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  1. Harminder S Dua,
  2. Arun D Singh, Editors-in-Chief

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    RETROBULBAR TRIAMCINOLONE FOR BRANCH RETINAL VEIN OCCLUSION

    In a retrospective interventional case series involving 50 consecutive patients (50 eyes), trans-Tenon’s retrobulbar triamcinolone acetonide (20 mg; TA) injection was given as initial treatment for macular oedema associated with branch retinal vein occlusion (BRVO). Foveal thickness decreased significantly at 3 months after injection (p<0.0001). Improvement in visual acuity of at least 0.20 logMAR was seen in 22 eyes (44%). After 3-month follow-up, 29 eyes (58%) needed additional TA injections or pars plana vitrectomy (PPV). PPV seemed to be effective for macular oedema resistant to TA. IOP elevation and cataract progression occurred in less than 10% of all patients. Kawaji et al conclude that trans-Tenon’s retrobulbar TA injection appears to be safe and relatively effective for macular oedema associated with BRVO. Further evaluation of the effect of PPV on macular oedema resistant to TA injection is warranted.

    See pages 10.1136/bjo.2007.124578

    ACANTHAMOEBA DNA EXTRACTION

    To minimise false negative results of nucleic-acid based Acanthamoeba diagnostic tests, efficient lysis of cysts (without affecting the DNA) is necessary. Detection of Acanthamoeba by real-time PCR was studied by processing a mixture of Acanthamoeba cysts and a tag virus with several commercially available DNA preparation kits. Goldschmidt et al observed that significant increase in the detection rates were obtained by adding a Proteinase K treatment (10 min at 56°C) prior to using commercially available DNA extraction kits.

    See pages 10.1136/bjo.2007.125898

    INTRAVITREAL TRIAMCINOLONE VS BEVACIZUMAB FOR REFRACTORY DIABETIC MACULAR OEDEMA

    To compare the morphological and visual acuity outcomes associated with a single intravitreal injection of triamcinolone acetonide (4 mg/0.1 cc) versus bevacizumab (1.5 mg/0.06 cc) for the treatment of refractory diffuse diabetic macular oedema (DMO), 28 patients were randomly assigned to two treatments groups. Central macular thickness was significantly reduced in the intravitreal triamcinolone group when compared with the bevacizumab group at weeks 4, 8, 12 and 24 (p<0.05). LogMAR best-corrected visual acuity was significantly higher at weeks 8 and 12 in the intravitreal triamcinolone group when compared with the bevacizumab group (p<0.05). Significant change in mean intraocular pressure was observed only in the intravitreal triamcinolone group. Cataract progression was not observed during the study. Paccola et al conclude that a single intravitreal injection of triamcinolone may offer certain advantages over bevacizumab in the short-term management of refractory DMO. These preliminary findings, however, remain to be confirmed in larger studies.

    See pages 10.1136/bjo.2007.129122

    AMNIOTIC MEMBRANE TRANSPLANTATION FOR THE MANAGEMENT OF CORNEAL EPITHELIAL DEFECTS: AN IN VIVO CONFOCAL MICROSCOPIC STUDY

    Much is known about the effects of amniotic membrane (AM) transplantation for the treatment of persistent corneal epithelial defects. It can be used as a graft, when the healing corneal epithelial cells (CEC) migrate on the surface of the AM, which becomes part of the host; or as a patch, when the cells migrate under the AM. Very little is known about the fate of the AM during such healing. Nubile et al have used in vivo confocal microscopy (IVCM) to show that when the AM acts as a patch the AM epithelium has a mean thickness of 35 μm and a cell density of 4613/mm on day one and is completely lost by day 15 of transplantation. The mean AM stroma thickness was 116 μm and demonstrated a dense superficial and a loose deeper layer. It too completely disappeared between 4 to 8 weeks. In all the 20 eyes studied, complete corneal epithelial healing occurred beneath the membrane. IVCM allowed visualisation of migrating CEC through the AM.

    See pages 10.1136/bjo.2007.123026

    MOTION-IN-DEPTH PERCEPTION IN STRABISMIC PATIENTS

    To investigate motion-in-depth perception in patients with strabismus, Watanabe et al developed a stereo motion test using four types of computer-generated dynamic visual stimuli. Three of them were random dot stereograms of two parallel planes moving in depth. The fourth type of stimulus was a random dot stereogram of a rotating cylinder. Titmus stereo test using static visual stimuli was used to assess static depth perception. The results of the measurements performed on 52 strabismic patients suggested that the dynamic binocular depth perception is preserved in some of the strabismic patients who lack static stereopsis.

    See pages 10.1136/bjo.2007.117507

    COMBINED PEGAPTANIB SODIUM (MACUGEN) AND PHOTODYNAMIC THERAPY IN JUXTAFOVEAL CHOROIDAL NEOVASCULARISATION IN AMD

    In a prospective, open label, non-comparative, observational case series of 7 eyes of 7 patients with predominantly classic juxtafoveal choroidal neovascularisation (CNV) in age-related macular degeneration (AMD), photodynamic therapy (PDT) followed by Pegaptanib Sodium (Macugen) was administered. At 6 months, BCVA diminished by a mean of five letters. Initial area of CNV increased significantly from 1.4 mm2 to 2.7 mm2. There was a significant increase in the greatest linear dimension from 1280.3 μm to 2065.7μm at 24 weeks follow-up. Calvo-González et al conclude that predominantly classic juxtafoveal CNVs are highly aggressive lesions that demonstrate poor response to combined therapy using PDT and Macugen.

    See pages 10.1136/bjo.2007.128942

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