Visual and morphological outcomes of bevacizumab (Avastin<Superscript>®</Superscript>) versus ranibizumab (Lucentis<Superscript>®</Superscript>) treatment for retinal angiomatous proliferation

Retinal angiomatous proliferation (RAP) is a variant of exudative age-related macular degeneration with particularly bad prognosis. The purpose of this work is to describe the long-term functional and morphological outcome of patients treated with intravitreal bevacizumab and ranibizumab. Retrospective case series of 16 eyes treated with bevacizumab and 19 eyes treated with ranibizumab. All patients received initially three intravitreal injections of bevacizumab (1.25 mg/0.05 ml) or ranibizumab (0.5 mg/0.05 ml) every 4 weeks. Follow-up ranged from 1 to 7 months after the third injection. Complete ophthalmologic examination including best-corrected visual acuity (VA), optical coherence tomography, fluorescein angiography, and in selected cases, indocyanine green angiography was performed. Triple intravitreal injections resulted in improvement of VA in bevacizumab-treated as well as in ranibizumab-treated patients; logarithm of the minimal angle of resolution (logMAR) 0.84 before treatment and 0.67 at month 9, and logMAR 0.75 before treatment and 0.59 at month 9, respectively. Central macular thickness (CMT) in the bevacizumab group improved from 363.67 ± 47.4 μm at baseline to 328 ± 49.77 μm at month 6 (p = 0.03) and 301 ± 129.69 at month 9 (p = 0.35). CMT in the ranibizumab group improved from 545.62 ± 167.39 μm at baseline to 395.88 ± 169.37 μm at month 6 and 411.83 ± 212.41 μm at month 9 (p = 0.03, p = 0.05, respectively). Patients with RAP might benefit from both intravitreal bevacizumab and ranibizumab treatments with stabilization of VA over a longer period of time. Close follow-up should nevertheless be performed in this special subgroup because of the high recurrence rate.     

Vitritis in the contralateral uninjected eye following intravitreal bevacizumab (Avastin<Superscript>®</Superscript>)

Purpose To report a case of contralateral vitritis following intravitreal bevacizumab (Avastin^®, Roche Pharma). Case summary A 54-year-old man was treated with intravitreal bevacizumab (IB) for a choroidal neovascularization secondary to anisometropic high myopia in the right eye that did not respond to photodynamic treatment. After the second injection, he showed a moderate vitritis in the fellow un-injected eye a few hours later. Results The patient was treated with a sub-Tenon’s injection of 40 mg triamcinolone (Kenacort^®, Squibb) and entirely recovered his vision. No further complications were observed. Discussion Although IB has a satisfactory safety profile, the possibility of unusual complications associated with the drug or the procedure itself should always be considered.     

Reversed papilledema in an MPS VI patient with galsulfase (Naglazyme<Superscript>®</Superscript>) therapy

MPS VI (mucopolysaccharidosis VI, known as Maroteaux-Lamy syndrome) is a multi-systemic inherited disease, resulting from a deficiency of N-acetylgalactosamine-4-sulfatase, causing accumulation of the glycosaminoglycan (GAG) dermatan sulfate in all tissues. It is one of almost 50 lysosomal storage disorders. Ocular pathology is common in patients with MPS VI, with complications including ocular hypertension, progressive corneal clouding, optic nerve swelling (or papilledema) often associated with communicating hydrocephalus (Ashworth et al., Eye 20(5), 553-563, 2006; Goldberg et al., AJO 69(6), 969-975), and raised intracranial pressure (ICP) progressing to atrophy with loss of vision (Goodrich et al., Loss of vision in MPS VI is a consequence of increased intracranial pressure, 2002). This is the first case report of reversed papilledema and improved visual acuity in an 11-year-old MPS VI patient receiving galsulfase (Naglazyme), an enzyme-replacement therapy (ERT) of recombinant human arylsulfatase B (rhASB) (Harmatz et al., J Pediatr 148(4), 533-539, 2006).     

Adalimumab (Humira<Superscript>™</Superscript>): a promising monoclonal anti-tumor necrosis factor alpha in ophthalmology

Tumor necrosis factor alpha (TNF-α) is a key soluble mediator involved in the inflammatory cascade of many disorders including uveitis. Among the anti-TNF-α agents, one of the most used in immune-mediated diseases, such as inflammatory arthropathies, is adalimumab (Humira^™, Abbott Pharmaceutical Inc.), a fully humanized antibody. The purpose of this review is to analyze the main pharmacological and clinical aspects of adalimumab and its efficacy both in systemic and ocular inflammatory disorders. Adalimumab was effective in treating several autoimmune diseases, such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. In recent years, adalimumab has been used successfully in refractory cases of intraocular inflammation. Moreover, this biological agent showed good safety and efficacy profiles in ocular use including childhood uveitis. Switching from other anti-TNF-α agents to adalimumab may offer several advantages, such as easier administration, better patient compliance, and lower rate of adverse events. Adalimumab is a promising drug for the therapy of uveitis, although further studies are needed on its application in uveitis.     

