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Efficacy and Safety of Subthreshold Laser in Refractory DME Demostrated by Swept Source OCT and Microperimetry

SCIENTIFIC POSTER 2016_Efficacy and Safety of Subthreshold Laser in Refractory DME Demostrated by Swept Source OCT and Microperimetry Patricia Udaondo Purpose: To demostrate de efficacy and safety of subthreshold laser therapy in the management of refractory diabetic macular edema cases. Methods: Patients with persistent macular edema despite several intravitreal injections with antiVEGF and/or steroids were treated with the new streamline...

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Alternative Diffuse DME Treatment: Laser Photostimulation versus Topical Medical Therapy

Introduction: The standard first-line treatment for diffuse diabetic macular edema (DDME) is intravitreal injections. Although considered safer and more effective than laser, these drugs may have serious ocular and systemic complications. Recent research of the pharmacological properties of Nepafenac, found that this drug could reach the retina in sufficient concentrations to produce beneficial effects. We evaluated the efficacy of...

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The Impact of Macular and Peripheral Ischemia in DME

Purpose: To describe the effect of macular and peripheral retinal ischemia in diabetic macular edema (DME). Methods: This is a retrospective study on 259 eyes of 187 patients with DME. Degree of macular ischemia and peripheral retinal ischemia were graded in FFA for each case and macular edema with central foveal thickness (CFT) and structural changes of retinal layers were assessed using OCT. Results: There was macular ischemia of...

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Micropulse Contiguous Grid Laser for Diffuse DME

Objective: To investigate micropulse contiguous grid laser in fovea involved DDME and to correlate SD-OCT structural changes with resolution target visual fields. Purpose: To investigate micropulse contiguous grid laser in the treatment of eyes with DDME involving the fovea, and second, to correlate OCT findings with resolution target visual field (RTVF) measurements of threshold acuity at fixation, best acuity measured at any...

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Approach to Diabetic Epimacular Membranes in DME Surgery

Approach to Diabetic Epimacular membranes in Diabetic macular Edema surgery Risk of Diabetic Epimacular membranes (ERM) Peeling: These membranes are rather toughly adherent to an underlying fragile ischemic macula. Vascular connections may be present, in or around, the area of the membranes. This may elicit: iatrogenic retinal breaks, uncontrolled retinal bleeding. My Technique: I use Chandelier as the illumination tool, and an aspheric...

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Vitreo-retinal Interface in Non-tractional DME

Vitrectomy is a well-known technique for dealing with “tractional DME”. Most doctors however prefer medical treatment for “non-tractional” DME. Recently performed, ME EVRS study proved that vitrectomy may be a valuable treatment option for “non-tractional” DME. The aim of this presentation is to show the vitreo-retinal relationship in “nontractional DME” revealed during the surgery, pointing that in...

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Role of Endo-diathermy Probe in PDR Surgery

I use the endodiathermy probe as one of two instruments for bimanual dissection of diabetic fibrovascular proliferations. It replaces either the forceps or the vitreous cutting probe and scissors. Forceps Replacement: I identify the surgical planes, by inserting the endodiathermy probe tip underneath the membranes; this allows me to dissect with the vitreous cutting probe under good visulaization. Probe/scissors Replacement: In the...

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Macular Hole in RD PDR

          Giant macular hole in a 13 yo girl after surgery for retinal detachment. Subretinal strands are also visible. Tamponade is silicone oil. Contact Details: Email: parolinibarbara@gmail.com Cell Phone:...

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Chronic Diffuse DME: The Role of Vitrectomy vs Intravitreal Therapy

Introduction: Macular edema is the main cause of visual loss in diabetic patients. In spite of the ample choice of therapeutic modalities, chronic macular edema management is a challenge to this date. Aside from laser and intravitreal therapies, the newest proposal by some authors has been vitrectomy with ILM peeling as a possible solution for many therapy-resistant cases, or even naive cases. Reducing traction, increasing retinal...

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Qualitative and Quantitative Analysis of Retinal Vascular Impairment in Diabetic Maculopathy: An OCT-Angiography Assessment

Purpose: To perform a qualitative and quantitative assessment of the foveal microvasculature in eyes with diabetic maculopathy (DM) using optical coherence tomography angiography (OCT-A). Methods: Retrospective case series of 50 eyes of 34patients with DM (14 females, mean age 64.4 ± 9.2 years) and 30 eyes of 30 age-matched controls, evaluated by conventional multimodal imaging andSpectralis OCT-A (Heidelberg Engineering, Heidelberg,...

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Safety and Efficacy of Intravitreal Ocriplasmin in DME with Vitreomacular Adhesion

Introduction: There are many reports supporting that the relationship of the posterior cortical vitreous to the macula plays a role in the development of diabetic macular edema (DME). Until recently, the only treatment option available for vitreomacular adhesion (VMA) was vitrectomy. Given the risks for vitrectomy, the standard of care has generally been to wait until visual symptoms from VMT have deteriorated enough to justify the...

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Subthreshold Diode Micropulse Laser for the Treatment of Clinically Significant DME Less than 400 μ

Purpose: To assess effect of micropulse diode laser (MPDL) on best corrected visual acuity (BCVA) and central foveal thickness (CFT) in treatment of clinically significant diabetic macular oedema (CSME) as compared to conventional argon green laser (CGL) treatment. Design: Single-center, prospective, interventional, comparative study. Methods: Twenty four patients (40 eyes) with diabetic CSME were randomly assigned to MPDL (n=20) or CGL...

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Micropulse Contiguous Grid Laser for Diffuse DME

Objective: To investigate micropulse contiguous grid laser in fovea involved DDME and to correlate SD-OCT structural changes with resolution target visual fields. Purpose: To investigate micropulse contiguous grid laser in the treatment of eyes with DDME involving the fovea, and second, to correlate OCT findings with resolution target visual field (RTVF) measurements of threshold acuity at fixation, best acuity measured at any intercept...

