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Purpose: To report the 1-year results of intravitreal ranibizumab (IVR) injections for neovascular age-related macular degeneration (nAMD) in patients with good baseline visual acuity (VA)., Methods: Thirty-six eyes of 36 patients with nAMD with best-corrected VAs (BCVAs) >0.6 (equal to 0.22 in the logarithm of the minimum angle of resolution unit) were enrolled. IVR was the primary treatment; additional treatment was administered as needed. BCVAs and central retinal thickness (CRT) were measured periodically., Results: The mean number of injections at month 12 was 3.3. The mean BCVAs were 0.11 ± 0.02 at baseline and 0.12 ± 0.03 at month 12, which did not significantly differ. The mean CRT significantly improved from 320 ± 15 to 254 ± 12 μm at month 12 (p < 0.01). Photodynamic therapy was applied in 2 cases because of frequent recurrences., Conclusions: IVR maintained VA and improved morphological changes in wet AMD with good baseline VA., (© 2014 S. Karger AG, Basel.)

Intravitreal injection of triamcinolone acetonide (TA) is essential for clinical treatment in patients who insufficiently respond to vascular endothelial factor inhibitors for diabetic macular edema (DME). The aim of this study was to investigate microvascular changes treated with TA using optical coherence tomography angiography (OCTA). After TA in twelve eyes of eleven patients with central retinal thickness (CRT), there was a 20% or more reduction observed. Visual acuity, the number of microaneurysms, vessel density, and the foveal avascular zone (FAZ) area were compared before and at 2 months after TA. At baseline, the number of microaneurysms was 2.1 ± 1.1 in the superficial capillary plexuses (SCP) and 2.0 ± 1.1 in the deep capillary plexuses (DCP), with a significant decrease post-treatment to 1.0 ± 1.0 for SCP and 0.8 ± 0.8 for DCP (SCP; p = 0.018, DCP; p = 0.008). There was significant enlargement of the FAZ area from 0.28 ± 0.11 mm2 to 0.32 ± 0.14 mm2 (p = 0.041). There was no significant difference in the visual acuity and vessel density of SCP and DCP. Results indicated that OCTA was useful for the evaluation of qualitative and morphological retinal microcirculation and that intravitreal TA may decrease microaneurysms. [ABSTRACT FROM AUTHOR]

