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Outcomes of intravitreal bevacizumab and macular photocoagulation for treatment of diabetic macular edema in a tertiary care eye hospital at Karachi
摘要： Objective: To study the outcomes of intravitreal injection of Bevacizumab and laser photocoagulation in the treatment of diabetic macular edema (DME). Methods: Seventy-two eyes of 59 patients with diabetic macular edema were divided into two groups of 41 eyes (Group-A) and 31 eyes (Group-B). Subjects in group-A were treated with three intravitreal injections of Bevacizumab (IVB), and that of group-B with macular photocoagulation. Duration of study was 9 months. Follow up pattern for both groups was 1, 2, 3 and 6 months. Best Corrected Visual acuity on log MAR (BCVA) for distance as well as near in each visitwas recorded. Retinal OCT for central macular thickness (CMT) was performed on baseline. SPSS version 20.0 was used to analyze the data. Results: Mean age of the patients was 53.76 ± 8.82 ranging to 36-71 years. Out of 59 patients, 40 (67.8%) were male and 19 (32.2%) female. It was observed that the difference of results among both groups was not significant. Fig.2 documents visual acuity recorded as Improved; Stable and Worse. Conclusion: The improvement in BCVA was significant at 6 months in both treatments. The final improvements in BCVA has been almost similar between both the treatment groups although it was noted that IVB group showed early improvement in BCVA at follow-ups of 1 and 3 months. A long term follow-up is required in these cases to see the effect of both these treatment strategies.
关键词： Diabetic Macular edema,Anti-VEGF,Central macular thickness
更新于2025-09-19 17:15:36
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Direct photocoagulation to leakage points to treat chronic macular edema associated with branch retinal vein occlusion: a pilot study
摘要： Background: The aim was to investigate the effect of direct photocoagulation for treating chronic macular edema associated with BRVO. Methods: This study was a noncomparative, pilot interventional case series. We examined the CFT and best-corrected visual acuity over 6 months in patients with BRVO treated with direct photocoagulation. Results: Sixteen eyes of 16 patients had been treated with direct photocoagulation (mean follow-up period, 20.5 months). The mean CFT decreased significantly (P<0.001) between the baseline (465 μm) and the final visit (304 μm). The mean (logarithm of the minimum angle of resolution equivalent) best-corrected visual acuity at the baseline was 0.39 and improved significantly (P<0.001) to 0.20 at the final visit. Conclusion: Direct photocoagulation to leakage points is beneficial for treating chronic macular edema associated with chronic BRVO of longer than 12 months duration.
关键词： macular edema,optical coherence tomography,VEGF,photocoagulation,branch retinal vein occlusion
更新于2025-09-19 17:15:36
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A predictive screening tool to detect diabetic retinopathy or macular edema in primary health care: construction, validation and implementation on a mobile application
摘要： The most described techniques used to detect diabetic retinopathy and diabetic macular edema have to be interpreted correctly, such that a person not specialized in ophthalmology, as is usually the case of a primary care physician, may experience difficulties with their interpretation; therefore we constructed, validated and implemented as a mobile app a new tool to detect diabetic retinopathy or diabetic macular edema (DRDME) using simple objective variables. We undertook a cross-sectional, observational study of a sample of 142 eyes from Spanish diabetic patients suspected of having DRDME in 2012–2013. Our outcome was DRDME and the secondary variables were: type of diabetes, gender, age, glycated hemoglobin (HbA1c), foveal thickness and visual acuity (best corrected). The sample was divided into two parts: 80% to construct the tool and 20% to validate it. A binary logistic regression model was used to predict DRDME. The resulting model was transformed into a scoring system. The area under the ROC curve (AUC) was calculated and risk groups established. The tool was validated by calculating the AUC and comparing expected events with observed events. The construction sample (n = 106) had 35 DRDME (95% CI [24.1–42.0]), and the validation sample (n = 36) had 12 DRDME (95% CI [17.9–48.7]). Factors associated with DRDME were: HbA1c (per 1%) (OR = 1.36, 95% CI [0.93–1.98], p = 0.113), foveal thickness (per 1 μm) (OR = 1.03, 95% CI [1.01–1.04], p < 0.001) and visual acuity (per unit) (OR = 0.14, 95% CI [0.00–0.16], p < 0.001). AUC for the validation: 0.90 (95% CI [0.75–1.00], p < 0.001). No significant differences were found between the expected and the observed outcomes (p = 0.422). In conclusion, we constructed and validated a simple rapid tool to determine whether a diabetic patient suspected of having DRDME really has it. This tool has been implemented on a mobile app. Further validation studies are required in the general diabetic population.
