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Of the many types of laser cyclophotocoagulation procedures, micropulse cyclophotocoagulation diode is praised as a noninvasive, safe, and effective procedure with few complications. In this case report, we describe a rare complication that, to the best of our knowledge, has not been previously reported. We report on the case of a 66-year-old African man with a history of end-stage primary open-angle glaucoma. One week after undergoing micropulse cyclophotocoagulation diode therapy in both eyes, he developed severe intermediary inflammation in one eye, associated with decreased visual acuity. The intraocular pressure had significantly decreased after the procedure and was well controlled with intraocular-pressure-lowering medications. Slit lamp examination revealed a moderate anterior chamber inflammation, anterior vitritis, and a large inflammatory membrane attached to the posterior surface of the intraocular implant. A vitrectomy was finally performed in the left eye because of the persistent intermediary inflammation despite the use of high doses of topical and subconjunctival corticosteroids. Intermediary uveitis is a rare complication after micropulse cyclophotocoagulation diode therapy. To the best of our knowledge, there have been no reports of vitritis after a noncomplicated micropulse cyclophotocoagulation diode in primary open-angle glaucoma.

Photocoagulation of blood vessels offers unambiguous advantages to current radiofrequency approaches considering the high specificity of blood absorption at available laser wavelengths (e.g., 532 nm and 1.064 µm). Successful treatment of pediatric vascular lesions, such as port-wine stains requiring microvascular hemostasis, has been documented. Although laser treatments have been successful in smaller diameter blood vessels, photocoagulation of larger sized vessels is less effective. The hypothesis for this study is that a primary limitation in laser coagulation of large diameter blood vessels (500-1000 µm) originates from shear stress gradients associated with higher flow velocities along with temperature-dependent viscosity changes. Laser (1.07 µm) coagulation of blood vessels was tested in the chicken chorio-allantoic membrane (CAM). A finite element model is developed that includes hypothetical limitations in laser coagulation during irradiation. A protocol to specify laser dosimetry is derived from OCT imaging and angiography observations as well as finite element model results. Laser dosimetry is applied in the CAM model to test the experimental hypothesis that blood shear stress and flow velocity are important parameters for laser coagulation and hemostasis of large diameter blood vessels (500-1000 µm). Our experimental results suggest that shear stress and flow velocity are fundamental in the coagulation of large diameter blood vessels (500-1000 µm). Laser dosimetry is proposed and demonstrated for successful coagulation and hemostasis of large diameter CAM blood vessels.

PrcisShort-term overall success rates were high with either SGDD or CPC. However, SGDD was associated with more clinic visits and an increased risk of additional glaucoma surgery. Both treatments were reasonable options for eyes with inadequately controlled IOP after a single GDD.PurposeThe purpose of this study is to compare the implantation of a second glaucoma drainage device (SGDD) and transscleral cyclophotocoagulation (CPC) in eyes with inadequately controlled intraocular pressure (IOP), despite the presence of a preexisting glaucoma drainage device.MethodsPatients with inadequately controlled IOP, despite the medical therapy and a preexisting glaucoma drainage device, were enrolled at 14 clinical centers and randomly assigned to treatment with a SGDD or CPC.Main outcome measuresSurgical failure was defined as: (1) IOP ≤5 mm Hg or >18 mm Hg or <20% reduction below baseline on maximum tolerated topical ocular hypotensive therapy, (2) reoperation for glaucoma, or (3) loss of light perception. The primary outcome measure was overall success with or without adjunctive medical therapy.ResultsForty-two eyes of 42 participants were randomized to SGDD (n=22) or CPC (n=20). Mean duration of follow-up was 18.6 (±12.1; range: 1.1-38.6) months. The cumulative success rate was 79% for SGDD and 88% for CPC at 1 year ( P =0.63). Although the study was underpowered, no significant differences in IOP, postoperative number of IOP-lowering medications, or adverse events were observed. The number of additional glaucoma surgeries ( P =0.003), office visits during the first 3 months ( P <0.001), and office visits per month after month 3 ( P <0.001) were greater in the SGDD group.ConclusionsShort-term overall success rates were high with either SGDD or CPC. However, SGDD was associated with more clinic visits and an increased risk of additional glaucoma surgery.

PurposeTo evaluate refractive and structural outcomes for patients treated for retinopathy of prematurity (ROP) with the anti-vascular endothelial growth factor (anti-VEGF) agent ranibizumab and "delayed laser," defined as any laser photocoagulation treatment administered at least 2 weeks and <1 year after the initial anti-VEGF injection.MethodsThe medical records of infants with type 1 ROP treated between 2015 and 2020 with intravitreal 0.25 mg ranibizumab followed by delayed laser photocoagulation, with a minimum of 6 months' follow-up, were reviewed retrospectively. Refractive and structural outcomes were extracted from the record.ResultsA total of 68 eyes of 34 neonates were included, with median gestational age of 24 weeks and birthweight of 657 g. Patients were aged 0.9 to 4.4 years at last follow-up; mean follow-up interval was 2.7 ± 1.02 years. There was no progression to stage 4 or 5 following treatment during the study period. At 2 years' follow-up (mean age, 2.41 ± 0.23 years), median spherical equivalent (SE) was -0.13 D (IQR, 4.20 D). At most recent examination (mean age, 2.70 ± 1.02 years), the most common ocular findings included strabismus (32%), optic atrophy (24%), amblyopia (21%), high myopia (7%), and nystagmus (4%).ConclusionsIn our small cohort, neonates with type 1 ROP treated with intravitreal ranibizumab and delayed laser demonstrated good structural outcomes, with no progression to retinal detachment. We found lower rates of high myopia compared with previous reports of laser photocoagulation monotherapy.

Photocoagulation of blood vessels offers unambiguous advantages to current radiofrequency approaches considering the high specificity of blood absorption at available laser wavelengths (e.g., 532 nm and 1.064 µm). Successful treatment of pediatric vascular lesions, such as port-wine stains requiring microvascular hemostasis, has been documented. Although laser treatments have been successful in smaller diameter blood vessels, photocoagulation of larger sized vessels is less effective. The hypothesis for this study is that a primary limitation in laser coagulation of large diameter blood vessels (500-1000 µm) originates from shear stress gradients associated with higher flow velocities along with temperature-dependent viscosity changes. Laser (1.07 µm) coagulation of blood vessels was tested in the chicken chorio-allantoic membrane (CAM). A finite element model is developed that includes hypothetical limitations in laser coagulation during irradiation. A protocol to specify laser dosimetry is derived from OCT imaging and angiography observations as well as finite element model results. Laser dosimetry is applied in the CAM model to test the experimental hypothesis that blood shear stress and flow velocity are important parameters for laser coagulation and hemostasis of large diameter blood vessels (500-1000 µm). Our experimental results suggest that shear stress and flow velocity are fundamental in the coagulation of large diameter blood vessels (500-1000 µm). Laser dosimetry is proposed and demonstrated for successful coagulation and hemostasis of large diameter CAM blood vessels.

Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single-center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ≥6 months of follow-up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 ± 0.8 vs. 1.9 ± 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant. Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.

