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Nassar GA, Makled HS, Youssef MM, Hassan LM. Functional and perfusion changes associated with silicone oil tamponade after macula-off rhegmatogenous retinal detachment surgery: an optical coherence tomography angiography/microperimetry study. Int Ophthalmol 2024; 44:107. [PMID: 38386180 PMCID: PMC10884141 DOI: 10.1007/s10792-024-03037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE The current study utilizes microperimetry and optical coherence tomography angiography (OCTA) to assess the optic nerve head vasculature, retinal microvasculature, and retinal sensitivity before and after silicone oil (SO) removal. METHODS This prospective observational case series study involved 30 eyes subjected to silicone oil endotamponade. Microperimetry and OCTA were utilized to assess the vascular density (VD) of the macula and optic nerve head, as well as the retinal sensitivity (RS), of the participants preoperatively and 1 month following SO removal. The correlation between the various parameters of OCTA and microperimetry was evaluated. RESULTS There was a significant improvement in the postoperative best-corrected visual acuity (BCVA) (p-value < 0.001) and the postoperative total RS, which was 6.38 ± 2.34 dB as compared to a mean preoperative total RS of 5.04 ± 2.06 dB (p-value < 0.001) and showing a significant increase in all rings. However, there was no significant difference in the pre and postoperative macular VD. On the other hand, there was a significant increase in the postoperative VD of the whole disk and the peripapillary capillary plexus, p-values < 0.001 and 0.002, respectively. CONCLUSION The removal of SO resulted in significant improvements in retinal sensitivity, vision, and optic nerve perfusion. However, no significant change was observed in macular VD. CLINICAL TRIALS gov Identifier: NCT04928196.
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Affiliation(s)
- Ghada A Nassar
- Ophthalmology Department, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Hebatalla Samir Makled
- Ophthalmology Department, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Maha Mohamed Youssef
- Ophthalmology Department, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Lameece Moustafa Hassan
- Ophthalmology Department, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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Prabha AJ, Venkatesan C, Fathimal MS, Nithiyanantham KK, Kirubha SPA. RD-OCT net: hybrid learning system for automated diagnosis of macular diseases from OCT retinal images. Biomed Phys Eng Express 2024; 10:025033. [PMID: 38335542 DOI: 10.1088/2057-1976/ad27ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/09/2024] [Indexed: 02/12/2024]
Abstract
Macular Edema is a leading cause of visual impairment and blindness in patients with ocular fundus diseases. Due to its non-invasive and high-resolution characteristics, optical coherence tomography (OCT) has been extensively utilized for the diagnosis of macular diseases. The manual detection of retinal diseases by clinicians is a laborious process, further complicated by the challenging identification of macular diseases. This difficulty arises from the significant pathological alterations occurring within the retinal layers, as well as the accumulation of fluid in the retina. Deep Learning neural networks are utilized for automatic detection of retinal diseases. This paper aims to propose a lightweight hybrid learning Retinal Disease OCT Net with a reduced number of trainable parameters and enable automatic classification of retinal diseases. A Hybrid Learning Retinal Disease OCT Net (RD-OCT) is utilized for the multiclass classification of major retinal diseases, namely neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusion (RVO), and normal retinal conditions. The diagnosis of retinal diseases is facilitated by the use of hybrid learning models and pre-trained deep learning models in the field of artificial intelligence. The Hybrid Learning RD-OCT Net provides better accuracy of 97.6% for nAMD, 98.08% for DME, 98% for RVO, and 97% for the Normal group. The respective area under the curve values were 0.99, 0.97, 1.0, and 0.99. The utilization of the RD-OCT model will be useful for ophthalmologists in the diagnosis of prevalent retinal diseases, due to the simplicity of the system and reduced number of trainable parameters.
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Affiliation(s)
- A Jeya Prabha
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu-603203, Tamil Nadu, India
| | - C Venkatesan
- Department of Ophthalmology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu-603203, Tamil Nadu, India
| | - M Sameera Fathimal
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu-603203, Tamil Nadu, India
| | - K K Nithiyanantham
- Department of Aeronautical Engineering, Rajalakshmi Engineering College, Thandalam , Kancheepuram-602105, Tamil Nadu, India
| | - S P Angeline Kirubha
- Department of Biomedical Engineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu-603203, Tamil Nadu, India
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Dou R, Li R, Li RC, Yu YR, Zhou JX, Li RM, Wang XP, Zhang DC, Jiang J, Chen S. Evaluation of retinal structural and functional changes after silicone oil removal in patients with rhegmatogenous retinal detachment: a retrospective study. Int J Retina Vitreous 2024; 10:1. [PMID: 38167553 PMCID: PMC10759386 DOI: 10.1186/s40942-023-00519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To evaluate retinal structural and functional changes after silicone oil (SO) removal in eyes with macula-off rhegmatogenous retinal detachment (RRD). METHODS Best-corrected visual acuity (BCVA) testing, microperimetry, and optical coherence tomography angiography were performed in 48 eyes with macula-off RRD before and 3 months after SO removal. The values of healthy contralateral eyes were used as control data. Correlations between retinal vessel density (VD), retinal nerve fiber layer thickness (RNFLT), the interval between retinal detachment and surgery, the duration of SO tamponade, the follow-up time after SO removal, and visual function were analyzed. RESULTS Significant increases in 2˚ fixation rate (FR), 4˚ FR, 2˚ mean retinal sensitivity (MRS), 6˚ MRS, parafoveal superficial capillary plexus VD and RNFLT were observed after SO removal (all P < 0.05). The increase of 2˚ MRS and 6˚ MRS were correlated with the duration of SO tamponade and the follow-up time after SO removal respectively (all P < 0.05). The last 2˚ MRS and 6˚ MRS were correlated with the duration of SO tamponade, the interval between retinal detachment and surgery, and the follow-up time after SO removal (all P < 0.01). The last FR in RRD eyes was close to that of contralateral eyes (P > 0.05). CONCLUSION Retinal structure and function improved to different degrees after SO removal. Fixation stability and retinal sensitivity increased more than BCVA postoperatively. Retinal sensitivity, which was affected by the interval between retinal detachment and surgery and the duration of SO tamponade, gradually recovered after SO removal.
