Foldable iris‐fixated intraocular lens implantation in children

Purpose: To describe the results of foldable iris‐fixated intraocular lens (IOL) implantation in children. Methods: Children with high bilateral or unilateral myopia who were intolerant of spectacle or contact lens correction were implanted with an iris‐fixated foldable IOL and prospectively followed. We measured pre‐ and postoperative visual acuity, refraction, endothelial cell density (ECD) and National Eye Institute Visual Functioning Questionnaire‐25. Results: Eleven eyes of six children were implanted. Indications were high bilateral myopia in children with comorbid neurobehavioural disorders, high anisometropia and high myopic astigmatism. Mean preoperative spherical equivalent (SE) refraction was ?14.6 dioptres (D) ± 4.2 SD. Mean follow‐up was 15 months. Postoperative SE refraction was ?2.40 D ± 2.40 SD. Corrected distance visual acuity (CDVA) improved from mean logMAR 0.84 ± 0.4 SD to postoperative 0.67 ± 0.34 SD (p = 0.005). CDVA was reduced because of coexistent ocular disorders and amblyopia. Vision‐related quality of life (QOL) measures improved significantly. There were no intraoperative or postoperative serious complications. Conclusion: Foldable iris‐fixated IOL insertion can give a significant improvement in vision and in vision‐related QOL in a subset of paediatric patients with special refractive needs who are intolerant to conventional treatment. Long‐term follow‐up is required for monitoring of ECD.     

Intravitreal ranibizumab treatment of retinal angiomatous proliferation

Purpose: To determine the efficacy of intravitreal injections of ranibizumab in the treatment of retinal angiomatous proliferation (RAP) in neovascular age‐related macular degeneration. Methods: Retrospective, consecutive case series of 26 eyes (26 patients) treated with intravitreal injections of 0.5 mg ranibizumab for RAP. Patients received intravitreal injections at monthly intervals during upload phase for a 3‐month period. Results: Mean visual acuity before treatment was 0.75 ± 0.38logMAR (mean ± SD, n = 26). In the upload phase, mean visual acuity improved 4 weeks after the initial injection to 0.6 ± 0.37logMAR (n = 26) and to 0.53 ± 0.34logMAR (n = 26) 4 weeks after the third monthly intravitreal injection of ranibizumab. The mean optical coherence tomography (OCT) central foveal thickness reduced from 345 ± 55 μm at baseline to 215 ± 87 μm at 3 months. In the maintenance phase, mean visual acuity after 6 months was 0.66 ± 0.38logMAR (n = 12) and 0.7 ± 0.37logMAR after 9 months (n = 6). The mean OCT central foveal thickness was 259 ± 59 μm (n = 13) at 6 months and 280 ± 127 μm (n = 6) at nine‐month follow‐up. Conclusion: Intravitreal ranibizumab resulted in an improvement of visual acuity 4 weeks after the first injection but was more pronounced after 3 months. A reduction in leakage and OCT central foveal thickness was seen 3 months after the commencement of treatment.     

Visual recovery after vitrectomy for macular hole using 25‐gauge instruments

Purpose: To determine whether vitrectomy with 25‐gauge instruments contributes to better postoperative visual recovery after macular hole (MH) surgery. Methods: The medical records for 46 consecutive eyes operated for MH by a single surgeon were retrospectively examined. Vitrectomy had been performed with a 25‐gauge instrument in 23 eyes (25‐G group) and with a 20‐gauge instrument in 23 eyes (20‐G group). Postoperative visual acuity (VA) in logMAR (logarithm of the minimum angle of resolution) units after 1 week and 1, 3, 6, 9 and 12 months, operating time, and volume of intraocular irrigating fluid were compared between the two groups. Results: Mean preoperative logMAR VA was 0.72 in the 25‐G group and 0.68 in the 20‐G group (p = 0.282, unpaired t‐test). One week after surgery, VA was significantly better in the 25‐G group (0.40 ± 0.34) than in the 20‐G group (0.58 ± 0.30) (p = 0.020). This significant difference was maintained until 9 months after surgery, but was no longer evident at 12 months (p = 0.182). Operating time was significantly shorter in the 25‐G group (56 ± 16 mins) than in the 20‐G group (85 ± 28 mins) (p = 0.003, unpaired t‐test). The volume of intraocular irrigating fluid was significantly less in the 25‐G group (244 ± 72 ml) than in the 20‐G group (416 ± 113 ml) (p < 0.0001). Conclusions: The use of 25‐gauge vitrectomy instruments leads to better postoperative visual recovery following surgery for MH during the first 9 months, probably as a result of shorter surgical time and a lower volume of intraocular irrigating fluid.     

