Search

Purpose: To compare a topical nonsteroidal antiinflammatory drug (nepafenac 0.1%) and a topical steroidal antiinflammatory drug (fluorometholone 0.1% ) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract extraction with foldable intraocular lens (IOL) implantation., Setting: Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan., Design: Randomized double-masked single-center clinical trial., Methods: Patients were randomized to receive nepafenac 0.1% eyedrops or fluorometholone 0.1% eyedrops for 5 weeks after phacoemulsification with foldable IOL implantation. The incidence and severity of CME were evaluated by fluorescein angiography, retinal foveal thickness on optical coherence tomography, and BAB disruption on laser flare-cell photometry., Results: Thirty patients received nepafenac and 29 patients, fluorometholone. Five weeks postoperatively, the incidence of fluorescein angiographic CME was significantly lower in the nepafenac group (14.3%) than in the fluorometholone group (81.5%) (P<.0001). The fovea was thinner in the nepafenac group than in the fluorometholone group at 2 weeks (P=.0266) and 5 weeks (P=.0055). At 1, 2, and 5 weeks, anterior chamber flare was significantly less in the nepafenac group than in the fluorometholone group (P<.0001, P<.0001, and P=.0304, respectively). The visual acuity recovery from baseline was significantly greater in the nepafenac group (80.0%) than in the fluorometholone group (55.2%) (P=.0395). There were no serious side effects in either group., Conclusion: Nepafenac was more effective than fluorometholone in preventing angiographic CME and BAB disruption, and results indicate nepafenac leads to more rapid visual recovery., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the 12-month follow-up results of intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion and to identify the pretreatment factors that were associated with an improvement of the final visual outcome., Methods: Fifty eyes of 50 patients with macular edema secondary to branch retinal vein occlusion received an injection of 1.25 mg/0.05 mL bevacizumab. Additional injections were done when recurrence of macular edema occurred or the treatment was not effective. The best-corrected visual acuity and foveal thickness were measured. Stepwise multiple regression analyses were also performed., Results: The mean logarithm of the minimum angle of resolution visual acuity improved significantly from 0.53 to 0.26, and the mean foveal thickness decreased significantly from 523 to 305 microm during the 12-month follow-up period. The mean number of injections was 2.0 (range, 1-4). Stepwise multiple regression analyses showed that younger patients had both better visual acuity at 12 months and greater improvement of visual acuity during 12 months. In addition, better pretreatment visual acuity was associated with better visual acuity at 12 months but with less improvement of the visual acuity., Conclusion: Intravitreal bevacizumab therapy can be a long-term effective treatment for macular edema secondary to branch retinal vein occlusion.

Purpose: To compare the effectiveness of a topical nonsteroidal drug (diclofenac 0.1%) and a topical steroidal drug (betamethasone 0.1%) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract surgery and foldable intraocular lens (IOL) implantation., Settings: Shohzankai Medical Foundation Miyake Eye Hospital, Tokyo, Japan., Methods: This multicenter interventional double-masked randomized study comprised 142 patients having phacoemulsification and foldable IOL implantation. Seventy-one patients were randomized to receive diclofenac eyedrops and 71, betamethasone eyedrops for 8 weeks postoperatively. The incidence and severity of CME were evaluated by fluorescein angiography. Blood-aqueous barrier disruption was determined by laser flare-cell photometry., Results: Of the patients, 63 were men and 79 were women. Five weeks after surgery, the incidence of fluorescein angiographic CME was lower in the diclofenac group (18.8%) than in the betamethasone group (58.0%) (P<.001). At 1 and 2 weeks, the amount of anterior chamber flare was statistically significantly less in the diclofenac group than in the betamethasone group (P<.05). At 8 weeks, intraocular pressure was statistically significantly higher in the betamethasone group (P = .0003)., Conclusions: Diclofenac was more effective than betamethasone in preventing angiographic CME and BAB disruption after small-incision cataract surgery. Thus, nonsteroidal antiinflammatory agents should be considered for routine treatment of eyes having cataract surgery.

