Asheesh Tewari

Effect of treatment of rectal cancer metastasis with intravitreal bevacizumab (Avastin) in patient with subretinal fluid and macular oedema: short-term follow-up

We describe the management of subretinal fluid and macular oedema due to colorectal cancer metastasis to the choroid using intravitreal bevacizumab. A patient with grade VI KRAS mutation rectal cancer with metastasis to the lung and cerebellum presented with left eye choroidal metastasis 1 week after being started on the experimental medication KTN3379. After intravitreal bevacizumab administration, the patient had improvement in macular subretinal fluid, but eventually progressed to severe cystoid macular oedema despite monthly intravitreal bevacizumab treatment.

Visualizing the internal limiting membrane: what is effective and what is safe?

The internal limiting membrane (ILM), composed of collagen fibers, glycosaminoglycans, laminin, and fibronectin, is the basement membrane of the retinal Müller cells and serves as an interface between the vitreous and retina. It is thickest in the macular and peripapillary regions, where it measures 2.5mm, and progressively thins to 0.5mm in the vitreous base. Not until the 1980s when vitrectomy and removal of epimacular proliferations became common and ILM fragments were identified in specimens did ILM removal begin to attract clinical attention. Then, from a pilot study presented by Kelly and Wendel at the Annual Meeting of the American Academy of Ophthalmology, the identification and removal of the ILM and, with it, the removal of the cortical vitreous were described. Han et al had previously described complete removal of the posterior hyaloid and cortical vitreous to relieve vitreoretinal traction and the ‘‘scaffold’’ for subsequent cellular proliferation. In addition to the posterior hyaloid and posterior cortical vitreous, the ILM is thought to act as a scaffold for cellular proliferation. Glial cells may collect on the ILM thereby creating tangential contractile forces. Morris et al advocated ILM removal in eyes with hemorrhagic macular cysts secondary to Terson syndrome and later recommended removal of the ILM in other pathologies causing macular traction. ILM peeling to treat idiopathic macular holes (IMH) was described by Eckardt et al in 1997. Brooks showed in a retrospective, nonrandomized, comparative trial of 225 eyes in 221 patients that underwent vitrectomy with and without ILM peeling, that ILM removal significantly improves visual and anatomic success in all stages of macular holes. A meta-analysis by Mester and Kuhn of 1654 eyes from published reports concluded that ILM-maculorhexis increases anatomic