Long-term follow-up of management of choroidal neovascularisation secondary to angioid streaks with intravitreal anti-vascular endothelial growth factor.

PURPOSE: To assess the short-term and long-term visual outcomes in patients with choroidal neovascularisation (CNV) secondary to angioid streaks treated with intravitreal anti-vascular endothelial growth factor (VEGF). METHODS: Retrospective, single-centre study. RESULTS: Overall 66 eyes of 52 patients were analysed. Follow-up ranged from 1 to 10 years. BCVA was 62 ETDRS letters at baseline, 68 letters at 1 year, 60 ETDRS letters at 5 years and 58 letters at 7 years. At 2 years patients gained 5.7 ETDRS letters from baseline but this gain was lost at 5 years. At 5 years there was an average loss of ETDRS letters from baseline of 3.3 letters. Sub-group analysis of subfoveal CNV showed worse outcome compared with eyes with extrafoveal and juxtafoveal CNV. In subfoveal CNV, BCVA was 53 ETDRS letters at 1 year (p < 0.0001) and 39 ETDRS at 5 years (p = 0.0005). CONCLUSION: Anti-VEGF therapy is effective at stabilising visual acuity in patients with choroidal neovascularisation secondary to angiod streaks, however there is a gradual decline in visual acuity observed with 5-10 years of follow-up. Furthermore, subfoveal CNV have worse visual outcome compared with extrafoveal and juxtafoveal CNV.

Factors affecting treatment outcomes with voriconazole in cases with fungal keratitis.

PURPOSE: To report clinical experience with the use of voriconazole for management of cases with fungal keratitis and to evaluate the factors affecting treatment outcomes. METHODS: Retrospective database review of all cases with fungal keratitis that were treated with topical voriconazole at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, between January 2003 and July 2010, was undertaken. Main parameters evaluated were clinical and microbiological profile of the cases, treatment, and final outcomes. RESULTS: A total of 26 cases were treated with voriconazole eye drops during the study period. In addition, voriconazole was used in the form of oral tablets (n = 16, 61.5%), intracorneal injection (n = 7, 26.9%), and intracameral injection (n = 2, 7.7%). Overall, 50% (n = 13) of cases responded to medical treatment. Further definitive surgical intervention in the form of penetrating keratoplasty was required in 11 cases (42.3%). Two cases (7.7%) underwent enucleation for severe nonresolving keratitis. Nonresponders were more likely to have peripheral infiltrates (38.5% vs. 7.7%, P = 0.16) and hypopyon (61.5% vs. 23%, P = 0.11) as compared with responders. There was no significant variation in the microbiological results between responders and nonresponders. CONCLUSIONS: Voriconazole was successful in the management of 50% cases of fungal keratitis in our study. Cases with peripheral infiltrates and hypopyon are less likely to respond to medical treatment.

Corneal metallic foreign body injuries due to suboptimal ocular protection.

Retrospective review of 100 consecutive presentations of metallic corneal foreign body to the Royal Victorian Eye and Ear Hospital emergency department was undertaken between November and December 2009. The majority of the patients (97%) were male with a mean age of 42 ± 13 years (range 19-73 years). The most common mode of injury was grinding (88%). Nearly half (45%) of patients were wearing "safety eye wear" at the time of injury. Combination of 25-gauge needle and burr was the commonest method employed for removal of foreign body. Overall, 88% (n = 88) cases healed with corneal scar at the site of corneal foreign body and 1 case developed bacterial keratitis. Metallic corneal foreign bodies are common presentations to the emergency department and may be related to inadequate implementation of occupational safety measures.

Sudden visual loss after intravitreal triamcinolone.

PURPOSE: To report a case of sudden loss of vision after intravitreal triamcinolone for the management of cystoid macular edema secondary to a central retinal vein occlusion with subsequent development of nonarteritic anterior ischemic optic neuropathy. METHOD: Retrospective case report. CONCLUSION: The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NAION) still remains controversial. Our report does not allow any conclusion about a direct causal relationship, however we postulate a contributory role of intrvitreal triamcinolone in the development of NAION in our patient.