1: Retina. 2010 Jul 24; [Epub ahead of print] 

COMPARISON OF CLINICAL OUTCOMES BETWEEN 23-GAUGE AND 20-GAUGE VITRECTOMY IN
PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY.

Park DH, Shin JP, Kim SY.

From the Department of Ophthalmology, School of Medicine, Kyungpook National
University, Daegu, Korea.

PURPOSE:: The purpose of this study was to compare the clinical outcomes and
complications between 23-gauge transconjunctival sutureless vitrectomy and
20-gauge vitrectomy in patients with proliferative diabetic retinopathy.
METHODS:: This is a retrospective comparative study comprising 101 eyes from 90
consecutive patients who had diabetic vitrectomy due to nonclearing vitreous
hemorrhage. Thirty-five eyes underwent 23-gauge transconjunctival sutureless
vitrectomy, and 66 eyes underwent 20-gauge vitrectomy. Main outcome measures
were best-corrected visual acuity, intraocular pressure, and incidence of
intraoperative and postoperative complications with at least six months of
follow-up. RESULTS:: Best-corrected visual acuity of both groups at
postoperative months 1, 3, and 6 significantly improved from the preoperative
best-corrected visual acuity (P < 0.0001, respectively). There was no difference
for best-corrected visual acuity between the two groups at each follow-up period
(P > 0.05, respectively). Intraocular pressure of the 23-gauge group at
postoperative Day 1 and Week 1 was less than the preoperative intraocular
pressure (P < 0.0001 and 0.017). Operating time of the 23-gauge group was
shorter than the 20-gauge group (P < 0.0001). There was no difference in the
incidence of intraoperative and postoperative complications except transient
postoperative hypotony, which occurred in 8 eyes (22.9%) from the 23-gauge group
(P < 0.0001). CONCLUSION:: Twenty three-gauge transconjunctival sutureless
vitrectomy appears to be as effective for proliferative diabetic retinopathy as
20-gauge vitrectomy.

PMID: 20661174  [PubMed - as supplied by publisher]

2: Retina. 2010 Jul 24; [Epub ahead of print] 

FUNDUS AUTOFLUORESCENCE AND OPTICAL COHERENCE TOMOGRAPHIC FINDINGS IN ACUTE
ZONAL OCCULT OUTER RETINOPATHY.

Fujiwara T, Imamura Y, Giovinazzo VJ, Spaide RF.

From the *LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear & Throat
Hospital, New York, New York; and daggerVitreous-Retina-Macula Consultants of
New York, New York.

PURPOSE:: The purpose of this study was to investigate the fundus
autofluorescence and optical coherence tomography findings in eyes with acute
zonal occult outer retinopathy (AZOOR). METHODS:: A retrospective observational
case series of the fundus autofluorescence and spectral domain optical coherence
tomography in a series of patients with AZOOR. RESULTS:: There were 19 eyes of
11 patients (10 women), who had a mean age of 49.1 +/- 13.9 years. Fundus
autofluorescence abnormalities were seen in 17 of the 19 eyes, were more common
in the peripapillary area, and were smaller in extent than the optical coherence
tomography abnormalities. Nine eyes showed progression of hypoautofluorescence
area during the mean follow-up of 69.7 months. The mean thickness of the
photoreceptor layer at fovea was 177 mum in eyes with AZOOR, which was
significantly thinner than controls (193 mum, P = 0.049). Abnormal retinal
laminations were found in 12 eyes and were located over areas of loss of the
photoreceptors. The subfoveal choroidal thickness was 243 mum, which is normal.
CONCLUSION:: Fundus autofluorescence abnormalities in AZOOR showed distinct
patterns of retinal pigment epithelial involvement, which may be progressive.
Thinning of photoreceptor cell layer with loss of the outer segments and
abnormal inner retinal lamination in the context of a normal choroid are
commonly found in AZOOR.

PMID: 20661173  [PubMed - as supplied by publisher]

3: Retina. 2010 Jul 24; [Epub ahead of print] 

A New Approach for Active Removal of 5,000 Centistokes Silicone Oil Through
23-Gauge Cannula.

Song ZM, Chen D, Ke ZS, Wang RH, Wang QM, Lu F, Qu J.

From the Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China.

PMID: 20661172  [PubMed - as supplied by publisher]

4: Retina. 2010 Jul 24; [Epub ahead of print] 

Correspondence.

Chhablani JK, Narayanan R.

L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Andhra Pradesh,
India.

PMID: 20661171  [PubMed - as supplied by publisher]

5: Retina. 2010 Jul 24; [Epub ahead of print] 

Correspondence.

Lim SJ, Roh MI, Kwon OW.

*Retina Department, Nune Eye Hospital Seoul, Korea daggerYonsei University
Medical Center Seoul, Korea.

