Efficacy and timing of adjunctive therapy in the anti-VEGF treatment regimen for macular oedema in retinal vein occlusion: 12-month real-world result.

PurposeVarious combination treatment regimens have been tried to improve the short-term efficacy of intravitreal monotherapy for the treatment of macular oedema (MO) secondary to retinal vein occlusion (RVO). Our study introduces the RandOL protocol (Ranibizumab and Ozurdex with Laser photocoagulation) of initial anti-VEGF therapy, controlling recurrent non-ischaemic MO with an intravitreal steroid and applying laser therapy to non-perfused retina. We describe our 12-month follow-up experience on timing for adjunctive therapy and real-world effectiveness and safety data.MethodsA retrospective analysis was carried out on 66 consecutive treatment-naive RVO patients with MO who received our RandOL treatment regimen. Baseline visual acuity (VA) and central retinal thickness (CRT) were compared with 12-month result.ResultsAt 12 months, 77% had significant VA improvement, 52% had ≥3-line improvement, and 15% were worse. Significant improvements in CRT were observed in 97% (baseline median CRT=531 µm (IQR 435-622) reduced to 245 µm (IQR 221-351, P<0.001) at 12 months); 76% achieved a dry fovea at 1 year. Mean number of total injections required was 5.5 (range 2-11) and 6% required ≥9 injections in 1 year. Although 70% received additional Ozurdex, 82% received ≥1 sessions of laser therapy. The BRVO subgroup achieved better VA and CRT improvement at 1 year, but small numbers limit definitive statistical conclusions.ConclusionsOur real-world results using a combination treatment protocol for RVO-related MO achieved similar desirable anatomical and visual outcomes as with a single-agent therapy with less intravitreal re-treatment rates at first year. Randomised controlled studies are needed to evaluate the role of laser and the ideal timing of combination therapy.

Report of 12-months efficacy and safety of intravitreal fluocinolone acetonide implant for the treatment of chronic diabetic macular oedema: a real-world result in the United Kingdom.

PurposeTo report the 12-months visual and anatomical outcomes of chronic diabetic macular oedema (DMO) treated with ILUVIEN in a real-world clinical practice in a single tertiary referral centre.MethodRetrospective data collection and analysis of consecutive 28 eyes of 23 diabetic patients received ILUVIEN implant for refractory DMO. Standard assessment included visual acuity (VA), central retinal thickness (CRT), slit-lamp biomicroscopy, and Goldmann tonometry for intraocular pressure (IOP) at 1, 6, and 12 months.ResultsBaseline mean VA was 47 (SD 18) letters improved to 55 (SD 17) letters (P=0.004) at 12 months. VA was improved in 16 eyes (57%), stabilised in 9 eyes (32%), and decreased in 3 eyes (11%). Seven eyes (25%) gained ≥15 letters, and 10 eyes (36%) gained >10 letters from baseline. The percentage of eyes achieved driving vision (≥70 Early Treatment Diabetic Retinopathy Study letters) was doubled from baseline 18 to 36% at 6 months and 32% at 12 months. Mean CRT decreased by 198 µm from baseline 494 µm (SD 191) to 296 µm (SD 121) at 12 months (P<0.001). Two eyes received additional anti-vascular endothelial growth factor injections after 10 months. COMPLICATIONS: Raised IOP in three eyes (11%) controlled with IOP-lowering drops, vitreous haemorrhage in one eye and one endophthalmitis (1 year vision improved to 6/24).ConclusionOur real-world results show that the visual and the anatomical improvements achieved by a single ILUVIEN implant injection were maintained up to 12 months with minimal adjunctive therapy. IOP monitoring remains essential in ILUVIEN patients, although our study shows a relatively low risk of IOP elevation post ILUVIEN injection, even in existing controlled ocular hypertension. Our results demonstrate that ILUVIEN is an effective long-term option in treating chronic refractory DMO.

Sharps injuries in ophthalmic practice.

PURPOSE: Accidental sharps injuries are a potential route for transmission of blood-borne infection to healthcare workers. Ophthalmic staff in particular are at risk of sustaining such injuries due to the microsurgical nature of the speciality. Forthcoming European Union legislation aimed at reducing sharps injuries requires the development of risk-based sharps policy. The authors believe that this is the first study to assess the risks of sharps injuries and their management specific to ophthalmic practice within the European Union. METHODS: A retrospective review of all reported sharps injuries across three eye units in the UK over a period of 6 years was undertaken. Data were analysed to determine the circumstances surrounding the injury, occupation of the injured person, and whether appropriate actions were taken following incidents. RESULTS: A total of 68 sharps injuries were reported over the 6-year period. Nurses sustained 54.4% (n=37) of needlestick injuries, doctors 39.7% (n=27), and allied healthcare staff 5.9% (n=4). In all 51.5% (n=35) of sharps injuries occurred in the operating theatre, 30.9% (n=21) in the outpatient clinic, 13.2% (n=9) on the ophthalmic ward, and 4.4% (n=3) in unspecified locations. There was a median rate of 1.3 sharps injuries per 1000 surgical procedures per year and a range of 0.4-3.5 per 1000. CONCLUSIONS: This study demonstrates the need to raise awareness of the unique risks of sharps injuries in ophthalmic practice. This is necessary in order to develop speciality-specific policy that promotes strategies to reduce such injuries, enhances the accuracy of reporting of such events, and provides guidance for appropriate management.

