Long-Term Effect of Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Injections in Choroidal Neovascularization Secondary to Angioid Streaks.

Purpose: This study aimed to evaluate the long-term effectiveness of intravitreal anti-vascular endothelial growth factor (VEGF) injections in the treatment of choroidal neovascularization (CNV) associated with angioid streaks. Methods: Multicenter retrospective cohort study, including eyes with CNV secondary to angioid streaks treated with anti-VEGF injections, were performed. Best-corrected visual acuity (BCVA) in ETDRS letters; qualitative and quantitative (foveal thickness) OCT parameters; anti-VEGF type; and number of injections were collected at baseline and at 3, 6, 12, 24, 36, 48, 60, and 72 months. Results: Thirty-nine eyes from 29 patients, 17 (58.6%) females, were included. The mean follow-up time was 69.4 ± 34.5 months. BCVA was 59.3 ± 23.3 letters at baseline and 63.7 ± 21.9 letters at 48 months. At 3 months, BCVA improved 6.9 ± 11.7 letters (P=0.003). Then, BCVA remained stable. The mean foveal thickness decreased from 343.3 ± 120.2 µm at baseline to 268.3 ± 65.4 at 48 months (P=0.021). The mean number of injections was 4.6 ± 2.1 at 12 months, decreasing to 1.7 ± 2.4 injections between 36 and 48 months (P=0.093). Conclusion: This real-world study suggests that the functional and morphologic response to anti-VEGF therapy for CNV related to angioid streaks is generally satisfactory and maintained in the long term.

Ahmed Valve Upstream Obstruction Caused by Fibrous Ingrowth: Surgical Approach.

Glaucoma secondary to penetrating keratoplasty can be challenging and multiple surgeries may be needed to control the intraocular pressure (IOP), including the use of glaucoma drainage implants. However, late failure of these drainage implant surgery is common, mostly because of excessive scarring or bleb encapsulation which may require further surgical intervention. We present a case of a young patient referred for advanced glaucoma secondary to penetrating keratoplasty and chronic uveitis. He presented with elevated IOP under maximal therapy, already with 2 failed trabeculectomies and a nonfunctional Ahmed Valve. As no bleb was seen overlying the plate of the valve, an exploratory surgical revision was scheduled. The cause for defective aqueous humour drainage was identified as a fibrovascular ingrowth into the valve's plate slit. We proceeded with removal of this membrane, as well as confirmation of patency with trypan blue and application of mitomycin C to prevent recurrence of the fibrous ingrowth. With a 6 month follow-up, a diffuse bleb exists over the plate, with IOP values within the target values for this patient (<16 mm Hg). This exploratory procedure identified an unusual cause for drainage device failure, as well as reporting its management without explanting the device.

Angle closure as a cause for intermittent headache in a child.

Angle closure is usually associated with older patients, as it typically manifests in middle to later life, being associated with an age-related increased lens volume. However, angle closure can occur in any age group if there is an anatomical predisposition that promotes pupillary block or an anterior pulling of the iris. During an acute angle closure, patients generally experience ocular pain, headache, nausea, vomiting and conjunctival hyperaemia. These attacks can be misinterpreted as migraine, particularly if subacute or chronic and the demographic characteristics of the patient do not suggest a primary angle closure event. Diagnosing a headache as ocular related is of paramount importance, since there is an effective treatment. We report a case of a child with intermittent headache which revealed a subacute angle closure in both eyes.