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Definition of Cystoid Macular Degeneration in DME

Purpose: To describe cystoid macular degeneration (CMD) which had no clear definition in diabetic macular edema (DME) and to investigate related characteristics. Method: Retrospective study. Two hundred fifty one eyes of 179 patients who had cystic changes in OCT were enrolled. The horizontal and vertical diameters of the biggest cyst in the area of 1000µm from the center of the fovea were measured for the definition of CMD. The analysis...

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Microstructural Changes Depicted by OCT in DME: Insight into Pathomorphology and Tailored Management

The introduction of OCT and intravitreal pharmacotherapy has revolutionized the management of diabetic macular edema (DME). So far, central retinal thickness (CRT) is the most commonly used measure to quantify DME in randomized controlled trials and by retinal physicians in clinical practice. However, various studies showed that CRT has a modest correlation with visual acuity in DME and this relation is sometimes paradoxical. This...

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Anatomical & Functional Results After Different Treatment Modalities in Serous Macular Detachment Accompanying DME

Mehmet Demir_SCIENTIFIC POSTER 2015_1 Aim: To investigate the effect of application of a variety of treatment modalities on central macular thickness (CMT), serous macular detachment height (SMD) and best corrected visual acuity (BCVA) in diabetic macular edema (DME) with serous macular detachment. Methods: Eighteen eyes of 15 female and 20 eyes of 13 male Type 2I diabetic patients with DME and SMD applied to Retina Clinic were included in...

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Triamcinolone Versus Ranibizumab Intravitreal Injection Combined with Grid Laser Photocoagulation in the Management of Diffuse DME

The present study was conducted at Mansoura Health Insurence Hospital, Mansoura, Egypt. The study included 136 eyes diabetic patients, 80 males 56 females. All eyes had diffuse diabetic macular edema (DME). The best corrected visual acuity was tested. Fluorescein angiography (FA) and OCT were preformed. The 136 eyes were divided into two groups. Group I included 72 eyes which were subjected to intravitreal injection of triamcinolone (4 mg,...

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Flucinolone Acetate Intravitreal Implant in the Treatment of Persistent and Chronic DME. A Tertiary Multicentre Study

Introduction: Diabetic macular oedema (DMO) is a well known complication of diabetes. Until the last decade argon laser was considered the gold standard treatment of clinically significant macular oedema. Recent landmark studies (READ2, RESTORE, Relight, DRCR.net protocol I) shifted the focus of treatment towards intravitreal injections of anti-VEGF. However, anti-VEGF showed a limited effect in chronic CMO. The FAME study revealed...

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Posterior SubTenon Triamcinolone Acetonide Treatment in DME Cases

Burak ERDEN_SCIENTIFIC POSTER 2015 Aim: To evaluate the efficacy and safety of posterior subTenon triamcinolone acetonid injection in diabetic macular edema cases Material/Method: 13 eyes of 12 diabetic macular edema patients ( 7 M, 5 F ) were enrolled into this retrospective study. 40 mg triamcinolone acetonide was injected into the subTenon space via blunt tip cannula through a minor conjunctival incision in the inferonasal quadrant...

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Algorithm of Surgical Treatment & Rehabilitation of Patients with Tractional RD and ME in Diabetes Type I

Actuality: Proliferative diabetic retinopathy (PDR) is one of the most common complications of diabetes type I. Proliferative retinal changes lead to a sharp vision reduction and, consequently, loss of life quality in young able-bodied patients. Modern technology of vitreoretinal surgery can be successfully used to eliminate the effects of the proliferative process in an eye and improve vision up to its full recovery. However, in most...

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Factors Affecting Functional Outcome of Vitrectomy for PDR

Aim: To determine the factors which influence on the functional outcome of treatment after vitrectomy in patients with proliferative diabetic retinopathy (PDRP). Material & Methods: The study involved 56 patients (56 eyes) with PDRP in time of 2 months after vitrectomy. There were included patients with achieved positive anatomical outcome of treatment, the absence of residual macular edema by optical coherence tomography investigations...

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Neuroretina Degeneration After Vitrectomy for PDR with Vitreous Hemorrhage & Tractional RD

Aim: To compare the degree of neuroretinal degeneration by the complex of electrophysiological methods, pattern visual evoked potentials (PVEP) in patients with proliferative diabetic retinopathy (PDRP) who underwent vitrectomy due to only vitreous hemorrhage and tractional retinal detachment. Material & Methods: We examined 43 patients with PDRP (43 eyes) in terms of 2 months after vitrectomy. The study included patients with positive...

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Changes in Macular Appearance in OCT After Diabetic Vitrectomy

Jae Pil Shin_SCIENTIFIC POSTER 2015_2 Purpose: To classify the changes of macula with optical coherence tomography (OCT) and to analyze the visual prognosis according to the macular appearance in OCT after diabetic vitrectomy. Methods: We reviewed medical records of 60 eyes (56 patients) who had diabetic vitrectomy and had gradable OCT examination before and after surgery. We categorized OCT findings into several groups and analyzed visual...

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Intravitreal Dexamethasone Implant for Chronic DME Resistant to Ranibizumab Injections

Nil İrem Uçgun_SCIENTIFIC POSTER 2015 Purpose: To assess the effect of intravitreal dexamethasone (DEX) 0,7 mg implant (Ozurdex) in patients with chronic diabetic macular edema resistant to prior intravitreal (IV) monthly 5 dose Ranibizumab. Materials & Methods: Twenty five eyes of 24 patients were included the study. Before and after IV DEX implant visual acuity, central macular thickness (CMT) and intraocular pressure (IOP) were...

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Vitrectomy in Treatment Naive Diabetic Macular Edema

This movie presents the idea behind vitrectomy in treatment naive diabetic macular edema with and without epiretinal membranes. Surgical technique with ILM peeling will be demonstrated in multiple cases. Everything will be documented with SD-OCT and Swept Source OCT images. Intrasurgically, vitreomacular traction is present in most cases of diabetic macular edema, even if not visible in OCT images. Finally, surgical anatomic and functional...

