Shorya Vardhan Azad

Intravitreal Bevacizumab for Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration in an Indian Population

PurposeTo investigate the 6-month safety profile and clinical outcomes of intravitreal bevacizumab for treating subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD).MethodsWe performed a prospective nonrandomized interventional study of 40 consecutive patients (40 eyes) with subfoveal CNV due to AMD. Patients underwent standard ophthalmic examination, optical coherence tomography, and fundus fluorescein angiography. All patients were administered one or more intravitreal injections of bevacizumab (1.25 mg) as primary therapy. Outcomes were also analyzed in subgroups based on lesion type (classic or occult) and lesion size (≤3000 μm or >3000 μm).ResultsAt the 6 months’ follow-up, mean best-corrected visual acuity (BCVA) improved from 20/160 to 20/100 (P = 0.014), and the mean contrast sensitivity improved from 0.38 to 0.62 (P = 0.001). The mean greatest linear diameter and mean central macular thickness significantly decreased from 3.79 mm to 2.4 mm (P = 0.0001) and from 438.5 μm to 363 μm (P = 0.0001), respectively. Visual acuity gain of 15 letters or more was seen in 20% of patients, and the gain was more in the small-lesion subgroup (31.5%) than in the large-lesion subgroup (9.5%). No significant adverse effects were observed.ConclusionIntravitreal bevacizumab is a safe and effective modality for treatment of CNV secondary to AMD. A significant improvement in BCVA with intravitreal bevacizumab was observed for all lesion types.

Optical Coherence Tomography Angiography of Shallow Irregular Pigment Epithelial Detachments in Pachychoroid Spectrum Disease

family history of glaucoma and the association of axial length with intraocular pressure. Unfortunately, our study has a retrospective design and, as such, lacks specific information on the subjects’ parents. Furthermore, we enrolled only normal children without glaucoma, and so information on family history of glaucoma was not available in most cases. We did not routinely check ocular parameters such as axial length; therefore, comparing axial length with intraocular pressure was not possible. Further prospective study would be required to meet their suggestions. In closing, we agree with the opinion regarding the importance of public education on pediatric glaucoma. We hope that further prospective research on tonometers for children will facilitate detection of undiagnosed childhood glaucoma.

Genetic determinants of uveal melanoma

Melanoma of the uveal tract is the most common primary intraocular tumor in adults. With advances in genetic research and the open source access of genetic databases, new insights are emerging into the molecular changes of this cancer. As with most other tumors, the driving force behind such research is the hope of finding and developing new modalities for therapeutic purposes, prognosticating disease and understanding risk factors for metastasis. With advances in proteomics, cytogenetics and gene profiling, the stage is set to unearth the underlying genetic basis which can in the future be a target of therapeutic modalities. This article describes the cytogenetic, molecular pathogenesis, and prognostic factors along with the most important findings and their attribution to current and future management of uveal melanoma.

Comparative evaluation between ranibizumab combined with laser and bevacizumab combined with laser versus laser alone for macular oedema secondary to branch retinal vein occlusion

Purpose: To evaluate the anatomical and functional efficacy of combination therapy of intravitreal ranibizumab with laser or intravitreal bevacizumab with laser treatment compared to only laser treatment for macular edema due to branch retinal vein occlusion (BRVO). Materials and Methods: Thirty eyes of 30 patients with BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received a single dose of intravitreal Ranibizumab followed by grid laser treatment, Group 2 received a single dose of intravitreal Bevacizumab followed by grid laser treatment, and Group 3 received grid laser alone. Outcomes at 6 months follow-up were reported. Data were collected on best corrected visual acuity (BCVA), central foveal thickness (CFT), and gain in lines of Snellen acuity. Results: At 6 month follow-up, the difference in the mean BCVA and CFT between the three treatment groups was not statistically significant (P > 0.05, all comparisons). Six eyes (60%) in Group 1, four eyes (40%) in Group 2 and two eyes (20%) in Group 3 had a statistically significant gain of ≥3 lines of Snellen acuity (P < 0.05). Conclusion: Both ranibizumab and bevacizumab combined with laser photocoagulation, resulted in better outcomes than grid laser treatment.

Blood flow pattern in a choroidal hemangioma imaged on swept-source-optical coherence tomography angiography

This report demonstrates the blood flow pattern in a case of choroidal hemangioma (CH) using swept-source-optical coherence tomography angiography (SS-OCTA). Fluorescein angiography, SS-OCT, and SS-OCTA images of a patient with CH were obtained using a standard protocol. The internal vascular pattern of the tumor was identified on both OCT and OCTA. Dark areas were identified in the CH. These were interspersed between areas of visible blood flow, as imaged on SS-OCTA. Peripheral vascular arcades were also identified within the tumor. SS-OCTA should be evaluated as an imaging tool to study the blood flow within choroidal tumors.

Optical Coherence Tomography and Multifocal Electroretinography in Diabetic Macular Edema: A Neurovascular Relation With Vision.

