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Cachero Rodríguez JM, Artaraz J, Imaz N, Fonollosa A. Fluocinolone intravitreal implant (Iluvien) for macular edema secondary to immune recovery uveitis in patient with acute myeloid leukemia. J Ophthalmic Inflamm Infect 2024; 14:19. [PMID: 38700565 PMCID: PMC11068715 DOI: 10.1186/s12348-024-00397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE To report the use of Fluocinolone intravitreal implant (Iluvien) for the treatment of persistent cystoid macular edema (CME) due to immune recovery uveitis syndrome in a patient with previous cytomegalovirus retinitis and acute myeloid leukemia. DESIGN Case report. METHODS The clinical history of a patient who received an Iluvien implant in one eye for the treatment of cystoid macular edema due to immune recovery uveitis syndrome, previously treated with peribulbar Triamcinolone and intravitreal Dexamethasone injections, was reviewed. RESULTS A 48-year-old woman presented with cystoid macular edema due to immune recovery uveitis syndrome. The patient had a history of cytomegalovirus retinitis 3.5 years prior, secondary to immunosuppressive treatment for an acute myeloid leukemia. Three periocular triamcinolone injections and two dexamethasone intravitreal implants were performed, but the edema recurred, so fluocinolone intravitreal implant was used, achieving a sustained control of the condition at one year of follow-up. CONCLUSION The Fluocinolone intravitreal implant may be an effective treatment for persistent CME in patients with immune recovery uveitis syndrome.
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Affiliation(s)
- J M Cachero Rodríguez
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain.
- Instituto Oftalmológico Etxeandia, Galdakao, Spain.
| | - J Artaraz
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | - Nora Imaz
- Department of Ophthalmology, Donostia University Hospital, Donostia, Spain
| | - A Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain
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Shah YS, Abidi M, Ahmed I, Arsiwala-Scheppach LT, Ong SS, Wu D, Handa JT. Risk Factors Associated with Cystoid Macular Edema among Patients Undergoing Primary Repair of Rhegmatogenous Retinal Detachment. Ophthalmol Retina 2024; 8:456-464. [PMID: 38036083 PMCID: PMC11070291 DOI: 10.1016/j.oret.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To investigate predictors of the development and resolution of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. DESIGN Retrospective cross sectional study. SUBJECTS Patients who underwent primary repair of uncomplicated RRD. METHODS Demographics, ophthalmic history, visual acuity, RRD features, time to development/resolution of CME, OCT characteristics of CME/epiretinal membrane (ERM), type of surgery, and treatments were collected. Logistic regressions were used to identify predictors of CME development and resolution. MAIN OUTCOME MEASURES Predictors of CME development and resolution. RESULTS A total of 708 eyes were included, of which 55 (7.8%) developed CME. Factors associated with an increased risk of CME development included total number of retinal detachment surgeries (odds ratio [OR] 1.66 [1.24-2.23], P < 0.001), prior intraocular surgery (OR 4.43 [1.19-16.51], P = 0.03), and presence of ERM after surgery (OR 4.49 [2.30-8.74], P < 0.001). Patients undergoing pars plana vitrectomy (PPV) were more likely to develop CME compared with patients undergoing scleral buckling (SB; OR 3.09 [1.18-8.10], P = 0.02). A longer average time to CME detection was associated with lower CME resolution (OR 0.94 [0.89-0.998], P = 0.04). In patients who developed an ERM postsurgically, those who developed CME after ERM had a lower rate of resolution compared with those who developed CME before ERM (P = 0.03). CONCLUSIONS Cystoid macular edema may be more likely to develop in patients undergoing PPV than SB, those who underwent more surgeries for RRD repair, those who had prior intraocular surgery, or those who developed an ERM after RRD repair. Resolution of CME may be affected by the time to detection of CME and ERM development. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yesha S Shah
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | | | - Ishrat Ahmed
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Lubaina T Arsiwala-Scheppach
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Wilmer Biostatistics Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sally S Ong
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David Wu
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - James T Handa
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland.
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Shah SM, Tanke LB, Deufel CL, Petersen IA, Corbin KS, Hodge DO, Olsen TW, Dalvin LA. Central subfield thickness predicts visual acuity outcomes in plaque-irradiated eyes with choroidal melanoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:1305-1320. [PMID: 37950755 DOI: 10.1007/s00417-023-06313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVE To determine the association between pre-operative central subfield thickness (CST) and post-radiotherapy visual acuity (VA), cystoid macular edema (CME), and intravitreal anti-vascular endothelial growth factor (VEGF) requirement. DESIGN Single-center retrospective study. PARTICIPANTS Patients with plaque-irradiated extramacular choroidal melanoma treated between 11/11/2011 and 4/30/2021. Pre-operative CST difference between the affected and unaffected eye was used. Kaplan-Meier analysis and hazard ratios were calculated. RESULTS Of 85 patients, pre-operative CST was greater in the melanoma-affected eye (vs. fellow eye) by mean of 20.4 μm (median 14.0, range - 60.0-182.0). Greater CST at presentation (vs. fellow eye) was associated with larger tumor diameter (p = 0.02), greater tumor thickness (p < 0.001), and more frequent tumor-related Bruch's membrane rupture (p = 0.006). On univariate analysis of outcome data, greater CST at presentation (vs. fellow eye) was associated with higher 5-year risk (1.09 [1.02-1.17], p = 0.02) of VA 20/200 or worse and increased (1.10 [1.01-1.20], p = 0.03) likelihood for anti-VEGF injections after plaque irradiation. There was no significant association with CME. The association between CST and VA outcome remained significant on multivariate analysis accounting for impact of tumor thickness and radiation dose to optic disc, while tumor distance to fovea was the only significant factor on multivariate analysis for anti-VEGF injections. CONCLUSION Greater CST at presentation (vs. fellow eye) was associated with worse VA outcome following plaque radiotherapy for choroidal melanoma. Large-sized tumors may contribute to a higher intraocular VEGF burden, potentially leading to greater preoperative CST, which correlates with poor VA outcome post-plaque radiotherapy.
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Affiliation(s)
- Saumya M Shah
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Laurel B Tanke
- Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Christopher L Deufel
- Department of Radiation Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - David O Hodge
- Department of Biomedical Statistics and Informatics, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA.
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Iovino C, Rosolia A, Marano E, Della Corte M, Testa F, Simonelli F. Navigated yellow subthreshold micropulse laser for refractory cystoid macular edema following rhegmatogenous retinal detachment surgery. Am J Ophthalmol Case Rep 2024; 33:101981. [PMID: 38274400 PMCID: PMC10809002 DOI: 10.1016/j.ajoc.2023.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 11/03/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
Purpose To report the efficacy and safety of navigated 577nm yellow subthreshold micropulse laser (YSML) treatment in a case of refractory cystoid macular edema (CME) following combined phaco-vitrectomy for rhegmatogenous retinal detachment (RRD). Observations A 69-year-old male patient complained a slow and progressive visual loss in the right eye (RE) since two months. A complete ophthalmological evaluation was performed. Best corrected visual acuity (BCVA) was hand motion and slit lamp examination revealed a nuclear cataract and a total macula-off RRD in the RE. Patient underwent a combined phaco +25 gauge pars plana vitrectomy (PPV) with 5000 cSt silicon oil (SO) tamponade. At the 3-month follow up BCVA was 20/250, retina was completely flat but a macular proliferative vitreoretinopathy (PVR) was detected with swept source optical coherence tomography (SS-OCT) and a second 23 G PPV with PVR peeling and SO removal was performed. At 1 month visit from the second surgery retina was flat and BCVA was 20/200 due to a persistent CME. Oral carbonic anhydrase inhibitors and topical steroids were administered for 2 months without any improvements. At this point, YSML was applied with a macular grid pattern and at three months follow up visit SS-OCT showed a complete resolution of CME, BCVA was 20/100 and these anatomical and functional outcomes were maintained at 6 months follow-up. Conclusions and importance YSML treatment may be considered a safe and effective treatment strategy for the management of refractory CME following complex RRD surgery cases.
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Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Rosolia
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ernesto Marano
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Michele Della Corte
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Estawro R, Abraham N, Fouad Y, Bousquet E, Sarraf D. Cystoid macular edema as a complication of central retinal artery occlusion. Am J Ophthalmol Case Rep 2024; 33:101998. [PMID: 38333032 PMCID: PMC10850887 DOI: 10.1016/j.ajoc.2024.101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/15/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose To describe the development of cystoid macular edema (CME) as a complication of central retinal artery occlusion (CRAO) in 2 cases. Observations The first patient was a 51-year-old female who presented with acute loss of vision in the left eye. Multimodal retinal imaging revealed a CRAO with a perfused cilioretinal artery. CME acutely developed one week after presentation. Cystoid spaces predominantly involved the outer nuclear layer (ONL) on optical coherence tomography (OCT) and completely resolved in two weeks. The second case was a 50-year-old man who presented with acute vision loss in the right eye for 3 weeks. Multimodal retinal imaging illustrated an acute CRAO of the right eye. Four weeks later, visual acuity spontaneously improved to 20/20 and was maintained at 20/20 for more than 2 years. After 28 months, the patient returned with a recurrent drop of vision in the right eye. Cross sectional and en face OCT revealed CME in the right eye without leakage on FA. Cystoid spaces predominantly involved the inner nuclear layer (INL) and resolved with intravitreal anti-VEGF injection combined with carbonic anhydrase inhibitor (CAI) and steroid topical drop therapy. Conclusions and Importance CME can rarely complicate both the acute and chronic phase of CRAO. In the acute phase, cystoid spaces were transient and confined to the ONL on OCT. While in the chronic phase, cystoid spaces were confined to the INL on OCT and angiographically silent on FA. Further studies are needed to identify the incidence, underlying pathophysiology and visual prognosis of CME in cases of CRAO.
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Affiliation(s)
- Rania Estawro
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Retina Department, Al-Watany Eye Hospital, Cairo, Egypt
| | - Neda Abraham
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
| | - Yousef Fouad
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Elodie Bousquet
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Department of Ophthalmology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, CA, United States
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Mikropoulos DG, Kymionis GD, Chatzea MS, Xanthopoulou K, Ageladarakis PK, Voudouragkaki IC, Konstas AG. Acute Corneal Melting Induced by the Concomitant Use of a Non-steroidal Anti-inflammatory Agent with an Antiseptic Eye Drop. Ophthalmol Ther 2024; 13:645-649. [PMID: 38127195 PMCID: PMC10787727 DOI: 10.1007/s40123-023-00864-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed perioperatively to reduce intraoperative prostaglandin release, diminishing pain, preventing miosis, modulating postoperative inflammation, and reducing the incidence of cystoid macular edema (CME). CASE REPORT A 70-year-old female patient without previous history of ocular or systemic disease was urgently referred to our hospital because of a sudden corneal perforation concerning her left eye (OS). The patient had instilled bromfenac eye drops and antiseptic eye drops twice and four times daily, respectively, for 2 days only, in preparation of scheduled cataract surgery. Slit-lamp examination revealed diffuse inferior corneal melting with a 1 × 2 mm area of full-thickness perforation and a very shallow anterior chamber. Both topical agents were immediately discontinued. Cyanoacrylate glue was applied to seal the perforation and a bandage contact lens was applied together with a topical antibiotic given hourly. Two hours later, the anterior chamber started to reform. The following day, the anterior chamber was fully reformed with a negative Seidel test. At her next follow-up appointment, 1 month later, the glue was detached and the cornea was seen to have successfully healed with only some corneal thinning remaining inferiorly. CONCLUSIONS Perioperative use of topical NSAIDs in combination with antiseptic eye drops may rarely elicit corneal perforation in certain susceptible elderly individuals. Their use should therefore be carefully monitored.
