Effect of intravitreal injections due to neovascular age-related macular degeneration on retinal nerve fiber layer thickness and minimum rim width: a cross sectional study.

PURPOSE: The present study tested the hypothesis that repeated anti-VEGF injections are associated with reduced retinal nerve fiber layer (RNFL) and minimum rim width (MRW) of the optic nerve head. PATIENTS AND METHODS: Sixty-six patients with a history of intravitreal injections due to neovascular age-related macular degeneration were included. RNFL and MRW were measured using optical coherence tomography (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany). RESULTS: Mean global RNFL was 90.62 µm and both RNFL as well as MRW significantly decreased with advanced age (p = 0.005 and p = 0.019, respectively). Correlating for the number of injections, no significant impact on RNFL was found globally (p = 0.642) or in any of the sectors. In contrast, however, global MRW was significantly reduced with increasing numbers of intravitreal injections (p = 0.012). The same holds true when adjusted for the confounding factor age (RNFL p = 0.566 and MRW p = 0.023). CONCLUSION: Our study shows that repeated intravitreal injections due to choroidal neovascularization seem to have a deleterious effect on MRW but not on RNFL. This suggests that MRW is a more sensitive marker than RNFL for evaluating the effect of frequent intravitreal injections on the optic nerve head since it seems to be the first structure affected.

Prospective analysis of anatomic features predisposing patients to intraoperative floppy iris syndrome.

PURPOSE: To aid preoperative risk assessment by identifying anatomic parameters corresponding with a higher risk of intraoperative floppy iris syndrome (IFIS) during cataract surgery. METHODS: Prospective cohort study of 55 patients with α1-adrenergic receptor antagonist (α1-ARA) treatment and 55 controls undergoing cataract surgery. Anterior segment optical coherence tomography (AS-OCT), video pupilometer, and biometry measurements were performed preoperatively and analyzed regarding anatomic parameters that corresponded with a higher rate of IFIS. Those statistically significant parameters were evaluated with logistic regression analysis and receiver operating characteristic (ROC) curve. RESULTS: Pupil diameter was significantly smaller in patients who developed IFIS compared to those who did not develop IFIS (AS-OCT 3.29 ± 0.85 vs. 3.63 ± 0.68, p = 0.03; Pupilometer 3.56 ± 0,87 vs. 3.95 ± 0.67, p = 0.02). Biometric evaluation revealed shallower anterior chambers in the IFIS group (ACD 3.12 ± 0.40 vs. 3.32 ± 0.42, p = 0.02). Cutoff values for 50% IFIS probability (p = 0.5) were PD = 3.18 mm for pupil diameter and ACD = 2.93 mm for anterior chamber depth. ROC curves of combined parameters were calculated for α1-ARA medication with pupil diameter and anterior chamber depth, which yielded an AUC of 0.75 for all IFIS grades. CONCLUSION: The combination of biometric parameters with history of α1-ARA medication can improve assessment of risk stratification for IFIS incidence during cataract surgery.

Brolucizumab for pre-treated patients with choroidal neovascularization and signs of tachyphylaxis to aflibercept and bevacizumab.

PURPOSE: Treatment of choroidal neovascularization due to age-related macular degeneration is a challenging topic since an increasing number of patients show reduced morphological response to conventional treatment with intravitreal injections. The present study tested the hypothesis that the newly introduced anti-VEGF antibody brolucizumab does not only show promising results in pre-treated patients but is also a viable option in cases of tachyphylaxis to aflibercept or bevacizumab. METHODS: Thirty-six eyes of 34 patients with a history of at least 10 anti-VEGF injections as well as persistent retinal fluid following the past 5 monthly injections with aflibercept and bevacizumab prior to first treatment with brolucizumab were included in the study. Morphological and functional treatment response was compared before and after switching to brolucizumab. RESULTS: Mean best-corrected visual acuity did not significantly change after treatment with brolucizumab. In contrast, central retinal thickness significantly decreased 4 weeks after treatment with brolucizumab from 340.36 to 282.22 µm (p < 0.001) as well as pigment epithelial detachment from 346.73 to 280.47 µm (p < 0.001). In 24 eyes (66.67%), complete resolution of intra-and subretinal fluid was observed after a single dose of brolucizumab. No serious adverse events, such as intraocular inflammation and retinal vasculitis, were reported after a single injection of brolucizumab. CONCLUSION: Brolucizumab is not only effective in treatment-naïve patients as shown in the pivotal HAWK and Harrier trials, but also in pre-treated patients as seen in the present study. Our data also suggest that brolucizumab is potent in patients with signs of tachyphylaxis to other anti-VEGF agents and thus a viable treatment option.