PMID: 20661170  [PubMed - as supplied by publisher]

6: Retina. 2010 Jul 15; [Epub ahead of print] 

RETINAL TOXICITY OF INTRAVITREAL GENISTEIN IN A RABBIT MODEL.

Fiore T, Iaccheri B, Pietrolucci F, Giansanti F, Cavaliere A, Coltella R, Mameli
MG, Androudi S, Brazitikos P, Cagini C.

From the *Department of Ophthalmology, Eye Clinic, University of Perugia,
Perugia, Italy; the daggerDepartment of Ophthalmology, University of Florence,
Florence, Italy; the double daggerDepartment of Pathology and Histology,
University of Perugia, Perugia, Italy; and the section signDepartment of
Ophthalmology, Aristotle University, Thessaloniki, Greece.

PURPOSE:: The purpose of this study was to evaluate the preclinical safety of
intravitreal genistein in rabbit eyes over a short-term period. METHODS:: Twelve
New Zealand albino rabbits were selected for this study. Four concentrations of
genistein (LC Laboratories, Woburn, MA) were prepared: 24 mg/0.1 mL, 135 mg/0.1
mL, 270 mg/0.1 mL, and 540 mg/0.1 mL. Each concentration was injected
intravitreally in one eye of three rabbits. As a control, the vehicle solution
was injected into the other eye of each animal. Retinal safety of intravitreal
genistein was studied with electroretinography and histologic examination in
rabbits. Electroretinography recordings were made before the injection and 3
weeks after the injection. Eventually, the rabbits were euthanatized and the
retinas were examined by light microscopy. Immunohistochemical staining with
caspase-3 and caspase-9 was also performed to evaluate apoptotic expression in
all study and control eyes. RESULTS:: Electroretinography studies showed no
significant difference between control and genistein-injected eyes at any of the
doses in the rabbit model. Histologic examination showed no retinal abnormality
in the rabbits injected with different concentrations of genistein.
Immunohistochemical staining with caspase-3 and caspase-9 showed no different
apoptotic protein expression in any study or control eyes. CONCLUSION:: Our
results indicate that genistein is a safe intravitreal drug in the rabbit model
up to 540 mg. If proven safe and efficacious in human studies, intravitreal
injection of genistein could be considered a treatment alternative for ocular
neovascularisation in selected cases.

PMID: 20634778  [PubMed - as supplied by publisher]

7: Retina. 2010 Jul 15; [Epub ahead of print] 

ROLE OF INTRAVITREAL BEVACIZUMAB (AVASTIN) INJECTED AT THE END OF DIABETIC
VITRECTOMY IN PREVENTING POSTOPERATIVE RECURRENT VITREOUS HEMORRHAGE.

Cheema RA, Mushtaq J, Al-Khars W, Al-Askar E, Cheema MA.

From the *Division of Vitreoretinal Surgery, Dhahran Eye Specialist Hospital,
Dhahran, Saudi Arabia; and the daggerCardiff University School of Medicine,
Cardiff, United Kingdom.

PURPOSE:: The purpose of this study was to evaluate the role of bevacizumab
(Avastin), an antivascular endothelial growth factor agent, injected at the end
of surgery for preventing postoperative recurrent vitreous hemorrhage in
patients undergoing vitrectomy for diabetic eye disease. METHODS:: This was a
retrospective, comparative, and nonrandomized study on a consecutive series of
patients who underwent vitrectomy for diabetic eye disease. Recurrence of
postoperative vitreous hemorrhage was compared in patients with and without
intravitreal 1.25 mg bevacizumab given at the end of surgery. RESULTS:: During
the study period, 58 patients had vitrectomy for diabetic disease. In 33
patients (the control group), no intravitreal bevacizumab was injected at the
end of surgery, and in 25 patients (the intervention group) intravitreal
bevacizumab 1.25 mg/0.05 mL was injected at the end of surgery. Both groups were
matched for the number of patients, age, sex, diagnosis, and status of systemic
disease. Recurrent postoperative vitreous hemorrhage was noted in 14 patients in
the control group (14 of 33, 42.40%) and in 1 patient in the intervention group
(1 of 25, 4.0%). The difference in postoperative vitreous hemorrhage between the
2 groups was statistically significant (P = 0.001). There was no statistical
difference in the mean postoperative visual acuity between the 2 groups during
the follow-up period (P = 0.410). CONCLUSION:: Intravitreal injection of 1.25 mg
bevacizumab given at the end of vitrectomy appears safe and effective for
reducing the incidence of recurrent postoperative vitreous hemorrhage after
diabetic vitrectomy. Further randomized studies should be performed to evaluate
the potential of this therapy in preventing postoperative recurrent vitreous
hemorrhage after diabetic vitrectomy.