Bevacizumab as adjuvant for neovascular glaucoma

Purpose: We aimed to evaluate the longterm effects of intraocular bevacizumab (Avastin^®) injections as adjuvant treatment in patients with neovascular glaucoma. Methods: Twenty eyes of 18 consecutive patients with secondary neovascular glaucoma caused by proliferative diabetic retinopathy (n = 7), ischaemic central retinal vein occlusion (n = 7), ischaemic ophthalmopathy (n = 2) and retinal ischaemia resulting from persistent detachment (n = 2) were treated with intraocular bevacizumab injections (1.25 mg/0.05 ml) in addition to other treatments. The main outcome measure was the change in degree of iris rubeosis. Secondary outcomes included intraocular pressure (IOP), best corrected visual acuity (BCVA) and numbers of additional interventions or antiglaucoma medications administered after injection. Results: Mean (± standard deviation) follow‐up was 67.7 ± 13.8 weeks (range 50–93 weeks). At the last follow‐up, complete regression of rubeosis was detectable in five (20%) eyes, incomplete regression in seven (35%), stabilization in six (30%), and an increase in two (10%) eyes. Mean IOP was 26.0 ± 8.9 mmHg at baseline and significantly decreased to 14.75 ± 5.3 mmHg at the last follow‐up visit (p = 0.000005). Mean baseline BCVA (logMAR [logarithm of the minimum angle of resolution] 1.43 ± 0.89) was stabilized during the follow‐up period (logMAR 1.5 ± 0.98). Patients received an average of 2.75 injections. Additional treatments were laser photocoagulation in 13 (65%) eyes, cyclodestructive procedure in 14 (70%), cryopexy in six (30%), drainage procedures in two (10%), and vitrectomy in five (25%) eyes. Conclusions: Bevacizumab may be beneficial as adjuvant treatment in neovascular glaucoma because of its anti‐angiogenic properties and its ability to prevent establishment or progression of angular obstruction. The causative disease inducing the angiogenic process requires treatment in all cases. Antiglaucoma treatment is needed in cases of persistent elevated IOP.     

Correcting post‐keratoplasty anisometropia with the implantable collamer phakic intraocular lens

Background: We evaluate the Visian Implantable Collamer Lens (Staar, Monrovia, CA, USA) phakic intraocular lens for treating post‐keratoplasty anisometropia. Methods: Case series of three eyes (2 phakic and 1 pseudophakic). Results: The mean age was 47.3 years (range 30–73 years), with a minimum of 3‐month follow up. The mean preoperative spherical equivalent was ?8.75 ± 5.17 D (?4.00 to ?14.25 D) improving to ?0.29 ± 1.21 D postoperatively (range 0.75 to ?1.625 D). Mean logMAR uncorrected visual acuity improved from 1.66 ± 0.60 (6/240) preoperatively to 0.41 ± 0.52 (6/15²). Mean logMAR best spectacle‐corrected visual acuity improved from 0.32 ± 0.15 (6/12) preoperatively to 0.10 ± 0.11 (6/7.5). Anisometropia improved from a difference of 6.37 ± 2.59 D preoperatively to 2.09 ± 1.37 D postoperatively, and there were no complications. Conclusion: Our technique for this clinical indication shows that the Visian Implantable Collamer Lens is a safe and effective alternative for treating post‐keratoplasty anisometropia.     

