PURPOSE: To evaluate the analgesic effect of topical sodium diclofenac 0.1% before retinal laser photocoagulation for diabetic retinopathy. METHODS: Diabetic patients who were candidates for peripheral laser photocoagulation were included in a randomized, placebo-controlled, intraindividual, two-period, and crossover clinical trial. At the first session and based on randomization, one eye received topical sodium diclofenac 0.1% and the other eye received an artificial tear drop (as placebo) three times before laser treatment. At the second session, eyes were given the alternate drug. Patients scored their pain using visual analogue scale (max, 10 cm) at both sessions. Patients and the surgeon were blinded to the drops given. Difference of pain level was the main outcome measure. RESULTS: A total of 200 eyes of 100 patients were enrolled. Both treatments were matched regarding the applied laser. Pain sensation based on visual analogue scale was 5.6 ± 3.0 in the treated group and 5.5 ± 3.0 in the control group. The calculated treatment effect was 0.15 (95% confidence interval, −0.27 to 0.58; p = 0.486). The estimated period effect was 0.24 (p = 0.530) and the carryover effect was not significant (p = 0.283). CONCLUSIONS: Pretreatment with topical sodium diclofenac 0.1% does not have any analgesic effect during peripheral retinal laser photocoagulation in diabetic patients.
Diabetic Retinopathy* ; Diclofenac* ; Humans ; Light Coagulation* ; Outcome Assessment (Health Care) ; Random Allocation ; Retinaldehyde* ; Sensation ; Sodium* ; Tears

PURPOSE: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR). METHODS: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate. RESULTS: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. CONCLUSIONS: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.
Diabetic Retinopathy* ; Follow-Up Studies ; Humans ; Incidence ; Odds Ratio ; Prognosis ; Retinaldehyde ; Retrospective Studies ; Silicon* ; Silicone Oils ; Silicones* ; Visual Acuity ; Vitrectomy*

AIM: To evaluate the role of a single intravitreal injection of tissue plasminogen activator ( TPA) alone for treatment of vitreomacular traction and the effect of combined intravitreal TPA and bevacizumab on retinal vascular diseases.? METHODS: In this prospective, interventional case series a total of 24 eyes from 24 patients were studied. There were 5 eyes with symptomatic vitreomacular traction syndrome ( VMT ) and 19 eyes with retinal vascular diseases including diabetic macular edema ( DME ) , diabetic vitreous hemorrhage ( VH ) , central retinal vein occlusion ( CRVO ) and neovascular age related macular degeneration ( AMD ) . Measurement of visual acuity, B-scan and OCT were performed at the baseline and 1mo after injections. Three eyes with VMT received a single intravitreal injection of 50 μg and two eyes received 100 μg TPA. And 19 eyes with retinal vascular diseases received combined intravitreal TPA ( 50μg) and bevacizumab (1. 25 mg).?RESULTS: The mean ages for retinal vascular diseases and VMT patients were 56. 8y and 60. 4y, respectively. Ten patients ( 41. 7％) were male and 14 patients ( 58. 3％) were female. And 22 eyes ( 91. 7％) were phakic and 2 eyes ( 8. 3％) were pseudophakic. The incidence of posterior vitreous detachment (PVD) was 0 (0 of 5) and 57. 8％ (11 of 19) for VMT and retinal vascular diseases, respectively (P= 0. 04). Improvement of best corrected visual acuity ( BCVA ) and decrement of central macular thickness ( CMT ) were significantly greater in PVD positive eyes compared with PVD negative eyes.?CONCLUSION: Intravitreal injection of TPA was not successful to induce complete PVD in VMT patients. Combined intravitreal injection of TPA and bevacizumab can induce PVD and improve BCVA and decrease central macular thickness in eyes with retinal vascular diseases.