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Affiliation(s)
- Dimitrios G Mikropoulos
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Georgios D Kymionis
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina S Chatzea
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kassandra Xanthopoulou
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis K Ageladarakis
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Irini C Voudouragkaki
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Anastasios G Konstas
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece.
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Català-Mora J, Santamaría Álvarez JF, Kyriakou D, Alforja S, Barraso Rodrigo M, Blasco Palacio PB, Casaroli-Marano R, Cobos Martín E, Coco Martín RM, Esmerado C, García Tirado A, García P, Gómez-Benlloch A, Rodríguez Fernández CA, Vilaplana Mira F. Protocol for the treatment of cystoid macular edema secondary to retinitis pigmentosa and other inherited retinal dystrophies. Arch Soc Esp Oftalmol (Engl Ed) 2024; 99:67-81. [PMID: 37940089 DOI: 10.1016/j.oftale.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the working population. Cystic macular edema (CME) is one of the treatable causes of visual loss, affecting up to 50% of the patients. A bibliographic review has been carried out combining "inherited retinal dystrophy", "retinitis pigmentosa", "macular oedema" and a diagnostic-therapeutic protocol according to the levels of evidence and recommendations of the "US Agency for Healthcare Research and Quality". This protocol has been discussed in the monthly meetings of the XAREA DHR group with the participation of more than 25 ophthalmologists, creating a consensus document. The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pigment epithelium, and Müller cells, inflammation, and vitreous traction. OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD. The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors (IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internal limiting membrane do not have sufficient evidence. A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patients and another for IRD and cataract surgery. Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment with corticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinical trials are required to establish the therapeutic scale in these patients.
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Affiliation(s)
- J Català-Mora
- CSUR Distrofias Hereditarias de Retina, Hospital Sant Joan de Déu, Institut Oftalmològic del Pilar, Esplugues de Llobregat, Barcelona, Spain; Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J F Santamaría Álvarez
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Kyriakou
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - S Alforja
- Departamento de Cirugía, Facultad de Medicina y Ciencias de la Salud, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Barraso Rodrigo
- CSUR Distrofias Hereditarias de Retina, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - R Casaroli-Marano
- Departamento de Cirugía, Facultad de Medicina y Ciencias de la Salud, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - E Cobos Martín
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R M Coco Martín
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Facultad de Medicina de la Universidad de Valladolid, Valladolid, Spain; RICORS de Enfermedades Inflamatorias, Instituto de Salud Carlos III, Madrid, Spain
| | - C Esmerado
- Hospital Viladecans, Viladecans, Barcelona, Spain
| | - A García Tirado
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - P García
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - A Gómez-Benlloch
- Servicio de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitario General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - C A Rodríguez Fernández
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Vilaplana Mira
- Servicio de Oftalmología, Hospital Germans Trias i Pujols, Badalona, Barcelona, Spain
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Gnanaraj R, Shah AA, Palestine AG, Reddy AK. Uveitis in the Setting of Co-Existing Systemic Sarcoidosis and Multiple Sclerosis. Ocul Immunol Inflamm 2024; 32:181-183. [PMID: 37467487 DOI: 10.1080/09273948.2023.2236211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/26/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
We report a case of intermediate uveitis in the setting of both systemic sarcoidosis and multiple sclerosis. A 68-year-old female was diagnosed with bilateral granulomatous intermediate uveitis and cystoid macular edema. Initial systemic work-up was unrevealing. The uveitis was treated successfully with local corticosteroid injections. Eighteen months after presentation, the patient developed new systemic symptoms. Additional testing revealed systemic lymphadenopathy, with biopsy showing non-caseating granulomas, leading to a diagnosis of sarcoidosis. However, MRI of the brain and spinal cord along with cerebrospinal fluid analysis was consistent with MS. The management of the uveitis and systemic inflammation was co-managed by ophthalmology, neurology, and rheumatology, and eventually controlled with leflunomide and rituximab. Patients can rarely have co-existing systemic sarcoidosis and multiple sclerosis. Although challenging to diagnose, radiographic findings and cerebrospinal fluid analysis can be helpful to differentiate multiple sclerosis and neurosarcoidosis. Management of these patients requires coordination between multiple specialties.
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Affiliation(s)
- Ramya Gnanaraj
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anna A Shah
- Department of Neurology & Rocky Mountain MS Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amit K Reddy
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Johari M, Attar A, Eghtedari D, Razavizadegan SA. Characteristics of macular edema associated with retinal vein occlusion showing poor anatomic response to three loading anti-vascular endothelial growth factor injections: an optical coherence tomography analysis. BMC Ophthalmol 2024; 24:30. [PMID: 38254100 PMCID: PMC10801953 DOI: 10.1186/s12886-024-03298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE To analyze the clinical features of refractory cystoid macular edema related to retinal vein occlusion associated with the response to three consecutive loading doses of anti-vascular endothelial growth factor. METHODS A retrospective chart review was performed on retinal vein occlusion patients treated by three anti-vascular endothelial growth factor injections. They were divided into a group according to resolution of macular edema in optical coherence tomography (Group 1) and with persistent macular edema (Group 2). We analyzed qualitative and quantitative morphologic features of optical coherence tomography. RESULTS We enrolled a total of 120 eyes from 120 patients (Group 1: n = 54, Group 2: n = 66). The baseline choroidal thickness differed significantly between groups 1 and 2 (290.70 ± 19.58 μm and 311.06 ± 17.87 μm P < 0.001). The presence of Hyperreflective foci (16.70% vs. 36.40% P < 0.001), Disorganization of the retinal inner layers (14.80% vs. 87.90%) and external limiting membrane disruption (16.60% vs. 39.3% P < 0.001) differed significantly. Logistic regression analysis showed that the initial central macular thickness (B = 0.012; P = 0.006), baseline choroidal thickness (B = 0.232; P = 0.016) and presence of hyperreflective foci (B = 1.050; P = 0.019), disorganization of the retinal inner layers (B = 1.132; P = 0.001) and external limiting membrane disruption (B = 1.575; P = 0.012) significantly affected the anti-vascular endothelial growth factor treatment response. CONCLUSION A thicker sub-fovea choroid and the presence of hyperreflective foci, disruption of the external limiting membrane and disorganization of the retinal inner layers associated with a poorer response to three loading anti-vascular endothelial growth factor injections in macular edema associated retinal vein occlusion.
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Affiliation(s)
- Mohammadkarim Johari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Attar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dorna Eghtedari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ahmad Razavizadegan
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Tenney S, Oboh-Weilke A, Wagner D, Chen MY. Tamoxifen retinopathy: A comprehensive review. Surv Ophthalmol 2024; 69:42-50. [PMID: 37482306 DOI: 10.1016/j.survophthal.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
Tamoxifen is a selective estrogen receptor modulator used mainly for the treatment of breast cancer. Based on the case reports and studies performed to date on the retinal toxicity of tamoxifen, retinopathy appears to occur in as many as 12% of patients taking 20 mg tamoxifen a day for over 2 years. Of this 12%, as many as half develop symptomatic changes in visual acuity. Retinal changes consist primarily of crystalline deposits, cystoid macular edema, hyperreflective deposits in the inner retinal layers, and telangiectasia. Tamoxifen retinopathy is currently managed by discontinuing tamoxifen therapy as the cancer prognosis permits; however, discontinuing therapy demonstrates little to no improvement in visual acuity once visual changes have taken place. Intravitreal injections of steroids or antivascular endothelial growth factor therapy have been performed, but require further studying before conclusions can be made. Until then, optical coherence tomography screening for retinal changes should be performed every 6 months for patients who have been on tamoxifen therapy for 2 years or more. This way, patients can become aware of retinal changes, and their physicians can consider adjusting tamoxifen therapy before they risk developing changes in visual acuity.
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Affiliation(s)
- Stephen Tenney
- Georgetown University School of Medicine, Washington, DC, USA.
| | | | - David Wagner
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mike Yuan Chen
- Georgetown University School of Medicine, Washington, DC, USA
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Haraguchi A, Wakuta M, Ariyoshi N, Funatsu M, Wasai Y, Ohta M, Ogata T, Higashijima F, Kimura K. Treatment of Failure of Macular Hole Closure due to Post-Vitrectomy Macular Edema Using Sub-Tenon Triamcinolone Acetonide Injection: A Case Report. Case Rep Ophthalmol 2024; 15:326-334. [PMID: 38618210 PMCID: PMC11014721 DOI: 10.1159/000538026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/16/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Post-vitrectomy cystoid macular edema (CME) can lead to failure of macular hole (MH) closure. We report 2 cases of failure of MH closure due to post-vitrectomy CME, which were successfully treated using sub-Tenon triamcinolone acetonide (STTA) injection. Case Presentations Case 1 involved a 72-year-old male patient with a Gass Stage 3 MH in the right eye. He underwent pars plana vitrectomy (PPV), internal limiting membrane translocation, and sulfur hexafluoride (SF6) gas injection with cataract surgery in his right eye. The MH did not close postoperatively; further, CME developed at the edge of the MH. Accordingly, the patient underwent an STTA injection. Approximately 2 weeks after the STTA injection, the CME disappeared and the MH closed, which has remained closed 1 year after PPV. Case 2 involved a 78-year-old female patient with Gass Stage 3 MH in the left eye. The patient underwent the same surgical procedure as that performed in case 1. Further, she presented with failure of MH closure caused by CME; therefore, an STTA injection was performed. Approximately 6 weeks after STTA injection, the CME disappeared and the MH closed; further, there was maintained improvement of best-corrected visual acuity for 6 months. Conclusions STTA injection could be considered before reoperation in cases involving failure of MH closure due to postoperative CME.
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Affiliation(s)
- Aiko Haraguchi
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
- Shuto General Hospital, Yamaguchi, Japan
| | - Makiko Wakuta
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Nobuaki Ariyoshi
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiko Funatsu
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yuki Wasai
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Manami Ohta
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tadahiko Ogata
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Fumiaki Higashijima
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuhiro Kimura
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Cicinelli MV, Benatti E, Starace V, Nadin F, Di Nisi E, Bandello F, Coppola M. Recurrences and Macular Complications after Perfluorocarbon-Liquid-Free Vitrectomy for Primary Rhegmatogenous Retinal Detachment. Ophthalmol Ther 2023; 12:3219-3232. [PMID: 37775683 PMCID: PMC10640444 DOI: 10.1007/s40123-023-00811-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION This study investigates factors associated with recurrent rhegmatogenous retinal detachment (RRD), macular complications, and visual outcomes after pars plana vitrectomy (PPV) without perfluorocarbon liquids (PFCLs) for primary RRD. METHODS A longitudinal cohort study included consecutive patients with RRD who underwent PFCL-free PPV. Postoperative visual acuity and spectral-domain optical coherence tomography findings [cystoid macular edema (CME), epiretinal membrane (ERM), ellipsoid zone/interdigitation zone (EZ/IZ) damage] were collected. Logistic regression and linear mixed models analyzed rates and risk factors for RRD recurrence, CME, ERM, EZ/IZ damage, and visual acuity at 12 months. RESULTS 346 eyes with RRD were studied. Single-operation success rates were 96% and 93% for uncomplicated (n = 274 eyes) and complicated (n = 72 eyes) RRD, respectively. Factors associated with RRD recurrence were posterior retinal breaks [odds ratio (OR) = 10.7 compared to peripheral retinal breaks, p = 0.008], silicone oil tamponade (OR = 5.66 compared to gas, p = 0.01), and sectorial laser retinopexy (OR = 4.34 compared to 360° laser retinopexy, p = 0.007). The prevalence of CME, ERM, and EZ/IZ damage at 12 months was 10%, 9%, and 6%, respectively. Eyes with EZ/IZ defects had worse postoperative visual acuity in both uncomplicated and complicated RRD. Proliferative vitreoretinopathy (OR = 2.95, p = 0.03) and silicone oil tamponade (OR = 3.70 compared to gas, p = 0.05) were associated with EZ/IZ damage. CONCLUSIONS PFCL-free PPV demonstrated satisfactory single-operation success rates for uncomplicated and complicated RRD, with a low prevalence of macular complications. Analyzing factors associated with RRD recurrence can provide provisional recommendations for PFCL-free approaches in the absence of randomized trials.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Ophthalmology Unit, Azienda Ospedaliera di Monza, Monza, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | | | | | - Francesco Nadin
- Ophthalmology Unit, Azienda Ospedaliera di Monza, Monza, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Edoardo Di Nisi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Coppola
- Ophthalmology Unit, Azienda Ospedaliera di Monza, Monza, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Ahmad KT, Chauhan MZ, Soliman MK, Elhusseiny AM, Yang YC, Sallam AB. Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study. Graefes Arch Clin Exp Ophthalmol 2023; 261:3511-3520. [PMID: 37347245 DOI: 10.1007/s00417-023-06120-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/07/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery. DESIGN Retrospective clinical database study. METHODS Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22-26; reference group), and long AL (> 26). MAIN OUTCOMES AND MEASURES We analyzed visual acuity (VA) outcomes at 4 weeks, 4-12 weeks, and 12-24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD). RESULTS Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4-12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60-2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different. CONCLUSION In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.
