Neovascular Glaucoma Associated with Chronic Rhegmatogenous Retinal Detachment

Background To demonstrate the clinical features and natural course of chronic retinal detachment associated neovascular glaucoma. Methods Ten patients, diagnosed with chronic retinal detachment-associated neovascular glaucoma during 2007-2016 were retrospectively investigated. Besides chronic retinal detachment, no patients had any neovascular glaucoma-predisposing conditions, such as carotid artery disease. Retinal perfusion status was evaluated from postoperative visual acuity, intraocular pressures, ocular examination findings, and fluorescein angiography images. Results The mean age of patients was 57.5 (range: 22-78) years. Complete retinal reattachment was achieved in 3 eyes, while partial or total chronic retinal detachment persisted in 7 eyes. Wide-angle fundus fluorescein angiography revealed peripheral retinal capillary obstruction and severe non-perfusion. Neovascular glaucoma developed 213.4 months (17-634 months) after retinal detachment. Three eyes received Ahmed valve implantation, while 5 eyes received intravitreal bevacizumab injection. Intraocular pressure was controlled in 10 eyes. Two eyes developed phthisis bulbi during follow-up. Conclusions In eyes with a chronic retinal detachment history, iris neovascularization and neovascular glaucoma can develop due to retinal capillary obstruction and chronic retinal ischemia, even after achieving retinal reattachment. We suggest routine follow-up examinations for patients with chronic retinal detachment, particularly for eyes with retinal non-perfusion, as detected on fundus fluorescein angiography.

Eales’ disease: epidemiology, diagnostic and therapeutic concepts

Background To describe the epidemiological traits, clinical characteristics, diagnostic procedures, therapeutic interventions and evolution in a large series of patients with diagnosis of Eales’ disease. Methods A clinical retrospective review of patients with Eales’ disease, evaluated and treated between April 2009 and April 2018, with a 1-year minimum follow-up. Thirty patients (59 eyes), were included. Age, sex, laboratory results (CBC, glycemia, protein electrophoresis, ACE levels) immunological profile and a Quantiferon-TB Gold Plus test were recorded. The patients were divided into groups according to their evolution, medical or surgical treatment, and visual outcomes. Results Seventeen male patients and 13 female patients were included, and their ages ranged from 14 to 35 years. The Quantiferon-TB Gold Plus test was positive in 25 patients. Twenty-eight patients had unilateral vitreous hemorrhage, 10 of whom presented with vasculitis and non-perfusion areas in the contralateral eye, 9 presented contralateral peripheral neovascularization and 9 had contralateral fibrovascular proliferation. The remaining 2 patients presented with a rhegmatogenous retinal detachment. In 6 patients, conservative treatment with intravitreal anti-VEGF injections and photocoagulation was performed after the hemorrhage cleared. Twenty-two patients, required vitrectomy, with good visual outcomes. Macular edema was found in 16 eyes, which responded to periocular and/or systemic corticosteroid therapy, except for 9 eyes that required intravitreal bevacizumab, with complete resolution in 7 eyes and partial resolution in 2 eyes. Conclusions Eales’ disease is a pathology of significant prevalence in our country. The distribution according to sex, tends to be equivalent. The etiology, even when it is not specifically determined, according to laboratory tests, confirms the probable immunologic response in the presence of Mycobacterium tuberculosis antigens. This is still a diagnosis of exclusion, and therefore, it is advisable to perform a complete laboratory work-up in each case. Timely application of laser and other medical treatments, help to avoid progression to more advanced stages and their complications. The surgical treatment of vitrectomy for vitreous hemorrhage, and/or tractional vitreous detachment yields good primary anatomical and functional outcomes. Secondary macular edema responds to periocular and intravitreal corticosteroids, and in refractory cases, the use of anti-VEGF therapy leads to an effective resolution.

EFFECTS OF UNILATERAL INTRAVITREAL BEVACIZUMAB ON THE CONTRALATERAL EYE HAVING DIABETIC MACULAR EDEMA

Objective: To investigate the effect of unilateral intravitreal Bevacizumab on contralateral eye in bilateral diabetic macular edema. Study Design: Quasi-experimental study. Place and Duration of Study: Retina Department of Al-Shifa Trust Eye Hospital, Rawalpindi, from Sep to Dec 2020. Methodology: Thirty-two patients were enrolled with consecutive sampling. All the patients had clinically diagnosed diabetic macular edema having >275µm macular thickness on OCT. They were injected with 1.25mg/0.05mL of Bevacizumab in one eye. Baseline macular thickness was compared with 4 weeks follow up macular thickness, using Optical Coherence Tomography. Results: The central macular thickness in the untreated eye at baseline was 396.97 ± 29.79 µm and 388.34 ± 30.06 µm at 4 weeks (p-value=0.001). The difference in central macular thickness in treated and untreated eyes were 28.44 ± 4.11 µm and 19.81 ± 5.31 µm respectively (p-value = 0.001). There were statistically significant differences between these measurements. Conclusion: Injecting Bevacizumab in one eye for diabetic macular edema has statistically significant effect on the contralateral non-injected eye macular thickness.