PMID: 20634777  [PubMed - as supplied by publisher]

8: Retina. 2010 Jul-Aug;30(7):1152-4. 

Gaze-evoked vitreous hemorrhage in choroidal melanoma.

Jacobs DJ, Murray TG, Cubillas AV.

Bascom Palmer Eye Institute, Miami, Florida 33136, USA. jacobs.retina@gmail.com

PMID: 20632468  [PubMed - in process]

9: Retina. 2010 Jul-Aug;30(7):1160; author reply 1160. 

Correspondence.

Rajpal S, Narula R, Agarwal M, Chaudhary SP.

Publication Types:
    Comment
    Letter

PMID: 20616693  [PubMed - in process]

10: Retina. 2010 Jul-Aug;30(7):1159. 

Gaze-evoked vitreous hemorrhage in choroidal melanoma.

Jacobs DJ, Murray TG, Cubillas AV.

Bascom Palmer Eye Institute, Miami, Florida 33136, USA. jacobs.retina@gmail.com

PMID: 20616691  [PubMed - in process]

11: Retina. 2010 Jul-Aug;30(7):1155-8. 

Diagnostic and therapeutic challenges.

Roe RH, Boyer DS, Spirn MJ, Bakri SJ.

Retina-Vitreous Associates, Los Angeles, California, USA.

PMID: 20616690  [PubMed - in process]

12: Retina. 2010 Jul-Aug;30(7):1135-43. 

Superficial retinal precipitates in patients with syphilitic retinitis.

Fu EX, Geraets RL, Dodds EM, Echandi LV, Colombero D, McDonald HR, Jumper JM,
Cunningham ET Jr.

San Francisco Retina Foundation, San Francisco, California, USA.

PURPOSE: The purpose of this study was to describe the occurrence of superficial
retinal precipitates in patients with syphilitic retinitis. METHODS: This was a
retrospective, observational case series of nine eyes of eight patients with
syphilitic retinitis associated with superficial retinal precipitates. The
clinical, photographic, angiographic, and laboratory records were reviewed.
Characteristics and treatment response of these superficial retinal precipitates
were observed. RESULTS: All patients were Caucasian men, including 5 men who
have sex with men (62.5%) and 6 (75.0%) who were positive for human
immunodeficiency virus. None of the patients were previously diagnosed with
syphilis. All patients developed panuveitis and a distinctly diaphanous or
ground-glass retinitis associated with creamy yellow superficial retinal
precipitates. In 3 patients (37.5%), the retinitis had a distinctive
wedge-shaped appearance. Five patients (62.5%) had associated retinal
vasculitis, 3 (37.5%) had serous retinal detachment, 2 (22.2%) had intraretinal
hemorrhage, and 2 (22.2%) had papillitis. Within 2 weeks of initiating
intravenous penicillin treatment, 7 patients (87.5%) experienced visual recovery
to >or= 20/40. All affected eyes showed rapid resolution of clinical signs with
minimal alternations of the retinal pigment epithelium in areas of prior
retinitis after completion of antibiotic therapy. CONCLUSION: Characteristic
superficial retinal precipitates may occur over areas of syphilitic retinitis.
Improved recognition of this highly suggestive clinical sign may aid in early
diagnosis and treatment.

PMID: 20616689  [PubMed - in process]

13: Retina. 2010 Jul-Aug;30(7):1128-34. 

Clinical factors related to visual outcome in central serous chorioretinopathy.

Aggio FB, Roisman L, Melo GB, Lavinsky D, Cardillo JA, Farah ME.

Vision Institute, Retina Section, Department of Ophthalmology, Federal
University of Sao Paulo, Sao Paulo, Brazil. aggio@oftalmo.epm.br

PURPOSE: The purpose of this study was to describe clinical, angiographic, and
tomo-graphic prognostic factors in central serous chorioretinopathy. METHODS:
This is a prospective uncontrolled case series. Forty-six eyes (43 patients)
with clinical and angiographic findings consistent with central serous
chorioretinopathy were included. Clinical data regarding age, sex, duration of
symptoms, associated conditions, and best-corrected visual acuity (BCVA) were
collected at baseline. Optical coherence tomography was performed at baseline,
monthly until fluid resolution occurred, and at the end of the follow-up.
RESULTS: Mean follow-up was 22.8 months. Mean baseline and final logarithm of
the minimum angle of resolution BCVA were 0.3 and 0.12 (P < 0.0001),
respectively. Statistically significant correlations were observed between the
baseline BCVA as well as duration of symptoms and final BCVA. Angiographic
patterns were not significantly correlated with the visual outcome. Shorter
periods of subfoveal fluid during the follow-up were correlated with better
visual acuity. Mean foveal thickness after fluid resolution was 178 +/- 22
microm. Both baseline and final BCVA were strongly correlated with the foveal
thickness after fluid resolution. CONCLUSION: Initial BCVA may be a reliable
predictor of the visual outcome in central serous chorioretinopathy. Eyes with
worse BCVA may have an increased risk of foveal atrophy. Fluid persistence on
optical coherence tomography may be associated with worse visual prognosis.