Descemet’s stripping automated endothelial keratoplasty and penetrating keratoplasty for Fuchs’ endothelial dystrophy

Purpose: To compare the outcome of Descemet’s stripping endothelial keratoplasty (DSAEK) to that of penetrating keratoplasty (PK) in patients with Fuchs’ endothelial dystrophy. Methods: The first 20 patients who underwent DSAEK at the Department of Ophthalmology, Aarhus University Hospital were compared to 20 patients treated with classic PK. Best‐corrected visual acuity, subjective spectacle refraction and corneal thickness were registered before surgery and 1, 3, 6 and 12 months after DSAEK surgery; they were also measured before surgery and 12 months and 2–3 years after PK. Endothelial cell density was measured 12 months after surgery in both groups. Results: Two primary graft failures were observed in the DSAEK group; no failures were seen in the PK group. Best spectacle‐corrected visual acuity (BSCVA) at 12 months after surgery was significantly better in the DSAEK group (0.56 ± 0.04) than in the PK group (0.33 ± 0.06). At this time, 70% of the DSAEK‐treated eyes but only 25% of PK‐treated eyes had obtained a BSCVA of 0.5 or better. Two to three years after surgery, BSCVA was 0.5 or better in 55% of PK‐treated eyes. Refractive ametropia and astigmatism were significantly smaller in DSAEK‐treated eyes than in PK‐treated eyes, even after suture removal and arcuate keratotomy. Endothelial cell density (cells/mm²) after 1 year was lower in DSAEK‐treated (1.338 ± 113) than in PK‐treated eyes (1.610 ± 124), but the difference was not statistically significant. Conclusion: DSAEK seems to be superior to PK in treating Fuchs’ endothelial keratoplasty, although primary graft failure may be more common. Visual recovery is faster, and major ametropia and astigmatism is not induced. Long‐term follow‐up studies are essential to assess whether this conclusion also holds true more than 1 year after surgery.     

Intravitreal triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema

Background: To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema. Design: Prospective, non‐randomized, masked, interventional case series. Participants: Twenty‐four eyes of 24 subjects with centre‐involved diabetic macular oedema extending over two disc‐areas with predominant cystic changes on spectral domain optical coherence tomography were selected. Methods: Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide. Main Outcome Measures: Change in central macular volume on spectral domain optical coherence tomography and best‐corrected visual acuity were measured at 6‐week follow‐up. Results: Baseline data were matched in both groups. Post‐injection central macular volume (7.46 ± 0.73 mm³) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre‐injection central macular volume (9.11 ± 1.0 mm³) or when compared with the post‐injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm³). However, post‐injection best‐corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best‐corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre‐injection central macular volume (r = 0.55, P = 0.005). Conclusions: Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best‐corrected visual acuity.     

Femtosecond (FS) laser vision correction procedure for moderate to high myopia: a prospective study of ReLEx® flex and comparison with a retrospective study of FS‐laser in situ keratomileusis

Purpose: To present our initial clinical experience with ReLEx^® flex (ReLEx) for moderate to high myopia. We compare efficacy, safety and corneal higher‐order aberrations after ReLEx with femtosecond laser in situ keratomileusis (FS‐LASIK). Methods: Prospective study of ReLEx compared with a retrospective study of FS‐LASIK. ReLEx is a new keratorefractive procedure, where a stromal lenticule is cut by a femtosecond laser and manually extracted. Forty patients were treated with ReLEx on both eyes. A comparable group of 41 FS‐LASIK patients were retrospectively identified. Visual acuity, spherical equivalent (SE) and corneal tomography were measured before and 3 months after surgery. Results: Preoperative SE averaged ?7.50 ± 1.16 D (ReLEx) and ?7.32 ± 1.09 D (FS‐LASIK). For all eyes, mean corrected distance visual acuity remained unchanged in both groups. For eyes with emmetropia as target refraction, 41% of ReLEx and 61% of FS‐LASIK eyes had an uncorrected distance visual acuity of logMAR ≤ 0.10 at day 1 after surgery, increasing to, respectively, 88% and 69% at 3 months. Mean SE was ?0.06 ± 0.35 D 3 months after ReLEx and ?0.53 ± 0.60 D after FS‐LASIK. The proportion of eyes within ±1.00 D after 3 months was 100% (ReLEx) and 85% (FS‐LASIK). For a 6.0‐mm pupil, corneal spherical aberrations increased significantly less in ReLEx than FS‐LASIK eyes. Conclusions: ReLEx is an all‐in‐one femtosecond laser refractive procedure, and in this study, results were comparable to FS‐LASIK. Refractive predictability and corneal aberrations at 3 months seemed better than or equal to FS‐LASIK, whereas visual recovery after ReLEx was slower.     

