Efficacy and timing of adjunctive therapy in the anti-VEGF treatment regimen for macular oedema in retinal vein occlusion: 12-month real-world result.

PurposeVarious combination treatment regimens have been tried to improve the short-term efficacy of intravitreal monotherapy for the treatment of macular oedema (MO) secondary to retinal vein occlusion (RVO). Our study introduces the RandOL protocol (Ranibizumab and Ozurdex with Laser photocoagulation) of initial anti-VEGF therapy, controlling recurrent non-ischaemic MO with an intravitreal steroid and applying laser therapy to non-perfused retina. We describe our 12-month follow-up experience on timing for adjunctive therapy and real-world effectiveness and safety data.MethodsA retrospective analysis was carried out on 66 consecutive treatment-naive RVO patients with MO who received our RandOL treatment regimen. Baseline visual acuity (VA) and central retinal thickness (CRT) were compared with 12-month result.ResultsAt 12 months, 77% had significant VA improvement, 52% had ≥3-line improvement, and 15% were worse. Significant improvements in CRT were observed in 97% (baseline median CRT=531 µm (IQR 435-622) reduced to 245 µm (IQR 221-351, P<0.001) at 12 months); 76% achieved a dry fovea at 1 year. Mean number of total injections required was 5.5 (range 2-11) and 6% required ≥9 injections in 1 year. Although 70% received additional Ozurdex, 82% received ≥1 sessions of laser therapy. The BRVO subgroup achieved better VA and CRT improvement at 1 year, but small numbers limit definitive statistical conclusions.ConclusionsOur real-world results using a combination treatment protocol for RVO-related MO achieved similar desirable anatomical and visual outcomes as with a single-agent therapy with less intravitreal re-treatment rates at first year. Randomised controlled studies are needed to evaluate the role of laser and the ideal timing of combination therapy.

Review of lateral orbital wall ossifying fibroma.

Significant histological overlap exists between fibro-osseous lesions and diagnosis is made on a clinicopathological basis. Ossifying fibroma is a benign fibro-osseous neoplasm of the jaw and craniofacial complex that has generated a degree of controversy regarding diagnosis and classification, especially with respect to the psammomatoid variant. Orbital lesions mainly arise from the paranasal sinuses affecting the medial or inferior orbital wall. Lateral orbital wall ossifying fibroma is, therefore, a rare condition with only a single previous case report. We present a second case of lateral orbital wall ossifying fibroma and a review of the associated literature.

Ciliary body melanoma with partial deletion of chromosome 3 detected with multiplex ligation-dependent probe amplification.

BACKGROUND: The management of a patient with a small, pigmented ciliary body tumour is controversial, the various options including observation, radiotherapy, fine needle aspiration biopsy and excision biopsy. We report a case of ciliary body melanoma with partial deletion of chromosome 3, which was missed with fluorescence in situ hybridization (FISH) but detected with multiplex ligation-dependent probe amplification (MLPA). METHODS: A 23-year-old woman underwent an excision biopsy for a 4.5 mm by 3.9 mm by 2.0 mm ciliary body tumour, which was assessed by histology, immunohistochemistry, FISH and MLPA. RESULTS: Histology showed the tumour to a melanoma of mixed cell type. FISH with a centromeric probe indicated that the tumour was of disomy 3 type with a good prognosis; however, MLPA revealed a partial deletion of the long arm of chromosome 3. CONCLUSION: This case highlights the limitations of FISH, and demonstrates the value of MLPA in testing multiple chromosomal loci of prognostic significance. To our knowledge this is the first reported case of ciliary body melanoma assessed by MLPA.