Transconjunctival fat removal combined with conservative medial wall/floor orbital decompression for Graves orbitopathy.

PURPOSE: To evaluate the utility of transconjunctival fat removal combined with conservative ("strut-sparing") bony medial/floor orbital decompression for Graves orbitopathy. METHODS: Retrospective, noncomparative case series of 52 orbits in 28 patients that underwent decompression using this technique. Preoperative and postoperative exophthalmos, diplopia, logMAR visual acuity, and orbital symmetry were measured. RESULTS: Reduction in exophthalmos up to 8 mm with a mean of 3.3 mm (+/-1.5 mm) was achieved for decompressed orbits (p < 0.001). Postoperative symmetry within 2 mm was achieved in all patients. Diplopia was improved in 4 patients (14%), unchanged in 23 (82%), and worse in 1 (4%). Mean logMAR visual acuity improved -0.11 units (p = 0.007). CONCLUSIONS: Orbital fat removal combined with conservative ("strut-sparing") bony medial/floor orbital decompression via a single transconjunctival incision is an effective and efficient technique with minimal morbidity.

Vitreous levels of unbound bevacizumab and unbound vascular endothelial growth factor in two patients.

BACKGROUND: Vitreous levels of unbound bevacizumab (Avastin) and unbound vascular endothelial growth factor (VEGF) were determined in two patients. Patient 1 underwent repair of an 8-day-old rhegmatogenous retinal detachment 4 weeks after a single intravitreal bevacizumab injection, and Patient 2 underwent vitreous biopsy for endophthalmitis 48 hours after a combined bevacizumab and triamcinolone injection. METHODS: The samples of vitreous fluid were analyzed for unbound bevacizumab and unbound VEGF levels using microsphere immunoassays targeted for bevacizumab and VEGF. RESULTS: In Patient 1, the unbound bevacizumab level was 0.16% of the loading dose (or 500,000 pg/mL) and the unbound VEGF concentration was <41 pg/mL 4 weeks after the bevacizumab injection. In Patient 2, the unbound bevacizumab level was 53% of the loading dose (or 166,000,000 pg/mL) at 48 hours, with an unbound VEGF level of <41 pg/mL. CONCLUSION: A single dose of intravitreal bevacizumab is likely to provide complete intravitreal VEGF blockade for a minimum of 4 weeks, with an intravitreal bevacizumab half-life of approximately 3 days.

Central corneal thickness and glaucoma in aphakic and pseudophakic children.

BACKGROUND: The risk of glaucoma among aphakic children is as high as 32%, based primarily on intraocular pressure (IOP) measurements. Although IOP may be falsely elevated by increased central corneal thickness, central corneal thickness (CCT) values have not been reported in this population. METHODS: Patients from the practices of 2 pediatric ophthalmologists and 2 glaucoma specialists had measurements of CCT, IOP, and optic nerve cupping, with visual field analysis when possible. Normal fellow eyes of unilateral aphakes and pseudophakes were included as controls. RESULTS: In 36 aphakic and 6 pseudophakic eyes CCT averaged 660 microns compared with 576 microns for phakic fellow eyes (P < 0.0001). Glaucoma, defined by IOP at least 35 mm Hg or by IOP at least 22 mm Hg associated with optic nerve changes, occurred in 21% of 28 aphakic patients but in no pseudophakic patient. CONCLUSIONS: CCT in aphakic/pseudophakic children is substantially increased compared with control patients. These values may be important in interpreting IOP measurements in these children.