Change in cardiac troponin T level after intravitreal anti-vascular endothelial growth factor treatment: Prospective pilot study.

BACKGROUND: Evaluate subclinical myocardial injury associated with intravitreal anti-vascular endothelial growth factor therapy by measuring serum high-sensitivity cardiac troponin T. METHODS: This is a prospective pilot comparative study conducted at American University of Beirut Medical Center, Beirut, Lebanon. In total, 40 consecutive patients were randomized to receive either intravitreal bevacizumab or ranibizumab. Patients received three consecutive monthly injections of the assigned drug, then continued treatment as needed. Systemic concentrations of high-sensitivity cardiac troponin T and vascular endothelial growth factor were obtained at baseline, week 9, and week 24. Primary endpoint measure was change in high-sensitivity cardiac troponin T levels compared to baseline. Secondary endpoint measure was change in systemic vascular endothelial growth factor levels. RESULTS: There was no significant difference in high-sensitivity cardiac troponin T levels over time (p = 0.227) within each treatment group and no significant difference between treatments at any time point (p = 0.276). There was a significant decrease in plasma vascular endothelial growth factor levels at week 9 (p = 0.001) and week 24 (p < 0.001) compared to baseline. In the ranibizumab group, vascular endothelial growth factor levels were not significantly different at weeks 9 and 24 compared to baseline (p = 0.708 and p = 0.117, respectively). There was a significant association between the number of bevacizumab injections from weeks 8 to 24 and the decrease in vascular endothelial growth factor levels at week 24 (R = -0.67, p = 0.032). This correlation was not observed in the ranibizumab group (R = -0.341, p = 0.141). CONCLUSION: Repeated intravitreal bevacizumab or ranibizumab did not influence serum high-sensitivity cardiac troponin levels. Intravitreal bevacizumab but not ranibizumab lowered free-systemic vascular endothelial growth factor levels, which was observed in this study to be inversely related to the number of bevacizumab injections.

Sequential pars plana vitrectomy and cataract extraction with intraocular lens implantation in patient with corneal inlay who developed retinal detachment followed by cataract.

Twenty-one months after successful small-aperture corneal inlay (Kamra) implantation simultaneous with myopic laser in situ keratomileusis, a patient presented with a superior rhegmatogenous macula-involving retinal detachment. Successful pars plana vitrectomy, transscleral cryotherapy, and gas tamponade were performed with the inlay in situ. Three months later, uneventful phacoemulsification and posterior chamber intraocular lens implantation were performed, also with the inlay in situ, for a visually significant cataract. Visualization of the central and peripheral retina and the anterior segment was possible in both procedures through the central aperture and around the periphery of the inlay. An indirect noncontact visualization system was helpful in the retinal surgery, and rotating the eye was helpful in both surgeries if the inlay blocked visualization.

INTRAVITREAL DEXAMETHASONE IMPLANT AS ADJUVANT TREATMENT FOR BEVACIZUMAB- AND RANIBIZUMAB-RESISTANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Prospective Pilot Study.

PURPOSE: To study the benefit of intravitreal dexamethasone implant in the management of neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. METHODS: Patients with persistent macular fluid on optical coherence tomography despite monthly treatment with at least three consecutive bevacizumab injections followed by at least three ranibizumab injections were prospectively enrolled. A single dexamethasone implant was administered followed by intravitreal ranibizumab 1 week later. Ranibizumab was continued afterward on an as-needed basis. Main outcomes were improvement in central retinal thickness and best-corrected visual acuity. RESULTS: Nineteen patients (19 eyes) were enrolled. There was no significant change in best-corrected visual acuity over 6 months. Greatest reduction in mean central retinal thickness, from 295.2 µm to 236.2 µm, occurred 1 month after dexamethasone implant (P < 0.0001). By Month 6, mean central retinal thickness was 287.3 µm (P = 0.16). Eyes with only intraretinal fluid (13 eyes) achieved a fluid-free macula. Eyes with predominantly subretinal fluid (6 eyes) did not improve central retinal thickness and continued monthly ranibizumab. Mean baseline intraocular pressure was 13.2 mmHg, which peaked at 15.6 mmHg by Month 2 (P = 0.004). CONCLUSION: Intravitreal dexamethasone implant improved only macular intraretinal fluid in eyes with neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. However, this treatment had a limited duration.

