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PurposeTo correlate the response of topical dorzolamide (Trusopt; Merck) in patients with X-linked retinoschisis (XLRS) with genotype.MethodsWe carried out a retrospective evaluation of four patients (seven eyes) with XLRS, treated with topical dorzolamide. The change in best-corrected visual acuity (VA) and central macular thickness (CMT; central 1 mm subfield thickness) from optical coherence tomography (OCT) was analysed over the follow-up period, using Student's t-test. Each patient also had genetic analysis for mutations in the retinoschisisgene (RS1).ResultsThe mean age at the start of treatment was 14.7±11 years, and mean follow-up duration was 21.7±7.7 months. Mean CMT at the final follow-up was significantly better than at baseline (291±123 vs352±119 μm, P=0.007); however, mean VA was worse (0.38±0.25 vs0.31±0.24 logMAR score, P=0.041). All four patients had a mutation in the RS1gene; there was no apparent association between the type of mutation and the response to topical dorzolamide.ConclusionTopical dorzolamide may have some effect in reducing central macular thickness in patients with XLRS, but this does not necessarily correlate with improvement in VA. In our case series, genotypic information did not predict the response to this treatment. [ABSTRACT FROM AUTHOR]

PurposeTo compare retinal thickness (RT) measurement and segmentation performance of time domain (TD, Stratus) and spectral domain (SD) optical coherence tomography (OCT) devices (Cirrus, Spectralis) for imaging macular oedema (ME) secondary to branch retinal vein occlusion (BRVO).MethodsIn this study, 20 eyes of 20 consecutive patients with acute BRVO were included. A total of 18 unaffected fellow eyes served as control group. RT measurement was analysed in the five inner fields of the early-treatment diabetic retinopathy grid, and proportional segmentation errors were evaluated.ResultsCentral millimetre thickness (CMT) showed a mean difference of −64, −74, and −18 μm (P<0.001) in the control group and −31 μm (P=0.107), −92 μm (P<0.001), and −105 μm (P=0.016) in the BRVO group, between Stratus and Cirrus, between Stratus and Spectralis, and between Cirrus and Spectralis, respectively. Mean RT showed the highest variability between different devices in the area most intensively affected by BRVO-related ME. In eyes with BRVO, 14.6% of Spectralis, 20% of Stratus, and 36.6% of Cirrus scans demonstrated moderate and severe segmentation errors.ConclusionRT measurement in eyes with BRVO, by TD and SD OCT, is compromised by a significant rate of segmentation errors. Deviations are most pronounced in the areas most severely affected by ME. [ABSTRACT FROM AUTHOR]

This presentation covers two topics. First is a basic laboratory study, designed to explore the mechanism for the phenomenon of 'early worsening,' in which individuals with type 1 diabetes and early to moderate retinopathy are rapidly placed on 'tight' blood glucose control, after which about 10% of these individuals develop a worsening of retinopathy with the appearance of multiple 'cotton wool' spots. Our studies on cultured retinal cells used vascular endothelial growth factor (VEGF) production as an index of cellular ischaemia. VEGF production increases substantially when cells are cultured in low oxygen, but VEGF production in these hypoxic cultures decreases when the medium contains a fivefold excess glucose concentration. Cultures with no medium glucose also show increased VEGF production. In the clinical situation, we infer from these results that retinas with early retinopathy have a reduced blood supply and are therefore relatively ischaemic, thus increasing their VEGF production. Adding glucose provides an alternative energy supply, thus reducing the demand for VEGF and hence, reducing the likelihood of 'early worsening.' However, reducing the glucose supply to these already compromised retinas further increases their ischaemia and, therefore, the stimulus to produce more VEGF. The second part of this presentation is a clinical exploration of possible reasons for the frequent, wide discrepancy between measured central macular thickness by optical coherence tomography (OCT) and visual acuity in eyes with diabetic macular oedema. I explore the influence of different diseases in which macular oedema appears, the presence or absence, and size, of cystoid cavities; duration of the oedema; age of the subject, different anatomic derangements including epiretinal membranes and disruptions of the photoreceptor layer, and various biochemical and physiological mechanisms. [ABSTRACT FROM AUTHOR]