Для лечения диабетической ретинопатии в современной практике применяется лазерная коагуляция. В процессе лазерной операции параметры лазерного воздействия подбираются вручную врачом, что требует от врача достаточного опыта и знаний, чтобы достичь терапевтического эффекта. На основе математического моделирования процесса лазерной коагуляции можно оценить основные параметры без проведения операции. Однако сетчатка имеет достаточно сложную структуру, и при применении даже низкозатратных численных методов для моделирования требуется значительное время для получения результата. В связи с этим разработка эффективных по времени алгоритмов трехмерного моделирования является актуальной задачей, поскольку применение таких алгоритмов позволит обеспечить проведение комплексного исследования в рамках ограниченного времени. В настоящей работе проводится исследование времени выполнения алгоритмов, реализующих различные вариации применения метода расщепления и метода конечных разностей, адаптированных под поставленную задачу теплопроводности, выявляется наиболее эффективный алгоритм, который далее подвергается векторизации и реализации с использованием технологии CUDA. Исследование проводилось с использованием Intel Core i7-10875H и Nvidia RTX 2080 MAX Q и показало, что аналог векторного алгоритма, ориентированного на решение многомерной задачи теплопроводности, обеспечивает ускорение не более, чем в 1,5 раза, по сравнению с последовательным вариантом. Разработанный векторный алгоритм, ориентированный на применение метода прогонки по всем направлениям трехмерной задачи, существенно снижает временные издержки, затрачиваемые на копирование в память видеокарты, и обеспечивает 40-кратное ускорение по сравнению с последовательным алгоритмом трехмерного моделирования. На основе такого же подхода разработан параллельный алгоритм математического моделирования, который обеспечил 20-кратное ускорение при полной загрузке процессора. For diabetic retinopathy treatment, laser coagulation is use

PurposeTo compare the macroscopic and microscopic histologic changes in eyes treated with micropulse transscleral cyclophotocoagulation (MP-TCP) versus continuous wave transscleral cyclophotocoagulation (CW-TCP).MethodsTwelve halves of globes from three pairs of adult cadaveric eyes were randomly assigned to nontreated control, CW-TCP, single MP-TCP treatment, or double MP-TCP treatments, and then sectioned for histologic analysis. Presence or absence of the following four unique histologic changes was recorded: splitting within the ciliary process epithelium (splitting), separation of the pigmented ciliary process epithelium from the stroma (separation), coagulation of collagen and destruction of ciliary process stroma (coagulation), and full-thickness destruction of ciliary process epithelium (destruction).ResultsA total of 498 slides were analyzed, and laser scars in all treated specimens were located in the pars plana. Logistic regression analysis showed that compared with controls, CW-TCP-treated specimens were significantly more likely to experience separation (odds ratio [OR] = 11.1, P = 0.02), coagulation (OR = 24.3, P = 0.002), and destruction (OR = 11.1, P = 0.03). Destruction of the ciliary process epithelium was observed exclusively in CW-TCP-treated sections. No significant differences in histologic features were observed between controls and MP-TCP.ConclusionsMP-TCP does not produce significant histologic changes in cadaveric eyes, whereas CW-TCP treatment does.Translational relevanceThese findings improve understanding of the mechanism of MP-TCP, help explain the increased rates of adverse effects following CW-TCP treatment compared with MP-TCP, and describe effects of MP-TCP at various doses.

Objectives: The purpose of this article was to further elucidate the pathophysiology of Mirror (Ballantyne) syndrome within the context of known biomarkers for preeclampsia. Method(s): This novel insight from clinical practice involved a case of post-twin-to-twin transfusion syndrome-laser hydrops in an ex-donor twin, corroborated by histopathologic placental territory edema and maternal sequelae of Mirror syndrome. We serially measured the levels of activin A, follistatin, endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), soluble fms-like tyrosine kinase 1 (sFlt), and von Willebrand factor (vWF) in the maternal serum from disease evolution through to recovery. Result(s): The paired finding of hydropic ex-donor twin and placenta, supports the theory of placental injury as the source of potential molecular mediators, leading to local placental edema, associated fetal hydrops and the maternal preeclamptic picture. Notably, we elucidated a temporal spectrum of maternal serum mediators (soluble Flt-1, endothelin-1, 8-isoprostane, activin-A, ICAM-1, and vWF) involved in the pathogenesis of Mirror syndrome. Conclusion(s): Better understanding of the pathogenesis of Mirror syndrome has important implications for clinical management.Copyright © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Objectives: The purpose of this article was to further elucidate the pathophysiology of Mirror (Ballantyne) syndrome within the context of known biomarkers for preeclampsia. Method(s): This novel insight from clinical practice involved a case of post-twin-to-twin transfusion syndrome-laser hydrops in an ex-donor twin, corroborated by histopathologic placental territory edema and maternal sequelae of Mirror syndrome. We serially measured the levels of activin A, follistatin, endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), soluble fms-like tyrosine kinase 1 (sFlt), and von Willebrand factor (vWF) in the maternal serum from disease evolution through to recovery. Result(s): The paired finding of hydropic ex-donor twin and placenta, supports the theory of placental injury as the source of potential molecular mediators, leading to local placental edema, associated fetal hydrops and the maternal preeclamptic picture. Notably, we elucidated a temporal spectrum of maternal serum mediators (soluble Flt-1, endothelin-1, 8-isoprostane, activin-A, ICAM-1, and vWF) involved in the pathogenesis of Mirror syndrome. Conclusion(s): Better understanding of the pathogenesis of Mirror syndrome has important implications for clinical management.Copyright © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

PURPOSE OF THE STUDY: To examine the cause of treatment failures in Type 1 retinopathy of prematurity (ROP). PATIENTS AND METHODS: The medical charts of all infants with disease persistence after laser treatment at Uppsala University Hospital, Sweden, during a 10-year period (2009-2019) were reviewed. RetCam photography and angiography were used to document the retinal appearance before and after retreatment. RESULTS: Ten infants (18 eyes), of whom nine were referred from other hospitals, had persistence of Type 1 ROP in zone I or zone II despite previous laser treatment. Their mean gestational age was 24 weeks and their mean birth weight was 618 g. Seven eyes were diagnosed as stage 3 plus, eight eyes as stage 4A and three eyes as stage 4B. In eight infants (14 eyes), inadequate laser coagulation was suspected to be the cause for persistence of type 1 disease. Two infants (four eyes) were appreciated to have persistence of plus disease because of presence of zone I disease. For persistence of Type 1 ROP, five infants (seven eyes) were treated with vitrectomy, two infants (three eyes) with laser photocoagulation and anti-vascular endothelial growth factor (VEGF), two infants (four eyes) with anti-VEGF alone and finally two infants (four eyes) with laser photocoagulation alone. The anatomical outcome was good in 14 eyes and poor in four eyes (three infants). CONCLUSIONS: Inadequate laser coagulation is an important cause of treatment failure of ROP Type 1. Another cause is laser coagulation in zone I. To minimize remaining visual disability, some kind of centralization of the ROP treatment is suggested.

Лечение диабетической ретинопатии с использованием лазерной коагуляции сетчатки по зонам глазного дна, выбираемым врачом, обеспечивается на основе наведения лазера, после чего осуществляется обстрел, способствующий образованию коагулятов, которые препятствуют кровоизлияниям. Основная проблема при проведении лазерной коагуляции заключается в выборе зон обстрела так, чтобы охватить все проблемные области и подобрать параметры лазерного воздействия, чтобы излишне не повредить сетчатку. У каждого пациента индивидуальная структура глазного дна. Необходимо учитывать индивидуальное строение патологических и анатомических элементов, чтобы достичь требуемого терапевтического эффекта. Терапевтический эффект достигается при образовании коагулятов во всех областях, в которых происходит кровоизлияние. Сосудистый слой должен нагреться до достаточной температуры, чтобы образовался коагулят, но при этом не должна быть повреждена сетчатка. Такой эффект можно прогнозировать при помощи математического моделирования лазерного воздействия. В настоящей работе рассматриваются методы математического моделирования лазерного воздействия, основанные на уравнении теплопроводности. Проводится сравнение методов по вычислительной сложности и устойчивости решения. Выполняется анализ возможности прогнозирования терапевтического эффекта при помощи методов математического моделирования лазерного воздействия. When laser coagulation of eye retina is carried out, the laser beam is directed to target retinal areas selected by an ophthalmologist. The exposure to laser light produces a photocoagulate. When using laser coagulation, the main problem is selecting both the laser exposure areas that would cover all pathological zones and the laser exposure parameters to prevent retina damage. Any patient has an individual fundus structure. The individual structure of pathological and anatomical elements must be taken into account to achieve the desired therapeutic effect. The formation of coagulates in all hemo

