (BRVO) Methods Recent randomized studies have evaluated the safety and efficacy of corticosteroids (triamcinolone, dexamethasone) and anti-VEGF therapies (ranibizumab). Score study evaluates preservative-free intravitreal triamcinolone with standard care in BRVO and CRVO. In Geneva study, dexamethasone (DEX) intravitreal implant is compared with sham in BRVO and CRVO. BRAVO and Cruise studies evaluate intraocular injections of ranibizumab in patients with ME following BRVO and CRVO, respectively. Results In SCORE study, there was no difference identified in visual acuity at 12 months for the standard care group compared with the triamcinolone groups in BRVO patients. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Improvements in BCVA with DEX implant were seen in patients with BRVO and CRVO, although the patterns of response differed. Intraocular injections of 0.3 mg or 0.5 mg ranibizumab provided rapid, effective treatment for ME following BRVO and CRVO Conclusion Grid photocoagulation remains the standard care for patients with vision loss associated with ME secondary to BRVO. Intravitreal triamcinolone is superior to observation for treating vision loss associated with ME secondary to CRVO. Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO. Anti-VEGF therapies represent new therapeutical option in the treatment of ME secondary to BRVO and CRVO. Further randomized studies are needed [source] 3413: Treatment options of macular edema in uveitisACTA OPHTHALMOLOGICA, Issue 2010Y GUEX-CROSIER Purpose To summarize current concepts on therapeutic approach in inflammatory cystoid macular edema (ICME). Methods A review of relevant literature concerning treatment options of ICME was performed. Results ICME is a major factor related to poor visual acuity in long term follow-up of uveitis. Topical corticosteroids administration has a minor therapeutic effect on ICME. Local therapies consist mostly of posterior sub-tenon's, intraocular corticosteroids injections or drug delivery systems. The effect of systemic corticosteroids, immunosuppressive agents or biological therapies will be discussed. Conclusion The recent development of drug delivery systems and biological therapies has considerably improved the prognosis of ICME. [source] 3415: Treatment of postoperative macular edemaACTA OPHTHALMOLOGICA, Issue 2010I PETROPOULOS Purpose Cystoid macular edema (CME) is a frequent complication of a number of interventions in ophthalmology, such as cataract surgery (Irvine-Gass syndrome), laser procedures, and trabeculectomy. The purpose of this talk is to present the latest bibliographic data regarding the appropriate treatment of postoperative CME. Methods A review of the existing literature concerning the treatment of postoperative CME is performed. Characteristic personal cases are presented. Results In more than two-thirds of the cases, postoperative CME resolves spontaneously within weeks or months. Prophylactic topical treatment with indomethacin or flurbiprofen seems to reduce the frequency of clinical and angiographic CME, but its beneficial effect on final visual acuity is not established. Curative therapy includes topical corticosteroids; topical non-steroidal anti-inflammatory drugs (e.g. ketorolac); oral acetazolamide; sub-Tenon or intravitreal injection of triamcinolone acetonide; intravitreal injection of anti-VEGF drugs; and pars plana vitrectomy. The indications, role, and efficacy of each of the above treatment modalities are discussed, based on the latest bibliographic data. Conclusion Most cases of postoperative CME are mild and resolve spontaneously. In refractory cases, sub-Tenon or intravitreal injection of triamcinolone acetonide can be effective, but the risk of ocular hypertony is high. Intravitreal injection of anti-VEGF drugs offers promising results, yet large-scale randomized studies are necessary to validate their utility. Finally, pars plana vitrectomy is the treatment of choice when vitreomacular traction and/or epiretinal membrane is present. [source] 3416: Surgical therapy of macular edemaACTA OPHTHALMOLOGICA, Issue 2010CJ POURNARAS Purpose Persistent macular oedema (ME) is the main cause of poor visual outcome during the evolution of retinal ischemic microangiopathies and traction related macular distortion. Among multiples treatment approaches, vitreoretinal surgery is applied with the goal to achieve the release of a traction related component of macular oedema . Methods Vitrectomy with peeling of the posterior hyaloid, epiretinal