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Affiliation(s)
- Kinza T Ahmad
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Muhammad Z Chauhan
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Mohamed K Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdelrahman M Elhusseiny
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA.
- Department of Ophthalmology, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom.
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14
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Jevnikar K, Počkar S, Umek L, Rothova A, Valentincic NV. Prognostic factors of cataract surgery in patients with uveitis. Int Ophthalmol 2023; 43:4605-4612. [PMID: 37697081 PMCID: PMC10724088 DOI: 10.1007/s10792-023-02860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To evaluate the long-term visual outcomes of patients with uveitis undergoing cataract surgery and to identify possible factors influencing the visual prognosis and the development of postoperative complications. METHODS Retrospective study of all patients with uveitis who underwent cataract surgery between January 2015 and February 2020 in our tertiary referral center. RESULTS A total of 78 eyes from 78 patients were included in the study. The best-corrected visual acuity (BCVA) improved in 86% of patients, and a BCVA of 0.5 or better was achieved in 57 (73%) patients. A significant correlation was shown between the preoperative and postoperative BCVA (Spearman r = 0.521, p < 0.01). Final BCVA differed between diverse anatomical uveitis entities (p = 0.047), and anterior uveitis demonstrated the best outcomes. Chronic uveitis resulted in a worse final BCVA than acute recurrent uveitis (p = 0.001). The presence of CME any time before the surgery and intermediate uveitis were associated with worse visual prognosis, while systemic therapy for uveitis before surgery and iris manipulation during surgery were not related to visual outcomes. Postoperative development of cystoid macular edema (CME) was closely associated with preexisting CME (p < 0.001) and intermediate uveitis (p = 0.01). CONCLUSIONS Visual results of cataract surgery in patients with uveitis were beneficial, but limited visual outcomes were more frequently observed in patients with chronic uveitis and intermediate uveitis with a history of CME. In consequence, prevention, or adequate treatment of CME, especially in patients with intermediate uveitis, might result in better visual results of their cataract surgery.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Saša Počkar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lan Umek
- Faculty of Public Administration, University of Ljubljana, Ljubljana, Slovenia
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Natasa Vidovic Valentincic
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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15
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Iftikhar M, Dun C, Schein OD, Lum F, Woreta F. Cystoid Macular Edema after Cataract Surgery in the United States: IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2023; 130:1005-1014. [PMID: 37302490 DOI: 10.1016/j.ophtha.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To determine the incidence, risk factors, and visual outcomes of cystoid macular edema (CME) after cataract surgery in the United States. DESIGN Retrospective, longitudinal, case-control study. PARTICIPANTS Patients aged ≥ 18 years who underwent phacoemulsification cataract surgery. METHODS The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) was used to analyze patients who underwent cataract surgery between 2016 and 2019. Patients who received a diagnosis of CME within 90 days after cataract surgery were classified as cases, and the rest were classified as controls. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with the development of CME as well as poor visual outcome (defined as a best-recorded visual acuity worse than 20/40 Snellen equivalent at postoperative month 12). MAIN OUTCOME MEASURES Incidence, demographics, baseline characteristics, and visual outcomes. RESULTS Of 3.1 million cataract surgeries performed during the study period, CME was diagnosed in 25 595 eyes (0.8%), with an average onset of 6 weeks. Patients with CME were more likely to be male, to be aged < 65 years, to be Black, and to have preexisting diabetic retinopathy. Patients with CME were more likely to have a poor visual outcome (OR, 1.75; 95% CI, 1.66-1.84; P < 0.001), with a mean best-recorded visual acuity of 20/30 at postoperative month 12 (compared with 20/25 for those without CME; P < 0.001). Other factors associated with a poor visual outcome included smoking, Medicaid insurance, non-White race, and baseline ocular comorbidities such as macular degeneration and retinal vein occlusion. CONCLUSIONS Although the incidence of CME after cataract surgery is low and most eyes achieve a visual acuity of 20/40 or better, there are significant outcome disparities that warrant further exploration. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver D Schein
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Dave AD, Chen KG, Chiang TTK, Singaravelu J, Alvarez JA, Wong WT, Cukras CA. Oral minocycline for the treatment of retinitis pigmentosa-associated cystoid macular edema: results of a phase I/II clinical trial. Graefes Arch Clin Exp Ophthalmol 2023; 261:2209-2220. [PMID: 36882562 DOI: 10.1007/s00417-023-05986-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/13/2023] [Accepted: 01/27/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE The etiology of retinitis pigmentosa (RP)-associated cystoid macular edema (CME) has been related to retinal neuroinflammation and microglial activation. Minocycline, a drug FDA-approved for anti-microbial indications, also inhibits microglial activation and expression of inflammatory mediators. This study investigates the safety and efficacy of oral minocycline as primary treatment for RP-associated CME. METHODS A single-center, prospective, open-label phase I/II clinical trial enrolled five participants with RP-associated CME. Participants had lead-in assessments prior to the initiation of oral minocycline 100 mg twice daily for 12 months. Main outcome variables included changes in best-corrected visual acuity (BCVA) and retinal central subfield thickness (CST) measured using spectral domain optical coherence tomography relative to mean of pre-treatment measurements. RESULTS The study drug was well tolerated and not associated with any severe adverse events. No significant changes in mean BCVA from study baseline were noted in either the study eye (+ 0.7 ± 4.1 letters at 6 months, - 1.1 ± 1.7 letters at 12 months) or the qualifying fellow eye (- 0.3 ± 3.4 letters at 6 months, - 0.3 ± 4.6 letters at 12 months) (p > 0.05 for all comparisons). Mean percentage changes in CST from baseline however decreased progressively with treatment (decreases at 6 and 12 months: study eyes 3.9 and 9.8%; qualifying fellow eyes 1.4 and 7.7%). Considering all eyes (n = 10), mean percentage CST decrease at 6 and 12 months was 2.7 ± 9.5% (p = 0.39) and 8.7 ± 9.5% (p = 0.02) respectively. CONCLUSION Oral minocycline administration over 12 months was associated with no significant changes in mean BCVA and a small but progressive decrease in mean CST. TRIAL REGISTRATION NCT02140164 (05/2014).
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Affiliation(s)
- Amisha D Dave
- National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | | | | | | | | | - Wai T Wong
- National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | - Catherine A Cukras
- Unit On Clinical Investigation of Retinal Disease, Division of Epidemiology and Clinical Research, National Eye Institute, National Institute of Health, Bethesda, MD, 20892, USA.
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Pant P, Kundu A, Rathinavelu JK, Wei X, Agrawal R, Stinnett SS, Kim JS, Thomas AS, Fekrat S. Longitudinal Assessment of the Choroidal Vascularity Index in Eyes with Branch Retinal Vein Occlusion-Associated Cystoid Macular Edema. Ophthalmol Ther 2023; 12:2103-2115. [PMID: 37221425 PMCID: PMC10287880 DOI: 10.1007/s40123-023-00731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Cystoid macular edema (CME) is the most common cause of central vision loss in eyes with branch retinal vein occlusion (BRVO eyes). In recent literature, choroidal vascularity index (CVI) has been proposed to be an enhanced depth imaging optical coherence tomography (EDI-OCT) metric that may help characterize choroidal vascular changes in the setting of retinal ischemia, and potentially prognose visual outcomes and treatment patterns for patients with BRVO-related CME. This study sought to further characterize choroidal vascular changes in BRVO by comparing the CVI, subfoveal choroidal thickness (SFCT), and central subfield thickness (CST) in BRVO eyes with CME compared to unaffected fellow eyes. METHODS This was a retrospective cohort study. Subjects included treatment-naïve BRVO eyes with CME diagnosed within 3 months of onset of symptoms and unaffected fellow eyes. EDI-OCT images were collected at baseline and at the 12-month follow-up visit. CVI, SFCT, and CST were measured. Demographics, treatment patterns, and best-corrected visual acuity (VA) were abstracted. Median CVI, SFCT, CST, and VA were compared between the two cohorts. Longitudinal relationships between these variables were analyzed. RESULTS A total of 52 treatment-naïve eyes with BRVO and CME and 48 unaffected fellow eyes were identified. Baseline CVI was lower in eyes with BRVO than in fellow eyes (64.7% vs. 66.4%, P = 0.003). At 12 months, there was no difference in CVI between BRVO eyes and fellow eyes (65.7% vs 65.8%, P = 0.536). In BRVO eyes, there was a strong correlation between reduced CST and improved VA over the 12-month study period (r = 0.671, P < 0.001). CONCLUSION There are differences in CVI in treatment-naïve BRVO eyes with CME at presentation compared to fellow eyes, but these differences resolve over time. Anatomic changes in macular thickness in BRVO eyes with CME may be correlated with VA outcomes.
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Affiliation(s)
- Praruj Pant
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Anita Kundu
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Jay K Rathinavelu
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Xin Wei
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Jane S Kim
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Akshay S Thomas
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
- Tennessee Retina, Nashville, TN, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA.
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Bae BJ, Kang EM, Lee SY. Cystoid macular edema associated with omidenepag isopropyl in a phakic eye with an implantable collamer lens: a case report. BMC Ophthalmol 2023; 23:334. [PMID: 37495978 PMCID: PMC10373310 DOI: 10.1186/s12886-023-03091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/20/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Cystoid macular edema is a known complication of omidenepag isopropyl usage. Omidenepag isopropyl is a selective prostanoid EP2 receptor agonist, and its association with macular edema has mainly been identified in pseudophakic eyes. Herein, we report a case of cystoid macular edema caused by omidenepag isopropyl use in a phakic eye with an implantable collamer lens. CASE PRESENTATION A 38-year-old woman was diagnosed with left eye glaucoma and prescribed omidenepag isopropyl. She had undergone bilateral implantation of implantable collamer lenses approximately 12 years prior to the glaucoma diagnosis. After 9 months of using omidenepag isopropyl, she presented with blurred vision in the left eye; swept source optical coherence tomography revealed cystoid macular edema in this eye. Omidenepag isopropyl usage was discontinued, and bromfenac sodium hydrate was administered twice daily instead. After 2 months, the patient's visual discomfort was completely ameliorated. Additionally, an optical coherence tomography examination confirmed that the macula had normalized. CONCLUSIONS We report a case of cystoid macular edema development after omidenepag isopropyl use in a patient with glaucoma who had undergone bilateral implantable collamer lens implantation. This case shows that the possibility of cystoid macular edema occurrence should be considered when omidenepag isopropyl is used, even in phakic eyes, after the insertion of implantable collamer lenses.
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Affiliation(s)
- Byung-Jin Bae
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do, 16995, Korea
| | | | - Sang Yeop Lee
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do, 16995, Korea.
