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Purpose To report on the rebound effect of macular edema (ME) following dexamathasone implant for the treatment of non-ischemic central retinal vein occlusion (CRVO). Methods Twenty-one patients affected by ME secondary to CRO underwent intravitreal implant of dexamethasone (700micrograms) on compassionate use program. The patients were followed up monthly. ETDRS best corrected visual acuity (BCVA), central foveal thickness (CFT) on OCT, and intraocular pressure were monthly registered. Results BCVA improved in all the cases as well as CRT at months 1, and 2. Interestingly, CFT turned out to be double with respect to the baseline value at the month-3 examination visit in 1 case, and another 2 cases at month-4 examination visit. Visual acuity reduced accordingly to the worsened CFT values. Additional treatment with intravitreal dexamethasone implant allowed both visual acuity recovery, and CFT reduction. Conclusions Rebound effect can develop after intravitreal dexamethasone implant for the treatment of ME related to CRVO. Rebound effect does not affect functional or anatomical recovery when re-treatment is provided. Re-treatment rate with intravitreal desamethasone implant should be customized according to the patient’s response.

Age-related macular degeneration (AMD) is an irreversible pathology that is the principal cause of serious loss of central vision and legal blindness among people over 60 years of age. There are two forms of AMD: the dry, or atrophic form, and the wet, neovascular form. The latter is less frequent but is the cause of approximately 80–90% of cases of serious loss of vision in a short time period. Early diagnosis is therefore essential to permit intervention as promptly as possible. Currently, the most effective therapy for neovascular AMD uses the new class of anti-VEGF drugs, and ranibizumab is today’s ‘gold standard’ for this treatment. The Progetto LUCE (LUCE Project) consists of an advisory board of retinal disease specialists in Lombardy, Italy, whose task is to propose a consensus for the diagnosis, treatment and follow-up of neovascular AMD patients treated with ranibizumab on the basis of a review of the scientific evidence and Italian national health service regulations and the clinical experience of the advisory board members.

Purpose To assess the effects of intravitreal bevacizumab injections in the treatment of juxtafoveal choroidal neovascularization (CNV) associated with multifocal choroiditis (MC). Methods Non-randomized interventional case series with fourteen patients (14 eyes) affected by juxtafoveal CNV secondary to MC. All patients underwent a complete ophthalmologic examination, including ETDRS best corrected visual acuity (BCVA) measurement, optical coherence tomography and fluorescein angiography. The protocol treatment included a first injection, followed by repeated injections over a 12-month follow-up period on the basis of OCT parameters and angiographic features. Primary outcome measures: mean changes in BCVA and proportion of eyes gaining at least 15 letters (3 ETDRS lines) at the end of the follow-up. Secondary outcomes: mean changes of central macular thickness (CMT) and extension to the fovea. Results Mean BCVA changed from 0.41 Log MAR at baseline to 0.16 Log MAR at the 12-month examination (p

Purpose Dexamethasone intravitreal implant (DEX implant 0.7 mg; OZURDEX®, Allergan, Inc.) is a FDA-EMA approved therapy for the treatment of macular edema (ME) secondary to Branch and Central retinal vein occlusion (BRVO and CRVO) and intermediate and posterior non-infectious uveitis. Aim of the study is to report the adverse events related to this treatment in the clinical practice. Methods We reviewed the charts of all consecutive patients affected by ME secondary to different pathologies, who had undergone DEX implant 0.7 mg.Patients were instructed to use antibiotics postoperatively and followed up for at least 4 months after injections. Adverse events following DEX implant were recorded. Results Forty-three eyes of 42 patients were included for analysis. ME was related to BRVO (15 eyes), CRVO (14 eyes) and diabetes (14 eyes). Overall, 45 injections (mean 1,1 injections/patient) were performed. The mean follow-up was 6,1 months. Most common adverse events were related to the injection, and included mild and transient foreign body sensation (77,8%), conjunctival hyperemia (71,1%), conjunctival edema (53,3%), conjunctival haemorrhage (53,3%), eye pain (28.9%). Increased intraocular pressure (

Purpose To evaluate the agreement between fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) in detecting the activity of myopic choroidal neovascularization (CNV) during the treatment with intravitreal bevacizumab injection (IVBI). Methods Patients affected by myopic subfoveal CNV were prospectively enrolled in the study; at baseline and at all planned monthly visit, each patient underwent a complete ophthalmological examination, including BCVA assessment on ETDRS charts, slit lamp examination, FA and SD-OCT examination. After the first IVBI (1.25mg), additional injections were performed on the basis of the detection of any type of fluid on SD-OCT and/or presence of leakage or progression on FA. Inter-rater agreement kappa analysis was performed to examine the concordance between FA and SD-OCT in assessing CNV activity. Moreover, considering FA as standard reference examination, sensitivity and specificity were calculated. Results Thirty-four eyes were included in the study. At the baseline, FA and SD-OCT achieved an agreement in 26/34 cases (X%) with a k value of 0.23; sensitivity and specificity were respectively 77.4 and 66.7. The remaining eight cases, 7 eyes presented leakage on FA and absence of fluid on SD-OCT examination, whereas 1 case showed intraretinal fluid on SD-OCT and absence of leakage on FA. At 1-month examination, specificity and K value improved and a concordance was reached in 30/34 cases. At 3- and 4-month examination a discordance was noted in 6 case and the k values were 0.60 and 0.51, respectively. From 5-month examination on, a consensus was achieved in at least 30/34 cases (88%) and reached a complete agreement in 9 sessions. Conclusions The present study reveals that FA still plays a main role in the diagnosis of CNV in myopic eyes. However, it seems possible to hypothesize a role of SD-OCT for monitoring the anti-VEGF treatment over the follow-up.