membranes, vitreoretinal tractions and/or internal limiting membrane removal, were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema with significant change in best corrected visual acuity, in epiretinal membranes, vitreoretinal traction syndrome and ischemic microangiopathies related macular thickening central, hemiretinal, branch retinal vein occlusion and diabetic macular edema). Evidence to date does not support any therapeutic benefit from radial optic neurotomy and arteriovenous crossing sheathotomy for BRVO and CRVO related macular oedema. Conclusion In the era of intravitreal injection of steroids and anti VEGF substances, vitrectomy seems to have a beneficial effect in traction related, selected pathologies associated to chronic macular edema. [source] 2412: Laser and oxygenACTA OPHTHALMOLOGICA, Issue 2010CJ POURNARAS Purpose To evaluate the changes in the retinal oxygen partial pressure (PO2) following photocoagulation as well as the resulting effect of the laser induced improved oxygenation, on the retinal vessels hemodynamics. Methods Measurements of the partial pressure of oxygen (PO2) distribution within the retina in various animal species using oxygen sensitive microelectrodes and evaluation of changes on the retinal vessels reactivity, following laser treatment, gave additional insights concerning photocoagulation mechanisms. Results Preretinal intervascular PO2 , far away from vessels, remain constant in all retinal areas. Intervascular intraretinal PO2 gradually decreases from both the vitreo-retinal interface and the choroid towards the mid-retina. Close to the pigment epithelium, it is significantly higher than at the vitreoretinal interface due to the much higher O2 supply provided by choroidal compaires to retinal circulation. Laser photocoagulation reduces the outer retina O2 consumption and allows O2 diffusion into the inner retina from the choroid raising the PO2 in the inner healthy retinal layers and in the preretinal intervascular normal areas. In this way, laser treatment relieves retinal hypoxia in experimental branch vein occlusion (BRVO). In patients with diabetic retinopathy (DR), the retinal PO2 is also higher in areas previously treated with laser. Following photocoagulation, the resulting reversal of hypoxia, the down-regulation of the VEGF expression, the retinal vasculature constriction and the improvement of the auto-regulatory response to physiological stimuli, all affect favorably both the retinal neovascularisation and macular edema. Conclusion Photocoagulation induces an increase of the inner retinal oxygenation resulting to an improvement of the autoregulatory retinal vessels response. [source] 2414: Laser and vitrectomyACTA OPHTHALMOLOGICA, Issue 2010E STEFANSSON Purpose Modern vitreous surgery involves a variety of treatment options in addition to vitrectomy itself, such as photocoagulation, anti-VEGF drugs, intravitreal steroids and release of vitreoretinal traction. A full understanding of these treatment modalities allows sensible combination of treatment options. Methods Vitrectomy reduces the risk of retinal neovascularization, while increasing the risk of iris neovascularization, reduces macular edema and stimulates cataract formation. These clinical consequences may be understood with the help of classical laws of physics and physiology. The laws of Fick, Stokes-Einstein and Hagen-Poiseuille state that molecular transport by diffusion or convection is inversely related to the viscosity of the medium. When the vitreous gel is replaced with less viscous saline, the transport of all molecules, including oxygen and cytokines, is facilitated. Oxygen transport to ischemic retinal areas is improved, as is clearance of VEGF and other cytokines from these areas, thus reducing edema and neovascularization. At the same time, oxygen is transported faster down a concentration gradient from the anterior to the posterior segment, while VEGF moves in the opposite direction, making the anterior segment less oxygenated and with more VEGF, stimulating iris neovascularization. Results Retinal photocoagulation has also repeatedly been shown to improve retinal oxygenation. Oxygen naturally reduces VEGF production and improves retinal hemodynamics. The VEGF-lowering effect of photocoagulation and vitrectomy can be augmented with anti-VEGF drugs and the permeability effect of VEGF reduced with corticosteroids Conclusion Vitrectomy and laser retinal treatment both improve oxygenation of the ischemic retina, reduce