Retinal pigment epithelial characteristics in eyes with neovascular age-related macular degeneration : Long-term retinal changes under anti-vascular endothelial growth factor treatment.

PURPOSE: The aim of this study was to assess retinal pigment epithelial (RPE) and retinal structural changes in eyes with neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (anti-VEGF) during long-term follow-up and to evaluate morphological markers potentially influencing prognosis. METHODS: A total of 18 eyes of 18 patients with neovascular AMD were examined subsequent to completion of the Avastin Versus Lucentis in Age Related Macular Degeneration (MANTA) study following a mean period of 84 months (range 69-93 months). After receiving a loading dose of 3 intravitreal anti-VEGF injections subsequent to baseline of the MANTA study, patients were treated as needed (pro re nata, PRN). Functional and morphological changes were assessed, the latter using spectral domain optical coherence tomography (SD-OCT). RESULTS: Retinal/RPE atrophy generally increased significantly during follow-up compared to baseline (fibrosis 28% vs. 89%, p = 0.0001, geographic atrophy, GA 0% vs. 67%, p = 0.0002, RPE porosity 61% vs. 100%, p = 0.009) whereas regenerative alterations tendentially increased until 3 months and then subsequently declined until the last visit (RPE thickening 28% vs. 11%, p = 0.22 and intraretinal hyperreflective foci 89% vs. 78%, p = 0.39). CONCLUSION: Atrophic alterations of the retina and RPE are progressive and may partly be induced by anti-VEGF. Morphological findings may aid in the identification of prognostic markers in the progression of neovascular AMD. This could lead to a more targeted education of affected patients.

Clinical evaluation of neovascular and non-neovascular chronic central serous chorioretinopathy (CSC) diagnosed by swept source optical coherence tomography angiography (SS OCTA).

PURPOSE: To evaluate the clinical characteristics of eyes with chronic central serous chorioretinopathy based on swept source optical coherence tomography angiography (SS OCTA). METHODS: Twenty-nine eyes presenting with chronic central serous chorioretinopathy (CSC) were examined with the Topcon SS OCTA, using the DRI optical coherence tomography (OCT) Triton machine, and were classified as neovascular or non-neovascular CSC depending on whether a vascular pattern was detected in the outer retina on OCT angiogram. The two groups were compared based on the following clinical findings: best corrected distance and reading visual acuity (BCDVA, best corrected reading acuity (BCRA)), rate of subretinal fluid, intraretinal fluid, hyperreflective flat pigment epithelial detachment (PED), and serous PED. RESULTS: Of 29 eyes with chronic CSC, 10 (34.5%) showed a neovascular pattern, suggesting neovascular CSC, in the outer retina of SS OCTA. Eyes with neovascular CSC showed a significantly worse initial and final BCDVA, with a mean value of 0.39 ± 0.20 logMAR (Snellen equivalent 20/49) and 0.33 ± 0.36 logMAR (Snellen equivalent 20/43), compared to eyes with non-neovascular CSC with a mean value of 0.16 ± 0.15 logMAR (Snellen equivalent 20/29) and 0.04 ± 0.11 logMAR (Snellen equivalent 20/22) (p < 0.05), respectively. Final mean BCRA was 0.14 ± 0.20 logRAD for non-neovascular CSC compared to 0.34 ± 0.28 logRAD (p = 0.031) for neovascular CSC. The mean time between the first and final visits was 3 years for both groups. The mean anti-VEGF injection rate was 6.4 for neovascular CSC and 2.9 for non-neovascular CSC, whereas 26.3% of non-neovascular CSC eyes had an additional half fluence photodynamic therapy (PDT). CONCLUSION: SS OCTA provides a promising CNV detection rate, secondary to chronic CSC, in a clinical setting. Neovascular CSC is associated with a worse outcome in terms of visual and reading acuity compared to non-neovascular CSC.