BackgroundCyclodestructive procedures are often used in patients with refractory glaucoma who have failed to achieve lower intraocular pressure (IOP) from filtration procedures and maximal medical therapy. Destruction of the ciliary body helps to lower IOP by reducing aqueous humor formation. Of the many types of cyclodestructive procedures, laser cyclophotocoagulation (CPC) has become the most common surgical method for reducing aqueous inflow. Options for CPC are wide-ranging: they can be performed using a neodymium:yttrium-aluminum-garnet (Nd:YAG) or diode laser and laser energy can be delivered by either the contact or non-contact method. Another cyclodestructive procedure is endoscopic cyclophotocoagulation (ECP), which the ophthalmologist can use selectively to target the ciliary epithelium and ablate ciliary body tissue. There is debate regarding which cyclodestructive method is best and how they compare to other glaucoma surgeries.ObjectivesTo assess the relative effectiveness and safety of cyclodestructive procedures compared with other procedures in people with refractory glaucoma of any type and to assess the relative effectiveness and safety of individual cyclodestructive procedures compared with each other.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 9); Ovid MEDLINE; Embase.com; PubMed; LILACS BIREME; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 21 September 2018.Selection criteriaWe included randomized controlled trials or quasi-randomized trials in which participants underwent a secondary procedure for refractory glaucoma. We included trials with any laser type, route of administration, and laser settings. The primary comparison was any cyclodestructive procedure versus another glaucoma treatment, and the secondary comparisons were individual cyclodestructive procedures versus another cyclodestructive procedure.Data

Topicality. In some regions about ¼ of the population suffers from venous disease (VD), and the main methods of treatment are endovascular laser coagulation (EVLC) and a traditional phlebectomy using Babcock technique though the optimization of such surgical measures demands perfection. Objective: to assess the results of EVLC and phlebectomy in VD at different stages after the performed surgical procedure and to distinguish the factors defining the efficiency of the operation. Material and methods. There were 302 patients with VD of the lower extremities (¼ of men and ¾ of women aged from 29 to 72 years) under the survey. C2, C3, C4, C5 and C6 classes of VD are established in 10%, 14%, 37%, 16% and 23% of the cases, respectively. EVLC was carried out by means of the device “Fotonika-Lika-Surgeon” (Ukraine). The patients were observed 2, 4 and 24 weeks later after the operation. Results. EVLC in the patients with VD of shins statistically authentically exceeds the efficiency of phlebectomy both 2–4 and 24 weeks later after the performed operation, and, the presence of comorbide gonarthrosis has a negative effect on the first method of surgical treatment, while the results of the second one depend on the severity of the disease, laser ablation is closely connected with the initial indicators of prostacyclinemia and the level of superficial viscous properties of venous blood serum whereas the efficiency of phlebectomy defines the module of viscoelasticity, at the same time both groups of the patients didn't differ on parallel using of the medications, but they differed considerably on the character of the complications (the development of phlebitis, paresthesias, thrombosis of deep veins after the exposure to laser beams and the appearance of seromas, hematomas and a hyperpigmentation of the skin in other cases), besides the administration of rivaroxaban and low-molecular heparins was prescribed for the representatives of the first group within the month from the mome, Актуальность. В некоторых регионах варикозной болезнью вен (ВБ) страдает до ¼ населения, а основными методами лечения являются эндоваскулярная лазерная коагуляция (ЭВЛК) и традиционная флебэктомия по Бебкокку, хотя оптимизация таких хирургических мероприятий требует совершенства. Цель работы — оценить результаты ЭВЛК и флебэктомии при ВБ на разных этапах после выполненного хирургического вмешательства и выделить факторы, определяющие эффективность операции. Материал и методы. Под наблюдением находились 302 больных ВХ нижних конечностей (¼ мужчин и ¾ женщин в возрасте от 29 до 72 лет). С2, С3, С4, С5 и С6 классы ВБ соответственно установлены в 10%, 14%, 37%, 16% и 23% случаев. ЭВЛК осуществляли с помощью аппарата «Фотоніка-Ліка-Хірург» (Украина). Пациенты наблюдались спустя 2, 4 и 24 недели после операции. Результаты. ЭВЛК у больных ВБ голеней статистически достоверно превышает эффективность флебэктомии как спустя 2–4, так и 24 недели после выполненной операции, причем, на первый метод хирургического лечения оказывает негативное влияние наличие коморбидного гонартроза, а результаты второго зависят от степени тяжести заболевания. Лазерная абляция тесно связана с исходными показателями простациклинемии и уровнем поверхностных вязких свойств сыворотки венозной крови, тогда как эффективность флебэктомии определяет модуль вязкоэластичности. При этом по параллельному использованию медикаментозных препаратов обе группы больных не отличались, но значительно разнились по характеру осложнений (развитие флебита, парестезий, тромбоза глубоких вен после воздействия лучами лазера и возникновение сером, гематом и гиперпигментации кожи в остальных случаях). К тому же для представителей первой группы в течение месяца от момента операции было показано назначение ривароксабана и низкомолекулярных гепаринов, а для второй — цикло-3-форта. Заключение. В выборе метода оперативного лечения варикозной болезни вен предпочтение следует отдавать эндоваскулярной лазерной коагуляции., Актуальність. У деяких регіонах на варикозну хворобу вен гомілок (ВХ) страждає до ¼ населення, а основними методами лікування є ендоваскулярна лазерна коагуляція (ЕВЛК) і традиційна флебектомія за Бебкокком, хоча оптимізація таких хірургічних заходів вимагає досконалості. Мета роботи — оцінити результати ЕВЛК і флебектомії при ВХ на різних етапах після виконаного хірургічного втручання і виділити чинники, що визначають ефективність операції. Матеріал і методи. Під наглядом перебували 302 хворих на ВХ нижніх кінцівок (¼ чоловіків і ¾ жінок віком від 29 до 72 років). С2, С3, С4, С5 і С6 класи ВХ відповідно встановлено в 10%, 14%, 37%, 16% і 23% випадків. ЕВЛК здійснювали за допомогою апарата «Фотоніка-Ліка-Хірург» (Україна). Пацієнти спостерігалися через 2, 4 і 24 тижні після операції. Результати. ЕВЛК у хворих на ВХ статистично достовірно перевищує ефективність флебектомії як через 2,4, так і 24 тижні після виконаної операції, причому, на перший метод хірургічного лікування чинить негативний вплив наявність коморбідного гонартрозу, а результати другого залежать від ступеня тяжкості захворювання. Лазерна абляція щільно пов'язана з початковими показниками простациклінемії та рівнем поверхневих в'язких властивостей сироватки венозної крові, тоді як ефективність флебектомії визначає модуль в`язкоеластичності. При цьому за паралельним використанням медикаментозних препаратів обидві групи хворих не відрізняються, але значно різняться за характером ускладнень (розвиток флебіту, парестезій, тромбозу глибоких вен після дії променями лазера й виникнення сером, гематом і гіперпігментації шкіри в інших випадках). Для представників першої групи впродовж місяця від моменту операції показано призначення ривароксабану та низькомолекулярних гепаринів, а для другої — цикло-3-форту. Висновок. У виборі методу оперативного лікування варикозної хвороби вен гомілок перевагу слід надавати ендоваскулярній лазерній коагуляції.

