Krishnappa C Madhusudhana

Interleukin 8 promoter polymorphism -251A/T is a risk factor for age related macular degeneration.

Background/aims: To determine whether four expression-related cytokine polymorphisms are associated with age-related macular degeneration (AMD). Methods: DNA from 478 cases with AMD and 555 normal controls was genotyped for the pro-inflammatory IL1β −511C/T, IL6 −174C/G, IL8 −251A/T and anti-inflammatory IL10 −1082G/A cytokine polymorphisms using the 5′ nuclease TaqMan® assay for allelic discrimination. Associations with AMD were analysed using allelic frequencies. Results: The −251A allele of the IL8 promoter gene polymorphism was more prevalent in AMD patients than controls (p = 0.037, OR = 1.21, 95% CI = 1.01 to 1.44). Adjusting for age, sex, body mass index (BMI), current smoking and past smoking status did not alter the AMD association significantly (corrected p value = 0.043, OR = 1.23, 95% CI = 1.0 to 1.50). Conclusion: The pro-inflammatory homozygous IL8 –251AA genotype is an important risk factor for AMD. This may have implications for future therapy with biological agents that could target this cytokine.

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 …

Use of optomap for retinal screening within an eye casualty setting

Aim: To compare nurse-guided Optomap retinal imaging with examination by an eye casualty officer, in detecting clinically significant peripheral retinal lesions in patients with retinal symptoms. Methods: 219 patients presenting to eye casualty with retinal symptoms (flashing lights and floaters) were recruited. Retinal images were taken with the Optomap imaging system, and graded by an independent masked ophthalmologist. The findings from the Optomap and casualty officer were compared with a gold-standard examination with scleral indentation performed by a retinal specialist. We calculated the sensitivity and specificity of the Optomap and casualty officer. Results: The final analysis included 205 eyes of 187 patients. The sensitivity of the Optomap for detecting retinal detachment (n = 7) was 100% (95% CI 59–100%), the same as the casualty officer. For retinal holes/tears (n = 18) the Optomap sensitivity was 33% (13–59%), compared with 67% (41–87%) for the casualty officer. Combining all retinal lesions (n = 52), the sensitivity was 62% (47–75%) and 73% (59–84%), with specificity 96% (92–99%) and 98% (94–100%) for the Optomap and casualty officer respectively. Conclusion: The Optomap detects retinal detachments successfully but, due to limitations in the optics, is not able to accurately detect retinal holes and tears.

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 …

Can optical coherence tomography predict the outcome of laser photocoagulation for diabetic macular edema

BACKGROUND AND OBJECTIVE To compare the effectiveness of augmented superior oblique Z-tenotomy (SOZT) with fixed standard SOZT in canceling preoperative superior oblique overaction associated with A pattern anisotropia or V pattern in Browns syndrome. PATIENTS AND METHODS Sixteen consecutive patients with superior oblique overaction or Browns syndrome were treated by removal of a triangular piece of the superior oblique tendon near its insertion (augmented SOZT). Outcome was compared with 20 consecutive historical controls after standard SOZT. RESULTS The decrease in superior oblique overaction in the right and left eyes and fundus intorsion and the collapse of A pattern anisotropia were more significant for patients with superior oblique overaction (P = .003, P = .007, P = .05, P = .0015, respectively) and patients with Browns syndrome (P = .025, P = .03, and P = .05, respectively). No study patient with superior oblique overaction and A pattern anisotropia required reoperation compared with 5 of 14 controls (37.5%); rates for patients with Browns syndrome were 0 for the study group and 3 of 6 (50%) for the control group. CONCLUSIONS Augmented SOZT is superior to standard SOZT for correcting superior oblique overaction, intorsion, A or V pattern, and stereopsis. It is not associated with complications or reoperation. The size of the Z-tenotomy can be modified according to the intraoperative assessment to achieve symmetric results.

Retinal pigment epithelial tear following intravitreal bevacizumab for choroidal neovascular membrane due to age-related macular degeneration

Retinal pigment epithelium (RPE) tears are an uncommon but visually damaging complication of pigment epithelial detachment (PED), caused by weak atrophic margins of chronic PED and contraction of sub-RPE fibrovascular scar tissue. RPE tears can occur spontaneously or following treatment of the choroidal neovascular (CNV) membrane. There have been reports of RPE tears following laser photocoagulation,1 transpupillary thermotherapy,2 photodynamic therapy with or without combined intravitreal triamcinolone3,4 and intravitreal Macugen.5 We report a case of a patient with PED with submacular haemorrhage and occult CNV who developed an RPE tear following intravitreal bevacizumab (Avastin). A 74-year-old man presented with a 10-day history of diminished right visual acuity. The corrected visual …

Optometric telemedicine: community-based screening for choroidal neovascularisation.

Effective management of choroidal neovascularisation (CNV) requires timely referral of patients, as irreversible visual loss occurs within the first 3 months of the disease. However, a significant proportion of patients with CNV see a specialist, who is able to administer treatment, more than 6 months after the onset of symptoms.1 Many elderly patients are asymptomatic, particularly when the first eye that is affected is non-dominant. Screening and early intervention may prevent visual loss in these patients, especially with the advent of anti-VEGF therapies. We evaluated the effectiveness of photographic screening in the community for CNV. A total of 628 consecutive patients (1177 eyes) aged 75 and over attending their optometrists were assessed. Stereo colour fundus photographs were obtained and the images transmitted electronically and graded by a retinal specialist …