The Effects of Intravitreal Agents on Systemic Vascular Diseases in Patients with Diabetic Retinopathy

Purpose: To assess the risk for cerebrovascular desease (CVD) and coronary artery disease (CAD) in diabetic patients who were treated with intravitreal anti-VEGF agents and compare the rates of CVD and CAD with diabetic controls. Methods: A retrospective chart review of diabetic patients was performed. The need for intravitreal injection and type of agent were noted. If clinically significant or center-involving diabetic macular edema (DME) were determined, intravitreal anti-VEGF agents were used. The CVD and/or CAD occurred within 6 months of the intravitreal injection were accepted as the main outcomes of the study. The records of diabetic patients who were followed up but not needed intravitreal injections were accepted as the control group of the study. Comparisons between these groups were performed.Results: The number of patients enrolled in the study was 9751 (5243 female, 4508 male patients). Of these patients, 1261 patients were received various intravitreal injections. Patients who had CVD history were divided into two groups according to whether they received intravitreal injection or not. There was statistically significant difference between these groups in terms of CVD history (p<0,001). There was statistically significant difference in the hazard of CVD between different anti-VEGF treatments (p<0,001). Patients who had CAD history were divided into two groups according to whether they received intravitreal injection or not. There was no statistically significant difference between these groups in terms of CAD history (p=0,31). Discussion: The risk for CVD was seen to increase with the intravitreal anti-VEGF treatment in diabetic patients. The rate of CVD was higher in patients who received intravitreal bevacizumab treatment.

Evaluation of Ellipsoid Zone Changes in Different Types of Diabetic Macular Edema After Intravitreal Bevacizumab Injection

Purpose: To evaluate the ellipsoid zone (EZ) changes according to the types of diabetic macular edema (DME) on optical coherence tomography (OCT) after intravitreal bevacizumab injection. Methods: In this retrospective study, medical records of the patients who had treatment-naive DME and underwent intravitreal bevacizumab treatment between January 2015 and December 2021 were analyzed. Patients who meet the inclusion criteria and completed the follow-up period of 12 months were divided into 4 groups according to the types of diabetic macular edema on OCT (Diffuse DME [Group-1], cystoid DME [Group-2], diffuse DME with serous retinal detachment (SRD) [Group-3] and cystoid DME with SRD [Group-4]). Primary outcomes were EZ changes between the groups.Results: 125 eyes of 96 patients who fulfilled the inclusion criteria and completed the follow-up period were included in the study. There were no statistically significant differences in EZ improvements between the groups at 4, 6 and 12 months after treatment (p =0,594, p=0,836, p=0,486, p=0,748 respectively). The mean logMAR BCVA and CMT of all eyes showed significant improvement at 4, 6 and 12 months. When the mean CMT was compared between each groups, there were significant differences between the Group-1and Group-4 at 4, 6 and 12 months after treatment. (p<0,05)Conclusion: The BCVA gains and improvement in the CMT were maintained in all four DME types during the first year of intravitreal bevacizumab therapy. The improvement in EZ disruption was not depent on the type of DME and improved similarly in all groups.

Refractive Outcomes of Patients Treated for Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is a disease where the blood vessels in the eye fail to develop appropriately in infants born prematurely. Two effective treatments for ROP include laser photocoagulation therapy and intravitreal bevacizumab (IVB). Laser therapy has been linked to causing high myopia in children post-treatment. We hypothesize that patients treated with IVB alone or in combination with laser will have less myopia development than patients treated with laser therapy alone. Methods: Patient demographics, treatment details, refractive data at 6-9 months and 3-4 years, the occurrence of strabismus at 3 years, and the most recent vision data were collected from 133 ROP patients. Patients not treated at IU health and those lost to follow-up, or deceased before both eye exams, were excluded from the study. Quantitative analysis was used to compare the refractive error, strabismus, and vision outcomes between the three treatment groups. A linear regression model was used to analyze the relationship between the number of laser spots applied and refractive error. Results: Refractive outcomes at 6-9 months and 3-4 years, occurrence of strabismus, and vision outcomes were statistically similar between the three treatment groups. However, the laser group had the most occurrences of high myopia. We also observed a 0.002 unit decrease in refractive error, reported at 6–9-months, with each laser spot applied (p<0.001). This may be due to the influence of outliers because no significant relationship was seen at the 3–4 year exam. Conclusion and Potential Impact: There was no difference in outcomes among patients treated with IVB, laser, or a combination of both, with the exception of more myopic outliers in the laser-only group. We can therefore assume that ROP patients who have received one of these three treatments had developed differences in myopia independent of treatment modality.

Effect of intravitreal bevacizumab for retinopathy of prematurity on weight gain

Purpose To evaluate the short-term effect on body weight (BW) gain after intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP). Methods This was a retrospective 1:1 matched case-control study. Infants with ROP treated by IVB or photocoagulation (PC) at Shiga University of Medical Science Hospital between April 2010 and December 2019 were included in the study. To match BWs at treatment between the IVB and PC groups, 1:1 matching for BWs at treatment within 100 g was performed. The BW gains for the 7 days before treatment (pre-treatment week), the 7 days after treatment (first post-treatment week), and the period from 7 to 14 days after treatment (second post-treatment week) were compared between the IVB and PC groups. Results Following 1:1 matching, 13 infants in both groups were enrolled in the analysis. The weekly BW gain for the first post-treatment week was significantly lower in the IVB group compared with the PC group (86 g vs. 145 g; P = 0.046), whereas the weekly BW gains for the pre-treatment week (173 g vs. 159 g; P = 0.71) and the second post-treatment week (154 g vs. 152 g; P = 0.73) were comparable between the two groups. The short-term inhibitive effect of IVB on BW gain was particularly observed in infants weighing less than 1500 g at treatment (<1500 g: 47 g vs. ≥1500 g: 132 g; P = 0.03). Conclusion IVB could have a short-term inhibitive effect on BW gain in infants with ROP, and this effect is more likely to occur in infants with a lower BW at the time of treatment.