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19
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Nassar GA, Maqboul IM, El-Nahry AG, Hassan LM, Shalash AB. Macular vascular features of different types of diabetic macular edema using ocular coherence tomography angiography- a comparative study. Int J Retina Vitreous 2023; 9:32. [PMID: 37202824 DOI: 10.1186/s40942-023-00469-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND To compare the microvascular features of different subtypes of diabetic macular edema (DME) by optical coherence tomography angiography (OCTA). METHODS A cross-sectional study including treatment-naive patients with DME. Eyes were divided according to optical coherence tomography determined morphology into two groups: cystoid macular edema (CME) and diffuse retinal thickening (DRT), with further subdivision according to the presence of subretinal fluid. All patients underwent 3 × 3 and 6 × 6 mm OCTA scans of the macula to compare the foveal avascular zone (FAZ) area, vascular density (VD) of the superficial (SCP) and deep (DCP) capillary plexus and choriocapillaris flow (CF). Laboratory findings (HbA1C and triglyceride levels) were also correlated with the OCTA findings. RESULTS The study included 52 eyes, 27 had CME and 25 had DRT. There were no significant differences between the VD of the SCP (p = 0.684) and DCP (p = 0.437), FAZ of SCP (p = 0.574), FAZ of DCP (p = 0.563) and CF (p = 0.311). Linear regression analysis revealed that DME morphology was the strongest predictor for BCVA. Other significant predictors included HbA1C and triglyceride levels. CONCLUSION The morphology of DME, irrespective of SRF, was most significantly correlated with BCVA in treatment-naive patients and CME subtype could be an independent predictor of poor BCVA in patients with DME.
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20
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Tarım B, Kılıç M. Ocular side effects of Trametinib and Dabrafenib: a case report. J Ophthalmic Inflamm Infect 2023; 13:17. [PMID: 37046057 PMCID: PMC10097848 DOI: 10.1186/s12348-023-00339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
A 53-year-old man who has stage 4 non-small cell lung carcinoma and treated with Dabrafenib-Trametinib combination chemotherapy; presented with decreased bilateral visual acuity. We checked out slit lamp examination, fundoscopy, optical coherence tomography and fundus fluorescein angiography. In slit lamp biomicroscopy; bilateral posterior synechiae, granulomatous keratic precipitates and + 4 cells in the anterior chamber were detected. Cystoid macular edema and subretinal fluid accumulation were revealed in optical coherence tomography. Dabrafenib and Trametinib treatments were discontinued and systemic methylprednisolone, topical corticosteroid and topical cyclopentolate were started. His best corrected visual acuity was increased from counting fingers from 2 m to 0,9 bilaterally and cystoid macular edema and serous retinal detachment were completely regressed as a result of systemic and topical corticosteroid treatment.
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Affiliation(s)
- Bilge Tarım
- Department of Ophthalmology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Meltem Kılıç
- Department of Ophthalmology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
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21
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Bernabei F, Marcireau I, Frongia F, Azan F, Vagge A, Peiretti E, Guerrier G, Rothschild PR. Risk Factors of Cystoid Macular Edema After Pars Plana Vitrectomy for Pseudophakic Retinal Detachment. Ophthalmol Ther 2023; 12:1737-1745. [PMID: 37029838 PMCID: PMC10164198 DOI: 10.1007/s40123-023-00705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the prevalence of cystoid macular edema after pars plana vitrectomy for the treatment of pseudophakic rhegmatogenous retinal detachment and identify possible related risk factors. METHODS A retrospective monocentric study was conducted within a cohort of pseudophakic patients undergoing vitrectomy for rhegmatogenous retinal detachment between January 2019 and December 2022. Demographic data, initial and intraoperative characteristics of rhegmatogenous retinal detachment, and postoperative data were analyzed. Cystoid macular edema was defined on optical coherence tomography exclusively. RESULTS A total of 164 eyes of 164 patients were included for analysis. The mean age of the patients at surgery was 65.7 ± 12.0 years. The mean best-corrected visual acuity was 2.1 ± 1.0 logMAR preoperatively and 1.0 ± 0.7 logMAR postoperatively. The mean follow-up was 13.4 ± 7.7 months. The prevalence of cystoid macular edema was 17.1% [9.8-26.4]. In multivariate analysis, severe proliferative vitreoretinopathy (relative risk 3.6 [1.3-9.7]) and laser retinopexy (relative risk 8.4 [1.1-64.7]) were independently and significantly associated with cystoid macular edema. CONCLUSION The prevalence of cystoid macular edema in pseudophakic rhegmatogenous retinal detachment after pars plana vitrectomy was 17.1%. Severe proliferative vitreoretinopathy stage and the use of endolaser retinopexy were independent risk factors for development of cystoid macular edema.
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Affiliation(s)
- Federico Bernabei
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Service d'ophtalmologie, 8 Rue Mechain, 75014, Paris, France.
| | - Ianis Marcireau
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francesca Frongia
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Frederic Azan
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genoa, Italy
| | - Enrico Peiretti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Gilles Guerrier
- Anaesthetic and Intensive Care Department, Hôpital Cochin, Paris Descartes University, 75014, Paris, France
- Université Paris Cité, Centre de Recherche des Cordeliers, INSERM, UMR_1138, 75006, Paris, France
| | - Pierre-Raphaël Rothschild
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Centre de Recherche des Cordeliers, INSERM, UMR_1138, 75006, Paris, France
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22
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Motta L, Frisina R, Ripa M, Gius I, Greggio A, Tozzi L, De Salvo G, Meduri A. Postoperative complications after successful primary rhegmatogenous retinal detachment repair. BMC Ophthalmol 2023; 23:77. [PMID: 36829144 PMCID: PMC9960660 DOI: 10.1186/s12886-023-02824-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD). METHODS Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD "pending foveal detachment" subgroup. RESULTS Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6). CONCLUSIONS The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.
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Affiliation(s)
- Lorenzo Motta
- grid.417122.30000 0004 0398 7998Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Rino Frisina
- grid.413861.9Department of Guglielmo da Saliceto Hospital, Ophthalmology Unit of Surgery, Piacenza, Italy
| | - Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy. .,Catholic University "Sacro Cuore", Rome, Italy.
| | - Irene Gius
- grid.5608.b0000 0004 1757 3470Ophthalmology Department, University of Padova, Padova, Italy
| | - Angelo Greggio
- grid.5608.b0000 0004 1757 3470Ophthalmology Department, University of Padova, Padova, Italy
| | - Luigi Tozzi
- grid.410345.70000 0004 1756 7871Ophthalmology department, San Martino Hospital, Belluno, Italy
| | - Gabriella De Salvo
- grid.430506.40000 0004 0465 4079Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alessandro Meduri
- grid.10438.3e0000 0001 2178 8421Department of Biomedical Sciences, Eye Clinic, University of Messina, Messina, Italy
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23
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Haddad F, Mimouni M, Nemet A, Safuri S, Achiron A, Shapira Y, Mtanis K, Duvdevan-Strier N, Ben-Ner D, Zayit-Soudry S. Changes in chorioretinal flow index after cataract surgery: an optical coherence tomography angiography study. Int Ophthalmol 2023; 43:35-41. [PMID: 35810396 DOI: 10.1007/s10792-022-02385-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Pseudophakic cystoid macular edema (CME) occurs in up to 2% of uneventful cataract surgeries. This study evaluates changes in macular blood flow succeeding uneventful phacoemulsification cataract extraction among otherwise visually healthy subjects. METHODS This prospective study included 18 eyes of 18 patients undergoing routine phacoemulsification. Optical coherence tomography angiography (OCT-A) was performed using the Angio-Retina 6 × 6 mm protocol with the XR Avanti Angio-Vue system (Optovue Inc., Fremont, California) prior to the surgery and 4-8 weeks thereafter. Exclusion criteria included motion artifacts, segmentation errors and signal strength index (SSI) < 40. The main outcome measure was change in flow index (FI) measured in all 4 retinal segmentation layers within an area of 1 mm diameter around the foveal center. RESULTS Following surgery, a significant increase in SSI (46.65 ± 8.62 versus 53.12 ± 8.07, p = 0.01), superficial plexus FI (0.98 ± 0.23 versus 1.16 ± 0.16, p = 0.02) and deep plexus FI (0.54 ± 0.46 versus 0.93 ± 0.39, p = 0.01) was found. No significant changes were noted in the outer retina or the choriocapillaris. CONCLUSION The study demonstrates a significant increase in FI in the superficial and deep retinal plexus following uneventful cataract surgery, with the greatest changes occurring in the latter. These findings corroborate evidence from structural imaging and support the vascular etiology of pseudophakic CME.
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Affiliation(s)
- Fadi Haddad
- Department of Ophthalmology, The Baruch Padeh Poriya Medical Center, Tiberias, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Achia Nemet
- Department of Ophthalmology, Assuta Ashdod University Medical Center, Ashdod, Israel.
| | - Shadi Safuri
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Asaf Achiron
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Ophthalmology, E. Wolfson Medical Center, Holon, Israel.,Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yinon Shapira
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kamal Mtanis
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Nitzan Duvdevan-Strier
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Ben-Ner
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Zayit-Soudry
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,The Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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24
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Miguel-Escuder L, Olate-Pérez Á, Sala-Puigdoners A, Moll-Udina A, Figueras-Roca M, Navarro-Angulo MJ, Adán A, Pelegrín L. Intravitreal fluocinolone acetonide implant for the treatment of persistent post-surgical cystoid macular edema in vitrectomized eyes. Eur J Ophthalmol 2023; 33:NP23-NP27. [PMID: 34836464 DOI: 10.1177/11206721211046718] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Cystoid macular edema (CME) is the most common cause of decreased visual acuity after both vitrectomy and cataract surgery. Various strategies have been used for its treatment, such as intravitreal corticosteroids. The intravitreal fluocinolone acetonide implant (Iluvien®) is approved for the treatment of persisting diabetic macular edema and for the prevention of recurrence of non-infectious uveitis affecting the posterior segment. There are very few reports about its off-label use for post-surgical CME. We present four clinical cases of post-surgical CME (three following vitrectomy and one following cataract surgery in a vitrectomized eye 2 years ago). All of them had been previously treated with an average of four injections of intravitreal dexamethasone implant (Ozurdex®), with repeated recurrence of CME. After treatment with Iluvien, three cases showed improvement of both visual acuity and macular anatomy, with resolution of the macular edema. One patient required additional treatment with Ozurdex during follow-up, further improving CME. Two of the cases required topical pressure lowering treatment, and none required filtering surgery. Iluvien could be an effective therapeutic option for persistent non-diabetic macular edema after vitrectomy or cataract surgery refractory to other intravitreal therapies, with the benefit of being able to provide longer recurrence-free periods.
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Affiliation(s)
- Lucia Miguel-Escuder
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Álvaro Olate-Pérez
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Anna Sala-Puigdoners
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Aina Moll-Udina
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Alfredo Adán
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Pelegrín
- Clínic Institute of Ophthalmology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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25
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Hirji SH. Clinical Evaluation of Patients with Retinitis Pigmentosa. Methods Mol Biol 2023; 2560:31-39. [PMID: 36481881 DOI: 10.1007/978-1-0716-2651-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter describes the clinical evaluation process of patients with retinitis pigmentosa (RP). The clinical evaluation consists of a complete history and ophthalmic examination. Here, we outline the aspects of the history and ophthalmic exam that are most important for the evaluation of RP patients. In addition, the expected findings of RP patients and the etiology of these findings are discussed.
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Affiliation(s)
- Sitara H Hirji
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA.