Early intravitreal bevacizumab for non‐ischaemic central retinal vein occlusion

Purpose: To evaluate the effect of early intravitreal bevacizumab injections for the treatment of macular oedema caused by non‐ischaemic central retinal vein occlusion (CRVO). Methods: The study included 25 patients (25 eyes) with macular oedema caused by non‐ischaemic central retinal vein occlusion, who received three intravitreal injections of 1.5 mg bevacizumab with an interval of 6 weeks between the injections. Mean duration of central retinal vein occlusion prior to the first injection was 4.2 ± 3.6 days. All patients were re‐examined 1, 3 and 6 months after the first injection. The main outcome parameters were visual acuity and macular thickness, as measured by optical coherence tomography. Results: Mean visual acuity improved significantly from 0.97 ± 0.40 logMAR at baseline to 0.70 ± 0.42 logMAR (P = 0.007) at 1 month, 0.69 ± 0.46 (P = 0.006) 3 months and 0.69 ± 0.52 (P = 0.015) 6 months after the first injection. Mean central retinal thickness decreased significantly from 530 ± 152 μm at baseline to 347 ± 127 μm (P < 0.001) at 1 month, 370 ± 165 μm (P < 0.001) 3 months and 346 ± 129 μm (P < 0.001) 6 months (P < 0.001) after the first injection. The increase in visual acuity correlated significantly (P < 0.01) with the decrease in macular thickness. Mean intraocular pressure was 14.2 ± 3.2 mmHg at baseline and did not differ significantly from the measurement obtained at 1 month (P = 0.59), 3 months (P = 0.88) and 6 months after the first injection (P = 0.65). Conclusion: Intravitreal bevacizumab injections given shortly after onset of non‐ischaemic central retinal vein occlusion may result in a significant increase in vision and a corresponding decrease in macular oedema.     

缺乏囊膜支持的无晶状体眼中两种人工晶状体植入方式的疗效比较

目的：在缺少囊膜支撑的无晶状体眼中,比较后房植入虹膜夹人工晶状体(IOL)与后房睫状沟巩膜缝合固定人工晶状体的疗效。

方法：本研究收集缺少囊膜支撑的无晶状体患者70例进行回顾性对比分析,患者根据手术方式的不同分为A、B两组,A组35眼行后房植入虹膜夹IOL,B组35眼行后房睫状沟巩膜缝合固定IOL。比较两组患者术前及术后3d,1、3、6mo,1a的裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压(IOP)、角膜内皮细胞密度(CECD),并且观察两组IOL的稳定性,记录术中及术后并发症。

结果：随访12～14mo。术后3d,A组的UCVA较术前明显改善(P<0.01),而BCVA较术前无差异(P=0.073); B组的UCVA较术前无差异(P=0.097),而BCVA较术前差(P=0.002); 两组患者术后1mo UCVA、BCVA均较术前显著改善(P<0.05),分别于术后6、3mo保持稳定。两组患者随访期间的IOP均维持于正常水平。A组、B组患者术后1a的CECD分别较术前平均降低0.7%、2.3%(均P<0.05)。两组患者随访期间各时间点IOP及CECD的均无差异(P>0.05)。两组患者术后1、3mo的全眼散光较角膜散光无明显差异(均P>0.05)。术后两组各有1眼IOL脱位,均经手术复位,其余患者术后随访期间IOL无显著倾斜和偏位; 其他术后并发症较轻微,组间并发症发生率无差异(P>0.05)。

结论：对于缺少囊膜支持的无晶状体眼患者,后房植入虹膜夹IOL与后房睫状沟巩膜缝合固定IOL均是安全有效的手术方式。后房植入虹膜夹IOL的操作相对简单,对眼球内组织损伤较小,手术时间较短,术后视力恢复较快,是有效的治疗方法之一。     

Combined intravitreal bevacizumab and triamcinolone in exudative age‐related macular degeneration

Acta Ophthalmol. 2010: 88: 630–634

Abstract.