PurposeTo investigate whether interleukine-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) are related with macular oedema in patients with branch retinal vein occlusions (BRVOs).DesignRetrospective case–control study.ParticipantsNineteen patients who had macular oedema due to BRVO and nine patients with non-ischaemic ocular diseases (control group).MethodsMacular oedema was examined by optical coherence tomography. Both venous blood and vitreous samples were obtained at the time of vitreoretinal surgery. IL-8 and MCP-1 levels in vitreous fluid and plasma were determined with enzyme-linked immunosorbent assay kits. Variables were compared with the Mann–Whitney U-test, Wilcoxon's signed-ranked test, and the χ2-test, when appropriate. To examine correlations, Spearman's rank-order correlation coefficients were calculated. Statistical significance was set at P<0.05.ResultsThe vitreous fluid levels of IL-8 (median: 63.5 pg/ml) and MCP-1 (median: 1522.4 pg/ml) were significantly higher in the patients with BRVO than in the control group (median: 5.1 and 746.5 pg/ml respectively; P<0.001 and <0.001 respectively). Vitreous IL-8 and MCP-1 were significantly correlated in patients with BRVO (P=0.009).ConclusionsBoth IL-8 and MCP-1 were elevated in the vitreous fluid of patients with BRVO and macular oedema. Both chemokines may contribute to the pathogenesis of macular oedema in patients with BRVO. [ABSTRACT FROM AUTHOR]

PurposeThe first aim (I.) was to measure the change of macular thickness in diabetic (DM group) and nondiabetic patients (NORMAL group), the values of operated eye (OP) were compared I.A.) to the fellow, non-operated eye (CONTROL) and I.B.) to preoperative baseline value of the operated eye (PRE). The second aim (II.) was to compare postoperative macular thickening of DM group to NORMAL group eyes.MethodsRetinal thickness values of the foveal and perifoveal (fovea+3.0 mm, fovea+6.0 mm) sectors and the minimum values were measured in a prospective study using optical coherence tomography (OCT) in 18 eyes of 18 diabetic patients and 53 eyes of 53 nondiabetic patients who underwent uneventful cataract surgery. Data were collected on the preoperative day and on postoperative 1, 7, 30, and 60 days. Student's t-test was used for statistical analysis.ResultsNo significant change of the thickness values could be measured one day after surgery. However, a significant increase could be detected on the postoperative 7, 30, and 60 days in the perifoveal 3.0 mm and 6.0 mm sectors either calculated alone or averaged together with the foveal values. The initial (preoperative) average value of 232.7±3.5 μm (mean±SEM, n=144) in the 6.0 mm perifoveal region increased to 246.0±8.2 μm (mean±SEM, n=120, P=0.032) one week, to 249.9±5.1 μm (n=112, P=0.017) one month, and to 249.5±6.2 μm (n=104, P=0.009) 2 months after surgery.DiscussionOur results indicate that diabetes did not influence significantly the thickening of the macular regions after uncomplicated cataract surgery. [ABSTRACT FROM AUTHOR]

The late complications of proliferative diabetic retinopathy (PDR) comprise vitreous haemorrhage, tractional retinal detachment, combined tractional–rhegmatogenous retinal detachment, and severe fibrovascular proliferation (including macular distortion or dragging, tractional macular oedema, and media opacity due to fibrovascular tissue). This article will review the indications, techniques, and outcomes of vitrectomy surgery to treat these conditions. A careful assessment of the surgical anatomy, with particular attention to the configuration of vitreoretinal attachments, is important when determining the precise surgical procedure required. The surgical outcome after diabetic vitrectomy has steadily improved with advances in vitreoretinal surgical instrumentation and technique. Significant post-operative complications may, however, occur including cataract formation, recurrent vitreous cavity haemorrhage (early or delayed), rhegmatogenous retinal detachment, and neovascular glaucoma. Most patients will regain or retain useful vision after diabetic vitrectomy, although the visual outcome does remain unpredictable. The development of adjunctive pharmacotherapy should enable further improvements in visual outcome in the future. [ABSTRACT FROM AUTHOR]