Combined Nonmydriatic Spectral-Domain Optical Coherence Tomography and Nonmydriatic Fundus Photography for the Detection of Age-Related Macular Degeneration Changes.

BACKGROUND AND OBJECTIVE: Nonmydriatic fundus photography (FP) has been a suboptimal tool for detecting age-related macular degeneration (AMD) changes. This study sought to enhance the detection of AMD changes by combining nonmydriatic FP with nonmydriatic spectral-domain optical coherence tomography (SD-OCT). PATIENTS AND METHODS: The study population included 249 patients aged 65 years and older who were assessed for AMD changes using standard mydriatic biomicroscopic fundus examination. Each eye then underwent nonmydriatic FP in one session followed 1 week later with nonmydriatic FP coupled with nonmydriatic SD-OCT. Images were interpreted for detection of AMD changes, and findings were compared to the original mydriatic biomicroscopic examination. RESULTS: Nonmydriatic FP had 64% sensitivity, 97% specificity, and a kappa value of 0.67 in detecting AMD changes compared with the traditional mydriatic biomicroscopic examination. Combined nonmydriatic FP and nonmydriatic SD-OCT increased sensitivity to 91.5%, specificity to 98.6%, and kappa to 0.91. CONCLUSION: The addition of nonmydriatic SD-OCT to nonmydriatic FP enhances the detection of AMD changes.

Indocyanine Green-Enhanced Thermotherapy for Retinoblastoma.

PURPOSE: To report the outcome of pediatric patients with retinoblastoma refractory to traditional local therapy who were treated with indocyanine green (ICG)-enhanced thermotherapy. MATERIALS AND METHODS: This is a retrospective review of a case series of 3 patients with bilateral retinoblastoma who were treated with ICG-enhanced thermotherapy after showing no response to conventional chemothermotherapy or transpupillary thermotherapy (TTT) alone noted on two consecutive examinations under anesthesia. RESULTS: The 3 patients had had one eye enucleated previously due to advanced disease, and the remaining eye was diagnosed with a large tumor, which showed either a marginal or no response to systemic chemotherapy and TTT. Addition of ICG enhancement during the subsequent TTT session shrunk the tumor to a measurable size that could then be followed by TTT alone as a means of treatment. One patient had tumor recurrence, at which time additional TTT without ICG was successfully applied after the tumor size had decreased; ICG enhancement was then added whenever TTT alone provided no response. CONCLUSIONS: ICG enhancement with TTT led to a measurable tumor regression in lesions that had previously not been responsive to traditional chemothermotherapy or isolated TTT. MESSAGE: These tumors had shown a minimal to no response to previous TTT treatment. However, adding ICG resulted in a measurable regression even though the same TTT treatment parameters were applied.

Induction with intravitreal bevacizumab every two weeks in the management of neovascular age-related macular degeneration.

PURPOSE: To explore the benefit of rapid induction with intravitreal bevacizumab for neovascular age-related macular degeneration (AMD). DESIGN: Single-institution prospective randomized pilot study. METHODS: Patients with treatment-naïve neovascular AMD were randomized 1:1:1 into 1 of 3 groups based on the induction sequence: (1) every 2 weeks for 3 consecutive injections; (2) every 4 weeks for 3 consecutive injections; and (3) immediate pro re nata (prn) after the first injection. Retinal angiomatous proliferation and polypoidal choroidal vasculopathy were excluded. Best-corrected visual acuity (BCVA) and central retinal thickness using optical coherence tomography (OCT) were measured at baseline and at each follow-up. After induction, bevacizumab was administered as needed based mainly on OCT. Main outcome measure was mean initial fluid-free interval after induction. Secondary outcomes were mean improvement in BCVA and central retinal thickness. RESULTS: Each group included 30 patients (30 eyes). Mean initial fluid-free interval was 2.4, 3.4, and 3.5 months for biweekly induction, monthly induction, and immediate prn groups, respectively (P = .03). Significance was lost when corrected for age and sex (P = .073). Mean improvement in BCVA, central retinal thickness, and total number of injections were similar among the groups at 12 months. Six eyes in the biweekly induction group developed subretinal fibrosis vs no eyes in the other 2 groups (P = .003). CONCLUSION: Biweekly induction with intravitreal bevacizumab for treatment-naïve neovascular AMD does not increase initial fluid-free interval or cause significant anatomic and functional benefit compared to monthly induction or immediate prn. There is also the potential development of subretinal fibrosis with biweekly induction.