Purpose: We report on the combined application of intravitreal bevacizumab and triamcinolone acetonide for treatment of exudative age‐related macular degeneration (AMD). Methods: The clinical interventional case‐series study included 16 patients (16 eyes) with exudative AMD who had previously received 3.5 ± 1.8 mono‐injections of bevacizumab (1.5 mg) without significant improvement in visual acuity (VA) or reduction in macular exudation. All patients underwent a combined intravitreal injection of bevacizumab (1.5 mg) and triamcinolone acetonide (about 20 mg). Main outcome measures were VA and macular thickness as determined by optical coherence tomography. All patients were re‐examined at 2–3 months after the intervention. Results: Visual acuity improved significantly (p = 0.03) from 0.80 ± 0.40 logMAR prior to the combined injection to 0.65 ± 0.42 logMAR at 3 months after the injection. An improvement of ≥ 1 Snellen line was found in eight subjects, an increase of ≥ 2 lines in five subjects, and an improvement of ≥ 3 lines in two subjects. One patient lost 1 line and one patient lost 3 lines. Central retinal thickness decreased significantly from 272 ± 62 μm to 220 ± 47 μm (p = 0.03). At the 6‐month follow‐up examination, central retinal thickness had increased again to 319 ± 142 μm, which was not significantly (p = 0.30) different from baseline measurements. Conclusions: The combined intravitreal application of bevacizumab and triamcinolone may temporarily be helpful in the treatment of exudative AMD if previous intravitreal bevacizumab mono‐injections have failed to improve vision and reduce macular oedema.     

超声乳化吸除术治疗Fuchs综合征并发白内障的疗效

目的:探讨超声乳化吸除术治疗Fuchs综合征并发白内障的临床效果.方法:分析在我院行超声乳化吸除术的Fuchs综合征并发白内障患者18例18眼,术中观察并发症的情况,术前及术后测量视力、眼压、角膜内皮细胞密度,术后观察眼内炎症反应程度、并发症等情况.结果:平均随访时间为9.8±3.3mo.术中唯一的并发症为周边虹膜出血(17%).最佳矫正视力(LogMAR)术前为0.98±0.85,术后6mo为0.08±0.14,差异具有统计学意义(P<0.001).眼压术前为15.11±2.63mmHg,术后有2眼一过性高眼压,术后6mo为14.94±2.49mmHg,与术前相比,差异无统计学意义(P>0.05).术后角膜内皮细胞丢失率为10%±6%.术后2眼出现轻度的瞳孔区纤维素样渗出,1眼囊袋收缩综合征以及4眼后发性白内障.结论:超声乳化吸除术治疗Fuchs综合征并发白内障安全有效、并发症少.     

Endoscopic cyclophotocoagulation for the treatment of glaucoma: an Asian experience

Background: To describe the efficacy and safety of endoscopic cyclophotocoagulation in Asian patients with glaucoma. Methods: Retrospective case series. Consecutive cases of endoscopic cyclophotocoagulation performed by one surgeon during the study period were included. Patients' records were reviewed for clinical and demographic factors, treatments, intraocular pressure (IOP), visual acuity and any complications. Results: Twenty‐nine eyes of 29 patients were treated. Their mean age was 73.6 ± 9.4 years. The mean follow‐up duration was 15.9 ± 8.9 months. Eleven patients had primary open‐angle glaucoma, two normal tension glaucoma, six chronic angle‐closure glaucoma, five neovascular glaucoma, four secondary open‐angle glaucoma and one secondary angle‐closure glaucoma. Twenty patients had endoscopic cyclophotocoagulation combined with cataract surgery. Mean pretreatment IOP was 21.8 ± 6.6 mmHg. Mean post‐treatment IOP at 18 months (n = 17) was 16.2 ± 4.1 mmHg (P = 0.02) and 17.9 ± 4.9 mmHg (P = 0.18) at 24 months (n = 10). The mean number of anti‐glaucoma medications pretreatment was reduced from 2.0 ± 1.0 to 0.9 ± 0.9 at 18 months post‐treatment (P = 0.04) and 1.2 ± 0.8 at 24 months (P = 0.13). The overall success rate based on IOP reduction of 20% or greater at last follow‐up was 48.3%. Visual acuity was reduced in five eyes. Complications included one case each of hyphaema, bullous keratopathy, transient pigment dispersion and iris burn. Conclusion: Endoscopic cyclophotocoagulation may have a treatment role in Asian patients with glaucoma. The success rate appears poorer than previously reported in Caucasian populations. The treatment effect appeared to wane between 18 and 24 months post‐treatment.     

