Treatment Landscape of Macular Disorders in Indian Patients with the Advent of Razumab™ (World's First Biosimilar Ranibizumab): A Comprehensive Review.

Ranibizumab is approved for the treatment of several macular disorders, including wet age-related macular degeneration (wet AMD), diabetic macular edema (DME), retinal vein occlusion (RVO) and myopic choroidal neovascularization (mCNV), among others. The unaffordability of the innovator ranibizumab among patients from developing countries such as India led to the development of the world's first biosimilar ranibizumab, which is a cost-effective alternative that does not compromise efficacy and safety. Razumab™, developed and produced by Intas Pharmaceuticals Ltd., India, is the world's first biosimilar of ranibizumab, and is approved in India for the treatment of various macular disorders, including wet AMD, DME, RVO and mCNV. The efficacy and safety of Razumab for the treatment of these macular disorders have been evaluated in both prospective and real-world retrospective studies. Razumab has shown an efficacy similar to that of the innovator ranibizumab, achieving improved visual acuity, as measured by the best corrected visual acuity, and reduction in the central macular thickness, leading to improved patient outcomes. The safety profile of Razumab is comparable to that of the innovator ranibizumab and is well tolerated without any new safety concerns. Here, we review the clinical and real-world data of Razumab in the treatment of macular disorders.

Prosthetic iris devices.

Congenital iris defects may usually present either as subtotal aniridia or colobomatous iris defects. Acquired iris defects are secondary to penetrating iris injury, iatrogenic after surgical excision of iris tumours, collateral trauma after anterior segment surgery, or can be postinflammatory in nature. These iris defects can cause severe visual disability in the form of glare, loss of contrast sensitivity, and loss of best corrected visual acuity. The structural loss of iris can be reconstructed with iris suturing, use of prosthetic iris implants, or by a combination of these, depending on the relative amount of residual iris stromal tissue and health of the underlying pigment epithelium. Since the first implant of a black iris diaphragm posterior chamber intraocular lens in 1994, advances in material and design technology over the last decade have led to advances in the prosthetic material, surgical technique, and instrumentation in the field of prosthetic iris implants. In this article, we review the classification of iris defects, types of iris prosthetic devices, implantation techniques, and complications.

Multifocal intraocular lenses in the setting of glaucoma.

PURPOSE OF REVIEW: The purpose of this review is to collate evidence and make recommendations regarding the use of multifocal intraocular lenses in patients with glaucoma. RECENT FINDINGS: Multifocal intraocular implants have been in use since the 1980s. Several studies have been done comparing their advantages and disadvantages compared with conventional monofocal intraocular implants. Most of these studies have looked at patients with cataract and no ocular comorbities. Reports of their use in eyes with concurrent disease are scarce. We review the available evidence and the potential benefits and pitfalls of using multifocal intraocular lenses in glaucomatous eyes. A recently published Cochrane review identified eight trials which had stringent criteria to recruit patients. These studies excluded all patients with concurrent eye diseases. No recent publications are available specifically evaluating the use of multifocal intraocular lenses in patients with glaucoma. SUMMARY: Firm recommendations cannot be made on the use of multifocal intraocular lenses in patients with glaucoma as large studies have not been done to evaluate their benefit. Currently, the decision of whether to use multifocal intraocular lenses in patients with glaucoma has to be made on an individual basis.

Conjunctival necrosis following intravitreal injection of triamcinolone acetonide.

PURPOSE: To report a case of localized conjunctival necrosis following intravitreal injection of triamcinolone acetonide (TA). DESIGN: Single observational case report. METHODS: A 63-year- old man presented with inferotemporal branch retinal vein occlusion and macular edema in his left eye (OS). He underwent pars plana vitrectomy combined with arteriovenous sheathotomy. Postoperatively, as the macular edema persisted, he underwent an uneventful intravitreal injection of TA. RESULTS: Ten days following the intravitreal injection, he presented with an area of localized conjunctival necrosis overlying the scleral entry site. Gram stain showed a few white blood cells and no organisms. The conjunctival swab showed no growth on culture. The area of conjunctival necrosis responded well to intense topical antibiotic therapy. CONCLUSIONS: Conjunctival necrosis is a rare anterior segment complication of intravitreal injection of TA. With the increased usage of intravitreal TA for various posterior segment disorders, the treating physician should be aware of this complication.

Outcomes of sulcus implantation of Array multifocal intraocular lenses in second-eye cataract surgery complicated by vitreous loss.

PURPOSE: To evaluate the outcomes of implantation of the Array((R)) multifocal intraocular lens (IOL) (model SA-40N, AMO) in the ciliary sulcus in second-eye cataract surgery complicated by vitreous loss. SETTING: Department of Ophthalmology, Arrowe Park Hospital, Wirral, United Kingdom. METHODS: This retrospective study comprised 15 patients who had complicated second-eye cataract surgery with loss of posterior capsule support leading to sulcus implantation of an Array multifocal IOL. The patients were recalled for assessment. Objective evaluation included uncorrected and corrected distance and near visual acuities, complications, and IOL centration. Subjective assessment was performed using a questionnaire that included the VF-14 index of visual function; the questions were related to satisfaction with vision, limitations from halos and glare, and the frequency of spectacle wear. RESULTS: Fourteen eyes (93%) had postoperative visual improvement. The best corrected distance acuity was 6/12 or better in 11 eyes (73%). The best corrected near acuity was J2 or better in 12 eyes (80%). The IOL was well centered in 11 eyes (73%) and slightly decentered in 4 eyes (27%). Subjectively, patients indicated a high level of satisfaction with their distance and near vision. The VF-14 indicated high levels of visual function, with 73% of patients having a score higher than 90 (out of 100). Seventy-three percent of patients were not troubled by glare or halos, and 40% did not wear spectacles. CONCLUSION: Implantation of the Array multifocal IOL in the sulcus during complicated phacoemulsification led to good visual outcomes based on objective and subjective patient measures.

Entry of antibiotic ointment into the anterior chamber after uneventful phacoemulsification.

A 77-year-old woman had uneventful phacoemulsification. Postoperative examination revealed that chloramphenicol ointment instilled in the conjunctival fornix had entered the anterior chamber and smeared the intraocular lens (IOL). Immediate surgical removal of the ointment with IOL exchange was performed. The eye settled in 6 weeks with a best corrected visual acuity of 6/9. This case raises concerns about the integrity of clear corneal incisions and the need for postoperative review of uneventful phacoemulsification surgery.