VEGF formation and thereby reduce neovascularisation and edema. [source] 2122: Role of prophylactic topical nepafenac in prevention of post pars-plana vitrectomy macular edemaACTA OPHTHALMOLOGICA, Issue 2010S MISHRA Purpose To evaluate the effects of topical nepafenac in patients undergoing pars plana vitrectomy (PPV) with special emphasis on its role in post PPV macular edema. Methods 108 patients undergoing PPV were randomized to receive either topical nepafenac 0.3% (53 eyes) or placebo (55 eyes) from 3 days preoperatively till 4 weeks postoperative in addition to topical steroids and antibiotics in this single center investigator masked study. Optical coherence tomography (OCT) was done at week 2,4,6 and 8 post operatively. Results Patients taking nepafenac and those taking placebo had mean postoperative day 1 pain scores of 0.25 and 1.08 (P=0.03) and mean inflammation grades of 0.49 and 1.34 (P=0.002) respectively. Although centre subfield macular thickness (CSMT) was lesser in nepafenac group as compared to placebo group (260.56 µm Vs 270.70 µm at week 2, 228.44 µm Vs 236.21 µm at week 4, 215.02 µm Vs 218.74 µm at week 6 and 205.35 µm Vs 205.17 µm at week 8 respectively), the difference did not reach statistically significant levels (P>0.05) at any visit. There was also, no statistically significant improvement in best corrected visual acuity between the nepafenac group and the placebo group at any postoperative visit. Conclusion Although addition of 0.3% nepafenac decreased postoperative pain and inflammation, it did not reduce incidence of macular edema in patients undergoing PPV. Topical nepafenac was well tolerated and safe but did not improve visual recovery in this set of patients. [source] Longterm results after phacovitrectomy and foldable intraocular lens implantationACTA OPHTHALMOLOGICA, Issue 8 2009Wensheng Li Abstract. Purpose:, This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co-existing vitreoretinal diseases. Methods:, We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results:, The most common indications for surgery were non-diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by , 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow-up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions:, Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co-existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract. [source] Evaluation of choroidal blood flow after treatment of retinal diseasesACTA OPHTHALMOLOGICA, Issue 2009C CHIQUET Purpose this review aims to summarize studies which assessed the effect of treatment on choroidal blood flow. Methods this presentation will focus on studies using the laser Doppler flowmeter for the analysis of choroidal blood flow parameters (velocity, volume and flow) before and after treatment. Therapies have been assessed in different ocular disease, such as age-related macular degeneration (laser photocoagulation therapy, photodynamic therapy, transpupillary thermotherapy, sildenafil citrate, niacin, pentoxifylline), diabetes mellitus (panretinal photocoagulation, intravenous C-peptide infusion), retinal vein occlusions (isovolemic hemodilution), macular edema (diclofenac), inflammation (corticosteroid), retinal detachment (surgery) or glaucoma (nimodipine, endothelin receptor antagonist, bimatoprost, timolol, trabeculectomy). Results this paper will give insight to the effects of laser treatment (laser photocoagulation, photodynamic therapy), surgery (scleral buckling, trabeculectomy, ocular anesthesia) or systemic drugs on the choroidal blood flow. Methodological considerations will be analyzed, such as the calculation of the sensitivity of the experiments, the comparisons of different groups with or without randomization. Conclusion laser Doppler flowmetry is a useful and a non invasive technique to study the effect of treatment on choroidal blood flow. In ocular disease, investigators should be aware of the tissue scattering changes associated with a retinal or choroidal disease and the necessity of a controlled foveal fixation. [source] Retinal photocoagulation and oxygenationACTA OPHTHALMOLOGICA, Issue 2009CJ POURNARAS Purpose The clinical role of photocoagulation for the treatment of hypoxia related complications of retinal ischemic microangiopathies is well established. Methods Measurements of the partial pressure of oxygen (PO2) distribution within the the retina in various animal species using oxygen sensitive microelectrodes and evaluation of the retinal vessels reactivity