Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients

AIM: To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography(OCT) foveal thickness and multifocal electroretinogram(MF-ERG) parameters.METHODS: The study included two groups. Group 1 included 50 diabetic patients with senile cataract(50 eyes, 30 females, 20 males, aged 55±7 y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract(50 eyes, 22 female, 28 males, aged 53.8±8 y) did not receive nepafenac. All patients were followed up for 3 mo postoperatively. OCT and MF-ERG were done preoperative and at 1 wk, 1, 2 and 3 mo.RESULTS: The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema(CMO)(10%), and no patients in Group 1 developed central macular thickening more than 50 μm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. CONCLUSION: Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.

Beneficial effects of vincamine with thioctic acid and lutein on retinal and optic nerve functions in an opaque media

AIM: To detect whether the combination of vincamine, thioctic acid and lutein will improve the retina and optic nerve functions in cases of an opaque media with an optic nerve and/or a retinal defect or not.METHODS: Totally 2000 patients(2000 eyes) of corneal opacities with defects in the optic nerve or/and the retinal functions were studied. Every patient received three types of drugs: thioctic acid with cyanocobalamine, vincamine, and lutein. The drugs were given daily for 3-12 mo according to patient’s responses. Full field flash electroretinogram(ERG) and flash visual evoked potential(VEP) were done before treatment and at 1, 3, 6, and 12 mo sequentially. Patients were followed up for 12 mo.RESULTS: In the 2000 eyes, 1000 eyes had both moderate optic nerve and retinal function defects;and 840 eyes out of the 1000 improved with the medical treatment. Another 500 eyes out of the 2000 eyes had extinguished retinal function with normal optic nerve function and only 125 eyes of them improved. The 290 out of the 2000 eyes had severe defects in optic nerve with normal retinal function and 130 of them improved. Another 210 eyes have mild optic nerve and retinal function defects and 194 improved.CONCLUSION: The combination of vincamine, thioctic acid with cyanocobalamine, and lutein improved both retina and optic nerve functions mainly in mild and moderate defect than in severe cases.

Collagen crosslinking with photoactivated riboflavin in advanced infectious keratitis with corneal melting: Electrophysiological Study

AIM: To assess the effect of photoactivated chromophore for keratitis crosslinking(PACK-CXL) in case of severe keratitis with melting on the electrophysiological function of the retina and the optic nerve.METHODS: The study included 32 eyes of 32 patients with smear positive severe infectious keratitis with corneal melting. The patients were randomly divided into two groups. Group I(control group) included 16 eyes received systemic and topical antimicrobial drugs guarded by culture and sensitivity test. Group II underwent CXL and then continued their antimicrobial treatment. Full field electroretinogram(ERG) and flash visual evoked potential(VEP) were done for each patient in both groups basically and then 1 wk, 1 and 3 mo post-treatment to assess the changes in the electrophysiological function of the retina and optic nerve.RESULTS: Healing of 10 eyes in group I in comparison to 14 eyes in group II was recorded. The mean duration of healing was 36.56±5.21 d in group I vs 20.2±4.4 d in group II(P<0.005). In group II, ERG showed an insignificant reduction of all parameters of ERG and VEP after CXL. The amplitude of scotopic rod response, oscillatory potential amplitude, flicker amplitude and photopic cone response were insignificantly decreased(P=0.4, 0.8, 0.1, and 0.3 respectively). There were insignificant prolongation of latencies of scotopic rod, oscillatory potential, flicker and photopic cone response(P=0.2, 0.7, 0.5 and 0.1). There was slight delay in latency of VEP without a significant reduction in amplitude.CONCLUSION: CXL is an effective technique in treatment of severe infectious keratitis with melting as it halts the melting process with acceptable safety on the retinal and optic nerve function.