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Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods: This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients’ baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, μm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results: The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 μm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 μm at the 3, 6, 12, 24, and 36-month visits (p

Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives:To evaluate the effectiveness of the Lobe application, a machine learning (ML) tool that can be used on a personal computer without requiring coding expertise, in the recognition and classification of diabetic macular edema (DME) in spectral-domain optical coherence tomography (SD-OCT) scans.Materials and Methods:A total of 695 cross-sectional SD-OCT images from 336 patients with DME and 200 OCT images of 200 healthy controls were included. Images with DME were classified into three main types: diffuse retinal edema (DRE), cystoid macular edema (CME), and cystoid macular degeneration (CMD). To develop the ML model, we used the desktop-based code-free Lobe application, which includes a pre-trained ResNet-50 V2 convolutional neural network and is available free of charge. The performance of the trained model in recognizing and classifying DME was evaluated with 41 DRE, 28 CMD, 70 CME, and 40 normal SD-OCT images that were not used in the training.Results:The developed model showed 99.28% sensitivity and 100% specificity for class-independent detection of DME. Sensitivity and specificity by labels were 87.80% and 98.57% for DRE, 96.43% and 99.29% for CME, and 95.71% and 95.41% for CMD, respectively.Conclusion:To our knowledge, this is the first evaluation of the effectiveness of Lobe with ophthalmological images, and the results indicate that it can be used with high efficiency in the recognition and classification of DME from SD-OCT images by ophthalmologists without coding expertise.

INTRODUCTION: We aimed to investigate the monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR) in diabetic macular edema (DME) patients with hyperreflective foci (HF) on optical coherence tomography (OCT) and compare them with the results of patients without HF. METHODS: The data were obtained by retrospectively reviewing the data of patients followed up with a diagnosis of diabetes mellitus in the internal medicine clinic and with a diagnosis of DME in our clinic. DME patients who have blood monocyte and HDL-C levels before the treatment of DME in the laboratory archive were included in the study. DME and HF were detected by OCT. The patients with DME were divided into two groups according to the presence of HF observed on OCT. Thirty-five DME patients with HF were included in the study group. Thirty-five DME patients without HF were determined as the control group. RESULTS: The mean MHR was significantly higher in DME patients with HF (p=0.002). The optimal cutoff value of MHR for HF was 9.72. The area under the receiver operating characteristics curve was 0.681. DISCUSSION AND CONCLUSION: The MHR described as a potential biomarker of inflammation was significantly higher in DME patients with HF, suggesting that elevated MHR might be associated with severity of inflammation in DME patients.

Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives:To compare the functional and anatomical outcomes of ranibizumab and aflibercept monotherapies given according to a pro re nata (PRN) protocol in treatment-naive eyes with diabetic macular edema (DME) in a real-life clinical setting.Materials and Methods:The medical charts of treatment-naive patients with center-involved DME retrieved from our institutional database were reviewed in this retrospective cohort study. A total of 512 treatment-naive eyes with DME underwent either ranibizumab (Group I; 308 eyes) or aflibercept (Group II; 204 eyes) monotherapy and 462 patients were included. The primary outcome was visual gain over 12 months.Results:The mean number of intravitreal injections within the first year was 4.34±1.83 and 4.39±2.12 in Group I and II, respectively (p=0.260). The mean best corrected visual acuity (BCVA) improvement at 12 months was +5.7 and +6.5 ETDRS letters in Group I and II, respectively (p=0.321). However, among eyes with a BCVA score less than 69 ETDRS letters (54% of the study population), visual gain was more prominent in Group II (+15.2 vs. +12.1 ETDRS letters; p

Objectives:To analyze the current preferences of ophthalmologists for the treatment of macular edema and age-related macular degeneration (AMD) and to evaluate off-label use of bevacizumab in Turkey.Materials and Methods:All members of the Turkish Ophthalmological Association were contacted by e-mail to complete an anonymous, 47-question internet-based survey. The second part of the survey (questions 36-47) was evaluated.Results:When current legal regulations were considered, ophthalmologists used bevacizumab as the first-line agent in patients with diabetic macular edema (DME), AMD, and retinal vein occlusion (RVO) (58.25%, 55.89%, and 52.29%, respectively). When economic and legal constraints were disregarded, the participants’ preference for bevacizumab in the treatment of DME, AMD, and RVO decreased (11.64%, 10.58%, and 10.93%, respectively). Approximately three-quarters (75.75%) of ophthalmologists stated that dispensing multiple syringes from a single bevacizumab bottle could increase the risk of endophthalmitis. Most participants (93.68%) did not feel legally safe from harm caused by off-label bevacizumab use. However, 66.43% of ophthalmologists stated that bevacizumab is as effective as other anti-vascular endothelial growth factor (anti-VEGF) drugs.Conclusion:Bevacizumab is widely used as a first-line treatment for all indications of anti-VEGF use in the current reimbursement conditions, which preclude the right of ophthalmologists to treat according to their own preferences.

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives:To identify the prevalence of findings in optical coherence tomography (OCT) sections before intravitreal anti-VEGF treatment in patients with diabetic macular edema (DME), and to evaluate the relationship between these findings and final visual acuity and number of injections.Materials and Methods:This retrospective study included 296 eyes of 191 patients (104 male, 87 female) who started intravitreal ranibizumab treatment after being diagnosed with DME in the retina unit between January 2013 and April 2017 were included the study. Spectral domain OCT findings at the time of presentation such as presence of serous macular detachment (SD), vitreomacular traction (VMT), and epiretinal membrane (ERM) were recorded. In addition, the regularity of the ellipsoid zone (EZ) and inner retinal layers was also studied.Results:The mean central retinal thickness measured in SD-OCT was 449±81 μm before treatment and 350±96 μm after treatment (p

Objectives:To describe cystoid macular degeneration (CMD), which has no clear definition in diabetic macular edema (DME), and examine its features in optical coherence tomography (OCT) and fundus fluorescein angiography (FFA).Materials and Methods:This study was conducted using OCT images of patients who were followed in Gazi University between November 2011 and March 2015. A total of 259 eyes (187 patients) found to have cystic changes on OCT were included. Macular ischemia, peripheral ischemia, and type of edema were identified on FFA. Vitreomacular interface abnormalities, foveal contour integrity, internal reflectivity of the cysts, and outer retinal layer defects were analyzed from OCT images. The horizontal and vertical diameters of the largest cyst within 1000 μm of the foveal center were measured for the definition of CMD. Cut-offs for these values were determined by receiver operating characteristic curve analysis. Cystoid macular edema (CME) and CMD groups were created and their characteristics were analyzed.Results:The horizontal and vertical diameters of the largest cyst were moderately positively correlated with visual acuity (rs=0.349, r=0.419, respectively). Eyes with horizontal diameter of the largest cyst ≥450 μm were classified as CMD; in this group, sensitivity in the prediction of visual acuity ≤20/60 was 58%. Eyes with horizontal diameter of the largest cyst 20/60 was 73%. For the threshold of 300 μm determined for vertical diameter of the largest cyst, sensitivity was 62% and specificity was 69%. The CME and CMD groups were formed according to these cut-off values. Compared to the CME group, the CMD group had greater central subfield thickness and higher prevalence of outer retinal damage, severe disruption of foveal contour, macular ischemia, and diffuse/mixed type edema.Conclusion:In eyes with DME, CMD can be defined as the largest cyst within 1000 μm of the foveal center having a horizontal diameter of ≥450 μm and vertical diameter ≥300 μm, especially if associated with macular ischemia, outer retinal damage, loss of foveal contour, and diffuse/mixed type edema.