Novel 'heavy' dyes for retinal membrane staining during macular surgery: multicenter clinical assessment.

PURPOSE: To evaluate the feasibility of two novel 'heavy' dye solutions for staining the internal limiting membrane (ILM) and epiretinal membranes (ERMs), without the need for a prior fluid-air exchange, during macular surgery. METHODS: In this prospective nonrandomized multicenter cohort study, the high molecular weight dyes ILM-Blue™ [0.025% brilliant blue G, 4% polyethylene glycol (PEG)] and MembraneBlue-Dual™ (0.15% trypan blue, 0.025% brilliant blue G, 4% PEG) were randomly used in vitrectomy surgeries for macular disease in 127 eyes of 127 patients. Dye enhanced membrane visualization of the ILM and ERMs, 'ease of membrane peeling', visually detectable perioperative retinal damage, postoperative best-corrected visual acuity (BCVA), dye remnants and other unexpected clinical events were documented by 21 surgeons. RESULTS: All surgeries were uneventful, and a clear bluish staining, facilitating the identification, delineation and removal of the ILM and ERMs, was reported in all but five cases. None of the surgeries required a fluid-air exchange to assist the dye application. BCVA at 1 month after surgery improved in 83% of the eyes in the MembraneBlue-Dual™ group and in 88% in the ILM-Blue™ group. No dye remnants were detected by ophthalmoscopy, and no retinal adverse effects related to the surgery or use of the dyes were observed. CONCLUSION: The 'heavy' dye solutions ILM-Blue™ and MembraneBlue-Dual™ can be injected into a fluid-filled vitreous cavity and may facilitate staining and removal of the ILM and/or ERMs in macular surgery without an additional fluid-air exchange.

Impact of thiazolidinediones on macular thickness and volume in diabetic eyes.

OBJECTIVE: To assess the impact of thiazolidinedione (TZDs) use on macular thickness and volume in patients with diabetes with no macular edema and no diabetic retinopathy (DR) or mild nonproliferative diabetic retinopathy (NPDR). DESIGN: Cross-sectional prospective pilot study. PARTICIPANTS: One hundred twenty patients (60 in each group) were enrolled, but 108 completed the study (59 in the TZD group and 49 in the non-TZD group). METHODS: Patients with type II diabetes mellitus were categorized into 2 groups depending on TZD intake. Those with no prior history of treatment for DR were considered for the study. Patients in both groups had assessment of visual acuity and dilated fundus examination. Only patients with no evidence of macular edema and no DR or mild-NPDR were included. Spectral-domain ocular coherence tomography (SD-OCT) was used for measurement of central retinal thickness (CRT) and macular volume. Main outcome measure was difference in mean macular volume and central thickness between the TZD and the non-TZD groups. RESULTS: Baseline demographics and characteristics were well matched between both groups. There was no significant difference in mean CRT of both groups (p = 0.13), but macular volume was significantly lower in the TZD group (p = 0.038). CONCLUSIONS: Patients with no macular edema and no DR or mild NPDR on TZDs did not show evidence of fluid retention in the macula on SD-OCT. Larger studies are needed to confirm these results.

Intravitreal bevacizumab in the management of neovascular age-related macular degeneration: effect of baseline visual acuity.

