Effectiveness of ranibizumab for neovascular age-related macular degeneration using clinician-determined retreatment strategy.

AIMS: To report the effectiveness of intravitreal ranibizumab treatment for neovascular age-related macular degeneration in a tertiary centre. METHODS: 1 year prospective cohort study of patients with a diagnosis of neovascular age-related macular degeneration on fundus fluorescein angiography treated with ranibizumab. Patients received three consecutive monthly treatments, followed by a clinician-determined re-treatment strategy. Data collected included demographic details, baseline and subsequent follow-up visit measurements, refraction protocol best corrected visual acuity (BCVA), contrast sensitivity (CS) and central foveal thickness (CFT) on optical coherence tomography. RESULTS: 81 patients were included in the study. The mean age was 79.5 years with a male:female ratio 32:49. The mean number of treatments was 5.6 ± 2.3. Visual outcomes at 12 months showed 17.1% gained ≥ 15 letters BCVA, 97.4% lost <15 letters and 2.5% lost ≥ 15 letters. Mean changes at 12 months were: BCVA +3.7 ± 11.1 (p<0.01); CS +2.3 ± 5.1 letters (p<0.001); CFT -100.1 ± 111.9 µm (p<0.001). CONCLUSIONS: Clinician-determined re-treatment after a three-dose initiation phase appears to be less effective in improving BCVA than in randomised controlled trials.

Spontaneous subconjunctival orbital fat prolapse: presentation of four cases.

BACKGROUND: Subconjunctival orbital fat prolapse is a benign entity characterized by orbital fat herniation through a dehiscence in Tenon's capsule, usually between the superior and lateral recti muscles. It is often associated with ocular trauma or surgery, although spontaneous cases have also been reported with a predilection for obese individuals. PATIENTS AND METHODS: A retrospective study of four subconjunctival orbital-fat prolapse cases with no history of ocular surgery or trauma was performed. A trans-conjunctival surgical approach with Tenon's capsule repair was offered to all subjects. Differential diagnosis is discussed. RESULTS: The diagnosis of subconjunctival orbital fat prolapse was confirmed in all cases by histopathological examination. Functional and aesthetic postoperative results were excellent, with no recurrences during follow-up, for all cases. CONCLUSIONS: Although rare, subconjunctival orbital fat prolapse should be recognized. Surgical management offers excellent results.

[Pseudophakic inferior retinal detachment or detachment with inferior breaks: clinical outcome and recurrences after primary vitrectomy-gas]. / Décollement de rétine du pseudophake inférieur ou comportant des brèches inférieures: résultats et récidives après vitrectomie-gaz en première intention.

BACKGROUND: This study aims to evaluate the outcome of primary vitrectomy/gas for pseudophakic retinal detachment (RD) located inferiorly or associated to inferior breaks. PATIENTS AND METHODS: We performed a retrospective, non-randomised study comprising 18 pseudophakic RD eyes with inferior RD (group A) and 19 pseudophakic RD eyes with inferior breaks (group B) treated with primary vitrectomy and gas tamponade (SF (6) 20 %). Pre- and postoperative characteristics were analysed, focusing on RD recurrences. RESULTS: In group A, RD recurred in 2/18 eyes (11 %) and was associated to proliferative vitreoretinopathy (PVR) both at first intervention and on recurrence. In group B, RD recurred in 4/19 eyes (21 %). One eye presented PVR at first intervention and all at re-intervention. Anatomic reapplication was achieved after second vitrectomy/gas in 2/4 eyes of group B, whereas long-term silicon oil tamponade was needed in 2 eyes of each group. CONCLUSIONS: This series shows a high success rate of primary vitrectomy/gas in pseudophakic RD patients with inferior RD or detachment associated to inferior breaks. Recurrences after vitrectomy are most often related to the presence of PVR.

[Recurrence after primary vitrectomy for pseudophakic retinal detachment]. / Décollements de rétine récidivants après vitrectomie en première intention chez le patient pseudophake.

INTRODUCTION: The aim of this study was to evaluate the incidence of pseudophakic retinal detachment (RD) recurrence after primary vitrectomy. PATIENTS AND METHODS: This was a prospective nonrandomized consecutive case series study, evaluating two series presenting to our clinic with pseudophakic RD from 1998 to 2004 (103 eyes of 97 patients). The study included 24 consecutive pseudophakic eyes treated with gas vitrectomy surgery with placement of an encircling band from January 1998 to December 2000 (group A) and 79 consecutive pseudophakic eyes treated with gas vitrectomy surgery with no encircling band from January 2001 to December 2004 (group B). Pre- and postoperative characteristics were analyzed in both groups. In the cases of postoperative RD recurrence, we particularly analyzed the pre- and postoperative risk factors, as well as the anatomic and functional outcome. RESULTS: Visual acuity improved in 74/103 (71.8%) eyes from both groups postoperatively. Recurrence of RD after primary vitrectomy occurred in eight of 103 (7.8%) eyes in both groups. More specifically, two of 24 (8.3%) eyes in group A and six of 79 (7.6%) eyes in group B presented a recurrence after gas vitrectomy with encircling band and gas vitrectomy alone, respectively. Among these eight eyes, four eyes (50%) presented proliferative vitreoretinopathy (PVR) at the time of initial vitrectomy, while all eyes presented PVR at the time of recurrence (one grade B, seven grade C). These eyes required two additional interventions on average. Five eyes (62.5%) required silicone-oil tamponade for a good anatomic reapplication. DISCUSSION: These results show that recurrence after primary vitrectomy for pseudophakic RD is most often related to the presence of PVR before or after the first intervention. This series reports a success rate of 91.7% and 92.4%, respectively, for group A and B, thus demonstrating the efficacy of vitrectomy in the treatment of pseudophakic RD. This study also shows a nonsignificant difference in the recurrence rate among patients treated by gas vitrectomy and those undergoing gas vitrectomy in association with encircling band placement, which raises the question of the usefulness of an additional encircling band in pseudophakic RD.

Frontal sinus anatomical variations with potential consequences for the orbit. Study on cadavers.

Anatomical variations of the frontal sinuses that may play a role in the correlation between frontal sinusitis and orbital complications are described. There were used 18 cadavers during routine educational cadaver dissections, one month after theirs withdrawal from the formol basin. The dissections of the cranial cavity and the orbits were performed so as to reveal the frontal sinuses. An unusual bilateral posterior extension of the frontal sinus mucosa was found in two of the cadavers. The projection of the mucosa was covering half of the orbital roof in a 60 year old male and one third of the orbital roof in a 59 year old male. Among the other cadavers that presented normal variations of the frontal sinuses, there was also a case of a 57 year old female with a complete aplasia of the frontal sinuses. Such anatomical variations with unusual extension of the frontal sinuses above orbital roof may support the correlation between frontal sinusitis and the possible complications from the orbit and these cases may be considered as 'high risk' cases for orbital complications during a frontal sinusitis.