Objectives:To report the effectiveness and long-term outcomes of intravitreal dexamethasone implantation for diabetic macular edema (DME) in vitrectomized eyesMaterials and Methods:Medical records of patients were retrospectively reviewed. Time of pars plana vitrectomy (PPV), PPV indications, interval between DEX injection and PPV, other intravitreal treatment prior to DEX application, best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness (CRT) measured by optical coherence tomography were recorded.Results:Seventeen eyes of 17 patients were included in the study. The mean follow-up after DEX injection was 21±2.4 months (12-43 months). The female/male ratio was 11/6. Mean age was 60.7 years (46-70 years). Sixteen eyes (94.1%) were pseudophakic at the time of DEX treatment. The most common indication for PPV was tractional retinal detachment (8 eyes, 47.1%). Ten eyes (58.8%) received a single injection and a total of 30 DEX implantations were performed. Mean BCVA was 0.77 logarithm of the minimum angle of resolution (logMAR) units before the first injection and improved to 0.64, 0.68 and 0.66 logMAR after 1, 3 and 6 months, respectively (p0.05). Two eyes (%8) received topical anti-glaucoma medication (IOP≥25 mmHg). Similar results were observed in eyes receiving repeated DEX injections.Conclusion:Intravitreal DEX injection treatment seems to be effective for improving BCVA and decreasing CRT in vitrectomized eyes with DME. This effect seemed to last for 6 months in most eyes, but maximized at 3 months. Patients with repeated injections often require injection before 6 months.

Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives:To evaluate the relationship between cyst characteristics and macular and peripheral ischemia in diabetic macular edema (DME).Materials and Methods:We retrospectively reviewed eyes with DME and included those with clinically significant macular edema as defined by ETDRS (Early Treatment Diabetic Retinopathy Study) and cystoid spaces in optical coherence tomography scans in this study. Central subfield thickness (CSFT), horizontal and vertical diameters of the largest cyst, cyst area, and the remaining retinal thickness outside the cyst were determined. The presence and number of hyperreflective foci in the cyst wall and the internal reflectivity of the cyst were analyzed. Outer retinal damage was graded. Fluorescein angiography was used to determine the areas of macular and peripheral ischemia, which were graded as mild or severe. Correlations between macular and peripheral ischemia and cyst-related measurements and structural changes in the retina were evaluated.Results:This retrospective study included 250 eyes of 186 patients with DME. Mean CSFT was significantly greater in eyes with macular ischemia (510.4±144.7 μm) compared to eyes without macular ischemia (452.1±114.6 μm) (p=0.001). Horizontal and vertical diameter of the largest cyst increased with the presence and severity of macular ischemia (p=0.045 and p=0.016, respectively). Remaining retinal thickness increased with the presence and severity of peripheral ischemia (p=0.009). There was a statistically significant relationship between the number of the hyperreflective foci in the cyst wall and internal reflectivity of the cyst (p=0.007). Patients with greater CSFT had a 1.04-times higher odds of having macular ischemia and 0.25-times higher odds of having outer retinal damage.Conclusion:The likelihood of macular ischemia increases with larger cyst diameter, CSFT, and extent of outer retinal damage. Thickness of the noncystic area is increased in the presence of peripheral ischemia.

Objectives:To investigate the efficacy of single dose intravitreal dexamethasone implant in patients with diabetic macular edema (DME) resistant to anti-VEGF therapy.Materials and Methods:Twenty eyes of 14 patients (8 male, 6 female; mean age, 65±5.7 years) with DME resistant to intravitreal ranibizumab injections were studied. A single intravitreal dexamethasone implant was injected into each eye and patients were followed up for 6 months. Response to therapy was assessed monthly by measuring intraocular pressure (IOP), best-corrected visual acuity (BCVA), and central foveal thickness (CFT).Results:Baseline (before injection) IOP was 14.9±2.7 mmHg and did not change significantly in the six months following injection. Baseline BCVA was 1.04±0.35 LogMAR and improved to 0.86±0.31 at month 1 without statistical significance (p=0.056). CFT was significantly lower in all monthly measurements compared to its baseline value of 682.2±229.2 μm. During the follow-up period, endophthalmitis, significant cataract, or rhegmatogenous retinal detachment were not detected.Conclusion:Intravitreal dexamethasone implant injection is associated with significant CFT reduction for up to six months without causing any complications. Although BCVA did not improve in parallel with the CFT reduction, intravitreal dexamethasone implant should be considered as an effective and safe treatment option in the management of DME patients resistant to anti-VEGF injections.

Objectives: The aim of this study was to evaluate the efficacy of micropulse yellow laser (MPL) on best corrected visual acuity (BCVA) and retinal thickness in patients with non-center-involving diabetic macular edema (DME). Materials and Methods: We retrospectively reviewed 9 eyes of 8 patients with non-center-involving DME who underwent MPL treatment between January 2015 and December 2016. BCVA (logMAR) and retinal thickness were evaluated before and 3 months after treatment. Maximum retinal thickness was determined manually from simultaneous spectral-domain optical coherence tomography images and recorded. The change in the measurements from before to after treatment was analyzed statistically. Results: Of the 8 patients, 3 were female and 5 were male. The mean age was 52.8 years. Two of the 9 eyes had received previous intravitreal anti-vascular endothelial growth factor injection(s). Median BCVA was improved 3 months after treatment, although the difference was not statistically significant (0.34 logMAR before and 0.29 logMAR after treatment). BCVA was improved in 4 eyes while it showed no change in the remaining 5 eyes. The mean retinal thickness was 470.6 μm at baseline and 416 μm at 3 months after MPL treatment (p=0.01). Retinal thickness decreased in all eyes after treatment. Conclusion: In this study, parafoveal retinal thickness showed significant decrease after MPL treatment in patients with DME. The limited increase in BCVA may be due to the inclusion of a low number of patients and only those with non-center-involving macular edema. MPL may be used as an alternative to conventional argon laser in non-center-involving DME.

Diabetic macular edema is the most common cause of visual impairment in patients with diabetes mellitus. The pathogenesis of macular edema is complex and multifactorial. For many years, laser photocoagulation has been considered the standard therapy for the treatment of diabetic macular edema; however, few patients achieve significant improvements in visual acuity. Today the intravitreal administration of anti-inflammatory or anti-angiogenic agents together with the use of laser photocoagulation represents the standard of care for the treatment of this complication. The intravitreal route of administration minimizes the systemic side effects of corticosteroids. Steroid-related ocular side effects are elevated intraocular pressure and cataract, while injection-related complications include endophthalmitis, vitreous hemorrhage, and retinal detachment. In order to reduce the risks and complications, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated injections for the management of diabetic macular edema. In this review, the efficacy, safety, and therapeutic potential of intravitreal corticosteroids in diabetic macular edema are discussed with a review of recent literature.