关键词： Diabetes mellitus,Macular edema,Diagnostic tests,Statistical models,Diabetic retinopathy,Optical coherence tomography
更新于2025-09-19 17:15:36
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Assessment of the Dynamic Alteration of Choriocapillaris Vessel Density after Focal Laser Photocoagulation with OCT Angiography
摘要： Purpose. To evaluate the changes of choriocapillaris blood ?ow beneath laser lesions in noncenter-involved diabetic macular edema patients using optical coherence tomography angiography (OCTA). Methods. This was a retrospective case-series study. We used OCTA to analyze the characteristics of the choriocapillaris blood ?ow beneath laser lesions before laser treatment and at several intervals after treatment. The choriocapillaris vessel density (CCVD) beneath the laser lesions was based on the OCTA images and was de?ned as the proportion of ?ow pixels in the selected area calculated using FIJI software through automatic binarization processing based on threshold methods. Results. A total of 63 laser lesions in 8 eyes of 5 patients were included in this study. There was a signi?cant decrease in the CCVD at 1 hour and 1 day following laser treatment (24.25% ± 5.04% and 22.00% ± 4.71%, respectively) when compared with the baseline value (39.09% ± 3.71%, all p < 0.001). The CCVD was 31.82% ± 4.53% in 1 week after laser treatment, which was signi?cantly higher than that in 1 day after treatment (p < 0.001), and then continued to improve at 1 month after treatment (34.44% ± 4.16%). Additionally, in the group with smaller spot size and lower energy, the CCVD recovery at 1 month after laser was signi?cantly better than that in the group with larger spot size and higher energy (p ? 0.006). Conclusions. OCTA image analysis can re?ect changes in the choriocapillaris blood ?ow beneath laser lesions at di?erent times following laser treatment in vivo. Spot size and laser energy may a?ect blood ?ow recovery.
关键词： laser photocoagulation,choriocapillaris,diabetic macular edema,OCT angiography
更新于2025-09-19 17:13:59
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PDG31 COST-EFFECTIVENESS OF RANIBIZUMAB VERSUS LASER PHOTOCOAGULATION OR OBSERVATION FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION: FROM CHINESE SOCIETAL PERSPECTIVE
摘要： To evaluate the cost-effectiveness of ranibizumab compared with laser photocoagulation or no treatment (observation) in patients with macular edema secondary to branch retinal vein occlusion (BRVO-ME) and macular edema secondary to central retinal vein occlusion (CRVO-ME), respectively, from the Chinese societal perspective. Methods: A Markov model was constructed to simulate the long-term outcomes and costs of Chinese BRVO-ME and CRVO-ME patients. Model health states were de?ned by increments of 10 letters in best corrected visual acuity (BCVA) ranging from # 25 letters to 86-100 letters, with an extra absorbing state ’death’. Lifetime horizon was used, with a 1-month cycle length. Transition probabilities were calculated from the BLOSSOM clinical trial and CAMELLIA clinical trial. Health state utilities were estimated through literature, and costs were estimated from experts consultation of 6 hospitals in China and published literature. The primary outcomes of the model were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Uncertainty was addressed via univariate and probabilistic sensitivity analyses. Results: For BRVO-ME patients, lifetime costs of ranibizumab and laser photocoagulation were U80,834 and U44,799, respectively; lifetime QALYs gained were 8.95 and 8.31, respectively. Adopting a willingness to pay of U180,000/ QALY (3 times per-capita GDP, 2017 China) as the threshold, ranibizumab was found to be cost-effective compared with laser photocoagulation, with the ICER of U56,303/QALY. For CRVO-ME patients, lifetime costs of ranibizumab and observation were U120,246 and U117,757, respectively; lifetime QALYs gained were 9.48 and 8.93, respectively. Ranibizumab was found to be cost-effective compared with observation, with the ICER of U4,525/QALY. Univariate and probabilistic sensitivity analysis demonstrated the robustness of the results. Conclusions: From Chinese societal perspective, ranibizumab is the cost-effective therapy for both the treatment of BRVO-ME and CRVO-ME when compared to laser photocoagulation and observation, respectively.
