Long-term results and recurrence rates after spironolactone treatment in non-resolving central serous chorio-retinopathy (CSCR).

PURPOSE: To evaluate the long-term results of spironolactone in non-resolving central serous chorio-retinopathy (CSCR) and recurrence rates of CSCR. METHODS: Interventional uncontrolled open-label prospective clinical trial of patients with non-resolving CSCR who were treated with spironolactone 50 mg daily (Spironolacton AL® 50 mg, ALIUD PHARMA) for up to 16 weeks. Follow-up visits were performed at 3, 6, 9, and 12 months. Retreatment criteria for recurrence were: gain in sub-retinal fluid (SRF) of more than 25 % plus/or increase of central retinal thickness (CRT) of more than 50 µm plus visual symptoms compared to last visit. MAIN OUTCOME MEASURES: 12-month efficacy of upload treatment with spironolactone. Secondary outcome measure was the recurrence rate at 6, 9, and 12 months. RESULTS: Of the 21 study eyes treated, 71 % (n = 15) showed significant improvement or complete regression on OCT examination over 12 months. Nineteen percent of the patients (n = 4) showed a stable course from visit 1 to visit 12. The overall reduction of sub-retinal fluid from visit 1 (156 µm ± 131 SD) to visit 12 (53 µm ± 93 SD) was statistically significant (p = 0.003). The change of mean visual acuity (log MAR) from 0.25 (± 0.17 SD) at baseline to 0.17 (± 0.18 SD) at visit 12 was statistically significant, with p = 0.044. CONCLUSION: Our results confirm a positive effect of spironolactone in non-resolving CSCR in 71 % of cases. Evaluation of recurrence rates and retreatments showed good results in patients who responded to spironolactone primarily. A prospective randomized trial may provide better data about this non-invasive treatment.

Interferon alpha for the treatment of melanocytic conjunctival lesions.

BACKGROUND: To evaluate the effect of topical interferon alpha-2b therapy in the treatment of melanocytic conjunctival lesions. DESIGN: Non-comparative prospective case series. METHODS: Nine patients with histologically proven acquired melanosis with atypia and/or conjunctival melanoma were treated with recombinant IFN alpha-2b (Intron A, Essex Pharma, Luzern, Switzerland). The agent was diluted under sterile conditions to one million international units per ml Intron A and packed in single-dose units (EDO) by the pharmacy. It was stored in the refrigerator and applied 5 x 1 drop/day topically by the patient for 6 weeks. The patients were seen after 2 weeks and after the end of the treatment. Endpoint of the treatment was the complete regression of pigmentation or absence of cytological atypia in a re-biopsy. RESULTS: Seven lesions of nine patients showed regression and lost pigmentation. Three patients required a second cycle after the first therapy because of incomplete regression and one patient needed a third cycle of interferon. Only one of the patients needed a fourth cycle of therapy and additional surgery to show stable regression. The follow-up is 24.8 months (median). No local or systemic side-effects were encountered. The pre- and post-treatment photos of two cases will be presented. CONCLUSIONS: Our observations suggest that topical interferon alpha-2b might be an effective agent for the adjuvant treatment of melanocytic conjunctival tumors without side-effects. It might be an alternative to other more toxic chemotherapeutical agents. A prospective multicenter study will help to finally evaluate the potential of topical interferon therapy for melanocytic conjunctival tumors, in particular PAM with atypia and minimal invasive conjunctival melanoma.

3-year-data of combined navigated laser photocoagulation (Navilas) and intravitreal ranibizumab compared to ranibizumab monotherapy in DME patients.

PURPOSE: The prospective, comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema has shown advantage of a combination therapy compared to ranibizumab monotherapy at year 1 with significantly reduced injections. The purpose of this retrospective study was to determine the long-term visual gains and need of injections in a 3 year-follow-up period. METHODS: Retrospective analysis of patients of the original study in the long-term follow-up from month 12 to 36. BCVA measurements following the original 1 year study were taken using logMAR charts. Injections were provided with standard of care using PRN, based on change in BCVA and CRT using SD-OCT scans. Main outcome measures were change in BCVA and mean number of injections from 12 to 36 months. RESULTS: BCVA was stable in both groups from 12 through 36 months, showing a change of 0.16 ± 0.1 log MAR. Following the initial reduction in required injections at month 12, combination therapy patients continued to require 1.3 times fewer injections over the next 24 months (2.91 ± 2.3 vs 3.85±3.7 injections for monotherapy). CONCLUSIONS: Combination of navigated laser and ranibizumab achieved BCVA gains equivalent to anti-VEGF monotherapy. These results could be maintained through month 36. Required injections were 2.0 injections lower in year 1 and further 1.3 times fewer in year 2 and 3 in the combination group compared to monotherapy. Adding navigated laser photocoagulation to intravitreal anti-VEGF therapy may still represent a superior therapeutic approach to DME patients.

Hemianopia and visual loss due to progressive multifocal leukoencephalopathy in natalizumab-treated multiple sclerosis.

This case describes typical ophthalmic findings as a key feature for diagnosis of progressive multifocal leukoencephalopathy (PML) and its possible differential diagnosis. A 58-year-old female patient with relapsing-remitting multiple sclerosis on immunotherapy with natalizumab developed visual disturbance, reading problems, and visual field defects due to PML. PML is a reactivation of latent infection with the John Cunningham virus, which is a type of polyomavirus acquired in childhood or adolescence and is quite common in the general population. PML so far has been mostly associated with other immunodeficiency disorders, such as acquired immunodeficiency syndrome, but is also gaining importance in association with the increasing use and duration of treatment with natalizumab in patients suffering from multiple sclerosis. Natalizumab is a highly specific α4-integrin antagonist approved for treatment of patients with active relapsing-remitting multiple sclerosis.