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Young EVRS Course: Treatment of DME

                    Exerts: Didier Ducournau & Paul Tornambe Young EVRS Course is dedicated to ophthalmologist at the beginning of their carriers. The course is intended to serve as the forum for asking questions and getting valuable answers. World class experts Didier Ducournau and Paul Tornambe will be gathered to present the topics. So prepare your questions and grill the...

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Retinal Inflammation and DME: Novel Approach

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Objectives: To evaluate the efficacy of topical nepafenac in patients with impaired blood-retinal barrier (BRB) in the macular area. Methods: In a prospective pilot study 15 eyes were included; in the first visit and controls complete eye examination was performed (mean follow-up: 79 days). Visual acuity (VA), central thickness (CT) and...

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577nm Yellow Laser vs 532nm Green Laser for DME

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Advantages: Macular photocoagulation is a standard of care therapy for Diabetic macular edema and it is desirable to use a laser wavelength that is least noxious to the macular tissue. We present our study and concept, suggesting that Yellow laser (577 nm) be used a safe and efficacious alternative to the standard Green Laser (532nm) as...

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Subthreshold Diode Micropulse Photocoagulation for Significant DME

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Purpose: To assess effect of micropulse diode laser (MPDL) on best corrected visual acuity (BCVA) and central foveal thickness (CFT) in treatment of clinically significant diabetic macular oedema (CSME) as compared to conventional argon green laser (CGL) treatment. Design: Single-center, prospective, interventional, comparative...

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My Way Treating Diabetic Retinopathy in a Vitrectomized Eye

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   With either diabetic macular edema or with proliferative retinopathy we should ascertain that all retinal laser treatment needed has been done and above all emphasize the importance of a good metabolic control to achieve good results. We certainly should not give up and use anti-angiogenic or corticosteroid intra-vitreal injections as...

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Management of Postvitrectomy Vitreous Hemorrhage in Patients with PDR

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Post vitrectomy vitreous hemorrhage is the main cause of failure in patients with proliferative diabetic retinopathy, the rate of this complication is 25 -65% of cases. Most of surgeon usually perform vitrectomy again, sometimes with gas tamponade for haemostatic effect. We propose to do more easy procedure – outpatient fluid gas...

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Endodiathermy Probe as an Aid to Membrane Delamination in Diabetic Traction RD

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Purpose: Eyes with diabetic traction detachment (DTRD) can differ in severity. Systemic control and medication is also very important, which may play a role in the intraoperative and postoperative follow-up. One important complication during surgery is bleeding; when cannot be contolled effectively during pars plana vitrectomy, can...

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Bi-linear Aspiration Flow & Cutting Frequency Control and Segmentation in PDR

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Different techniques have been described for the dissection of proliferative diabetic retinopathy (PDR). When there is a strong adherence between the fibrovascular proliferation and the retinal vessels, segmentation is a safe technique to reduce the risk of bleeding and retinal tear. With the advance of vitrectomy machines, the control...

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Advanced PDR: Surgical Approach

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Methods: Preoperative Avastin 24 hours Always Bimanual approach For dissection I use: a 23G vitreous cutter, Scissors, Fashioned 23G Pick. I use the lower temporal trocar sometimes- in cases with dense fibrovascular proliferations in the upper retina. the working trocars in these cases are the lower temporal and upper nasal The membrane...

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Change of Microaneurysm in Diabetic Retinopathy Patients Who Undergo Bevacizumab Injection

Purpose: To evaluation of microvasular change(microaneurysm) in diabetic retinopathy patients who undergo intravitreal bevacizumab injection by FAG(fluorescein angiography). Method: Thirty- one eyes of 31 diabetic retinopathy patients undergoing intravitreal bevacizumab injection(1.25mg/0.05ml) only one eye were included in this study. The control group(31 eyes) were the opposite eyes. We made an exception for both intravitreal bevacizumab...

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Vitrectomy in Diabetic Macular Edema

For many years, pars plana vitrectomy with posterior hyaloid detachment and peeling of internal limiting membrane (ILM) has been considered a treatment option for diabetic macular edema by retina surgeons worldwide. The 2012 large scale study by EVRS surgeons showed that the surgical option alone resulted, by far, in the most significant visual acuity improvement. However the surgical treatment has, so far, failed to gain widespread...

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PDR : Small Gauge Vitrectomy For Complex Cases

Advantages: Small-Gauge transconjunctival Vitrectomy is a minimally invasive surgical technique. The recent advances in instrumentation have helped to improve the safety and efficacy of surgical technique for Diabetic Retinopathy for Complex Cases. Methods: The video we present, highlights the various spectrum of surgical techniques we can use to treat severe Proliferative Diabetic Retinopathy. The video shows our experience and the...

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Small-gauge Endodiathermy Probe As An Aid to Elevate Tractional Membranes in eyes with Diabetic Traction Retinal Detachment

Purpose: Diabetic traction detachment (DTRD) can differ in severity. Systemic control and medication is very important and may play a role in intraoperative and postoperative follow-up. One important complication during surgery is bleeding; when this cannot be controlled effectively during pars plana vitrectomy, it can cause difficulty in membrane dissection, and even complicate the procedure with retinal tear formation. Preoperative...

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My Way of Treating Diabetic ME

Diabetic macular edema is a multifactorial disorder that needs a multimodal and individualized approach. First we must understand the main mechanism behind each particular case (ischemic, inflammatory, tractional or even mixed) and then select the best treatment option. If it is not possible to clarify the main mechanism (which can change with time, as the natural history of this ocular disease) we should always choose the best way that...