PMID: 20616688  [PubMed - in process]

14: Retina. 2010 Jul-Aug;30(7):1122-7. 

Intravitreal injection of microplasmin for treatment of vitreomacular adhesion:
results of a prospective, randomized, sham-controlled phase II trial (the
MIVI-IIT trial).

Stalmans P, Delaey C, de Smet MD, van Dijkman E, Pakola S.

Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
Peter.Stalmans@uzleuven.be

PURPOSE: Vitreomacular adhesion causing vitreomacular traction is a common
indication for vitrectomy. It may be avoided by using enzymatic vitreolysis. The
MIVI-IIT (traction) study evaluated the ability of a single or repeated
injection of microplasmin to release vitreomacular traction. METHODS: This
randomized, double-masked, Phase II trial with control sham injection enrolled
60 patients. Patients in each of the 4 cohorts were randomized (4:1) to active
treatment or sham injection. In the first 3 cohorts, increasing doses of
microplasmin (75, 125, and 175 microg) were administered. In the fourth cohort,
an initial injection of 125 microg microplasmin or sham was administered
followed 1 month later by an injection of 125 microg microplasmin if no release
of adhesion occurred. A third dose was injected 4 weeks later if there was still
no release of adhesion. RESULTS: Within 28 days of sham, 75, 125, and 175 microg
microplasmin administration, nonsurgical resolution of vitreomacular adhesion
was observed in 8, 25, 44, and 27% of the patients, respectively. When the 125
microg dose was repeated up to 3 times, adhesion release was observed in 58% of
patients 28 days after the final injection. CONCLUSION: These results provide
support for the potential of microplasmin as a nonsurgical treatment for
vitreomacular adhesion.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20616687  [PubMed - in process]

15: Retina. 2010 Jul-Aug;30(7):1090-4. 

Correlation of visual acuity and macular thickness measured by optical coherence
tomography in patients with persistent macular edema.

Blumenkranz MS, Haller JA, Kuppermann BD, Williams GA, Ip M, Davis M, Weinberg
DV, Chou C, Whitcup SM.

Department of Ophthalmology, Stanford University School of Medicine, Stanford,
California 94305, USA. mark.blumenkranz@stanford.edu

PURPOSE: The purpose of this study was to evaluate the correlation between
best-corrected visual acuity (BCVA) and macular thickness in patients with
persistent macular edema treated with a dexamethasone intravitreal drug delivery
system (dexamethasone DDS). METHODS: In a randomized, multicenter, controlled,
parallel-group, dose-ranging study, patients with macular edema lasting at least
90 days despite treatment were randomized to observation or treatment with 350-
or 700-microg dexamethasone DDS. Macular thickness was assessed in 80 patients
using optical coherence tomography. Best-corrected visual acuity was measured
using Early Treatment Diabetic Retinopathy Study methodology. RESULTS: At
baseline, macular thickness was significantly inversely correlated with BCVA (r
= -0.406, P < 0.001). Patients treated with 350- or 700-microg dexamethasone DDS
showed a significant decrease in macular thickness from baseline to Day 90 (P =
0.002). In the 700-microg dexamethasone DDS treatment group, there was a modest
inverse correlation between changes in macular thickness from baseline to Day 90
and improvement in BCVA (r = -0.530, P = 0.009). In the 350-microg dexamethasone
DDS treatment group, the correlation was weaker and not statistically
significant (r = -0.206, P = 0.304). CONCLUSION: The correlation between
baseline BCVA and macular thickness in patients with persistent macular edema
was modest. Improvement in BCVA after treatment with 700-microg dexamethasone
DDS was consistent with changes in macular thickness measured using optical
coherence tomography.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20616686  [PubMed - in process]

16: Retina. 2010 Jul-Aug;30(7):1084-9. 

Effect of macular edema on optical coherence tomography signal strength.

Hosseini H, Razeghinejad MR, Nowroozizadeh S, Jafari P, Ashraf H.