PURPOSE: To study prospectively the safety and efficacy of intravitreal bevacizumab for eyes with neovascular age-related macular degeneration with baseline visual acuity better than 70 letters (Snellen equivalent better than 20/40). METHODS: Patients with treatment-naive neovascular age-related macular degeneration were categorized prospectively into three groups according to baseline visual acuity: Group 1 (better than 70 letters), Group 2 (70 to 61 letters), and Group 3 (60 to 51 letters). Best-corrected visual acuity and central retinal thickness using optical coherence tomography were measured at baseline and at each follow-up visit. Intravitreal bevacizumab was administered according to an as-needed optical coherence tomography-guided regimen. Main outcome measure was mean best-corrected visual acuity for each group at 12 months. RESULTS: Each group included 30 patients (30 eyes). Improvement in central retinal thickness was similar among the 3 groups (P = 0.964). Mean letter gain in visual acuity at 12 months was +0.4, +3.8, and +4.2 for Groups 1, 2, and 3, respectively (P = 0.42). Mean best-corrected visual acuity at 12 months was 78.4 letters for Group 1, 70.0 letters for Group 2, and 61.1 letters for Group 3 (P < 0.001). All eyes in Group 1 (100%) avoided losing 15 letters of best-corrected visual acuity versus 83.3% in Group 2 and 80.0% in Group 3. This difference was significant only between Group 1 and Group 3 (P = 0.02). CONCLUSION: Intravitreal bevacizumab for eyes with neovascular age-related macular degeneration and baseline visual acuity better than 70 letters was safe and able to maintain this vision over 12 months.

Macular ultrastructural features in amblyopia using high-definition optical coherence tomography.

PURPOSE: To study macular morphology in amblyopic eyes using high-definition spectral domain optical coherence tomography (SD-OCT) and to compare the findings with fellow eyes. METHODS: This was a prospective institutional study of patients ≥6 years of age with unilateral amblyopia. Enhanced high-definition single line macular scans of amblyopic eyes were obtained using SD-OCT and compared with fellow eyes. Scans were evaluated qualitatively for structural differences. Central foveal thickness was measured and areas of the different retinal layers were computed within 500 µm from the foveal centre nasally and temporally. RESULTS: Forty-five patients with unilateral amblyopia were included: 25 with strabismic and 20 with anisometropic amblyopia with a mean age of 24.8 years. Qualitatively, the bulge in the inner segment/outer segment junction of the central fovea was noted to be attenuated or absent in 60% of amblyopic eyes compared with 29% of normal eyes, p=0.02. Also, amblyopic eyes demonstrated a shallow foveal pit compared with normal fellow eyes. Mean foveal thickness was significantly increased in amblyopic (228.56 µm) versus fellow eyes (221.72 µm), p=0.03. Upon exploring different retinal layers, the temporal inner nuclear layer area was increased (p=0.04) while the outer nuclear layer area was decreased (p=0.04) in amblyopic eyes compared with fellow eyes. CONCLUSIONS: Using enhanced high-definition SD-OCT, amblyopic eyes demonstrated qualitative and quantitative differences in macular features, possibly representing signs of immaturity compared with normal fellow eyes.

Fixed-interval versus OCT-guided variable dosing of intravitreal bevacizumab in the management of neovascular age-related macular degeneration: a 12-month randomized prospective study.

PURPOSE: To compare the efficacy of as-needed or variable dosing of intravitreal bevacizumab to continuous fixed-interval dosing in the management of neovascular age-related macular degeneration (AMD). DESIGN: Prospective, open-label, randomized clinical study. METHODS: One hundred twenty eyes of 120 patients with treatment-naïve subfoveal neovascular AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. Eyes were randomized (1:1) to fixed-interval dosing (every 4 to 6 weeks) or variable dosing with intravitreal bevacizumab (1.25 mg/0.05 mL). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) using optical coherence tomography (OCT) were measured at baseline and at each follow-up visit. Presence or recurrence of fluid on OCT was the main indicator for retreatment in variable dosing. Main outcome measure was improvement in BCVA and CRT at 12 months. RESULTS: Compared to baseline, variable dosing had a mean improvement in BCVA of 11.0 letters after 12 months vs 9.2 letters for fixed-interval dosing (P = .81). Similarly, CRT decreased after 12 months by 80.7 µm for variable dosing vs 100.5 µm for fixed-interval dosing (P = .37). The average number of injections over 12 months was higher for fixed-interval dosing than variable dosing (9.5 vs 3.8 injections, P < .001). CONCLUSIONS: Fixed-interval and variable dosing regimens of intravitreal bevacizumab improved visual acuity and anatomic outcomes after 12 months in eyes with neovascular AMD. However, variable dosing had a reduced treatment burden. Larger trials are needed to confirm these results.