Predictable signs of benign course of polypoidal choroidal vasculopathy: based upon the long‐term observation of non‐treated eyes

Purpose: To find predictable signs of benign polypoidal choroidal vasculopathy (PCV). Methods: Medical records of 13 eyes from 12 patients who were followed up for 5 years or longer without treatment among 258 consecutive patients with PCV were reviewed retrospectively. The main outcomes measured were best corrected visual acuity (BCVA) and fundus findings during the follow‐up period. Results: The average age at presentation was 68 years, and the average follow‐up period after diagnosis was 80 months (range, 62–119 months). The initial mean logarithmic value of the minimal angle of resolution (logMAR) BCVA was 0.28 ± 0.26, and the final mean logMAR BCVA was 0.62 ± 0.72. The difference in the logMAR BCVA values between the two points was not statistically significant (p > 0.05). The trend of change from baseline at 2‐year follow‐up was consistent with those at 5‐year follow‐up in nine eyes. Fundus findings at the initial examination were classified into two patterns: (i) reddish‐orange nodules and detachment of the retinal pigment epithelium with/without detachment of the neurosensory retina (nine eyes); (ii) reddish‐orange nodules alone, or nodules and small subretinal haemorrhage (four eyes). In the eyes with the first pattern, clinical course and visual prognosis were variable. An absence of hard exudates could be a sign to maintain a benign clinical course or stable vision with this pattern. The eyes with the second pattern took a benign clinical course with stable vision. Conclusions: There is certainly a group of PCV eyes with a benign prognosis. Considering the huge cost and risk of current therapies, the initial ocular findings could be deciding factors that determine the necessity for further treatment.     

Effect of intravitreal bevacizumab (Avastin®) in neovascular age‐related macular degeneration using a treatment regimen based on optical coherence tomography: 6‐ and 12‐month results

Purpose: To study the effect of intravitreal bevacizumab therapy on visual and anatomical outcomes in patients with neovascular age‐related macular degeneration (AMD) within a follow‐up period of 6 and 12 months. Methods: A retrospective analysis of 102 eyes of 102 consecutive patients with neovascular AMD evaluated repeated intravitreal bevacizumab (1 or 2.5 mg) injections. Retreatment was performed following an optical coherence tomography (OCT)‐based regimen. Ophthalmic examination included best‐corrected visual acuity (BCVA), dilated fundus examination and OCT imaging. Data were analysed at baseline, 6 months (24 weeks) and 12 months (48 weeks) after treatment initiation. Results: BCVA remained stable at 6 months (mean: 0.00 ± 0.41 logMAR; p = 0.95) and 12 months (mean: +0.02 ± 0.43 logMAR; loss of ～ 1 letter; p = 0.70) after the first treatment. OCT retinal thickness decreased by a mean of ?37.8 ± 101.6 μm (p < 0.05) compared to baseline at month 6 and ?38.6 ± 93.3 μm (p < 0.05) at month 12. A mean of 2.6 ± 1.2 injections were needed to obtain absence of fluid by OCT, and the time to recurrence was 23 ± 11 weeks thereafter. There was no difference in BCVA and OCT outcomes between treatment‐naive eyes and eyes that had undergone prior treatment. Conclusion: The 6‐ and 12‐month follow‐up of repeated intravitreal bevacizumab therapy in eyes with neovascular AMD demonstrated stabilization of vision and no safety concerns. An OCT‐based retreatment strategy appears appropriate in the management of patients treated with intravitreal bevacizumab.     

