Electrophysiological effects of intravitreal Avastin (bevacizumab) in the treatment of exudative age-related macular degeneration.

OBJECTIVE: To examine the sensitivity of the multifocal electroretinogram (mf-ERG) at measuring changes in retinal electrical activity in response to Avastin (bevacizumab) treatment for age-related macular degeneration (ARMD). METHODS: Nine subjects with exudative ARMD, not previously treated with bevacizumab in the investigated eye, underwent pretreatment testing with mf-ERG and intravenous fluorescein angiography (IVFA). A second mf-ERG test was conducted post-treatment. The P1 response amplitudes were examined for the hexagons corresponding to areas of pathology on the IVFA. Intertest variability was accounted for by examining areas without pathology. Aggregate responses were also generated for central and lesion-associated responses. RESULTS: Changes in P1 response amplitude correlated with changes in visual acuity (R(2)>0.96). An improvement in Snellen visual acuity correlated with a significant improvement in P1 response amplitude from lesion associated recordings (p<0.03). Changes in P1 response amplitudes were not observed when aggregate responses were generated. CONCLUSION: This study represents a novel method for assessing an improvement of mf-ERG responses. This is the first study to demonstrate a statistically significant change in retinal electrical activity postbevacizumab in patients with ARMD. This study demonstrates a method for utilising mf-ERG to assess changes in retinal electrical activity and to assess the effectiveness of treatments such as bevacizumab.

Intra-arterial thrombolysis for central retinal artery occlusion: a systematic review.

INTRODUCTION: This review provides an updated analysis of the evidence supporting intra-arterial thrombolysis (IAT) for the treatment of central retinal artery occlusion (CRAO). METHODS: A systemic review of the literature indexed by Ovid MEDLINE was performed for the following medical subject headings: central retinal artery occlusion, thrombolysis, intra-arterial, fibrinolysis. Studies were analysed individually and categorised by study type, and extracted data grouped together for statistical analysis. Only studies with five patients or more were included in the review. RESULTS: Twenty-three studies were identified in the original search; eight were selected for the analysis. Of these studies, 158 patients were represented, in which treatment was instituted within an average of 8.4 (SD 4) h of symptom onset. In these patients, visual improvement occurred on average in 93% of patients, with 13% achieving 20/20 or better, 25% achieving 20/40 or better, and 41% achieving 20/200 or better. Complications occurred in 4.5% of cases. CONCLUSION: IAT may produce superior visual outcomes compared with conventional treatments for CRAO when instituted in certain situations. At the moment, there is insufficient evidence to support the routine use of IAT to treat CRAO. Well-designed prospective, randomised trials remain to be done.

Using medical lubricating jelly in human cadaver eyes to teach ophthalmic surgery.

Attempting to learn phacomemulsification through the severely edematous cornea of a human cadaver eye is often difficult. We propose a method of improving the view of the anterior chamber structures. Medical lubricating jelly is injected into the anterior chamber of a cadaver eye. After 10 minutes, excellent corneal clarity is achieved. There was no change in the corneal edema with the injection of sodium hyaluronate 1.4% (Healon GV as a control. Using medical lubricating jelly in place of viscoelastic material is an inexpensive, effective adjunct in ophthalmic surgical teaching.