Combined intravitreal bevacizumab with phacoemulsification in visually significant cataract and visually significant exudative maculopathy.

PURPOSE: We investigated the visual outcome of combined phacoemulsification with intravitreal bevacizumab, in eyes with dense cataract and visually significant exudative maculopathy. MATERIALS AND METHODS: Prospective longitudinal pilot study of consecutive patients treated by two surgeons in 2006, using intravitreal bevacizumab at the end of phacoemulsification. The historical control group consisted of consecutive subjects with exudative maculopathy and dense cataract treated by the same surgeons with the help of phacoemulsification without intravitreal bevacizumab prior to 2006. RESULTS: Thirty-one treated patients had the mean (SD) logMar best corrected visual acuity improving from - 1.48 (0.50) preoperatively to - 0.67 (0.38) in the first postoperative week (P < 0.001), to - 0.64 (0.40) in the first postoperative month (P < 0.001), and to - 0.62 (0.42) (P < 0.001) on the last follow-up (mean 4.2 months, range 1 - 9 months). Fourteen control patients had the mean (SD) logMar best corrected visual acuity improving from - 1.78 (0.79) preoperatively, to - 0.91 (0.53) in the first postoperative week (P < 0.001), to - 0.86 (0.45) in the first postoperative month (P < 0.001), and to - 0.90 (0.47) (P < 0.001) on the last follow- up (mean 19.6 months, range 1 - 49 months). Initial visual acuities, final visual acuities, and percentage of visual improvement at one month were all not significantly better in the intervention compared to the control group at one month. In the study group, the fovea was flattened at the one-month follow-up, by 90-diopter slit lamp examination and / or Optical coherence tomography. CONCLUSION: The combination of intravitreal bevacizumab and phacoemulsification is beneficial for maximal visual rehabilitation in the first postoperative month.

Bevacizumab and neovascular age related macular degeneration: pathogenesis and treatment.

The pathogenesis of neovascular age related macular degeneration (AMD) is multifactorial including inflammation and angiogenesis leading to choroidal neovascularization (CNV). Therapy against vascular endothelial growth factor (VEGF) has revolutionized the treatment of neovascular AMD. Intravitreal off-label use of bevacizumab proved to be safe. This literature review was conducted to study improvement in visual acuity, change in central retinal thickness (CRT), safety, pharmacodynamics, and possible resistance to intravitreal bevacizumab over a one-year period in eyes with neovascular AMD. We reviewed articles between 1997 and January 2010 that included at least 30 patients with AMD who received intravitreal bevacizumab monotherapy for at least 1 year. The mean number of letters gained, decrease in CRT, and number of injections were 8 letters, 125.3 µm, and 4.3 injections, respectively. Further, randomized prospective clinical trials are needed to determine the efficacy and safety of intravitreal bevacizumab in the treatment of neovascular AMD.

Retinal nerve fibre layer and macular thickness in amblyopia as measured by spectral-domain optical coherence tomography.

BACKGROUND/AIMS: To study peripapillary retinal nerve fibre layer (RNFL) and macular thickness in amblyopia using high-definition spectral-domain optical coherence tomography (SD-OCT) and to compare the results with available literature using the time-domain modality. METHODS: This was a prospective institutional study of patients ≥ 6 years of age with unilateral amblyopia (strabismic or anisometropic) and non-amblyopic anisometropia. RNFL and macular thicknesses were measured using SD-OCT and compared between fellow eyes. RESULTS: The mean age was 20 (± 12) years; 45 patients had amblyopia: 14 strabismic and 31 anisometropic. 20 patients had non-amblyopic anisometropia. The mean macular thickness was significantly increased in the amblyopic (273.8 µm) vs fellow eyes (257.9 µm), p=0.001. This difference remained significant in the anisometropic group (p=0.002) but not the strabismic group. The mean RNFL thickness was similar in amblyopic (95.4 µm) and fellow eyes (94.0 µm). Similar results were obtained regardless of the level of visual acuity, age or refractive error. In the control group of non-amblyopic anisometropia, the interocular difference did not reach statistical significance. CONCLUSIONS: Central macular thickness was significantly increased in anisometropic amblyopia using SD-OCT. Anisometropia alone did not produce such a difference, which points to a possible correlation between amblyopia and the development of the retinal layers.

