Eyeworld

EW FEATURE 81 the bleeding during the surgery was very difficult," Dr. Berrocal said. "When pretreating them with a VEGF inhibitor, all the vessels regress so we can perform all of our surgical maneuvers in a very safe and efficient way with minimal complications." Central retinal vein occlusion, retinal branch vein occlusion, and regular diabetic macular edema pa- tients can be treated for several months in a row. "Once the eyes have no edema and look reasonably stable, then I usually just observe them from there," Dr. Berrocal said. She added that practitioners need to be wary of fibrous tissue in diabetic eyes, which can contract and cause tractional retinal detach- ment or rhegmatogenous retinal de- tachment. Also, in eyes with massive edema, she cautioned that the injec- tions could cause precipitation of lipid exudates near the fovea and subsequent decrease of vision. "You have to be careful," she said. Steroid injections Anti-VEGF injections aren't the only treatment in the retinal specialists' armamentarium. Practitioners also inject steroid treatments when nec- essary. "Steroids still have a role," Dr. Dugel said. "We still use steroids in certain cases, usually in patients with recalcitrant diabetic macular edema or vein occlusion." The go-to steroid in those cases is intravitreal triamcinolone ace- tonide (Kenalog, Bristol-Myers Squibb, New York). The disadvantages of using steroid injections are twofold. The main side effect of any steroid is in- creased IOP; the second is cataract formation. "Increased IOP can be prohibi- tive, especially in patients who are genetically susceptible or have glau- coma," Dr. Dugel said. Dr. Dugel added that in the past there was a concern about the in- creased risk of endophthalmitis with the Kenalog injection. "The steroid itself is a suspen- sion, so when it floats to the front of the eye after being injected, it can kind of look like endophthalmitis, but it may not be actual endoph- thalmitis. The term pseudoendoph- thalmitis has been used. It's still a bit of a controversial topic." EW Editors' note: The physicians inter- viewed have no financial interests re- lated to their comments. Contact information Berrocal: mariahberrocal@hotmail.com Dugel: pdugel@gmail.com February 2011 February 2011 GLAUCOMA • Industry Leading Resolution • 100% Measurement Capability including dense cataracts • Automatic Alignment Detection • Simplified Personalization of Lens Constants • Unlimited patient data storage, recall, and transfer via USB Memory Stick Every purchase of an A-Scan Plus 4.20 comes with an on-site training program. Receive a Free Toric Marker with Purchase 3222 Phoenixville Pike, Malvern, PA 19355 • USA 800-979-2020 • 610-889-0200 • FAX 610-889-3233 • www.accutome.com Product #24-4200 Right On Target... The New A-Scan Plus ® 4.20 Right On Target... The New A-Scan Plus ® 4.20 Meeting the Needs of Your Premium IOL Patient acc-1896_Layout 1 1/14/2011 11:46 AM Page 1 58-81 Feature_EW February 2011-DL2_Layout 1 2/4/11 2:32 PM Page 81

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