Department of Ophthalmology and Poostchi Ophthalmic Research Center, Shiraz
University of Medical Sciences, Shiraz, Iran. hosseinashraf@yahoo.com

PURPOSE: The purpose of this study was to examine the effect of macular edema
(ME) on Stratus optical coherence tomography (OCT) (Stratus OCT, Carl Zeiss
Meditec, Dublin, CA) signal strength (SS). METHODS: Part 1: Macular OCT was
performed in 57 eyes with ME, at 2 different time points with different degrees
of ME. The relationships between SS change and change in center point thickness
and total macular volume in two scans were examined. Part 2: In 54 eyes with ME,
Stratus OCT examinations with macular thickness mapping and retinal nerve fiber
layer analysis protocols were performed. The paired values of SS obtained with
two scan protocols were compared. The relationship between SS difference between
two test protocols with center point thickness and total macular volume was
evaluated. RESULTS: Part 1: There was a significant correlation between SS
change and the change in center point thickness and total macular volume in 2
consecutive scans. Part 2: Maximum SS obtained during macular OCT examination
was significantly less than that obtained during retinal nerve fiber layer OCT.
Significant correlations were observed between the difference in SS obtained in
two scan protocols and center point thickness as well as total macular volume.
CONCLUSION: Macular edema decreases macular OCT SS. In patients with ME, SS
obtained during macular OCT examination was significantly lower than that
obtained during retinal nerve fiber layer OCT examination.

PMID: 20616685  [PubMed - in process]

17: Retina. 2010 Jul-Aug;30(7):1065-71. 

Incidence of retinal detachment after small-incision, sutureless pars plana
vitrectomy compared with conventional 20-gauge vitrectomy in macular hole and
epiretinal membrane surgery.

Rizzo S, Belting C, Genovesi-Ebert F, di Bartolo E.

Santa Chiara Hospital, Eye Surgery Clinic, Pisa, Italy.
chiroftalmica@ao-pisa.toscana.it

PURPOSE: The purpose of this study was to evaluate the incidence of retinal
detachment (RD) after a small-incision, sutureless vitrectomy compared with
conventional 20-gauge vitrectomy in macular hole and epiretinal membrane surgery
and to investigate the clinical features and possible causative agents. METHODS:
The authors performed a computerized database analysis to retrospectively
identify all patients who underwent vitrectomy at our institution between March
2001 and March 2009 for epiretinal membrane and macular hole. The authors
further investigated the clinical features of patients who showed RD within 6
months postoperatively in the study eye. The incidence rate and clinical
features of the affected eyes were analyzed. RESULTS: During the study period,
2,432 vitrectomies were performed for epiretinal membrane and macular hole. The
incidence of RD was 1.7% (31 of 1,862) after sutureless 25- or 23-gauge
vitrectomy and 1.2% (7 of 570) after conventional 20-gauge vitrectomy. The
difference was not statistically significant. Moreover, the difference between
25-gauge surgery (28 of 1,580) and 23-gauge surgery (3 of 282) was not
statistically significant. In 9 of 38 cases (24%), the RD was probably
attributable to the underlying pathology (e.g., an unclosed macular hole and
reopening of preexisting retinal tears). Twenty-one eyes (76%) presented new
retinal tears that were not related to the sclerotomies in both groups.
CONCLUSION: The incidence of RD after macular surgery is not increased in
small-gauge, sutureless vitrectomy compared with the standard 20-gauge
procedure. In most cases, the RD is not caused by the surgical technique itself
but caused by new retinal breaks.

PMID: 20616684  [PubMed - in process]

18: Retina. 2010 Jul-Aug;30(7):1051-7. 

Clinical characteristics of endophthalmitis after an injection of intravitreal
antivascular endothelial growth factor.

Mezad-Koursh D, Goldstein M, Heilwail G, Zayit-Soudry S, Loewenstein A, Barak A.

Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

PURPOSE: The purpose of this study was to describe the clinical characteristics
and management of patients with bacterial endophthalmitis after an intravitreal
antivascular endothelial growth factor injection. METHODS: This is a
retrospective chart review of all patients admitted with suspected
endophthalmitis from 2006 to 2008. RESULTS: Endophthalmitis was verified by
positive Gram stain and culture in nine eyes. The mean preinjection visual
acuity of the 9 eyes was 0.02 +/- 0.021 diopters (decimal visual acuity scale)
and dropped to 0.01667 +/- 0.02449 diopters in the eyes with endophthalmitis.
All nine patients presented with reduced visual acuity, of whom seven also had
ocular pain. Initial treatment was administered without delay and consisted of
vitreous tap and intravitreal antibiotics injection in five cases and pars plana
vitrectomy with intravitreal antibiotics injection in the other four cases.
Vitreous tap failed in one case. Seven patients underwent a second procedure and
two underwent a third procedure. The mean posttreatment visual acuity in all 9
eyes improved significantly (0.19 +/- 0.24, P = 0.0071). Five patients had major
complications (e.g., retinal detachment, phacolytic glaucoma, and recurrent
endophthalmitis). CONCLUSION: Acute endophthalmitis following anti-VEGF
injection appears within days and can result in severe loss of vision if not
treated promptly. In our series the clinical and prognostic characteristics were
considerably different between culture positive endophthalmitis cases and
culture negative cases.