Conductive keratoplasty for symptomatic presbyopia following monofocal intraocular lens implantation

Background: To evaluate the visual outcomes of conductive keratoplasty for relief of symptomatic presbyopia of pseudophakia with monofocal intraocular lens implantation. Design: It was a prospective clinical study and set in Eye Center, Second Affiliated Hospital, Zhejiang University. Participants: This study comprised 27 eyes from 27 patients with presbyopia symptom. Methods: The patients received conductive keratoplasty via monovision approach after monofocal intraocular lens implantation and were followed up at 1 week and 1, 3, 6 and 12 months postoperatively. Main Outcome Measures: The main outcomes including uncorrected near visual acuity, uncorrected distance visual acuity, best spectacle‐corrected visual acuity, manifest refraction spherical equivalent, keratometric astigmatism, contrast and glare sensitivity, spherical aberration and pseudoaccommodation were evaluated. Results: Twelve months after conductive keratoplasty, the binocular uncorrected near visual acuity was significantly improved from logMAR 0.88 ± 0.16 preoperatively to logMAR 0.30 ± 0.13 (P < 0.05); the binocular uncorrected distance visual acuity and best spectacle‐corrected visual acuity remained unchanged; manifest refraction spherical equivalent was significantly reduced from 0.01 ± 0.68 D preoperatively to ?1.68 ± 0.39 D (P < 0.05); spherical aberration was increased from 0.266 ± 0.204 µm preoperatively to 0.358 ± 0.277 µm (P < 0.05), and pseudoaccommodation was from 1.38 ± 0.38 D to 1.73 ± 0.61 D (P < 0.05). Conclusions: Conductive keratoplasty is a safe and effective method for relief of symptomatic presbyopia of pseudophakia with monofocal intraocular lens implantation.     

Panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab for high‐risk proliferative diabetic retinopathy

Purpose: To evaluate the effects of panretinal photocoagulation (PRP) compared with PRP plus intravitreal injection of 0.5 mg of ranibizumab (IVR) in patients with high‐risk proliferative diabetic retinopathy (PDR). Methods: Prospective study included patients with high‐risk PDR and no prior laser treatment randomly assigned to receive PRP (PRP group) or PRP plus IVR (PRPplus group). PRP was administered in two sessions (weeks 0 and 2), and IVR was administered at the end of the first laser session in the PRPplus group. Standardized ophthalmic evaluations including best‐corrected visual acuity (BCVA) measured according to the methods used in the Early Treatment Diabetic Retinopathy Study (BCVA), fluorescein angiography to measure area of fluorescein leakage (FLA) and optical coherence tomography (OCT) for the assessment of central subfield macular thickness (CSMT), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). Results: Twenty‐nine of 40 patients (n = 29 eyes) completed the 48‐week study follow‐up period. At baseline, mean ± SE FLA (mm²) was 9.0 ± 1.3 and 11.7 ± 1.3 (p = 0.1502); BCVA (logMAR) was 0.31 ± 0.05 and 0.27 ± 0.06 (p = 0.6645); and CSMT (μm) was 216.3 ± 10.7 and 249.4 ± 36.1 (p = 0.3925), in the PRP and PRPplus groups, respectively. There was a significant (p < 0.05) FLA reduction at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48 (PRP = 2.9 ± 1.3 mm²; PRPplus = 5.8 ± 1.3 mm²; p = 0.0291). Best‐corrected visual acuity worsening was observed at 16, 32 and 48 weeks after treatment in the PRP group (p < 0.05), while no significant BCVA changes were observed in the PRPplus group. A significant CSMT increase was observed in the PRP group at all study visits, while a significant decrease in CSMT was observed in the PRPplus group at week 16, and no significant difference in CSMT from baseline was observed at weeks 32 and 48. Conclusions: Intravitreal ranibizumab after PRP was associated with a larger reduction in FLA at week 48 compared with PRP alone in eyes with high‐risk PDR, and the adjunctive use of IVR appears to protect against the modest visual acuity loss and macular swelling observed in eyes treated with PRP alone.     

Use of heavy silicone oil (Densiron‐68®) in the treatment of persistent macular holes