Retinopathy: variable clinical spectrum and post-endarterectomy changes.

BACKGROUND: The Carotid Artery Insufficiency Retinopathy (CAIR) is an uncommon sign of carotid artery obstruction. It is mainly found in patients with complete occlusion or severe obstruction of internal Carotid Artery (ICA). Retinopathy is caused by progressive and chronic hypoxia to ocular tissues. The purpose of the study is to describe the variable presentation of CAIR in patients with internal carotid artery stenosis and to asses the resolution of retinopathy in patients who had carotid endarterectomy. METHODS: Records of the patients with confirmed internal carotid artery stenosis were reviewed. Patients' demographic data and way of presentation to ophthalmologist was recorded. Associated systemic vascular diseases were also recorded on the proforma. Records of the patients with confirmed internal carotid artery stenosis were reviewed. RESULTS: Thirteen eyes of 10 patients were included in study with male to female ratio of 9:1. Patients' clinical presentation ranged from scattered blot haemorrhages to ocular ischemic syndrome. Patients presented with retinopathy at different stages. The presentation of retinopathy varied from scattered blot haemorrhages to ocular ischemic syndrome. Endarterectomy resolved CAIR in 2 out of 3 patients, with one patient having bilateral resolution. CONCLUSION: CAIR should be suspected if retinopathy is unilateral. On the other hand patients with asymptomatic Carotid artery stenosis should be examined for signs of ocular ischemia. All patients with CAIR should be investigated for cardiovascular diseases. Endarterectomy in selected patients can resolve CAIR.

Phacoemulsification in true exfoliation of the lens capsule: a case series.

PURPOSE: We report five cases (seven eyes) of true exfoliation during an 18-month period. Of the two bilateral cases, the first was identified immediately before cataract surgery and the second spontaneously developed a split in the anterior capsule just before capsulorrhexis, mimicking a partial capsulorrhexis. In the three unilateral cases, true exfoliation was noted during the first examination. METHODS: Vision blue aided uneventful capsulorrhexis differentiating its edge from the true exfoliation edge, and in the first two cases, the anterior capsule was sent for histopathology and ultrasound of the fellow eye was requested. RESULTS: Ultrasound and histopathology demonstrated lamellar separation of the anterior portion of the lens capsule, confirming the diagnosis of true exfoliation. Cataract surgery by phacoemulsification was uneventful in all cases. CONCLUSION: True exfoliation of the lens capsule can masquerade as a partial capsulorrhexis and should be looked for before surgery and immediately before capsulorrhexis to avoid creating a partial thickness capsulorrhexis and its related surgical complications. No zonule weakness was appreciated in our cases. To our knowledge, the spontaneous occurrence of a curvilinear lamellar capsular dehiscence with a flap before capsulorrhexis has not been reported before. This series highlights that cataracts associated with true exfoliation of the lens capsule can be safely operated, with the help of vision blue, by routine phacoemulsification without having to convert to the extracapsular technique.

Retinal detachment and the second stage of labour: a survey of regional practice and literature review.

Following several referrals for 'assessment', obstetricians in the West Midlands Health Region were surveyed regarding patients perceived to be at high risk of retinal detachment during the second stage of labour. A questionnaire was sent to 95 practicing obstetricians. This was a four-item questionnaire, based on four identifiable categories of referral to the ophthalmologist, by the obstetricians. It also covered the perceptions of the obstetricians of the ocular problem in relation to their obstetric clinical decision. With a 70% response rate, a significant number of obstetricians consider that certain ophthalmic conditions predispose to retinal detachment during labour. Even though they hold this view, the obstetricians generally do not modify their obstetric practice in response to any perceived ophthalmic risk. Such a view is not borne out by current literature, with no evidence to support a causative link between labour and rhegmatogenous (versus serous) retinal detachment, even in eyes predisposed to that condition.

Isolated inferior sagittal sinus thrombosis: a case report.

We present a case of isolated inferior sagittal sinus thrombosis shown on CT, MRI and angiography. This condition has not, to our knowledge, been described previously.