Macular Degeneration: Moroz I

Zayit-Soudry S, Moroz I, Loewenstein A. · Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel. · Surv Ophthalmol. · Pubmed #17472800 No free full text.

Abstract: Detachment of the retinal pigment epithelium is a prominent feature of many chorio-retinal disease processes, the most prevalent of which is age-related macular degeneration (AMD). Detachment of the retinal pigment epithelium may or may not be associated with choroidal neovascularization and may be caused by different types of pathogenesis, each associated with distinct angiographic features, natural course, visual prognosis, and response to treatment. The phrase "detachment of the retinal pigment epithelium" is used quite often, not always in the correct association and with no clear differentiation between its various types. It is important to identify the specific nature of detachment of the retinal pigment epithelium, and to establish an accurate diagnosis and treatment plan. Therefore, we present a review of the existing types of detachment of the retinal pigment epithelium with what we propose as being appropriate nomenclature and classification, and potential treatment recommendations.

Desatnik H, Habot-Wilner Z, Alhalel A, Moroz I, Glovinsky J, Moisseiev J. · Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel. · Isr Med Assoc J. · Pubmed #16833165 links to  free full text

Abstract: BACKGROUND: The major cause of visual impairment in diabetic patients is macular edema. The failure of laser photocoagulation in a large subgroup of patients with clinically significant diabetic macular edema has prompted interest in other treatment methods. OBJECTIVES: To evaluate the long-term efficacy and safety of an intravitreal injection of triamcinolone acetonide for clinically significant diabetic macular edema. METHODS: In a retrospective case series 31 diabetic patients with persistent, recurrent or diffuse clinically significant diabetic macular edema received a single 4 mg (0.1 ml) intravitreal triamcinolone acetonide injection and were followed for at least 6 months. The main outcome measures evaluated were classified as primary: visual acuity and central macular thickness, and secondary: intraocular pressure and cataract progression. Statistical analysis included Student's t-test, chi-square test and the MacNamar test. RESULTS: Best visual acuity results were observed 2.6 +/- 2.4 months post-injection. At that time the mean foveal thickness had decreased by 37% from a baseline of 455 +/- 100 to 288 +/- 99 mu (P< 0.001) and the mean visual acuity improved from 6/42 to 6/23 (P< 0.001). Final mean visual acuity after an average of 10 +/- 1.8 months follow-up (range 6-13 months) was identical to the baseline, although mean foveal thickness was still significantly lower than the initial thickness (368 +/- 166 vs. 455 +/- 100 mu, P< 0.01). Statistical analysis did not identify any pre-injection prognostic factors for improved visual acuity. The only complications that occurred were elevated intraocular pressure in 42% of patients and cataract progression in 21%. There was no endophthalmitis. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide for clinically significant diabetic macular edema is effective in reducing foveal thickness and improving visual acuity in the short term. Longer follow-up revealed that visual acuity returned to pre-injection values, even though a modest decrease in the foveal thickness persisted. Further studies are needed to evaluate the long-term efficacy in conjunction with laser photocoagulation treatment.