A 54-years-old diabetic patient was referred to our clinic for fundus examination. The best corrected visual acuity(BCVA) with Snellen's chart was 0,3; 0,5 in the right and left eye. In the fundus examination, moderate non-proliferative diabetic retinopathy(DR) signs and diabetic macular oedema(DME) were detected in both eyes. FFA was planned. The increase in macular thickness(CMT) of both eyes, DME, serous macular detachment were shown by OCT. Intravitreal anti-VEGF injections were recommended at least 3 times 1 month apart for both eyes. However, because of the patient's diabetic foot, we were not able to treat the patient and he received a month of hyperbaric oxygen therapy(HBOT). The patient again applied, indicating that there was a rapid vision decrease in his both eyes just at the 10th day after the end of HBOT. The BCVA was 0,1; 0,05 in the right and left eye with Snellen's chart. Increase in DME, serous macular detachment in both eyes, and optic disc neovascularization (NVD) in the left eye, was detected. This progression may be due to the patient's poorly controlled diabetes regulation and the lack of intravitreal treatment. However, visual acuity decrease not observed during HBOT but observed just at the 10th day after the end of treatment, and the development of NVD needed questioning the situation. We think that the sudden drop in oxygen saturation after the end of HBOT may have contributed to this situation. We believe that this condition should be addressed in all patients with elevated VEGF levels, such as DR. [ABSTRACT FROM AUTHOR]

Diabetic macular edema is an important cause of visual loss. Previously the vision could be stabilized with focal/grid laser photocoagulation therapies for central involving macular edema. Recently it became possible to attain visual gains with the help of intravitreal corticosteroids and anti-VEGF agents. [ABSTRACT FROM AUTHOR]

Intravitreal dexamethasone implantation (IVDI) is indicated for the indication of retinal venous occlusion, diabetic maculopathy and macular edema due to posterior uveitis. A 65-year-old male patient who developed bilateral diabetic macular edema and had limited response to intravitreal anti-vascular endothelial growth factor injection bilaterally was planned to undergo bilateral IVDI. IVDI was performed without any complication in the right eye but IVDI could not be performed in the left eye due to failure of full-scleral access with the implant applicator during the left eye IVDI application. When the applicator was checked after unsuccessful application, it was determined that the implant partially spilled slightly from the conical part of the applicator needle. Controlling applicator needle and implant position prior to IVDI application is important for application success. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of intravitreal aflibercept (IVA) in the patients with refractory diabetic macular edema (DME) to previous intravitreal ranibizumab (IVR) treatment. Materials and Methods: A total of 21 eyes of 21 patients who were switched to IVA theraphy due to recalcitrant DME to prior IVR treatment were studied retrospectively. The visual and anatomical parameters at baseline, post IVR treatment and 6 months following initial IVA injection were compared. The effect of DME type on the outcomes and the predictive factors were also evaluated by performing a multiple lineer regression model. Results: The mean number of IVR injections was 6.1±1.4 (5-9) before switching. The mean number of IVA injections after switching was 3.3±0.5 (3-5). The mean central macular thickness (CMT) was 426.3±91.7 μm at baseline and 417.6±80.8 μm after IVR injections. After switching to IVA the mean CMT was decreased to 285.7±46.8 μm (p<0.001). The best corrected visual acuity (BCVA) was 0.5±0.3 Logmar at baseline and 0.3±0.2 Logmar after IVR injections. After switching to IVA the mean BCVA was improved to 0.16±0.15 Logmar (p<0.001). The patients with diffuse retinal thickening responded better to IVA injections than the patients with other DME subtypes regarding to CMT (p=0.044). However, BCVA improvement was limited in those patients. The number of IVA injections was a good predictor for final CMT and the DME subtype was a good predictor for BCVA. Conclusion: In patients with refractory DME to prior IVR injections, switching to IVA resulted in anatomical and visual improvement. [ABSTRACT FROM AUTHOR]

Aim: Comparison of anatomical and visual results of unilateral and bilateral intravitreal ranibizumab treatment in patients with diabetic macular edema. Material and Method: The files of patients with diabetic macular edema (DME) who underwent intravitreal ranibizumab (IVR) for a total of 3 times between April 2012 and May 2017 were reviewed retrospectively at Ataturk University Ophtalmology Department. Age, gender, duration of diabetes, duration between complaints and first ranibizumab treatment, other treatments, follow-up period, intraocular pressure, best corrected visual acuity (BCVA) were recorded. The paired-t test was used for statistical analysis, p<0.05 was considered significant. Results: 120 eyes of 80 patients with DME, whose 43 were males, 37 were females and 59-82 years old were included. 40 patients were treated unilaterally because of DME and 40 patients were treated bilaterally due to DME. Mean BCVA was 0.19±0.23 (Snellen) in unilateral cases, 0.21±1.35 in the right eye, 0.29±0.76 in the left eye in bilateral case p>0.05) at the time of admission, in the 6th month, the mean values were 0.42±0.32, 0.53±2.59, 0.49±1.92 (p>0.05), respectively. Mean central foveolar thickness (CFT) was 458.1±177.6 μm in unilateral cases, 412.5±233.8 μm in right eye and 463.2±721.9 μm in left eye (p>0.05) in bilateral cases. After treatment, at the 6th month, respectively; mean CFT was 301.3±129.6 μm, 297.3±316 µm, 280.1±317.3 μm (p>0.05). Conclusion: We didn't determine any significant change in CFT and BCVA in the other eyes of the patients applied unilateral IVR. When comparing unilateral IVR with bilateral IVR, we conclude that there isn't statistically significant difference in terms of changes in BCVA and CFT and there isn't synergistic effect of bilateral IVR administration. [ABSTRACT FROM AUTHOR]

DR is a leading cause of acquired blindness among young adults and the working-age population in developed countries. DR is the most frequent microvascular complication of diabet, the prevalence of which increases with the duration of diabetes, with an overall rate of up to 30%. Although severe vision loss may occur due to proliferative DR at diabetic patients, the most common cause of visual loss in these patients is diabetic macular edema(DME). FFA is an invasive, costly, and time-consuming technique but is a sensitive method to detect vascular changes in the course of an established DR. In contrast to retinography or fluorescein angiograms, OCT has become the gold standard for the diagnosis, treatment approach, prognosis, assessment of treatment response of patients with DME. OCT angiography(OCTA) is a new noninvasive imaging technique that employs motion contrast imaging to high-resolution volumetric blood flow information generating images similar to angiographic images in a matter of seconds . With the widespread use of anti-VEGF, the role of laser photocoagulation in the treatment of DME has decreased, but recent progresses in laser therapy are noteworthy. As a result, anti-VEGF therapy has replaced macular laser therapy and is now the first-line treatment for DME. Intraocular steroids should be considered in pseudophakic, certain groups of patients with systemic vascular comorbidities that are unable to use anti-VEGF or unrespond to anti-VEGF agents [ABSTRACT FROM AUTHOR]