Purpose: To study the chronological change in choroidal blood flow (ChBFlow), disruption of the blood-aqueous barrier, and incidence of cystoid macular edema (CME) in early postoperative pseudophakic eyes, as well as the effect of nonsteroidal anti-inflammatory drug (NSAID) eye drops on these phenomena., Methods: Fifty patients who underwent phacoemulsification and foldable intraocular lens (IOL) implantation were randomized to receive either topical diclofenac or fluorometholone for 5 postoperative weeks. An additional 20 subjects, with long-standing pseudophakia served as the control. The blood-aqueous barrier was examined by laser flarimetry and choroidal blood velocity (ChBVel), volume (ChBVol), and ChBFlow by laser Doppler flowmetry (LDF) at 2 days and 1, 2, and 5 weeks after surgery. The incidence and severity of CME were evaluated by fluorescein angiography at 2 and 5 weeks after surgery., Results: Compared with patients taking diclofenac, those receiving fluorometholone showed significantly reduced ChBVol at 2 weeks (0.38 +/- 0.08 vs. 0.32 +/- 0.07, P = 0.022) and ChBFlow at 1 (11.01 +/- 1.74 vs. 9.35 +/- 1.51, P = 0.003) and 2 (11.15 +/- 1.43 vs. 8.47 +/- 1.27, P = 0.000) weeks after surgery, as well as a significantly elevated amount of anterior flare at 1 (8.9 +/- 2.2 vs. 24.4 +/- 18.9, P = 0.001) and 2 (9.2 +/- 3.5 vs. 16.7 +/- 12.3, P = 0.025) weeks after surgery. The ChBVol and ChBFlow in the fluorometholone group, however, returned to normal and was not different from the diclofenac group at 5 weeks after surgery. The incidence of fluorescein angiographic CME trended to be higher (P = 0.08) at 2 weeks and was significantly higher (P = 0.001) at 5 weeks after surgery in eyes with fluoromethalone than with diclofenac., Conclusions: Reduction of ChBFlow, disruption of the blood-aqueous barrier, and incidence of CME in early postsurgical pseudophakic eyes were more effectively prevented chronologically in eyes treated with diclofenac than in those treated with fluorometholone.

Purpose: The aim of this study was to study the effects of the sub-Tenon triamcinolone acetonide (STA) injection on ischemic cystoid macular edema (CME) or macular edema (ME) and blood-aqueous barrier (BAB) disruption associated with branch or central retinal vein occlusion (BRVO or CRVO)., Methods: Prior to, and 1, 2, 3, and 4 months after, STA injection, central retinal thickness was measured by using optical coherence tomography and the amount of aqueous flare by using laser flare metry., Results: In the BRVO group treated by STA, the amount of flare was significantly less at 1, 2, and 3 months after injection than in the untreated BRVO group (P < 0.05). In the CRVO group treated by STA, the amount was significantly less at 1 month after injection than in the untreated CRVO group (P < 0.05). In the BRVO group with STA treatment, central retinal thickness was significantly less at 1 and 2 months after the treatment than in the untreated BRVO group (P < 0.05). In the CRVO group with STA treatment, the thickness was significantly less at 1 month after treatment than in the untreated CRVO group (P < 0.05). A correlation test revealed the amount of aqueous flare and the central retinal thickness to be well correlated (P < 0.01)., Conclusions: The effects of STA and its time course on CME or ME correlated well with those on BAB disruption. Since there is the close correlation between the BAB and blood-retinal barrier function, the effects of medical treatment on ME associated with BRVO or CRVO can be evaluated by means of the BAB function.

