William G. Campbell

Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series

Purpose:  Bevacizumab (Avastin) is a monoclonal antibody which targets all isoforms of vascular endothelial growth factor A. Its potent anti‐angiogenic effects have been shown to cause regression of neovascularization in proliferative diabetic retinopathy. The aim of this study is to investigate the role of Avastin as an adjunct to vitrectomy in the management of severe diabetic eye disease.

Needle drainage of subretinal fluid. A randomized clinical trial.

Abstract: Needle drainage of subretinal fluid with simultaneous observation using the indirect ophthalmoscope has been reported to have a very low complication rate. The technique was evaluated by a prospective clinical trial. The study group consisted of 100 patients undergoing scleral buckling for rhegmatogenous retinal detachment who were randomly assigned to groups treated with needle drainage or conventional two-stage drainage. At 1 month, the retina was anatomically flat in 88% of all cases. Subretinal hemorrhage occurred in 10 of 45 patients (22.2%) after needle drainage and in 7 of 55 patients (12.7%) after conventional drainage. The difference was not statistically significant. Retinal puncture occurred during conventional drainage in one case and in no cases during needle drainage. There were no cases of retinal incarceration. The results showed that subretinal hemorrhage was more common after needle drainage, but a larger study would be required to show whether this difference was statistically significant. The fear that the retina would be damaged by placement of a needle in the subretinal space throughout the drainage procedure was unfounded.

Endogenous endophthalmitis associated with intravenous drug abuse: seven-year experience at a tertiary referral center

Purpose: Intravenous drug use (IVDU) is a known risk factor for endogenous endophthalmitis. Endogenous fungal endophthalmitis (EFE) is emerging as a common problem among this community. We describe the management and visual outcomes of acute IVDU-associated EFE. Methods: A prospective consecutive case series of 19 patients presenting with presumed acute IVDU-associated EFE from 2001 to 2007 to the Royal Victorian Eye and Ear Hospital was included. All data were collected in a standardized manner. Outcome measures included visual acuity, microbial profiles, and vitrectomy rate. Results: Nineteen cases of IVDU-associated EFE were identified. Eight of these (42%) were men, and the mean age was 32.7 years (SD ± 8.0 years). Presenting visual acuity ranged from 6/6 to perception of light, with 58% having a visual acuity of 6/48 or less at presentation. Thirteen (68.4%) were culture positive with all cultures identifying Candida species, and 52.7% underwent vitrectomy. Fifty percent of subjects overall achieved a final visual acuity of 6/18 or better. Men demonstrated improved visual acuity when compared with women (P = 0.04). Age had no effect on final acuity. Conclusion: Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.

Wound‐related complications and clinical outcomes following open globe injury repair

Background Careful surgical management of traumatic wounds is important in open globe injury repair. This study examines the clinical outcomes following repair of open globe injuries with particular focus on wound-related issues. Design Retrospective, cohort study of consecutive open globe injuries presenting to a tertiary referral eye hospital from 1 January 2009 to 31 December 2011. Participants A total of 267 eyes of 263 patients, mainly male (82.5%) with a mean age of 44.8 (range: 4–97) years. Average follow up was 6.9 months. Methods All cases classified according to Ocular Trauma Classification Group. Main Outcome Measures Visual outcomes, risk factors for and rates of postoperative complications and endophthalmitis. Results There were 83 globe ruptures, 182 penetrating and 2 perforating eye injuries, of which 43 cases had intraocular foreign body. Factors contributing to final visual acuity (VA) <6/60 were poor presenting VA (odds ratio [OR] = 16.0, 95% confidence interval [CI]: 4.81–53.1), globe rupture (OR = 4.64, [1.99–10.8]), retinal detachment (OR = 3.40, [1.19–9.74]) and age ≥50 (OR = 2.45, [1.05–5.74]). Wound leak occurred in 44 eyes (16%). Of these, 18 (41%) proceeded to re-suturing. Factors contributing to wound leak were stellate-shaped wound (OR = 3.28, [1.39–7.73]) and delayed presentation (OR = 2.80, [1.02–7.71]). Ten eyes (3.7%) developed endophthalmitis. Factors associated with endophthalmitis were delayed presentation (OR = 8.91, [1.71–46.6]), microbial keratitis (OR = 12.5, [1.85–85.0]) and lens capsule breach (OR = 12.4, [1.85–83.1]). Conclusions Wound leak is an important postoperative complication of open globe injury repair. Delayed presentation is an important risk factor for postoperative wound leak and endophthalmitis. Prompt and meticulous wound management of open globe injury may reduce these complications.Careful surgical management of traumatic wounds is important in open globe injury repair. This study examines the clinical outcomes following repair of open globe injuries with particular focus on wound‐related issues.