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Affiliation(s)
- Ran Dou
- Department of Ophthalmology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, China
| | - Rui Li
- Shanxi Aier Eye Hospital, Taiyuan, 030000, Shanxi Province, China
| | - Rui-Chan Li
- Shanxi Aier Eye Hospital, Taiyuan, 030000, Shanxi Province, China
| | - Yan-Ru Yu
- Shanxi Aier Eye Hospital, Taiyuan, 030000, Shanxi Province, China
| | - Jin-Xiu Zhou
- Shanxi Aier Eye Hospital, Taiyuan, 030000, Shanxi Province, China
| | - Rui-Mei Li
- Shanxi Aier Eye Hospital, Taiyuan, 030000, Shanxi Province, China
| | - Xia-Ping Wang
- Shanxi Aier Eye Hospital, Taiyuan, 030000, Shanxi Province, China
| | - Dong-Chang Zhang
- Shanxi Aier Eye Hospital, Taiyuan, 030000, Shanxi Province, China
| | - Jian Jiang
- Department of Ophthalmology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, China.
| | - Song Chen
- Clinical College of Ophthalmology, Tianjin Eye Hospital, Tianjin Medical University, No.4 Gansu Road, Heping District, Tianjin, 300020, China.
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Tanaka T, Kase S, Saito M, Hirose I, Murata M, Takakuwa E, Ishida S. Clinicopathological findings in refractory diabetic macular edema: A case report. Biomed Rep 2024; 20:13. [PMID: 38124764 PMCID: PMC10731153 DOI: 10.3892/br.2023.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
The present study describes the case of a patient with refractory diabetic cystoid macular edema who underwent vitrectomy with en bloc removal of the cystoid lesion component. The current study also performed histopathological and immunohistochemical analyses of the cystoid lesion component to assess fibrin/fibrinogen and advanced glycation end-products (AGEs) immunoreactivity. A 69-year-old Japanese man presented with visual loss in the left eye due to residual cystoid macular edema (CME) refractory to anti-vascular endothelial growth factor therapy. Best-corrected visual acuity was 1.2 in the right eye (OD) and 0.5 in the left eye (OS). Fundus examination showed dot hemorrhages and hard exudates in the peri-macular region with pan-retinal photocoagulation scars in both eye. Swept-source optical coherence tomography revealed CME with slight hyperreflectivity in the cyst OS. A total of 3 months after the initial visit, pars plana vitrectomy was performed, and the translucent solidified component within the cystoid lesion was isolated. Histopathologically, the excised component was elliptical in shape, measuring 0.7x0.4 mm and exhibited homogeneous eosinophilic material without cellular components. No membranous structure was observed surrounding the component. Immunohistochemistry demonstrated that the tissue was positive for fibrin/fibrinogen and weakly positive for AGEs, but was negative for glial fibrillary acidic protein, type 1 collagen and receptor for AGEs. To the best of our knowledge, the present case report is the first to histopathologically examine the contents of refractory CME, and to immunohistochemically demonstrate that fibrin in diabetic CME may be post-translationally modified by AGEs. These results suggested that fibrin in CME may escape degradation by plasmin due to post-translational modifications.
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Affiliation(s)
- Takayuki Tanaka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Michiyuki Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Ikuyo Hirose
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Miyuki Murata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido 060-8648, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
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Kim AY, Moon JY, Jun RM, Kim HJ, Han KE. Ocular Surface and Tear Cytokine Changes after Cataract Surgery in Patients with Type 2 Diabetes. Ocul Immunol Inflamm 2023; 31:1615-1622. [PMID: 35787222 DOI: 10.1080/09273948.2022.2088565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate changes in ocular surface indices and tear cytokines after cataract surgery in type 2 diabetic patients. METHODS Ocular surface indices and concentrations of tear cytokines (MCP-1, IL-6, IL-8, and VEGF) were evaluated at baseline and one week and one month postoperatively. RESULTS Patients (30 diabetic and 30 control) were enrolled. In the diabetic group, changes in ocular symptom and tear breakup time remained until one month postoperatively (P < .05, respectively); in the control group, ocular symptom increased at one week postoperatively (P = .015). MCP-1 level in the diabetic group significantly increased postoperatively (all P < .05); however, in the control group, the IL-8 level was significantly decreased postoperatively (all P < .05). MCP-1 concentration was negatively correlated with TBUT in the diabetic group. CONCLUSION Diabetic patients can experience more prominent changes after surgery and these changes were accompanied by an increase of several tear cytokines.
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Affiliation(s)
- Ah Young Kim
- Department of Ophthalmology, Ewha Womans Univsersity, Seoul Hospital, Seoul, South Korea
| | - Ji Young Moon
- Department of Ophthalmology, Ewha Womans Univsersity, Mokdong Hospital, Seoul, South Korea
| | - Roo Min Jun
- Department of Ophthalmology, Ewha Womans Univsersity, Seoul Hospital, Seoul, South Korea
| | - Hyun Jin Kim
- Department of Ophthalmology, Ewha Womans Univsersity, Mokdong Hospital, Seoul, South Korea
| | - Kyung Eun Han
- Department of Ophthalmology, Ewha Womans Univsersity, Mokdong Hospital, Seoul, South Korea
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Baldwin G, Vingopoulos F, Zeng R, Wescott H, Bannerman A, Koch T, Wang K, Garg I, Katz R, Kim LA, Miller JB. Association Between Contrast Sensitivity and Central Subfield Thickness in Center-Involving Diabetic Macular Edema. JOURNAL OF VITREORETINAL DISEASES 2023; 7:232-238. [PMID: 37188217 PMCID: PMC10170612 DOI: 10.1177/24741264231165611] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To evaluate the association between contrast sensitivity (CS) and central subfield thickness (CST) in diabetic macular edema (DME). Methods: This prospectively recruited, cross-sectional study included eyes with DME evaluated from November 2018 to March 2021. CST was measured using spectral-domain optical coherence tomography on the same day as CS testing. Only eyes with center-involving DME (CST >305 µm for women; >320 µm for men) were included. CS was evaluated using the quantitative CS function (qCSF) test. Outcomes included visual acuity (VA) and the following qCSF metrics: area under the log CS function, contrast acuity (CA), and CS thresholds at 1 to 18 cycles per degree (cpd). Pearson correlation and mixed-effects regression analyses were performed. Results: The cohort included 52 eyes of 43 patients. Pearson correlation analysis showed a stronger association between CST and CS thresholds at 6 cpd (r = -0.422, P = 0.002) than CST and VA (r = 0.293, P = 0.035). Mixed-effects univariate and multivariate regression analyses showed significant associations between CST and CA (β = -0.001, P = .030), CS at 6 cpd (β = -0.002, P = .008), and CS at 12 cpd (β = -0.001, P = .049) but no significant associations between CST and VA. Among the visual function metrics, the effect size of CST was largest on CS at 6 cpd (βStandardized = -0.37, P = .008). Conclusions: In patients with DME, CS may be more strongly associated with CST than VA. Including CS as an adjunct visual function outcome measure in eyes with DME may prove clinically valuable.