Objectives: To investigate the epidemiology and frequency of serous macular detachment (SMD) in patients diagnosed with diabetic macular edema (DME). Materials and Methods: Hundred and forty-three eyes of 104 patients with DME were examined retrospectively. According to the results of OCT, the patients were separated into two groups; patients diagnosed with SMD and DME (group 1) and patients diagnosed with DME (group 2). They were assessed based on demographic characteristics, average age, duration of diabetes mellitus (DM), hypertension (HT) history, best-corrected visual acuity, and diabetic retinopathy stages. Results: The average age of the patients was 61±8.7 years. Forty-three patients (41.3%) were female and 61 patients (58.7%) were male. Fifty-four of 104 patients (51.9%) had DME with SMD. 21 (38.8%) patients had bilateral SMD. In group 1, 31 patients were male (57.4%) and 23 patients were female (42.6%). In group 2, 30 (60%) patients were male and 20 (40%) patients were female. In group 1, average age was 60.2±9.6 and the average duration of DM was 12.2±7.0 years, whereas the average age was 61.9±7.6 and the average duration of DM was 14.06±6.8 years in group 2. Forty-two patients in group 1 (77.8%) and 30 patients (60%) in group 2 had history of HT. Before the treatment, the average best-corrected visual acuity was found to be 0.30±0.24 in group 1 and 0.32±0.25 in group 2. Conclusion: Today, it is thought that diabetic maculopathy is the leading cause of SMD and it is a determining factor of treatment applications. In our study, we aimed at investigating the frequency of SMD in DME and the risk factors for the development of SMD. Although there were some differences between the factors, only the history of HT was found statistically higher in patients with SMD (p=0.04). (Turk J Ophthalmol 2015; 45: 92-96)

Objectives: To compare the intravitreal injections of 4 mg/0.1mL and 20 mg/0.1 mL triamcinolone acetonide with respect to efficacy and side effects in the treatment of diabetic macular edema (DME). Materials and Methods: A total of 56 pseudophakic eyes of 56 patients with the diagnosis of DME were evaluated retrospectively. Twenty-eight eyes were randomly injected with 4 mg of intravitreal triamcinolone (IVTA) (group 1), while 28 eyes were applied 20 mg IVTA (group 2). The patients were evaluated before the injection and were followed up monthly for 6 months and in the 8th month afterwards. Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and complication rates were determined and compared between the two groups. Results: When compared in terms of BCVA, there was a statistically significant increase in both groups (p

Purpose: To evaluate the real life functional and anatomical outcomes, visit and injection numbers of ranibizumab treatment in diabetic macular edema patients. Materials and Methods: The patients who were admitted to the clinic for the first time, treatment naive, completed the follow-up time of 12 months, and received only ranibizumab treatment were included, retrospectively. The patients first received 3 monthly loading doses of ranibizumab which was tried to be followed by a monthly pro re nata treatment regimen. Primary outcome measures were the visual acuity and central retinal thickness (CRT) at baseline, month 3, 6, 9, and 12, and the visit and injection numbers at month 12. Results: A total of 150 eyes of 107 patients were included. The mean baseline visual acuity was 0.59±0.29 LogMAR. The mean visual acuity at month 3, 6, 9, and 12 was 0.54±0.40, 0.47±0.36, 0.48±0.38, and 0.49±0.34 LogMAR, respectively. The mean baseline central macular thickness (CMT) was 477±105 micrometers. The mean CMT at month 3, 6, 9, and 12 was 387±111, 362±90, 370±117, and 368±115 micrometers, respectively. The mean planned visit number was 4.8±1.0, and the mean completed visit number was 4.5±1.0 visits. The mean planned injection number was 4.2±1.6, and the mean completed injection number was 4.0±1.4 injections. Conclusion: Although it is not possible to achieve adequate number of visits and injections, limited visual and anatomical improvements may be obtained. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of the initial status of hard exudates on visual and anatomical outcomes in diabetic macular edema (DME) following intravitreal antivascular endothelial growth factor (anti-VEGF) treatment. Material and Method: In this retrospective study, 80 eyes of 80 patients who treated with anti-VEGF due to DME were examined. All of the patients underwent at least three anti-VEGF treatment. The baseline, follow-up and last visit optical coherence tomography parameters and best-corrected visual acuity (BCVA) were all noted. Results: The mean baseline central macular thickness (CMT) was 415±95 µm and mean baseline BCVA was 0.67±0.52 LogMAR. Average number of injections was 4.1±1.6. %35 of patients had exudates before the treatment. The improvement in BCVA was correlated with initial BCVA, initial CMT and absence of exudates and this correlations were statically significant (p=0.000, p=0.030 and p=0.047 respectively). The improvement in CMT was statically significant correlated with initial CMT and initial BCVA, however presence of hard exudates did not effect CMT improvement (p=0.000, p=0.016 and p=0.214 respectively). Conclusion: Although the presence of exudates was found to be a negative predictor for visual outcomes, it did not have any effects on anatomical outcomes in patients with DME under anti-VEGF treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the short-term outcomes with intravitreal aflibercept (IVA) therapy in cases with incomplete response to intravitreal ranibizumab (IVR) therapy in diabetic macular edema (DME). Material and Methods: Cases with the diagnosis DME and with central macular thickness (CMT)≥300 μm, despite treatment with at least 4 IVR injections of which 3 were consecutive, were included in the study. Medical records of the cases were evaluated retrospectively. Demographical datas, interventions before IVA therapy, best corrected visual acuity (BCVA) and CMT measured with optical coherence tomography before and after the IVA therapy of the patients were recorded. Results: Seventen eyes of 11 cases (7 female and 4 male), were included in the study. The mean age was 61.8±12 years. The cases had received a mean number of 7.2±4 IVR injections during a mean 11.6±5.7 months follow-up before aflibercept therapy. The mean BCVA of the cases before and after the 3 consecutive IVA injections were 0.63±0.32 and 0.54 ±0.33 LogMAR, respectively (p=0.005). The mean CMT of the cases before and after the 3 consecutive IVA injections were 471±74 and 338±88 μm, respectively (p=0.001). Conclusion: In most of the cases which were converted to aflibercept, successful results were reached both anatomically and visually in short term. Conversion to aflibercept may be an effective alternative therapy in DME cases with incomplete response to ranibizumab. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effect of a single intravitreal triamcinolone acetonide (IVTA) injection in eyes with diabetic macular edema (DME) of different patterns determined by optical coherence tomography (OCT). Materials and Methods: In the present study, we retrospectively reviewed the records of patients who had a single IVTA injection for the treatment of DME. Eyes with a clinically significant macular edema and a central foveal thickness (CFT) of 250 microns or more were included. Diabetic retinopathy stage and previous history of laser treatment were not taken into account for patient selection. Bestcorrected visual acuity (BCVA), CFT, and total macular volume values before and after the injection were analyzed. The eyes were divided into 3 groups according to the morphology on OCT: DRT (sponge-like diffuse retinal thickening), CME (cystoid macular edema), and SRD (serous retinal detachment) groups. Results: 104 eyes (50 with DRT, 30 with CME, and 24 with SRD) were included in the study. Post-injection measurements were obtained 9.65±2.27 weeks after the injection. There was no statistically significant difference between the three groups regarding the change in BCVA (p=0.212). The variations in the amount and percentage of change in CFT among the groups was statistically significant (p=0.001 and p=0.001, respectively). Although the difference between CME and SRD groups was not statistically significant, both groups had significantly greater reductions in CFT compared to the DRT group. Conclusion: DME improved better in CME and SRD groups in response to a single dose of IVTA. However, the visual outcomes did not differ significantly between the groups. (Turk J Ophthalmol 2014; 44: 53-7)

