Complications of intravitreal triamcinolone acetonide for macular edema and predictive factors for intraocular pressure elevation

AIM: To investigate the complications of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema, and to determine the risk factors for intraocular pressure (IOP) elevation. METHODS: Charts of patients with macular edema secondary to branch retinal vein occlusion (BRVO), diabetic retinopathy and uveitis who had received IVTA injections were reviewed to document its complications. IOP elevation was defined as a pressure of ≥24mmHg at some point during follow-up. Multivariate logistic regression analysis was performed to characterize baseline risk factors for this elevation. RESULTS: The study included 111 eyes of 65 female and 46 male patients with a mean follow-up of (11.6±5.1) months. Of the 111 eyes, 52 (46.8%) had macular edema secondary to BRVO, 44 (39.6%) had clinically significant diabetic macular edema (CSDME) and 15 (13.5%) had non-infectious uveitis with macular edema. IOP was recorded ≥24mmHg in 38 eyes (34.2%) during the follow-up. Higher baseline IOP (P =0.022), younger age (P =0.003), and male gender (P = 0.014) were significant risk factors for IOP elevation after IVTA injection. Eyes with prior vitrectomy were less likely to have IOP elevation (P =0.054). Two eyes (5.2% of eyes with increased IOP) underwent trabeculectomy, and 9 eyes (16.3% of the phakic eyes) necessitated cataract surgery. Other complications included branch vein occlusion (1.8%), sterile endophthalmitis (0.9%) and pseudohypopyon (0.9%). CONCLUSION: IVTA has side effects with IOP elevation and cataract formation being the two most common. A subset of patients is more prone to developing increased IOP following IVTA, namely, younger male patients with higher baseline IOP.

Appreciation letter from Dr.Pinar Kosekahya from Turkey the lcuky recipient of the IJO 2022 funds

To Dear Prof.Xiu-Wen Hu International Journal of Ophthalmology Press,China I am Dr.Pinar Kosekahya from Ankara,Turkey.I wanted to personally thank you and the organization you represent,for sponsoring me in an IOFF-Subspeciality Fellowship.I am very grateful for this opportunity and I want you to know that I will not take it for granted.Once I was accepted into the International Ophthalmology Fellowship Foundation,I became overwhelmed with excitement.My country was in an economic crisis due to Covid-19 pandemic and I was very worried that I would miss this chance if I can not get a sponsorship.I was extremely happy when dear Cordula informed me about my Educational Grant.

Appreciation letter from Dr. Pinar Kosekahya from Turkey the lcuky recipient of the IJO 2022 funds

ToDearProf.Xiu-Wen Hu International Journal of Ophthalmology Press,China I am Dr.Pinar Kosekahya from Ankara,Turkey.I wanted to personally thank you and the organization you represent,for sponsoring me in an IOFF-Subspeciality Fellowship.I am very grateful for this opportunity and I want you to know that I will not take it for granted.Once I was accepted into the International Ophthalmology Fellowship Foundation,I became overwhelmed with excitement.My country was in an economic crisis due to Covid-19 pandemic and I was very worried that I would miss this chance if I can not get a sponsorship.I was extremely happy when dear Cordula informed me about my Educational Grant.

Cataract in diabetes mellitus

Diabetes mellitus (DM) is a chronic systemic disease that has increases in prevalence over time. DM can affect all ocular structures, with cataract being the most common ocular complication. Cataract is the leading cause of blindness worldwide. Due to several mechanisms, there is an increased incidence of cataract formation in the diabetic population. Advancements in technology have now made cataract surgery a common and safe procedure. However, the diabetic population is still at risk of vision-threatening complications, such as diabetic macular edema (ME), postoperative ME, diabetic retinopathy progression, and posterior capsular opacification.

Short-term effects of intravitreal triamcinolone acetonide injection on ocular blood flow evaluated with color Doppler ultrasonography

AIM:To evaluate the changes in ocular blood flow with color Doppler ultrasonography(CDU) after intravitreal triamcinolone acetonide(IVTA) injection.METHODS:A total of 46 patients who underwent IVTA(4 mg/0.1 mL) injection for diabetic macular edema(DME)(n =22), central retinal vein occlusion(CRVO)(n =12) and choroidal neovascular membrane(CNVM)(n =12) were included in the study. Peak systolic velocity(PSV), end diastolic velocity(EDV) and resistivity index(RI) were measured from the ophthalmic artery(OA), the central retinal artery(CRA) and the posterior ciliary artery(PCA)of each patient with CDU before, at the end of the first week and at the end of the first month following IVTA injection.RESULTS:In the DME group, PSV of OA at the first of the first month(mean ±SD)(37.48 ±10.87 cm/s) increased compared to pre-injection value(31.39 ±10.84 cm/s)(P =0.048). There was a statistically significant decrease(P =0.049) in PSV of CRA at the end of the first month(7.97±2.67 cm/s) compared to the pre-injection(9.47±3.37 cm/s).There was not any statistically significant difference onthe other parameters in the DME group. Also, there was not any statistically significant difference on the ocular blood flow values in the CRVO and CNVM groups.CONCLUSION:We observed that 4 mg/0.1 mL IVTA increased PSV of OA and decreased PSV of CRA in DME patients and did not have any effect on ocular blood flow values of CRVO and CNVM patients.