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Affiliation(s)
- Grace Baldwin
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Hannah Wescott
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Augustine Bannerman
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Thomas Koch
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Kira Wang
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
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Sugimoto M, Wakamatsu Y, Miyata R, Kato K, Matsubara H, Kondo M. Effectiveness of microperimetry in evaluating anti-vascular endothelial growth factor therapy for diabetic macular edema patients with relatively good vision: A retrospective observational study. Medicine (Baltimore) 2021; 100:e28404. [PMID: 34941181 PMCID: PMC8702257 DOI: 10.1097/md.0000000000028404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/02/2021] [Indexed: 11/25/2022] Open
Abstract
No studies have evaluated the retinal sensitivity (RS) for diabetic macular edema (DME) patients with good vision. Therefore, this study aimed to determine the effectiveness of microperimetry in evaluating the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) treatment for DME patients with relatively good vision.Twenty-seven eyes of 27 patients (mean age, 61.3 ± 11.2 years) with DME and decimal best-corrected visual acuity (BCVA) ≥0.6 were studied. All patients received 3 consecutive monthly injections of intravitreal anti-VEGF agents. The BCVA, central subfield macular thickness (CMT), and RS were evaluated by microperimetry (MAIA) within the 10 degree of the foveal center. To determine significant differences between the values, we used paired t tests.Patients were evaluated at baseline and 4 weeks after the third injection. The BCVA improved significantly from 0.18 ± 0.06 logarithm of the minimum angle of resolution (logMAR) units to 0.13 ± 0.13 logMAR units (P = .002; paired t test). The CMT decreased significantly from 464.3 ± 91.8 μm to 393.4 ± 129.0 μm (P = .005), and the RS also improved significantly from 21.8 ± 3.1 dB to 24.1 ± 2.8 dB at 4 weeks after treatment (P = .006). Among the patients with a decimal BCVA of 0.7 or better at baseline, there was no significant improvement in the BCVA (P = .28). However, the CMT decreased significantly from 479.5 ± 79.1 μm to 394.0 ± 99.8 μm at 4 weeks after treatment (P = .007). The RS also improved significantly from 22.0 ± 2.4 dB to 24.0 ± 3.1 dB at 4 weeks after treatment (P = .004).Measuring RS by microperimetry is a good option for evaluating the effectiveness of anti-VEGF treatment for DME patients with a relatively good BCVA.
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Automated segmentation of macular edema for the diagnosis of ocular disease using deep learning method. Sci Rep 2021; 11:13392. [PMID: 34183684 PMCID: PMC8238965 DOI: 10.1038/s41598-021-92458-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
Macular edema is considered as a major cause of visual loss and blindness in patients with ocular fundus diseases. Optical coherence tomography (OCT) is a non-invasive imaging technique, which has been widely applied for diagnosing macular edema due to its non-invasive and high resolution properties. However, the practical applications remain challenges due to the distorted retinal morphology and blurred boundaries near macular edema. Herein, we developed a novel deep learning model for the segmentation of macular edema in OCT images based on DeepLab framework (OCT-DeepLab). In this model, we used atrous spatial pyramid pooling (ASPP) to detect macular edema at multiple features and used the fully connected conditional random field (CRF) to refine the boundary of macular edema. OCT-DeepLab model was compared against the traditional hand-crafted methods (C-V and SBG) and the end-to-end methods (FCN, PSPnet, and U-net) to estimate the segmentation performance. OCT-DeepLab showed great advantage over the hand-crafted methods (C-V and SBG) and end-to-end methods (FCN, PSPnet, and U-net) as shown by higher precision, sensitivity, specificity, and F1-score. The segmentation performance of OCT-DeepLab was comparable to that of manual label, with an average area under the curve (AUC) of 0.963, which was superior to other end-to-end methods (FCN, PSPnet, and U-net). Collectively, OCT-DeepLab model is suitable for the segmentation of macular edema and assist ophthalmologists in the management of ocular disease.
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Yamada H, Imai H, Tetsumoto A, Hayashida M, Otsuka K, Miki A, Kusuhara S, Nakamura M. Cystotomy with or without fibrinogen clot removal for refractory cystoid macular edema secondary to branch retinal vein occlusion. Sci Rep 2021; 11:8460. [PMID: 33875734 PMCID: PMC8055692 DOI: 10.1038/s41598-021-88149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
To demonstrate the long-term effect of cystotomy with or without fibrinogen clot removal for treatment-resistant cystoid macular edema (CME) secondary to branch retinal vein occlusion (BRVO). Retrospective clinical study. We retrospectively analyzed medical records of 22 eyes of 22 patients with treatment-resistant CME secondary to BRVO with 12 months observation after cystotomy with or without fibrinogen clot removal. Patients included 11 women and 11 men. The mean ± SD age was 72.7 ± 10.2 years. LogMAR-converted best corrected visual acuity (BCVA) was statistically better at 12 months after surgery (0.30 ± 0.30) than preoperative BCVA (0.39 ± 0.27) (p = 0.01). The central sensitivity of microperimetry (dB) was maintained during follow-up (preoperative sensitivity: 25.4 ± 4.1, postoperative sensitivity at 12 months after the surgery: 25.9 ± 4.2, p = 0.69). Twelve months after surgery, there was a significant improvement in the central retinal thickness (CRT) on optical coherence tomography (OCT) (303.7 ± 80.1) (μm) compared with the preoperative CRT (524.2 ± 114.8) (p < 0.01). In 12 months, CME recurred in 3 of 22 eyes. The preoperative reflectivity in cystoid cavity on OCT was significantly higher in patients with fibrinogen clot removal (n = 5) than in patients without fibrinogen clot removal (n = 17) (p < 0.01). For treatment-resistant CME secondary to BRVO, Cystotomy with or without fibrinogen clot removal may be one of the treatment options.
