Efficacy of memantine in acute non-arteritic ischemic optic neuropathy

Evaluation of efficacy of Memantine [N-Methyl-D-Aspartate Receptor Antagonist] on visual function of patients with acute non-arteritic ischemic optic neuropathy [NAION]. The study was conducted as interventional case series from November 2005 through November 2006 in Farabi Eye Hospital. Twenty-two patients with acute NAION of less than 8 weeks duration entered the study. Memantine was prescribed with a dose of 5 mg per day for the first week and 10 mg per day for the following two weeks. Baseline best corrected visual acuity [BCVA]; visual evoked potential [VEP] and visual field was done for all patients. BCVA recording repeated 3 weeks, 3 and 6 months later. VEP and perimetry repeated 3 months after treatment. After 3 weeks, 3 and 6 months, BCVA improved -0.32 +/- 0.40 LogMAR, -0.51 +/- 0.49 and -0.51 +/- 0.49, respectively [P=0.005, P=0.001 and P=0.001, respectively]. VEP recordings after 3 months, demonstrated -8.61 +/- 14.51 db mean decrease in implicit time [P=0.019]. Amplitude of voltage did not show significant difference with baseline [P=0.10]. Perimetry results after 3 months showed that mean deviation [MD] improved 2.77 +/- 3.94 db [P=0.016]. Memantine resulted in significant improvement of BCVA 3 weeks, 3 and 6 months after treatment of acute NAION. Memantine also resulted in significant decrease of implicit time and significant improvement of mean deviation in VEP and perimetry after 3 months

Intravitreal bevacizumab versus combined bevacizumab and triamcinolone acetonide for neovascular age-related macular degeneration

To compare the short-term outcomes of intravitreal bevacizumab [IVB] with the combination of IVB and intravitreal triamcinolone acetonide [IVB/IVT] for treatment of neovascular age-related macular degeneration [AMD]. This randomized clinical trial was performed on 92 eyes of 90 patients with subfoveal and juxtafoveal choroidal neovascularization [CNV] secondary to AMD. The eyes were randomly assigned to receive IVB 1.25 mg alone [53 eyes] or in combination with IVT 2 mg [39 eyes]. Best-corrected visual acuity [BCVA] and fundus autofluorescence were assessed, and fluorescein angiography [FA] and optical coherence tomography [OCT] were performed at baseline and repeated 6 weeks after treatment. Mean age was 70.6 +/- 8.7 [range 50-89] years and 57.7% of the patients were male. BCVA improved from 1.03 +/- 0.40 to 0.93 +/- 0.38 logMAR [P=0.001] in the IVB group and from 1.08 +/- 0.33 to 0.91 +/- 0.38 logMAR [P=0.008] in the IVB/IVT group. There was a trend toward greater visual improvement with combined therapy [P=0.06]. BCVA improvement was greater in eyes with +1 versus those with +2 [P=0.049] and +3 [P < 0.001] fundus autofluorescence at baseline. Mean decrease in central macular thickness was 113 +/- 115 micro m [P < 0.001] in the IVB group versus 53.96 +/- 125 micro m [P=0.008] in the IVB/IVT group with no intergroup difference [P=0.38]. FA showed decreased leakage in 57.4%, increased leakage in 12.8% and no change in 29.8% of patients in the IVB group. Corresponding figures were 60.0%, 5.7% and 34.3% in the IVB/IVT group [P=0.556]. Addition of triamcinolone acetonide to bevacizumab for treatment of neovascular AMD does not seem to significantly increase its short-term efficacy. More severe fundus autofluorescence appears to be predictive of poorer response to treatment