Influence of unilateral intravitreal bevacizumab injection on the incidence of symptomatic choroidal neovascularization in the fellow eye in patients with neovascular age-related macular degeneration (Review).

Neovascular age-related macular degeneration (neovascular ARMD) represents only 10% of ARMD cases but is responsible, if untreated, for quick and severe central vision loss due to major macular changes. The presence of choroidal neovascularization (CNV) in one eye is associated with an approximately 10% risk of CNV development in the fellow eye each year. Intravitreal anti-VEGF therapy has quickly evolved as the standard treatment in neovascular ARMD in the last decade due to significant anatomical and functional improvements, especially in the early stages. In many reports an improvement in the untreated fellow eye was mentioned and systemic exposure was soon confirmed for all anti-VEGF agents after unilateral intravitreal injection. In particular, bevacizumab intravitreal injection is followed by a consistent reduction of serum VEGF levels and the drug was shown to have the longest serum half-life raising important debates about its safety. Once bevacizumab was detected in the fellow eye of an animal model after unilateral injection, the possible influence on fellow eye conversion rate into neovascular ARMD was questioned. Although comparative studies have not found statistically significant differences between drugs regarding the incidence of symptomatic CNV in the fellow eye during treatment, we observed, on a retrospective 36-month evaluation, a reduced incidence of symptomatic CNV in the fellow eye that might be explained by the consistent systemic exposure of bevacizumab.

PLATEAU IRIS SYNDROME--CASE SERIES.

Plateau iris is characterized by closing the anterior chamber angle due to a large ciliary body or due to its anterior insertion that alters the position of iris periphery in respect to the trabecular meshwork. There are two aspects that need to be differentiated: plateau iris configuration and plateau iris syndrome. The first describes a situation when the iris root is flat and the anterior chamber is not shallow, the latter refers to a post laser iridotomy condition in which a patent iridotomy has removed the relative pupillary block, but goniscopically confirmed angle closure recurs without central shallowing of the anterior chamber. Isolated plateau iris syndrome is rare compared to plateau iris configuration. We hereby present two case reports of plateau iris syndrome in young patients who came to an ophthalmologic consult by chance.

[Perimetric changes in advanced glaucoma]. / Modificari perimetrice în glaucoamele avansate.

AIM: The evaluation of various perimetric aspects in advanced glaucoma stages correlated to morpho-functional changes. MATHERIAL AND METHOD: Retrospective clinical trial over a 10 months time period that included patients with advanced glaucoma stages, for which there have been recorded several computerised visual field tests (central 24-2 strategy, 10-2 strategy with either III or V--Goldman stimulus spot size) along with other morpho-funtional ocular paramaters: VA, lOP optic disk analysis. RESULTS: We included in our study 56 eyes from 45 patients. In most cases 89% it was an open angle glaucoma (either primary or secondary) Mean visual acuity was 0.45 +/- 0.28. Regarding the perimetric deficit 83% had advanced deficit, 9% moderate and 8% early visual changes. As perimetric type of defect we found a majority with general reduction of sensitivity (33 eyes) + ring shape scotoma. In 6 eyes (10.7%) having left only a central isle of vision we performed the central 10-2 strategy with III or V Goldmann stimulus spot size. Statistic analysis showed scarce correlation between the visual acuity and the quantitative perimetric parameters (MD and PSD), and variance analysis found present a multiple correlation parameter p = 0.07 that proves there is no liniary correspondence between the morpho-functional parameters: VA-MD(PSD) and C/D ratio. CONCLUSIONS: In advanced glaucoma stages, the perimetric changes are mostly severe. Perimetric evaluation is essential in these stages and needs to be individualised.

[Modern assessment of perimetric progression in glaucoma]. / Evaluarea moderna a progresiei perimetrice în glaucom.

OBJECTIVE: Analysis of perimetric deficit progression and accurate evaluation of certain factors that are associated with perimetric progression in glaucomatous patients. MATERIAL AND METHODS: Cohort clinical trial that included a number of 80 eyes in 46 patients having a clear diagnosis of open angle glaucoma or ocular hypertension medically and/or surgically treated in which there have been followed both the dynamics in perimetric deficits and morpho functional parameters related closely and characteristically to the glaucomatous disease. Progression analysis was made using two different methods: manual, testing each spot's sensitivity at a time (EGS criterias were utilized) and automatic (through GPATM--Glaucoma Progression Analysis software). RESULTS: The study group (80 eyes) was evaluated and analyzed over a period of 63.8 months; in 27.5% we detected perimetric progression as it follows: 15 eyes by the GPA analysis and 19 eyes by the manual method. Concurrency rate between the two methods reached 87%. Associated factors with perimetric progression were: pseudoexfoliation, thin cornea, older age and cardiovascular diseases. CONCLUSIONS: Perimetry represents an essential method for the detection of glaucomatous progression. Computerized analysis methods are extremely important and come in clinician's help.