EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
113 EW RETINA October 2014 Contact information Singh: asingh2@kumc.edu Tewari: atewari@med.wayne.edu clear to patients that there is surface disease present by showing them an OCT of a normal eye and demon- strating how it is different in an eye with CME and ERM. "Usually because of surface trac- tion, the gains from an intravitreal injection are temporary," he said. "So as the intraretinal cysts resolve, the patient may be a candidate for a vitrectomy with membrane peel." However, doing this too soon with large cysts can lead to "deroofing" of cysts and the development of lamellar macular holes, Dr. Tewari warned. If BDR is present Dr. Tewari said that if background diabetic retinopathy (BDR) is present, he would consider these patients high risk. In fact, he said that for any patient with co-existing retinal vascular disease, a fluore - cein angiography is very helpful in looking for leaking microaneurysms from diabetic eye disease. Using a focal laser as an adjunct treatment is also helpful. Avastin (bevacizumab, Genentech, San Francisco) has a role in this condition as well, he said. "I find myself using combin - tion therapy because it is usually a diabetic cystoid macular edema, " Dr. Tewari said. In this case, a combination of steroids and Avastin and sometimes a laser if the fluorescein angiogram shows discrete leaking microaneu- rysms may be the best treatment plan. Dr. Singh has found that CME with background diabetic retinop- athy responds well to anti-VEGF treatment. These vessels are already abnormal, even if there is no frank diabetic macular edema. Cataract surgeons have noticed that there is a greater incidence of CME in patients who have diabetes, Dr. Singh said, so they always pretreat with an NSAID and continue it in the recovery period. How long should corticosteroids and NSAIDs be used? Dr. Tewari uses topical corticoste- roids and NSAIDs for 2 months before moving on to second-line therapy. Similarly, Dr. Singh uses corti- costeroids and NSAIDs for about 8 to 10 weeks before moving on to second line therapy. However, it also depends on the patient, the cause, and other factors influencing the patient's condition. EW Editors' note: Drs. Singh and Tewari have no financial interests related to their comments. FOR REFRACTIVE AND CATARACT SURGERY Reaching a new level in corneal tomography Patented Dual Scheimpflug system provides highly accurate pachymetry and ray-tracing, even when the measurement is decentred. Iris-based eye motion compensation Have confidence in your follow-up measurements with realignment of maps in 3-D. The only true solution Placido and Scheimpflug for highly accurate pachymetry, elevation and curvature data – in all eyes. One platform, one solution. We simplify the daily workflow in your clinic with an all-in-one solution, from refractive to cataract surgery. Only the GALILEI G4 unites Placido and Dual Scheim- pflug technologies in one measurement. With the GALILEI G4, you get highly precise measurements for posterior and anterior curvature, pachy metry, Total Corneal Power, Total Corneal Wavefront and the anterior segment of your patient's eye. The new GALILEI G4, for first-class clinical results. The GALILEI G4 is a modular platform, which can be upgraded according to your needs. Learn more on galilei.ziemergroup.com. Visit us at AAO booth #2362