关键词： ranibizumab,retinal vein occlusion,cost-effectiveness,macular edema,laser photocoagulation
更新于2025-09-16 10:30:52
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EFFECT OF LASER PHOTOCOAGULATION ON MACULAR EDEMA ASSOCIATED WITH MACULAR HOLES
摘要： To report the outcomes of laser therapy to barricade eccentric full-thickness macular hole with associated cystoid macular edema. We report two patients who developed an eccentric full-thickness macular hole with persistent cystoid macular edema after pars plan vitrectomy with and without internal limiting membrane peel for epiretinal membrane and the results of argon laser therapy. Barricade argon laser therapy was applied concentric to the full-thickness macular hole. Associated cystoid macular edema was noted to resolve within 1 to 3 months of therapy in both cases. Barricade laser therapy surrounding a macular hole can lead to resolution of associated cystoid macular edema. Pathogenic mechanisms to explain this favorable outcome are discussed.
关键词： cystoid macular edema,argon laser,epiretinal membrane,PPV/ILM,laser retinopexy,laser barricade,eccentric macular hole,macular hole
更新于2025-09-12 10:27:22
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Novel Triamcinolone Acetonide-Loaded Liposomal Topical Formulation Improves Contrast Sensitivity Outcome After Femtosecond Laser-Assisted Cataract Surgery
摘要： Purpose: To assess visual results, macular modi?cations, and the incidence of clinically signi?cant macular edema (CSME) in patients using a topical triamcinolone acetonide-loaded liposomal formulation (TA-LF) after femtosecond laser-assisted cataract surgery (FLACS). Methods: Fifty-six eyes after FLACS were selected. Twenty-eight eyes in the combined therapy group (P + N) were treated with prednisolone 1% and nepafenac 0.1% for 21 days postoperatively, whereas 28 eyes in the TA-LF group received a liposomal formulation containing 2 mg/mL of TA (0.2%) for the same period of time. Follow-up visits at 1 day, 6 weeks, and 12 weeks after surgery consisted of visual acuity, contrast sensitivity (CS), central foveal thickness (CFT), total macular volume (TMV) measurements, and the detection of CSME. Results: CS improved in the TA-LF group (basal value: 1.087 – 0.339 vs. 1.276 – 0.147 at week 12, P = 0.0346), whereas in the P + N group, CS was not different from the baseline (basal value: 1.130 – 0.331 vs. 1.274 – 0.133 at week 12, P = 0.1276). There were similar increases in postoperative CFT and TMV in both groups. CFT and TMV signi?cantly correlate with CS only in the TA-LF group. The r2 for CFT and CS was 0.1963 (P = 0.0206), whereas the r2 for TMV and CS was 0.3615 (P = 0.0007) at 12 weeks. No difference was observed in the incidence of CSME between the groups. Conclusion: TA-LF is associated with better CS outcomes compared to combined therapy after FLACS.
关键词： femtosecond laser-assisted cataract surgery,macular edema,liposomes,visual outcomes,contrast sensitivity
更新于2025-09-11 14:15:04
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QUALITY IMPROVEMENT OF LASER TREATMENT (QUILT)A New Retinal Laser Simulation System for Training in Resource-Poor Countries
摘要： In resource-poor countries, there is a reported lack of quality and structured retinal laser training in residency and hospital eye programs. This unmet training need has been validated in current international diabetic retinopathy screening centers. Quality Improvement of Laser Treatment (QUILT) is a novel laser photocoagulation simulator that contains modules for laser treatment of PDR, diabetic macular edema (DME), retinal vein occlusion, and laser retinopexy. The primary objective of the QUILT simulation is to introduce a new bespoke application to support practical skills training in retinal laser treatment in countries where laser training is suboptimal for ophthalmologists and trainees/residents. The application was first developed as an online application but has subsequently been developed as a standalone application that can be downloaded or copied onto individual laptops or computers, so that the training is not dependent on a good internet connection.