BACKGROUND AND OBJECTIVES To evaluate retinal neuropathy in patients with diabetic macular edema (DME) with multifocal electroretinograph (mfERG), and to evaluate the simultaneous impact of retinal neuropathy and vasculopathy on visual acuity in subtypes of DME. PATIENTS AND METHODS This prospective, controlled, investigative study conducted at a tertiary eye care center of Northern India included 79 eyes of 50 treatment-naïve patients with DME (Group 1), 94 eyes of 50 diabetic patients without diabetic retinopathy (Group 2), and 100 eyes of 100 normal volunteers as controls. Comprehensive ocular evaluation along with mfERG and optical coherence tomography (OCT) were performed for all patients. N1 and P1 mfERG waveforms in the two central-most rings of macula were evaluated for amplitudes and implicit time. OCT was used to sub-classify types of DME and evaluate macular thickness, ellipsoid zone (EZ), and external limiting membrane (ELM) disruption. Best-corrected visual acuity (BCVA) relative to other variables was the primary outcome measure. The three groups were compared for all the parameters inclusive of OCT and mfERG patterns. Further, OCT subtypes of DME were analyzed for mfERG waveform patterns. RESULTS All mfERG values were significantly lower in Group 1 and Group 2 as compared to Group 3 (P < .05). BCVA strongly correlated with central macular thickness, EZ, and ELM disruption scores in Group 1 (P = .001), but correlated modestly with mfERG waveform amplitudes in Group 1 patients with intact EZ and ELM only. BCVA correlated with mfERG amplitudes in patients with neurosensory detachment, but not in those with cystoid macular edema. CONCLUSIONS Neural changes set in before the clinical changes related to vasculopathy manifest in diabetic patients. Neuroretinopathy in patients with DME affects all retinal layers symmetrically in early stages, but impacts the middle retinal layers severely in advanced disease form. BCVA correlates with electrophysiological changes till the time morphological features are visible when stronger correlation is seen with anatomical disruption. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:626-631.].

Endoillumination (chandelier) assisted scleral buckling for a complex case of retinal detachment

Endoilluminator-assisted scleral buckling combines the advantages of scleral buckling for its external approach and pars plana vitrectomy for its better visual visualization in the management of retinal detachment (RD). It has recently been proven to be safe and efficacious in simple cases. This report discusses successful management of a complex case of RD in a patient with the single functioning eye, where vitrectomy was expected to have a complicated course.

Iatrogenic parafoveal macular hole following Nd-YAG posterior hyaloidotomy for premacular haemorrhage

Premacular sub-internal limiting membrane (sub-ILM) haemorrhage is a known cause of sudden profound loss of vision. Neodymium-doped yttrium aluminium garnet (ND-YAG) posterior hyaloidotomy is an inexpensive, effective and safe treatment modality for rapid drainage of haemorrhage covering the macula. An 18-year-old male patient presented to us with a history of Nd-YAG posterior hyaloidotomy for Valsalva-related premacular bleed. At the posterior pole, a cavity formed by the detached ILM with a central defect in ILM-posterior hyaloid complex was evident. High-definition optical coherence tomography (HD-OCT) showed normal foveal contour with a parafoveal macular hole. Hence, good clinical judgement, appropriate positioning of hyaloidotomy and use of lowest possible energy level is the key to a successful and safe laser drainage of a premacular haemorrhage.

Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease

IN THEIR STUDY ENTITLED ‘‘OUTCOMESOF 27 GAUGEMICROincision Vitrectomy Surgery for Posterior Segment Disease,’’ Khan and associates present their initial experience with the 27 G microincision vitrectomy system (MIVS) in 95 eyes. The study is extremely valuable, as it includes the largest sample of patients operated with 27 G MIVS to date. The current study evaluated intraocular pressure (IOP) and reports an initial fall in IOP over the first week, after which IOP started increasing again by day 30, although minimally. This result was nearly statistically significant (P 1⁄4 .05) in the straight incision group and consistent with both types of incisions. A recently published study of patients operated with 20 G, 23 G, and 25 G vitrectomy systems found mean IOP to decrease from the baseline over a period of 3 months, followed by a steady increase toward baseline value until a follow-up of 2 years. Hence, it appears that IOP increases at a faster rate toward baseline value with a smaller gauge of MIVS. The 0.4 mm sclerotomy of the 27 G system is expected to become watertight quickly vis-à-vis the conventional vitrectomy systems. However, the overall mean IOP in the current study remained low at 3 months. The ambiguity between day 30 and day 90 results can be resolved by evaluating IOP at day 90 in both the incision groups separately, as has been done for other follow-up visits. Movement of viscous fluid through smaller-gauge cannulas is slow, and 25 GMIVS has previously been evaluated for removal of silicone oil in this regard too. It is heartening to note that converting to hybrid vitrectomy was not needed for such cases in this series. However, 3 silicone oil–filled eyes eventually needed sutures for closing a single sclerotomy site at the end of the surgery. The authors interpret this finding in terms of the type of 27 G scleral incision used. As only 1 sclerotomy needed sutures for adequate wound closure in these 3 cases, the need for suture-assisted wound closure is more likely to be linked to the excessive sclerotomy site manipulation involved owing to the complexity of the cases, as evidenced by the need for injecting silicone oil. Nearly half of the silicone oil–filled eyes needed wound suturing. During vitrectomy, it is second nature for the surgeon to hinge the eye with the cutter or the illuminator at the sclerotomy site and rotate it for adequate visualization of peripheral retinal

Vascular endothelial growth factor (VEGF-634G/C) polymorphism and retinopathy of prematurity: a meta-analysis

PURPOSE Vascular endothelial growth factor polymorphism (VEGF-634G/C, rs 2010963) has been considered a risk factor for the development of retinopathy of prematurity (ROP). However, the results remain controversial. Therefore, the aim of the present meta-analysis was to determine the association between VEGF-634G/C polymorphism and ROP risk. METHODS Published literature from PubMed and other databases were retrieved. All studies evaluating the association between VEGF-634G/C polymorphism and ROP risk were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random or fixed effects model. A total of six case-control studies including 355 cases and 471 controls were included. RESULTS By pooling all the studies, we found that VEGF-634G/C polymorphism was not associated with ROP risk at co-dominant and allele levels and no association was also found in dominant and recessive models. While stratifying on ethnicity level no association was observed in Caucasian and Asian population. DISCUSSION This meta-analysis suggests that VEGF-634G/C polymorphism may not be associated with ROP risk, the association between single VEGF-634G/C polymorphism and ROP risk awaits further investigation.