Aim: To assess the efficacy of 577nm subthreshold yellow wavelength micropulse laser (MPL) in our patients with diabetic macular edema (DME). Material and Methods: Retrospective case series. A single session of subthreshold 577nm yellow wavelength MPL treatment was performed in 23 eyes of 18 patients with center involved DME. In all but one patient, previous intravitreal anti vascular endothelial growth factor (IV anti-VEGF) and/or IV steroid treatment and/or conventional laser treatment had been performed. In patients with > 300μ central macular thickness (CMT) at the first control visit, IV anti-VEGF treatment was performed if deemed necessary. Treatment efficacy was evaluated by comparing CMT and best corrected visual acuity (BCVA) before treatment and at first and second control visits and assessing the ratio of patients with CMT ≤ 300μ or whose CMT decreased at least 10% at first control visit compared to pre-treatment. Results: CMT was not found different when compared between pre and post-treatment at first control visit. A significant decrease in CMT was assessed at second visit. CMT decreased at least 10% or was 300μ or less at first visit post-treatment. BCVA was not found different at first and second visits compared to pre-treatment. Conclusion: Yellow subthreshold MPL treatment might be effective in DME solely or additional to anti-VEGF agents. Its role in treatment should be better assessed by prospective controlled studies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate long-term results and prognostic factors influencing long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) undergoing intravitreal ranibizumab injection (IVRI). Methods: One-hundred-thirty eyes of 96 patients were evaluated retrospectively. Fundus fluorescein angiography(FFA) was performed during the baseline and as needed at the visits. Three consecutive monthly injection and then additional injections as needed were performed. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data at baseline, month 3, 6 and 12 were analyzed. Results: The mean age of the patients (50M-46F) was 62.06±7.63-years. Mean number of injection was 6.5±2.1. Baseline FFA showed diffuse edema in 56 eyes(43.1%), focal edema in 74 eyes(56,9%); and OCT showed cystic DME in 42 eyes(32,3%), swelling( sponge-like) and cystic DME in 43 eyes (33.1%), swelling-serous DME in 11 eyes(8.5%), cystic-serous in 27 eyes(20.8%), and serous in 7 eyes(5.4%). Peripheral retinal ischemia was present in 59 eyes(45.3%). Central macular thickness (CMT) at baseline, month 3, 6 and 12 was 433.7±149.6μm, 362.1±117.6μm, 342.4±101.6μm and 323.4±96.7μm, respectively (p<0,001). The mean LogMAR BCVA at baseline, month 3, 6 and 12 was 0.65±0.31, 0.47±0.28, 0.47±0.29 and 0.46±0.28, respectively (p<0,001). A statistically significant correlation was found between final BCVA and type of leakage, edema pattern, presence of peripheral retinal ischemia, baseline and final CMT and baseline BCVA Conclusion: The amount and type of leakage, BCVA and the presence of peripheral retinal ischemia at baseline as well as metabolic control seem to be significant prognostic factors influencing final visual outcome after long-term IVRI in patients with DME. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of short term intraocular pressure (IOP) change after low-dose intravitreal triamcinolone acetonid (IVTA) injection and sustained-release dexamethasone (DEX) implantation in cases with persistent diabetic macular edema (DME). Materials and Methods: In this study, 59 eyes of 59 patients, who received intravitreal corticosteroids due to persistent DME were analyzed retrospectively. Group 1 was consisted of 27 eyes with IVTA injection (2 mg/0.05 ml) and group 2 had 32 eyes with DEX implantation (0.7 mg). IOP, best corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated before injection and at the 1st and 3rd months after injection. Results: The mean baseline, 1st and 3rd month IOP measurements were 14.6 ± 3.1, 16.1 ± 3.2 and 17.8 ± 4.8 mmHg in group 1, 15.1 ± 2.2, 17.6 ± 4.8 and 18.3 ± 4.2 mm Hg in group 2, respectively. Baseline, 1st and 3rd month IOP measurements were not significantly different between groups (p>0.05). At the end of 3rd month follow-up, steroid induced ocular hypertension (OHT) was observed in 7 cases (%25) in group 1 and 9 cases (%30) in group 2. In each group, the improvement of BCVA and CMT from baseline were statistically significant at the 1st and 3rd months follow-up (p=0.001 for each). Conclusions: Intravitreal corticosteroid injection was an effective treatment method in the treatment of persistent DME. After low-dose IVTA injection and DEX implantation, the change in IOP levels were similar in the short term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy of single-dose intravitreal dexamethasone implantation in the treatment of persistent diabetic macular edema (DME) unresponsive to five consecutive ranibizumab injections over a period of 6 months. Material and Methods: Ten patients with a previous history of treatment for DME including at least five montly consecutive intravitreal ranibizumab injections were enrolled in this retrospective study. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) levels were evaluated from baseline to 6th month. Results: Ten eyes of ten patients were included (4 men and 6 women, mean age 55.4 ± 3.7 years) into the study. After the end of the 6th month since the application of intravitreal dexamethasone, CMT and BCVA showed a significant improvement compared to baseline levels. At the baseline, the mean CMT was 423±67.3 µm which improved to 250 ±28.3, 252 ± 31.1 and 261 ±22.2 µm at the 1st, 3rd and 6th month, respectively (p<0.001). The preinjection mean BCVA was 0.13± 0.08 which improved to 0.36 ± 0.14 (p<0.001), 0.34 ± 0.15 (p<0.001), and 0.13±0.08 (p=0.001) at the 1st, 3rd and 6th month, respectively. At the end of the 1st month in 5 patients IOP levels were measured over 21 mmHg but only two patients required an antiglaucomatous treatment and IOP levels were controlled at the end of 6th month. Cataract formation was observed in one patient at the end of 6th month. Conclusion: Intravitreal dexamethasone implantation caused a significant improvement of BCVA and reduction of CMT in the patients with persistent DME that were unresponsive to five consecutive ranibizumab injections. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of initial central foveal thickness (CFT) on the anatomical and visual prognosis on intravitreal ranibizumab treatment for diabetic macular edema (DME). Materials and Methods: Patients received intravitreal ranibizumab treatment for DME and having follow-up at least 6 months were evaluated. The demographic features, the CFT and best corrected visual acuity (BCVA) initially, at 3 month, at 6 month and at last follow up was recorded. The cases having CFT less than 400 µm (group 1) and having CFT 400 µm and more (group 2) were compared according to anatomical and functional outcomes. Results: The mean follow up period of 35 eyes in group 1 and 47 eyes in group 2 was 16.49±7.58 months. The CFT initially, at 3 month, at 6 month and at last follow up in group 1 was 345.06±44.38 μmm, 299.14±78.8 μmm, 315.83±98.6 μmm, 277.47±85 μmm and in group 2, 510.23±85.16 μmm, 368.64±138.4 μmm, 380.30±145.1 μmm and 322.23±134.15 μm respectively. There was no statistical significant difference between groups at last follow up. The BCVA initially, at 3 month, at 6 month and at last follow up in group 1 was 0.63±0.47 logMar, 0.5±0.5 logMar, 0.38±0.43 logMar, 0.36±0.48 logMar and in group 2, 0.72±0.4 logMar, 0.58±0.5 logMar, 0.58±0.5 logMar and 0.55±0.42 logMar respectively. The difference between groups at last follow up was statistical significant. Conclusion: The beginning CFT may be a factor affecting adversely the visual prognosis. In cases with high macular thickness, successful anatomic results can be obtained. [ABSTRACT FROM AUTHOR]