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26
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Li SS, Wang HH, Wang YL, Zhang DW, Chen X. Comparison of the efficacy and safety of non-steroidal anti-inflammatory drugs and corticosteroid drugs for prevention of cystoid macular edema after cataract surgery. Int Ophthalmol 2023; 43:271-284. [PMID: 36065039 DOI: 10.1007/s10792-022-02426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION To compare the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAID), corticosteroid (CS), and a combination of both drugs to prevent cystoid macular edema (CME) after cataract surgery. METHODS We searched Pubmed, Cochrane Library, and Embase electronic databases to assess the relevant randomized controlled trials (RCTs) up to 28 April 2021. Network meta-analysis was registered on PROSPERO (CRD42020182520). RESULTS Twenty-four RCTs were included in this review. The NSAID and combination of both drugs were significantly reduced the risk of developing CME than CS alone in non-diabetics and mix populations. In the ranking profiles, the combination therapy showed a significant advantage over the single drugs and was less likely to develop CME. Diclofenac was the most likely to reduce the odds of developing CME compared with bromfenac and nepafenac. Dexamethasone was the most likely to reduce the odds of developing CME compared with betamethasone and fluorometholone. CONCLUSION NSAID combination with CS has significantly reduced the risk of developing CME postoperatively than the single drug. Diclofenac was superior to bromfenac and nepafenac in preventing CME. Dexamethasone was superior to betamethasone and fluorometholone in preventing CME.
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Affiliation(s)
- Shan-Shan Li
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| | - Hui-Hui Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan-Ling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Da-Wei Zhang
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xi Chen
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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27
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Pennipede D, Sciulli H, Ajlan R. Bilateral Cystoid Macular Edema with Zanubrutinib Therapy: A Case Report. Case Rep Oncol 2023; 16:519-524. [PMID: 37485014 PMCID: PMC10359683 DOI: 10.1159/000529069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/04/2023] [Indexed: 07/25/2023] Open
Abstract
We present a patient with recurrent mantle cell lymphoma (MCL) who was treated with zanubrutinib, a Bruton's tyrosine kinase inhibitor. He subsequently developed bilateral cystoid macular edema (CME) in both eyes. This is the first report of CME in a patient with MCL who was treated with zanubrutinib. CME was refractory to topical corticosteroid therapy, but sub-Tenon's steroid injections and holding off zanubrutinib managed to decrease the CME. Treatment managed to prevent further vision loss but did not restore lost vision. The prompt ophthalmic exam is recommended for patients on zanubrutinib with decreased vision.
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Affiliation(s)
- Dante Pennipede
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Harrison Sciulli
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Radwan Ajlan
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, KS, USA
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28
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Yamane H, Itagaki T, Kajitani K, Koura Y, Kawabuchi Y, Ohara M. Cystoid Macular Edema following Treatment with Nanoparticle Albumin-Bound Paclitaxel and Atezolizumab for Metastatic Breast Cancer. Case Rep Oncol 2023; 16:1121-1128. [PMID: 37900858 PMCID: PMC10601834 DOI: 10.1159/000533999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/24/2023] [Indexed: 10/31/2023] Open
Abstract
Cystoid macular edema (CME) is a rare side effect associated with chemotherapy. Although the development of CME has been reported to occur following treatment with taxane drugs, such as nanoparticle albumin-bound paclitaxel (Nab-PTX), the occurrence of CME with treatment with atezolizumab has not yet been reported. Here, we report the case of a 49-year-old woman who developed CME 19 months into chemotherapy with Nab-PTX and atezolizumab. Improvement was not achieved with steroid injections into the Tenon's sac, and Nab-PTX and atezolizumab treatments were ceased. One month later, there was subjective improvement in her symptoms. Although many reports have indicated that cessation of chemotherapy has successfully improved CME, a specific treatment for CME has not yet been established. Clinicians should be aware of the ophthalmologic side effects and offer immediate treatment if symptoms develop.
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Affiliation(s)
- Hiroaki Yamane
- Department of Breast Surgery, Hiroshima General Hospital, Hiroshima, Japan
- Department of Surgery, Yamane Clinic, Hiroshima, Japan
| | - Tomoko Itagaki
- Department of Breast Surgery, Hiroshima General Hospital, Hiroshima, Japan
| | - Keiko Kajitani
- Department of Breast Surgery, Hiroshima General Hospital, Hiroshima, Japan
| | - Yuji Koura
- Department of Ophthalmology, Koura Eye Clinic, Hiroshima, Japan
| | - Yoshiharu Kawabuchi
- Department of Breast Surgery, Hatsukaichi Breast Care Clinic, Hiroshima, Japan
| | - Masahiro Ohara
- Department of Breast Surgery, Hiroshima General Hospital, Hiroshima, Japan
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29
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Karaca I, Korot E, Ghoraba H, Regenold J, Mobasserian A, Khan Y, Zaidi MH, Or C, Nguyen QD. Acute iridocyclitis and cystoid macular edema related to kinked Hydrus ® Microstent in advanced glaucoma. Saudi J Ophthalmol 2022; 36:390-393. [PMID: 36618568 PMCID: PMC9811929 DOI: 10.4103/sjopt.sjopt_215_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023] Open
Abstract
A 58-year-old male who underwent cataract extraction with combined intraocular lens and Hydrus® Microstent (Ivantis Inc, Irvine, CA, US) implantation 2 years ago in the right eye (OD) due to advanced glaucoma presented with blurry vision in right eye (OD) for 3 months. The visual acuity was 20/60 and slit-lamp examination indicated mild anterior chamber inflammation with unexposed, functioning tube shunt superotemporally in OD. Optical coherence tomography demonstrated cystoid macular edema (CME) with subretinal fluid. Fluorescein angiography demonstrated petaloid pattern leakage of CME. Gonioscopy revealed a kinked appearance of a Hydrus® Microstent protruding into the anterior chamber and causing iris chafing. Topical ketorolac tromethamine and prednisolone acetate were started. At the 2nd month of follow-up, the anterior chamber was quiet, and the CME resolved completely. Protruded kinked Hydrus® Microstent may lead to acute iridocyclitis and CME through iris chafing, which may be responsive to topical anti-inflammatory drops.
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Affiliation(s)
- Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Edward Korot
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Youan Khan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Moosa H. Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan D. Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA,Address for correspondence: Prof. Quan D. Nguyen, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Palo Alto, California, USA. E-mail:
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30
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Thenappan A. Current Management Options for Patients with Retinitis Pigmentosa. Methods Mol Biol 2022; 2560:353-361. [PMID: 36481910 DOI: 10.1007/978-1-0716-2651-1_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With an estimated prevalence of 1 in 4000 worldwide [1], retinitis pigmentosa (RP) comprises a spectrum of progressive inherited retinal disorders that can lead to blindness as early as age 30 [2]. Despite its relatively high prevalence and devastating consequences, RP does not have a definitive cure. Therapeutic attempts have been made with nutritional supplementation, but these strategies only have proven benefit in a limited number of patients with rare forms of RP. Thus, current standards of care involve regular follow-up, management of associated ocular pathology such as macular edema and cataracts, and genetic counseling and low vision rehabilitation. In recent years, gene therapy, visual prostheses, and stem cell therapy have emerged as FDA-approved treatments for RP, but these options are not yet widely used. Herein, this chapter will discuss the therapeutic strategies listed above that comprise the current standards of care and briefly discuss some emerging options.
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Affiliation(s)
- Abinaya Thenappan
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA.
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31
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Menteş J, Değirmenci C. Multimodal Imaging of Pigmented Paravenous Retinochoroidal Atrophy in a Pediatric Patient with Cystoid Macular Edema. Turk J Ophthalmol 2022; 52:432-435. [PMID: 36578225 PMCID: PMC9811229 DOI: 10.4274/tjo.galenos.2022.39032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this case report is to present the multimodal imaging characteristics of pigmented paravenous retinochoroidal atrophy (PPRCA) in a pediatric patient with cystoid macular edema (CME). A 7-year-old girl was admitted to our clinic with complaints of mild blurred vision and poor night vision. Best corrected visual acuity was 10/10 in both eyes. Fundus examination showed atrophic areas around the optic nerve and along the retinal vessels in both eyes. A few small dot-shaped paravenous pigmentations were observed in the mid-peripheral retina. Fundus autofluorescence was consistent with PPRCA. Spectral-domain optical coherence tomography (OCT) revealed the presence of CME and loss of the outer retinal layers outside the macula, with intact retinal layers in the macula. OCT angiography revealed normal choriocapillaris vasculature and flow. The patient was followed up for 6 months but showed no change in CME or clinical appearance. CME without ocular inflammation is an unusual finding of PPRCA and may suggest the involvement of chronic or latent inflammation in the etiology of PPRCA.
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Affiliation(s)
- Jale Menteş
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Cumali Değirmenci
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey E-mail:
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Sabaner MC, Dogan M. Treatment of Intravitreal Ranibizumab Resistant Radiation Retinopathy with Intravitreal Dexamethasone Implant: A Case Report. Beyoglu Eye J 2022; 7:324-8. [PMID: 36628082 DOI: 10.14744/bej.2022.72602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 01/13/2023]
Abstract
A 43-year-old female patient presented with complaints of decreased vision in both eyes. Her medical history revealed the diagnosis of metastatic breast cancer. She was treated with chemotherapy, and whole-brain, manubrium sterni, and right chest wall radiation therapy. Best-corrected visual acuity (BCVA) was 20/200 and 20/160 in the right and left eye, respectively. Optical coherence tomography (OCT) confirmed the presence of cystoid macular edema (CME). OCT angiography confirmed the presence of microaneurysms, ischemia, and capillary drop-out on the macula. Fundus fluorescein angiography revealed multiple microaneurysms with surrounding ischemia and leakage. Based on these findings and medical history, a diagnosis of radiation maculopathy was considered. The patient was administered intravitreal four doses of ranibizumab injections. Laser photocoagulation was performed on the ischemic areas of the retina in both eyes. Despite the follow-up and treatment, the presence of residual CME and BCVA 20/200 in both eyes was determined; it was decided to change the treatment regimen to an intravitreal dexamethasone implant. One month after injection, BCVA was 20/80 in both eyes, and normal foveal contour and no edema as confirmed on OCT. The DEX implant showed a promising result and should be kept in mind in the treatment of radiation retinopathy.
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Dabas G, Shukla P, Mithal K, Bhartiya S, Singh VP, Agarwal S. Central macular thickness change after uneventful small-incision cataract surgery - An observational study. Indian J Ophthalmol 2022; 70:3995-3999. [PMID: 36308142 PMCID: PMC9907309 DOI: 10.4103/ijo.ijo_793_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The purpose of this study was to diagnose CME with the help of optical coherence tomography (OCT) after uneventful cataract surgery to prevent visual deterioration. Methods This study was conducted on 120 patients, who underwent manual small-incision cataract surgery with posterior chamber intra-ocular lens implantation. Follow-up was performed after the first week, sixth week, and 12th week post-operatively. Detailed examination was performed at each visit along with measurements of central macular thickness using OCT. Statistical analysis was performed using SPSS 22.0. Result The mean age of the patients was 61.85 ± 11.41 years having female preponderance. The pre-operative mean best corrected visual acuity (BCVA) was found to be 0.05 ± 0.04, whereas the mean post-operative BCVA was found to be 0.65 ± 0.17 at the first week, 0.66 ± 0.17 at the sixth week, and 0.67 ± 0.17 at the 12th week follow-up. The post-operative mean macular thicknesses at the first week, sixth week, and 12th week post-operatively were documented to be 221.66 ± 8.49 μm, 224.60 ± 8.75 μm, and 219.17 ± 8.22 μm, respectively. Conclusion A sub-clinical increase in macular thickness occurs even after uncomplicated cataract surgery. The maximum increase was observed after 6 weeks of surgery, which returns to near normal values within 3 months. Comparison of central macular thicknesses pre-operatively and post-operatively at the first week, sixth week, and 12th week suggests a significant correlation.