В работе предложена технология отбора эффективных признаков для локализации индивидуальных особенностей анатомических и патологических структур на глазном дне человека. Она позволила провести интеллектуальный анализ признаков с использованием цветовых подпространств для решения задачи выделения областей интереса. Данная задача является актуальной для повышения эффективности проведения операции лазерной коагуляции. В основу технологии положен текстурный анализ определённых паттернов изображений. Исходные текстурные признаки производятся из разных статистических дескрипторов изображений, вычисленных с использованием библиотеки MaZda (гистограмма изображения, градиент изображения, матрицы длины серий и смежности). Анализ информативности пространства признаков и выбор наиболее эффективных осуществляется с использованием дискриминантного анализа данных. Определены наилучшие значения размеров окна фрагментации изображений для проведения кластеризации глазного дна и наборы признаков, обеспечивающих необходимую точность идентификации областей интереса при анализе следующих 4 классов изображений: экссудаты, толстые сосуды, тонкие сосуды и здоровые участки. В технологии отбора признаков применялась кластеризация с использованием метода К-средних, а в качестве меры сходства использовалось расстояние Евклида и Махаланобиса. Необходимый минимальный размер окна фрагментации и мера сходства выбирались из критерия минимума ошибки кластеризации среди всех наименьших размеров окон. Наилучшие результаты продемонстрировало использование 6 признаков, сформированных попарным отбором с поворотом и применением расстояния Махаланобиса, и окна фрагментации размером 12. В статье представлена также система автоматического формирования плана коагулятов, которую планируется использовать для поддержки принятия решений при проведении операции лазерной коагуляции сетчатки при лечении диабетического макулярного отёка, разрабатываемая на основе предложенной технологии. The paper proposes a technology

PurposeDiabetic retinopathy is the most common eye complication in patients with diabetes. The purpose of this study is to identify genetic factors contributing to severe diabetic retinopathy.MethodsA genome-wide association approach was applied. In the Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) datasets, cases of severe diabetic retinopathy were defined as type 2 diabetic patients who were ever graded as having severe background retinopathy (Level R3) or proliferative retinopathy (Level R4) in at least one eye according to the Scottish Diabetic Retinopathy Grading Scheme or who were once treated by laser photocoagulation. Controls were diabetic individuals whose longitudinal retinopathy screening records were either normal (Level R0) or only with mild background retinopathy (Level R1) in both eyes. Significant Single Nucleotide Polymorphisms (SNPs) were taken forward for meta-analysis using multiple Caucasian cohorts.ResultsFive hundred and sixty cases of type 2 diabetes with severe diabetic retinopathy and 4,106 controls were identified in the GoDARTS cohort. We revealed that rs3913535 in the NADPH Oxidase 4 (NOX4) gene reached a p value of 4.05 × 10-9 . Two nearby SNPs, rs10765219 and rs11018670 also showed promising p values (p values = 7.41 × 10-8 and 1.23 × 10-8 , respectively). In the meta-analysis using multiple Caucasian cohorts (excluding GoDARTS), rs10765219 and rs11018670 showed associations for diabetic retinopathy (p = 0.003 and 0.007, respectively), while the p value of rs3913535 was not significant (p = 0.429).ConclusionThis genome-wide association study of severe diabetic retinopathy suggests new evidence for the involvement of the NOX4 gene.

Background: Twin-to-twin transfusion syndrome (TTTS) is a serious complication of 10-15% of twin or triplet pregnancies in which multiple fetuses share a single placenta. Communicating placental vessels allow one fetus (the donor) to pump blood to the other (the recipient). Mortality rates without intervention are high, approaching 100% in some series, with fetal deaths usually due to cardiac failure. Surgical correction using laser photocoagulation of communicating placental vessels was developed in the 1980s and refined in the 1990s. Since it was introduced in Victoria in 2006, laser surgery has been performed in approximately 120 pregnancies. Survival of one or more fetuses following laser surgery is currently > 90%, however the neurodevelopmental outcomes for survivors remain incompletely understood. Prior to laser therapy, at least one in five survivors of TTTS had serious adverse neurodevelopmental outcomes (usually cerebral palsy). Current estimates of neurological impairment among survivors following laser surgery vary from 4 to 31% and long-term follow-up data are limited. Method(s): This paper describes the methodology for a retrospective cohort study in which children aged 24 months and over (corrected for prematurity), who were treated with laser placental photocoagulation for TTTS at Monash Health in Victoria, Australia, will undergo comprehensive neurodevelopmental assessment by a multidisciplinary team. Evaluation will include parental completion of pre-assessment questionnaires of social and behavioural development, a standardised medical assessment by a developmental paediatrician or paediatric neurologist, and age-appropriate cognitive and academic, speech and fine and gross motor assessments by psychologists, speech and occupational therapists or physiotherapists. Assessments will be undertaken at the Murdoch Children's Research Institute/Royal Children's Hospital, at Monash Health or at another mutually agreed location. Results will be recorded i

Background: Twin-to-twin transfusion syndrome (TTTS) is a serious complication of 10-15% of twin or triplet pregnancies in which multiple fetuses share a single placenta. Communicating placental vessels allow one fetus (the donor) to pump blood to the other (the recipient). Mortality rates without intervention are high, approaching 100% in some series, with fetal deaths usually due to cardiac failure. Surgical correction using laser photocoagulation of communicating placental vessels was developed in the 1980s and refined in the 1990s. Since it was introduced in Victoria in 2006, laser surgery has been performed in approximately 120 pregnancies. Survival of one or more fetuses following laser surgery is currently > 90%, however the neurodevelopmental outcomes for survivors remain incompletely understood. Prior to laser therapy, at least one in five survivors of TTTS had serious adverse neurodevelopmental outcomes (usually cerebral palsy). Current estimates of neurological impairment among survivors following laser surgery vary from 4 to 31% and long-term follow-up data are limited. Method(s): This paper describes the methodology for a retrospective cohort study in which children aged 24 months and over (corrected for prematurity), who were treated with laser placental photocoagulation for TTTS at Monash Health in Victoria, Australia, will undergo comprehensive neurodevelopmental assessment by a multidisciplinary team. Evaluation will include parental completion of pre-assessment questionnaires of social and behavioural development, a standardised medical assessment by a developmental paediatrician or paediatric neurologist, and age-appropriate cognitive and academic, speech and fine and gross motor assessments by psychologists, speech and occupational therapists or physiotherapists. Assessments will be undertaken at the Murdoch Children's Research Institute/Royal Children's Hospital, at Monash Health or at another mutually agreed location. Results will be recorded i

Purpose: To compare structural outcome at age 4 years of eyes treated with intravitreal injection of bevacizumab with fellow eyes treated with conventional laser photoablation in type 1 retinopathy of prematurity (ROP). Design: Single, randomized, controlled trial. Participants: All inborn babies with type 1 zone 1 ROP at the Neonatal Intensive Care Unit of the Catholic University, Rome, from September 1, 2009, to March 31, 2012. Methods: In 21 infants (42 eyes), 1 eye was randomized to receive an intravitreal injection of 0.5 mg bevacizumab; the fellow eye underwent conventional laser photoablation. Digital retinal imaging and fluorescein angiography (FA) were performed at an average of 4 years after treatment in follow-up after these studies performed at treatment and 9 months. Main Outcome Measures: Fluorescein angiograms were examined by 2 experts to document retinal and choroidal findings. Results: Among the 20 bevacizumab-treated eyes available at 4 years of age, all showed abnormalities at the periphery (avascular area, vessel leakage, shunts, abnormal vessel branching, and tangles) or the posterior pole (hyperfluorescent lesions, absence of foveal avascular zone). These lesions were not observed in the majority of the lasered eyes. Among the 19 laser-treated eyes, leakage was noted in 1 eye, shunts and tangles were noted in 3 eyes, and macular abnormalities were noted in 3 eyes. Conclusions: Fluorescein angiography has shown potentially serious and long-term ocular effects that are present more commonly after treatment with bevacizumab for acute-phase ROP than after laser.