PMID: 20616683  [PubMed - in process]

19: Retina. 2010 Jul-Aug;30(7):1034-8. 

Aqueous vascular endothelial growth factor after intravitreal injection of
pegaptanib or ranibizumab in patients with age-related macular degeneration.

Sawada O, Miyake T, Kakinoki M, Sawada T, Kawamura H, Ohji M.

Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan.
osawada@belle.shiga-med.ac.jp

PURPOSE: The purpose of this study was to evaluate vascular endothelial growth
factor (VEGF) concentrations in the aqueous humor of eyes after intravitreal
injections of pegaptanib or ranibizumab in patients with age-related macular
degeneration. METHODS: Aqueous humor samples were obtained from 16 eyes with
choroidal neo-vascularization secondary to age-related macular degeneration
before and after intravitreal injections of pegaptanib (0.3 mg; 5 eyes) and
ranibizumab (0.5 mg; 11 eyes). The VEGF concentration was measured using an
enzyme-linked immunosorbent assay using a primary antibody against VEGF121 and
VEGF165. RESULTS: The VEGF concentrations in the aqueous humor of eyes with
age-related macular degeneration ranged from 35.3 pg/mL to 142.4 pg/mL (mean +/-
standard deviation, 90.9 pg/mL +/- 40.0 pg/mL) before the injection of
pegaptanib and increased significantly, ranging from 298.2 pg/mL to 571.3 pg/mL
(mean +/- standard deviation, 452.0 pg/mL +/- 106.4 pg/mL) 6 weeks after the
injection (P = 0.005). The VEGF concentrations ranged from 47.2 pg/mL to 307.4
pg/mL (mean +/- standard deviation, 125.9 pg/mL +/- 77.2 pg/mL) before injection
of ranibizumab and decreased to <31 pg/mL, the lower limit of detection, 4 weeks
after injection. CONCLUSION: The VEGF concentrations in the aqueous humor of
eyes with age-related macular degeneration decreased after injections of
ranibizumab and increased after injections of pegaptanib.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20616682  [PubMed - in process]

20: Retina. 2010 Jul-Aug;30(7):1025-33. 

Electrophysiological assessment of retinal function during 6 months of
bevacizumab treatment in neovascular age-related macular degeneration.

Pedersen KB, Moller F, Sjolie AK, Andreasson S.

Department of Ophthalmology, Odense University Hospital, Odense, Denmark.
karenbjerg@yahoo.dk

PURPOSE: The purpose of this study was to assess the alteration of retinal
function by multifocal electroretinography and full-field electroretinography in
patients with age-related macular degeneration treated with bevacizumab.
METHODS: We performed a prospective pilot study of 26 eyes of 26 previously
treatment-naive patients with neovascular age-related macular degeneration
receiving intravitreal injections with 1.25 mg bevacizumab. Patients were
examined with multifocal electroretinography, full-field electroretinography,
optical coherence tomography, and visual acuity. Follow-up was performed at 1
week, 6 weeks, 3 months, and 6 months. RESULTS: Mean multifocal
electroretinography P1 amplitudes were significantly improved at 1 week in the
central zone and after 3 and 6 months, improvement was seen in all 6 concentric
rings corresponding to +/-25 degrees of the central visual field. Full-field
electroretinography results indicated a decrease in cone photoreceptor function
at 3 months, which was normalized at 6 months compared with baseline.
Furthermore, 2 of 3 of the combined rod-cone responses showed signs of decreased
retinal function at 6 months. CONCLUSION: Our results indicate passing signs of
an altered retinal cone photoreceptor function assessed by full-field
electroretinography. The results do not show any conclusive signs of global
retinal toxicity after 6 months. Multifocal electroretinography results show
improved photoreceptor function with no sign of focal toxicity in the central
retina.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20616681  [PubMed - in process]

21: Retina. 2010 Jul-Aug;30(7):1012-6. 

Fibrous membranes in diabetic retinopathy and bevacizumab.

Pattwell DM, Stappler T, Sheridan C, Heimann H, Gibran SK, Wong D, Hiscott P.

