6-weekly bevacizumab versus 4-weekly ranibizumab for neovascular age-related macular degeneration:a 2-year outcome

AIM： To compare visual acuity and central macular thickness（CMT） changes in neovascular age-related macular degeneration patients treated with either 6weekly bevacizumab regimen or 4 weekly ranibizumab on an as required basis.·METHODS： Patients made an informed choice between bevacizumab 1.25 mg or ranibizumab 0.5 mg. The selected treatment was administered in the first 3 visits.Bevacizumab patients were followed-up 6 weekly and ranibizumab 4 weekly. Retreatment criteria was based on the reduction of 〉5 letters in the best-corrected visual acuity（BCVA）, the presence of retinal fluid on optical coherence tomography（OCT） or new retinal haemorrhage.·RESULTS： Visual acuity at 2y bevacizumab patients gained 7. 0 letters and ranibizumab 9. 2（ P = 0. 31, 95 %CI-6.4 to 2.0）. At 2y 86% of bevacizumab and 94%ranibizumab patients had not lost 15 letters or more（P =0.13）. Mean CMT decreased at 2y bevacizumab by 146 μm,ranibizumab 160 μm（P =0.72）. Mean number of injections was at 2y bevacizumzb 11.9, ranibizumab 10.3（P =0.023）.· CONCLUSION： Bevacizumab 6 weekly on an as required basis was not demonstrably non-inferior to ranibizumab 4 weekly pro re nata（prn） in terms of BCVA and change in CMT. In the bevacizumab group, one more injection was required in the second year compared to the ranibizumab group.

Ophthalmic profile and systemic features of pediatric facial nerve palsy

Background: Facial nerve palsy(FNP) occurs less frequently in children as compared to adults but most cases are secondary to an identii able cause. These children may have a variety of ocular and systemic features associated with the palsy and need detailed ophthalmic and systemic evaluation.Methods: This was a retrospective chart review of all the cases of FNP below the age of 16 years, presenting to a tertiary ophthalmic hospital over the period of 9 years, from January 2000 to December 2008.Results: A total of 22 patients were included in the study. The average age at presentation was 6.08 years(range, 4 months to 16 years). Only one patient(4.54%) had bilateral FNP and 21 cases(95.45%) had unilateral FNP. Seventeen patients(77.27%) had congenital palsy and of these, five patients had a syndromic association, three had birth trauma and nine patients had idiopathic palsy. Five patients(22.72%) had an acquired palsy, of these, two had a traumatic cause and one patient each had neoplastic origin of the palsy, iatrogenic palsy after surgery for hemangioma and idiopathic palsy. Three patients had ipsilateral sixth nerve palsy, two children were diagnosed to have Moebius syndrome, one child had an ipsilateral Duane's syndrome with ipsilateral hearing loss. Corneal involvement was seen in eight patients(36.36%). Amblyopia was seen in ten patients(45.45%). Neuroimaging studies showed evidence of trauma, posterior fossa cysts, pontine gliosis and neoplasms such as a chloroma. Systemic associations included hemifacial macrosomia, oculovertebral malformations, Dandy Walker syndrome, Moebius syndrome and cerebral palsy.Conclusions: FNP in children can have a number of underlying causes, some of which may be life threatening. It can also result in serious ocular complications including corneal perforation and severe amblyopia. These children require a multifaceted approach to their care.

联合光动力治疗及玻璃体内注射曲安奈得治疗1例13岁女性患儿近视性脉络膜新生血管

Background:Combination photodynamic therapy with verteporfin(PDT)and intravitreal triamcinolone acetonide(IVT)is currently being investigated as a treatment for choroidal neovascularization(CNV)due to age-related macular degeneration.However,PDT with triamcinolone has never previously been described in the treatment of CNV secondary to pathologic myopia,or in a young person.We describe the case of a young girl treated with combination PDT and IVT for a myopic subfoveal CNV membrane.Methods:This study was an interventional case report.The medical chart of a 13-year-old child treated with combination PDT with IVT was reviewed for changes in visual acuity on the ETDRS chart,CNV leakage on fluorescein angiography,and adverse events reported.Results:ETDRS visual acuity improved from 20/80-2 to 20/25 in the right eye over 7 months following two treatments of a myopic CNV lesion with combination PDT and IVT.Following treatment,an inactive scar with no further leakage was visible on fluorescein angiography.An increase in intraocular pressure was associated with the second IVT treatment,and successfully treated with topical therapy.Conclusions:Combination PDT with IVT may be considered under appropriate circumstances to treat children with CNV.

中等程度的眼内压改变对青光眼患者的共焦扫描激光断层摄影地形图测量结果的影响

Objective:To evaluate optic disc topography changes after intraocular pressure(IOP)modulation in patients with glaucoma.Methods:Twenty-three patients with glaucoma were studied.Three mean optic disc topography images were obtained with the Heidelberg Retina Tomograph II at baseline and weeks 1,2,4,and 8(visits 1,2,3,4,and 5,respectively).Topical medications were discontinued in the study eye after visit 1 and resumed after visit 4 but maintained in the contralateral control eye.Central corneal thickness was measured at the last visit.Topographic changes were determined by stereometric parameters(rim area and mean cup depth)and at discrete topographic locations using the Topographic Change Analysis program(from the Heidelberg Retina Tomograph II).Results:In the study eyes,IOP increased significantly(5.4 mm Hg at visit 4;P<.001)after withdrawal of topical medications but returned to baseline levels after resuming medications;no statistically significant topographic changes,however,were observed.Moreover,no relationship between change in IOP and stereometric parameters was observed.Central corneal thickness was not associated with changes in optic disc topography induced by IOP modulation.Conclusion:In patients with glaucoma,significant but relatively moderate IOP increases and decreases on the order of 5 mm Hg did not appear to have an effect on optic disc topography.