Outcome of ranibizumab treatment in neovascular age related macula degeneration in eyes with baseline visual acuity better than 6/12.

BACKGROUND: The beneficial effect of intravitreal ranibizumab in the treatment of neovascular age-related macula degeneration (nAMD) is well known. Outcome data for eyes presenting with visual acuity better than 6/12 is limited. AIMS: To assess the effect of baseline vision on outcome in ranibizumab-treated nAMD eyes, including a subgroup with baseline vision ≥6/12 (<0.30 logmar). DESIGN: Prospective, consecutive and interventional case series. METHODS: A consecutive cohort of patients treated with intravitreal ranibizumab for nAMD with 52-week follow-up were studied. Patients who had received previous treatment for nAMD were excluded. Eyes were stratified according to baseline logmar visual acuity into four groups: <0.30 (>6/12), 0.30-0.59 (6/12-6/24), 0.60-0.99 (6/24-6/60) and 1.00-1.20 (6/60-6/96). Intravitreal ranibizumab (0.5 mg in 0.05 ml) was administered in three loading monthly doses followed by PRN dosing according to optical coherence tomography (OCT) findings. RESULTS: A total of 615 eyes were studied including 88 eyes with baseline vision <0.30. The mean change in logmar letters at 52 weeks was +5.5 (entire study group), -0.5 (<0.30 subgroup), +2.2 (0.30-0.59 subgroup), +6.5 (0.60-0.99 subgroup) and +15.3 (1.00-1.20 subgroup). In the <0.30 subgroup, 60 of 88 eyes (68%) had best-corrected visual acuity (BCVA) equal to or better than baseline and 82 of 88 eyes (93%) lost <15 letters at 52 weeks. Within this subgroup 56 of 67 eyes (84%) maintained UK driving standard BCVA visual acuity over the study period. CONCLUSIONS: This study provides evidence that intravitreal ranibizumab treatment stabilises good vision in nAMD presenting with vision better than 6/12 over 52 weeks follow-up.

Diode laser trabeculoplasty versus argon laser trabeculoplasty in the control of primary open angle glaucoma.

A randomised prospective study was carried out to determine whether diode laser trabeculoplasty (DLT) is as effective as argon laser trabeculoplasty (ALT) in the control of primary open angle glaucoma (POAG). Forty eyes of 40 patients with uncontrolled intraocular pressure (IOP) despite maximum topical medication were entered into the study. Twenty eyes received DLT, spot size 100 µm, exposure time 0.2 s, mean power 1034 (±56.4) mW. Twenty eyes received ALT, spot size 50 µm, exposure time 0.2 s, mean power 528 (±44.7) mW. They were reviewed at 2 h, 2 and 8 weeks, and 3, 6, 12, 18 and 24 months after laser treatment. Two eyes were withdrawn from the DLT group and four from the ALT group because of uncontrolled IOP during follow-up. Of the remaining eyes in the trial, mean IOP reductions for DLT and ALT, respectively, were: 6 months 7.42 (±2.36) mmHg and 6.36 (±2.3) mmHg; 12 months 7.02 (±2.6) mmHg and 6.28 (±2.2) mmHg; 18 months 6.86 (±2.8) mmHg, 5.98 (±2.02) mmHg; 24 months 6.50 (±2.72) mmHg, 5.92 (±2.02) mmHg. There was a significant reduction in each laser group when IOP at each stage was compared with baseline (p<0.001) (paired Student's t-test), but no significant difference between the two groups. In the ALT group peripheral anterior synechiae developed in four eyes and post laser pain in seven eyes. These complications were not noted following DLT. We conclude that DLT and ALT are equally effective in IOP control, but DLT is associated with less anterior segment inflammation.

Ophthalmic manifestations of Rathke's cleft cysts.

PURPOSE: We studied the neuro-ophthalmic features of patients with symptomatic Rathke's cleft cysts, to distinguish features of Rathke's cleft cysts from those of craniopharyngioma. METHODS: Eleven patients who had undergone surgery for symptomatic Rathke's cleft cysts in the Liverpool University Department of Neurological Science were identified from the records. Histopathologic analyses, clinical notes, and radiologic investigations were reviewed. RESULTS: Eight of the 11 patients initially had visual problems. Reduced visual acuity, visual field defect, or both, were detected in nine patients. Optic atrophy was observed in eight patients. Other initial features included headaches, epilepsy, and endocrine disturbance. All patients recovered from surgery, and an improvement in the visual acuity or visual field defect was noted in six patients. CONCLUSIONS: Symptomatic Rathke's cleft cysts often manifest as visual disturbance. Every effort to distinguish Rathke's cleft cysts from craniopharyngiomas should be made preoperatively. Rathke's cleft cysts only require limited surgical intervention, and radiotherapy is not necessary. Early recognition and treatment can lead to improvement in visual function.