Unit of Ophthalmology, School of Clinical Sciences, University of Liverpool,
Liverpool, UK. david.pattwell@manchester.ac.uk

PURPOSE: The purpose of this study was to determine the histopathologic
characteristics of bevacizumab-treated human proliferative diabetic retinopathy
(PDR) membranes with particular regard to membrane vasculature as a step toward
addressing the effects of the drug on PDR membranes. Intravitreous injection of
bevacizumab, an antivascular endothelial growth factor monoclonal antibody, has
recently been advocated as an adjunct in surgery for PDR. In this context, a
clinically observed decrease in PDR epiretinal membrane vascularity (vascular
regression) occurs from 24 hours to 48 hours after injection, but the exact
mechanisms of drug action are unknown. METHODS: A consecutive series of seven
PDR membrane specimens that had been removed sequentially from seven
bevacizumab-treated patients were studied retrospectively. The membrane
specimens were examined using light microscopic methods, including
immunohistochemistry. RESULTS: Five of the seven membranes were clinically
avascular (one contained "ghost" vessels) and did not hemorrhage during
excision. Of these 5 specimens, which included 1 removed 7 days after a total of
6 intravitreous injections of 1.25 mg bevacizumab, 4 contained histologically
detectable capillaries (1 did not). These blood vessels were lined by
endothelial cells as determined by immunohistochemistry for the endothelial
markers CD31 and CD34. The two remaining membranes were clinically and
histologically still vascularized despite bevacizumab treatment. All the
specimens also contained smooth muscle actin-containing fibroblastic cells
within the collagenous stroma. CONCLUSION: The findings do not support the
concept that the clinical phenomenon of vascular regression in PDR membranes
after bevacizumab injection in the vitreous is resulting from obliteration of
the membrane blood vessels. Another mechanism appears to be involved in at least
some patients, possibly a vasoconstrictive response. Such a mechanism might
explain reversal of the effects of bevacizumab that has been reported after this
treatment.

PMID: 20616680  [PubMed - in process]

22: Retina. 2010 Jul-Aug;30(7):1002-11. 

Comparison of two doses of intravitreal bevacizumab as primary treatment for
macular edema secondary to central retinal vein occlusion: results of the pan
American collaborative retina study group at 24 months.

Wu L, Arevalo JF, Berrocal MH, Maia M, Roca JA, Morales-Canton V, Alezzandrini
AA, Diaz-Llopis MJ.

Instituto de Cirugia Ocular, San Jose, Costa Rica. LW65@cornell.edu

PURPOSE: The purpose of this study was to compare the injection burden, central
macular thickness (CMT), and change in best-corrected visual acuity after
injecting 1.25 mg or 2.5 mg bevacizumab as needed in patients with primary
macular edema secondary to central retinal vein occlusion. METHODS: This is an
interventional, retrospective, comparative multicenter study of 86 eyes with
macular edema secondary to central retinal vein occlusion that were treated
primarily with intravitreal bevacizumab (44 eyes, 1.25 mg; 42 eyes, 2.5 mg). The
main outcome measures were the CMT and the change of best-corrected visual
acuity at 24 months. RESULTS: All patients completed at least 24 months of
follow-up. The mean number of injections per eye were 7.2 for the 1.25-mg dose
group and 8.1 for the 2.5-mg dose group (P = 0.4492). At 24 months, in the
1.25-mg dose group, the logarithm of the minimal angle of resolution
best-corrected visual acuity improved from baseline 0.35 +/- 0.57 units (P <
0.0001) versus 0.27 +/- 0.68 units for the 2.5-mg dose group (P < 0.0001). These
differences were not statistically significant between both dose groups. In the
1.25-mg dose group, 25 (56.8%) eyes gained >or=3 lines of Early Treatment of
Diabetic Retinopathy Study visual acuity and 6 (13.6%) lost >or=3 lines of Early
Treatment of Diabetic Retinopathy Study visual acuity. In the 2.5-mg dose group,
24 (57.1 %) eyes improved >or=3 lines of Early Treatment of Diabetic Retinopathy
Study visual acuity and 7 (16.7%) lost >or=3 lines of Early Treatment of
Diabetic Retinopathy Study visual acuity. The CMT in the 1.25-mg dose group
improved from 635 +/- 324 microm to 264 +/- 160 microm (P < 0.0001) versus 528
+/- microm to 293 +/- 137 microm in the 2.5-mg dose group (P < 0.0001). There
was no statistically significant difference between both dose groups with regard
to the CMT reduction. CONCLUSION: Intravitreal bevacizumab at doses up to 2.5 mg
seems to be effective in improving visual acuity and reducing CMT in macular
edema secondary to central retinal vein occlusion. There were no statistically
significant differences between the two dose groups with regard to the number of
injections, CMT, and change in visual acuity.

PMID: 20616679  [PubMed - in process]

23: Retina. 2010 Jul-Aug;30(7):983-1001. 

Progress toward the maintenance and repair of degenerating retinal circuitry.

Vugler AA.