Для сегментации изображений глазного дна перспективно использовать технологию отбора эффективных признаков, которые обеспечивают минимальную ошибку распознавания объектов, используя при этом минимальное количество параметров для сегментации одного фрагмента изображения. Технология позволяет провести интеллектуальный анализ признаков с использованием цветовых подпространств для решения задачи выделения областей интереса. Для повышения эффективности проведения операции лазерной коагуляции задача наиболее точного выделения области интереса является особенно актуальной. Технология ориентирована на текстурный анализ выделенных паттернов изображений и позволяет, используя минимальное количество признаков, демонстрировать достаточно точную сегментацию. Для повышения эффективности сегментации предлагается использовать алгоритмы предобработки изображений, которые обеспечат более чёткое выделение объектов. В работе проводится исследование информативности полученного пространства признаков с использованием дискриминантного анализа данных. Определены наилучшие значения размеров окна фрагментации изображений для проведения сегментации и наборы признаков обеспечивающих необходимую точность идентификации областей интереса при анализе следующих 4 классов изображений: экссудаты, толстые сосуды, тонкие сосуды и здоровые участки. We propose a technique for selecting effective features for fundus image segmentation. The technique has made it possible to conduct smart feature analysis with the aid of color subspaces when solving a problem of selecting the regions of interest. The relevance of the problem is associated with enhancing the effectiveness of laser coagulation surgery. The technique is based on the texture analysis of image patterns. To improve the efficiency of segmentation we propose to use image preprocessing algorithms that will provide a more precise selection of objects. The analysis of the information content of the resulting feature space and selection of most effecti

We report the case of severe retinopathy of prematurity (ROP) in the donor twin with twin anemia-polycythemia sequence managed with the novel treatment of intrauterine blood transfusions. The fellow polycythemic twin was managed with intrauterine venesection and developed only mild ROP. Thus, despite intrauterine improvement of the twins' hemodynamic conditions, the risk of developing severe ROP remained in the donor twin.Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus

We report the case of severe retinopathy of prematurity (ROP) in the donor twin with twin anemia-polycythemia sequence managed with the novel treatment of intrauterine blood transfusions. The fellow polycythemic twin was managed with intrauterine venesection and developed only mild ROP. Thus, despite intrauterine improvement of the twins' hemodynamic conditions, the risk of developing severe ROP remained in the donor twin.Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus

The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of 'competence based' assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.Copyright © The Author(s) 2016.

The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of 'competence based' assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.Copyright © The Author(s) 2016.

AimTo determine the effect of alpha-2-agonist (AA) premedication (PM) on intraocular pressure (IOP) following selective laser trabeculoplasty (SLT).MethodsRetrospective cohort study of all patients undergoing 360° SLT at an institution with two prevalent practice patterns consisting of SLT performed with PM and without premedication (NPM) with AA. The association between pre- and post-operative IOP was evaluated using a linear regression model in 49 (59%) PM and 34 (41%) NPM eyes.ResultsThe prevalence of IOP elevations up to 5 mmHg 1 h postoperatively was similar in both groups, occurring in 18% of PM and in 15% of NPM. Elevations above 5 mmHg were seen in 4% of PM and 8% of NPM (P = 0.732). After correcting for age, gender, diagnosis, number of medications, and preoperative IOP, the presence or absence of AA PM had no significant association with any postoperative IOP (P > 0.5).ConclusionThe practice of using AAs before SLT and measuring IOP at 1 h has not been validated yet adds to expenses and workflow burden. Our retrospective study showed no significant correlation between PM and postoperative or longer-term IOP. IOP at 1 h should be measured in patients who cannot tolerate transient pressure elevations. Further studies are needed to elucidate this relationship.

PURPOSE: A recent threefold increase in laser treatment for advanced retinopathy of prematurity (ROP) triggered a nationwide preschool ophthalmic and developmental status among extremely preterm survivors. Here, we discuss refraction and visual acuity.METHODS: Survivors (n = 178) from a national birth cohort (February 2004 to March 2006) of gestational age <28 weeks (PT) and 56 full-term (FT) controls attended for evaluation at age 4 years. Cycloplegic refraction and keratometry were achieved by Retinomax autokeratorefractor and visual acuities by symbol recognition (HOTV, logMAR).RESULTS: The refractive distribution presented a myopic tail (4.5%) and a hyperopic tail (11.9% ≥+2.5 D) as special preterm features, and corneas were more curved. Astigmatism and anisometropia were only marginally increased, and visual acuities were generally good. Best-corrected binocular median logMAR visual acuity was 0.1 in FT and 0.2 in PT, in Snellen equivalents 0.8 and 0.63. Snellen acuity ≤0.5 occurred across the ROP subgroups, but mainly in those with at least ROP stage 3. Two children had low vision.CONCLUSIONS: The overall fair outcome for refraction and function is in accordance with other recent northern Europe experience. The results differ in particular from the poorer ophthalmic outcomes reported in the pioneer US treatment studies (cryotherapy for ROP and ETROP). The diode laser ablations (n = 32) appeared effective in our series; except one child, all treated subjects had good or fair social vision at the age of 4 years.

OBJECTIVE: To compare the efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion (BRVO).DESIGN: Randomised controlled trials (RCTs) evaluating the efficacy and safety of approved treatments for macular oedema secondary to BRVO were identified from an updated systematic review.SETTING: A Bayesian network meta-analysis of RCTs of treatments for macular oedema secondary to BRVO.INTERVENTIONS: Ranibizumab 0.5 mg pro re nata, aflibercept 2 mg monthly (2q4), dexamethasone 0.7 mg implant, laser photocoagulation, ranibizumab+laser, or sham intervention. Bevacizumab and triamcinolone were excluded.OUTCOME MEASURES: Efficacy outcomes were mean change in best corrected visual acuity (Early Treatment Diabetic Retinopathy Study scale) and the percentage of patients gaining ≥ 15 letters. Safety outcome was the percentage of patients with increased intraocular pressure (IOP)/ocular hypertension (OH).RESULTS: 8 RCTs were identified for inclusion with 1743 adult patients. The probability of being the most efficacious treatment at month 6 or 12 based on letters gained was 54% for ranibizumab monotherapy, 30% for aflibercept, 16% for ranibizumab plus laser (adjunctive or prompt), and 0% for dexamethasone implant, laser or sham. The probability of being the most efficacious treatment for patients gaining ≥ 15 letters was 39% for aflibercept, 35% for ranibizumab monotherapy, 24% for ranibizumab plus laser, 2% for dexamethasone implant, and less than 1% for laser or sham. There was no statistical difference between ranibizumab monotherapy and aflibercept for letters gained (+1.4 letters for ranibizumab vs aflibercept with 95% credible interval (CrI) of -5.2 to +8.5 letters) or the OR for gaining ≥ 15 letters: 1.06 (95% CrI 0.16 to 8.94)). Dexamethasone implant was associated with significantly higher IOP/OH than antivascular endothelial growth factor agents (OR 13.1 (95% CrI 1.7 to 116.9)).CONC

Background Mirror syndrome (Ballantyne's syndrome) is a rare condition recognised in the context of non-immune and immune fetal hydrops with the presence of 'triple oedema' - a hydropic fetus, alongside marked maternal and placental oedema - hallmarking the maternal-fetal mirror. The mother may also develop proteinuria and hypertension, thereby simulating a clinical picture of preeclampsia; however, unlike pre-eclampsia, mirror syndrome is characterised by maternal haemodilution alongside fetal hydrops and polyhydramnios. The exact pathophysiology of mirror syndrome is not known, however that of pre-eclampsia is widely acknowledged to have genesis in abnormal placentation leading to hypoxia, placental oxidative stress and release of factors causing endothelial activation and vasoconstriction. Frequently implicated factors in this pathway include angiogenic factors such as the VEGF receptor sFlt, activin and follistatin, along with 8-isoprostane, endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1) and von Willebrand factor (vWF). Since mirror syndrome resembles a 'preeclampsia phenotype', we test the hypothesis that its clinical features are mediated by the same circulating factors as those in preeclampsia. Case We report the case of a 29 year-old at 26 + 2 weeks that underwent successful fetoscopic laser photocoagulation for Stage IV TTTS. Between days 4-5 post-procedure, the patient became increasingly hypertensive and proteinuric. Follow-up ultrasound was performed paradoxically showing new-onset ascites in the donor twin. On day 7, the patient became increasingly tachycardic, dyspnoeic and hypoxic. Blood indices showed: Hb 7.8 g/dL, Hct 0.22 L/L, albumin 16, CRP 56 and pO2 64 mmHg on room air. Chest X-ray confirmed pulmonary oedema. A diagnosis of mirror syndrome was made and the twins delivered by caesarean. Placental histopathology showed oedematous villi confined to the donor twin territory, pathognomonic of mirror syndrome. Concurrent to the clini