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Affiliation(s)
- Hiroko Yamada
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hisanori Imai
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Akira Tetsumoto
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Mayuka Hayashida
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keiko Otsuka
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Kobe Kaisei Hospital, 3-11-15 Shinohara Kitamachi, Nada-ku, Kobe, 657-0068, Japan
| | - Akiko Miki
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery-Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Imai H, Tetsumoto A, Yamada H, Hayashida M, Otsuka K, Miki A, Kusuhara S, Nakamura M. LONG-TERM EFFECT OF CYSTOTOMY WITH OR WITHOUT THE FIBRINOGEN CLOT REMOVAL FOR REFRACTORY CYSTOID MACULAR EDEMA SECONDARY TO DIABETIC RETINOPATHY. Retina 2021; 41:844-851. [PMID: 32732609 DOI: 10.1097/iae.0000000000002921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To show the long-term effect of cystotomy with or without fibrinogen clot removal for refractory cystoid macular edema secondary to diabetic retinopathy. METHODS Retrospective analyses of the medical records of 30 eyes of 30 patients with refractory cystoid macular edema secondary to diabetic retinopathy who had followed up for 12 months after the surgery were performed. RESULTS There were 15 men and 15 women. The mean ± SD age was 68.4 ± 7.9 years. The best-corrected visual acuity (logarithm of the minimal angle of resolution) at 12 months after the surgery (0.33 ± 0.25, Snellen equivalent, 20/42) was statistically better than the preoperative best-corrected visual acuity (0.45 ± 0.33, Snellen equivalent, 20/56) (P < 0.01). The central sensitivity on microperimetry (dB) was not statistically changed between preoperatively (24.0 ± 4.9) and 12 months after the surgery (24.1 ± 4.0) (P = 0.75). The central retinal thickness on optical coherence tomography (μm) at 12 months after the surgery (300.3 ± 99.0) was statistically improved compared with the preoperative central retinal thickness (565.6 ± 198.7) (P < 0.01). During the follow-up period, cystoid macular edema relapsed in seven of 30 eyes. The preoperative cystoid cavity reflectivity on optical coherence tomography in patients with fibrinogen clot removal (n = 16) was significantly higher than that in patients without fibrinogen clot removal (n = 14) (P < 0.04). CONCLUSION The cystotomy with or without fibrinogen clot removal may be a promising treatment option for refractory cystoid macular edema secondary to diabetic retinopathy.
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Affiliation(s)
- Hisanori Imai
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
| | - Akira Tetsumoto
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
| | - Hiroko Yamada
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
| | - Mayuka Hayashida
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
| | - Keiko Otsuka
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
- Kobe Kaisei Hospital, Nada-ku, Kobe, Japan
| | - Akiko Miki
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
| | - Sentaro Kusuhara
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
| | - Makoto Nakamura
- Department of Surgery-related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan ; and
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Abstract
Purpose: Evaluate the prevalence and incidence, demographic characteristics, anatomical classification, concomitant complications and treatment of uveitis, as well as its association with systemic diseases in the northern Portuguese population referred to a tertiary care centre (São João Hospital, Porto).Methods: A retrospective observational study of 545 consecutive uveitis cases was performed between 12th April 2012 and the 26th October 2017. Uveitis was classified according to Standard Uveitis Nomenclature, while aetiology and complications were diagnosed by specific clinical and laboratory testing.Results: Prevalence was calculated to be 12,4 cases per 100,000 people while incidence was 3.9 cases per 100,000 people annual incidence. The ratio of females to males was 1.32:1 and the mean age at diagnosis was 47,86 years. Anterior uveitis was the most common classification making up 47.5%, followed by non-infectious posterior uveitis 18,0%, infectious posterior uveitis 8,4%, intermediate uveitis 5,5% and panuveitis 4,2%. Extra-uveal entities made up the rest of the causes (16.4%). In terms of aetiology, the majority of uveitis was idiopathic (32,1%) followed by axial spondylarthritis (12.1%), Behçet's disease (8,8%), sarcoidosis (6,1%), tuberculosis (5,5%), herpes (5,1%), toxoplasmosis (3,1%) among other less frequent causes.Conclusion: In our referral region, 72% of uveitis cases were correctly identified surpassing other studies. There was a higher rate of intermediate uveitis and lower number of panuveitis cases when compared to a previous Portuguese study. Extensive monitoring of the development of uveitis by international multicentre prospective studies could be useful for increasing practitioner awareness and diagnostic approach.
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Affiliation(s)
- Lukasz Hermann
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Ophthalmology, Hospital S. João, Porto, Portugal
| | - Luís Figueira
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Ophthalmology, Hospital S. João, Porto, Portugal.,Center for Drug Discovery and Innovative Medicines (Medinup), University of Porto, Porto, Portugal
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12
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EFFECTIVENESS OF EN BLOC REMOVAL OF FIBRINOGEN-RICH COMPONENT OF CYSTOID LESION FOR THE TREATMENT OF CYSTOID MACULAR EDEMA. Retina 2021; 40:154-159. [PMID: 30334924 DOI: 10.1097/iae.0000000000002359] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To introduce the methodology and outcomes of en bloc removal of the component of cystoid lesion during pars plana vitrectomy as a novel approach for the treatment of cystoid macular edema and show evidence that the component is an aggregation of fibrinogen by mass spectrometry analysis. METHODS The surgical en bloc extraction of the component of cystoid lesion was performed for cystoid macular edemas secondary to diabetic retinopathy and retinal vein occlusion. Perioperative change of best-corrected decimal visual acuity, and the central retinal thickness and the continuity of subfoveal ellipsoid zone and external limiting membrane on optical coherence tomography were evaluated. Mass spectrometry was performed for the identification of protein constituting the component. RESULTS Six eyes from six patients were included in the study. In all cases, central retinal thickness was improved after the surgery and remained stable during the follow-up period. Best-corrected decimal visual acuity and the continuity of ellipsoid zone and external limiting membrane were kept in all cases during the follow-up period. The mass spectrometry analysis disclosed that the component was composed of fibrinogen. CONCLUSION The en block removal of the component of cystoid lesion combined with pars plana vitrectomy may be a promising option for treatment of cystoid macular edema. The component of cystoid lesion is presumably a fibrinogen aggregate.
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Khochtali S, Tugal-Tutkun I, Fardeau C, Maestri F, Khairallah M. Multimodality Approach to the Diagnosis and Assessment of Uveitic Macular Edema. Ocul Immunol Inflamm 2020; 28:1212-1222. [DOI: 10.1080/09273948.2020.1797112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Christine Fardeau
- Ophthalmology Department, Reference Centre for Rare Diseases, Pitié-Salpétrière Hospital, University Paris VI, DHU Sight Restore, Paris, France
| | - Federico Maestri
- Ophthalmology Department, Reference Centre for Rare Diseases, Pitié-Salpétrière Hospital, University Paris VI, DHU Sight Restore, Paris, France
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Cho JH, Bae SH, Kim HK, Shin YJ. Optical Quality Assessment in Patients with Macular Diseases Using Optical Quality Analysis System. J Clin Med 2019; 8:jcm8060892. [PMID: 31234385 PMCID: PMC6617055 DOI: 10.3390/jcm8060892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
Macular diseases cause vision loss, as the macula is the functional center for vision. In this study we assessed optical quality in eyes with macular diseases and evaluated the effectiveness of the Optical Quality Analysis System (OQAS) to detect macular diseases. We analyzed 88 eyes of 88 patients with macular diseases (51 men and 37 women; mean age: 65.24 ± 12.96 years) and 43 eyes of 43 control subjects (11 men and 32 women; mean age: 54.70 ± 15.03 years). The macular diseases included age-related macular disease (n = 62), diabetic macular edema (n = 19), and retinal vein occlusion (n = 7). We measured the objective scattering index (OSI), modulation transfer function (MTF), Strehl ratio, and predicted visual acuities (PVAs) at 100, 20, and 10% contrast levels in both groups using OQAS. We measured the retinal thickness in the macular disease group on optical coherence tomography. The macular disease and control groups significantly differed in OSI, MTF, Strehl ratio, and PVAs at 20 and 10% contrast levels (p < 0.05). In the macular disease group, retinal thickness correlated with OSI (r = 0.370, p < 0.001) and MTF (r = -0.264, p = 0.014). In conclusion, optical quality was worse in the patients with macular diseases compared to the control subjects, and retinal thickness affected optical quality. Therefore, the distortion of macular shape may contribute to vision disturbance in patients with macular diseases.