Physiological diurnal variability and characteristics of the ocular pulse amplitude (OPA) with the dynamic contour tonometer (DCT-Pascal<Superscript>®</Superscript>)

PURPOSE: The Pascal dynamic contour tonometer (DCT) allows measurement of intraocular pressure (IOP) independently of corneal properties. It records, simultaneously, haemodynamic IOP fluctuations and the difference between the systolic and the diastolic IOP corresponding to the ocular pulse amplitude (OPA). The OPA indirectly reflects choroidal perfusion and could be considered as an independent risk factor in glaucoma. We aimed to establish the physiological diurnal variability of the OPA and its correlations with other biophysical parameters because its characteristics remain partly unclear. METHOD: Prospective study including 52 eyes of 28 normal subjects with Goldmann applanation tonometry (GAT) IOPs < 22 mmHg. Subjects treated with systemic medications that could interfere with blood pressure or heart rate were excluded. IOP was measured at 9:00 am, 1:00 pm, and 4:00 pm by GAT and DCT. Two consecutive GAT followed by three consecutive DCT measurements were performed in each session by the same clinician (SP). Only DCT measurements with quality 1 and 2 were taken into account. Blood pressure, pulse rate, and central corneal thickness (CCT) were recorded after the last IOP measurements. Spearman correlation coefficient was used for assessment of correlations. RESULTS: Mean age was 40 +/- 14 years. Mean DCT values were significantly higher than GAT readings (mean = 16.8 +/- 2.0 vs. 15.2 +/- 2.8 mmHg, P < 0.02). The mean OPA was 2.2 +/- 0.7 mmHg (range: 1-3.4 mmHg). The mean amplitude of diurnal OPA fluctuations was 0.4 mmHg. There was no significant difference in the mean OPA values at each time of the diurnal curve. The intraclass correlation (ICC) of only one OPA measurement in relation to part of total variance due to inter-measurement variation was 78%. Averaging over three independent readings of OPA improved ICC to 91%. The OPA was correlated with GAT (r = 0.31, P < 0.0001) and DCT IOP measurements (r = 0.49, P < 0.0001). It was correlated neither with blood pressure nor with age. OPA values of both eyes of the same individual were highly correlated (r = 0.89, P < 0.0001). CONCLUSION: In normal healthy eyes, the ocular pulse amplitude remains stable during normal outpatient office hours and was not correlated with blood pressure or age of patients.     

Two-year topographic and densitometric outcomes of accelerated (45 mW/cm<Superscript>2</Superscript>) transepithelial corneal cross-linking for keratoconus: a case-control study

Background

Conventional corneal cross-linking is effective for retarding the progression of keratoconus. However the long-term efficacy and safety of accelerated (45?mW/cm2) transepithelial corneal cross-linking (ATE-CXL) on progressive keratoconus (KC) treatment is not fully understood. The purpose of this study is to evaluate the 2-year changes in corneal topographic parameters and densitometry values after ATE-CXL for KC.

Methods

Twenty-five progressive eyes of 25 KC patients (KC group) and 25 eyes of 25 myopes without KC (control group) were enrolled. Corneal topography and densitometry values were evaluated pre-operatively and at 6, 12 and 24?months post-operatively in the KC group.

Results

The mean values of flat keratometry (K1), steep keratometry (K2), mean keratometry (Km), corneal astigmatism (CA), maximum keratometry (Kmax), central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior corneal elevation (ACE) and posterior corneal elevation (PCE) all remained unchanged over time (all P values >?0.05). The densitometry values of the anterior, central, posterior and total layers over the annular diameters 0?mm to 2?mm (Φ0-2?mm) and Φ2–6?mm all decreased significantly (all P values <?0.05). At post-operative month 24, except for the densitometry value of the posterior layer (Φ0-2?mm), which was significantly lower than that of the control group (post hoc P?=?0.010), all densitometry values obtained from the remaining locations of the KC eyes were equal to those of the control group (All post hoc P values >?0.05). Subgroups with Km?≥?50.30D or ACE ≥35.3?μm progressed significantly when compared with those with Km?<?50.30D (F?=?8.167, P?=?0.004) or ACE<?35.3?μm (F?=?5.207, P?=?0.022).