by laser doppler velocimetry gave additional insights concerning photocoagulation mechanisms. Results The PO2 within the vitreo-retinal interface is heterogeneous. Preretinal and trans-retinal PO2 profiles indicate that the preretinal PO2 far away from vessels remain constant in all retinal areas. Intervascular intraretinal PO2 gradually decreases from both the vitreo-retinal interface and the choroid towards the mid-retina. Close to the pigment epithelium, it is significantly higher than at the vitreoretinal interface due to the much higher O2 supply provided by choroidal compaires to retinal circulation. Laser photocoagulation reduces the outer retina O2 consumption and allows O2 diffusion into the inner retina from the choroid raising the PO2 in the inner healthy retinal layers and in the preretinal intervascular normal areas. In this way laser treatment relieves retinal hypoxia in experimental branch vein occlusion (BRVO). In patients with diabetic retinopathy (DR), the retinal PO2 is higher in areas previously treated with laser. Following photocoagulation, the resulting reversal of hypoxia, the retinal vasculature constriction and the improvement of the regulatory response to hyperoxia all affect favorably both the retinal neovascularisation and macular edema. Conclusion Photocoagulation induces an increase of the inner retinal oxygenation reversing the retinal hypoxia and improving the regulatory response of the retinal vessels [source] Non surgical approach in diabetic macular edema : the future ?ACTA OPHTHALMOLOGICA, Issue 2009C CHIQUET Purpose To present the different non surgical therapeutical options of diabetic macular edema Methods The pathogenesis of diabetic macular edema is multifactorial. Hyperglycemia and poor systemic factor balance are major risk factors. Laser treatemnts and antiagiogenic treatments represent the main non surgical options to treat macular edema. Results Focal macular edema remains the best indication of laser treatment. Laser remains also the standard of care of diffuse macular edema but some edemas remain resistant. Several therapeutic options have been proposed : Steroid intravitreal injection and antiVEGF therapy (either PKC inhibitors, VEGF aptamers or VEGF antibodies) represent the future alternative treatments as well as their potential combination. Conclusion Laser remains the main treatment of diabetic macular edema. However, steroids and antiangiogenic agents either isolated or combined represent the main alternative treatment for non responding diffuse macular edema. [source] Which place for surgery for macular edema due to diabetic retinopathy ?ACTA OPHTHALMOLOGICA, Issue 2009JB JONAS Purpose To present treatment options for macular edema Methods The various types of macular edema will briefly be discussed and available and potentially future treatment strategies will be presented. Results The results of the current multicenter trials as well as the findings of previous studies using different medical agents for the treatment of diabetic macular edema will be compared. Conclusion It may still be unclear which treatment strategy appears to be the best for which type of diabetic macular edema. Commercial interest [source] Is there still a place for vitrectomy in the treatment of macular edema due to venous occlusion ?ACTA OPHTHALMOLOGICA, Issue 2009CJ POURNARAS Purpose Persistent macular edema (ME) is the main cause of poor visual outcome in either non-ischemic BRVO or CRVO. Among multiples treatment approaches, vitreoretinal surgery with the goal to achieve the recanalisation of the occluded vessels and/or the resolution of ME, were proposed. Methods Vitrectomy with peeling of the posterior hyaloid and/or the internal limiting membrane,asociated to intravitreal (IVT) triamcinolone , neurotomy, sheathotomy, intravascular rtPA injection were studied in numerous nonrandomized cases series. Results Pars plana vitrectomy has been shown to reduce macular oedema and restore the normal foveal contour without significant change in best corrected visual acuity. In contrast, visual improvement occurs after vitrectomy for vitreous haemorrhage, epiretinal membrane formation and retinal detachment complicating BRVO. Evidence to date does not support any therapeutic benefit from radial optic neurotomy, optic nerve decompression, arteriovenous crossing sheathotomy or intravascular rtPA. Vitrectomy combined with IVT triamcinolone, induces a ME decrease rapidly and durably, without any improvement in visual