A novel method to evaluate quality of care from the perspective of cataract patients.

PURPOSE: To evaluate quality of care from patient's perspective following cataract surgery using a novel questionnaire and to assess validity of the survey in context with the identification of lacks in quality of care. METHODS: Assessment of quality of care in 150 patients (150 eyes) who underwent cataract surgery in an Austrian clinical setting based on a novel "Quality of Care from Patient's perspective following Cataract Surgery" (QCPCS)-questionnaire including 10 subjective, 10 objective and 7 general health care criteria. Quality of care was graded according to importance (range: 1 = not important to 4 = extremely important) and frequency of occurrence (range: 1 = never to 4 = often, 0 = not applicable). Quality-impact indices (QI-respective grading by patient/4) were assessed. RESULTS: Mean performance score was 3.84 (SD = 0.42, range: 1-4). Mean QI was 0.89 for subjective, 0.90 for objective and 0.96 for general health care criteria (p = 0.29). All-over skewness and coefficient of variation were -2.65 and 5.85 respectively. Internal consistency was high (Cronbach's α = 0.75) confirming causal taxonomy of disease-specific and generic items. CONCLUSION: A valid new method to reliably and holistically evaluate patient's satisfaction related to cataract surgery including a broad range of patient needs is presented, suitable to assess potential lacks in quality of health care in daily ophthalmological clinical practice.

Treatment of Diabetic Macular Edema with Intravitreal Antivascular Endothelial Growth Factor and Prompt versus Deferred Focal Laser during Long-Term Follow-Up and Identification of Prognostic Retinal Markers.

PURPOSE: Long-term follow-up of patients with diabetic macular edema (DME) treated with intravitreal antivascular endothelial growth factor (anti-VEGF) combined focal laser and identification of prognostic morphological characteristics. METHODS: Prospective clinical trial (50 treatment-naive eyes) with DME randomized 1 : 1 receiving intravitreal ranibizumab (0.5 mg/0.05 ml) and prompt grid laser compared with ranibizumab and deferred laser. Morphological characteristics potentially relevant for prognosis were assessed at baseline, month 6, month 9, and years 1, 2, 3, 4, and 5 of follow-up. RESULTS: Although functional results were slightly higher in the prompt group at week 12 (0.5; 20/40 Snellen (SD = 0.04, 0.3 logMAR) versus 0.4; 20/50 Snellen (SD = 0.04, logMAR: 0.4), p=0.4) and month 9 (prompt group: 0.5; 20/40 Snellen (SD = 0.03, 0.3 logMAR) versus deferred group: 0.4; 20/50 Snellen (SD = 0.04, 0.4 logMAR), p=0.4), these were statistically insignificant. There was no significant benefit regarding functionality during long-term follow-up in the prompt group compared to the deferred group. BCVA in the eyes with clusters of hyperreflective foci in the central macular region was inferior compared with the eyes without these alterations at year 5 (0.39; 20/50 Snellen, (SD = 0.25, 0.4 logMAR) versus 0.63; 20/80 Snellen (SD = 0.22, 0.2 logMAR), p < 0.01). CONCLUSION: Grid laser and ranibizumab therapy are effective in DME management during the long-term follow-up. Intraretinal hyperreflective material in SD-OCT is negatively related to BCVA.

Comparison of Two Toric IOLs with Different Haptic Design: Optical Quality after 1 Year.

BACKGROUND: The purpose of this prospective, randomised study was to interocularly compare the visual performance after implantation of two different toric IOLs with different haptic design. METHODS: 59 subjects with corneal astigmatism greater than 1.25 diopter (D) were implanted with an AT TORBI 709M IOL (Carl Zeiss Meditec AG) in one eye and with a Tecnis toric aspheric IOL (Abbot Medical Optics) in the other eye. Observation procedure was performed 12 months postoperatively. Main outcome measures included uncorrected distance visual acuity (UDVA), manifest refraction, IOL rotation, and IOL position. RESULTS: Mean UCDVA was 0.04 ± 0.14 logMAR for AT TORBI eyes and 0.06 ± 0.15 logMAR for Tecnis eyes (p = 0.3). The postoperative spherical equivalent values were significantly lower in the AT TORBI group. Mean toric IOL axis rotation was 3.0 ± 2.26 degrees for AT TORBI eyes and 3.27 ± 2.37 for Tecnis eyes (p = 0.5). The mean vertical IOL tilt and vertical decentration values measured with the Visante OCT were significantly larger in the AT TORBI group (p < 0.05). CONCLUSIONS: Both the Tecnis and the AT TORBI toric IOLs successfully reduced ocular astigmatism. Emmetropia could be better achieved with the AT TORBI IOL, whereas the Tecnis showed better positional stability. This trial is registered with ICMJE NCT03371576.

Patients' maximum acceptable waiting time for cataract surgery: a comparison at two time-points 7 years apart.

PURPOSE: To evaluate the maximum acceptable waiting time (MAWT) of cataract patients and assess the determinants of their perception of MAWT at two time-points 7 years apart. METHODS: In 2007 (prior to the transformation of our cataract service to a day case unit) and 2014, 500 consecutive patients with cataract were asked to fill in a preoperative questionnaire addressing their MAWT to undergo cataract surgery. The patients' visual impairment (VF-14 score), education and social status were evaluated. RESULTS: The mean MAWT was 3.2 months in both periods, whereas the actual waiting time decreased significantly by 1.7 months (p < 0.001). Patients who had self-noted visual impairment were nearly four times (p < 0.001) more likely to accept only an MAWT of <3 months in 2007. In both periods, patients with a VF-14 score lower than the mean were more likely to accept a shorter MAWT (p = 0.002 and p = 0.034). Living together with children or having relatives close by was associated with a greater acceptance of an MAWT longer than 3 months (p = 0.002 and p = 0.023). CONCLUSION: Reducing the actual mean waiting time had no impact on the mean MAWT. Patients with poor tolerance of waiting had greater self-reported difficulty with vision. Social support was also a strong predictor from the patients' perspective. The VF-14 score had a greater impact than clinical visual acuity (VA) testing. Considering the implementation of standards for waiting lists, objective criteria to guarantee a transparent system should be taken into account.

The Influence of Lunar Phases on Complications in Cataract Surgery: An Analysis of 16,965 Patients.

PURPOSE: Popular beliefs exert an impact of lunar phases on elective surgery. The aim of our study was to evaluate potential correlations between complications in cataract surgery and the phases of the moon during its passage through the zodiac and Fridays that fall on the 13th. METHODS: Patients with complications during cataract surgery were extracted retrospectively from the clinical database from 2010 to 2014. The dates of surgeries were viewed in relation to the phase and the position of the moon (sign of the zodiac). RESULTS: Of 16,965 cataract surgeries, 132 eyes developed complications. 0.70% developed complications with a waxing moon, and 0.87% with a waning moon (p = 0.745). After Bonferroni correction, there were no statistically significant differences between the numbers of complications under the different signs of the zodiac and no complications on Fridays that fell on the 13th. CONCLUSIONS: The analysis of "non-moon-fitting days" for surgery showed quantitative differences, without statistically significant findings. Our results revealed more complications when the moon was waning, which is in contrast to esoteric belief. Patients may be informed that phases of the moon, signs of the zodiac, or a particular date will have no impact on their surgeries.

More frequent requests for day-case cataract surgery : An impressive mind switch in the Austrian population within 7 years.