Treatment of amelanotic choroidal melanoma with photodynamic therapy.

Purpose: To evaluate the effect of photodynamic therapy on amelanotic choroidal melanoma. Methods: Nine patients with posteriorly located amelanotic choroidal melanomas, one with a pigmented portion, underwent photodynamic therapy using verteporfin as the photosensitizing agent. The basal diameters ranged from 4 mm to 16 mm and the heights from 1.3 mm to 5.7 mm. Treatment was repeated until the melanoma was completely flat or its height had reached a stable end point. Tumor response was assessed by clinical examination, photography, and ultrasonography. Annual screening for hepatic metastases was performed. Results: Eight tumors demonstrated apparent complete regression over 1 month to 14 months. The amelanotic portion of the mixed tumor flattened, whereas the height of the pigmented part remained stable at 2 mm. In 8 patients there has been no recurrence during follow-up of between 34 months and 81 months. One case developed 2 separate local recurrences at 21 months and 34 months. There were no serious complications, no patient lost vision after treatment, and none developed metastatic disease. Conclusion: In this series photodynamic therapy was highly effective in causing regression of posteriorly located amelanotic choroidal melanomas, without a detrimental effect on vision. While the short-term results are encouraging, there is some uncertainty regarding complete tumor destruction and long-term efficacy.

A novel technique for high-density silicone oil removal.

A Novel Technique for High-Density Silicone Oil Removal The use of high-density silicone oil such as Densiron 68 (Fluoron GmbH, Neu-Ulm, Germany) has transformed the surgical management of inferior retinal pathology. Removal of this agent is, however, more difficult and time consuming than removal of conventional 1,000-centistoke silicone oil. A commonly used technique involves aspiration with a long 18-gauge cannula attached to a viscous fluid syringe pump, but this carries the potential risk of intraocular damage if the eye suddenly collapses because of failure to reduce the vacuum at the final stage of oil removal. Stappler et al identified that it was possible to remove Densiron using finer (20 gauge), shorter (7.5 mm) cannulae inserted into the superior portion of the oil globule, taking advantage of its cohesive properties and using the “tubeless siphon” effect. Romano et al reported successful removal of high-density oil using a 7-mm 23 gauge cannula and stated that approximately similar extraction times were recorded for both 20-gauge and 23-gauge cannulae. Injecting perfluorocarbon liquid to displace the oil through a 20-gauge sclerotomy is another recently described technique that avoids the need for a syringe pump altogether. We present a novel technique using a 23-gauge trocar cannula for the removal of high-density silicone oil that does not require perfluorocarbon liquid and is effective, as well as significantly faster than other described methods.

Bilateral ipilimumab-induced posterior uveitis following treatment for metastatic choroidal melanoma: Letter to the Editor

Ipilimumab is a CTLA-4 monoclonal antibody that amplifies T-cell activation and response to melanoma. It is approved to treat unresectable or metastatic melanoma. Immune-related adverse events are common (up to 90% of patients), and include colitis, hypophysitis, hypothyroidism, hepatitis and dermatitis.1 1.3% of patients suffer from ocular side effects, such as scleritis, anterior uveitis and Graves-type ophthalmopathy.2.