Anti-VEGF intervention in neovascular AMD: benefits and risks restated as natural frequencies.

OBJECTIVE: Clear information is essential to properly determine preference in medical intervention. In neovascular age-related macular degeneration, patients need to understand the balance of risk and benefit of anti-vascular endothelial growth factor (VEGF) treatment. This balance is altered by the number of injections administered. METHODS: Natural frequencies, displayed as pictographically as icon arrays, are used to show material outcomes from the MARINA and HARBOR (12 months) trials. We also calculated the number needed to treat (NNT) and number needed to harm (NNH). RESULTS: MARINA 24-month data show the absolute risk reduction is 37% and the NNT is 3; meaning for one patient to benefit three need to be treated.12 months' HARBOR data show that compared with as-needed treatment, scheduled monthly injection treatment increases the number of patients achieving a better visual outcome. The number of patients suffering harm is also increased by the additional injections. CONCLUSION: Displaying MARINA and HARBOR trial data as natural frequencies, with numbers needed to treat and harm, communicates complimentary information on the positive and negative aspects of anti-VEGF treatment.

Unilateral orbital fat change.

A man in his 60s suffering from open-angle glaucoma attended a routine glaucoma follow-up complaining that his left eye has changed in appearance. On examination, there was extensive loss of orbital fat giving the appearance of a sunken in globe. A diagnosis of prostaglandin-associated periorbitopathy was made as the man had been taking a prostaglandin analogue for his glaucoma for over 4 years in his left eye only.

A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy: clinical presentation, microbiology, management and outcome.

BACKGROUND/AIMS: This is the first prospective and nationwide study aiming to provide epidemiological data relating to presentation, microbiology, management and outcome of endophthalmitis following vitrectomy. METHODS: Two years of prospective and nationwide surveillance for cases of presumed infectious endophthalmitis within 6 weeks of pars plana vitrectomy was completed. The study obtained case reports via the established British Ophthalmological Surveillance Unit (BOSU) system. RESULTS: Thirty-seven cases were reported and 28 met the diagnostic criteria for presumed infectious endophthalmitis following vitrectomy. Mean age was 61 years and 67% were male. Nineteen cases were 23/25 gauge and 9 cases were 20 gauge. Mean time from surgery to endophthalmitis was 5 days. Blurred vision (85.2%), pain (77.8%) and a hypopyon (77.8%) were the commonest presenting symptoms and signs. Seventeen cases (60.7%) had a positive culture. Culture-positive endophthalmitis, relative to culture-negative endophthalmitis, was no different with respect to time to presentation, symptoms, signs or outcome. Outcome was poor, with 29.6% of eyes being eviscerated or having no perception of light or perception of light. CONCLUSIONS: This study helps surgeons promptly identify cases of endophthalmitis following vitrectomy and informs them about the various management options currently used and the likely outcome of this devastating complication.

A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy: incidence and risk factors.

BACKGROUND/AIMS: This is the first nationwide prospective study to investigate the incidence and risk factors of endophthalmitis following pars plana vitrectomy (PPV). METHODS: This was a prospective, nationwide case-control study. Cases of presumed infectious endophthalmitis within 6 weeks of PPV were reported via the established British Ophthalmological Surveillance Unit. The surveillance period was 2 years. Controls (patients who had PPV but no endophthalmitis) were recruited from nine randomly selected UK centres. RESULTS: 37 reports were received and 28 cases met the diagnostic criteria for presumed infectious endophthalmitis following PPV. The incidence of endophthalmitis following PPV was 28 cases per 48 433 PPVs (1 in 1730 with a 95% CI of 1 in 1263 to 1 in 2747). 272 controls were randomly recruited from nine UK centres. Smaller gauge port sizes were not found to be a risk. Immunosuppression (OR 19.0, p=0.001) and preoperative topical steroids (OR 131.4, p<0.001) increased the endophthalmitis risk. Operating for retinal detachment was associated with a reduced risk of endophthalmitis (OR 0.10, p=0.005). CONCLUSIONS: Endophthalmitis following PPV is rare. Operating with smaller gauge port sizes does not increase the risk of endophthalmitis.

Penetrating eye injury caused by eyelash curlers--a cause for concern?

PURPOSE: To report a case of open globe injury caused by eyelash curlers. METHODS: Interventional case report. RESULTS: A 19-year-old female presented with a history of accidentally poking herself in the left eye when her eyelash curlers broke suddenly. Initial assessment revealed a laceration in the infero-nasal cornea of the left eye. The patient was also noted to have developed a traumatic cataract. Surgical exploration of the penetrating eye injury also revealed damage to the posterior capsule of the lens. Lensectomy, anterior vitrectomy, and implantation of an intraocular lens were performed. The first day after the operation, the patient's visual acuity in the left eye improved to 20/30 unaided. At 3-months follow-up, the sutures were removed and visual acuity remains at 20/30 unaided. CONCLUSION: Our case represents an unusual cause of serious ocular injury in a domestic setting wherein appropriate and timely intervention resulted in a good clinical outcome.

Bilateral severe fibrinous anterior uveitis--an unusual complication of pamidronate therapy exacerbated by topical latanoprost.

AIM: The aim of this study was to report a case of severe bilateral fibrinous anterior uveitis following pamidronate therapy in a patient on latanoprost. METHODS: This study is presented as an interventional case report. RESULTS: Clinical examination showed bilateral severe fibrinous uveitis following an intravenous infusion of disodium pamidronate. Ocular signs and symptoms responded to stopping latanoprost and treatment with oral prednisolone (60 mg) and hourly topical prednisolone acetate 1%. The reintroduction of latanoprost resulted in a recurrence, which was stopped with subsequent improvement. CONCLUSIONS: Mild anterior uveitis is an unfamiliar adverse effect of pamidronate therapy. However, severe fibrinous uveitis has not been previously described. This may be due to the compounding effect of latanoprost. This case highlights the importance of history taking and awareness of the otherwise uncommon side effect of this commonly prescribed medication.

Bilateral combined resection and recession of the medial rectus muscle for convergence excess esotropia.

Five patients with true convergence excess esotropia were surgically managed with combined resection and recession of the medial rectus muscles. This technique was chosen to address the near/distance angle disparity. The use of this surgical technique produced full asymptomatic binocular control at near and distance fixation in four patients. One patient developed a consecutive exotropia but regained full binocular control following a second surgical procedure.

Modified Lundie loops improve apraxia of eyelid opening.

BACKGROUND: Current treatments are unsatisfactory for improving apraxia of eyelid opening, defined as a delay or inability to open closed eyelids voluntarily in the presence of intact motor pathways. METHODS: Improvement in functional health was assessed using the Blepharospasm Disability Scale (BDS) in five consecutive patients with apraxia of eyelid opening treated with wire loops affixed behind ordinary spectacles (Lundie loops) and modified to provide pressure on the brow as a stimulus to keep the eyelids elevated. RESULTS: All five patients showed improvement in BDS scores. The mean percentage of normal activity of the study population improved from 25% to 37.6%. Outdoor activities were not significantly altered with the use of the device. CONCLUSIONS: Modified Lundie loops appear to be helpful in improving the functional health of patients with eyelid apraxia. These results will need to be verified in larger trials.