BACKGROUND: Cataract surgery is the most commonly performed elective surgical procedure worldwide. While the operation has been mainly conducted as day-case (outpatient) surgery throughout the world since the beginning of this millennium, this development has been much slower in Austria. The number of patients requesting day-case surgery has markedly increased in the last few years. METHODS: Prior to the introduction of a day clinic at our department in 2007, we evaluated the patients' acceptance of day-case surgery using a questionnaire. At the time, less than half of the patients wished to undergo day-case surgery. Another survey was performed 7 years later to determine if there were any changes. RESULTS: The desire for day-case surgery increased significantly from 38.8 to 87.1%. The mean age of the patients and their visual impairment had decreased. Home care improved, but not to the same extent. The number of patients who had to travel more than an hour to reach the hospital had significantly increased. CONCLUSIONS: Improvements in perioperative limitations and most of all patients becoming accustomed to the idea have led to an impressive mind switch, culminating in a clear desire for day-case cataract surgery.

Patient knowledge concerning age-related macular degeneration: an AMD questionnaire.

BACKGROUND: Age-related macular degeneration (AMD) is a disease with rising prevalence. This study evaluates patients' knowledge and the need for more patient information. METHODS: 271 patients with AMD were asked to complete a questionnaire concerning their knowledge about AMD. 150 patients were interviewed by a physician and 121 patients completed the questionnaire on their own. RESULTS: 79.4 % of patients had previous knowledge about AMD. Most patients, 97.3 %, got their information from physicians. 58 % of patients find their knowledge concerning AMD adequate. Only 23.9 % knew about aid organizations for patients with visual impairments. DISCUSSION: Though the majority of patients had good knowledge concerning AMD, there was a large percentage of patients who seemed to lack information. Physicians should actively ask their patients if they have any questions related to their disease. Medial focus on AMD and information about aid organizations could help patients to cope with their disease. CONCLUSION: A large number of patients seemed to need additional information. We suggest that ophthalmologists provide general information concerning AMD to their patients every 3 to 5 years. Information about aid organizations specializing in visual impairment could also be provided. Well-informed patients would be better able to follow their physician's instructions and would have a better understanding of their disease, particularly for the sake of therapy.

Short-term effect of aflibercept on visual acuity and central macular thickness in patients not responding to ranibizumab and bevacizumab.

PURPOSE: To analyze the clinical outcome of treatment with aflibercept in patients not responding to ranibizumab and bevacizumab. METHODS: Retrospective review of 32 eyes from 30 consecutive patients with choroidal neovascularization (CNV) who showed no response to treatment with ranibizumab or bevacizumab and were switched to aflibercept. Visual acuity, central macular thickness (CMT) and presence or absence of intraretinal or subretinal fluid were analyzed before switching to aflibercept, after each of three uploading dose injections of aflibercept and 6, 8 and 10 weeks after the third aflibercept injection. All eyes had previous ranibizumab injections and the mean number of previous injections was 14.75 (± 7.38). Mean duration of previous anti-vascular endothelial growth factor (VEGF) treatment was 38 months (± 27.35 months). RESULTS: Mean visual acuity before switching to aflibercept was 0.40 ± 0.30 logMAR. After the third injection visual acuity was 0.3 ± 0.3 logMAR and 10 weeks after the third injection it was 0.50 ± 0.20 logMAR. No significant differences were seen during treatment and follow-up. The mean CMT was 394 ± 118 µm at baseline, at follow-up (first, second and third, group week 6, group week 8 and group week 10) it was 317 ± 108 µm, 301 ± 99 µm, 292 ± 83 µm, 270 ± 78 µm, 340 ± 146 µm and 377 ± 92 µm, respectively. Significant reductions in CMT were seen between the first and third follow-up injections and at group week 8. Of the patients 59.4 % were complete non-responders to aflibercept. CONCLUSION: Aflibercept results in improvement in CMT in non-responders to ranibizumab and bevacizumab as long as therapy is given continuously and can therefore be an alternative therapy.

Clinical risk management - a 3-year experience of team timeout in 18 081 ophthalmic patients.