acuity. Conclusion Vitrectomy with IVT triamcinolne seems to have a more durable effect than IVT triamcinolone alone.Vitrectomy, A-V sheathotomy combined with intravenous t-PA may offer benefits in BRVO. Despite uncertainty and open questions, surgical interventions are likely to be a therapeutic option for RVO in the future. Randomized and controlled studies are needed to confirm these results and to compare them to the natural course of the disease. [source] Macular edema in epiretinal membrane and vitreomacular tractionACTA OPHTHALMOLOGICA, Issue 2009C CREUZOT Purpose Macular edema occuring during macular diseases is a frequent situation. The purpose of this course is to highlight the clinical signs and the different treatments which can be used to treat macular edema occuring during epiretinal membrane and vitreomacular traction syndrome. Methods Macular edema is frequently associated with epiretinal membranes and vitreomacular traction. Up to now, no specific preoperative macular edema phenotype can predict the postoperative recovery. Different methods were proposed to improve functional results: ILM peeling, intravitreal steroid injection, intravitreal antiangiogenic injections, Results The widespread use of transconjunctival vitrectomy, the combination of cataract and macular surgeries will probably change the indication of macular surgery leading to sooner surgical indications for better recovery. By contrast, vitreomacular traction often leads to a rapidly progressive visual loss. The analysis should distinguish diffuse diabetic macular edema which remains the only validated surgical indication of macular edema in diabetes and the vitreomacular traction without diabetes. This latter needs a rapid surgical management as macular edema is often severe. Conclusion Macular edema is a frequent situation associated to macular disease. It can compromise the outcomes after macular surgeriy. Attempts to define the best moment to consider surgery should improve the functional results. [source] What is the consequence of retinal detachment on anatomy and function?ACTA OPHTHALMOLOGICA, Issue 2009C CREUZOT Purpose To present the structural and functional consequences on retina after retinal detachment Methods Author will show the consequences of experimental retinal detachment in animal models. These changes prevent retinal cells from a normal post-operative functioning. However, these conditions have to be differentiated from post-operative visual loss due to macular edema, long-standing subretinal fluid, epiretinal membrane or macular hole formation. Results Retinal detachment leads to severe changes on retinal cells: outer segment shortening, fibrosis, glial proliferation. This situation is the target of neuroprotective treatment. By contrast, some situations where the bad recevoery is due to an associated disease (edema, membrane...) illustrated by clinical cases can need surgical treatment. Conclusion Bad functional recovery after retinal detachment can be explained by anatomic consequences on photoreceptors with subclinical fibrosis or some associated complications. [source] Assessing macular edema- prognostic parameters by OCTACTA OPHTHALMOLOGICA, Issue 2009M DE SMET [source] High-definition Fourier domain OCT: non-invasive assessment of BRB changesACTA OPHTHALMOLOGICA, Issue 2009R BERNARDES Purpose To demonstrate the possibility of using a non-invasive imaging technique, the high-definition spectral domain optical coherence tomography, as a surrogate detector of blood-retinal barrier (BRB) breakdown. Methods Healthy volunteers and diabetic patients with diabetic retinopathy, age- related macular degeneration, choroidal neo-vascularisation and cystoid macular edema, underwent optical coherence tomography by Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA, USA). Profiles of reflectivity distribution between the inner-limiting membrane and the retinal pigment epithelium were built, normalized, aligned and compared. Patients underwent retinal leakage analyzer (RLA) to identify areas of retinal fluorescein leakage into the vitreous as areas of blood-retinal barrier breakdown. Results The comparison between healthy volunteers' and patients' reflectivity distribution demonstrates these profiles differ. Moreover, when comparing reflectivity distribution within the same eye between areas of leakage and areas of non-leakage, the sum of the squared differences is over one decade relatively to the comparison between two similar areas (leakage/leakage or