Ocular surface and glaucoma, a mutual relationship. Practical suggestions for classification and management.

The chronic use of glaucoma medications could improve the development of an ocular comorbidity, the glaucoma therapy-related ocular surface disease. This could be related to the exposure of the conjunctiva to preservatives, but also active compounds such as prostaglandin analogues may improve the risk of ocular surface inflammation. Inflammation has a negative impact on tolerability and adherence to eyedrops and to the outcome of filtration surgery as well. A stratification of glaucoma patients based not only on visual field progression but also on glaucoma therapy-related ocular surface disease would be desirable for a strategic management. Early diagnosis, individualized treatment, and safe surgical management should be the hallmarks of glaucoma treatment. One of the main issues for the proper and successful management of patients is the right timing, effectiveness and safety for both medical and surgical treatment options leading to a precision medicine in glaucoma disease as the best modern treatment.

Intravitreal bevacizumab for choroidal neovascularization secondary to angioid streaks: a long-term follow-up study.

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab (IVB) to treat choroidal neovascularization (CNV) in patients with angioid streaks. METHODS: Retrospective chart review of 16 eyes of 10 patients treated with IVB for CNV secondary to angioid streaks between November 2005 and November 2011. Intravitreal bevacizumab was performed in all patients with a pro re nata regimen. Seven eyes received an additional photodynamic therapy and 1 eye argon laser photocoagulation. The diagnosis of CNV was confirmed by fluorescein angiography (FA) and indocyanine green (ICG) angiography; central macular thickness (CMT) was evaluated by optical coherence tomography. Outcome measures included changes in best-corrected visual acuity, retinal thickness, and degree of leakage on FA and ICG angiography. RESULTS: The median number of IVB was 2.5 (range 1-6) during a mean follow-up of 52 months (range 30-67). Risk of recurrence increased during the first 50 weeks; then it remained stable. In 6 of 16 eyes, the CNV was obliterated with a single injection. Increasing CNV reactivation corresponded with an increased number of injections. Final visual acuity was related to initial VA and not to number of injections or shorter follow-up. Previous treatments, CMT, or baseline CNV size were not related to final visual acuity. CONCLUSIONS: Intravitreal bevacizumab proved to be well-tolerated in patients with CNV secondary to angioid streaks and in our small cohort IVB was efficacious for long-term follow-up. Larger series of patients are needed to confirm the effects of this treatment.

Diagnosis and detection.

PURPOSE: To evaluate features of macular edema assessed by optical coherence tomography (OCT)and other imaging tools such as infrared, blue retinography and autofluorescence, and fluorescein and indocyanine green angiography (ICGA) in different pathologic conditions. METHODS: The principal causes of macular edema were reviewed to evaluate its aspect in each pathology. Correlations between OCT and other imaging techniques were analyzed. RESULTS: Optical coherence tomography and other imaging tools allowed the authors to confirm the existence of different macular edema patterns for different pathologies and to describe their characteristics; in particular, some conditions, like idiopathic macular telangiectasias and age-related maculopathy, were found to present specific edema patterns. CONCLUSIONS: Simultaneous use of different imaging techniques allowed a better evaluation and follow-up of conditions causing cystoid macular edema.

Macular edema. Diagnosis and detection.

The aim of the chapter is to provide a practical but exhaustive guide in detecting macular edema and to describe its features depending on the retinal condition which cause it. The most useful imaging techniques and tools (Biomicroscopy, retinography, Optical Coherence Tomography, Fluorescein/Indocyanine-Green Angiography) will be analysed in order to identify the best diagnostic algorithm in each pathology. At the end of the chapter a summary table synthesize what previously widely described.