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ILM Peeling During Vitrectomy for Tractional DME. My Way

I do ERM-ILM peeling by using: Chandelier illumination, aspheric macular contact lens, 23 G needle OR closed tip ILM Forceps for creating the ILM flap, clamping the infusion cannula during the BBG stain injection. Chandelier allows for satisfactory illumination with a free second hand that stabilizes the working hand and thus provides stability, precision, control and dexterity. However, positioning and redirecting by the assistant may...

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Removal of the Internal Borderline Membrane in DME Treatment

buy zyban nline canada. buy zyban nline uk. buy cheap zyban nline. rder zyban n prescriptin. nn-prescriptin zyban. zyban nline n prescriptin. zyban generic … Poster Olga Yevsyukova apr 4, 2012 – most of the dramatic side effects occur rarely, buy zoloft from mexico, zoloft online cod , zoloft maximum dosage, three weeks apart. price advair diskus generic name of advair diskus order fluticasone Topicality of the...

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Combined Tractional and Rhegmatogenous RD in Diabetic Patients

Poster Zbiba Walid Goals: The aim of our study was to evaluate the clinical characteristics, the results of surgery and the functional prognosis factors of combined tractional and rhegmatogenous retinal detachment in diabetic patients. Methods: Retrospective study of 32 eyes of 32 diabetic patients who underwent vitrectomy for combined tractional retinal detachment. Extension of fibro vascular proliferation was classified according to its...

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Comparison of Clinical Outcomes of 25 and 23 Gauge Vitrectomy for PDR

Poster Mehmet Onen Purpose: To compare anatomical and functional outcomes of 25 gauge and 23 gauge transconjunctival sutureless vitrectomy (TSV) for treatment of proliferative diabetic retinopathy (PDR). Methods: Retrospective review of 81 consecutive eyes from 81 patients undergoing 25 gauge and 23 gauge TSV with a minimum of 6-month follow-up (vitreous hemorrhage (VH), n=51; tractional retinal detachment (TRD), n=30). Vitrectomy was...

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MH After Intravitreal Ranibizumab Injection for DME

Poster Jaeryung Oh Purpose: To report a case of macular hole formed after intravitreal ranibizumab injection in diabetic macular edema. Case summary: A 76-year-old woman with a 30-year history of type 2 diabetes visited the clinic presenting with the complaint of decreased vision in her right eye. The best-corrected visual acuity of the right eye was 6/20, and 6/12 in the left eye. Intraocular pressure was 20 mmHg in her right eye and she...

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The Change of Macular Thickness Measured by OCT in Diabetic Patients

Advantages: To demonstrate the change in macular thickness using optical coherence tomography in diabetic patients and to assess its relationship with glycosylated hemoglobin (HbA1c) levels and hypertension state. Methods: Diabetic patients who underwent at least two macular thickness measurements with OCT within a 12-month period were include d. HbA1c values within 1 month of each OCT study, and clinical data such as age, insulin...

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Clinical Outcomes According to Silicone Oil Removal Timing in PDR

Advantages: To evaluate the visual prognosis and the occurrence of complications after different terms of silicone oil removal (SOR) in proliferative diabetic retinopathy (PDR). Methods: 21 patients who underwent SOR less than 3 months and 12 patients more than 6 months were included in this retrospective study. The length of silicone oil retention in the eye, visual acuity (VA) and intraocular pressure (IOP) prior to the SOR procedure...

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Intravitreal Triamcinolone Versus Bevacizumab for Treatment of Subretinal Fluid in Diabetic Retinopathy

Poster V. Levent Karabas Purpose: To evaluate the efficacy of intravitreal triamcinolone acetonite (IVT) injection versus intravitreal bevacizumab (IVB) injection in the management of subretinal fluid in patients with diabetic retinopathy. Methods: Forty-seven patient affected by diabetic macular edema with subretinal fluid were included. Patients were assigned randomly to two groups. IVT group, patients who received 4mg/0.1ml...

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Macular Photocoagulation Assisted by Intravitreal Bevacizumab (IVB) Versus Triamcinolone (IVTA) in Diabetic Macular Edema with Serous Macular Detachment

Advantage: Diabetic macular edema (DME) with serous macular detachment (SMD) responds poorly to laser treatment due to presence of subretinal fluid but has been seen to resolve following both IVB and IVTA. Re-injections maybe required owing to their limited period of action. We, thus, compared the efficacy of IVTA and IVB followed by laser photocoagulation, in treating DME with SMD. Methods: In this prospective interventional case...

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The Appropriate Timing of Pars Plana Vitrectomy After Pretreatment with Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy

Purpose: The purpose of this study was to determine the appropriate timing of pars plana vitrectomy after pretreatment with intravitreal bevacizumab (IVB) for proliferative diabetic retinopathy using histopathological examination of epiretinal membrane biopsies. Material & Methods: This prospective study was conducted in Maghrabi Eye Hospital & Kuwait University Hospital, Sana, between January 2009 – May 2010. Forty...

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23 Gauge Probe Surgery in Severe Proliferative Diabetic Retinopathy

Technological advances in 23 gauge probe design and vitrectomy machines, allowed the use of the probe to perform many intraoperative techniques and manipulations during complex diabetic vitrectomy. The aim of this work is to describe techniques for using the 23 gauge vitrectomy probe to manage complex diabetic vitrectomy. 120 eyes with severe complications of proliferative diabetic retinopathy were included in this work. They include cases...

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Diabetic Retinopathy

Introduction: Diabetes mellitus is the most common cause of proliferative vascular retinopathy, which also includes retinal venous occlusive disease, Sickle cell retinopathy and retinopathy of prematurity. The underlying abnormality in these disorders is retinal ischemia, which may ultimately lead to the formation and contraction of proliferative fibrovascular membranes with subsequent vitreous hemorrhage and/or retinal detachment. In...

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Limited Surgery in Diabetic Retinopathy

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The EVRS Macular Edema Study Results

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The Effectiveness and Safety of Triamcinolone Injections in DME

Advantages: Intravitreal triamcinolone injections turned out to be effective in reducing macular edema and improving vision in refractory DME after a laser treatment or even as an initial treatment. The steroid-related adverse events, e.g. cataract and elevated intraocular pressure, should be weighed against the benefits of the treatment. Methods: Twenty-mg triamcinolone acetonide intravitreal injections (IVTA) were applied to 110 DME...

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Effectivity of Intravitreal Triamcinolone Injections for Diabetic Cystoid Macular Edema

Persistent diffuse macular edema (ME) or cystoid ME is a result of chronic inflammation with the generalized breakdown of the inner blood retinal barrier and fluid accumulation, primarily in the outer plexiform layer. This process is characterized by the development of hard exudates and progressively lost of vision. Triamcinolone acetonide is the most effective anti-inflammatory agent. After injection into the vitreous cavity...

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Comparison of Endovitreal Triamcinolone with Betamethasone in DME

Advantages: Use of intravitreal injection of crystalline corticosteroids- bethamethasone and triamcinole dose of 4 mg in 0.1 ml allows to improve visual acuity and restore adequate morphological retinal thickness in patients with diffuse diabetic macular edema. Methods: Comparison of efficacy and safety of intravitreal injection of 4 mg (0.1 mL) triamcinolon (36 patients – 40 eyes) and 4 mg (0.1 mL) bethamethasone (60 patients...

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Fluocinolone Acetonide Implants for the Treatment of Chronic DME

Advantages: Given the chronic nature of diabetic macular edema (DME), an implant (ILUVIEN®) that releases a continuous, submicrogram daily dose of fluocinolone acetonide (FAc) could fill an unmet need for continuous long-term therapy. Methods: The Fluocinolone Acetonide in Diabetic Macular Edema (FAME) study consisted of 2 randomized, prospective, multicenter, double-masked, sham-controlled, parallel-group phase 3 trials enrolling...

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Micropulse Contiguous Grid Laser for Resistant Diffuse DME

Purpose: To investigate micropulse contiguous grid laser (MCGL) for DDME involving the fovea, and to correlate OCT findings with resolution target visual fields (RTVF) scotomas and global macular acuity (GMA). Methods: One year retrospective review of sequentially treated eyes including, OCT, FA, RTVF and NEI-VFQ 25. Results: In 56 eyes GMA improved 0.2 logMAR in 34%, with none worsening >0.3 logMAR. Central OCT decreased 173 µm+9.3....

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Effectiveness of Combined Betamethasone and Laser Coagulation for DME

Advantages: Combined treatment of diffuse diabetic macular edema using intravitreal injection of bethamethasone and laser coagulation is effective in improving visual acuity and restoration of the morphofunctional state of the retina. Methods: Intravitreal injection 4 mg (0.1 ml) of bethamethasone combined with laser coagulation was conducted in 33 patients (33 eyes) with diffused diabetic macular edema. Patients were divided into 2...

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Micropulse Laser Following Intra Vitreal Bevacizumab in Diffuse DME

Advantages: Intravitreal bevacizumab followed by laser micropulse in CSME offers a clear advantage of non-inducing a visible retinal burn and having a potential efficiency in reducing foveal thickness and visual acuity Methods: Prospective case series. One hundred and twenty cases of non-ischemic non-tractional CSME with macular thickness more than 400 microns as defined by OCT were managed by initial intravitreal bevacizumab injection...

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Micropulsed 577 nm Laser Stimulation for DME

Advantages: Laser stimulation seems to be effective, safer, non-tissue harmful and cost effective to treat diabetic macular edema. Methods: Eighty-eight eyes of 78 diabetic patients with DME were treated with yellow diode laser (577 nm) suited for micropulse treatment in macular area. ETDRS best corrected visual acuity, High definition optical coherence tomography to determine central macular thickness, Fluorescein angiography (FA) and...

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Aflibercept (VEGF Trap Eye, Eylea) for Treatment of Diabetic Macular Edema

Advantages: Aflibercept (VEGF Trap Eye, Eylea) has a longer duration of action compared to ranibizumab (Lucentis). Methods: Randomized clinical trials. Effectiveness / Safety: In a phase II trial patients with diabetic macular edema gained 9.7 letters with aflibercept every 8 weeks and 13.1 letters with aflibercept every 4 weeks.  Phase III trials, VISTA and VIVID, are underway. Take home message: Aflibercept may be an effective...

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Treatment of Diabetic Macular Edema with Ranibizumab

Advantages: Intravitreal ranibizumab improves vision of patients with diabetic macular edema. Methods: Review of recent clinical trials such as DRCR.net. Effectiveness / Safety: DRCR trials showed that in patients with diabetic macular edema, intravitreal ranibizumab with prompt or deferred focal/grid laser had superior Visual Acuity outcome compared with focal/grid laser treatment alone. Take home message: Intravitreal ranibizumab is...

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ILM Peeling in Patients with Clinically Significant DME: Long-term Outcomes

Background: Diabetic macular edema (DME) is a frequent complication of diabetic retinopathy. It is characterized to increased vascular permeability, due to blood-retinal barriers breakdown. Since macular laser treatment has shown poor efficacy to diffuse edema, surgical option of therapy is discussed. Several studies have proven the efficacy of pars plana vitrectomy (PPV) with inner limiting membrane (ILM) peeling in case of DME with a...

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Does Vitreous Surgery for Diabetes Complications Have an Influence on the Course of Macular Edema in Long-term Follow-up?

Advantages: To evaluate the influence of vitreous surgery performed for vitreous hemorrhage and traction retinal detachment (macular edema excluded) as a complication of diabetic retinopathy with or without ILM peeling on macular edema formation. Additionally to evaluate long-term spectral domain optical coherence tomography (SD-OCT) follow- up of macular structure. Methods: 101 eyes of patients, who had undergone vitrectomy were...