PurposeTo compare the short-term visual and morphological results of intravitreal triamcinolone acetonide vsintravitreal bevacizumab for eyes with macular oedema secondary to branch retinal vein occlusion (BRVO).DesignRetrospective interventional consecutive case series.MethodsWe reviewed the clinical records of 29 patients (29 eyes) who had macular oedema due to BRVO with minimum follow-up of 6 months. A total of 16 patients were treated with intravitreal injection of 4 mg/0.1ml triamcinolone acetonide. The other 13 patients received intravitreal bevacizumab of 1.25 mg in 0.05 ml. Baseline visual acuity, macular thickness, and intraocular pressure were recorded. Final visual acuity, final macular thickness, intraocular pressure, and adverse events were also recorded throughout the follow-up.ResultsAll patients completed at least 6 months of follow-up. There were significant improvement in visual acuity and showed significant macular oedema decrease in optical coherence tomography examination in both the two groups postoperatively. However the therapeutic effects showed no statistically significant difference between these two groups with regard to visual results (F=6.012, P=0.083) and macular thickness decline (F=0.007, P=0.570). Seven eyes developed recurrent macular oedema and received reinjections of triamcinolone acetonide or bevacizumab.ConclusionThese short-term results indicate that intravitreal injection of triamcinolone acetonide or bevacizumab can both improve visual acuity and decrease macular oedema temporarily in eyes with BRVO. However, the therapeutic effects of intravitreal triamcinolone acetonide showed no significant differences compared with intravitreal bevacizumab with regard to anatomical and functional outcomes but seemed to cause more adverse events than bevacizumab. [ABSTRACT FROM AUTHOR]

Diabetic eye disease confers substantial burden on the patient quality of life. Current therapeutic strategies indicate an unmet clinical need for preventive therapy. Tight control of blood pressure and glycaemia are mandatory components of primary prevention strategies, but are insufficient to eliminate risk in all patients. A body of evidence supports a role for lipid-modifying therapy in reducing the diabetic retinopathy endpoints. Although inconclusive for statin therapy, results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study show beneficial effects of fenofibrate in reducing the requirement for laser therapy, and particularly in preventing disease progression in patients with pre-existing diabetic retinopathy. However, there is a need for confirmation of these findings in large prospective studies with progression of retinopathy as the primary endpoint, such as the ACCORD-EYE (Action to Control Cardiovascular Risk in Diabetes-EYE) study, and in a clinical trial specifically conducted for diabetic maculopathy. In addition, elucidation of the mechanism(s) of effect of fenofibrate is indicated.Eye (2009) 23, 997–1003; doi:10.1038/eye.2008.428; published online 23 January 2009 [ABSTRACT FROM AUTHOR]