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Affiliation(s)
- Joon Hee Cho
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea.
- Hyemin Eye Hospital, Seoul 05829, Korea.
| | - So Hyun Bae
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea.
| | - Ha Kyoung Kim
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea.
| | - Young Joo Shin
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea.
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Multimodal OCT Reflectivity Analysis of the Cystoid Spaces in Cystoid Macular Edema. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7835372. [PMID: 31016197 PMCID: PMC6446091 DOI: 10.1155/2019/7835372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/12/2018] [Accepted: 12/30/2018] [Indexed: 11/24/2022]
Abstract
Purpose To compare and evaluate images of macular cysts with different degrees of reflectivity (from gray to black signal) as observed in B scan spectral domain OCT (SDOCT) and EnFace OCT with decorrelation signal obtained with OCT-angiography (OCTA) in eyes with cystoid macular edema (CME) secondary to diabetic retinopathy (DR) and retinal vein occlusion (RVO). Methods Images from 3033 patients affected by CME secondary to diabetes or RVO examined OCTA (Optovue XR Avanti, Optovue, USA) at the University Eye Clinic of Créteil, Hôpital Intercommunal, France, and at the University Eye Clinic of Cagliari, “San Giovanni di Dio” Hospital, Italy, were retrospectively examined. The deep capillary plexus OCTA images and the corresponding EnFace OCT images, both acquired with the same automatic segmentation, had been overlapped to compose RGB color images as red and green channels, respectively, using ImageJ software (National Institutes of Health, Bethesda, MD). Afterward, linear regions of interest were traced on the color images to obtain the profiles of OCTA and EnFace gray values. Number of pixels, mean gray value and standard deviation of the area traced in OCT-A, and EnFace image were analyzed and statistically correlated. Data were exported to Excel to create the plots. Results 94 patients with DME and 27 patients with RVO showed intraretinal macular cystoid spaces with similar homogeneous, gray-looking content; 73 patients with DME and 113 patients with RVO showed macular cystoid spaces with homogeneous, black-looking content, as observed at SD-OCT, EnFace and OCTA scans. Interestingly, the limits of macular cystoid spaces were clearly detectable with OCTA. The analysis of red and green profiles demonstrated a clearly visible overlap between average OCTA and EnFace signal observed around cystoid spaces that could be attributed to a relationship between the dynamic vascularization and the structural density of the tissue. Conclusions This is the first investigation that characterizes and correlates OCTA and EnFace signals on images of macular cystoid spaces in DR and RVO. The low intensity OCTA signals observed inside cystoid spaces raise a relevant question about their nature, as to whether they are due to the presence of corpusculated material pouring out from bloodocular-barrier or they should be considered OCTA artifacts.
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Choi W, Park SE, Kang HG, Byeon SH, Kim SS, Koh HJ, Lee S, Seong GJ, Kim CY, Kim M. Intraocular pressure change after injection of intravitreal dexamethasone (Ozurdex) implant in Korean patients. Br J Ophthalmol 2018; 103:1380-1387. [PMID: 30523044 DOI: 10.1136/bjophthalmol-2018-312958] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/26/2018] [Accepted: 11/14/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIMS To analyse intraocular pressure (IOP) changes over a period of 1 year after intravitreal dexamethasone (DEX, Ozurdex) implant injection and to compare the results with those of previously published studies that involved non-Asian populations. METHODS A retrospective observational study was conducted. A total of 540 eyes of 503 patients who received DEX implant injection and were diagnosed with macular oedema (ME) due to various retinal diseases were examined. IOP was measured prior to injection and at 1 week, 1 month, 2 months, 3 months, 6 months and 12 months after DEX implant injection. IOP elevation was divided into four categories: postinjection IOP of >35 mm Hg, >30 mm Hg and >25 mm Hg, and an IOP elevation of >10 mm Hg, relative to the baseline measurement. RESULTS The mean baseline IOP was 13.45±2.95. The mean IOP gradually increased until 2 months postinjection (IOP=16.85±5.96 mm Hg, p<0.001) and then gradually decreased until 12 months postinjection (IOP=13.80±4.04mm Hg, p=0.16). IOP was >25 mm Hg in 57 eyes (10.6%), >30mm Hg in 29 eyes (5.4%) and >35mm Hg in 9 eyes (1.7%); IOP exhibited >10 mm Hg elevation from the baseline IOP in 61 eyes (11.3%). Overall, the incidence rate of IOP elevation after DEX treatment was 12.6% (68 eyes). Among the 68 eyes (12.6%) with elevated IOP, 60 (11.1%) required treatment: 59 (10.9%) required IOP-lowering medication and 1 (0.2%) ultimately required surgical interventions. CONCLUSIONS The incidence of adverse IOP elevation requiring the prolonged use of IOP-lowering medication and surgical intervention after DEX implantation was significantly lower than the incidence reported in previous Western population-based studies. Intravitreal DEX injection may therefore be an effective and relatively safe treatment modality for ME in Asian patients.
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Affiliation(s)
- Wungrak Choi
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Park
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungchul Lee
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gong Je Seong
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Bastakis GG, Dimopoulos D, Stavrakakis A, Pappas G. Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema. Eye (Lond) 2018; 33:411-418. [PMID: 30302004 DOI: 10.1038/s41433-018-0219-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 08/04/2018] [Accepted: 08/16/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficacy and duration of action of an intravitreal (dexamethasone (Ozurdex)) implant in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema (DMO). METHODS We retrospectively analysed the records for 18 eyes that had or had not been vitrectomised but required an intravitreal dexamethasone implant for DMO after a poor response to anti-vascular endothelial growth factor. Optical coherence tomography and visual acuity (VA) examinations were performed before and 1, 3 and 6 months after implantation. The six months following implantation constituted one treatment round; up to three rounds were studied. RESULTS Ten of 18 eyes had undergone vitrectomy. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were significantly improved by months 1-3 after implantation of the Ozurdex device in all rounds of treatment. The BCVA and CMT deteriorated gradually after month 3 through to month 6 post implantation. There were no statistically significant differences between the vitrectomised and non-vitrectomised groups at any time point. When the implantation interval was <6 weeks from the end of each treatment round, the improvement in BCVA and CMT was obvious even after 18 months of treatment. CONCLUSIONS Vitrectomy did not have a negative effect on the duration of action or efficacy of the Ozurdex implant in patients with persistent DMO. The implant started working from the first month after implantation regardless of whether vitrectomy had or had not been performed. The maximum functional and anatomic improvement was achieved in the first 3 months post implantation in all treatment rounds.