Ranibizumab monotherapy versus single-session verteporfin photodynamic therapy combined with as-needed ranibizumab treatment for the management of neovascular age-related macular degeneration.

PURPOSE: To compare verteporfin photodynamic therapy combined with intravitreal ranibizumab (combination therapy) versus ranibizumab monotherapy for management of neovascular age-related macular degeneration. METHODS: Thirty patients (40 eyes) with neovascular age-related macular degeneration were prospectively allocated to combination therapy or monotherapy. In monotherapy, the induction phase consisted of 3 consecutive monthly ranibizumab injections (0.5 mg), while the combination therapy had a single session of photodynamic therapy with intravitreal ranibizumab. Follow-up treatment for either group consisted only of additional as-needed ranibizumab injections. The main outcome measure was that a proportion of eyes losing <15 letters of visual acuity after 12 months. RESULTS: Except for 1 eye in combination therapy, all eyes in both groups lost <15 letters of visual acuity. At 12 months, there was a mean gain of +12 letters and +3.2 letters for monotherapy and combination therapy, respectively (relative percent change of 32% vs. 7%, P = 0.03). Anatomical improvement was similar in both groups. After induction, the time until ranibizumab retreatment was longer for combination therapy (P = 0.002) while ranibizumab injections were required more frequently with monotherapy (P = 0.015). CONCLUSION: Ranibizumab monotherapy showed greater improvement in visual acuity versus combination therapy. However, combination therapy required fewer ranibizumab injections. Larger trials need to confirm the findings of this pilot study.

The distribution of visual field defects per quadrant in standard automated perimetry as compared to frequency doubling technology perimetry.

To test the ability of frequency doubling technology (FDT) perimetry to reveal defects in the same field quadrants as detected by standard automated perimetry (SAP). Ninety-two eyes with open-angle glaucoma and documented visual field defects by threshold SAP (Octopus Dynamic strategy) also underwent threshold FDT testing after successfully passing the FDT screening test. All eyes revealed varying stages of SAP defects while only 80 revealed FDT damage: 31:21 eyes in the early field loss stage, 36:35 in the moderate field loss stage, and 25:24 in the severe field loss stage in SAP versus FDT, respectively. SAP was able to detect abnormalities in 74 and 79% of the superotemporal, and inferotemporal quadrants, respectively, while the corresponding FDT figures were 70 and 69% for the same quadrants (P < 0.05 each). With regards to the nasal hemifield, SAP detected defects in 73 and 81% of the superonasal and inferonasal quadrants, respectively, compared to 69 and 66% for FDT (P < 0.001 each). The test duration per individual eye was significantly shorter with FDT than with SAP (P < 0.05). As well as the already established lower sensitivity of FDT compared to SAP, this study also demonstrated the significantly poorer ability of FDT in detecting the same field quadrant defects, especially in the early stages of glaucomatous damage.

Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: the second year of a prospective study.

PURPOSE: To demonstrate the efficacy of intravitreal bevacizumab for treatment of neovascular age-related macular degeneration (AMD). DESIGN: Prospective, open-label, nonrandomized clinical study. METHODS: Fifty-one patients (51 eyes) with subfoveal choroidal neovascularization (CNV) resulting from AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. These patients had already completed 12 months of follow-up. The criteria for reinjection were presence of fluid in the macula, increased central retinal thickness (CRT) of at least 100 microm, loss of at least 5 letters of vision associated with increased fluid in the macula, new classic CNV, or new macular hemorrhage. The main outcome measure was the proportion of eyes losing fewer than 15 letters of vision after 12 months. RESULTS: Fifty-one patients (51 eyes) completed the additional 12 months. Mean visual acuity improved from 45.7 letters at baseline to 54.3 letters at 24 months (P = .001), and 47 eyes (92.2%) lost fewer than 15 letters. Mean CRT decreased from 327.4 microm at baseline to 246.6 mum at 24 months (P < .001). A mean of 1.5 injections were administered over the course of the second year. No serious ocular or systemic side effects were noted. CONCLUSIONS: Eyes with neovascular AMD treated with intravitreal bevacizumab over 2 years had significant anatomic and functional improvement compared with baseline. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.