PurposeTo determine the prevalence of cystoid macular oedema (CME) by optical coherence tomography (OCT) in retinitis pigmentosa (RP) patients with no evidence of cystic macular lesions on fundus examination.MethodsWe included 63 RP patients with no evidence of cystic-appearing macular changes on fundus examination. All patients underwent a complete ocular examination including best-corrected visual acuity using an ETDRS (Early Treatment Diabetic Retinopathy Study) chart, intraocular pressure measurement, anterior segment examination, and a detailed fundus examination. On 50 of the 63 patients, Fourier-domain OCT was performed using the radial slicer protocol. An additional 13 of the 63 patients were scanned using the macular thickness protocol on a time-domain OCT unit. The diagnosis of CME was defined by the presence of hyporeflective lacunae with well-defined boundaries on at least two of the scans.ResultsThe mean age of patients included in the study was 36 years (range 9–71 years). Out of the 63 patients examined, 20 showed CME in at least one eye (32%), whereas 11 patients showed CME in both eyes (18%).ConclusionsOur findings demonstrate that a substantial number of RP patients with CME, as determined by OCT, may not show cystic changes by direct ophthalmoscopy or contact lens biomicroscopy. Knowledge of the high frequency for CME in such patients can serve to identify those who may be amenable to current or future treatment strategies of their macular oedema and can potentially impact on future therapeutic trials where visual acuity is used as an outcome measure.Eye (2009) 23, 915–919; doi:10.1038/eye.2008.110; published online 18 April 2008 [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the safety and outcome of intravitreal triamcinolone acetonide as treatment for macular oedema secondary to central retinal vein occlusion (CRVO) in Taiwanese.MethodsThe prospective clinical interventional study included 43 patients (43 eyes) with macular oedema due to CRVO. The study group consisted of 22 patients who had accepted an intravitreal injection of 4 mg of triamcinolone acetonide. The control group included 21 patients without intravitreal triamcinolone acetonide. Examination included assessment of best-corrected visual acuity, slit-lamp biomicroscopy, measurement of intraocular pressure, ophthalmoscopy, and optical coherence tomography (OCT).ResultsThe mean follow-up was 283.00±70.62 days in the study group and 354.05±173.18 days in the control group, respectively. In the study group, visual acuity measurements improved significantly (P=0.007) from 1.00±0.45 logMAR preoperatively to a best postoperative visual acuity of 0.67±0.65 logMAR. Seventeen eyes (77.3%) gained improvement in visual acuity with 12 eyes (54.5%) showing an increase in visual acuity of at least two Snellen lines. All 22 patients showed significant macular oedema resolution in OCT examination (P<0.001) from 594.36±177.78 μm preoperatively to a mean retinal thickness of 317.23±196.83 μm postoperatively postintravitreal injection. In the control group, baseline best-corrected visual acuity and best-corrected visual acuity during the follow-up did not vary significantly (P=0.457).ConclusionIntravitreal triamcinolone acetonide can lead to a significant improvement in visual acuity and a resolution of macular oedema in patients with CRVO.Eye (2009) 23, 849–857; doi:10.1038/eye.2008.136; published online 6 June 2008 [ABSTRACT FROM AUTHOR]

AimThere are changes in blood flow during the clinical stages of diabetic retinopathy with increasing leukostasis and secondary elaboration of cytokines. This study evaluated the vitreous concentrations of haemodynamic-related (endothelin-1 (ET-1) and nitric oxide (NO)), inflammatory and anti-inflammatory (interleukin-1 receptor antagonist, IL-1 Ra) cytokines in the diabetic patients (with nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR)), compared them with those of control patients (full thickness macular hole, FTMH) and correlated to macular structural indices.MethodVitreous samples from five FTMH patients representing normal controls were analysed together with the vitreous samples of 15 patients with NPDR and five with PDR. The vitreous concentrations of nitrite (total NO), ET-1, and prostacyclin was determined using ELISA kits (R&D Systems, Minneapolis, MN, USA) according to the manufacturer's instructions. A sandwich luminescent immunoassay technique was used to determine IL-1β and IL-1 Ra concentrations.ResultsIn the different clinical groups, there were no differences in the vitreous NO and prostacyclin concentrations. In NPDR, the median ET-1 concentration (0.7 pg/ml SD ±0.8 pg/ml) was significantly reduced (P<0.05), compared to PDR (6.35 pg/ml SD ±0.6 pg/ml) and FTMH (3.6 pg/ml SD ±0.14 pg/ml). Its concentration also positively correlated with foveal thickness and macular volume (P<0.05) in patients with NPDR and macular oedema. IL-1 β was detected in PDR, and diabetic patients demonstrated a lower concentration of the anti-inflammatory cytokine IL-1 Ra.ConclusionReduced concentrations of ET-1 in NPDR may reflect the haemodynamic changes of NPDR. The IL-1 Ra concentration suggests a change in the anti-inflammatory environment of the diabetic retina.Eye (2008) 22, 223–228; doi:10.1038/sj.eye.6702584; published online 22 September 2006 [ABSTRACT FROM AUTHOR]