Sonuç: DMÖ'de ranibizumab tedavisine alınan yanıt bakımından görme keskinliği ve maküla kalınlığı açısından kist büyüklüğünün tek başına prognostik bir faktör olmadığı saptanmıştır. Purpose: To evaluate the effect of intraretinal foveal cyst size prior to the treatment on the response of treatment and visual prognosis in patients treated with intravitreal ranibizumab for diabetic macular edema (DME). Materials and Methods: One hundred seventy-five eyes of 115 patients diagnosed as DME in our retina clinic between April 2009-June 2014 were included. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients were recorded before and after the treatment of intravitreal ranibizumab. The patients were classified into 3 groups according to the foveal cyst sizes on the baseline spectral-domain optical coherence tomography (SD-OCT) findings (Group 1; ≤300 mm, Group 2; 300-600 mm, Group 3; ≥600 mm). Results: The mean age of the patients was 60.24±8.49 (36-81) years and the mean of follow-up time was 22.64±12.03 (4-50) months. The number of enjections administered to the groups was similar (p>0.05). A significant improvement in visual acuity was provided in all 3 groups treated with ranibizumab. There wasn't any significant difference in BCVA between the groups in both baseline and final examinations. A significant reduction in CMT with ranibizumab treatment was found in all 3 groups. There was significant difference between the groups before the treatment, but there wasn't after ranibizumab treatment. There was no correlation between BCVA and the cyst size (r=0.138, p=0.196) and CMT (r=0.102, p=0.115). Conclusion: It was found that the cyst size is not the only prognostic factor in the response to ranibizumab treatment with respect to visual acuity and macular thickness in DME. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA) and bevacizumab (IVB) injection diffuse diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor. Materials and Methods: Twelve eyes of 12 diabetic patients (M/F:5/7, mean age 64.58±4.85 years) who were diagnosed as refractory DME to anti-VEGF injections were included in this study. Patients underwent combined injection of IVTA (preserver removed, 2 mg, 0.05 ml) and IVB (1.25 mg, 0.05 ml). The best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central macular thickness (CMT) were measured at baseline, one, three, and six months (respectively) after combined IVB-IVTA injection. Results: The mean CMTs were 441.75±61.39 µ (mean±standart deviation), 392.83±68.24 µ, 325.67±66.67 µ, and 387.58±57.02 µrespectively. The mean BCVAs were 1.08±0.80 Log MAR, 0.82±0.71 Log Mar, 0.84±0.72 Log MAR, and 1.01±0.87 Log Mar respectively. The values of both BCVA and CMT at one, two, and three months were significantly improved from baseline (p<0.05). After 6 months following combined injection 10 (%83.3) patients needed IV injection. Following the injection there was not any intra ocular reaction or inflammation. There were 4 (%33.3) patients with high IOP and their IOP's became normal with topical anti glaucomatous treatment. Conclusions: Combined IVTA-IVB injection is safe and effective procedure diffuse DME refractory to anti-VEGF therapy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the frequency of serous retinal detachment (SRD) in diabetic macular edema (DME) and relationship with serum glycosylated hemoglobin (HbA1c) levels. Material and Methods: 124 eyes of 124 patients with DME were investigated retrospectively. Cases with only DME was defined as group 1 and cases with DME and SRD was defined as group 2 due to optic coherence tomography (OCT) findings. Age, duration of diabetes, hypertension, HbA1c levels, best corrected visual acuity (BCVA) and central macular thickness (CMT) were compared between the groups. Results: The mean age of 66 male (%53) and 58 female (%47) patients was 63.4±7.5 years. SRD was present in 57 of 124 patients (45.9%). Age, duration of diabetes and presence of hypertension were statistically similar between the groups. Mean HbA1c level was 8.6±0.9 (6.1-11.3) mg/dl in group 1 and 9.8±1.32 (6.9-14.2) mg/dl in group 2 and the difference was statistically significant (p<0.001). Mean BCVA was 0.54±0.18 LogMAR (1-0.30) in group 1 and 0.64±0.23 LogMAR (1.30-0.40) in group 2 and the difference was statistically significant (p<0.001). Mean CMT was 398±72.4 µm in group 1 and 434.6±66.8 µm in group 2 and the difference was statistically significant (p<0.001). Conclusion: In our study, SRD was found to be common in patients with DME and higher HbA1c levels seemed to be related with presence of SRD. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy and safety of vitrectomy with triamcinolone acetonide (IVTA) injection followed by laser photocoagulation (LP) for diabetic macular edema (DME) refractory to anti-'vascular endothelial growth factor' (VEGF). Materials and Methods: Eleven eyes of 11 patients with DME refractory to anti-VEGF treatment. Patients underwent combined vitrectomy, internal limiting membrane (ILM) peeling with IVTA (4 mg) and 1 month later followed by argon LP. Corrected visual acuity (CVA), intraocular pressure (IOP) and central macular thickness (CMT) were measured and compared at baseline and one, three, and six months (respectively) after vitrectomy. Results: Eleven eyes of 11 patients [5(46.15%) male, 6(53.85%) female] with a mean age of 62.0±4.85 years (59-72 years) were included in this study. The mean IOP were 17.73±1.10 mmHg; 19.09±1.87 mmHg (p=0.015) and 19.73±1.68 mm Hg (p=0.006) respectively. The mean CMTs were 506.64±73.81 microns, 437.64±63.64 microns, 389.92±63.75 microns and 358.09±54.35 microns respectively (p=0.003). The mean CVAs (Log MAR) were 2.21±0.52 LogMAR, 1.77±0.63 LogMAR, 1.34±0.68 LogMAR, and 1.34±0.81, respectively. The values of both BCVA and CMT at one, three, and six months were significantly improved from baseline (p=0.003). Conclusions: In our study, combined vitrectomy with IVTA and followed by LP is found to be safe and effective for DME refractory to anti-VEGF therapy. Further studies are needed for more information. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the short term effect of combined intravitreal triamcinolone acetonide (IVTA) and bevacizumab (IVB) injection with topical nepafenac in diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor. Material and Methods: 16 eyes of 16 patients with refractory DME were included the study. IVTA (2mg 0.05ml) and IVB (1.25mg 0.05ml) combined injection was performed and topical nepafenac was applied for three months. Ocular examination of patients was made, corrected visual acuity (CVA) and central macular thickness (CMT) repeated before the injection, 1 month and 3 months after the injection. Results: Nine (56 %) patients were women and 7 (44 %) patients were men and their mean age was 62,75±5,73 years. Before treatment CMT was 437.44±76.34 micron and 1 month after combined injection CMT was 366.56±61.15 micron and 3 months after CMT was 309.75±61.17 micron. There was significant reduction in CMT 1 month and 3 months after injection (p<0.05) with respect to CMT before treatment. Before treatment CVA was 1.29±0.84 Log Mar and 1 month after combined injection CVA was 0.93±0.74 Log Mar and 3 months after CVA was 0.89±0.72 Log Mar. There was significant change in CVA 1 month and 3 months after injection (p<0.05) with respect to CVA before treatment. Three months after combined injection 10 (62.5 %) patients needed intravitreal injection. Conclusion: Combined IVTAIVB injection together with topical nepafenac treatment is safe and effective procedure in DME refractory to anti-VEGF therapy. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the efficacy, short and long term complications of single dose intravitrea intravitreal triamcinolone acetonide injection in diabetic macular edema. Material and Method: 54 eyes of 39 patients with diabetic macular edema were included in the study. The results of the patients who received single dose 4 mg/0,1 ml intravitreal triamcinolone acetonide injection were recorded. Best-corrected visual acuity, central macular thickness, intraocular pressure changes and complications were evaluated. Results: At the first month, best-corrected visual acuity increased and central macular thickness decreased significantly from baseline values (p<0.05). Mean central macular thickness before injection, at first and 6th month was 445.11±109.58 µm, 275.87±55.80 µm, 370.78±111.57 µm respectively. At 6th month, central macular thickness increased but did not reach pretreatment values. There was an increase in intraocular pressure at first, second and third months. Subconjonctival hemorrhage (%50), cataract formation (%44), triamcinolone acetonide particules on posterior capsule (%1.85), postoperative hypotony (%1.85), pseudohypopion (%5.55) were recorded as complications. Conclusion: Single dose intravitreal triamcinolone acetonide injection improved visual acuity and reduced central macular thickness in diffuse diabetic macular edema. However the effect was transient and complications such as cataract formation and increase in intraocular pressure were seen frequently. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of combined treatment of intravitreal bevacizumab injection followed by grid laser photocoagulation in patients with diabetic macular edema Methods: Patients with diabetic macular edema received single dose intravitreal bevacizumab injection and followed by grid laser photocoagulation treatment four weeks later in the retrospectively conducted study. All eyes had underwent a complete ophthalmic examination including optical coherence tomography at baseline and at first and third month after laser treatment. The changes between outcome and baseline measurements in central macular thickness, macular cube volume and best-corrected visual acuity were observed. The changes in intraocular pressure and any reported complication were also evaluated. Results: After the combined therapy the reduction in the mean of central macular thickness was 96.91 µm (24.94%) with a corresponding improvement in best-corrected visual acuity. The reduction in the mean of central macular thickness and the improvement in the mean of best-corrected visual acuity were statistically significant (p < 0.05). There was no significant changes in the mean of IOP (p = 0.95). No complication related to the intravitreal injection or laser photocoagulation was reported in the treated eyes. Conclusion: Combined therapy with intravitreal bevacizumab injection and sequential grid laser photocoagulation appeared to be effective in reducing central macular thickness and cube volume and improving visual acuity. A combination of intravitreal bevacizumab injection and sequential grid laser photocoagulation could be used as an initial treatment of diabetic macular edema. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate visual acuity and macular thickness alterations after intravitreal ranibizumab (IVR) monotherapy and İVR injection combined with laser therapy in treatment of diabetic macular edema(DME). Materials and Methods: Clinical records were retrospectively reviewed of 80 patients (98 eyes) who underwent intravitreal ranibizumab therapy for DME . The patients were divided into 2 groups according to the treat?ment modality: Group I included 53 eyes treated with ranibizumab monotherapy and Group II included 45 eyes treated IVR with combi?nation of focal/grid laser therapy. Patients were compared in terms of best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 1st and 6th months. Results: Mean follow-up period was 14.8±5.4 (6-22) months. The median (minimum-maximum) BCVA before the treatment in Group I and Group II was 0.7 (0.1-1.3) log?MAR and 1 (0.4-1.3) logMAR respectively. The visual acuity was 0.4 (0.1-1.3) logMAR and 0.7 (0.2-1.3) logMAR respectively at 6th month. The increase in BCVA was statistically significant in group I (p=0.0001). The median (minimummaximum) CMT before the treatment in Group I and Group II was 487 (277-847) µm and 493 (289-843) µm respectively. The CMT was 284 (178-496) µm and 352 (220-921) µm respectively at 6th month. The decrease in CMT was statistically significant in group I (p=0.001). Conclusion: According to our study intravitreal ranibizumab monotherapy is more effective than combination of IVR with focal/grid laser therapy in the treatment of DME. [ABSTRACT FROM AUTHOR]

