Real-World Clinical Experience With Idebenone in the Treatment of Leber Hereditary Optic Neuropathy.

BACKGROUND: Leber hereditary optic neuropathy (LHON) leads to bilateral central vision loss. In a clinical trial setting, idebenone has been shown to be safe and to provide a trend toward improved visual acuity, but long-term evidence of effectiveness in real-world clinical practice is sparse. METHODS: Open-label, multicenter, retrospective, noncontrolled analysis of long-term visual acuity and safety in 111 LHON patients treated with idebenone (900 mg/day) in an expanded access program. Eligible patients had a confirmed mitochondrial DNA mutation and had experienced the onset of symptoms (most recent eye) within 1 year before enrollment. Data on visual acuity and adverse events were collected as per normal clinical practice. Efficacy was assessed as the proportion of patients with either a clinically relevant recovery (CRR) or a clinically relevant stabilization (CRS) of visual acuity. In the case of CRR, time to and magnitude of recovery over the course of time were also assessed. RESULTS: At time of analysis, 87 patients had provided longitudinal efficacy data. Average treatment duration was 25.6 months. CRR was observed in 46.0% of patients. Analysis of treatment effect by duration showed that the proportion of patients with recovery and the magnitude of recovery increased with treatment duration. Average gain in best-corrected visual acuity for responders was 0.72 logarithm of the minimal angle of resolution (logMAR), equivalent to more than 7 lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Furthermore, 50% of patients who had a visual acuity below 1.0 logMAR in at least one eye at initiation of treatment successfully maintained their vision below this threshold by last observation. Idebenone was well tolerated, with most adverse events classified as minor. CONCLUSIONS: These data demonstrate the benefit of idebenone treatment in recovering lost vision and maintaining good residual vision in a real-world setting. Together, these findings indicate that idebenone treatment should be initiated early and be maintained more than 24 months to maximize efficacy. Safety results were consistent with the known safety profile of idebenone.

Outcomes of Trabeculectomy With Transconjunctival Application Versus Subconjunctival Application of Mitomycin C.

PURPOSE: To compare outcomes and complication rates of trabeculectomy with either transconjunctival mitomycin C (MMC) or subconjunctival MMC application. METHODS: Retrospective cohort study-35 eyes in subconjunctival group and 29 eyes in transconjunctival group. All surgeries were performed by 1 surgeon (E.A.) at 1 center with an average follow-up duration of 40 to 51 months. RESULTS: The mean percentage intraocular pressure reduction at final follow-up was with 44.4±25.3% reduction in the subconjunctival group compared with 48.0±24.6% reduction in the transconjunctival group, with no statistical significant difference between the 2 groups (P=0.57). Both groups also showed a >40% reduction in intraocular pressure in approximately 67% of eyes. There were no cases of endophthalmitis. There was 1 reported case of choroidal hemorrhage following subconjunctival application of MMC. There were similar low rates of postoperative bleb leakage and requirement for postoperative application of 5-fluorouracil. There was a greater incidence of hyphema in the subconjunctival group (5 vs. 1) as well as choroidal effusions (8 vs. 4). One patient underwent revision of trabeculectomy and this was in the subconjunctival group. CONCLUSION: Transconjunctival application of MMC offers a safe and effective method of performing trabeculectomy with adjunctive MMC with lower rates of complication than subconjunctival application.

Case report: ampiginous chorioretinopathy associated with eales disease in a patient with presumed tuberculosis.

PURPOSE: The purpose of this study was to present a case of ampiginous chorioretinopathy followed by Eales disease in association with mycobacterium tuberculosis infection. METHODS: Case report. RESULTS: The patient presented with signs of ampiginous chorioretinopathy, which subsequently developed into Eales disease with a background of mycobacterium tuberculosis infection. CONCLUSION: This case describes the unusual manifestations of tuberculosis in the retina.