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Affiliation(s)
- George G Bastakis
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece
| | - Dimitris Dimopoulos
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece
| | - Anastasios Stavrakakis
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece
| | - George Pappas
- Ophthalmology Clinic, Medical Retina & Vitreoretinal Surgery Department, Venizeleio Hospital of Crete, Knossos avenue 44, Crete, 71409,, Heraklion, Greece.
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Scheerlinck LM, Schellekens PA, Liem AT, Steijns D, van Leeuwen R. Retinal sensitivity following intraocular silicone oil and gas tamponade for rhegmatogenous retinal detachment. Acta Ophthalmol 2018; 96:641-647. [PMID: 29498239 DOI: 10.1111/aos.13685] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate whether intraocular silicone oil (SO) tamponade is associated with functional changes in patients with both macula-on and macula-off rhegmatogenous retinal detachments (RRDs). METHODS Prospective observational cohort study of patients with RRD treated by vitrectomy with gas or SO tamponade at the University Medical Center Utrecht. Outcome was best-corrected visual acuity (BCVA) and retinal sensitivity on microperimetry 2 months after surgery. RESULTS In total, 40 eyes were included. There are 10 eyes in each of the following groups: macula-on RRD and gas, macula-on RRD and SO, macula-off RRD and gas, and macula-off RRD and SO. Median retinal sensitivity on microperimetry was decreased following SO tamponade compared to gas tamponade for both macula-on and macula-off RRD (p < 0.037). CONCLUSION Foveal sensitivity was decreased in eyes after SO tamponade compared to gas tamponade. These effects were observed in patients with macula-on as well as macula-off RRD. Although further investigation is warranted to validate our results and to study underlying mechanisms, retinal surgeons need to be aware of these findings after the use of SO tamponade.
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Affiliation(s)
- Laura M. Scheerlinck
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Peter A. Schellekens
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Albert T. Liem
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Daan Steijns
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Redmer van Leeuwen
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
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19
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Obeid A, Su D, Patel SN, Uhr JH, Borkar D, Gao X, Fineman MS, Regillo CD, Maguire JI, Garg SJ, Hsu J. Outcomes of Eyes Lost to Follow-up with Proliferative Diabetic Retinopathy That Received Panretinal Photocoagulation versus Intravitreal Anti-Vascular Endothelial Growth Factor. Ophthalmology 2018; 126:407-413. [PMID: 30077614 DOI: 10.1016/j.ophtha.2018.07.027] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare anatomic and functional outcomes in eyes with proliferative diabetic retinopathy (PDR) that were lost to follow-up (LTFU) for more than 6 months after treatment with either intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) agents or panretinal photocoagulation (PRP). DESIGN Retrospective cohort study. PARTICIPANTS Fifty-nine patients who were LTFU immediately after treatment for more than 6 months between September 2013 and September 2016. METHODS Patients with eyes receiving either intravitreal anti-VEGF treatment or PRP with the next follow-up visit occurring more than 6 months after treatment were identified. Visual acuity (VA) and anatomic outcomes at the visit before being LTFU, the return visit, the 6-month visit after return, the 12-month visit after return, and the final visit were gathered and compared between the 2 treatment groups. MAIN OUTCOMES MEASURES Visual acuity and anatomic outcomes. RESULTS Seventy-six eyes of 59 patients were included in the study, of which 30 received IVI with anti-VEGF and 46 received PRP. In the anti-VEGF group, mean VA worsened significantly when comparing the visit before being LTFU (0.43±0.38 logarithm of the minimum angle of resolution [logMAR]) with the return visit (0.97±0.80 logMAR; P = 0.001) as well as with the final visit (0.92±0.94 logMAR; P = 0.01). In the PRP group, mean VA worsened significantly when comparing the visit before being LTFU (0.42±0.34 logMAR) with the return visit (0.62±0.64 logMAR; P = 0.03). However, no significant difference was observed at the final visit (0.46±0.47 logMAR; P = 0.38). There was a significantly greater number of eyes with tractional retinal detachment in the IVI group compared with the PRP group at the final visit (10 vs. 1, respectively; P = 0.005). There was a significantly greater incidence of neovascularization of the iris in the IVI arm compared with the PRP arm at the final visit (4 vs. 0, respectively; P = 0.02). CONCLUSIONS Eyes with PDR that received only intravitreal anti-VEGF demonstrated worse anatomic and functional outcomes after being LTFU compared with eyes that received PRP. Given the potential sequelae of being LTFU, the choice of treatment for PDR must be considered carefully.
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Affiliation(s)
- Anthony Obeid
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Daniel Su
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Samir N Patel
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Joshua H Uhr
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Durga Borkar
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Xinxiao Gao
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Mitchell S Fineman
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Carl D Regillo
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Joseph I Maguire
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
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Metamorphopsia Score and Central Visual Field Outcomes in Diabetic Cystoid Macular Edema. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4954532. [PMID: 29744359 PMCID: PMC5878917 DOI: 10.1155/2018/4954532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/18/2018] [Accepted: 01/31/2018] [Indexed: 11/23/2022]
Abstract
Aim To detect abnormality of the visual function in naïve patients with cystoid diabetic macular edema (DME) using M-charts, Amsler test, and white on white (W/W) and blue on yellow (B/Y) perimetry. Methods There were 64 eyes included in the study: 30 eyes with DME, 22 eyes with diabetes without DME, and 12 eyes of normal subjects. Conventional W/W perimetry and B/Y perimetry were performed within the central 10° of the visual field. To assess metamorphopsia, Amsler test and M-charts were used. Results The rate of detection of metamorphopsia was 37% with Amsler test examination and 50% with M-charts. Specificity of both tests was 100%. We found a significant difference between vertical scores of M-charts in all groups, but not in horizontal scores (p < 0.0001). Mean defect (MD) was 8.9 dB and 3.6 dB and loss variance (LV) 4.8 dB and 3.3 dB (p < 0.0001). Conclusions M-chart is more sensitive than Amsler test method for detection of metamorphopsia. The MD and LV are higher in b/y in comparison to W/W perimetry. B/Y perimetry and M-charts are more sensitive than conventional methods for detecting the visual function loss in cystoid DME.
