Treat-and-extend bevacizumab for neovascular age-related macular degeneration: the importance of baseline characteristics.

PURPOSE: To evaluate the factors affecting visual and anatomical outcomes and the number of intravitreal bevacizumab injections required in the treatment of neovascular age-related macular degeneration using a treat-and-extend regimen. METHODS: Retrospective consecutive case series. The charts of subjects treated with intravitreal bevacizumab for neovascular age-related macular degeneration using a treat-and-extend regimen over a 12-month period were reviewed. The key variables explored were patient age, phakic status, posterior vitreous detachment status, baseline best-corrected visual acuity (BCVA), baseline central macular thickness (CMT), and type of chorodial neovascularization. The primary outcome measures were improvement in BCVA of 3 logMAR lines or more, maintenance of BCVA within 3 logMAR lines of baseline, number of intravitreal injections delivered over a 12-month period, and final CMT on optical coherence tomography. RESULTS: A total of 230 eyes met the criteria. Mean presenting BCVA was Snellen 20/55 (0.44 logMAR) and mean final BCVA was Snellen 20/44 (0.35 logMAR) (P < 0.001). A total of 23.5% (95% confidence interval [CI], 18.5-29.4%) of the subjects demonstrated an improvement in BCVA of 3 or more logMAR lines, whereas 96.5% (95% CI, 93.3-98.2%) of the subjects lost fewer than 3 logMAR lines. Mean CMT on optical coherence tomography changed from a baseline average of 373.1 µm (95%CI, 360.3-386.1 µm) to a final average of 305.5 µm (95% CI, 290.0-316.0 µm). The average number of injections during the 12-month period was 9.2 (95% CI, 9.0-9.4). Posterior vitreous detachment was associated with fewer injections on univariate and multivariate analysis (8.7 injections in the posterior vitreous detachment group versus 9.8 in the non-posterior vitreous detachment group, P < 0.001). Patients with poorer presenting BCVA and greater baseline CMTs were more likely to demonstrate a 3 or more logMAR line improvement in BCVA. Thinner final CMTs were independently associated with thinner presenting CMTs and fewer injections. CONCLUSION: Favorable visual and anatomical outcomes may be achieved with intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration using a treat-and-extend regimen. Our study suggests that posterior vitreous detachment may play a role in the efficacy of intravitreal bevacizumab during the treatment of neovascular age-related macular degeneration.

The increased use of computed tomography scanning for diagnosing superficial soft tissue infections: a disturbing trend of increased radiation with no benefit.

BACKGROUND: Soft tissue infections have historically been diagnosed on the basis of clinical signs and symptoms. A trend toward the increased use of computed tomographic (CT) imaging in their evaluation has been noted. METHODS: A retrospective review was performed of soft tissue infection admissions in 2003 and 2004 and in 2009 and 2010. Intracavitary abscesses (eg, intra-abdominal, pelvic) that would not be evident on physical examination were excluded. Demographic and outcome variables, number of CT scans by body region, and total effective radiation dose were recorded. Radiation exposure was stratified into low, moderate, high, and very high categories. RESULTS: There was a significant increase in the number of patients receiving ≥1 CT scan for initial diagnosis, from 36.7% in the early cohort to 50% in the later cohort (P < .001). The mean cumulative effective dose increased from 5.46 to 7.82 mSv (P = .007). Greater proportions of patients fell into the moderate (32.9% vs 24.5%) and high (6.8% vs 10.6%) radiation exposure categories. CONCLUSIONS: CT scans are increasingly used in the evaluation of soft tissue infections, with resultant increase in radiation exposure.