AimTo investigate whether the aqueous levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) are correlated to the vitreous levels of these substances and to the severity of macular oedema in branch retinal vein occlusion (BRVO).MethodsAqueous and vitreous samples were obtained during cataract and vitreous surgery from 24 patients (24 eyes) with macular oedema in BRVO. The VEGF and IL-6 levels in aqueous humour, vitreous fluid, and plasma were determined by enzyme-linked immunosorbent assay. The degree of retinal ischaemia was evaluated in terms of the area of capillary nonperfusion using the Scion Image. The severity of macular oedema was evaluated using the OCT.ResultsThe aqueous level of VEGF was significantly correlated with the vitreous level of VEGF (P<0.0001). Vitreous levels of VEGF and IL-6 were significantly correlated with the nonperfusion area of BRVO (P<0.0001, P=0.0061, respectively), as were the aqueous levels of VEGF and IL-6 (P<0.0001, P=0.0267, respectively). Furthermore, the vitreous levels of VEGF and IL-6 and the aqueous level of VEGF were significantly correlated with the severity of macular oedema of BRVO (P=0.0001, P=0.0331, P=0.0272, respectively).ConclusionOur results suggest that the aqueous level of VEGF may reflect its vitreous level. Measurement of the aqueous level of VEGF may be clinically useful to indicate the severity of macular oedema with BRVO.Eye (2008) 22, 42–48; doi:10.1038/sj.eye.6702498; published online 7 July 2006 [ABSTRACT FROM AUTHOR]

PurposeCataract surgery is known to elicit postoperative macular oedema owing to its traumatic effect. The aim of the study was to measure the foveal and perifoveal thickness of the retina after uneventful phacoemulsification and posterior chamber intraocular lens (PC-IOL) implantation.MethodsRetinal thickness values of the foveal and perifoveal (fovea+3.0 mm, fovea+6.0 mm) sectors and the minimum values were measured in a prospective study using optical coherence tomography (OCT) in 71 eyes of 71 patients (34 men, 37 women, mean age: 68.8 years) who underwent cataract surgery. Phacoemulsification and ‘in the bag’ implantation of a foldable PC-IOL was performed under topical anaesthesia. Data were collected 1 day before the operation, and postoperatively at 1, 7, 30, and 60 days. Contralateral eyes of each patient served as controls. ‘Student's t-test’ was used for statistical analysis, and P<0.05 value was considered significant.ResultsNo significant change of the thickness values could be measured 1 day after surgery. However, a significant increase could be detected on the postoperative 7, 30, and 60 days in the perifoveal 3.0 and 6.0 mm sectors either calculated alone or averaged together with the foveal values. The initial (preoperative) average value of 234.1±2.6 μm (mean±SEM, n=536) in the 6.0 mm perifoveal region increased to 242.5±2.6 μm (mean±SEM, n=488, P<0.01) 1 week, to 247.7±4.6 μm (n=352, P<0.01) 1 month, and to 246.0±5.9 μm (n=208, P<0.05) 2 months after surgery, which proved to be significant. However, the relative change of macular thickness was moderate, 3.5, 5.6, and 5.3% at the above periods, respectively.In a subgroup of patients (n=34) minimum 6 months after cataract surgery, the 6.0 mm perifoveal values were found to be elevated at (237.8±3.9 μm, mean±SEM, n=272) as compared to the control eyes (233.9±3.8 μm, mean±SEM, n=272). The difference was 1.7% and proved not to be significant (P>0.05).ConclusionsMild subclinical perifoveal oedema following cataract surgery was detected using OCT at postoperative day 7 to 6 months. The minimal and the foveal values in itself are inadequate to describe the phenomenon. The macular thickness values of the perifoveal 3.0 and 6.0 mm sectors alone or averaged together with the foveal values provide more accurate description of the postoperative macular oedema.OCT enables the detection of minimal increases in perifoveal retinal thickness even 6 months after cataract surgery.Eye (2008) 22, 8–12; doi:10.1038/sj.eye.6702460; published online 2 June 2006 (2006) [ABSTRACT FROM AUTHOR]

