Mandeep Singh Dhalla

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.

Intravitreal injection of bevacizumab combined with verteporfin photodynamic therapy for choroidal neovascularization in age-related macular degeneration.

Purpose: To report the outcome for eyes treated with intravitreal injection of bevacizumab combined with verteporfin photodynamic therapy (PDT) for choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Study Design and Participants: Interventional, consecutive, retrospective case series including 40 eyes of 40 patients with newly diagnosed juxtafoveal or subfoveal CNV secondary to AMD. Methods: The charts of patients treated with a 1.25-mg intravitreal injection of bevacizumab followed by PDT within a 2-week period were reviewed. Main outcome measures were visual acuity stabilization (defined as no change or a gain in visual acuity) and need for retreatment. Results: Thirty-three (83%) of 40 eyes had stabilization of visual acuity. Mean improvement in visual acuity was 1.73 lines. Twenty-six eyes (65%) required only a single intravitreal injection of bevacizumab combined with PDT. Of the 23 eyes with 12 months of follow-up, 17 (74%) had stabilization of visual acuity, while 9 (40%) had improvement in visual acuity (mean, 1.22 Snellen lines). Eleven eyes (48%) required only a single combined treatment for CNV resolution at the 12-month follow-up. Fifteen (88%) of 17 eyes with only 6 months of follow-up required only a single combined treatment. There were no complications such as endophthalmitis, uveitis, or ocular hypertension. Conclusion: These findings suggest that eyes treated with both intravitreal injection of bevacizumab and PDT require none to a minimal number of re-treatments to have stabilization of vision, even at 12 months of follow-up. Further investigation with large controlled trials is warranted to outline the appropriate treatment paradigm for combination therapy.

Pigmentary maculopathy in a patient with Wolfram syndrome

CASE REPORT We describe a rare association of pigmentary maculopathy with Wolfram syndrome not previously reported in the literature. A 12-year-old boy presented to the retina service with a diagnosis of Wolfram syndrome and a history of poor central vision. The patient was found to have bilateral atrophic pigmentary maculopathy that was confirmed with fluorescein angiography. COMMENTS Wolfram syndrome may present with a pigmentary maculopathy and this rare finding may assist the clinician in making appropriate genetic referral when this diagnosis is suspected.

Macular photostress testing: sensitivity and recovery with an automated perimeter.

Purpose: To describe a novel method for the evaluation of macular function with photostress testing and outline normative foveal threshold and recovery data for the adult population. Methods: In this prospective study, 50 adult subjects (25 men and 25 women aged 30–49 years) with no ocular disease underwent foveal threshold testing using the Humphrey Visual Field Perimeter Model 750. Baseline values and recovery time after photostress were measured. Baseline measurements were compared with threshold sensitivity after photostress at 1, 2, 4, 6, and 10 minutes. Results: Mean foveal sensitivities were reduced from 38.53 db to 32.36 db after photostress, representing an average sensitivity reduction of 16%. The mean recovery time to baseline sensitivity was 6.58 minutes. There was no significant difference between sexes, races, or smokers and nonsmokers. Conclusions: This standardized protocol for testing the foveal threshold response to photostress is an inexpensive and noninvasive adjunct for following macular disease and also distinguishing optic neuropathy from macular disease.

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. A 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 …

Does Postoperative Near Visual Acuity Predict Macular Hole Closure

To determine whether prone postoperative near visual acuity following macular hole surgery can be used as a reliable indicator of successful hole closure, data from 21 patients undergoing macular hole surgery were collected. Seventeen of the 18 patients with hole closure and all 3 patients with persistent macular holes had a Rosenbaum acuity better than preoperative visual acuity, yielding 94% sensitivity, 0% specificity, 85% positive predictive value, and 0% negative predictive value. Fourteen of the 18 patients with macular hole closure and all 3 patients with persistent macular holes had a Rosenbaum acuity better than 20/40, yielding 78% sensitivity, 0% specificity, 82% positive predictive value, and 0% negative predictive value. Although postoperative near visual acuity can predict macular hole closure with 94% sensitivity, the test is not clinically useful to predict hole closure because of the high surgical success rate of macular hole surgery. The test could be useful in encouraging patients to maintain head prone positioning and alleviate patient anxiety.