A randomized trial to compare the safety and efficacy of two ranibizumab dosing regimens in a Turkish cohort of patients with choroidal neovascularization secondary to AMD.

PURPOSE: To compare visual outcomes, number of visits and ranibizumab injections in patients treated with a Wait & Extend (W&E) or Treat & Observe (T&O) regimen. METHODS: This 12-month, randomized, multicentre, open-label study enrolled patients aged ≥ 50 years with choroidal neovascularization (CNV) secondary to AMD who had not received anti-VEGF agents. Patients received three monthly injections of ranibizumab before randomization (1:1): (i) T&O patients were examined monthly and retreated if needed, (ii) W&E patients had a follow-up visit 1 month later. If no lesions were active, the interval to the next visit was extended by 2 weeks to a maximum of 8 weeks. Active lesions were re-treated and the follow-up schedule restarted. Primary end-point was change in BCVA at Month 12. RESULTS: Of the 104 screened patients, 99 were eligible and received ≥ 1 ranibizumab injection; 93 were randomized (T&O: 45, W&E: 48). The median (interquartile range [IQR]) change in BCVA (logMAR) from baseline at Month 12 was similar between groups (T&O: -0.12 [0.38]; W&E: -0.18 [0.32], p = 0.267). Median (IQR) number of visits at study end (including screening, baseline and control visit after 1st injection) was 15.0 (1.0) for T&O, and 12.0 (2.0) for W&E (p < 0.001). Injection numbers were similar between groups (median [IQR]: 6.0 [3.0] and 5.0 [4.0], respectively, p = 0.215). Adverse events were similar between groups. CONCLUSION: W&E regimen resulted in a similar efficacy and safety profile to the labelled T&O regimen in patients with CNV secondary to AMD, and may help reduce the burden of follow-up visits.

Pars plana vitrectomy in advanced coats' disease.

PURPOSE: To report 5 cases of advanced Coats' disease managed with pars plana vitrectomy and silicone oil tamponade. METHODS: Five patients with advanced Coats' disease and serous or tractional retinal detachment underwent pars plana vitrectomy with internal drainage, endolaser photocoagulation and silicone oil tamponade. One patient had combined phacoemulsification-vitrectomy surgery. Of the 5 patients, 1 had intravitreal hemorrhage and a retinal macrocyst and 1 had a retinal cyst. Follow-up period was 1-6 years. RESULTS: All patients had improved visual acuity after surgery. No intraoperative or postoperative complications were observed in any of the patients. The retina was attached and the disease was stable in all patients during follow-up. Two patients had cataract formation, and in one of them the cataract was successfully managed with phacoemulsification surgery. CONCLUSION: Pars plana vitrectomy, subretinal fluid drainage, and long-term silicone oil tamponade are effective methods in the management of advanced Coats' disease. Early and prompt management can prevent visual loss and secondary complications.

Intravitreal bevacizumab for persistent macular edema with proliferative diabetic retinopathy.

To evaluate the effectiveness of an intravitreal bevacizumab injection on retinal neovascularization and diabetic macular edema (DME) refractory to laser photocoagulation therapy. Thirty-four eyes of 22 patients with proliferative diabetic retinopathy and DME refractory to laser photocoagulation therapy received an intravitreal injection of 1.25 mg/0.05 ml of bevazicumab. Changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), regression of neovascularization over time, and correlation between BCVA and CMT were evaluated. Follow-up visits were at weeks 1, 2 and 4 and months 3 and 6. Mean BCVA was significantly better than baseline only at week 2 (P = 0.036). Mean CMT decreased significantly from baseline at weeks 1, 2, and 4 (P = 0.001). At months 3 and 6, mean CMT increased, albeit insignificantly (P = 0.804 and P = 1.0). The decrease in fluorescein leakage was moderate in all eyes at the end of week 1. At week 2, there was total resolution of fluorescein leakage in 24 (70.5%) eyes and moderate resolution in 10 (29.5%) eyes. At the end of month 3, the fluorescein leakage was fully resolved in 5 (14.7%) eyes, moderately resolved in 24 (70.5%) eyes, and was similar to baseline in 5 (14.7%) eyes. At month 6, the fluorescein leakage was fully resolved in 3 (8.8%) eyes, moderately resolved in 20 (58.8%) eyes, and was similar to baseline in 11 (32.4%) eyes. A moderate but insignificant negative correlation was found between visual acuity and CMT (P > 0.05). Persistence or recurrence of neovascular tissue after panretinal photocoagulation may be attributed to the production of vascular endothelial growth factor by the residual ischemic retina, which also results in persistent or recurrent DME despite macular grid photocoagulation.

Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation.

BACKGROUND: To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. METHODS: This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher's Exact test, Pearson Chi-square test, independent t-test, Mann-Whitney U-test, and a repeated ANOVA. RESULTS: The mean age of patients was 52.7 +/- 12.6 years in group 1 and 53.2 +/- 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 +/- 7.6 weeks in group 1 and 34.1 +/- 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 +/- 0.30 in group 1 and 0.72 +/- 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). CONCLUSION: ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity.