Faculty Bibliography

PURPOSE: To evaluate the short-term outcomes after intravitreal ranibizumab (Lucentis; Genentech, Inc., South San Francisco, CA) injection in patients with neovascular age-related macular degeneration. METHODS: A review of data for consecutive patients who received intravitreal ranibizumab injection was conducted. The main outcome measures were mean visual acuity and central macular thickness at 3 months compared with those at baseline. Response to ranibizumab therapy was evaluated with particular attention to prior treatment with bevacizumab (Avastin; Genentech, Inc.). RESULTS: Mean baseline visual acuity of 231 eyes of 231 patients was 20/152, and 189 patients (81.8%) had undergone prior treatment, with 153 (65.4%) having received intravitreal bevacizumab. Mean visual acuity at 3 months, available for 203 patients (88%), was 20/126 (P = 0.004). Mean visual acuity for 98 patients treated with bevacizumab within 3 months before ranibizumab injection was 20/100 at baseline and 20/98 at 3 months (P = 0.35). Mean baseline central macular thickness was 278 microm for all patients and improved to 211 microm at 3 months (P < 0.001). Macular thickness decrease was noted irrespective of previous bevacizumab therapy. CONCLUSION: Ranibizumab therapy was associated with significant improvements in mean visual acuity and central macular thickness for the group of all patients. Patients who had received bevacizumab treatment within 3 months before initiating ranibizumab treatment had stability of, but no improvement in, visual acuity

PURPOSE: To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions. DESIGN: Single-center, retrospective, noncomparative, consecutive interventional case series. PARTICIPANTS: Seventy-seven eyes of consecutive patients who underwent 23-gauge transconjunctival vitrectomy surgery by a single surgeon at the Manhattan Eye, Ear, and Throat Hospital from October 2004 through October 2005. INTERVENTION: All patients underwent 3-port 23-gauge vitrectomy using Dutch Ophthalmic Research Corporation instrumentation and an Alcon Accuris Vitrector. MAIN OUTCOME MEASURES: Postoperative visual acuity at months 1 and 3, intraoperative and postoperative complications, and operative time. RESULTS: Mean acuity improved from 20/190 at baseline to 20/108 (P<0.0001) and 20/74 (P<0.0001) at months 1 and 3, respectively. By diagnosis, patients with epiretinal membrane (n = 20) improved from 20/124 to 20/93 (P = 0.0046), macular hole (n = 18) from 20/174 to 20/57 (P = 0.0007), rhegmatogenous retinal detachment (RD) (n = 14) from 20/248 to 20/51 (P = 0.0004), tractional RD (n = 12) from 20/175 to 20/62 (P = 0.0159), nonclearing vitreous hemorrhage (n = 12) from 20/1345 to 20/189 (P = 0.0004), vitreomacular traction (n = 4) from 20/145 to 20/124 (P = 0.7525), and retained lens fragments (n = 4) from 20/308 to 20/140 (P = 0.0972). One patient who underwent diagnostic vitrectomy had stable 20/50 acuity. Two patients had hypotony on postoperative day 1, 1 patient required a sutured sclerotomy intraoperatively, and no patients developed choroidal effusions. No intraoperative tears were noted. Surgical times collected on 17 patients during the final month of the study demonstrated a mean opening time (range) of 103 seconds (70-162), mean closing time of 75 seconds (17-470), and net operating time of 24.1 minutes (7.1-74.6). CONCLUSIONS: Twenty-three-gauge instrumentation is effective for a variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems

The white dot syndromes are a heterogeneous group of rare inflammatory disorders affecting the retina, the retinal pigment epithelium, and the choroid. Not all of these diseases actually cause white dots, but they all have unique lesions in the fundus. We describe acute posterior multifocal placoid pigment epitheliopathy, serpiginous choroiditis, birdshot chorioretinopathy, multifocal choroiditis with panuveitis, diffuse subretinal fibrosis syndrome, punctate inner choroidopathy, multiple evanescent white dot syndrome, and diffuse unilateral subacute neuroretinitis as the white dot syndromes in this review. Some of these conditions share an association with systemic infectious diseases. In addition, treatment of these diseases is similar. Some can be treated with immunosuppressive therapy. Other treatment options include laser photocoagulation, topical or systemic steroid therapy, photodynamic therapy, and, most recently, anti-vascular endothelial growth factor agents. The new development in treatment may alter the visual prognosis of the patients, leading to a better outcome in visual acuity

PURPOSE: To describe the macular holes in patients with idiopathic parafoveal telangiectasis (IPT) and to propose a pathophysiologic explanation for their formation. METHODS: Four eyes of two patients with IPT were evaluated with biomicroscopy and optical coherence tomography (OCT). RESULTS: One patient had a nearly full-thickness hole with preservation of only the internal limiting membrane (ILM), but had a 20/60 visual acuity. The other patient had a large full-thickness macular hole, but retained 20/40 visual acuity. Each patient had a fellow eye showing prominent central inner foveal cavitation under a very thin ILM, which was devoid of associated tissue. CONCLUSIONS: This report describes the findings of two patients with IPT who developed pronounced central foveal structural abnormalities. The induced anatomic changes noted in our patients suggest that there is a loss of the structural aspects afforded by Muller cells, particularly the Muller cell cone, in the central macula in patients with IPT. The preservation of good visual acuity in our patients implies that the holes were the result of lateral separation of the photoreceptors within the fovea and that there could not have been profound atrophy of the photoreceptors

OBJECTIVE: To evaluate the short-term visual acuity and anatomic responses after intravitreal bevacizumab (Avastin, Genentech) treatment in patients with retinal angiomatous proliferation (RAP). METHODS: The authors conducted a retrospective review of consecutive patients with newly diagnosed or recurrent RAP treated with intravitreal bevacizumab (1.25 mg) during a 3-month period. Complete ocular examination was performed at baseline and follow-up visits. Interval data were analyzed statistically at 1 and 3 months follow-up. RESULTS: Twenty-three eyes of 23 patients underwent intravitreal bevacizumab treatment. The mean age of patients was 81.1 years, median baseline visual acuity of treated eyes was 20/80 (range 20/25-20/800), and mean baseline central macular thickness was 335 mum (optical coherence tomography was available for 22 eyes). Nine eyes had retinal pigment epithelial detachments (PEDs) at baseline. At 1-month follow-up, the median acuity improved to 20/60 (range 20/30-20/400) (P < 0.001), mean central macular thickness decreased to 202 microm (P < 0.001), and PED was present in only 2 eyes (P = 0.016). Seven of 23 eyes at 1 month (30.4%) had improved visual acuity, defined as halving of the visual angle, and no eyes had worse acuity, defined as doubling of the visual angle. Of the 17 eyes available for 3-month follow-up, 5 eyes (29.4%) had better visual acuity, 1 eye (5.9%) had worse acuity, and the remaining 11 (64.7%) had the same acuity. The median visual acuity at month 3 was 20/60 (range 20/25-20/400). There were no thromboembolic phenomena, endophthalmitis cases, retinal detachments, or any other adverse events. CONCLUSION: Treatment of RAP with intravitreal bevacizumab during this retrospective review resulted in a significant decrease in macular thickness and improvement or stabilization of visual acuity. Further long-term investigation is warranted given the promising short-term results