Bevacizumab treatment for neovascular age-related macular degeneration in the setting of a clinic: "real life" long-term outcome.

BACKGROUND: To evaluate the long-term outcome of bevacizumab therapy for neovascular age related macular degeneration (NVAMD) in the setting of a clinic. METHODS: Consecutive group of NVAMD patients who were treated in a single 3(rd) referral center with bevacizumab using a loading dosage of 3 monthly injections followed by variable dosing for at least 48 months were retrospectively evaluated. Genotyping was performed for CFH (rs1061170), HTRA1 (rs1200638), and C3 (rs2230199). Main outcome measures included functional and morphological treatment outcomes as well as their risk allele associations. RESULTS: Out of 128 patients who started bevacizumab treatment over 4 years before the study endpoint [mean (± SD): 60 ± 10.9 months], 75 eyes of 67 (52.3%) patients, were still followed. Mean best corrected visual acuity (BCVA) (LogMAR ± SEM) improved from 0.66 ± 0.07 at baseline to 0.48 ± 0.05 (p = 0.012) at 1 year, but deteriorated from the 3(rd) year on and at the final exam reduced to 0.69 ± 0.07 (p = 0.6, compared with initial BCVA). Macular thickness mirrored visual acuity (VA) changes showing initial thinning followed by thickening from the 3(rd) year on. Individuals carrying the CFH risk -allele had a mean thickening (microns ± SEM) of 66.9 ± 70.4 versus a mean thinning of 76.8 ± 22 in non-carriers (p = 0.015). CONCLUSIONS: Bevacizumab therapy for NVAMD using a flexible treatment algorithm in a "real life" clinical setting initially obtained VA gain and thinning of the macula that were maintained for two years, but were lost later on.

Pars plana vitrectomy to repair retinal detachment following brachytherapy for uveal melanoma.

AIMS: Retinal detachment can develop following brachytherapy for uveal melanoma. This complication may result in substantial visual loss and poses a significant therapeutic dilemma due to the required surgical intervention for correction of the detachment. We report the incidence of retinal detachment in eyes treated with brachytherapy for posterior uveal melanoma and the outcome of pars plana vitrectomy in those eyes. METHODS: Patients who developed tractional or combined tractional-rhegmatogenous retinal detachment following brachytherapy for posterior uveal melanoma in a single referral centre were retrospectively evaluated. Clinical findings, demographics, and ophthalmic imaging findings were recorded, as well as the manner of treatment and its success. RESULTS: Seven of the 473 posterior uveal melanoma patients (1.48%), who were treated between 2000 and 2011 with brachytherapy, developed tractional or combined tractional-rhegmatogenous retinal detachment. Retinal detachment developed at a mean of 50.1 months (range 3.5-120 months) following brachytherapy. All patients underwent pars plana vitrectomy. Retinas remained attached in each of the cases. In five of seven patients there was substantial improvement in visual acuity following repair of the retinal detachment. No tumour growth or dissemination were observed during the mean follow-up of 18.4 months after vitrectomy (range 10-36 months). CONCLUSIONS: Tractional and tractional-rhegmatogenous retinal detachment are rare complications of treated uveal melanoma. Pars plana vitrectomy appears to be an effective and safe procedure in such cases.