Intravitreal bevacizumab and aflibercept for the treatment of exudative age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To compare treatment of exudative age-related macular degeneration (AMD) with bevacizumab versus aflibercept in terms of central retinal thickness (CRT) and best corrected visual acuity (BCVA). PATIENTS AND METHODS: A retrospective cohort study examining changes in CRT and BCVA over 12 months of follow-up in 111 patients treated with bevacizumab and 91 treated with aflibercept for exudative AMD. RESULTS: Treatment with bevacizumab and aflibercept reduced CRT from baseline to 12 months. Aflibercept significantly reduced the mean change from baseline CRT at 12 months compared to bevacizumab. However, mean CRT at 12 months was not significantly different after aflibercept versus bevacizumab (271.6 ± 74.0 µm vs 257.9 ± 48.5 µm). BCVA was significantly better at 6 months in the aflibercept group. At baseline, 18.5% of bevacizumab and 26.4% of aflibercept patients had BCVA better than 20/40. At 12 months, 34.8% of bevacizumab and 38.9% of aflibercept patients had BCVA better than 20/40. CONCLUSION: CRT decreased and BCVA improved after treatment with bevacizumab and aflibercept for exudative AMD.

Visual field defects in deformational posterior plagiocephaly.

PURPOSE: We sought to determine whether visual field abnormalities occur in infants with deformational posterior plagiocephaly and to assess whether there is a relationship between the severity and laterality of visual field abnormalities with the severity and laterality of skull deformity. METHODS: A retrospective chart review was performed on 40 consecutive infants with deformational posterior plagiocephaly. Each was tested with standardized binocular arc perimetry in the horizontal plane. Sixteen patients also had 3-dimensional computed tomography of the skull. Hemifield asymmetry of >/=20 degrees and/or a decrease in hemifield values by >/=20 degrees from established normal patients was considered abnormal. Visual field data from study patients was plotted against previously published normative data. Graphs comparing visual field defects and laterality to cranial asymmetry also were generated. RESULTS: Thirty-five percent of infants with deformational posterior plagiocephaly had constriction of one or both hemifields by at least 20 degrees from established normal patients. Hemifield asymmetry of 20 degrees or more was found in 17.5% of infants tested. There was a significant difference in the worse hemifield values measured in each patient and the standard visual fields obtained from normative data ( P = 0.036). There was no correlation between the laterality of the visual fields to the laterality of the defects. A correlation between severity of hemifield constriction and % asymmetry on computed tomography was noted ( P = 0.209). CONCLUSIONS: Deformational posterior plagiocephaly may affect visual field development but neither the laterality nor the severity of skull deformity is predictive of the severity of visual field defects.

Conjunctival ulceration in recurrent Wegener granulomatosis.

PURPOSE: To describe a patient with Wegener granulomatosis (WG) previously in remission who developed conjunctival ulceration as the first sign of disease recurrence. METHODS: Case report and review of the literature. RESULTS: Twenty-one years after WG was originally diagnosed and with the disease thought to be in remission, a 52-year-old man with complaints of ocular irritation for the previous year was found to have multiple palpebral conjunctival ulcerations of the left eye. Incisional biopsy revealed mixed inflammation consistent with WG. Within 3 months of recognition of his conjunctival ulcers, newly recurrent pulmonary inflammation developed and serologies for cytoplasmic-pattern antineutrophil cytoplasmic antibodies (C-ANCA) became positive. CONCLUSION: Conjunctival ulceration is a rare manifestation of WG but may presage more widespread disease. Mucosal ulceration in a patient with a previous diagnosis of WG should stimulate an aggressive search for renewed systemic disease activity.