A. Tewari

Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration.

Purpose: To examine the 7-month results for patients treated with combined photodynamic therapy (PDT) with verteporfin and intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: This is a retrospective series of 24 eyes with juxtafoveal or subfoveal CNV secondary to AMD. Patients were treated with PDT with verteporfin and 1.25 mg of intravitreal bevacizumab. All patients were naive to treatment and had either treatment within a 14-day interval. Main outcome measures were visual acuity stabilization (defined as no change or a gain in visual acuity) and retreatment rate. Results: At the 7-month follow-up, 20 (83%) of 24 patients had stabilization of visual acuity. Sixteen eyes (67%) had improvement in visual acuity. Mean improvement in visual acuity (n = 24) was 2.04 Snellen lines. Fifteen eyes (63%) required only a single combined treatment for CNV resolution. There were no complications, including endophthalmitis, uveitis, and ocular hypertension. Conclusion: The results of this study suggest that combined treatment of PDT with verteporfin and intravitreal bevacizumab may be useful in treating neovascular AMD by reducing retreatment rates and improving visual acuity. Further investigation with large, controlled trials is warranted to outline the appropriate treatment paradigm for combination therapy.

Visual Outcomes With 23-gauge Transconjunctival Sutureless Vitrectomy

Purpose: To evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for various posterior segment conditions. Methods: A retrospective chart review of 81 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgery was performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center. All patients had at least 3-month follow-up. Main outcome measures included visual acuity, intraocular pressure, and operative complications. Results: Mean follow-up was 6.5 months (range 3–9 months). Mean overall preoperative visual acuity was 20/150 and final acuity was 20/70 (P < 0.0001). Mean intraocular pressure on postoperative day 1 was 14 mmHg (range 6–28 mmHg). There was a single case of intraoperative retinal tear that required treatment with cryotherapy. Twenty eyes of 48 phakic eyes (42%) had worsening of cataracts in the postoperative period. There were no postoperative complications of endophthalmitis or retinal detachment. Conclusions: Twenty-three-gauge transconjunctival sutureless vitrectomy is an effective surgical technique in the management of vitreoretinal diseases. Complications were rare and compared favorably with published literature on 20-gauge and 25-gauge surgery.

Combination photodynamic therapy and juxtascleral triamcinolone acetonide for the treatment of a peripapillary choroidal neovascular membrane associated with papilloedema

Peripapillary choroidal neovascularisation is an uncommon entity that can be associated with significant visual loss. It has been noted with papilloedema resulting from pseudotumour cerebri.1 Treatment for peripapillary choroidal neovascularisation has involved observation, thermal laser photocoagulation, or surgical excision.2 We report a case of peripapillary choroidal neovascularisation from papilloedema secondary to pseudotumour cerebri that was successfully treated with combination photodynamic therapy and juxtascleral triamcinolone acetonide.nnA 27 year old woman presented to the neuro-ophthalmology clinic for headaches and transient visual obscurations in both eyes. Visual acuity was 20/20 in both eyes and fundus examination was significant for optic nerve oedema in both eyes. After undergoing diagnostic testing, which included visual field analysis, lumbar puncture, and magnetic resonance imaging, a diagnosis of pseudotumour cerebri was firmly established. The patient was started on oral …