Background Mirror syndrome (Ballantyne's syndrome) is a rare condition recognised in the context of non-immune and immune fetal hydrops with the presence of 'triple oedema' - a hydropic fetus, alongside marked maternal and placental oedema - hallmarking the maternal-fetal mirror. The mother may also develop proteinuria and hypertension, thereby simulating a clinical picture of preeclampsia; however, unlike pre-eclampsia, mirror syndrome is characterised by maternal haemodilution alongside fetal hydrops and polyhydramnios. The exact pathophysiology of mirror syndrome is not known, however that of pre-eclampsia is widely acknowledged to have genesis in abnormal placentation leading to hypoxia, placental oxidative stress and release of factors causing endothelial activation and vasoconstriction. Frequently implicated factors in this pathway include angiogenic factors such as the VEGF receptor sFlt, activin and follistatin, along with 8-isoprostane, endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1) and von Willebrand factor (vWF). Since mirror syndrome resembles a 'preeclampsia phenotype', we test the hypothesis that its clinical features are mediated by the same circulating factors as those in preeclampsia. Case We report the case of a 29 year-old at 26 + 2 weeks that underwent successful fetoscopic laser photocoagulation for Stage IV TTTS. Between days 4-5 post-procedure, the patient became increasingly hypertensive and proteinuric. Follow-up ultrasound was performed paradoxically showing new-onset ascites in the donor twin. On day 7, the patient became increasingly tachycardic, dyspnoeic and hypoxic. Blood indices showed: Hb 7.8 g/dL, Hct 0.22 L/L, albumin 16, CRP 56 and pO2 64 mmHg on room air. Chest X-ray confirmed pulmonary oedema. A diagnosis of mirror syndrome was made and the twins delivered by caesarean. Placental histopathology showed oedematous villi confined to the donor twin territory, pathognomonic of mirror syndrome. Concurrent to the clini

Dijabetesna retinopatija je među vodećim uzročnicima stečenog slepila, kako u razvijenim zemljama, tako i zemljama u razvoju. Dijabetesna retinopatija je jedna od najčešćih komplikacija Dijabetes Mellitus-a. U sklopu dijabetesne retinopatije jedan od najranijih razloga koji dovodi do pada vidne oštrine je dijabetični makularni edem (DME). Pad vidne oštrine kod pacijenata sa dijabetesom narušava njihov kvalitet života i umanjuje radnu sposobnost. Dosadašnji oblik lečenja laserfotokoaguacijom makule, nije dao zadovoljavajuće rezultate. U novije vreme sve više je zastupljeno farmakološko lečenje edema koje podrazumeva intrvitrealnu aplikaciju lekova iz grupe inhibitora vaskularnog endotelnog faktora rasta (VEGF inhibitori), koji dovodi do stabilizacije zidova krvnih sudova. Cilj ove studije je da se ispita efikasnost lečenja DME uz pomoć intravitrealno aplikovanih lekova iz grupe inhibitora vaskularnog endotelnog faktora rasta u odnosu na konvencionalno do sada priznato lečenje laserfotokogulacijom makule. Efikasnost lečenja je procenjivana na dva načina: anatomski, na osnovu smanjenja centralne makularne debljine izražene u μm, merene metodom optičke koherentne tomografije, i funkcionalno, na osnovu poboljšanja vidne oštrine koja je izražavana u log MAR jedinicama. U ovoj prospektivnoj, randomiziranoj kliničkoj studiji sa minimumom praćenja od 6 meseci, u eksperimentalnoj grupi tretiran je 51 pacijent, odnosno 84 oka aplikacijom bevacizumaba (anti VEGF agens) u dozi od 1,25 mg, sa ili bez dodatnog laser tretmana. Uz prosečno 2,46 inekcije postignuta je prosečna redukcija centralne makularne debljine od 139,15 μm. Dobijene vrednosti su nakon svake aplikovane doze su značajno bolje u odnosu na početnu. Edemi sa većom centralnom makularnom debljinom su zahtevali tretman sa većim brojem inekcija. Kod većih edema je postignuta i veća redukcija centralne makularne debljine. U odnosu na vidnu oštrinu u eksperimentalnoj grupi postignuto je poboljšanje od 0,135 log MAR jed, Diabetic retinopathy is among the leading causes of acquired blindness in developed countries, as well as in developing countries. Diabetic retinopathy is one of the most frequent Diabetes Mellitus complications. Within diabetic retinopathy, diabetic macular edema (DME) is one of the earliest causes of the loss of visual acuity. Impaired vision causes decline in life quality in diabetic patients and it decreases their working ability. Up to this date, laser photocoagulation treatment has not given satisfactory results. Recently, new promising treatment forms have emerged, including the intravitreal application of vascular endothelium growth factor (VEGF inhibitors), which lead to stabilization of the vessel wall. The aim of this study is to evaluate the efficacy of DME treatment consisting of intravitreal VEGF inhibitor application alone or as a part of combined treatment (intravitreal VEGF inhibitor plus laser photocoagulation) compared with conventional laser treatment alone. The effect of treatment was evaluated according to morphological parameters by measuring central macular thickness (CMT) in μm with optical coherence tomography, and according to functional parameter by visual acuity in log MAR scale. In this prospective randomized clinical trial, with minimum follow up of 6 months, in experimental group 51 patient, or 84 eyes were treated with bevacizumab (VEGF inhibitor) in 1.25 mg dosage, alone or in combination with laser. The mean reduction in was 139.15 μm, which was achieved with 2.46 doses on average. The difference between the final and initial CMT values after each dos age was tatistically significant. Edemas with high central macular thickness required high number of intraviteal aplicatons and the reduction was higher. In our study, mean visual acuity improved significantly in 0.135 log MAR. In control group (50 patient, 92 eyes) treated with laserphotocolagulation alone, the effect on visual acuity and central acular thickness was not statistical

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AimTo determine the effect of alpha-2-agonist (AA) premedication (PM) on intraocular pressure (IOP) following selective laser trabeculoplasty (SLT).MethodsRetrospective cohort study of all patients undergoing 360° SLT at an institution with two prevalent practice patterns consisting of SLT performed with PM and without premedication (NPM) with AA. The association between pre- and post-operative IOP was evaluated using a linear regression model in 49 (59%) PM and 34 (41%) NPM eyes.ResultsThe prevalence of IOP elevations up to 5 mmHg 1 h postoperatively was similar in both groups, occurring in 18% of PM and in 15% of NPM. Elevations above 5 mmHg were seen in 4% of PM and 8% of NPM (P = 0.732). After correcting for age, gender, diagnosis, number of medications, and preoperative IOP, the presence or absence of AA PM had no significant association with any postoperative IOP (P > 0.5).ConclusionThe practice of using AAs before SLT and measuring IOP at 1 h has not been validated yet adds to expenses and workflow burden. Our retrospective study showed no significant correlation between PM and postoperative or longer-term IOP. IOP at 1 h should be measured in patients who cannot tolerate transient pressure elevations. Further studies are needed to elucidate this relationship.

