Comparative study of intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) in the treatment of neovascular age-related macular degeneration.

AIMS: To compare the safety and efficacy of 2 anti-vascular-endothelial-growth-factor agents - bevacizumab (Avastin) versus ranibizumab (Lucentis) - in the treatment of patients with neovascular age-related macular degeneration (AMD). METHODS: Retrospective analysis of patients who received intravitreal injections of bevacizumab or ranibizumab for neovascular AMD. Primary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) assessed by Spectral Domain scanning laser ophthalmoscope-optical coherence tomography (SD-OCT). A secondary outcome measure was the report of any adverse events in the 2 groups. RESULTS: The number of injections in the bevacizumab group was 184 (average of 4.7 per eye) compared to 187 in the ranibizumab group (average of 5.5 per eye). The mean logMAR equivalent of BCVA at 1 month after the injection improved by 0.18 in the bevacizumab group (p = 0.009) and by 0.13 in the ranibizumab group (p = 0.004). The average SD-OCT CFT decreased from 325 + or - 72 to 300 + or - 69 microm in the bevacizumab group (p = 0.016) and from 307 + or - 57 to 289 + or - 56 microm in the ranibizumab group (p = 0.017). In the bevacizumab group, there was 1 event of lower extremity pain (0.54%) and 1 event of increased arterial blood pressure (0.54%). In the ranibizumab group, there were 2 events of transiently increased intraocular pressure (1.1%) and 1 event (0.53%) of intraocular inflammation following injection. CONCLUSIONS: Bevacizumab and ranibizumab treatments resulted in similar gains in visual acuity and reduction in macular thickness, documented each month following injection. Intravitreal bevacizumab appears to be as safe and effective as intravitreal ranibizumab in the treatment of exudative AMD.

Sociodemographic, family history, and lifestyle risk factors for open-angle glaucoma and ocular hypertension. The Los Angeles Latino Eye Study.

PURPOSE: To evaluate the relationship between sociodemographic, family history, and lifestyle risk factors and open-angle glaucoma (OAG) and ocular hypertension (OHT) in Latinos. DESIGN: Population-based cohort study. PARTICIPANTS: Latinos 40 years and older from 6 census tracts in La Puente, California. METHODS: Participants underwent an in-home interview and in-clinic examination. Demographic, lifestyle, and family history variables were analyzed as risk factors using multivariable regression models to identify independent associations with OAG or OHT. MAIN OUTCOME MEASURES: Open-angle glaucoma and OHT. RESULTS: Two hundred eighty-nine participants were diagnosed as having OAG, 219 were found to have OHT, and 5624 persons had no evidence of either OAG or OHT. After adjustment for intraocular pressure, stepwise logistic regression analyses revealed that older age, male gender, unmarried marital status, and being a first-degree relative were independent risk factors for OAG. For age, the relative risk doubled with each decade. Males and unmarried participants had a higher risk of having glaucoma than females and those who were married (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.30-2.30, and OR, 1.39; 95% CI, 1.03-1.87, respectively). A positive family history of glaucoma in first-degree relatives was a risk factor for OAG (OR, 1.92; 95% CI, 1.25-2.94). Smoking, alcohol use, and female reproductive hormone use were not associated with OAG. Additionally, increasing age, Native American ancestry, unemployed status, and family history of glaucoma were found to be independent factors for increased risk of OHT. CONCLUSIONS: Although the mechanisms whereby age and family history lead to increased risk are partly understood, further study is needed to understand the biological significance of the other demographic risk factors identified such as male gender and unmarried status.

Treatment of vitreoretinal disorders in the developing world: indications and outcomes of vitreoretinal surgery in Nepal.

PURPOSE: To examine the outcomes of vitreoretinal surgery for retinal disorders at Tilganga Eye Centre in Kathmandu, Nepal. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Records of 255 patients undergoing vitreoretinal surgery from December 2000 to January 2003 were reviewed. METHODS: Demographics, diagnoses, duration of symptoms, vision, and examination findings were noted before and after vitreoretinal surgery. MAIN OUTCOME MEASURES: Postoperative data were categorized by surgery type and analyzed by anatomic success, symptoms, and visual acuity (VA). RESULTS: Sixteen percent of patients had >6/60 vision preoperatively, and the mean duration of vision loss before presentation was 4.9 months. Major indications for surgery were retinal detachment (RD) (75%) and vitreous hemorrhage (19%). Anatomic success was achieved in 74.5% of patients. Postoperatively, 39% of patients experienced improved VA, with 33% obtaining >6/60 vision. CONCLUSIONS: Despite prolonged duration of vision loss at presentation, vitreoretinal surgery in the developing world can restore useful vision in many patients with RD and vitreous hemorrhage.