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PPV in Management of Type 1 Non-tractional DME After Failure of all Therapies

Advantages: PPV is a useful method in management of non-tractional, non-ischemic resistant diffuse diabetic macular edema associated with type 1 DM Methods: Type 1 Diabetic macular edema (DME) is typically managed by thermal laser, intravitreal injections and systemic control. An entity of diffuse DME persists despite all therapies. We present 5 cases of diffuse non-tractional, non-ischemic diffuse DME in type 1 DM managed by clear...

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Vitrectomy Outcome in Resistent Non-tractional Diffuse DME

Advantages: Diabetic diffuse macular edema not responding to repeated IV injctions of Anti-VEGF and/or Triamcinolone may benefit from vitrectomy and ILM peeling. Vitrectomy helps to remove factors and mediators that may play a role in production of macular edema and/or its no or poor response to IV injections. ILM peeling ensure complete relieve of traction and may stimulate retinal glial cells mainly Muller cells to reactive fibrosis and...

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Vitrectomy Outcome in Traction Diffuse DME

Advantages: In eyes with diffuse diabetic macular edema and OCT evidence of tangential and/or anteroposterior traction, Vitrectomy techniques allow complete release of traction, restoration of normal or near normal retinal architecture, and functional improvement. Methods: 65 eyes with traction diabetic diffuse macular edema underwent 23 gauge vitrectomy. All eyes underwent preoperative FA and OCT. Vitrectomy was combined with...

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Vitrectomy for DME – An Alternative to Anti-VEGF Therapy?

Advantages: Vitrectomy for diabetic macula edema (DME) is and was used as a second line treatment. Published studies about this therapy option report mainly about small numbers of patients and show heterogenous results. In these times, when ranibizumab starts to dominate the therapy of DME, we want to present the functional results of vitrectomy for DME in a larger number of treated eyes. Methods: Retrospective analysis of the...

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DME: 15 Injections or 1 Surgery?

Advantages: The first author has operated on over 600 eyes with DME in the last two decades. Surgery is typically a one-time intervention, unlike intraocular injections. Methods: Complete vitrectomy with detachment of the triamcinolone-marked posterior hyaloid face. This is followed by removal of the internal limiting membrane (ILM), stained by Indocyanine green. While pneumoretinopexy used to be employed earlier, a preoperative...

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High Systolic Blood Pressure is Related to Macular Edema in Diabetic Patients

Advantages: Systolic blood pressure control might reduce macular edema in diabetic patients. Methods: Medical records of 378 patients who were hospitalized in Asan Medical Center from November 1st, 2007 to June 1st, 2011 were reviewed retrospectively. All the patients were diagnosed as non-proliferative diabetic retinopathy and were tested with Stratus optical coherence tomography (OCT) for macular edema. Blood pressure which was checked...

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Vitreoretinal Interface Abnormalities Associated with Diffuse DME: Diagnosis and Management

Advantages: Diabetic diffuse macular edema may be associated with multiple vitreoretinal interface abnormalities as epimacular membranes, vitreomacular traction syndrome, lamellar macular hole and full thickness macular hole. Vitrectomy combined with ILM peeling is effective in dealing with interface disorders with encouraging anatomical and functional results. Methods: Vitrectomy combined with ILM peeling was used to deal with...

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Terminologic Confusion in DME

Background: Genuine confusion in the terminology of diabetic macular edema (DME) classification has existed for a long time. Only the definitions: focal versus diffuse DME and clinically significant macular edema (CSME) have been available since the ETDRS study. This is a far from satisfactory way to define many types of DME in the era of spectral OCT. Methods: OCT records of all DME cases in a university retina clinic were reviewed to...

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Design of a Comparative Study Anti-VEGF vs Surgery for DME

We will present the study-design of our prospective randomized multi-center study that will start in autumn 2012. Anti-VEGF-therapy has developed to the standard care for diabetic macular edema.  Vitrectomy is an additional treatment option that is able to stabilize DME. The pharmacokinetic effect of a vitrectomy is an increased VEGF-clearance in the eye, but also a higher clearance of intravitreally administered drugs. Consequently,...

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Multiple Therapeutical Approaches for the Same DME

Advantages: Our approaches were directed all the time to the pathogenetic causes obtaining a good functional result and reducing in this way complications and secondary effects. We present a 52 years old patient (Diabetes type I for 40 years) managed by partial PRP before first seen in February 2009 with a huge retrohyaloidal macular hemorrhage in the RE (VA < 20/200). The right eye was managed by YAG laser hyaloidotomy, 25 Ga PPV and...

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Comparative Study of Vitrectomy with ILM Peeling vs Anti-VEGF in DME

Advantages: To compare anatomic and functional results of vitrectomy with internal limiting membrane (ILM) peeling and anti- VEGF (Avastin) injection for the course of diabetic macular edema. Methods: Comparative non- randomized study of 68 eyes, of patients with diabetic macular edema. 50 eyes were treated with repeated injections of anti- VEGF (Avastin), 18 eyes had undergone vitrectomy with ILM peeling. Pre- and best-achieved...

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Severe PDR Surgical Strategy

Advantages: Management of severe proliferative diabetic retinopathy is one of the most difficult medical problems of the present time. Methods: We would like to present 10 patients between 25-60 in whom control of diabetes has been unsatisfactory.  Fundus examination, in all of cases showed the final stage of diabetic retinopathy with vitreous hemorrhage, persistent macular edema, new vascular network, huge fibro – vascular...

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Miniinvasive Vitrectomy as a Gold Standard for Severe PDR

Advantages: To examine whether 25 gauge vitrectomy might be a good approach for the treatment of severe proliferative diabetic retinopathy (PDR) and macular edema. Methods: 11 patients with severe PDR and macular edema were randomized to either 23 or 25 gauge vitrectomy. The 25 gauge vitrectomy was performed with bimanual technique, 27 gauge chandelier illumination, Tano diamond dusted scraper. 5 patients underwent 23 gauge vitrectomy...

