A 12-year review on the aetiology and surgical outcomes of paediatric rhegmatogenous retinal detachments in Hong Kong.

PURPOSE: To evaluate the aetiology, clinical features, and surgical outcomes of paediatric rhegmatogenous retinal detachments (RRD) in Hong Kong.Patients and methodsThis is a retrospective consecutive case series of all patients aged 18 or under who underwent primary retinal detachment repair in the Hong Kong Eye Hospital from January 2000 to December 2012.ResultsForty-nine eyes of 47 patients were included. The mean age was 14, and the mean follow-up duration was 6.2 years. The most common aetiology for RRD was idiopathic (28.6%), followed by high myopia (24.5%), atopic dermatitis (AD) (18.4%), congenital and developmental abnormalities (16.3%), trauma (8.2%), and intraocular inflammation (4.1%). The mean preoperative visual acuity was LogMAR 1.0±0.8 (Snellen equivalent 6/60). The primary anatomical success rate in this series was 65.3%, and the final anatomical success rate was 85.7%. The mean postoperative visual acuity was LogMAR 0.9±1.2 (Snellen equivalent 6/48). Patients with congenital and developmental abnormalities or AD had worse anatomical and functional outcomes than patients who had no predisposing factor or high myopia. CONCLUSIONS: The primary and overall anatomical success rates in our series were comparable with existing literature. High myopia is the most commonly identifiable risk factor in Hong Kong and AD is associated with a higher re-detachment rates and a poor visual outcome.

Triple therapy for neovascular age-related macular degeneration using single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone.

AIM: To evaluate the efficacy and safety of triple therapy consisting single-session photodynamic therapy (PDT), intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVTA) for treatment of neovascular age-related macular degeneration (AMD) METHODS: Consecutive patients with subfoveal choroidal neovascularisation (CNV) secondary to AMD were treated with PDT using a standard protocol immediately followed by 1.25 mg of IVB and 4 mg of IVTA. 1.25 mg of IVB was given at 3 months for residual leakage. Best-corrected Snellen visual acuity (BCVA) and fluorescein angiography (FA) were performed prior to treatment. BCVA, intraocular pressure (IOP) and presence of vitritis were documented at 1 and 6 weeks, 3 and 6 months. FA was repeated at 3 and 6 months. Outcome measures included visual improvement measured by logMAR equivalent, angiographic evident of leakage and safety profile. RESULTS: 36 eyes of 33 patients, aged 76.4 (SD 10.5) years with mean follow-up of 14.7 (6.9-19.2) months were analysed. Baseline logMAR acuity was 1.22 (0.71). The mean logMAR acuity was 1.14 (0.62) and 1.18 (0.63) at 3 and 6 months respectively. At 6 months, 61.1% (22/36) showed stable or gaining vision, and 27.8% (10/36) gained three or more lines. Twenty-eight eyes (77.8%) achieved CNV resolution by single session of triple therapy. One eye lost more than six lines due to retinal pigment epithelium rip, three eyes showed a significant cataract requiring surgery, and two showed persistent raised IOP at 6 months. None resulted in endophthalmitis or reported thromboembolic event. CONCLUSIONS: Short-term results of single session triple therapy suggested that it might be a useful treatment option for neovascular AMD based on its low retreatment rates, sustainable CNV eradication result and visual gain achievement. However, the risk and benefits of using intravitreal triamcinolone in addition to combined PDT and IVB warrant further evaluation.