non-leakage/non-leakage). Conclusion These findings suggest that high-definition OCT may be useful in identifying areas of retinal leakage/BRB breakdown and therefore to be used as surrogate for fluorescein angiography and retinal leakage analyzer. [source] Experience with adalimumab for the treatment of non-infectious uveitisACTA OPHTHALMOLOGICA, Issue 2009B DOBNER Purpose Objective: The aim of this study has been to assess the efficacy of adalimumab (ADA) in patients with uveitis in 3 centers. Methods In a retrospective study we identified patients from all instituitions´databases, who were treated with ADA in an average period of 20.16 months (range 1.3-45 months). The 5 criteria that the efficacy of ADA had been judged on are: reduction of macular edema by OCT, visual acuity, anterior chamber cells, reduction of flares and a reduction of prednisone dose during the treatment. At least one of the criteria had to be improved and none of the others worsened to declare treatment as effective. Results Of the 61 patients who were treated with ADA, 38 were treated for uveitis and systemic disease, 3 primarily for active systemic disease and 20 primarily for active uveitis. 15 patients had been treated before with etanercept and 11 with infliximab, with insufficient response. We saw an improvement in 49 out of these 61 patients (80,3%) in 1 or more criteria and worsening in none, 5 patients did not meet improvement criteria and were given additional or alternative treatment, three of them mainly due to activity of systemic disease. 14 out of 49 (28,6%)Patients showed an Improvement in every criteria, the other patients showed increasing in at least one criteria, the other criterias remained stable. At the last follow-up there were 50 (81,9%) patients still on ADA treatment. 11 patients stopped ADA treatment for different reasons (inefficacy, active systemic disease, pregnancy etc.). Conclusion In this retrospective study we judged that the treatment with ADA in patients with uveitis with or without systemic disease was effective in 80,3%. Clinical trials are warrented Commercial interest [source] Foveal serous detachment in juvenile idiopathic arthritis(JIA)-associated uveitisACTA OPHTHALMOLOGICA, Issue 2009F LIANG Purpose To characterize the foveal serous detachment(FSD) in JIA-associated uveitis. To investigate the correlation with visual acuity (VA) and ocular inflammation. Methods 9 children having FSD with JIA-associated uveitis were identified between 2005-2007. All were treated with periocular steroid injection and systemic anti-TNF , antibody.Outcome measures included VA,ocular inflammation quantified by laser flare photometry and the macular profile analyzed by OCT. Results All patients(8 female,1 male) had bilateral uveitis and 6 had bilateral SRD. All patients had risk factors to develop severe anterior uveitis. The mean age at the onset of uveitis and at the onset of FSD was 4.1±1.1years and 7.6±2.2years. At the onset of FSD 6 children were refractory to methotrexate and systemic corticosteroids. It had a high frequency of ocular complications:87% posterior synechiae, 80% cataract, 60% band keratopathy and 20% glaucoma.FSD appeared isolated in 21% of eyes,it was associated with diffuse macular edema in 46% and with cystoid macular edema in 12% of cases. Before therapeutic intensification,the mean VA was 0.46logMAR,the mean foveal thickness(FT) was 261,m. At 6 months follow-up:VA increased to 0.22logMAR(p=0.017),the reduction of flare was 41%(p=0.003),the mean FT was 229,m(p=0.59). At 12 months follow-up,the mean VA was 0.19logMAR(p=0.0029),the mean FT was 196,m(p=0.009),only 1 eye showed persistant SRD. Conclusion FSD is a late-stage complication of sustained and insufficiently treated anterior uveitis in JIA-associated uveitis and must be considered for the long-term visual outcome. An agressive immunomodulatory strategy is mandatory in order to achieve strict control of ocular inflammation and improve the visual function. [source] Macular thickness alterations after cataract surgery determined by optical coherence tomographyACTA OPHTHALMOLOGICA, Issue 2009M ELEFTHERIADOU Purpose To evaluate macular thickness alterations with optical coherence tomography after phacoemulsification and posterior champer intraocular lens implantation. Methods In this prospective study,201 patients who underwent phacoemulsication(102 men and 99 women)with mean age 65±8years were included.Best corrected visual acuity,complete slit lamp examination with lens and OCT examination