Introduction: Anti-vascular endothelial growth factor (VEGF) therapy is the first-choice treatment for neovascular age-related macular degeneration (nvAMD); however, patients often are burdened physically, financially, and mentally. We investigated the relationship between mental status and feasibility of an intravitreal ranibizumab treat-and-extend (TAE) regimen for nvAMD.Methods: In this prospective, multicenter study, 75 patients with nvAMD received ranibizumab intravitreally in a TAE regimen. After two monthly injections, the injection intervals were extended step-by-step to 6, 8, 12, and 16 weeks in eyes with dry maculas on optical coherence tomography (OCT) and, if exudation persisted or relapsed, shortened by one step. The best corrected visual acuity (BCVA) measurement and OCT were performed at baseline and on the same days of the scheduled injections. At baseline, all patients completed a survey, the Hospital Anxiety and Depression Scale (HADS), regarding mental burden. At week 52, patients on the TAE regimen for 1 year completed the HADS and a questionnaire designated to assess treatment-associated mental status.Results: Fifty-one patients (68%) completed the 1-year TAE regimen; 24 eyes (32%) discontinued the TAE regimen because of the rescue treatment, difficulty in completing clinical visits, or financial burden. In 51 eyes on the TAE regimen for 1 year, the mean BCVAs improved from 64.3 letters at baseline to 71.6 letters at week 52. The mean anxiety and depression scores on HADS decreased significantly (p < 0.01) after the 1-year treatment. Women tended to have higher anxiety scores, possibly associated with fear of injection and recurrence, while some men had higher depression scores potentially associated with financial burden, difficulty in completing clinical visits, and subsequent interruption of the TAE regimen especially in eyes with low treatment efficacy.Conclusions: A TAE regimen of intravitreal ranibizumab injections preserves vision in eyes with nvAMD and reduces mental burden associated with disease relapse.Trial Registration: This clinical study was registered retrospectively on December 22, 2014 with the ClinicalTrials.gov identifier NCT02321839. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of indocyanine-green angiography (ICGA)-guided navigated focal laser photocoagulation for diabetic macular edema (DME). Study design: Prospective, interventional case series. Methods: Six patients (8 eyes) were enrolled in this study. Fluorescein angiography (FA) and ICGA were performed using the Heidelberg Retina Angiogram 2 (Heidelberg Engineering). Navigated focal laser photocoagulation was delivered to the microaneurysms on ICGA using Navilas® (OD-OS GmbH, Germany). Central retinal thickness (CRT) and macular volume (MV) were measured by Cirrus HD-OCT (Carl Zeiss Meditec). At 6 months, the best-corrected visual acuity (BCVA), CRT and MV were compared to the values measured on day 0. The distances from the center of fovea to the closest microaneurysms (MAs) were measured on the pre-planned Navilas® image. Results: All eyes had previous treatment history. At 6 months, ICGA-guided navigated focal laser photocoagulation significantly reduced the CRT and the MV (p<0.05), and there was improvement in the BCVA (p<0.05). At 3 months, 5 out of the 8 eyes (63%) underwent additional ICGA-guided navigated focal laser photocoagulation due to remnants of MAs that had been confirmed by ICGA. There was no observed recurrence of edema after the ICGA-guided navigated focal laser photocoagulation during the 6-month follow-up. The mean distance from the center of fovea to the closest MAs was 624.8 ± 377.7 μm (range 336.0–1438.9 μm). Conclusion: Our data suggest ICGA-guided navigated focal laser photocoagulation may be effective for the treatment of DME. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate navigated laser photocoagulation for the treatment of refractory diabetic macular edema (DME). Methods. Retrospective study of 25 eyes (21 patients) treated with Navilas 577+ focal laser system. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (OCT) parameters were measured at baseline, 1, 3, and 6 months, and final visit. Results. The mean follow-up period was 12.8 ± 2.4 (7–16 months). All subjects had history of previous treatment which was injection of triamcinolone acetonide or antivascular endothelial growth factor (VEGF) agents. The navigated laser photocoagulation was delivered to the microaneurysms on indocyanine green angiography (ICGA) in 21 of 25 eyes (84%), fluorescein angiography (FA) guided in 3 eyes, and OCT angiography guided in 1 eye. After initial navigated laser treatment, 16 of 25 eyes (64%) were needed additional navigated laser photocoagulation, injection of triamcinolone acetonide, and/or injection of VEGF agents. Although median BCVA remained stable, the central retinal thickness and macular volume were significantly decreased over 6 months (p<0.05). All patients were treated without complications. Conclusions. Focal photocoagulation using Navilas 577+ showed to be effective in treating DME with improvement in macular edema on OCT over 6 months. Navilas 577+ was beneficial to perform navigated laser photocoagulation based on three modalities (ICGA, FA, and OCT angiography). [ABSTRACT FROM AUTHOR]

Purpose: To report a case of laser in situ keratomileusis (LASIK) flap dehiscence during retinal detachment surgery 7 months after uneventful refractive surgery.Design: Interventional case report.Methods: A 47-year-old man noticed a defect of the upper visual field in his right eye 7 months after a LASIK procedure. The fundus showed rhegmatogenous retinal detachment, and a scleral buckling procedure was performed. During the buckling procedure, the corneal flap became detached.Results: At completion of the buckling procedure, the detached corneal flap was carefully raised and the exposed corneal stroma was cleansed of any residual epithelial cells or red blood cells with irrigation using balanced salt solution. One day after the operation, the LASIK flap was repositioned, the cornea had cleared, and the retina was reattached.Conclusions: As LASIK increases in popularity, the complication we have reported may become more common. We suggest that a retinal detachment surgery should be performed with careful avoidance of corneal trauma even if a long time has passed since the LASIK procedure. [ABSTRACT FROM AUTHOR]