Christina Rennie

Intravitreal bevacizumab (Avastin) for the treatment of choroidal neovascularization in age-related macular degeneration: results from 118 cases

Several vascular endothelial growth factor inhibitors have recently been studied as treatments for neovascular AMD.1 2 Pegaptanib sodium improved visual acuity in 6% of patients at one year;1 Ranibizumab 0.5 mg improved vision by three lines in 33% of patients at one year.2 Michels et al. 3 initially reported the use of intravenous bevacizumab for the treatment of choroidal neovascularization (CNV), and others have found visual improvement and reduction in macular thickness with intravitreal bevacizumab.4–8 We present the results from 118 cases treated with intravitreal bevacizumab based at a single centre. A retrospective review of 115 consecutive patients (118 eyes) based at Southampton Eye Unit, treated with intravitreal bevacizumab for CNV was performed. Lesions of all types irrespective of size or location that were either ineligible for photodynamic therapy (PDT) under the National Health Service (including minimally classic and occult CNV) or those not responding to PDT (classic or predominantly classic CNV with recurrent or persistent CNV activity) were included in the study (table 1). All patients underwent visual acuity testing (best corrected Snellen), slitlamp examination and fundus fluorescein angiography. Central macular thickness (CMT) was assessed using Stratus optical coherence tomography (Carl Zeiss Meditec, USA). View this table: Table 1 Baseline characteristics After discussion about the off-label nature of treatment and the potential risks, informed …

Idiopathic juxtafoveolar retinal telangiectasis in monozygotic twins

Monozygotic twins (aged 63 years old), with group-2A idiopathic juxtafoveolar retinal telangiectasia (JXT), underwent clinical examination, fluorescein angiography (FA) and optical coherence tomography (OCT). Twin 1 : Right fundus showed right-angled venules temporal to the fovea; FA demonstrated retino-retinal anastomosis and intraretinal leakage. Twin 2 : Fundoscopy revealed right-angled venules in both eyes. OCT demonstrated foveal cysts in all eyes. This is the third set of monozygotic twins with group-2A JXT that has been reported in the literature, further supporting a genetic predisposition for JXT. The twin who smoked had more severe disease, suggesting that smoking is a risk factor for progression. OCT is useful in the detection and monitoring of these patients. Group-2A JXT is characterised by bilateral regions of retinal thickening …

Long-term survival in a case of bilateral diffuse uveal melanocytic proliferation

Sir, Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a paraneoplastic syndrome described by Machemer1 in 1966, in which an underlying tumor causes diffuse bilateral proliferation of melanocytes in the uvea. Gass et al.2 later described five cardinal signs related to BDUMP: multiple red patches at the level of the RPE, corresponding early hyperfluorescence of these patches on fluorescein angiography, development of multiple pigmented and non-pigmented uveal melanocytic tumors with diffuse thickening of the uveal track, exudative retinal detachment, and rapidly progressive cataracts. Patients affected by BDUMP have a short life expectancy.2 We, however, report a case of BDUMP, which illustrates that long-term survival can occur despite multiple metastases.

Resolution of proliferative venous stasis retinopathy after carotid endarterectomy

Ocular ischaemic syndrome (OIS) may present as an asymmetric retinopathy in diabetic patients. We report a case of asymmetric diabetic retinopathy with posterior segment neovascularisation due to OIS associated with critical ipsilateral carotid stenosis where the neovascularisation resolved after carotid endarterectomy. A 50 year old woman presented in May 1996 with left sided weakness. She had hypercholesterolaemia, hypertension, a family history of vascular disease, and was a smoker. She was found to be diabetic with peripheral retinal ischaemia and disc neovascularisation in the right eye, and minimal retinal ischaemia in the left eye (Fig 1). Her visual acuities were 6/12 in the right eye and 6/9 on the left. There was no anterior segment neovascularisation in either eye. Carotid Doppler and carotid angiography showed critical stenosis at the origin of the right internal carotid artery. The right middle cerebral artery branches were visualised as a result of retrograde flow through the ophthalmic artery. The left internal carotid artery was narrowed by …