PurposeTo compare laser photocoagulation plans for diabetic macular edema (DME) using fluorescein angiography (FA) versus optical coherence tomography (OCT) thickness map superimposed on the retina.MethodsFourteen eyes with DME undergoing navigated laser photocoagulation with navigated photocoagulator had FA taken using the same instrument. Optical coherence tomography central retinal thickness map was imported to the photocoagulator and with same magnification aligned onto the retina. Three retina specialists placed laser spot marks separately on FA and OCT image in a masked fashion. The spots placed by each physician were compared between FA and OCT and among physicians. The area of dye leakage on FA and increased central retinal thickness on OCT of the same eye were also compared.ResultsThe average number of spots using FA and OCT template was 36.64 and 40.61, respectively (P = 0.0201). The average area of dye leakage was 7.45 mm, whereas the average area of increased central retinal thickness on OCT of the same eye was 10.92 mm (P = 0.013).ConclusionThere is variability in the treatment planning for macular photocoagulation with a tendency to place more spots when guided by OCT than by FA. Integration of OCT map aligned to the retina may have an impact on treatment plan once such information is available.

AimTo evaluate the efficacy of a standardised combination therapy for clinically significant diabetic macular oedema using bevacizumab injections followed by navigated laser photocoagulation to stabilise retinal thickness.MethodsIn this pilot study we retrospectively reviewed charts and imaging of 23 eyes treated with the standardised combination regimen. Eyes initially received monthly bevacizumab injections, followed by navigated laser photocoagulation when central retinal thickness (CRT) was <440 µm. Patients were then followed monthly for 12 months.ResultsAt the time of navigated laser after bevacizumab treatment mean vision gain was +10.4 Early Treatment Diabetic Retinopathy Study letters (p<0.01) and CRT reduction was 146 µm (p<0.001). At 12 months from baseline, the vision gain remained stable at +10.6 Early Treatment Diabetic Retinopathy Study letters (p<0.01), and CRT reduction was stable at 137 µm (p<0.001). At 12 months from laser, the vision gain was 7.8 letters from baseline (p<0.01), with no significant change compared with the gain at 12 months from baseline (p=0.108). At 12 months from laser, CRT reduction was 125 µm from baseline (p<0.001), with no significant change compared with CRT reduction at 12 months from baseline (p=0.601). Total injections needed were 4.4 from baseline to month 12, with 1.3 reinjection needed after laser. 57% of the eyes didn't require injections after laser, while 43% needed two additional injections.ConclusionsStandardised combination therapy using bevacizumab injections followed by navigated laser treatment for clinically significant diabetic macular oedema demonstrated significant visual gain and CRT reduction after bevacizumab treatment and stabilisation after navigated laser up to 12 months. The number of injections required in 12 months was lower than reported in previous combination studies.

PURPOSE: Diabetic vitrectomy represents an end-point of diabetic retinopathy progression. This study was designed to estimate long-term incidence of diabetic vitrectomy and associated risk factors.METHODS: Retrospective review of prospectively collected data from a large diabetes centre between 1996 and 2010. Surgical history was obtained from The Danish National Patient Register.RESULTS: The population consisted of 3980 patients with type 1 diabetes. Median follow-up was 10.0 years. In total, 106 patients underwent diabetic vitrectomy in the observation period. Surgery indications were nonclearing vitreous haemorrhage (43%) or tractional retinal detachment (57%). The cumulative incidence rates of diabetic vitrectomy were 1.6% after 5 years and 2.9% after 10 years. When excluding patients with no or mild diabetic retinopathy, the corresponding rates were higher; 3.7% and 6.4%, respectively (p < 0.001, log-rank test). The risk of reaching diabetic vitrectomy increased in patients experiencing glycosylated haemoglobin A1c > 75 mmol/mol in the observation period (p < 0.001, hazard ratio: 3.9, Cox regression analysis). Systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, diabetes duration, age, gender and nephropathy were not associated with an increased risk of reaching diabetic vitrectomy (p > 0.05 for all variables).CONCLUSIONS: Diabetic vitrectomy is rarely required in a type 1 diabetes population with varying degrees of retinopathy, but the risk increases markedly with poor metabolic control.

Aim: To demonstrate abnormalities found on fetal MRI in complicated monochorionic gestations and to discuss the adjunctive role of fetal MRI in the imaging diagnosis and management of these pregnancies. Method(s): Retrospective audit of all women referred to the Monash Health Fetal MRI service for evaluation of monochorionic twin gestations at >20 weeks following either spontaneous co - twin death or post-selective fetoscopic laser photocoagulation (SFLP) of placental anastomoses. Result(s): Fourteen women were referred for fetal MRI. A variety of findings were identified some of which were undiagnosed or nonspecific on ultrasound. These included polymicrogyria, dural sinus malformation, intraventricular haemorrhage, cerebral infarction, isolated ventriculomegaly and normal findings. Conclusion(s): Fetal MRI can provide additional for prognostication, counselling and further management of women with complicated monochorionic gestations as well as surrogate clinical follow-up data about the short term outcome of fetuses from pregnancies treated with SFLP. Fetuses that were the surviving donor in the setting of twin twin transfusion or co-twin death were at highest risk for cerebral malformations.

Aim: To demonstrate abnormalities found on fetal MRI in complicated monochorionic gestations and to discuss the adjunctive role of fetal MRI in the imaging diagnosis and management of these pregnancies. Method(s): Retrospective audit of all women referred to the Monash Health Fetal MRI service for evaluation of monochorionic twin gestations at >20 weeks following either spontaneous co - twin death or post-selective fetoscopic laser photocoagulation (SFLP) of placental anastomoses. Result(s): Fourteen women were referred for fetal MRI. A variety of findings were identified some of which were undiagnosed or nonspecific on ultrasound. These included polymicrogyria, dural sinus malformation, intraventricular haemorrhage, cerebral infarction, isolated ventriculomegaly and normal findings. Conclusion(s): Fetal MRI can provide additional for prognostication, counselling and further management of women with complicated monochorionic gestations as well as surrogate clinical follow-up data about the short term outcome of fetuses from pregnancies treated with SFLP. Fetuses that were the surviving donor in the setting of twin twin transfusion or co-twin death were at highest risk for cerebral malformations.

PURPOSE: Diabetic vitrectomy represents an end-point of diabetic retinopathy progression. This study was designed to estimate long-term incidence of diabetic vitrectomy and associated risk factors.METHODS: Retrospective review of prospectively collected data from a large diabetes centre between 1996 and 2010. Surgical history was obtained from The Danish National Patient Register.RESULTS: The population consisted of 3980 patients with type 1 diabetes. Median follow-up was 10.0 years. In total, 106 patients underwent diabetic vitrectomy in the observation period. Surgery indications were nonclearing vitreous haemorrhage (43%) or tractional retinal detachment (57%). The cumulative incidence rates of diabetic vitrectomy were 1.6% after 5 years and 2.9% after 10 years. When excluding patients with no or mild diabetic retinopathy, the corresponding rates were higher; 3.7% and 6.4%, respectively (p < 0.001, log-rank test). The risk of reaching diabetic vitrectomy increased in patients experiencing glycosylated haemoglobin A1c > 75 mmol/mol in the observation period (p < 0.001, hazard ratio: 3.9, Cox regression analysis). Systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, diabetes duration, age, gender and nephropathy were not associated with an increased risk of reaching diabetic vitrectomy (p > 0.05 for all variables).CONCLUSIONS: Diabetic vitrectomy is rarely required in a type 1 diabetes population with varying degrees of retinopathy, but the risk increases markedly with poor metabolic control.

The tools for managing retinoblastoma have been increasing in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stage that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation. However, IAC still has many obstacles to overcome. We present an update on the indications, complications, limitations, success, and technical aspects of IAC. Given its safety and high efficacy, it is expected that IAC will replace conventional strategies and will become a first-line option even for tumors that are amenable for other strategies.