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Clinical Outcomes of Intravitreal Bevacizumab Combined with Laser Photocoagulation as Primary Treatment of DME

Purpose: To know the clinical outcomes of intravitreal bevacizumab with laser photocoagulation as primary treatment in the diabetic macular edema. Methods: Patients who diagnosed with DME without vitreomacular traction and not underwent any other treatment were choosen to receive an intravitreal bevacizumab injection alone in 30 eyes and an intravitreal bevacizumab injection with laser photocoagulation in 31 eyes. We compared both groups....

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Intravitreal Ranibizumab Combined with Selective Laser Coagulation of Pigment Epithelium for Cystoid DME

Advantages: Selective laser coagulation of pigment epithelium (SLCPE) is effective laser procedure for treatment diffuse and focal diabetic macular edema with minimal damage of retina, but cystoid macular edema (CDME) is very torpid to different treatment modalities, and the majority of authors prefer grid laser for its treatment. We suggested that previous intravitreal ranibizumab (0.5 mg) will create conditions for effective SLCPE in...

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Determination of Ischemic Diabetic Maculopathy According to SOCT Data

Advantages: To develop the coefficient of ischemia in order to characterize pathological changes of retinal architectonics in microvascular occlusion in ischemic diabetic maculopathy according to non invasive method spectral optical coherence tomography in comparison to non ischemic retina without usage of fluorescent angiography. Methods: There were 25 eyes (18 patients) with diabetic macular ischemia to which along with general clinical...

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Clinical Outcomes of Ultrahigh-speed 23 G with Duty Cycle Control System in the Treatment of PDR Complicated by Tractional RD

Clinical Outcomes of Ultrahigh-speed 23 G with Duty Cycle Control System in the Treatment of PDR Complicated by Tractional RD Jung Ho Lee Advantages:          Dealing with vitreous of detached retina with fibrovascular proliferation and traction complicated by proliferative diabetic retinopathy is a challenge. A higher cutter rate may minimize vitreous turbulence by allowing only small bits of vitreous to enter the port,...

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Correlation Between Subfoveal Chroidal Thickness and Stage of Diabetic Retinopathy

Correlation Between Subfoveal Chroidal Thickness and Stage of Diabetic Retinopathy Jee Taek Kim Advantages: This study demonstrates differences in choroidal thickness according to DMR stage and DME type. Methods: Medical records of patients who were diagnosed with diabetic retinopathy between March and October 2011 were reviewed, retrospectively. Choroidal thickness was measured using enhanced-depth imaging optical coherence...

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Effect of Doxium on High Sensitivity CRP and Endothelin-1 Serum Levels in Patients with Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is a highly specific vascular complication of type 1 and type 2 diabetes mellitus. Calcium dobesilate (CD) or Doxium has been tested in the treatment of diabetic retinopathy showing a slowdown of the progression of the disease after long-term oral treatment, as a potent antioxidant. Endothelin-1 (ET-1) besides being a very potent vasoconstrictor, acts as a mitogen on the vascular smooth muscle and...

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Can Serous Macular Detachment Help to Predict the Types of Maculopathy and the Severity of Retinopathy in Diabetic Patients?

Advantages: To search the importance of serous macular detachment (SMD) to predict the types of maculopathy and the severity of retinopathy in diabetic patients. Methods: 189 patients with retinopathy and clinically significant macular edema were included. Patients were grouped as SMD + (group I, n: 107) and SMD – (group II, n: 82) in optical coherence tomography (OCT). Fundus fluorescein angiographic (FA) findings were evaluated...

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Assessment of Angiographic Findings of Diabetic Patients Who Underwent PPV for ERM or Taut Posterior Hyaloid

Advantages: To analyse the angiographic findings of diabetic patients who underwent pars plana vitrectomy for epimacular membrane or taut posterior hyaloid (TPH). Methods: Patients were grouped according to the presence of taut posterior hyaloid or ERM. Preoperative and postoperative angiographic, optical coherence tomography and visual acuity findings were compared in between groups. Arm to retinal circulation, arteriovenous transit...

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PPV for Treatment of Diffuse Non Tractional DME

Purpose: To evaluate the anatomical and functional results of Pars Plana Vitrectomy (PPV), Intravitreal Triamcinolone (IVT) with or without Internal Limiting Membrane (ILM) peeling in the treatment of diffuse non tractional Diabetic Macular Edema (DME). Methods: A total of 11 eyes (9 patients), those underwent primary vitrectomy with or without ILM peeling, during the past 2 years, were included in this study. Best Corrected Visual...

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Intravitreal Bevacizumab Injection Alone or Combined with Triamcinolone vs Macular Photocoagulation as Primary Treatment of DME

Purpose: To report the efficacy of a single intravitreal bevacizumab injection alone or in combination with intravitreal triamcinolone acetonide versus macular laser photocoagulation as primary treatment of diabetic macular edema. Methods:   72 eyes of 40 patients with clinically significant DME and no previous treatment were enrolled. The eyes were randomly assigned to one of three study arms: the intravitreal bevacizumab (IVB) group,...

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Combined Cataract Surgery and Intravitreal Ranibizumab in Preventing Postoperative ME in Non-proliferative Diabetic Retinopathy

Purpose: To evaluate the role of intravitreal ranibizumab, injected at the time of cataract surgery on the progression of postoperative diabetic macula edema (PME) in non-proliferative diabetic retinopathy (NPDR). Setting: Multi-center, prospective randomized study. Methods: 80 Patients with NPDR and cataract were randomized to 40 only cataract surgery (Sham group) or 40-cataract surgery plus intraoperative ranibizumab injection...

