Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyalo...Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyaloid and have been refractory to standard laser treatment. Methods: Review of 26 eyes of 20 patients consecutively were treated with PPV with ILM peel for refractory diabetic macular edema. Eyes were included if they had been unresponsive to conventional treatment defined as at least two focal laser applications by a retina specialist. Paired t- testing was performed to determine if a change in both optical coherence tomography (OCT)-Measured retinal thickness and logarithm of the minimum angle of resolution (logMAR) visual acuity occurred prior to and following PPV with epiretinal membrane vitrectomy. In addition, we performed multivariate regression analysis to determine if any clinical variables predicted a change in visual acuity. Results: The mean age in the sample was 65 years (range 29- 81 years). The mean follow-up time was 242 days (range35- 939). Sixteen of the 26 eyes were phakic and the remaining ten were pseudophakic. There was a statistically significant improvement of mean visual acuity from a preoperative logMAR vision of 1.0 to a best postoperative vision of 0.75 (P=0.016, paired t-test). Thirteen (50% ) of the 26 eyes gained at least two lines of best-corrected Snellen acuity, three (11.5% ) had a decline of at least two lines, and ten (38.5% ) showed stable visual acuity. Regression analysis demonstrated that baseline worse visual acuity was the only clinical variable that was associated with improvement in visual acuity (beta=0.602, P=0.016; R2=28.7). Fourteen eyes had preoperative and postoperative OCT. Thirteen eyes (93% )-had a significant decrease in foveal thickness; with an average preoperative thickness of 575 μ m compared to a postoperative average of 311 μ m (t=3.65, P=0.002). No surgical complications were observed during the follow-up period. Conclusions: Surgery for refractory diabetic edema without a taut hyaloid is associated with a significant improvement in visual acuity and diminution of retinal thickness as measured by OCT. Further investigations are warranted to define the role of surgery in the management of persistent diabeticmacular edema.展开更多
Objective: To investigate the penetration of 0.5% moxifloxacin hydrochloride into the aqueous and vitreous after topical administration in humans. Methods: A prospective, nonrandomized study of 20 patients scheduled f...Objective: To investigate the penetration of 0.5% moxifloxacin hydrochloride into the aqueous and vitreous after topical administration in humans. Methods: A prospective, nonrandomized study of 20 patients scheduled for vitrectomy surgery between September 1 and December 31, 2003. Aqueous and vitreous samples were obtained and analyzed after topical administration of 0.5% moxifloxacin hydrochloride, every 2 hours (q2h) or every 6 hours (q6h), for 3 days before surgery. Assays were performed using high-performance liquid chromatography. Results: Mean± SD moxifloxacin concentrations in the q2h group for the aqueous (n=9) and vitreous (n=10) were 2.28± 1.23 and 0.11± 0.05 μ g/mL, respectively. Mean± SD moxifloxacin concentrations in the q6h group for the aqueous (n=10) and vitreous (n=9) were 0.88± 0.88 and 0.06 ± 0.06 μ g/mL, respectively. The minimum inhibitory concentration for 90% of isolates (MIC90) was far exceeded in the aqueous for a wide spectrum of key pathogens, whereas it was not exceeded in the vitreous for several organisms. However, the minimum inhibitory concentration for 50% of the isolates was exceeded in the q2h vitreous group for Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Bacillus cereus, and other gram-negative pathogens. Conclusions: The Endophthalmitis Vitrectomy Study revealed that 94.2% of isolates from postoperative endophthalmitis are gram-positive pathogens. Moxifloxacin has a spectrum of coverage that appropriately encompasses the most common organisms in endophthalmitis. The pharmacokinetic findings of this investigation show that relatively high aqueous levels can be achieved after topical administration. Further studies will help define the precise role of 0.5% moxifloxacin ophthalmic solution in the treatment of or prophylaxis against intraocular infections.展开更多
To report the results of treating juxtafoveal choroidal neovascularization with photodynamic therapy using verteporfin in eyes with age-related macular degeneration. Seven patients with predominantly classic juxtafove...To report the results of treating juxtafoveal choroidal neovascularization with photodynamic therapy using verteporfin in eyes with age-related macular degeneration. Seven patients with predominantly classic juxtafoveal choroidal neovascularization were treated by photodynamic therapy using verteporfin. Three of the 7 patients had a gain in visual acuity and 2 had a stabilization of vision. The remaining 2 patients had a decrease in visual acuity. Subfoveal extension of the choroidal neovascularization was not observed in any patient and all choroidal neovascularization lesions after treatment were found to be nonperfused on fluorescein angiography. The encouraging results based on this small pilot study suggest that photodynamic therapy should be considered for treatment of select juxtafoveal choroidal neovascularization due to age-related macular degeneration.展开更多