Purpose: To compare of results the outcomes of best corrected visual acuity(BCVA) and central macular thickness (CMT) in phakic and pseudophakic eyes after intravitreal ranibizumab injection for diffuse diabetic macular edema. Materials and Methods: This retrospective study included 46 eyes with diffuse diabetic macular edema (DME), which had no history treatment for diabetic macular edema, received 3 injections of ranibizumaab with one month intervals. All patients had type 2 diabetes mellitus with nonproliferative diabetic retinopathy and diffuse DME which had no history of treatment. Detailed eye examination included measurement of BCVA, intraocular pressure (IOP) and CMT using optical coherence tomography(OCT) was performed in all patients. BCVA, CMT and IOP were compared between the two groups. A p<0.05 was considered statistically significant. Results: There were 24 eyes in phakic group and there were 22 eyes in pseudophakic group. Mean age was 59.5±9.2 and 66.3±10.8 years old in the phakic and pseudophakic group, respectively. Baseline BCVA was 0.36±0.24 in phakic and 0.28±0.25 in pseudophakic group. Postoperatively, mean BCVA was 0.64±0.28 and 0.60±0.37 in the phakic and pseudophakic group, respectively. Baseline CMT was 373±97 in phakic group, and 416± 91 µm in pseudophakic group. Postoperative mean CMT was 286±76 in the phakic group and 298±102 µm in the pseudophakic group. Retinal detachment, endopthalmitis and systemic side events. Conclusion: Three doses of intravitreal ranibizumab was effective in phakic and pseudophakic eyes with diffuse DME. The values of phakic group were better than pseudophakic group but not significant. [ABSTRACT FROM AUTHOR]