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Enhanced Depth Imaging OCT of the Choroid in DME

Enhanced Depth Imaging OCT of the Choroid in DME Francisco J. Ascaso Advantages: The choroidal thickness in patients with diabetic macular edema (DME) compared with that in healthy controls let us know the true role of choroids in DME. Methods: Twelve eyes of 9 patients with DME (65.5 ±8.4 years), 9 contralateral eyes without DME (60.2 ±13.7 years), and 186 eyes of 96 age-matched healthy volunteers (62.1 ±19.4 years) underwent enhanced...

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Preoperative Intravitreal Bevacizumab in Diabetic Tractional Retinal Detachment

Satyen Deka, H Bhattacharjee, H Deka, M J Barman, R Saibum, S M Das (Guwahati, India) Advantages: Preoperative intravitreal bevacizumab in diabetic tractional retinal detachment (TRD) facilitates surgery, decreases the intraoperative bleeding and improves the visual acuity. Methods: In this non comparative interventional case series 10 eyes of 8 candidate diabetic TRD patients received 1.25 mg intravitreal off level bevacizumab 2-7 days...

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Techniques and Results of En Bloc Perfluorodissection for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy

Shaheeda Mohamed*, Tsang Chi Wai (Hong Kong, China) Advantages: Retinal stability during hyaloid removal, better visualization of structures, assists dissection of fibrous membranes, facilitates endolaser of stabilised retina under tamponade, limits and confines blood. Methods: Prospective interventional case series of 13 eyes with tractional retinal detachment using en bloc perfluorocarbon dissection technique. Videos will be...

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Four in One 25 G Vitreoretinal Surgery in Advanced Proliferative Diabetic Retinopathy Treatment

Kh.P. Takhchidi, S.S. Tillyakhodzhaev, A.A. Gorin, A.N. Bessarabov (Moscow, Russia) Surgical treatment of proliferative diabetic retinopathy (PDR) using 25-Ga technology requires the employment of special instruments for epiretinal membrane peeling and dissection of fibro-vascular proliferations – endovitreal spatula, forceps and scissors, but this technique has a lot of disadvantages. The change of instruments requires the...

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Analgesic Effect of Topical Sodium Diclofenac During Retinal Photocoagulation for Diabetic Retinopathy; A Randomized Double-masked Placebo-controlled Crossover Clinical Trial

Alireza Ramezani, Morteza Entezari, Mohammad Mehdi Shahbazi, Yosef Semnani, Zhaleh Rajavi, Hossein Mohammad Rabie, Mehdi Yaseri (Tehran, Iran) Advantages: To evaluate the analgesic effect of topical sodium diclofenac 0.1% during retinal laser photocoagulation for diabetic retinopathy. Methods: In a randomized placebo-controlled intraindividual two-period crossover clinical trial, patients with diabetic retinopathy candidate for peripheral...

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Glycemic Control and Macular Thickness in Diabetic Patients

Angela VP Loo, YH Yew, S Menon (Kuala Lumpur, Malaysia) Purpose: To measure macular thickness and volume in diabetic patients with High Definition Optical Coherence Tomography (HD-OCT) and to assess their relationship with the respective glycosylated hemoglobin level (HbA1c). Methods: This was a cross sectional, observational study where 165 eyes in 165 diabetic patients with increased macular thickness regardless of diabetic retinopathy...

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The Dependence of Post-operative Visual Acuity on the Pre-operative State of Patients Operated for Complicated Diabetic Retinopathy

M. Zavorkova, L. Prochazkova, T. Benda (Usti nad Labem, Czech Republic) Advantages: Pars plana vitrectomy (PPV) helped us to resolve complications of diabetic retinopathy (DR) including tractional retinal detachment. Methods: Authors report the results of surgical interventions, performed between 2004-2009 to handle various complications of DR at the Department of Ophthalmology, Masaryk Hospital in Ústi nad Labem. PPV was performed in 106...

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Micropulse Contiguous Grid Laser in Eyes with Diffuse Macular Edema Due to Diabetic Retinopathy

SH Sinclair (Drexel Univ School Med), B Parvus (Pennsylvania College of Osteopathic Medicine), L Lofdahl (Salus University), P Presti (Georgia Institute of Technology, Atlanta) Objective: To investigate micropulse contiguous grid laser in the treatment of eyes with diffuse diabetic macular edema (DDME) involving the fovea, resistant to prior treatment and second, to correlate OCT findings with central discriminant visual fields...

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Article – Vitrectomy In Diabetic Retinopathy

Vitrectomy In Diabetic Retinopathy Hospital Geral de Santo António. Porto, Portugal Vitrectomy In Diabetic Retinopathy Ferreira N, Pessoa B, Macedo M, Queirós P, Meireles A Hospital Geral de Santo António. Porto, Portugal Background Diabetic retinopathy is a vascular retinal disease. Prolonged hyperglycaemia in diabetes can result in increased permeability and progressive occlusion of retinal vessels. These alterations may lead...

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Congress – Optical Coherence Tomography as a Screening Method for Diabetic Macular Edema

SYMPOSIUM:MACULOPATHIES Moderator: Ferenc Kuhn Monday, June 20, 2005 Optical coherence tomography (OCT) as a screening method for diabetic macular edema Author: M. Sydorova, R. Skripnik Abstract Purpose: This study aimed to reveal early macular thickening using optical coherence tomography (OCT) measurements in diabetic patients. Methods: We investigated 15 eyes from 8 patients with diabetes but no ophthalmoscopic evidence of...

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Surgical Removal and Analysis of Subfoveal Hard Exudate in Diabetic Retinopathy

http://www.evrs.eu/medias/2010/congress/Non-Proliferative-Diabetic-Maculopathies.flv Oh Kwon, Yongsung You (Seoul, South Korea) Purpose: To study the effect of surgical removal and the lipid composition of subfoveal hard exudates in diabetic retinopathy. Material and Methods: Retrospective study was done in consecutive 7 case series with dense subfoveal large hard exudates (> 1 DA) in diabetic retinopathy, which were surgically...

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