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Affiliation(s)
- Garvita Dabas
- Department of Ophthalmology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
| | - Prachi Shukla
- Department of Ophthalmology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India,Correspondence to: Dr. Prachi Shukla, B-37, Somdutt City, Near K L International School, Meerut - 250 004, Uttar Pradesh, India. E-mail:
| | - Kopal Mithal
- Department of Ophthalmology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
| | - Suman Bhartiya
- Department of Ophthalmology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
| | - Vijay Pratap Singh
- Department of Ophthalmology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
| | - Swati Agarwal
- Department of Ophthalmology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
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Sørland RØ, Erichsen AK, Jonsdottir TE, Bromnes MN, Lauritzen PM, Eidet JR. Successful treatment with repeated dexamethasone implant injections for recurrent macular edema after acute retinal necrosis. J Ophthalmic Inflamm Infect 2022; 12:33. [PMID: 36269441 PMCID: PMC9587196 DOI: 10.1186/s12348-022-00310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background The treatment of recurrent cystoid macular edema associated with acute retinal necrosis is challenging due to the concern that treatment with intravitreal steroids may reactivate the retinitis. Case report An immunocompetent patient diagnosed with acute retinal necrosis was treated with oral valacyclovir and intravitreal injections of foscarnet. Giant tears in her retina necessitated a vitrectomy with silicone oil. She developed cystoid macular edema after the removal of the silicone oil. The edema responded to high-dose prednisolone but recurred when the dose was tapered to 20 mg daily. Under close surveillance and increased antiviral medication, she was treated with a dexamethasone implant with complete resolution of the edema. Unfortunately, the edema recurred, and the treatment had to be repeated. Over 18 months, she received five dexamethasone implants without recurrence of the viral retinitis. Conclusions This case shows successful treatment of recurring cystoid macular edema following acute retinal necrosis with repeated intravitreal dexamethasone implants in a patient receiving valacyclovir maintenance treatment.
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Affiliation(s)
| | | | | | | | | | - Jon Roger Eidet
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
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Ahrabi B, Omidvari S, Mollazadeh Ghomi S, Ahmady Roozbahany N, Vafaei-Nezhad S, Shirazi Tehrani A, Abbaszadeh HA, Darabi S. Therapeutic Effects of Combination Therapy and Photobiomodulation Therapy on Retinal Regeneration. J Lasers Med Sci 2022; 13:e36. [PMID: 36743147 PMCID: PMC9841384 DOI: 10.34172/jlms.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/27/2022] [Indexed: 01/27/2023]
Abstract
Introduction: Many systemic and ocular diseases cause macular edema (ME). Macular edema is seen in two primary forms; the first is diffuse thickening of the macula, and the other is a macula with a distinct petaloid (cloverleaf) appearance called cystoid macular edema. Macular edema has a known role in the reduction of visual equity, and many options have been proposed for the reversal of this condition. Methods: Articles on the effects of macular laser grid photocoagulation on diabetic macular edema (DME) or cystoid macular edema published between 2000 and 2022 were collected from PubMed, Google Scholar, and Web of Science. The following keywords were used for the search: "macular laser photocoagulation", "macular edema", "cystoid macular edema", "intravitreal pharmacotherapies", and "antivascular endothelial growth factor". Two hundred nineteen articles were found in google scholar and 165 articles in PubMed, and a total of 58 articles were included in the study after applying the exclusion criteria. Results: We investigated the effects of various lasers photocoagulation such as Focal and/or grid macular laser, subthreshold micropulse laser (SMPL), as well as intravitreal pharmacotherapies with triamcinolone acetonide, and fluocinolone, and extended released intraocular implants such as Ozurdex, Retisert, Iluvien, and anti-vascular endothelial growth factors such as bevacizumab (Avastin), Eyela, and Lucentis. Corticosteroids were more effective than lasers, although some researchers have found that lasers and combined lasers and corticosteroids are more effective. In addition, some studies have shown that the frequency and concentrations of intravitreal pharmacotherapies are effective in increasing visual outcomes. Conclusion: The results of the studies showed that the combined intravitreal corticosteroids are much more effective in improving visual acuity (VA) than a single corticosteroid, and the low concentration of the drug is safer. Still, corticosteroids have side effects such as increased intraocular pressure and glaucoma. Therefore, combining the medication with a laser is much more reasonable than each alone. Also, the subthreshold photocoagulation laser (670 nm) is better at reducing the central macular thickness (CMT) and improving VA than the micro pulse yellow laser and pan-retinal photocoagulation (PRP).
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Affiliation(s)
- Behnaz Ahrabi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samareh Omidvari
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shamim Mollazadeh Ghomi
- Cellular and Molecular Research Center, Research Institute for Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Navid Ahmady Roozbahany
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Vafaei-Nezhad
- Department of Anatomical Sciences, School of Medicine, Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Atefeh Shirazi Tehrani
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hojjat Allah Abbaszadeh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to Hojjat Allah Abbaszadeh, Shahram Darabi,
| | - Shahram Darabi
- Cellular and Molecular Research Center, Research Institute for Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran,Correspondence to Hojjat Allah Abbaszadeh, Shahram Darabi,
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Gaudric A, Audo I, Vignal C, Couturier A, Boulanger-Scemama É, Tadayoni R, Cohen SY. Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022;:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
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Kokame GT, Tanji TT, Yanagihara RT, Shantha JG, Nirwan RS, Tanji TM. Refractive Outcomes of Combined Cataract Surgery and Vitrectomy Compared to Cataract Surgery Alone. Ophthalmologica 2022; 246:39-47. [PMID: 35858534 PMCID: PMC10906474 DOI: 10.1159/000526039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study was to evaluate the refractive outcomes of combined cataract surgery and vitrectomy compared to cataract surgery alone. METHODS This retrospective chart review study included two groups: (1) combined surgery in 103 eyes (101 patients) who underwent cataract surgery with posterior chamber intraocular lens (PCIOL) placement by a single cataract surgeon and vitrectomy by a single vitreoretinal surgeon at the same surgical setting; (2) cataract surgery alone by the same surgeon in 107 eyes (84 patients). Refractive outcomes and complications between the combined and cataract surgery alone group were compared. The predicted refractive error was compared to postoperative refractive outcomes in both groups, surgically induced astigmatism (SIA), intraoperative or postoperative complications of either cataract surgery or vitrectomy, and cystoid macular edema. RESULTS There was no statistically significant difference between predicted and actual postoperative refractive outcomes between the combined and cataract surgery alone groups (within ±0.5 diopters [D], p = 0.099; within ±1.0 D, p = 0.721). There was no difference in SIA refractive outcomes between the two groups (p = 0.509). The use of intraoperative gas for retina tamponade did not significantly affect postoperative refractive outcomes. Both cataract surgery and vitrectomy were successfully performed without unexpected complications from either procedure affecting the other. DISCUSSION/CONCLUSION Combined cataract surgery and vitrectomy allows excellent refractive outcomes equal to cataract surgery alone, allowing each procedure to be performed independently by separate anterior and posterior segment surgeons. Combined procedures can be performed in eyes with a variety of retinal indications and can include fluid-gas exchange with minimal risk of PCIOL malposition or change in targeted refraction.
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Affiliation(s)
- Gregg T. Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii, USA
- Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
- Retina Consultants of Hawaii, Honolulu, Hawaii, USA
| | - Tarin T. Tanji
- Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
- Retina Consultants of Hawaii, Honolulu, Hawaii, USA
| | - Ryan T. Yanagihara
- Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
- Retina Consultants of Hawaii, Honolulu, Hawaii, USA
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Jessica G. Shantha
- Department of Ophthalmology, Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Rajinder S. Nirwan
- Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Troy M. Tanji
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii, USA
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Di Pippo M, Di Staso F, De Ponte C, Fragiotta S, Abdolrahimzadeh S. Nab-Paclitaxel related cystoid macular edema. Clin Ter 2022; 173:377-383. [PMID: 35857057 DOI: 10.7417/ct.2022.2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Nab-paclitaxel is a chemotherapeutic drug used to treat various solid malignant tumors. It was conceived with a solvent free formulation to overcome toxicity events and hypersensitivity reactions associated with paclitaxel. However, it still carries ocular adverse effects. The present review examines nab-paclitaxel related cystoid macular edema (CME) and the available therapeutic options. MATERIALS AND METHODS The literature was reviewed on nab-paclitaxel related CME on published articles through January 2021 using the keywords "nab-paclitaxel "and "cystoid macular edema". RESULTS Bilateral CME is found in patients in treatment with nab-paclitaxel and causes considerable visual acuity decline. In ophthalmology multimodal imaging has an integral role in the diagnostic work up of patients and shows characteristic findings in nab-paclitaxel related CME. The case of a patient with treatment for bilateral CME is presented and analyzed. CONCLUSIONS The preferred management strategy for nab-paclitaxel-related CME is drug cessation that leads to complete resolution of edema. When discontinuation of treatment is not possible due to the systemic conditions of patients, effective alternative therapeutic modalities are topical dorzolamide or steroidal treatment. Given the higher complication hazards of intravitreal therapy topical treatment should be preferred owing to comparable efficacy.
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Affiliation(s)
- M Di Pippo
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
| | - F Di Staso
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
| | - C De Ponte
- Pharmacy Unit, INMI Lazzaro Spallanzani, Rome Italy
| | - S Fragiotta
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
| | - S Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, University of Rome Sapienza, St. Andrea Hospital, Rome, Italy
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Teo AYT, Betzler BK, Hua KLQ, Chen EJ, Gupta V, Agrawal R. Intermediate Uveitis: A Review. Ocul Immunol Inflamm 2022:1-20. [PMID: 35759636 DOI: 10.1080/09273948.2022.2070503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU). METHODS Narrative literature review. RESULTS IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice. CONCLUSIONS IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.
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Affiliation(s)
| | | | - Keith Low Qie Hua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Singapore Eye Research Institute, Singapore.,Duke NUS Medical School, Singapore
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Marques JP, Neves E, Geada S, Carvalho AL, Murta J, Saraiva J, Silva R. Frequency of cystoid macular edema and vitreomacular interface disorders in genetically solved syndromic and non-syndromic retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 2022. [PMID: 35389060 DOI: 10.1007/s00417-022-05649-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Retinitis pigmentosa (RP) corresponds to a group of inherited retinal disorders where progressive rod-cone degeneration is observed. Cystoid macular edema (CME) and vitreomacular interface disorders (VMID) are known to complicate the RP phenotype, challenging an age-old concept of retained central visual acuity. The reported prevalence of these changes varies greatly among different studies. We aim to describe the frequency of CME and VMID and identify predictors of these changes in a cohort of Caucasian patients with genetically solved syndromic (sRP) and non-syndromic RP (nsRP). METHODS Cross-sectional study of patients with genetically solved sRP or nsRP. Genetic testing was clinically oriented in all probands and coordinated by a medical geneticist. The presence/absence of CME and VMIDs such as epiretinal membrane (ERM), vitreomacular traction (VMT), lamellar hole (LH), macular hole (MH), and macular pseudohole (MPH), and the integrity of the neurosensory retina and retinal pigment epithelium were evaluated in individual macular SD-OCT b-scans. Mixed-effects regression analysis models were used to identify significant predictors of BCVA, CME, and VMID. Significance was considered at α < 0.05. RESULTS We included 250 eyes from 125 patients. Mean age was 44.9 ± 15.7 years and 55.2% were male. Eighty-eight patients had nsRP and 37 had sRP. Median BCVA was 0.5 (0.2-1.3) logMAR. CME was found in 17.1% of eyes, while ERM was found in 54.3% of eyes. The frequency of CME (p = 0.45) and ERM (p = 0.07) did not differ between sRP and nsRP patients, nor across different inheritance patterns. Mixed-effects univariate linear regression identified age (p = 0.04), cataract surgery (p < 0.01), and loss of integrity of outer retinal layers (p < 0.01) as significant predictors of lower visual acuity, while increased foveal thickness (p < 0.01) and the presence of CME (p = 0.04) were predictors of higher visual acuity. On mixed-effects multivariable analysis, only increased foveal thickness was significantly associated with better visual acuity (p < 0.01). CONCLUSION We found that the burden of ERM and CME in RP patients is high, highlighting the importance of screening for these potentially treatable conditions to improve the quality of life of RP patients.