关键词： diabetes,simulator,proliferative diabetic retinopathy,laser training,simulation,pattern scan laser,retinopexy,macular edema
更新于2025-09-11 14:15:04
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Efficacy of Multiple Dexamethasone Intravitreal Implants for Refractory Retinal Vein Occlusion-Related Macular Edema and Effect of Prior Vitrectomy
摘要： Purpose: To evaluate the efficacy of dexamethasone intravitreal implants (DEX implant) in patients with treatment-resistant macular edema (ME) owing to branch and central retinal vein occlusion (BRVO/CRVO), and the influence of prior vitrectomy on this treatment. Methods: Multicenter retrospective chart review was performed on 40 CRVO and 32 BRVO eyes with persistent ME despite intravitreal anti-vascular endothelial growth factor agents and/or intravitreal triamcinolone, and/or laser therapy. Each patient received ?1 dexamethasone 700 lg implant between March 2011 and December 2015. Thirteen patients underwent prior vitrectomy. Data were collected on best-corrected visual acuity (BCVA), central macular thickness (CMT), time to relapse, and adverse events. Results: At the end of follow-up, BRVO eyes had a lesser CMT reduction from baseline compared to CRVO eyes (-122.50 – 152.47 mm and -202.26 – 194.09 mm, respectively). Neither BRVO nor CRVO eyes had a (P = 0.7041 and P = 0.7027, respectively). Vitrectomized and nonvitrectomized eyes sustained BCVA benefit the study with -192.46 – 172.62 mm and -164.02 – 180.36 mm, respectively, at final follow-up. Similar time to relapse of 24.4 – 6.5 and 23.3 – 13.5 weeks, respectively, was observed. By the end of follow-up, BCVA had only improved in vitrectomized eyes. However, multivariable regression analyses showed no significant association between vitrectomy status and CMT or BCVA change after the first and last injection. Cataract formation and ocular hypertension occurred in 25% and 17%, respectively. Conclusions: Multiple DEX implant are effective in reducing CMT in patients resistant to previous treatments and appear to be similarly effective in vitrectomized and nonvitrectomized eyes.
关键词： macular edema,vitrectomy,dexamethasone,retinal vein occlusion,Ozurdex,treatment-resistant
更新于2025-09-11 14:15:04
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Association between Visual Acuity and Retinal Layer Metrics in Diabetics with and without Macular Edema
摘要： Purpose. Diabetes is known to cause alterations in retinal microvasculature and tissue that progressively lead to visual impairment. Optical coherence tomography (OCT) is useful for assessment of total retinal thickening due to diabetic macular edema (DME). In the current study, we determined associations between visual acuity (VA) and retinal layer thickness, reflectance, and interface disruption derived from enface OCT images in subjects with and without DME. Materials and Methods. Best corrected VA was measured and high-density OCT volume scans were acquired in 149 diabetic subjects. A previously established image segmentation method identified retinal layer interfaces and locations of visually indiscernible (disrupted) interfaces. Enface thickness maps and reflectance images of the nerve fiber layer (NFL), combined ganglion cell and inner plexiform layer (GCLIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor outer segment layer (OSL), and retinal pigment epithelium (RPE) were generated in the central macular subfield. The associations among VA and retinal layer metrics were determined by multivariate linear regressions after adjusting for covariates (age, sex, race, HbA1c, diabetes type, and duration) and correcting for multiple comparisons. Results. In DME subjects, increased GCLIPL and OPL thickness and decreased OSL thickness were associated with reduced VA. Furthermore, increased NFL reflectance and decreased OSL reflectance were associated with reduced VA. Additionally, increased areas of INL and ONL interface disruptions were associated with reduced VA. In subjects without DME, increased INL thickness was associated with reduced VA, whereas in subjects without DME but with previous antivascular endothelium growth factor treatment, thickening of OPL was associated with reduced VA. Conclusions. Alterations in retinal layer thickness and reflectance metrics derived from enface OCT images were associated with reduced VA with and without presence of DME, suggestive of their potential for monitoring development, progression, and treatment of DME.
关键词： retinal layer reflectance,visual acuity,retinal layer thickness,optical coherence tomography,diabetic macular edema,interface disruption
更新于2025-09-11 14:15:04