were performed in all patients before surgery and at one,three and six months postoperatively.Patients were divided into five groups:Group 1(control group-100 eyes):patients without any predisponding factors for cystoid macular edema,Group 2(15 eyes):patients with complicated surgery,Group 3(27 eyes):patients with epiretinal membrane,Group 4(35 eyes):patients with diabetes and Group 5(24 eyes):patients with glaucoma. Results The preoperative mean minimal foveal thickness(MMFT)in groups 1 and 2 was 204±24,m and 213±47,m respectively and had no significant changes throughout the follow up period(p>0,05). In groups 3,4 and 5 a significant increase of macular thickness was detected. In group 3 the preoperative MMTF was 248±72,m and at 1,3 and 6 months it was 263±86,m(p=0,01),240±30,m(p=0,18)and 270±64,m(p<0,01)respectively. In group 4 the preoperative MMTF was 219±39,m,after 1month the MMTF increased at 257±78,m(p=0,002),at 3months it was 231±46,m(p=0,005)and at the last examination at 6 months it was 236±49,m(p=0,005). In group 5 the initially MMTF(206±21,m)had significant increase in the first[213±30,m(p=0,07)]and in the third month[223±24,m(p=0,03)]. Conclusion Diabetic retinopathy, epiretinal membranes and glaucoma may predispose to increase in macular thickness after cataract surgery. [source] Contribution of OCT to evaluate macular disease in JIA associated uveitisACTA OPHTHALMOLOGICA, Issue 2008B BODAGHI Purpose To examine the frequency and characteristics of macular lesions observed in Juvenile Idiopathic Arthritis (JIA) uveitis, using Optical Coherence Tomography (OCT). Methods In this cross-sectional study, 38 consecutive patients were recruited from a tertiary referral center in uveitis. All eyes with JIA uveitis underwent complete ophthalmic examination including OCT 3. Exclusion criterion was the inability to obtain OCT scans. Flare and visual acuity were also analyzed by using linear regression. Results We analyzed foveal thickness (FT) and central foveal thickness (CFT) using the software mapping, to describe macular lesions in 61 eyes. Maculopathy was observed in 51 eyes (84%), compared to 12% in the literature (P<0.0001) and comprised four types: perifoveolar thickening in 45 eyes (74%), macular edema in 29 eyes (48%), foveal detachment in 11 eyes (18%), and atrophic changes in 6 eyes (10%). Only 4 eyes did not demonstrate any lesion. Conclusion Among children with JIA-uveitis, macular involvement is frequent, and characterized by perifoveolar thickening and serous retinal detachment. OCT is a non-invasive instrument. It may easily show this maculopathy, which could impair visual function, and conditioned a therapeutic intensification. [source] Validity of non-mydriatic cameras for screening and follow-up in diabetic retinopathyACTA OPHTHALMOLOGICA, Issue 2007J IBANEZ Purpose: To determine the validity of a non-mydriatic camera for screening and grading diabetic retinopathy (DR). To establish the number of photographs and the field width needed for a correct DR follow-up. Methods: A cross-sectional, observational study was carried out to assess the validity of the non-mydriatic Topcon TRC-NW6S retinograph. Validity proportions were calculated. Kappa analysis was made to determine the agreement with conventional fundoscopy exploration performed by indirect ophthalmoscopy and retinal biomicroscopy. One 45º single-field non-mydriatic digital photograph was taken in 82 eyes for DR screening. For DR grading, several combinations of retinal fields were photographed in 247 eyes, first without pupillary dilatation and later with mydriasis. Results: In DR screening, 88.2% sensitivity and 96.9% specificity were obtained, where 9% of the tests were invalid. In DR grading diagnosis, the kappa analysis showed close agreement (k>0.8) based on at least two 45º photographs with mydriasis. However, when attempting to detect macular edema (ME), the maximum kappa statistic obtained did not go above 0.71, showing 67% maximum sensitivity. The sensitivity for detecting derivable DR was similar to that obtained with indirect ophthalmoscopy (94-98%). Conclusions: The non-mydriatic retinograph is a valid instrument for DR screening only when taking one 45º non-mydriatic photograph per eye. However, given that the sensitivity for proliferative DR (PDR) was worse, when grading DR, we would recommend obtaining nine retinal photographs (mosaic) with mydriasis. Used in this way, the apparatus is extremely useful for detecting derivable DR cases. [source] | ||||||||||