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Aghaei H, Es'haghi A, Pourmatin R. Improvement of pseudophakic cystoid macular edema with subconjunctival injections of interferon α2b:a case report. Am J Ophthalmol Case Rep 2022; 26:101504. [PMID: 35372711 PMCID: PMC8968005 DOI: 10.1016/j.ajoc.2022.101504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To report a patient with resistant cystoid macular edema after an uneventful phacoemulsification cataract surgery who responded to subconjunctival interferon α2b injections. Observations This report describes a 60-year-old male patient with pseudophakic cystoid macular edema that was unresponsive to multiple courses of topical non-steroidal anti-inflammatory drugs and steroids during the follow-up period. Weekly subconjunctival interferon α2b (5 MIU/ml) was administered four times. Cystoid macular edema completely resolved after the 4th injection.During a six-month follow-up period, cystoid macular edema did not recur. No adverse local and systemic side effects were observed. Conclusions and importance Weekly subconjunctival interferon α2b injections might be a safe and effective treatment modality in the treatment of stubborn pseudophakic cystoid macular edema to conventional treatment.
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Affiliation(s)
- Hossein Aghaei
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Acieh Es'haghi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rama Pourmatin
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Sborgia G, Niro A, Pastore V, Favale RA, Sborgia A, Gigliola S, Giuliani G, Grassi MO, Coassin M, Aiello F, Iaculli C, Reibaldi M, Boscia F, Alessio G. Mid-term safety and effectiveness of intravitreal dexamethasone implant to treat persistent cystoid macular edema in vitrectomized eyes for bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2703-2710. [PMID: 35254512 DOI: 10.1007/s00417-022-05615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the mid-term safety and effectiveness of intravitreal dexamethasone implant (DEX-i) for treating unresponsive to medical therapy cystoid macular edema (CME) in vitrectomized eyes for endophthalmitis. METHODS Retrospective and interventional case series study conducted on vitrectomized eyes for endophthalmitis that developed a CME that did not adequately respond to medical therapy, who underwent 0.7-mg DEX-i. Main outcome measures were changes in central retinal thickness (CRT) and best corrected visual acuity (BCVA). RESULTS Eleven eyes were included in the study. Microbiological findings of vitreous biopsies were 7 (63.6%) staphylococcus epidermidis; 3 (27.3%) Pseudomonas aeruginosa; and 1 (9.1%) Propionibacterium acnes. Median (interquartile range, IqR) duration of CME was 4.0 (3.0-4.0) months. Median (IqR) time between vitrectomy and DEX-i was 9.0 (9.0-11.0) months. Median CRT was significantly decreased from 548.0 (412.8-572.5) µm at baseline to 308.0 (281.3-365.5) µm at month 6 (p = 0.0009, Friedman test). Median BCVA significantly improved from 38.0 (30.5-44.8) letters at baseline to 50.0 (46.8-53.0) letters at month 6 (p < 0.0001, Friedman), with 9 (81.8%) eyes gaining ≥ 10 letters. Elevation of intraocular pressure was observed in one (9.1%) eye, which was successfully controlled with medical therapy. No recurrence of endophthalmitis or other complications was observed. Eight (72.7%) eyes required an additional DEX-i, while 3 (27.3%) were successfully controlled with only one DEX-i. CME recurrence occurred in 5 (62.5%) Gram-positive and 3 (100.0%) Gram-negative bacteria (p = 0.2357). CONCLUSION In vitrectomized eyes for endophthalmitis affected by CME unresponsive to medical therapy, DEX-i had an acceptable safety profile and achieved favorable outcomes. The possibility of suppressing mechanisms for infection control should be taken into account, although correct management of endophthalmitis and long time without reactivation before DEX-i reduce the risk.
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Affiliation(s)
- Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy.
| | - Valentina Pastore
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Rosa Anna Favale
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alessandra Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Samuele Gigliola
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Maria Oliva Grassi
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Marco Coassin
- Ophthalmology, University Campus Bio Medico of Rome, 00128, Rome, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Cristiana Iaculli
- Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, 10126, Turin, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
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Nguyen KH, Smith AK, Kim BT, Browne AW. A case report of cystoid macular edema, uveitis and vitreomacular traction in a patient taking Anastrozole. Am J Ophthalmol Case Rep 2022; 25:101339. [PMID: 35128169 PMCID: PMC8802872 DOI: 10.1016/j.ajoc.2022.101339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 09/23/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose To report a case of cystoid macular edema, uveitis, and vitreomacular traction in a patient with a history of breast cancer and taking anastrozole. Observations A 73-year-old female with a history of estrogen receptor-positive breast cancer and treatment with anastrozole presented with bilateral blurry vision, photophobia, and eye soreness. Optical coherence tomography (OCT) of both maculae revealed vitreomacular traction (VMT), an epiretinal membrane, cystoid macular edema (CME) in the right eye, and drusen without subretinal fluid bilaterally. Although later, macular OCT did show evidence of cystoid intraretinal spaces in the left eye as well. Fluorescein angiography showed bilateral petaloid leakage, bilateral slow disc leaking, as well as peripheral leakage in the right eye. Anastrozole was discontinued and, subsequent macular OCT showed release of VMT in the right eye, and eventual resolution of intraretinal cystoid spaces bilaterally. Conclusions and importance Stopping of anastrozole was associated in resolution of refractory CME in a patient on aromatase inhibitor therapy for breast cancer. It is therefore important to consider anastrozole and other aromatase inhibitor drugs as possible factors predisposing patients to the development of CME.
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Affiliation(s)
- Kevin H. Nguyen
- Creighton University School of Medicine, 7500 Mercy Rd, Omaha, NE, 68124, USA
| | - Andrew K. Smith
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California-Irvine, 850 Health Sciences Rd, Irvine, CA, 92697, USA
| | - Brian T. Kim
- Harvard Eye Associates, 23961 Calle De La Magdalena Ste 300, Laguna Hills, CA 92654, USA
| | - Andrew W. Browne
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California-Irvine, 850 Health Sciences Rd, Irvine, CA, 92697, USA
- Institute for Clinical and Translational Sciences, University of California Irvine, Irvine, CA, USA
- Department of Biomedical Engineering, Henry Samueli School of Engineering, University of California Irvine, Irvine, CA, USA
- Corresponding author.
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Navarrete A, Vofo B, Matos K, Rivera A, Chowers I, Levy J. The detrimental effects of delayed intravitreal anti-VEGF therapy for treating retinal pathology: lessons from a forced test-case. Graefes Arch Clin Exp Ophthalmol 2022; 260:2201-2208. [PMID: 34994841 PMCID: PMC8739509 DOI: 10.1007/s00417-021-05549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Determine the anatomical consequences of delaying intravitreal injection (IVI) therapy with anti-vascular endothelial growth factor (anti-VEGF) in patients using treat-and-extend (T&E) protocol. Methods Retrospective medical record review of consecutive patients receiving intravitreal anti-VEGF therapy using T&E protocol prior to and during the COVID-19 pandemic. Results The study included 923 eyes of 691patients; 58.8% (543 eyes), 25% (231 eyes), and 16.2% (149 eyes) had nvAMD, DME, and RVO, respectively. Mean (± SD) patient age was 74.5 ± 11.7 years. Overall, 56.3% of cases had a delay in therapy of ≥ 7 days; specifically, 56.2%, 61.5%, and 49.0% of nvAMD, DME, and RVO cases, respectively, had a delay. The median delay in days, among cases ≥ 7 days late was 21 (IQR 7 to 42) days, with 21(IQR 7 to 45), 22.5(IQR 8 to 42), and 14(IQR 7 to 33.5) days of delay among patients with nvAMD, DME, and RVO, respectively. Delaying therapy by ≥ 7 days resulted in increased CST in 47.5%, 58.5%, and 58.9% of nvAMD, DME, and RVO cases, respectively, with a significant correlation between the length of treatment delay and the increase in CST (Spearman’s rho: 0.196; p < 0.001). Conclusions Delayed IVI treatment in eyes treated with T&E protocol was associated with increased macular thickness with potential consequences with respect to visual outcome.
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Affiliation(s)
- Ana Navarrete
- Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
| | - Brice Vofo
- Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
| | - Katherine Matos
- Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
| | - Antonio Rivera
- Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
| | - Itay Chowers
- Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel
| | - Jaime Levy
- Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
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Studsgaard A, Clemmensen KØ, Nielsen MS. Intravitreal fluocinolone acetonide 0.19 mg (Iluvien®) for the treatment of uveitic macular edema: 2-year follow-up of 20 patients. Graefes Arch Clin Exp Ophthalmol 2021. [PMID: 34851465 DOI: 10.1007/s00417-021-05504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate intravitreal 0.19 mg fluocinolone acetonide implant (FAi) (Iluvien®) for the treatment of chronic non-infectious uveitis with associated cystoid macular edema (CME). METHODS A retrospective review of medical reports from a single Danish tertiary centre including 20 patients (20 eyes), treated with 0.19 mg FAi for non-infectious uveitic CME. The primary endpoints were change in best corrected visual acuity (BCVA) and central retinal thickness (CRT). The secondary endpoints were recurrence rate, change in systemic treatment, and intraocular pressure (IOP). RESULTS Mean follow-up of the 20 eyes was 2.3 ± 1.1 years. BCVA improved at 6 (p = 0.13), 12 (p = 0.05), 18 (p = 0.03), and 24 months and CRT decreased at 6 (p = 0.004), 12 (p = 0.006), 18, and 24 months after 0.19 mg FAi. Within 18 months after implantation, four of 14 patients (28.6%) relapsed. Three of five patients discontinued systemic corticosteroids within 4 months and one patient continued with reduced dose. Five of 10 patients receiving disease-modifying antirheumatic drugs (DMARDs) at time of implantation discontinued within 1 year. No patients started new systemic treatment. Eight eyes were treated with topical IOP-lowering medication at the time of implantation, of these two later underwent trabeculectomy. There were no complications associated with previous glaucoma surgery. CONCLUSION This long-term follow-up study showed that intravitreal treatment with 0.19 mg FAi should be considered in the treatment of chronic non-infectious uveitic CME in selected patients. This treatment is safe even in selected glaucoma patients and may offer reduction or cessation of local or systemic anti-inflammatory treatment.
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Weldy EW, Patnaik JL, Pecen PE, Palestine AG. Quantitative effect of subretinal fluid and intraretinal edema on visual acuity in uveitic cystoid macular edema. J Ophthalmic Inflamm Infect 2021; 11:38. [PMID: 34635967 PMCID: PMC8505558 DOI: 10.1186/s12348-021-00266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background The effect of subretinal fluid (SRF) in uveitic cystoid macular edema (CME) is not fully understood. This study evaluates the quantitative effect of SRF and intraretinal thickness on visual acuity in eyes with uveitic CME. We separately measured SRF and intraretinal area on Optical Coherence Tomography (OCT) to determine the associations of each component with visual acuity and response to treatment. Main text Medical records were reviewed of patients with CME presenting to the University of Colorado uveitis clinic from January 2012 to May 2019. All available OCTs were reviewed to classify eyes as either having only CME or CME with SRF. Intraretinal area was manually measured using Image J along the central 1-mm section of B-scan OCT spanning from the internal limiting membrane to the outer most portion of the outer retina including both cysts and retinal tissue. SRF cross-sectional area was measured spanning from the outermost portion of the outer retina to retinal pigment epithelium. Response to treatment was assessed one to four months after presentation. Eyes with CME secondary to structural or non-inflammatory causes were excluded. Forty-seven (50.5%) eyes had CME alone and 46 (49.5%) eyes had SRF with CME. Measured SRF cross-sectional area was not associated (p = 0.21) with LogMAR at presentation. Conversely, intraretinal area was strongly correlated with visual acuity in eyes with SRF (p < 0.001) and without SRF (p < 0.001). Following treatment, there was a significant decrease in intraretinal area for both groups (p < 0.001), with a larger decrease in the SRF group compared to the non-SRF group (p = 0.001). Similarly, logMAR improved in both groups (p = 0.008 for SRF eyes and p = 0.005 for non-SRF eyes), but the change was more prominent in the SRF group (p = 0.06). Conclusions There was no direct association observed between the amount of SRF and visual acuity. In contrast, increased intraretinal area was significantly associated with decreased visual acuity. This relationship between intraretinal thickening and visual acuity may explain differences observed in response to treatment between SRF and non-SRF eyes, with a larger decrease in the intraretinal cross-sectional area in SRF eyes associated with a greater improvement in logMAR visual acuity.