PURPOSE: Clinical risk management aims to identify, analyse and avoid errors and risks systematically to improve patient's safety. Preoperative checklists to prevent mistakes have gained importance in the last few years. A so-called team timeout checklist was introduced in October 2011 at the Department of Ophthalmology, Hietzing Hospital, Vienna. The purpose of the study is to evaluate the benefits and demonstrate the value of team timeout. METHODS: After the team timeout had been in use for 6 months, all near misses that occurred over a period of 34 months were assigned to the following groups: wrong side, wrong lens, wrong patient and miscellaneous. RESULTS: Eighteen thousand and eighty-one surgeries were performed in the specified period; 53 cases of 'wrong side' and 52 cases of 'wrong intraocular lens' were noted. Ninety-six near misses concerned the patients' data and 38 concerned documentation. A reduction of near misses was noted after an adaptation phase of 3 months. CONCLUSIONS: Team timeout proved valuable, as it improved the patients' safety with minimum effort. Errors may occur despite several preoperative controls and can be detected by performing team timeout.

Predictors of 1-year visual outcome in OCT analysis comparing ranibizumab monotherapy versus combination therapy with PDT in exsudative age-related macular degeneration.

AIM: The aim of this study was to find predictive factors of 1-year visual outcome, analyzing novel optical coherence tomography (OCT) biomarkers in exsudative age-related macular degeneration (choroidal neovascularization (CNV)) in two groups of different treatment modalities. METHODS: In all, 34 consecutive patients with new-onset CNV were randomized 1:1 to receive either ranibizumab monotherapy or ranibizumab combined with photodynamic therapy (PDT) with verteporfin. After three initial injections with ranibizumab, re-treatment was performed according to an as-needed scheme; PDT was performed once at baseline. Best-corrected visual acuity (BCVA) and OCT parameters like central macular volume (CMV), central macular thickness (or central retinal thickness (CRT)), subretinal and intraretinal fluid, fibrovascular lesion thickness, or inner segment/outer segment (IS/OS) junction were analyzed. RESULTS: After 12 months, a visual gain of 6.1 letters was found in the monotherapy group, whereas patients in the combination therapy group lost - 4.8 letters from baseline to the 12-month visit. CMV and CRT decreased considerably between baseline and month 2-3 in both groups, with a following slight increase until month 12. Additional application of PDT had negative effect to 12-month BCVA, whereas higher baseline BCVA and integrity of the IS/OS junction at month 12 had positive effect to 12-month BCVA. CONCLUSIONS: Better baseline BCVA and the integrity of IS/OS junction at 12-month visit were the most important predictive factors for final BCVA. Combination therapy caused worse final BCVA and a higher degree of IS/OS disruption.

OCULAR WAVEFRONT ABERRATIONS AND OPTICAL QUALITY IN DIABETIC MACULAR EDEMA.

PURPOSE: To evaluate optical quality and internal aberrations in patients with diabetic macular edema. METHODS: In this prospective study, 33 eyes of patients with diabetic macular edema were scanned with a ray-tracing wavefront device. As a control group, wavefront aberrometry was performed in 31 patients. Ocular and internal aberrations and visual quality metrics were evaluated separately to determine whether the source of aberrations was ocular or internal. Main outcome measures included corrected visual acuities, ocular and internal aberrations, Strehl ratio, and modulation transfer function. RESULTS: There was a statistically significant difference between the groups in internal higher order (HO) root mean square (0.34 ± 0.24 vs. 0.16 ± 0.05), HO Strehl ratio (0.08 ± 0.05 vs. 0.18 ± 0.09), and modulation transfer function (0.29 ± 0.1 vs. 0.4 ± 0.1). There was no statistically significant difference in Strehl ratio and HO root mean square between phakic and pseudophakic patients. Height of cystoid spaces was a significant predictor (P < 0.001) of Strehl ratio. Besides inner and outer segment integrity, HO Strehl ratio significantly determined best-corrected visual acuity. CONCLUSION: In eyes with macular edema, internal HO wavefront aberrations were greater than in control eyes. This increase in HO wavefront error seems visually relevant. This study results suggest increased intraretinal edema as the source of HO aberrations.

Level of knowledge about glaucoma in Vienna.