Conclusions

K1, K2, Km, CA, Kmax, CCT, TCT, ACE, and PCE values may remain stable but severer KC patients tend to have poorer long-term outcomes. The densitometry values of the full corneal thickness (total layer over Φ0-2?mm and Φ2–6?mm) may decrease to normal levels at 2?years after ATE-CXL for KC.

     

Modelling lifetime cost consequences of ReSTOR<Superscript>®</Superscript>in cataract surgery in four European countries

Background

To compare the lifetime costs of liberating patients from spectacles after cataract surgery by implanting the multifocal intraocular lens (IOL) 'ReSTOR^®' versus monofocal IOLs in France, Italy, Germany and Spain.

Methods

A Markov model was created to follow patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles after cataract surgery were obtained from clinical trials. Resource utilisation included implant surgery, IOLs, spectacles, visits to ophthalmologists and eye centres, transport, and time lost by patients. Economic perspectives were those of Society and Sickness Funds (SFs).

Results

The mean number of spectacles purchased after ReSTOR^® was 1.34–1.61 and after monofocal IOLs 6.05–7.27. From the societal perspective, total cost estimates discounted by 3% were between €3,551 and €4,052 with ReSTOR^® compared to €3,989 and €5,548 with monofocal IOLs. Undiscounted savings related to ReSTOR^® ranged from €815 to €2,164. From the SFs' perspective total cost estimates discounted by 3% were between €2,150 and €2,524 with ReSTOR^® compared to €2,324 and €2,610 with monofocal IOLs. Savings related to ReSTOR^®, once costs discounted, ranged from €61 to €219. Discount and spectacle freedom prevalence rates were the most sensitive parameters.

Conclusion

The bulk of the savings related to ReSTOR^® were realized outside the SF. From both a societal and SF perspective, savings, after a 3% discounting, achieved by liberating patients from spectacles counterbalanced the initially higher cost of ReSTOR^®. ReSTOR^® is a cost saving alternative to spectacles for patients requiring cataract surgery.

     

Utility of QuantiFERON<Superscript>®</Superscript>-TB Gold test in diagnosis and management of suspected tubercular uveitis in India

The tuberculin skin test, used to detect latent systemic tuberculosis (TB), has its limitations. The utility of interferon-gamma assays, found useful in the diagnosis of latent TB, is still unestablished in tubercular uveitis. We present the results of QuantiFERON^®-TB Gold (QFT-G) test and its relevance in the diagnosis and management of suspected tubercular uveitis in India. All suspected tubercular uveitis patients seen at our uveitis clinic between October 2006 and June 2008 who underwent relevant blood investigations, chest X-rays, Mantoux tests and QFT-G tests were included. Clinical profile, systemic correlation and outcome with treatment were analysed. Fifty suspected tubercular uveitis patients underwent QFT-G testing. The age range of the patients was 6–55 years (mean 32.66 years). Seven patients presented with active and three with a past history of systemic TB. The QFT-G test was positive in 29 patients. Radiological findings of TB were seen in four patients with a positive QFT-G and one patient with a negative QFT-G test. In 11 patients both QFT-G and Mantoux tests were positive. Eighteen Mantoux-negative patients were QFT-G-positive. Significantly, no patient with a positive Mantoux had a negative QFT-G test. Of the 32 patients with posterior uveitis, 17 patients had serpiginous choroiditis, four patients had a choroidal granuloma, six patients had multifocal choroiditis, four patients had retinal vasculitis, and one patient had a subretinal abscess. All QFT-G-positive patients were treated with anti-tuberculosis therapy as well as systemic steroids with a favorable clinical outcome. Our study shows that the QFT-G test is very useful in the diagnosis and management of suspected ocular TB. It was found to be very sensitive in identifying latent TB patients who, upon treatment, had a significantly reduced frequency of recurrences. It was more sensitive than the Mantoux test and is not significantly affected by previous treatment with systemic steroids or immunosuppressives. A negative QFT-G test can also be used as an adjunct before initiation of systemic steroids or immunosuppressives in uveitic patients particularly in an endemic setting like India.     

Measuring benefits and patients' satisfaction when glasses are not needed after cataract and presbyopia surgery: scoring and psychometric validation of the Freedom from Glasses Value Scale (FGVS<Superscript>©</Superscript>)

Background  

The purpose of this study was to reduce the number of items, create a scoring method and assess the psychometric properties of the Freedom from Glasses Value Scale (FGVS), which measures benefits of freedom from glasses perceived by cataract and presbyopic patients after multifocal intraocular lens (IOL) surgery.     