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Takeyama M, Takeuchi F, Gosho M, Sugita K, Zako M, Iwaki M, Kamei M. Effect of oral tranexamic acid on macular edema associated with retinal vein occlusion or diabetes. Clin Ophthalmol 2018; 12:35-41. [PMID: 29339919 PMCID: PMC5745154 DOI: 10.2147/opth.s149935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose Tranexamic acid (TXA) is a widely used antifibrinolytic agent that can also cause a decrease in vascular permeability. We hypothesized that TXA could improve macular edema (ME) that is caused by an increase in retinal vascular permeability. The aim of this study is to evaluate the efficacy of oral TXA for ME associated with retinal vein occlusion (RVO) or diabetic ME (DME). Patients and methods Oral TXA (1,500 mg daily for 2 weeks) was administered to patients with persistent ME secondary to RVO (7 eyes) and DME (7 eyes). After 2 weeks (ie, the final day of administration) and 6 weeks (ie, 4 weeks after the final administration), best-corrected visual acuity and central macular thickness (CMT) were measured and compared with baseline. Analyses were performed for RVO and DME cases. No other treatment was performed during the study period. Results In RVO cases, significant improvement in CMT was found between baseline (467.7±121.4 μm) and 2-week measurements after treatment (428.7±110.5 μm, p=0.024). No significant change was found in CMT between measurements taken at baseline and 6 weeks after treatment. In DME cases, no significant change was found in CMT between measurements taken at baseline and 2 or 6 weeks after treatment. In all analyses of best-corrected visual acuity, no significant change was observed. Conclusion The results support the hypothesis that plasmin plays a role in the development of ME associated with RVO, and oral TXA administration may be useful as an adjuvant treatment when combined with other agents such as anti-vascular endothelial growth factor.
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Affiliation(s)
| | - Fumio Takeuchi
- Department of Biochemistry, Aichi Medical University, Nagakute
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Keijiro Sugita
- Department of Ophthalmology, Aichi Medical University, Nagakute
| | | | - Masayoshi Iwaki
- Department of Ophthalmology, Yokkaichi, Digestive Disease Center, Komono, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Nagakute
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22
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Mechanisms of macular edema: Beyond the surface. Prog Retin Eye Res 2017; 63:20-68. [PMID: 29126927 DOI: 10.1016/j.preteyeres.2017.10.006] [Citation(s) in RCA: 357] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023]
Abstract
Macular edema consists of intra- or subretinal fluid accumulation in the macular region. It occurs during the course of numerous retinal disorders and can cause severe impairment of central vision. Major causes of macular edema include diabetes, branch and central retinal vein occlusion, choroidal neovascularization, posterior uveitis, postoperative inflammation and central serous chorioretinopathy. The healthy retina is maintained in a relatively dehydrated, transparent state compatible with optimal light transmission by multiple active and passive systems. Fluid accumulation results from an imbalance between processes governing fluid entry and exit, and is driven by Starling equation when inner or outer blood-retinal barriers are disrupted. The multiple and intricate mechanisms involved in retinal hydro-ionic homeostasis, their molecular and cellular basis, and how their deregulation lead to retinal edema, are addressed in this review. Analyzing the distribution of junction proteins and water channels in the human macula, several hypotheses are raised to explain why edema forms specifically in the macular region. "Pure" clinical phenotypes of macular edema, that result presumably from a single causative mechanism, are detailed. Finally, diabetic macular edema is investigated, as a complex multifactorial pathogenic example. This comprehensive review on the current understanding of macular edema and its mechanisms opens perspectives to identify new preventive and therapeutic strategies for this sight-threatening condition.
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Rezar-Dreindl S, Eibenberger K, Pollreisz A, Bühl W, Georgopoulos M, Krall C, Dunavölgyi R, Weigert G, Kroh ME, Schmidt-Erfurth U, Sacu S. Effect of intravitreal dexamethasone implant on intra-ocular cytokines and chemokines in eyes with retinal vein occlusion. Acta Ophthalmol 2017; 95:e119-e127. [PMID: 27417275 DOI: 10.1111/aos.13152] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/04/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the influence of intravitreal dexamethasone implant on inflammatory and angiogenic cytokine levels in the aqueous of patients with retinal vein occlusion (RVO). METHODS Forty eyes of 40 consecutive patients with macular oedema (ME) due to branch and central retinal vein occlusion (BRVO/CRVO) were treated with an intravitreal dexamethasone implant (Ozurdex® ) at baseline and evaluated until month 6. Retreatment was performed in case of recurrent ME earliest 4 months after the baseline treatment. Aqueous humour samples were taken at baseline, months 1, 3, 6 and at the time of each retreatment. Concentrations of 29 different cytokines were measured by Luminex® bead assays. The control group comprised healthy patients undergoing cataract surgery. RESULTS At baseline concentrations of interleukin (IL)-8, angiopoietin (ANG)-2 and intercellular adhesion molecule (ICAM)-1 were highly elevated in patients with CRVO compared with controls (p = 0.006; p = 0.02; p = 0.03). Vascular endothelial growth factor (VEGF) concentrations were upregulated in patients with BRVO and CRVO (p = 0.003; p = 0.001). Retreatment with a dexamethasone implant was necessary after 4 months in 14/8 (BRVO/CRVO) patients, 5 months in 5/3 patients and 6 months in one patient (BRVO). After the initial treatment, macrophage chemo-attractant protein (MCP)-1 and IL17-E concentrations decreased in BRVO (p < 0.001; p = 0.01) and MCP-1 and IL1-α in CRVO (p = 0.01; p = 0.003). Vascular endothelial growth factor (VEGF) concentrations did not change during treatment in either group (p = 0.3). A mixed-effect model showed that cytokine concentrations positively correlated with central retinal thickness changes. CONCLUSIONS Intravitreal dexamethasone treatment resulted in alterations in the concentrations of pro-inflammatory cytokines MCP-1 and IL17-E in patients with BRVO and MCP-1 and IL1-α in patients with CRVO. These data highlight the important role of inflammatory mediators involved in ME due to RVO.