Purpose: To compare the short term effects of bevacizumab and ranibizumab on diffuse diabetic macular edema (DME). Materials and Methods: This retrospective study included 58 diabetic patients with diffuse DME. Bevacizumab group included 30 patients who received 3 doses intravitreal bevacizumab (1.25 mg/0.05 ml) for DME. Ranibizumab group included 28 patients who received 3 doses intravitreal ranibizumab (0.5 mg/0.05 ml) for DME. Baseline best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT) and retinal examination with +78 diopters lens, were performed and repeated at 1st, 2nd, and 3rd month after injections in all patients. BCVA, CMT, and IOP for baseline and after treatment were compared in both groups. Results: Mean age of patients was 59.97±9.48 years, diabetes duration was 10.5±7.27 years in the bevacizumab group. Mean age was 61.04±8.15 years, diabetes duration was 10.61±8.35 years in the ranibizumab group. Follow up time was 4.0±0.1 months. Baseline BCVA (in snellen) was 0.32 decimal (0.50 log MAR)in the bevacizumab group and 0.31 decimal (0.51 logMAR)in the ranibizumab group (p=0.82). Improvement in BCVA was significant in both groups (p<0.001). Baseline CMT was 394±93 µm in the bevacizumab group and 384±96 µm (p=0.71) in the ranibizumab group. Decrease in CMT was significant after intravitreal injection. Conclusion: Significant improvement in BCVA and CMT were observed after treatment with bevacizumab and ranibizumab injection with no significiant difference between groups at the short term. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the epidemiology and frequency of serous macular detachment (SMD) in patients diagnosed with diabetic macular edema (DME). Materials and Methods: Hundred and forty-three eyes of 104 patients with DME were examined retrospectively. According to the results of OCT, the patients were separated into two groups; patients diagnosed with SMD and DME (group 1) and patients diagnosed with DME (group 2). They were assessed based on demographic characteristics, average age, duration of diabetes mellitus (DM), hypertension (HT) history, best-corrected visual acuity, and diabetic retinopathy stages. Results: The average age of the patients was 61±8.7 years. Forty-three patients (41.3%) were female and 61 patients (58.7%) were male. Fifty-four of 104 patients (51.9%) had DME with SMD. 21 (38.8%) patients had bilateral SMD. In group 1, 31 patients were male (57.4%) and 23 patients were female (42.6%). In group 2, 30 (60%) patients were male and 20 (40%) patients were female. In group 1, average age was 60.2±9.6 and the average duration of DM was 12.2±7.0 years, whereas the average age was 61.9±7.6 and the average duration of DM was 14.06±6.8 years in group 2. Forty-two patients in group 1 (77.8%) and 30 patients (60%) in group 2 had history of HT. Before the treatment, the average best-corrected visual acuity was found to be 0.30±0.24 in group 1 and 0.32±0.25 in group 2. Conclusion: Today, it is thought that diabetic maculopathy is the leading cause of SMD and it is a determining factor of treatment applications. In our study, we aimed at investigating the frequency of SMD in DME and the risk factors for the development of SMD. Although there were some differences between the factors, only the history of HT was found statistically higher in patients with SMD (p = 0.04). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the ocular and systemic complications of intravitreal bevacizumab (IVB) injection for diabetic macular edema (DME). Materials and Methods: Between June 2012-May 2014, 610 IVB injections for DME of 163 patients were evaluated retrospectively. Patients were excluded if they had a history of a cerebrovascular or cardiovascular event in the 6 months before enrollment. Bevacizumab 1.25 mg/0.05 ml (Altuzan®) was used for injection. All patients were examined at 1st day, 1st week, 1st month and every 4 weeks after IVB application. Results: Mean age, of 72 female and 91 male patients, was 63.7±11.3 years. Mean follow-up time was 9.4 (4-24) months. Endophthalmitis in 1 eye (0.61%), hyphema in 1 eye (0.61%), trauma to the clear lens (0.61%), spontaneously resolved vitreous hemorrhage in 1 eye (0.61%), temporary intraocular pressure increase controlled by topical medication in 5 eyes (3.06%), punctate corneal epitelyopathy in 11 eyes (6.74%), mild inflammation in anterior chamber in 8 eyes (4.90%) and subconjunctival hemorrhage in 21 eyes (12.88%) in 21 eyes were noted as ocular complications. Cerebrovascular ischemic attack in 1 patient (0.61%) and increased systemic blood pressure in 1 patient (0.61%) were observed as systemic complications. Conclusion: IVB injections are technically simple operations and frequently used in daily practice. However, it should be kept in mind intravitreal injections may cause very serious complications. [ABSTRACT FROM AUTHOR]

Objectives: To compare the intravitreal injections of 4 mg/0.1mL and 20 mg/0.1 mL triamcinolone acetonide with respect to efficacy and side effects in the treatment of diabetic macular edema (DME). Materials and Methods: A total of 56 pseudophakic eyes of 56 patients with the diagnosis of DME were evaluated retrospectively. Twenty-eight eyes were randomly injected with 4 mg of intravitreal triamcinolone (IVTA) (group 1), while 28 eyes were applied 20 mg IVTA (group 2). The patients were evaluated before the injection and were followed up monthly for 6 months and in the 8th month afterwards. Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and complication rates were determined and compared between the two groups. Results: When compared in terms of BCVA, there was a statistically significant increase in both groups (p<0.05). This increase lasted for 4 months in group 1, whereas it lasted for 6 months in group 2. Mean CMT decreased till the 4th month in group 1, while it lasted till the 5th month in group 2, and these findings were statistically significantly different (p<0.05). There was significant IOP spikes in both groups (p<0.05). Increase in IOP was observed till the 5th month, but a return to baseline values was determined in the 6th month. Conclusion: High-dose IVTA injections seem to have longer efficacy in terms of BCVA and CMT. However, studies which consist of larger groups of patients and longer follow-up period are needed for determining appropriate IVTA dosages in the treatment of DME. [ABSTRACT FROM AUTHOR]

the factors that may affect the efficacy of the treatment. Materials and Methods: The patients with diffuse DME who were treated with intravitreal ranibizumab injection were enrolled. The demographic characteristics, diabetes duration, antidiabetic medication, hemoglobin A1c, previous treatment for DME were recorded. Diabetic retinopathy stage was evaluated on fluorescein angiography. Follow-up time and number of injections were noted. The effectiveness of the treatment was studied by comparing the best corrected visual acuity (BCVA) and central macular thickness (CMT) measured before and after the injections. The association between aforementioned factors and the change in BCVA and CMT was investigated. Results: In the study 65 eyes of 41 patients were studied. The mean follow-up time was 9.38±3 (6-18) months, the mean number of injections was 3.7±1.04 (1-6). The mean logMAR BCVA before and after the injections was 0.88±0.38 (0.1-1.8) and 0.62±0.4 (0-1.8) respectively. The mean CMT before and after the injections was 391.63±84.67 (254-733) µm and 291.89±113.65 (130-695) µm respectively. The difference in BCVA and CMT were statistically significant. There was no statistically significant correlation between the demographic, systemic, ocular factors and the difference in BCVA and CMT. Conclusion: Intravitreal injection of ranibizumab in DME is an effective treatment that provides increase in BCVA and decrease in CMT. Studies with larger number of patients and longer follow-up time is required to evaluate long term effectiveness of the treatment and factors that might affect prognosis. [ABSTRACT FROM AUTHOR]

Purpose: Aim: To evaluate efficacy and safety of pars plana vitrectomy (PPV) in non-tractional diabetic macular edema (DME). Materials and Methods: Eighteen eyes of 18 patients which underwent PPV by virtue of resistance to combined intravitreal triamcionolon acetonide injection and macular laser photocoagulation were rewieved retrospectively. Results: Baseline mean best spectacle corrected visual acuity (BSCVA) improved from 0.83±0.29 logMar to 0.70±0.31 log-Mar at the last follow-up visit after surgery (p=0.0686). Baseline mean macular thickness measured by OCT reduced from 434±72 µ (312-554 µ) to 369±51 µ (277-468 µ) at the last follow-up visit postoperatively (p<0.0001). Conclusion: PPV is controversial in the treatment of diffuse DME. It can be used as an adjunctive treatment in case of resistance to macular laser photocoagulation and intravitreal anti-VEGF injection which are less invasive methods. [ABSTRACT FROM AUTHOR]