Concomitant bilateral intravitreal anti-VEGF injections for the treatment of exudative age-related macular degeneration.

PURPOSE: To report the outcomes of same-day, bilateral intravitreal anti-vascular endothelial growth factor (VEGF) therapy for a consecutive series of patients treated for exudative age-related macular degeneration (ARMD). METHODS: A consecutive series of 254 eyes of 127 patients received bilateral, same-day anti-VEGF injections of either bevacizumab or ranibizumab between January 1, 2007 and July 1, 2008 and the outcomes were assessed. Approval was obtained from the Institutional Review Board at the University of Miami Miller School of Medicine. RESULTS: Bilateral, same-day anti-VEGF injections were well tolerated in all patients receiving the therapy. Indication for injection was exudative macular degeneration in all patients. The incidence of adverse effects was low, with only four events reported, none of which were serious. CONCLUSIONS: In this study, bilateral anti-VEGF injections performed on the same day were preferred over staggered injections and were well tolerated by patients. No major systemic or ocular adverse events were noted, despite the presence of risk factors in a subset of patients. Given that there are serious, albeit rare, complications following anti-VEGF injection, further study with a larger number of patients will be necessary to definitively prove the safety of this treatment modality.

Intravitreal injection analysis at the Bascom Palmer Eye Institute: evaluation of clinical indications for the treatment and incidence rates of endophthalmitis.

OBJECTIVE: To report the incidence of endophthalmitis, in addition to its clinical and microbiological aspects, after intravitreal injection of vascular-targeting agents. METHODS: A retrospective review of a consecutive series of 10,142 intravitreal injections of vascular targeting agents (bevacizumab, ranibizumab, triamcinolone acetonide, and preservative-free triamcinolone acetonide) between June 1, 2007 and January 31, 2010, performed by a single service (TGM) at the Bascom Palmer Eye Institute. RESULTS: One case of clinically-suspected endophthalmitis was identified out of a total of 10,142 injections (0.009%), presenting within three days of injection of bevacizumab. The case was culture-positive for Staphylococcus epidermidis. Final visual acuity was 20/40 after pars plana vitrectomy surgery. CONCLUSIONS: In this series, the incidence of culture-positive endophthalmitis after intravitreal injection of vascular agents in an outpatient setting was very low. We believe that following a standardized injection protocol, adherence to sterile techniques and proper patient follow-up are determining factors for low incidence rates.

Surgical management of vitreofoveal traction syndrome: optical coherence tomographic evaluation and clinical outcomes.

BACKGROUND AND OBJECTIVE: To characterize vitreofoveal traction syndrome and to correlate clinical observations, optical coherence tomography features, and surgical results. PATIENTS AND METHODS: A retrospective, consecutive, interventional case series of 36 patients. Clinical and optical coherence tomography features taken from patient charts were compared preoperatively and postoperatively and correlated with visual outcomes. RESULTS: Preoperatively, visual acuity ranged from 20/40 to 20/400 and improved more than 2 lines in 50% of eyes. A macular hole developed in 2 eyes. The optical coherence tomography appearance of traction resolved in all eyes; cystic change improved markedly or resolved in 86% of eyes. Preoperative optical coherence tomography features did not correlate with visual acuity. Patients with symptoms for less than a 6-month duration (P = .048) were more likely to obtain a visual acuity of 20/40 or better postoperatively. Presence or resolution of macular cystic changes and subretinal fluid did not correlate with visual acuity or change (P > .05). CONCLUSION: Patients with vitreofoveal traction syndrome usually achieve favorable visual optical coherence tomography outcomes after pars plana vitrectomy.

Echographic localization of periocular Carboplatin for treatment of advanced retinoblastoma.

PURPOSE: To study ocular ultrasonography as a means to effectively localize periocular carboplatin in patients with advanced retinoblastoma. METHODS: In a cases series, seven patients diagnosed with advanced retinoblastoma refractory to standard chemotherapy were treated with two to four periocular carboplatin injections. Echographic images were obtained before and after injection. RESULTS: The periocular carboplatin depot was a discrete homogeneous structure with lower internal reflectivity than the surrounding orbital tissue. The mean maximal juxtascleral height of the drug depot ± SD was 3.3 ±1.4 mm and was located directly posterior to the area of maximal intraocular tumor thickness in all seven patients. Moderate shadowing from calcification was present in one patient. Five patients had a pattern of a thinner pocket of drug visible after subsequent injections. CONCLUSIONS: Echography is a useful technique to study novel periocular drug delivery. It effectively images the drug in relation to the intraocular tumor, confirming the most effective drug placement for these resistant tumors.