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Affiliation(s)
| | | | - Andreas Pollreisz
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | - Wolf Bühl
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | | | - Christoph Krall
- Department of Medical Statistics; Medical University of Vienna; Vienna VIE Austria
| | - Roman Dunavölgyi
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | - Günther Weigert
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | | | | | - Stefan Sacu
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
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Abstract
PURPOSE To investigate whether cysts in diabetic macular edema are better visualized in the red channel of color fundus camera images, as compared with the green channel, because color fundus camera screening methods that emphasize short-wavelength light may miss cysts in patients with dark fundi or changes to outer blood retinal barrier. METHODS Fundus images for diabetic retinopathy photoscreening were acquired for a study with Aeon Imaging, EyePACS, University of California Berkeley, and Indiana University. There were 2047 underserved, adult diabetic patients, of whom over 90% self-identified as a racial/ethnic identify other than non-Hispanic white. Color fundus images at nominally 45 degrees were acquired with a Canon Cr-DGi non-mydriatic camera (Tokyo, Japan) then graded by an EyePACS certified grader. From the 148 patients graded to have clinically significant macular edema by the presence of hard exudates in the central 1500 μm of the fovea, we evaluated macular cysts in 13 patients with cystoid macular edema. Age ranged from 33 to 68 years. Color fundus images were split into red, green, and blue channels with custom Matlab software (Mathworks, Natick, MA). The diameter of a cyst or confluent cysts was quantified in the red-channel and green-channel images separately. RESULTS Cyst identification gave complete agreement between red-channel images and the standard full-color images. This was not the case for green-channel images, which did not expose cysts visible with standard full-color images in five cases, who had dark fundi. Cysts appeared more numerous and covered a larger area in the red channel (733 ± 604 μm) than in the green channel (349 ± 433 μm, P < .006). CONCLUSIONS Cysts may be underdetected with the present fundus camera methods, particularly when short-wavelength light is emphasized or in patients with dark fundi. Longer wavelength techniques may improve the detection of cysts and provide more information concerning the early stages of diabetic macular edema or the outer blood retinal barrier.
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Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes. J Ophthalmol 2016; 2016:7984576. [PMID: 27721989 PMCID: PMC5046017 DOI: 10.1155/2016/7984576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/28/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (P < 0.001). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 (P < 0.001) 12 months after one (P = 0.001), two (P = 0.041), and three (P < 0.001) implants but not four implants (P = 0.068). The mean baseline CRT decreased significantly (P < 0.001) from 463 to 254 microns after 12 months with one (P < 0.001), two (P = 0.002), and three (P = 0.001) implants but not with four implants (P = 0.114). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%). Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes.
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Dow CT, Harley CB. Evaluation of an oral telomerase activator for early age-related macular degeneration - a pilot study. Clin Ophthalmol 2016; 10:243-9. [PMID: 26869760 PMCID: PMC4734847 DOI: 10.2147/opth.s100042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Telomere attrition and corresponding cellular senescence of the retinal pigment epithelium contribute to the changes of age-related macular degeneration. Activation of the enzyme telomerase can add telomeric DNA to retinal pigment epithelium chromosomal ends and has been proposed as a treatment for age-related macular degeneration. We report the use of a small molecule, oral telomerase activator (TA)-65 in early macular degeneration. This study, focusing on early macular degeneration, provides a model for the use of TAs in age-related disease. Method Thirty-eight (38) patients were randomly assigned to a 1-year, double-blinded, placebo-controlled interventional study with arms for oral TA-65 or placebo. Macular functions via micro-perimetry were the primary measured outcomes. Results The macular function in the arm receiving the TA-65 showed significant improvement relative to the placebo control. The improvement was manifest at 6 months and was maintained at 1 year: macular threshold sensitivity (measured as average dB [logarithmic decibel scale of light attenuation]) improved 0.97 dB compared to placebo (P-value 0.02) and percent reduced thresholds lessened 8.2% compared to the placebo arm (P-value 0.04). Conclusion The oral TA significantly improved the macular function of treatment subjects compared to controls. Although this study was a pilot and a larger study is being planned, it is noteworthy in that it is, to our knowledge, the first randomized placebo-controlled study of a TA supplement.
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Affiliation(s)
- Coad Thomas Dow
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, USA; Chippewa Valley Eye Clinic, Eau Claire, Wisconsin, WI, USA
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Jiang D, Xiao X, Fu T, Mashaghi A, Liu Q, Hong J. Transient Tear Film Dysfunction after Cataract Surgery in Diabetic Patients. PLoS One 2016; 11:e0146752. [PMID: 26771186 PMCID: PMC4714744 DOI: 10.1371/journal.pone.0146752] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/20/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Diabetes mellitus is an increasingly common systemic disease. Many diabetic patients seek cataract surgery for a better visual acuity. Unlike in the general population, the influence of cataract surgery on tear film function in diabetic patients remains elusive. The aim of this study was to evaluate the tear function in diabetic and nondiabetic patients following cataract surgery. METHODS In this prospective, interventional case series, 174 diabetic patients without dry eye syndrome (DES) and 474 age-matched nondiabetic patients as control who underwent phacoemulsification were enrolled at two different eye centers between January 2011 and January 2013. Patients were followed up at baseline and at 7 days, 1 month, and 3 months postoperatively. Ocular symptom scores (Ocular Surface Disease Index, OSDI) and tear film function including tear film stability (tear film break-up time, TBUT), corneal epithelium integrity (corneal fluorescein staining, CFS), and tear secretion (Schirmer's I test, SIT) were evaluated. RESULTS In total, 83.9% of the diabetic patients (146 cases with 185 eyes) and 89.0% of the nondiabetic patients (422 cases with 463 eyes) completed all check-ups after the interventions (P = 0.095). The incidence of DES was 17.1% in the diabetic patients and 8.1% in the nondiabetic patients at 7 days after cataract surgery. In the diabetic patients, the incidence of DES remained 4.8% at 1 month postoperatively and decreased to zero at 3 months after surgery. No DES was diagnosed in nondiabetic patients at either the 1-month or 3-month follow-up. Compared with the baseline, the diabetic patients had worse symptom scores and lower TBUT values at 7 days and 1 month but not at 3 months postoperatively. In the nondiabetic patients, symptom scores and TBUT values had returned to preoperative levels at 1-month check-up. CFS scores and SIT values did not change significantly postoperatively in either group (P = 0.916 and P = 0.964, respectively). CONCLUSIONS Diabetic patients undergoing cataract surgery are prone to DES. Ocular symptoms and tear film stability are transiently worsened in diabetic patients and are restored more slowly than those in nondiabetic patients.
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Affiliation(s)
- Donghong Jiang
- Department of Ophthalmology, The Second People Hospital, Taixing, China
| | - Xiangqian Xiao
- Department of Ophthalmology, The Second People Hospital, Taixing, China
| | - Tongsheng Fu
- Department of Ophthalmology, People Hospital, Yangzhong, China
| | - Alireza Mashaghi
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail: (JH); (QL)
| | - Jiaxu Hong
- Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States of America
- Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shangha
- School of Life Sciences, Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian, China
- * E-mail: (JH); (QL)
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