PurposeTo report the effects of arteriovenous adventitial sheathotomy on anatomical and functional improvements in patients with macular oedema due to branch retinal vein occlusion (BRVO).MethodsPars plana vitrectomy and arteriovenous sheathotomy was performed on 11 patients with BRVO who had vision loss due to macular oedema. Ten patients with macular oedema due to BRVO and who have been treated with grid laser photocoagulation were included in the control group. The measurement of visual acuity with ETDRS chart was taken preoperatively and at 1, 3, 6, and 9 months follow-up in the study group and at 1, 3, 6, and 9 months after grid laser in the control group.ResultsThe mean preoperative logMAR visual acuity was 0.84±0.3 in the surgical group and 1.06±0.4 in the control group. The postoperative mean logMAR visual acuity was 0.41±0.2, 0.40±0.2, 0.40±0.3, and 0.36±0.3 at 1, 3, 6, and 9 months follow-up, respectively. In the control group the postlaser mean logMAR visual acuity was 0.92±0.3, 0.87±0.4, 0.85±0.3, and 0.82±0.3 at 1, 3, 6, and 9 months follow-up, respectively. The improvements of visual acuity in both groups were statistically significant when compared to pretreatment (P=0.003 and P=0.007 at 9 months in the study and control group, respectively).ConclusionArteriovenous sheathotomy for decompression of BRVO in patients who have vision loss due to macular oedema was safe and effective for anatomical and functional improvement and resulted in significantly better visual outcomes than a matched control group of laser-treated eyes.Eye (2008) 22, 120–127; doi:10.1038/sj.eye.6702633; published online 27 October 2006 [ABSTRACT FROM AUTHOR]

PurposeTo assess the long-term safety and efficacy of intravitreal triamcinolone acetonide injection in the management of macular oedema caused by central, hemi-, and branch retinal vein occlusion (CRVO, HRVO, or BRVO).MethodsThis prospective, interventional case series included 13 patients (13 eyes) with retinal vein occlusion and macular oedema. They received an intravitreal injection of 4 mg triamcinolone acetonide. Follow-up was for 1 year with repeat injections where appropriate. Outcome measures were visual acuity and macular thickness measured using ocular coherence tomography (OCT).ResultsThere were four patients with CRVO, one with HRVO, and eight with BRVO (13 eyes). Mean duration of symptoms before intravitreal triamcinolone acetonide injection was 6.8 months (SD 4.5 months). Eight eyes (62%) responded well with improved visual acuity and macular thickness 1–3 months postinjection. All eight eyes developed recurrent macular oedema and five received repeat injections. Three patients declined a second injection. No improvement in visual acuity or OCT macular thickness was seen after the second injection with visual acuity returning to baseline levels at 1-year follow-up. Three eyes (23%) showed no response to the initial injection (no improvement in macular thickness or visual acuity). Seven patients (54%) had a rise in intraocular pressure with six (46%) requiring treatment.ConclusionsIntravitreal injection of triamcinolone acetonide is effective as a short-term treatment of macular oedema owing to retinal vein occlusion, improving both visual acuity and macular thickness. However, this effectiveness is not maintained after 1 year despite repeat injections.Eye (2008) 22, 60–64; doi:10.1038/sj.eye.6702518; published online 11 August 2006 [ABSTRACT FROM AUTHOR]

PurposeIn some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails to improve visual acuity, although oedema shows clinical and angiographic improvement. Side effects can include increased intraocular pressure, cataract development, and (rarely) endophthalmitis. Our purpose was to identify prognostic factors for visual acuity improvement after IVTA.MethodsData on patients treated by IVTA for macular oedema were retrospectively reviewed. Three months postinjection, visual acuity was rated as ‘improved’ (two or more Snellen lines gained) or ‘nonimproved’ (unchanged or worsened). Comparative demographic data and pre- and post-IVTA clinical and fluorescein angiographic findings were analysed with SPSS software.ResultsOf 57 eyes (57 patients), 27 (47%) improved after IVTA. Initial visual acuity (‘good’, ‘moderate’, or ‘poor’) and aetiology of macular oedema (diabetic, venous occlusion, or pseudophakic) did not differ between the two groups. Improvement occurred in significantly more eyes with clinical or angiographic evidence of cystoid macular oedema (CME) than in those with diffuse retinal thickening (P=0.04) or diffuse leakage on fluorescein angiography (P=0.02), respectively, and in significantly more pseudophakic than phakic eyes (P=0.046).ConclusionsPseudophakia and clinical or angiographic CME, but not aetiology or initial visual acuity, were prognostic of visual acuity improvement after IVTA for macular oedema.Eye (2007) 21, 1067–1070; doi:10.1038/sj.eye.6702408; published online 12 May 2006 [ABSTRACT FROM AUTHOR]

