Variability of disease activity in patients treated with ranibizumab for neovascular age-related macular degeneration.

PurposeTo analyze choroidal neovasularization (CNV) activity and recurrence patterns in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab, and the correlation with individual intraocular vascular endothelial growth factor (VEGF) suppression time (VST).MethodsPost-hoc analysis of data from a prospective, non-randomized clinical study. Patients with nAMD treated with ranibizumab on a pro re nata regimen. Disease activity was analyzed monthly by spectral-domain optical coherence tomography and correlated with VSTs.ResultsOverall, 73 eyes of 73 patients were included in the study with a mean follow-up of 717 days (range: 412-1239 days). Overall, the mean CNV-activity-free interval was 76.5 days (range: 0-829 days). The individual range of the length of dry intervals was high. A total of 42% of patients had a range of more than 90 days. Overall, 16% of patients showed persistent activity. And 12% stayed dry after the initial ranibizumab treatment. No significant correlation was found between the CNV-recurrence pattern and VST (P=0.12).ConclusionsCNV activity in nAMD is irregular, which is reflected in the range of the duration of dry intervals and late recurrences. The biomarker VST solely seems not to be sufficient to explain recurrence pattern of CNV in all AMD patients.

[Comparison of Rebound tonometry versus Perkins tonometry in the supine glaucoma patient]. / Vergleich zwischen Rebound-Tonometrie und Perkins-Tonometrie am liegenden Glaukompatienten.

BACKGROUND: The aim of this study was to evaluate the concordance of intraocular pressure (IOP) measurements in the supine glaucoma patient using a Perkins applanation tonometer (PAT) compared to the iCare® rebound tonometer (RT), a hand-held device requiring no local anaesthesia. METHODS: 73 left eyes of 73 glaucoma patients were included in this consecutive case study and measured both by supine Perkins applanation tonometry and by right lateral posture rebound tonometry in the supine position (RLP). The patients were divided into three subgroups dependent on IOP (SG-1: 0 - 15 mmHg, SG-2: 16 - 22 mmHg, SG-3: more than 23 mmHg). RESULTS: The mean deviation between RT and PAT was 2.6 ± 4.0 mmHg, the 95 % confidence interval was -5.3 to 10.4 mmHg. 69 % of the measurements showed deviations within 3 mmHg between the two devices. Deviation was smallest in SG-2, and largest in SG-3. CONCLUSIONS: Rebound tonometry is comfortable to use even in supine patients. RT measurement agreed overall significantly with those of Perkins applanation tonometry, generally overestimating PAT measurement. In high IOP values, RT did not correlate as well with PAT as in moderate IOP levels.

[Panic after LASIK: acute medication-induced myopic recurrence after refractive surgery]. / Panik nach LASIK: Akutes medikamenteninduziertes Myopierezidiv nach refraktiver Chirurgie.

We report a case of acute myopic recurrence in a 38-year-old patient in a state of panic with a condition corresponding to LASIK 4 months earlier. The patient had commenced topiramate treatment 1 week previously, which is an antiepileptic drug also approved for migraine treatment. The symptoms were due to a rare topiramate-induced side effect (SE) with ciliochoroidal effusion, anterior shift of the lens-iris diaphragm and induced myopia. Cessation of topiramate led to complete remission of this idiosyncratic reaction, however, the patient's anxiety was impressive. Ocular administration of Topiramat-SE should thus be clarified.

Variant effect of first- and second-generation antihistamines as clues to their mechanism of action on the sneeze reflex in the common cold.

Treatment with first-generation antihistamines reduces sneezing, rhinorrhea, nasal mucus weight, and, in some instances, cough in subjects with experimental or natural colds; however, treatment with second-generation antihistamines has not been effective for these complaints in trials in subjects with natural colds. This article reports the negative results of a clinical trial with loratadine, a second-generation antihistamine, in adults in the rhinovirus challenge model. This finding in the highly controlled setting of the challenge model confirms the earlier negative studies with second-generation antihistamines in natural colds. First-generation antihistamines block both histaminic and muscarinic receptors as well as passing the blood-brain barrier. Second-generation antihistamines mainly block histaminic receptors and do not pass the blood-brain barrier. The effectiveness of first-generation antihistamines in blocking sneezing in colds may be due primarily to neuropharmacological manipulation of histaminic and muscarinic receptors in the medulla.