Bjoern Harder

Frequency of spontaneous pulsations of the central retinal vein

The central retinal vein is the only structure in the body which can be examined non-invasively, runs through the cerebrospinal fluid space, and has a shape that depends on the relationship between its internal pressure and the pressure in the space surrounding it. Estimation of central retinal vein pressure is, therefore, helpful in the assessment of cerebrospinal fluid pressure—that is, the intracranial pressure.1–4 Central retinal vein pressure may be assessed by determining the external pressure at which the central retinal vein starts to pulsate. This method of assessment is similar to Riva-Rocci’s method of indirect measurement of arterial blood presure. For the central retinal vein, the external pressure is the intraocular pressure. The purpose of the present study was to find out the proportion percentage of subjects in whom the central retinal vein shows spontaneous pulsations, indicating that the pressure in the vein is lower than the intraocular pressure. The assessment of spontaneous retinal venous pulsations may be very useful …

Intravitreal Bevacizumab versus Triamcinolone Acetonide for Exudative Age-Related Macular Degeneration

Background: To compare an intravitreal high-dose injection of triamcinolone acetonide with an intravitreal injection of bevacizumab for the treatment of progressive exudative age-related macular degeneration (AMD). Method: The comparative nonrandomized retrospective clinical interventional study included 305 patients with progressive AMD, divided into a bevacizumab group of 36 patients (1.5 mg bevacizumab) and a triamcinolone group of 269 patients (about 20 mg triamcinolone). All patients were consecutively included, in the first phase of the study for triamcinolone, and in the second phase of the study for bevacizumab. The mean follow-up was 8.5 ± 6.8 months (2–35.7 months). Results: In the bevacizumab group, best visual acuity increased significantly (p < 0.001) by 3.2 ± 3.4 Snellen lines, with 25 (69%) eyes and 21 (58%) eyes, improving by at least 2 and 3 Snellen lines, respectively. In the triamcinolone group, the visual acuity change was not statistically significant for any specific follow-up examination within the first 3 months. The maximal increase in visual acuity, the visual acuity change at 2 months after injection and the percentage of patients with an improvement by at least 2 and 3 Snellen lines were significantly (p < 0.001) higher in the bevacizumab group than in the triamcinolone group. Intraocular pressure increased significantly (p < 0.001) in the triamcinolone group and did not change significantly (p = 0.47) in the bevacizumab group. Conclusion: In exudative AMD, intravitreal bevacizumab (1.5 mg) compared with intravitreal triamcinolone acetonide (about 20 mg) results in a higher improvement of visual acuity and does not markedly influence intraocular pressure within 2 months after injection.

Early refractive outcome after intravitreous bevacizumab for retinopathy of prematurity.

2011;118(2):376-381. 4. Park JC, Moura AL, Raza AS, Rhee DW, Kardon RH, Hood DC. Toward a clinical protocol for assessing rod, cone, and melanopsin contributions to the human pupil response. Invest Ophthalmol Vis Sci. 2011;52(9):6624-6635. 5. Kardon R, Anderson SC, Damarjian TG, Grace EM, Stone E, Kawasaki A. Chromatic pupil responses: preferential activation of the melanopsinmediated vs outer photoreceptor-mediated pupil light reflex. Ophthalmology. 2009;116(8):1564-1573.

Repeated Intravitreal Injection of Triamcinolone for Exudative Age-Related Macular Degeneration

Background: Intravitreal triamcinolone acetonide has been discussed as treatment for exudative age-related macular degeneration (AMD). Objectives: To give an updated report on repeated intravitreal injections of triamcinolone acetonide (IVTA) for the treatment of exudative AMD. Methods: The case-series study included 24 patients (24 eyes) with progressive exudative AMD who had shown an increase in, or stabilization of, visual acuity after a first IVTA, and who eventually experienced a deterioration of visual acuity. The 24 (6.5%) eyes were selected out of a total group of 369 eyes who had received IVTA for exudative AMD within the last 5 years. All patients of the study received a second IVTA (approximately 20 mg) 3.7–38.5 months after the first injection. Main outcome measure was visual acuity. Results: After the first injection, best corrected visual acuity improved significantly (p = 0.001) from 0.75 ± 0.34 logMAR to a minimum of 0.58 ± 0.30 logMAR during follow-up, with 10 (42%) eyes improving in visual acuity by two or more Snellen lines. Towards the end of follow-up after the first injection, best corrected visual acuity decreased significantly (p = 0.03) compared with the baseline value. After the second injection, visual acuity did not change markedly from baseline to a mean maximal visual acuity during follow-up. Comparing the last postoperative examination at the end of the follow-up after the second IVTA with the preoperative examination, a significantly (p = 0.001) higher number of eyes lost in visual acuity [19 (79%) eyes] than gained in visual acuity [3 (12%) eyes]. Conclusions: In selected eyes with an increase in visual acuity after a first IVTA (20 mg), repeated IVTA temporarily stabilizes visual acuity with a drop in visual acuity towards the end of follow-up.