Intravitreal bevacizumab in inflammatory ocular neovascularization.

PURPOSE: To assess the role of bevacizumab in inflammatory ocular neovascularization. DESIGN: Retrospective, multicenter, consecutive case series of inflammatory ocular neovascularization. METHODS: Patients with inflammatory ocular neovascularization of varying causes for whom standard therapy failed were treated with intravitreal injection of bevacizumab. Main outcome measures included improvement of best-corrected visual acuity (BCVA) expressed in logarithm of minimum angle of resolution units, response of inflammatory ocular neovascularization by funduscopy and angiography, and decrease in central foveal thickness as measured by optical coherence tomography at the three-month follow-up. RESULTS: At the three-month follow-up, 84 eyes of 79 patients had been treated with a mean of 1.3 injections (range, one to three). Thirty-four eyes showed juxtafoveal choroidal neovascularization (CNV), 34 eyes showed subfoveal CNV, eight eyes showed peripapillary CNV, and 11 eyes showed neovascularization of the disc (NVD) or neovascularization elsewhere (NVE). BCVA improved 2.4 lines from 0.68 (6/28 or 20/94) to 0.44 (6/17 or 20/55) (P < .001). BCVA improved by one to three lines in 34.5% of the eyes, by four to six lines in 16.7% of the eyes, and by more than six lines in 14.2% of the eyes. Function was unchanged in 23.8% of the eyes. BCVA worsened in 10.7% (zero to three lines in 7.1%, more than four lines in 3.6%). Central foveal thickness decreased from baseline 346 to 252 microm (P < .001). For CNV, 32 eyes (43.2%) had complete regression after the injection, 27 (36.5%) had partial regression, five (6.8%) had no response, and 10 eyes (13.5%) were not evaluated by the contributors. For NVD or NVE, seven eyes (63.6%) had complete regression of new vessels and four eyes (36.4%) had partial regression after the injection. CONCLUSIONS: Intravitreal bevacizumab led to short-term significant visual improvement and regression of inflammatory ocular neovascularization in a wide variety of inflammatory ocular diseases.

Intravitreal triamcinolone acetonide: Pattern of secondary intraocular pressure rise and possible risk factors.

PURPOSE: To determine the pattern of increase in intraocular pressure (IOP) following intravitreal triamcinolone acetonide (IVTA) and identify possible risk factors associated with this rise in IOP. METHODS: We carried out a retrospective review of records for 185 patients (226 eyes) who received 4 mg of IVTA at the American University of Beirut Medical Center and Hotel Dieu de France eye clinics between 2003 and 2005 RESULTS: Mean follow-up was 8.17 months (range 6 to 24 months). The mean number of IVTA injections per eye was 1.31 +/- 0.69. The mean IOP increased after the first IVTA injection from 15.04 +/- 3.18 mmHg at baseline to a mean maximum of 17.20 +/- 5.75 mmHg (p < 0.0001, paired t-test) at month 3 of follow-up with a return to mean baseline IOP (15.49 +/- 4.79 mmHg) at month 12. Fifty nine of 226 eyes showed IOP higher than 21 mmHg during follow-up. Nine eyes started to have IOP greater than 21 mmHg, 6 to 12 months after a single injection. Intraocular pressure lowering medications were started when IOP exceeded 25 mmHg in 15 of the 226 eyes studied. No risk factors have been found to predict this IOP rise CONCLUSIONS: IOP elevation can occur in a significant number of eyes receiving 4 mg of IVTA. This phenomenon seems to be transient and a small number of eyes required treatment during this period. Eyes that received IVTA need to be monitored for IOP changes especially during the first 3 months, but the IOP may still rise 6 months and even 12 months after a single injection. This study did not show any risk factor that may predict this IOP rise.