Objective: To investigate the effects of timolol maleate with preservative and its preserved (PV) and nonpreserved vehicles (NPV) (benzalkonium chloride) on the blood-aqueous barrier and angiographic cystoid macular edema (CME) in early postoperative pseudophakia., Patients and Methods: Patients with ocular hypertension, normal tension glaucoma, and primary open-angle glaucoma who underwent surgery for cataracts. The study included a double-masked trial for timolol, PV, and NPV and a single-masked trial on the effect of diclofenac sodium and fluorometholone acetate on all three. The patients were divided into 6 groups, each of which were simultaneously administered the following different combinations of compounds: timolol and diclofenac (group A), timolol and fluorometholone (group B), PV and diclofenac (group C), PV and fluorometholone (group D), NPV and diclofenac (group E), and NPV and fluorometholone (group F). The 6 groups were then compared using a laser flare cell meter to determine the degree of disruption of the blood-aqueous barrier and fluorescein angiography to investigate angiographic CME. The differences in mean daily fluctuations in intraocular pressure were compared on the preoperative baseline day and for 5 weeks postoperatively. Twice daily administration of 0.5% timolol maleate or the vehicles was started 2 days before surgery, and continued until 5 weeks after surgery. Diclofenac or fluorometholone drops were instilled in the eyes 4 times preoperatively, on the day of surgery, and 3 times daily for 5 weeks postoperatively., Results: The flare amount was higher on the third and seventh days in group B than in group D, but was the same after the seventh day. The incidence of angiographic CME was the same between both groups. These 2 factors were significantly lower in group F. These 2 factors were also significantly lower in the 3 groups that received diclofenac instead of fluorometholone, with no difference among these groups. The intraocular pressure decline was significant in groups that received timolol compared with groups that received PV or NPV., Conclusions: Timolol and its preservative, benzalkonium chloride, cause disruption of the blood-aqueous barrier in early postoperative pseudophakia and increased incidence of angiographic CME. The concurrent administration of nonsteroidal anti-inflammatory drug such as diclofenac prevents these adverse effects without interfering with the drop in intraocular pressure caused by timolol. The addition of benzalkonium chloride to timolol contributes considerably to these adverse effects., Clinical Relevance: The present results suggest the cause of similar complications produced by other antiglaucoma eyedrops containing similar preservatives.

Objective: To study the effect of latanoprost, a prostaglandin analog, on the blood-aqueous barrier and angiographic cystoid macular edema (CME) formation in early postoperative pseudophakias., Patients and Methods: Included in the study were eyes with ocular hypertension, normal-tension glaucoma, or primary open-angle glaucoma undergoing surgery for cataract. The study consisted of a randomized double-masked trial for latanoprost and an open-label controlled trial for determining the effects of diclofenac sodium or fluorometholone eyedrop use on latanoprost or its placebo. We compared 4 groups of eyes with concurrent application of latanoprost and diclofenac (group A), latanoprost and fluorometholone (group B), latanoprost placebo and diclofenac (group C), and latanoprost placebo and fluorometholone (group D). A laser flare cell meter was used to determine the severity of blood-aqueous barrier disruption, and fluorescein angiography was performed to determine angiographic CME formation. Mean diurnal intraocular pressure differences were compared on the preoperative baseline day and in the fifth postoperative week. Latanoprost (0.005%) or its placebo was given once a day starting 2 days before surgery until the fifth postoperative week. Diclofenac or fluorometholone eyedrops were given 4 times a day before surgery on the day of surgery and 3 times a day until the fifth postoperative week., Results: In group B compared with group D, the amount of flare 3 days and 1 and 2 weeks after surgery and the incidence of angiographic CME in the fifth postoperative week were significantly higher. These 2 factors were significantly higher in group B than in group A (P < .05) and in group D than in group C (P < .01). There was no significant difference in these factors between groups A and C. The intraocular pressure decline was significant in groups A and B compared with groups C and D (P < .05), but there was no significant difference between groups A and B and between groups C and D., Conclusions: Latanoprost therapy enhances disruption of the blood-aqueous barrier and increases the incidence of angiographic CME formation in early postoperative pseudophakias. Because administration of nonsteroidal eyedrops such as diclofenac seems to prevent the adverse effects of latanoprost therapy while maintaining its effect to lower intraocular pressure, we suggest their concurrent application.