AimTo evaluate the efficacy of a standardised combination therapy for clinically significant diabetic macular oedema using bevacizumab injections followed by navigated laser photocoagulation to stabilise retinal thickness.MethodsIn this pilot study we retrospectively reviewed charts and imaging of 23 eyes treated with the standardised combination regimen. Eyes initially received monthly bevacizumab injections, followed by navigated laser photocoagulation when central retinal thickness (CRT) was <440 µm. Patients were then followed monthly for 12 months.ResultsAt the time of navigated laser after bevacizumab treatment mean vision gain was +10.4 Early Treatment Diabetic Retinopathy Study letters (p<0.01) and CRT reduction was 146 µm (p<0.001). At 12 months from baseline, the vision gain remained stable at +10.6 Early Treatment Diabetic Retinopathy Study letters (p<0.01), and CRT reduction was stable at 137 µm (p<0.001). At 12 months from laser, the vision gain was 7.8 letters from baseline (p<0.01), with no significant change compared with the gain at 12 months from baseline (p=0.108). At 12 months from laser, CRT reduction was 125 µm from baseline (p<0.001), with no significant change compared with CRT reduction at 12 months from baseline (p=0.601). Total injections needed were 4.4 from baseline to month 12, with 1.3 reinjection needed after laser. 57% of the eyes didn't require injections after laser, while 43% needed two additional injections.ConclusionsStandardised combination therapy using bevacizumab injections followed by navigated laser treatment for clinically significant diabetic macular oedema demonstrated significant visual gain and CRT reduction after bevacizumab treatment and stabilisation after navigated laser up to 12 months. The number of injections required in 12 months was lower than reported in previous combination studies.

Aims To evaluate the performance of a collaborative fetal therapy service for treatment for twin-twin transfusion syndrome (TTTS). Methods The Victorian Fetal Therapy Service (VFTS) was developed in 2006. It is a state-based three-centre collaborative service comprising a surgical team and clinical leadership group, designed to optimise access to, and performance of, fetoscopic procedures in Victoria. This is a prospective cohort study of VFTS patients referred for fetoscopic laser photocoagulation (FLP) for TTTS since 2006. Results Forty-nine consecutive women with advanced (stage 2-4) TTTS between 2006 and 2011 were included in this study. Overall survival was 67 of 98 (68%), and survival of >=1 twin was seen in 42 of 49 pregnancies (86%). There was no difference in survival by disease stage at diagnosis (>=1 survivor: 66% (stage 2 or 3 TTTS) vs 77% (stage 4 TTTS), P = 0.44), nor by surgical era (>=1 survivor: 60% (2006-2008) vs 74% of cases (2009-2011), P = 0.21). The median gestation gained post-FLP was 10.5 weeks. Conclusion These results are consistent with published series and confirm the success of a novel service delivery model for fetal therapy in Victoria. We suggest that collaborative models such as ours should be considered for fetal conditions where treatment is complex and the total number of cases is small to ensure a consistent approach to assessment, management and follow-up of patients and to optimise training and research opportunities. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Aims To evaluate the performance of a collaborative fetal therapy service for treatment for twin-twin transfusion syndrome (TTTS). Methods The Victorian Fetal Therapy Service (VFTS) was developed in 2006. It is a state-based three-centre collaborative service comprising a surgical team and clinical leadership group, designed to optimise access to, and performance of, fetoscopic procedures in Victoria. This is a prospective cohort study of VFTS patients referred for fetoscopic laser photocoagulation (FLP) for TTTS since 2006. Results Forty-nine consecutive women with advanced (stage 2-4) TTTS between 2006 and 2011 were included in this study. Overall survival was 67 of 98 (68%), and survival of >=1 twin was seen in 42 of 49 pregnancies (86%). There was no difference in survival by disease stage at diagnosis (>=1 survivor: 66% (stage 2 or 3 TTTS) vs 77% (stage 4 TTTS), P = 0.44), nor by surgical era (>=1 survivor: 60% (2006-2008) vs 74% of cases (2009-2011), P = 0.21). The median gestation gained post-FLP was 10.5 weeks. Conclusion These results are consistent with published series and confirm the success of a novel service delivery model for fetal therapy in Victoria. We suggest that collaborative models such as ours should be considered for fetal conditions where treatment is complex and the total number of cases is small to ensure a consistent approach to assessment, management and follow-up of patients and to optimise training and research opportunities. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Background/objectivesCurrent laser therapy of port wine stain (PWS) birthmarks with a single laser pulse (SLP) does not produce complete lesion removal in the majority of patients. To improve PWS therapeutic efficacy, we evaluated the performance of an approach based on multiple laser pulses (MLP) to enhance blood vessel photocoagulation.Study designThe hamster dorsal window chamber model was used. Radiant exposure (RE), pulse repetition rate (f(r)), total number of pulses (n(p)), and length of vessel irradiated were varied. Blood vessels in the window were irradiated with either SLP with RE of 4-7 J/cm(2) or MLP with RE per pulse of 1.4-5.0 J/cm(2), f(r) of 0.5-26.0 Hz, and n(p) of 2-5. The laser wavelength was 532 nm and pulse duration was 1 ms. Either a 2 mm vessel segment or entire vessel branch was irradiated. Digital photographs and laser speckle images of the window were recorded before and at specific time points after laser irradiation to monitor laser-induced blood vessel structural and functional changes, respectively.ResultsWe found that: (1) for a SLP approach, the RE required to induce blood vessel photocoagulation was 7 J/cm(2) as compared to only 2 J/cm(2) per pulse for the MLP approach; (2) for MLP, two pulses at a repetition rate of 5 Hz and a RE of 3 J/cm(2) can induce photocoagulation of more than 80% of irradiated blood vessel; and (3) irradiation of a longer segment of blood vessel resulted in lower reperfusion rate.ConclusionsThe MLP approach can induce blood vessel photocoagulation at much lower RE per pulse as compared to SLP. The 5 Hz f(r) and the need for two pulses are achievable with modern laser technology, which makes the MLP approach practical in the clinical management of PWS birthmarks.

PURPOSE: To investigate whether normal tension glaucoma (NTG) is associated with increased risk of developing dementia/Alzheimer disease (AD).METHODS: A total of 69 patients with NTG were identified in the case note files in the Glaucoma Clinic, University Hospital of Copenhagen (Rigshospitalet), Denmark from 1980 to 2001. The rate of a subsequent diagnosis of dementia as recorded in nationwide health care registers from 1980 to 2005 was estimated and compared with the rate for the general population [standard mortality rate (SMR) = observed number of cases of dementia/expected number of cases of dementia].RESULTS: The 69 patients had a median age of 64 years (quartiles 57 and 73) at the time of the diagnosis, and the average follow-up period was 12.7 years. The SMR(dementia) was 0.20 (95% CI 0.01-1.11). No patient developed AD.CONCLUSION: Normal tension glaucoma was not associated with an increased risk of developing dementia/AD.

PURPOSE: To investigate whether normal tension glaucoma (NTG) is associated with increased risk of developing dementia/Alzheimer disease (AD).METHODS: A total of 69 patients with NTG were identified in the case note files in the Glaucoma Clinic, University Hospital of Copenhagen (Rigshospitalet), Denmark from 1980 to 2001. The rate of a subsequent diagnosis of dementia as recorded in nationwide health care registers from 1980 to 2005 was estimated and compared with the rate for the general population [standard mortality rate (SMR) = observed number of cases of dementia/expected number of cases of dementia].RESULTS: The 69 patients had a median age of 64 years (quartiles 57 and 73) at the time of the diagnosis, and the average follow-up period was 12.7 years. The SMR(dementia) was 0.20 (95% CI 0.01-1.11). No patient developed AD.CONCLUSION: Normal tension glaucoma was not associated with an increased risk of developing dementia/AD.

The twin-to-twin transfusion syndrome (TTTS) continues to pose a major challenge in the area of fetal therapy. Untreated, the mortality and morbidity are extremely high, and the fact that there are two structurally normal fetuses at risk makes the case for effective in utero therapy even more compelling. Advances in therapeutic procedures, in particular the development of selective laser photocoagulation of intertwin vascular anastomoses, have improved outcomes, both in terms of survival and survival free of disability. This review examines the pathophysiology, diagnosis, surveillance, contemporary therapies, expected outcomes and ongoing challenges in TTTS. © 2007 The AuthorsJournal compilation © 2007 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.