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Affiliation(s)
- Eric W Weldy
- Department of Ophthalmology, University of Colorado School of Medicine, 1635 Aurora Ct, Aurora, CO, 80045, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, 1635 Aurora Ct, Aurora, CO, 80045, USA
| | - Paula E Pecen
- Department of Ophthalmology, University of Colorado School of Medicine, 1635 Aurora Ct, Aurora, CO, 80045, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, 1635 Aurora Ct, Aurora, CO, 80045, USA.
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Abstract
Purpose: The aim of this study was to evaluate the efficacy of topical interferon (IFN) therapy in pseudophakic cystoid macular edema (P-CME). Methods: This is a prospective, interventional case series of patients with P-CME. Patients presenting with P-CME were given the option of topical IFN therapy against conventional treatment with oral, topical, intravitreal, and periocular steroid therapy and antivascular growth factors. Patients who consented for the same were advised to use the IFN drops four times/day. Commercially available injection IFN alfa-2b was reconstituted to prepare the eye drops (1 MIU/ml). Optical coherence tomography (OCT) was done at the baseline and on each review visit until complete resolution of P-CME. Results: Eight eyes of eight patients diagnosed with P-CME were studied. Mean central macular thickness (CMT) on OCT at the presentation (n = 8) and at 4 weeks post topical IFN therapy (n = 6) was 560.1 μm (range: 349–702 μm) and 344.33 μm (range: 250–390 μm), respectively. All eyes except one had posterior capsular rent (PCR). Five patients had regular follow-up until resolution. The mean duration of complete first resolution of P-CME was 5 weeks (range: 4–7.1 weeks) in those patients. Relapse was seen in three patients who responded after resuming or continuing the therapy. Case 1 had 9 months follow-up after completion of IFN therapy, and no recurrence was noted. No ocular or systemic side effects related to the topical IFN therapy were noted clinically, except papillary conjunctivitis in one patient. Conclusion: Topical IFN therapy can be a noninvasive, economical, and effective choice of treatment for P-CME, especially in the case of PCR, and where steroids are contraindicated.
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Affiliation(s)
- Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ram Snehith
- Department of Vitreo-Retina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Vivek Singh
- Department of Vitreo-Retina, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Refractive Surgeries, Narayana Nethralaya, Bangalore, Karnataka, India
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Vijaysarathy C, Babu Sardar Pasha SP, Sieving PA. Of men and mice: Human X-linked retinoschisis and fidelity in mouse modeling. Prog Retin Eye Res 2021; 87:100999. [PMID: 34390869 DOI: 10.1016/j.preteyeres.2021.100999] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023]
Abstract
X-linked Retinoschisis (XLRS) is an early-onset transretinal dystrophy, often with a prominent macular component, that affects males and generally spares heterozygous females because of X-linked recessive inheritance. It results from loss-of-function RS1 gene mutations on the X-chromosome. XLRS causes bilateral reduced acuities from young age, and on clinical exam and by ocular coherence tomography (OCT) the neurosensory retina shows foveo-macular cystic schisis cavities in the outer plexiform (OPL) and inner nuclear layers (INL). XLRS manifests between infancy and school-age with variable phenotypic presentation and without reliable genotype-phenotype correlations. INL disorganization disrupts synaptic signal transmission from photoreceptors to ON-bipolar cells, and this reduces the electroretinogram (ERG) bipolar b-wave disproportionately to photoreceptor a-wave changes. RS1 gene expression is localized mainly to photoreceptors and INL bipolar neurons, and RS1 protein is thought to play a critical cell adhesion role during normal retinal development and later for maintenance of retinal structure. Several independent XLRS mouse models with mutant RS1 were created that recapitulate features of human XLRS disease, with OPL-INL schisis cavities, early onset and variable phenotype across mutant models, and reduced ERG b-wave to a-wave amplitude ratio. The faithful phenotype of the XLRS mouse has assisted in delineating the disease pathophysiology. Delivery to XLRS mouse retina of an AAV8-RS1 construct under control of the RS1 promoter restores the retinal structure and synaptic function (with increase of b-wave amplitude). It also ameliorates the schisis-induced inflammatory microglia phenotype toward a state of immune quiescence. The results imply that XLRS gene therapy could yield therapeutic benefit to preserve morphological and functional retina particularly when intervention is conducted at earlier ages before retinal degeneration becomes irreversible. A phase I/IIa single-center, open-label, three-dose-escalation clinical trial reported a suitable safety and tolerability profile of intravitreally administered AAV8-RS1 gene replacement therapy for XLRS participants. Dose-related ocular inflammation occurred after dosing, but this resolved with topical and oral corticosteroids. Systemic antibodies against AAV8 increased in dose-dependent fashion, but no antibodies were observed against the RS1 protein. Retinal cavities closed transiently in one participant. Technological innovations in methods of gene delivery and strategies to further reduce immune responses are expected to enhance the therapeutic efficacy of the vector and ultimate success of a gene therapy approach.
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Affiliation(s)
| | | | - Paul A Sieving
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA; Department of Ophthalmology, University of California Davis, 95817, USA.
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Shalabi O, Nazzal Z, Natsheh M, Iriqat S, Michaelides M, Ghanem M, Aslanian A, Alswaiti Y, AlTalbishi A. Swept-source optical coherence tomography changes and visual acuity among Palestinian retinitis Pigmentosa patients: a cross-sectional study. BMC Ophthalmol 2021; 21:289. [PMID: 34320936 PMCID: PMC8320214 DOI: 10.1186/s12886-021-02047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retinitis pigmentosa (RP) is a heterogeneous group of inherited ocular diseases that result in progressive retinal degeneration. This study aims to describe different Swept-source Optical Coherence Tomographic (SS-OCT) changes in Palestinian RP patients and to explore possible correlations with Visual Acuity (VA). METHODS A cross-sectional observational study was conducted on Retinitis Pigmentosa patients diagnosed with RP in a tertiary eye hospital. Full history and ocular examination were made. SS-OCT imaging was done for all eyes assessing the presence of cystoid macular edema, epiretinal membrane, macular holes, and external limiting membrane, ellipsoid zone status. Also, central macular thickness and choroidal vascular thickness were measured. RESULTS The study was run on 161 eyes of 81 patients; 53 males and 28 females. The average age at examination was 26.1 (6-78) years. Twenty-six eyes (16.1%) were of syndromic RP patients, mostly Usher syndrome; 20 eyes (12.4%). The mean Logaritmic minimal angle of resolution (LogMAR) of Best Corrected Visual Acuity (BCVA)of the study sample was 0.66 ± 0.7. The most prevalent change was cystoid macular edema [28 eyes, (17.4%)], followed by epiretinal membrane [17eye, (10.6%)]. A macular hole was noted only in one eye (0.6%). Ellipsoid zone and external limiting membrane were absent in 55 eyes (35.0%) and 60 eyes 37.5%. Vitreous hyperreflective foci were found in 35 eyes (43.8%). LogMAR of BCVA was associated significantly with cystoid macular edema (p = 0.001), ellipsoid zone(p = 0.001), and external limiting membrane (p = 0.001). CONCLUSIONS Detailed SS-OCT assessment in Palestinian patients diagnosed with RP identified different morphologies from other populations. Cystoid macular edema and vitreous hyperreflective foci may reflect signs of early or intermediate stages of the disease. Disease progression can be monitored by measuring the length/width (area) of ellipsoid zone +/- external limiting membrane and choroidal vascular thickness, which should be evaluated serially using high-resolution OCT.
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Affiliation(s)
- Orjowan Shalabi
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine
| | - Zaher Nazzal
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Muath Natsheh
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine
| | - Salam Iriqat
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine
| | - Michel Michaelides
- Department of genetics, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Muyassar Ghanem
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine
| | - Alice Aslanian
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine
| | - Yahya Alswaiti
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine
| | - Alaa AlTalbishi
- St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine.
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Otsubo M, Kinouchi R, Kamiya T, Yoshida A. Regression of taxane-related cystoid macular edema after topical dorzolamide treatment: two case reports. J Med Case Rep 2021; 15:355. [PMID: 34284818 PMCID: PMC8293476 DOI: 10.1186/s13256-021-02954-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cystoid macular edema is a rare, vision-threatening side effect of the taxane family of anticancer agents. There is no established treatment or standard treatment protocol for taxane-related cystoid macular edema. Here, we report two cases of taxane-related cystoid macular edema that were treated with topical dorzolamide. Case presentation In case 1, a 72-year-old Japanese woman with bilateral geographic choroiditis reported for a follow-up visit with a complaint of blurred vision in both eyes for 2 months after starting nanoparticle albumin-bound paclitaxel chemotherapy for multiple metastases of her breast cancer. Her best-corrected visual acuity had dropped from 1.2 to 0.9 in the right eye and from 1.0 to 0.4 in the left eye. Fundus examination showed no newly active geographic choroiditis lesion, but optical coherence tomography exhibited cystoid macular edema. We suspected taxane-related cystoid macular edema and terminated nanoparticle albumin-bound paclitaxel, and started topical dorzolamide treatment. Cystoid macular edema nearly resolved within 6 weeks in the right eye and within 10 weeks in the left eye after starting topical dorzolamide treatment. The resolution of cystoid macular edema without leaving a chorioretinal scar after discontinuation of paclitaxel confirmed our initial diagnosis of taxane-related cystoid macular edema. A few inconspicuous cystoid spaces persisted at the parafovea for a year after dorzolamide treatment ended, but regressed after restarting dorzolamide treatment without any side effects. Best-corrected visual acuity improved to 1.2 in the right eye and 1.0 in the left eye. In case 2, a 70-year-old Japanese man, who received nanoparticle albumin-bound paclitaxel for pancreatic cancer with multiple metastases, developed bilateral cystoid macular edema. Best-corrected visual acuity was 0.3 bilaterally. Cystoid macular edema resolved within 5 weeks after stopping nanoparticle albumin-bound paclitaxel and starting topical dorzolamide treatment confirming the diagnosis of taxane-related cystoid macular edema. Nine weeks later, best-corrected visual acuity improved to 0.8 in the right eye and 1.0 in the left eye. Conclusions Cystoid macular edema in each case resolved within a few months without any side effects using topical dorzolamide and terminating taxane-based chemotherapy. Topical dorzolamide appears to be a safe and effective treatment option for patients with taxane-related cystoid macular edema whose quality of life is threatened by visual disturbances.
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Affiliation(s)
- Mitsuru Otsubo
- Department of Ophthalmology, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, Japan.,Wakkanai City Hospital, 4-11-6 Chuuou, Wakkanai, Hokkaido, Japan
| | - Reiko Kinouchi
- Department of Ophthalmology, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, Japan. .,Medicine and Engineering Combined Research Institute, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Takayuki Kamiya
- Department of Ophthalmology, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, Japan
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido, Japan
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