汉斯·戈德曼(Hans Goldmann)

汉斯·戈德曼(Hans Goldmann)系瑞士眼科医生,1899年生于奥匈帝国(后来的捷克斯洛伐克)布拉格附近的Komotau镇.1991年11月19日卒于伯尔尼,享年92岁.幼年时在一所天主教教会学校学习,受一位犹太人指导.青年时期他就在数学等学科显露头角,当时曾决心做一名天文学家,但其父亲却鼓励他"做一些更实用的事情",随后到布拉格在德国人办的Charles大学学医,1923年毕业获得博士学位.     

Review of people with retinal vasculitis and positive QuantiFERON<Superscript>®</Superscript>-TB Gold test in an area nonendemic for tuberculosis

Purpose

To assess the frequency of a positive QuantiFERON^®-TB Gold test (quantiferon) among patients with retinal vasculitis in an area nonendemic for tuberculosis (TB); to review clinical characteristics and management of affected individuals.

Methods

Consecutive patients with retinal vasculitis and a positive quantiferon were retrospectively analyzed. Demographics, clinical data, laboratory, imaging findings, and therapy were evaluated.

Results

Among 49 patients with retinal vasculitis, 12 (24%) had a positive quantiferon. Median age was 37 years, there were five female patients. Five individuals (42%) had previously lived in a country endemic for TB. Retinal vasculitis was occlusive in six patients (50%). On chest imaging, pulmonary tuberculosis was suspected in one patient (8.3%). Treatment modalities included full antitubercular treatment (n = 1), isoniazid prophylaxis (n = 6), systemic corticosteroids (n = 8), and laser treatment (n = 5). After a median follow-up of 27.5 months, inflammation was inactive (n = 6) or recurrently present (n = 6). No patient lost ≥ 2 lines of best-corrected visual acuity during follow-up.

Conclusions

The quantiferon test is recommended in the evaluation of people with retinal vasculitis. Interpretation of a positive result can be challenging in a country nonendemic for TB. The majority of patients with quantiferon-positive retinal vasculitis were found to have latent TB.

     

Visante<Superscript>®</Superscript> anterior segment OCT in a patient with gas bubbles in the anterior chamber after femtosecond laser corneal flap formation

A patient with anterior chamber gas bubbles after LASIK flap formation with femtosecond laser is presented. A 33-year-old male patient had LASIK for myopia with corneal flap formation with IntraLase FS30 femtosecond laser. In the right eye, air bubbles were observed in anterior chamber after successful flap formation. Laser correction was completed successfully, by Wavelight Allegretto Wave Eye-Q excimer laser, without eye-tracker. Visante anterior segment optical coherence tomography imaging displayed that the pocket extended to limbal area, with stromal bed thickness of >600 microm at that area. We propose as possible causes of the air bubbles scattering of femtosecond laser beam producing direct photodissociation of aqueous humor, or direct cavitation effect in aqueous humor due to rapid pressure changes in corneal lamellar interface during the femtosecond laser procedure. Other causes such as migration of intrastromal bubbles through peripheral corneal stroma and trabecular meshwork, or through posterior stroma and endothelium, seem to be unlikely.     

恩斯特·富克斯(Ernst Fuchs)

奥地利著名眼科医师,1851年6月14日生于维也纳,1930年11月21日因心脏病辞世.     

西奥德·莱伯(Theodor Leber)

西奥德-莱伯(Theodor Leber)系德国眼科学家,1840年2月29日生于卡尔斯鲁厄(Karlsruhe),卒于1917年.其父亲是一位语言学教授.幼年时曾对化学研究产生兴趣,后来在Robert Bunsen教授(1811～1899)的劝说下学医.     

Leber’s视神经萎缩(附5例报告)

家族性遗传性视神经萎缩又称Leber′s视神经萎缩。1871年Leber′s首次描述该病以来,国内外已有陆续报告。国内刘永均1953年第一次报告至今,大约已有63个家系。但以往国内的病例均未作VEP检查,且发病年龄超过60岁以上者仅见一例。现将我们最近遇见的一家系5例(其中一例60岁起病,3例作VEP检查)患者,作如下报告。病例另附讨论 Leber′s视神经萎缩是一种遗传性眼     

Duane′s综合征临床分析(附35例报告)

Duane’s 综合征(Duane’s Retracti-on Syndrome-DRS)是一种先天性眼球运动异常,临床并不少见。现将我们于近十年所遇到的35例做临床分析如下:临床资料对象:为近十年我院眼科斜视弱视诊室5200例斜视弱视患者中所遇到的35例DRS患者。其发病率为0.6%。1.初诊年龄:如表1