文摘Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyaloid and have been refractory to standard laser treatment. Methods: Review of 26 eyes of 20 patients consecutively were treated with PPV with ILM peel for refractory diabetic macular edema. Eyes were included if they had been unresponsive to conventional treatment defined as at least two focal laser applications by a retina specialist. Paired t- testing was performed to determine if a change in both optical coherence tomography (OCT)-Measured retinal thickness and logarithm of the minimum angle of resolution (logMAR) visual acuity occurred prior to and following PPV with epiretinal membrane vitrectomy. In addition, we performed multivariate regression analysis to determine if any clinical variables predicted a change in visual acuity. Results: The mean age in the sample was 65 years (range 29- 81 years). The mean follow-up time was 242 days (range35- 939). Sixteen of the 26 eyes were phakic and the remaining ten were pseudophakic. There was a statistically significant improvement of mean visual acuity from a preoperative logMAR vision of 1.0 to a best postoperative vision of 0.75 (P=0.016, paired t-test). Thirteen (50% ) of the 26 eyes gained at least two lines of best-corrected Snellen acuity, three (11.5% ) had a decline of at least two lines, and ten (38.5% ) showed stable visual acuity. Regression analysis demonstrated that baseline worse visual acuity was the only clinical variable that was associated with improvement in visual acuity (beta=0.602, P=0.016; R2=28.7). Fourteen eyes had preoperative and postoperative OCT. Thirteen eyes (93% )-had a significant decrease in foveal thickness; with an average preoperative thickness of 575 μ m compared to a postoperative average of 311 μ m (t=3.65, P=0.002). No surgical complications were observed during the follow-up period. Conclusions: Surgery for refractory diabetic edema without a taut hyaloid is associated with a significant improvement in visual acuity and diminution of retinal thickness as measured by OCT. Further investigations are warranted to define the role of surgery in the management of persistent diabeticmacular edema.
文摘Objective: To investigate the penetration of 0.5% moxifloxacin hydrochloride into the aqueous and vitreous after topical administration in humans. Methods: A prospective, nonrandomized study of 20 patients scheduled for vitrectomy surgery between September 1 and December 31, 2003. Aqueous and vitreous samples were obtained and analyzed after topical administration of 0.5% moxifloxacin hydrochloride, every 2 hours (q2h) or every 6 hours (q6h), for 3 days before surgery. Assays were performed using high-performance liquid chromatography. Results: Mean± SD moxifloxacin concentrations in the q2h group for the aqueous (n=9) and vitreous (n=10) were 2.28± 1.23 and 0.11± 0.05 μ g/mL, respectively. Mean± SD moxifloxacin concentrations in the q6h group for the aqueous (n=10) and vitreous (n=9) were 0.88± 0.88 and 0.06 ± 0.06 μ g/mL, respectively. The minimum inhibitory concentration for 90% of isolates (MIC90) was far exceeded in the aqueous for a wide spectrum of key pathogens, whereas it was not exceeded in the vitreous for several organisms. However, the minimum inhibitory concentration for 50% of the isolates was exceeded in the q2h vitreous group for Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Bacillus cereus, and other gram-negative pathogens. Conclusions: The Endophthalmitis Vitrectomy Study revealed that 94.2% of isolates from postoperative endophthalmitis are gram-positive pathogens. Moxifloxacin has a spectrum of coverage that appropriately encompasses the most common organisms in endophthalmitis. The pharmacokinetic findings of this investigation show that relatively high aqueous levels can be achieved after topical administration. Further studies will help define the precise role of 0.5% moxifloxacin ophthalmic solution in the treatment of or prophylaxis against intraocular infections.
文摘To report the results of treating juxtafoveal choroidal neovascularization with photodynamic therapy using verteporfin in eyes with age-related macular degeneration. Seven patients with predominantly classic juxtafoveal choroidal neovascularization were treated by photodynamic therapy using verteporfin. Three of the 7 patients had a gain in visual acuity and 2 had a stabilization of vision. The remaining 2 patients had a decrease in visual acuity. Subfoveal extension of the choroidal neovascularization was not observed in any patient and all choroidal neovascularization lesions after treatment were found to be nonperfused on fluorescein angiography. The encouraging results based on this small pilot study suggest that photodynamic therapy should be considered for treatment of select juxtafoveal choroidal neovascularization due to age-related macular degeneration.