Department of Ocular Biology and Therapeutics, Institute of Ophthalmology,
University College London, London, United Kingdom. a.vugler@ucl.ac.uk

BACKGROUND: Retinal diseases such as age-related macular degeneration and
retinitis pigmentosa remain major causes of severe vision loss in humans.
Clinical trials for treatment of retinal degenerations are underway and
advancements in our understanding of retinal biology in health/disease have
implications for novel therapies. METHODS: A review of retinal biology is used
to inform a discussion of current strategies to maintain/repair neural circuitry
in age-related macular degeneration, retinitis pigmentosa, and Type 2 Leber
congenital amaurosis. RESULTS: In age-related macular degeneration/retinitis
pigmentosa, a progressive loss of rods/cones results in corruption of bipolar
cell circuitry, although retinal output neurons/photoreceptive melanopsin cells
survive. Visual function can be stabilized/enhanced after treatment in
age-related macular degeneration, but in advanced degenerations, reorganization
of retinal circuitry may preclude attempts to restore cone function. In Type 2
Leber congenital amaurosis, useful vision can be restored by gene therapy where
central cones survive. Remarkable progress has been made in restoring vision to
rodents using light-responsive ion channels inserted into bipolar cells/retinal
ganglion cells. CONCLUSION: Advances in genetic, cellular, and prosthetic
therapies show varying degrees of promise for treating retinal degenerations.
While functional benefits can be obtained after early therapeutic interventions,
efforts should be made to minimize circuitry changes as soon as possible after
rod/cone loss. Advances in retinal anatomy/physiology and genetic technologies
should allow refinement of future reparative strategies.

Publication Types:
    Research Support, Non-U.S. Gov't

PMID: 20616678  [PubMed - in process]

24: Retina. 2010 Jun 29; [Epub ahead of print] 

COMPARISON OF 20-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY WITH CONVENTIONAL
VITRECTOMY.

Lee JE, Kim KH, Kim IK, Jea SY, Kim WS.

From the *Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea;
the daggerDepartment of Ophthalmology, Haeundae Paik Hospital, Inje University
College of Medicine, Busan, Korea; and the double daggerMassachusetts Eye and
Ear Infirmary, Harvard Medical School, Boston, Massachusetts.

PURPOSE:: The purpose of the study was to compare the efficacy and safety of a
transconjunctival sutureless technique for pars plana vitrectomy using
conventional 20-gauge instruments versus the conventional technique. METHODS::
Clinical data were reviewed retrospectively for a consecutive series of patients
who underwent transconjunctival sutureless vitrectomy (TSV; 38 eyes of 37
patients) and a control group who underwent vitrectomy using the conventional
technique (38 eyes of 38 patients). RESULTS:: Eighty-nine of 107 sclerotomies
(83.2%) in the TSV group self-sealed without the need for sutures. The TSV group
showed earlier visual improvement from baseline, as early as 7 postoperative
days, compared with 60 days in the conventional group. This was attributed to
less surgically induced astigmatism in the TSV group; mean astigmatism at
baseline and postoperative days 7, 30, and 90 was -1.05 diopter (D), -2.53 D,
-1.32 D, and -1.09 D, respectively, in the TSV group and -1.09 D, -3.91 D (P =
0.0285), -2.57 D (P = 0.0203), and -1.18 D, respectively, in the conventional
group. No serious complications were observed in either group, including
postoperative hypotony, wound leakage, or endophthalmitis. CONCLUSION:: The
20-gauge TSV technique is as effective as the conventional technique and offers
earlier postoperative recovery.

PMID: 20588205  [PubMed - as supplied by publisher]

25: Retina. 2010 Jun 29; [Epub ahead of print] 

NATURAL EVOLUTION OF FUNDUS AUTOFLUORESCENCE FINDINGS IN MULTIPLE EVANESCENT
WHITE DOT SYNDROME: A Long-Term Follow-Up.

Dell'omo R, Mantovani A, Wong R, Konstantopoulou K, Kulwant S, Pavesio CE.

From the *Medical Retina Department, Moorfields Eye Hospital, London, UK; the
daggerDepartment of Ophthalmology, Valduce Hospital, Como, Italy; and the double
daggerMedical Illustration Department, Moorfields Eye Hospital, London, UK.

PURPOSE:: The purpose of the study was to investigate the natural evolution of
fundus autofluorescence (FAF) findings in eyes with multiple evanescent white
dot syndrome. METHODS:: This was a retrospective, observational case series of
nine eyes of eight consecutive patients with multiple evanescent white dot
syndrome who underwent color fundus photographs, fluorescein and indocyanine
green angiography, and FAF photography in two referral practices. RESULTS:: The
mean follow-up was 8.6 months (range, 3-14 months). In the acute/ subacute
phase, FAF showed 1) hypoautofluorescent areas, PMID: 20588204  [PubMed - as supplied by publisher]