Purpose: In this retrospective case series, we studied the effect of ‘heavy’ silicone oil on persisting macular holes. Patients with macular holes that failed to close after conventional macular hole surgery were retreated with the longterm internal tamponade Densiron‐68 ^® . Methods: Twelve patients with primary macular holes that persisted after pars plana vitrectomy, peeling of the internal limiting membrane and internal gas tamponade with SF6 (sulphur hexafluoride) were retreated with heavy silicone oil, Densiron‐68^®, in the University Eye Hospital, Cologne. After 1.5–4 months the Densiron‐68^® was removed. Best corrected visual acuity (VA), slit‐lamp examination, binocular fundus examination and optical coherence tomography (OCT) were used for evaluation pre‐ and postoperatively. The follow‐up period was 3–7 months. Results: Preoperatively, all patients displayed full‐thickness macular holes, with a mean size of 502.25 μm (± 129.39 μm). Postoperatively, 11 of 12 macular holes were closed. One patient experienced a reopening of the macular hole. Mean VA was 20/250 (1.07 ± 0.22 logMAR) prior to treatment with Densiron‐68^® and 20/160 (0.84 ± 0.24 logMAR) postoperatively. Visual acuity increased from baseline in nine patients and decreased in one. Conclusions: Retreatment of persisting macular holes with the heavy, longterm tamponade Densiron‐68^® resulted in anatomical closure of the hole in 11 of 12 cases. This result was accompanied by a functional improvement in VA in nine of 12 patients.     

Discontinuous drug combination therapy in autoimmune ocular disorders

Purpose: This study aimed to assess the effectiveness of a steroid‐sparing immunosuppressive treatment (IST) protocol in the control of severe or steroid‐resistant autoimmune ocular inflammatory diseases. Methods: We carried out a prospective, non‐randomized clinical study. Patients presenting with ocular inflammations that failed to respond adequately to steroids alone after monotherapy for a mean period of 9 ± 2 months (internal control) were offered the option to switch to a combined IST. The protocol consisted of different immunosuppressive drugs added in a stepladder sequence, where each drug (including the steroids) was administered discontinuously. Main outcome measures were control of inflammation, visual acuity and safety of treatment. Results: A total of 76 subjects (121 affected eyes) enrolled in the IST protocol. Mean length of follow‐up was 43 ± 15 months. Complete control of inflammation was achieved in 86% of patients. During the first year of IST, the rate of inflammatory recurrences/patient was 0.78 ± 1.13. This ratio diminished further during succeeding follow‐up. Mean best corrected visual acuity improved from 0.31 logMAR to 0.24 logMAR (p < 0.001). Blood pressure and uric acid blood levels significantly altered for the worse in the study group. Conclusions: Immunosuppressive treatment was effective in achieving inflammatory quiescence in a large majority of patients. The study also demonstrated the longterm safety of the protocol and its steroid‐sparing effect.     

Laser refractive correction of myopia in visually impaired patients improves visual acuity

Purpose: To retrospectively evaluate the visual and refractive outcome of visually impaired adults treated with refractive surgery (photorefractive keratectomy or laser‐assisted in situ keratomileusis). Methods: We searched a refractive surgery database comprising 1716 mildly visually impaired patients [best spectacle‐corrected visual acuity (BSCVA) on a logMAR scale ≤ ?0.1 (Snellen ≤ 0.8)] who had undergone either PRK or LASIK (n = 96). PRK patients who had visits at 5–7, 8–13 and 14–24 months postoperatively were selected. Eleven patients and nine PRK control myopic patients were found (cohort 1). From the same database, 41 visually impaired patients and 54 controls who had a postoperative control at 14–24 months postoperatively were chosen. These patients formed cohort 2. Results: Preoperatively, in cohort 1, the mean BSCVA on a logMAR scale was ?0.15 ± 0.13 (Snellen 0.73 ± 0.16) in visually impaired patients and 0.04 ± 0.02 (Snellen 1.11 ± 0.17) in myopic controls. At 14–24 months postoperatively, the mean BSCVA improved to 0.05 ± 0.04 (Snellen 1.13 ± 0.10) in visually impaired patients and 0.05 ± 0.08 (Snellen 1.13 ± 0.21) in control patients. In cohort 2, preoperatively the mean BSCVA on a logMAR scale was ?0.15 ± 0.12 (Snellen 0.74 ± 0.14) in visually impaired patients and 0.01 ± 0.03 (Snellen 1.04 ± 0.10) in myopic controls. At 14–24 months postoperatively, the mean BSCVA improved to 0.02 ± 0.07 (Snellen 1.06 ± 0.16) in visually impaired patients and 0.06 ± 0.06 (Snellen 1.15 ± 0.16) in control patients. Conclusion: Refractive surgery improves BSCVA in visually impaired patients, possibly through plastic changes in the visual cortex. Consequently, refractive surgery may be used successfully for the treatment of visually impaired adults to enhance their visual acuity.