AimsTo evaluate the efficacy and safety of low-dose (2 mg in 0.05 ml) intraocular triamcinolone injection for patients with uveitis-related cystoid macular oedema and/or intractable intraocular inflammation.Patients and methodsRetrospective clinical case series.ResultsCystoid macular oedema was eliminated in 24/30 eyes (80%). Intractable intraocular inflammation was eliminated in 4/8 eyes (50%). Snellen visual acuity was improved by two lines or more after 14/36 injections (38.9%). Intraocular pressure rose to above 21 mmHg after 8/36 injections (22%). There were no major complications.ConclusionsLow-dose (2 mg in 0.05 ml) intraocular triamcinolone acetonide injection is safe and effective for the management of refractory uveitic macular oedema. Its usefulness in controlling inflammation alone is questionable.Eye (2006) 20, 934–937. doi:10.1038/sj.eye.6702063; published online 12 August 2005 [ABSTRACT FROM AUTHOR]

PurposeA prospective study to evaluate the macular structural and functional effects of pars plana vitrectomy (PPV) for persistent diffuse clinically significant macular oedema (CSMO).MethodA total of 12 patients with persistent diffuse CSMO were recruited and underwent assessment including best-corrected visual acuity, fundus fluorescein angiography, optical coherence tomography (OCT) and fine matrix mapping (FMM) at baseline and over a period of a year poststandard three-port PPV.ResultsThe median baseline ETDRS letters score for all 12 patients was 52 (range 41–63) while at 12 months it had increased to 65 (range of 27–68), an improvement of two complete ETDRS lines (P=0.037). Similarly, there was an improvement in the perifoveal cone thresholds (P=0.02). The foveal thickening for all 12 patients ranged from a median of 183 to 751 μm (normal range 126–180 μm) and the macular volume ranged from a median of 2.13 to 6.42 mm3 (normal <1.66 mm3). After surgery, both the median foveal thickness (from 334 to 280 μm) and median macular volume (from 3.24 to 2.61 mm3) demonstrated decreases over 12 months (P=0.01). On baseline OCT, the patients fell into two anatomically distinct groups: Group 1 (n=4) had a dome-shaped thickened macula with a partial posterior hyaloid separation and a significantly higher foveal thickness and macular volume than Group 2 (n=8) which had a diffuse low-elevation profile of the thickened macula (P=0.007).ConclusionsIn this prospective study of PPV for persistent fovea-involving CSMO there was structural and functional improvement.Eye (2006) 20, 674–680. doi:10.1038/sj.eye.6701945; published online 21 October 2005 [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the clinical and visual outcome of an intravitreal injection of triamcinolone in patients with diabetic macular oedema refractory to laser treatment.Material and methodsProspective, interventional nonrandomised case series of 24 eyes of 24 patients that underwent intravitreal injection of 4 mg triamcinolone for chronic diabetic macular oedema refractory to previous laser treatment. All patients had best corrected visual acuity (bcva) on the LogMAR scale, near vision, slit-lamp biomicroscopy for the presence of clinically significant macular oedema, and intraocular pressure check at 1, 3, and 6 months.ResultsThe average duration of macular oedema before the injection was 38.2 months (range=6–120 months) with the mean number of laser treatments before the injection being 2.2 (range=1–5). The visual acuity improved in 19 of the 23 (83%) eyes at 1 month, 16 of the 21 eyes (76%) at 3 months and six of 11 eyes (55%) at 6 months follow-up. The mean bcva improved by an average of 10, nine, and six letters, respectively, compared to the baseline at 1, 3, and 6 months (P=0.0002 at 1 month and 0.001 at 3 months with the Wilcoxon signed-ranked test). The intraocular pressure rose by an average of 2.4, 2.8, and 2.7 mmHg at the same follow-up visits.ConclusionIntravitreal triamcinolone appears to be promising in the short term, for improving the vision in eyes with chronic diabetic macular oedema unresponsive to conventional laser treatment. Randomised controlled trials utilising varying doses of steroid are now required to define optimum treatment regimens.Eye (2005) 19, 747–751. doi:10.1038/sj.eye.6701636 Published online 10 September 2004 [ABSTRACT FROM AUTHOR]