BACKGROUND: Glaucoma is a chronic and serious disease calling for consistent lifelong therapy. The patient's compliance requires that he/she be well informed about the disease. The purpose of the present study was to determine the level of knowledge about glaucoma, and compare young patients with older ones as well as glaucoma patients with nonglaucoma ones. METHODS: A total of 1110 questionnaires were distributed to patients and their relatives at the outpatient eye clinic of Hietzing Hospital (Vienna), of which 1041 were returned. The questionnaire comprised 18 questions. Patients were divided into two groups: group 1 consisted of those aged 18-60 years, while group 2 consisted of those older than 61 years. RESULTS: In total, 941 questionnaires were evaluated; 72.8% of the respondents were older than 60 years, and one-half of the respondents had glaucoma (51%). The majority of patients had "moderate knowledge" of the disease (41.87%), followed by "poor knowledge" (32.52%). Glaucoma patients had considerably better knowledge of the disease (p < 0.01) than did nonglaucoma patients. Younger patients were significantly better informed than older ones (p < 0.01). Nonglaucoma patients with a positive diagnosis of glaucoma among their circle of friends or family were significantly better informed (p < 0.01) than those without such persons in their circle of friends. CONCLUSION: Persons with glaucoma are much better informed about the disease than nonglaucoma patients, but the general level of knowledge is very low. Notably, younger patients were better informed than older ones. The present study, comprising a large number of patients, revealed poor knowledge of glaucoma among patients with the disease and especially among nonglaucoma patients in Vienna.

Differences of frequency in administration of ranibizumab and bevacizumab in patients with neovascular AMD.

PURPOSE: Intravitreal ranibizumab or bevacizumab are the most used drugs for treatment of neovascular age-related macular degeneration (nAMD). Repeated intravitreal injections represent an economic burden and may be associated with serious complications. The aim of this study is to evaluate the number of needed injections within 1 year of treatment. METHODS: 55 patients over 50 years of age with nAMD and visual acuity (VA) between 20/40 and 20/320 were included. Scheduled visits and treatment were performed monthly for 1 year. After a loading dose of three intravitreal injections (either ranibizumab = group 1 or bevacizumab = group 2), an "as needed" regimen was performed. Primary endpoint was a difference in the injection frequencies of ranibizumab and bevacizumab. Secondary endpoints were best corrected visual acuity (BCVA) and central retinal thickness (CRT). RESULTS: Difference in number of injections was not significant (5.00 ± 1.67 (ranibizumab group) vs. 5.80 ± 2.28 (bevacizumab group), p = 0.084). Mean BCVA was 59.12 ± 16.64 letters after 12 months if patients received ranibizumab (p = 0.001) and 64.75 ± 17.03 letters if patients received bevacizumab (p = 0.037). There was no statistical significance between the two groups (p = 0.631). The mean CRT did not differ significantly between groups after 12 months (315.67 ± 65.86 µm for ranibizumab, 350.47 ± 102.84 µm for bevacizumab, p = 0.088). CONCLUSION: There was no difference in number of treatment, BCVA and CRT after 1 year between ranibizumab and bevacizumab in patients with nAMD.

Acute anterior uveitis is associated with depression and reduction of general health.

AIMS: This study explored the association of active acute anterior uveitis (AAU) with depressive feelings and patients' general health. METHODS: This case-control study comprised 80 participants: 35 patients with an active case of AAU and 45 healthy peers were analysed to compare their depressive moods (Beck depression inventory (BDI), Zerssen Mood Scale (ZMS)) and general health (Short form-8 health survey (SF8)). Furthermore, patients were questioned regarding the presence of distress, occupational satisfaction and impairment in performing daily life tasks. RESULTS: During an acute attack, AAU patients were shown to suffer from depressive moods more often than their healthy peers (BDI 54% vs 9%, respectively; ZMS 2.7-fold shift in mood levels towards depression) and experienced a reduction in mental and physical scores (SF8). Patients felt impaired reading (94%), driving (69%) and working (69%). In all, 74% of the patients believed that distress was a probable trigger. Lack of occupational satisfaction was associated with a persistence of depressive feelings and a reduction in physical health. CONCLUSIONS: AAU patients exhibited a significant psychopathology towards depression, a reduction of general health and impairment of performing daily life tasks. Patients who were unsatisfied at work seemed to suffer even more. The results underline the importance of offering psychological support to the patients and providing information to patients and close social contacts.