Effect of dorzolamide-timolol fixed combination prophylaxis on intraocular pressure spikes after intravitreal bevacizumab injection

AIM: To evaluate the effect of topical dorzolamide-timolol fixed combination prophylaxis on short term intraocular pressure(IOP) changes in patients who had intravitreal bevacizumab injection.METHODS: One hundred and fifty one eyes of 151 patients which were followed up in retina clinic in Ulucanlar Eye Training and Research Hospital were evaluated in this study. Patients were divided into two groups. Group 1 consists of 75 patients who had topical dorzolamid-timolol medication two hours before injection;while Group 2 consists of 76 patients without prophylaxis. Demographic data, IOP measurements prior to the injection and one, thirty and sixty minutes and twenty-four hours after the injection were recorded. The data were analyzed using SPSS software version 15.0(SPSS Inc., Chicago, IL, USA).RESULTS: There were no significant difference between two groups in age, gender distrubition and indications for injections. The mean IOPs in Groups 1 and 2 prior to the injection(T0) were 17.84±0.43 and 18.15±0.43 mm Hg,one minute after the injection(T1) were 29.75 ±1.6 and34.44 ±1.59 mm Hg, 30 minutes after the injection(T30)were 20.06 ±0.6 and 21.71 ±0.59 mm Hg respectively. The mean IOPs were 18.26 ±0.56 mm Hg in Group 1 and19.78 ±0.56 mm Hg in Group 2 sixty minutes after the injection(T60). All IOP values after the injection were compared between two groups, there was a significant difference between two groups only on T1; one minute after the injection(P =0.04). There were a statisciallysignificant difference between the baseline values and other recorded values; except on T60, in Groups 1 and 2(P 【0.05).CONCLUSION: After intravitreal bevacizumab injection;we observe a transient IOP elevation which normalizes about one hour after intravitreal injection. In patients who had topical dorzolamid-timolol combination prophylaxis before injections, a significant decrease is seen in IOP spikes due to this injection. The appropiate approach will monitor IOP after intravitreal injection and evaluate the using prophylactic antiglaucomatous drugs before the injection in patients with ganglion nerve cell damage.

An overlooked effect of systemic anticholinergics:alteration on accommodation amplitude

AIM： To investigate the effect of oral solifenacin succinate, tolterodine-L-tartarate and oxybutinin hydrochloride（HCl） on accommodation amplitude.·METHODS： Female overactive bladder syndrome（OAB）patients who were planned to use oral anticholinergics,patients that uses solifenacin succinate 5 mg（Group I,n =25）, tolterodine-L-tartarate 4 mg（Group II, n =25）,and oxybutinin HCl 5 mg b.i.d.（Group III, n =25） and age matched healthy female subjects（Group IV, n =25） were recruited and complete ophthalmological examination and accommodation amplitude assessment were done at baseline and 4wk after initiation of treatment.·RESULTS： The mean age of 100 consecutive female subjects was 51.6 ±5.7（40-60）y and there were no statistically significant difference with regard to the mean age（P =0.107） and baseline accommodation amplitude（P =0.148） between study groups. All treatment groups showed a significant decrease in accommodation amplitude following a 4-week course of anticholinergic treatment（P =0.008 in Group I, P =0.002 in Group II, P =0.001 in Group III）, but there was no statistically significant difference in Group IV（P =0.065）.·CONCLUSION： A 4-week course of oral anticholinergic treatment have statistically significant effect on accommodation amplitude. Clinicians should avoid both overestimating this result, as this would unnecessarily restrict therapeutic possibilities, and also underestimating it which may lead to drug intolerance.

Intravitreal drug administration for treatment of noninfectious uveitis

Intravitreal treatment became popular with the discovery of the blood ocular barriers, which significantly limit drug penetration in systemic or topical administration.As the mainstay of treatment in noninfectious uveitis(NOIU) is still corticosteroids, triamcinolone acetonide(TA) was the first intravitreally used agent in this subset of patients. Although it was very effective in controlling inflammation and improving the inflammation related complications, TA was found to have a high rate of intraocular complications and a relatively short half-life necessitating frequent reinjections. Other systemically used therapeutic options such as methotrexate and anti-tumor necrosis factor-α agents were also tried intravitreally. Additionally anti-vascular endothelial growth factor agents that are widely used intravitreally in the management of diabetic retinopathy and age related macular degeneration have become an option to control the uveitis related complications like macular edema, retinal and choroidal neovascularizations. Advances in biotechnology led to the slow release biodegradable implant era. These implants have a longer duration of action, which may help in decreasing the number of reinjections. Today two forms of implants have been approved for use in NOIU, Retisert(0.59 mg flucinolone acetonide, surgical intervention) and Ozurdex(0.7 mg dexamethasone, office based intervention). Studies dealing with newer agents(cyclosporine, LFG31, sirolimus) in the management of chronic NOIU are on the way. The search for ideal effective, safe and biocompatible intravitreal agents in the management of NOIU has not ended yet.

Bilateral papilledema in a child with osteogenesis imperfecta

Background:To present a female child patient with osteogenesis imperfecta who had bilateral papilledema.Case presentation:A twelve-year-old girl with osteogenesis imperfecta was referred to our clinic.Bilateral best corrected visual acuity of the patient was 5/10(corrected with+3.50 for right eye,+5.00 for left eye)with a standard Snellen scale at a distance of a 6 m.Anterior chamber,iris and lens examination of both of her eyes were unremarkable.In her fundus examination,bilateral stage 2 papilledema and the wrinkles in papillomacular area were noticed.Optical coherence tomography images revealed the macular pucker and thickening in the retinal nerve fibre layers of both eyes.Computed tomography images revealed that there were ossifications in the optic chiasma and occlusion in all periorbital sinus areas.Conclusion:Osteogenesis imperfecta is a rare,autosomal dominant connective tissue disorder characterised by bone fractures,deafness and blue sclera.We would like to draw attention to the clinical course of our patient with computed tomography,optical coherence tomography and visual field findings.