Real-world outcomes of intravitreal bevacizumab treat-and-extend for cystoid macular oedema secondary to central retinal vein occlusion.

INTRODUCTION: The purpose of this study was to report the real-world treatment outcomes using a treat-and-extend intravitreal bevacizumab protocol in cystoid macular oedema (CMO) secondary to central retinal vein occlusion (CRVO). METHODS: We conducted a retrospective case series of consecutive adult patients with CMO secondary to CRVO who presented between 1st January 2019 and 31st December 2021. All included patients were treated with bevacizumab using a treat-and-extend protocol, were followed up for a minimum of 6 months and had a clinical examination including best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at every visit. The primary outcome measure was mean change in BCVA. RESULTS: Thirty-three eyes of 33 patients were included in the study. The mean change in BCVA from baseline was + 24.5 (Median 18, SD 21.5) letters, with a mean follow-up duration of 18.5 (SD 8.9) months. The mean number of injections was 9.5 (SD 1.9) in year 1 and 7.8 (SD 2.8) in year 2. 87.9% of patients were still requiring active treatment, with a maximum interval achieved of 4-weekly in 18.2%, 6-weekly in 42.4%, 8-weekly in 6.1%, 10-weekly in 15.2%, and 12-weekly in 6.1%. The mean maximum interval achieved of those requiring ongoing treatment was 6.8 (SD 2.4) weeks. Multiple regression analyses showed that a higher baseline BCVA was negatively associated with mean visual acuity gain (P < 0.001) and positively associated with final BCVA (P < 0.001). CONCLUSION: The use of intravitreal bevacizumab in a treat-and-extend regimen is effective in treating CMO secondary to CRVO, in a real-world setting.

Quality of Life in Uveal Melanoma Patients in Ireland: A Single-Centre Survey.

BACKGROUND: Uveal melanoma and its treatment can influence the physical and psychological well-being of patients in a way that differs from other cancers. Factors influencing quality of life (QOL) include visual impairment, changes in appearance, day-to-day functioning, ocular discomfort, and worry regarding disease recurrence. OBJECTIVE: We aimed to study both general and disease-specific QOL in uveal melanoma patients in Ireland and compare QOL between a plaque radiotherapy group and an enucleation treatment group. This information was sought to enhance our understanding of QOL issues for uveal melanoma patients, in the context of improving care and providing appropriate psychosocial support. METHOD: The European Organisation for Research and Treatment of Cancer (EORTC) QOL questionnaires QLQ-C30 and QLQ-OPT30 were completed by patients with uveal melanoma treated by enucleation or brachytherapy. RESULTS: 138 of 206 patients completed the questionnaires. There was no significant difference in QOL scores between treatment groups. Thirty-two percent of patients reported concerns about tumour recurrence elsewhere in the body. The brachytherapy group had a significantly higher "role functioning" score (p = 0.030). Enucleation patients were more likely to have problems with appearance (p < 0.0005). Younger patients (12-54 years of age) were more likely to report headaches (p < 0.0005) and problems with reading (p = 0.042), and they had a lower cognitive functioning score (p = 0.003) than those aged ≥55 years. CONCLUSIONS: There was no significant difference in reported QOL between treatment groups. Our data identified a number of vulnerable patient subgroups. By anticipating which patients are more likely to suffer in terms of certain aspects of their QOL, we are better able to provide appropriate and timely psychosocial support.

Uveal Melanoma in Ireland.

PURPOSE: To report the clinical features and epidemiology of uveal melanoma in Ireland. METHODS: This was an observational study of 253 patients with a new diagnosis of uveal melanoma between June 2010 and December 2015. Main outcome measures included demographics, clinical features, age-adjusted incidence, relative survival, overall survival, and distant metastases-free survival. RESULTS: The mean patient age was 61.7 years. Tumour location was choroidal in 82%, ciliochoroidal in 9%, iridociliary in 2%, and iris in 7%. Treatment modalities included brachytherapy (ruthenium-106 and iodine-125 [64%]), enucleation (27%), and proton beam radiation (8%). The mean age-adjusted incidence of uveal melanoma in Ireland from 2010 to 2015 was 9.5 per million of the population (95% confidence interval [CI]: 8.4-10.7). Four-year relative survival was 81.3% (95% CI: 72.8-87.3). Four-year overall survival was 84% (95% CI: 78-90) and 4-year distant metastases-free survival was 79% (95% CI: 73-86). CONCLUSION: Based on this data, the incidence of uveal melanoma in Ireland is high when compared with other reported incidence rates in Europe and worldwide. Relative and observed survival were in keeping with other reported European survival rates.

Preloaded refractive-addition corneal inlay to compensate for presbyopia implanted using a femtosecond laser: one-year visual outcomes and safety.

PURPOSE: To report the results of the Icolens corneal inlay 12 months after implantation. SETTING: Department of Refractive Surgery, Mater Private Hospital, Dublin, Ireland. DESIGN: Prospective case series. METHODS: The inlay was implanted in the nondominant eye of emmetropic patients through a femtosecond laser-created corneal pocket. RESULTS: The mean uncorrected near visual acuity (UNVA) in the surgical eye (n = 52) improved from N18/N24 preoperatively to N8 postoperatively (P = .000); all patients had a UNVA of N16 or better and 9 (17%), of N5 or better. The uncorrected distance visual acuity (UDVA) in the surgical eye increased from 0.05 logMAR ± 0.12 (SD) preoperatively to 0.22 ± 0.15 logMAR postoperatively (P = .000). There was a mean loss of 1.67 ± 1.77 lines of UDVA (P = .000). Binocularly, there was a mean gain of 0.48 ± 1.16 lines of UDVA postoperatively (P = .000), with 22 patients (42%) gaining more than 1 line. The mean loss of corrected distance visual acuity postoperatively was 1.78 ± 1.04 lines (P = .000). There was no significant change in corneal topography or endothelial cell count. On the satisfaction survey, 90% of patients reported being happy ("yes" or "rather yes") with the overall procedure in general. Eleven implants were explanted because of minimal improvement in UNVA. No significant adverse events were reported throughout the study. CONCLUSION: The new refractive-addition corneal inlay effectively corrected presbyopia in emmetropic presbyopic patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

The difference in intraocular pressure readings between 3 applanation tonometers is independent of central corneal thickness, in glaucomatous and nonglaucomatous eyes.

PURPOSE: To look at tonometry differences between 3 tonometers and to correlate this difference with central corneal thickness (CCT) in glaucomatous and nonglaucomatous eyes. METHODS: A total of 145 patients were recruited (39 with glaucoma). Intraocular pressure (IOP) was carried out using the Tonosafe (TS), Tono-Pen XL (TP), and Goldmann applanation tonometer (GAT). CCT was also performed using a digital pachymeter. RESULTS: The TS underestimated IOP when compared with the GAT by a mean (±SD) of 1.03±2.14 mm Hg (P<0.001). The TP when compared to the GAT overestimated IOP by a mean (±SD) of +1.09±6.38 mm Hg (P=0.071). We found only 31% of TP readings to be within ±2 mm Hg of the GAT readings and only 60% to be within ±4 mm Hg of the GAT readings. Correlation was poor (F=0.247) between the GAT and TP with the coefficient of determination being 0.061. The difference in IOP was independent of CCT and a diagnosis of glaucoma. CONCLUSIONS: The TS, when compared with the GAT, underestimates IOP with a tendency for this to increase in the higher range of IOP readings. The TP is poorly correlated with the GAT.