Background/aims: To describe the clinical outcomes of four eyes with macular oedema due to radiation retinopathy treated with verteporfin photodynamic therapy (PDT).Methods: Interventional Case Series. Four charts of four patients who underwent PDT for macular oedema due to radiation retinopathy were reviewed. Snellen visual acuities, clinical examination and fundus photographs were performed before and after PDT. Main outcome measures were visual acuity, clinical examination before and after PDT.Results: All four eyes had a marked reduction in hard exudates. Three of four eyes had an improvement in vision following the PDT.Conclusion: PDT may have a role in the treatment of macular oedema due to radiation retinopathy. [ABSTRACT FROM AUTHOR]

AIMS:To systematically review the literature on the prevalence and incidence of diabetic retinopathy (DR) and macular oedema (MO). METHODS:A search of the bibliographic databases (Medline, Embase, CINAHL) was conducted up to October 2001. Selected relevant studies were scrutinized and included in the review. RESULTS:A total of 359 studies were included. The studies were reported in nearly 100 different journals and in over 50 countries. The majority of the studies were US-based, with large studies such as the Wisconsin Epidemiologic Study of Diabetic Retinopathy dominating the literature. The studies were quite dated and highly heterogeneous in nature in terms of patient selection with variable inclusion criteria (age range, gender, diabetes duration and type, ethnicity, comorbidity, and DR status, assessment, and classification). CONCLUSIONS:There are inconsistencies between epidemiological studies, and differences in study methods may contribute to conflicting reports of prevalence and incidence of DR and MO in diabetic populations. As new therapies for DR and its associated complications emerge, the need to capture and monitor new epidemiological data becomes increasingly important to be able to assess the impact and effectiveness of these therapies. Robust, longitudinal capture of patient data is, therefore, essential to evaluate the impact of current practice on the epidemiology of diabetic eye complications.Eye (2004) 18, 963-983. doi:10.1038/sj.eye.6701476 Published online 2 July 2004 [ABSTRACT FROM AUTHOR]

PurposeEvaluate the efficacy of intravitreal pegaptanib sodium (Macugen®) in refractory pseudophakic cystoid macular oedema (CME).Design and methodsProspective, nonrandomized, interventional case series. Four eyes of four patients with refractory pseudophakic CME to pars plana vitrectomy and intravitreal bevacizumab and triamcinolone, were treated with pegaptanib sodium, with a mean follow up of 4 months. Pre- and postinfection examinations included assessment of best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study chart (ETDRS), fluorescein angiography (FA), and optical coherence tomography (OCT).ResultsVisual acuity increased in all patients after intravitreal pegaptanib sodium. OCT showed improvement of the retinal thickness in the macular area.ConclusionIntravitreal pegaptanib sodium (Macugen®) is a promising treatment for pseudophakic cystoid macular oedema resistant to other medical treatment strategies. However, further study is needed to assess the treatment's long term efficacy and the need for retreatment.Eye (2008) 22, 1180–1182; doi:10.1038/eye.2008.2; published online 18 April 2008 [ABSTRACT FROM AUTHOR]

ObjectiveTo report the clinical outcome of a patient who received high-dose intravitreal triamcinolone acetonide as treatment for severe macular oedema secondary to adult Coat's syndrome.MethodCase report.ResultsA 74-year-old Indian man complaining of chronic gradual blurring of vision in the left eye was found to have adult Coat's syndrome with severe macular oedema. He received 25 mg of intravitreal triamcinolone acetonide following unsuccessful resolution with grid laser. Optical coherence tomography (OCT) demonstrated up to 75% decrease in macular oedema that was evident even after 9 months follow-up. However, there was no significant improvement in visual acuity.ConclusionIntravitreal triamcinolone is a reasonable option in reducing severe macular oedema in cases of adult Coat's syndrome.Eye (2006) 20, 163–165. doi:10.1038/sj.eye.6701828; published online 11 February 2005 [ABSTRACT FROM AUTHOR]