Purpose To record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists. Methods Collaborative multicenter case series (41 cases), literature review (15 cases), and reports to the FDA (46 cases) of cases that had ocular vascular occlusions during anti-VEGF therapy. Results 102 cases had ocular vascular events diagnosed a median of 14 days after anti-VEGF injection. A majority of patients had preexistent risk factors for cardiovascular events and 6 patients had prior history of glaucoma. Mean visual acuity dropped by 5 lines with severe visual loss after injection to NLP (2 eyes), LP (6 eyes), and HM (2 eyes). The overall risk of ocular vascular events was 0.087%, with predilection for eyes with advanced retinal ischemia like proliferative diabetic retinopathy and ocular ischemic syndrome. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation=27%) and mean venous constriction was 8% (standard deviation=30%). Conclusions The ocular vascular events during anti-VEGF therapy are rare, can lead to severe visual loss, and may be of multifactorial etiologies: vasoconstrictor effect of the drug, post-injection rise of intraocular pressure, stress of the procedure, and the natural history of underlying ocular or systemic diseases.

Purpose To investigate the characteristics of blue light (BL) and near infrared (NIR) fundus autofluorescence (FAF) in patients affected by Best vitelliform macular dystrophy (BVMD). Methods Clinical data (visual acuity -VA-, red free and colour photos, BL and NIR FAF) of 13 patients (25 eyes) with BVMD were retrospectively reviewed. The diagnosis of BVMD was based on the presence of a positive family history and an abnormally low to absent electrooculogram light rise (Arden ratio

Choroidal neovascularization can rarely complicate the course of a number of chorioretinal hereditary dystrophies leading to an even further impaired vision function. In recent years, several case reports and case series have shown that intravitreal injections of antivascular endothelial growth factor drugs can be effective in treating subfoveal choroidal neovascularization secondary to chorioretinal dystrophies either improving vision, or at least halting its progressive loss. Additional studies are warranted to confirm the initial positive response and to assess the best therapeutic regimen.

PURPOSE. To describe a rare adverse event characterized by anterior ischemic optic neuropathy (AION) associated with central retinal artery occlusion (CRAO) followed by central retinal vein occlusion (CRVO) secondary to treatment with intravitreal injection of ranibizumab for diabetic macular edema (DME). METHODS. A patient with DME refractory to focal grid laser photocoagulation in the left eye was prospectively followed and treated with intravitreal injection of ranibizumab. Over a 12-month period and after 4 injections, best-corrected visual acuity (BCVA) improved from 20/63 to 20/50 (Snellen equivalent) and central retinal thickness (CRT) reduced from 551 to 279 mu m. In July 2009, BCVA dropped to 20/100 with CRT of 421 mu m due to the recurrence of DME and a further injection was administered. RESULT. One month later, the left eye showed a sudden visual acuity loss. Best-corrected visual acuity was 20/400 and the fundus examination revealed a hyperemic and swollen optic disc, with several retinal hemorrhages. Retina at the posterior pole was pale, with attenuation and sheathing of arterial vessels. Fluorescein angiography showed a delayed optic disc and arterial filling with retinal ischemia involving both posterior pole and periphery and confirmed the diagnosis of AION associated with CRAO. One month later, the BCVA decreased to 20/800, and fundus examination evidenced a CRVO with diffuse retinal hemorrhages in the 4 quadrants, congestion, and tortuosity of the retinal veins. CONCLUSIONS. Although severe ocular adverse events are generally rare, patients receiving intraocular anti-vascular endothelial growth factor injection should be monitored carefully for the development of vascular complications.

Purpose To evaluate the long-term efficacy and safety of intravitreal bevacizumab injection (IVBI) for the treatment of extrafoveal choroidal neovascularization (CNV) secondary to pathologic myopia. Methods The design of the study was an open-label prospective nonrandomized interventional case series. Seven eyes from 7 patients with extrafoveal CNV secondary to pathologic myopia were recruited. All patients underwent a complete ophthalmologic examination,including ETDRS visual acuity, optical coherence tomography, and fluorescein angiography. The protocol required 3 monthly consecutive IVBI (1,25 mg), followed by repeat injections on the basis of OCT parameters and angiographic features over the 24-month follow-up. Results Three eyes underwent previous photodynamic therapy, whereas the remaining 4 eyes were naive. All patients completed follow-up at 24 months. The mean baseline best corrected visual acuity was 0.6 logMAR, which improved to 0.43 logMAR at 24 months (p

Purpose. To describe autofluorescence, microperimetry, and electrophysiology findings in a case of macular congenital hypertrophy of the retinal pigment epithelium (CHRPE). Methods. A 58-year-old man was referred to the Department of Ophthalmology of the University of Udine for the evaluation of a pigmented macular lesion in the right eye. The patient underwent blue-light autofluorescence (BL-AF), near-infrared autofluorescence (NIR-AF), electrooculogram, full-field electroretinogram and multifocal electroretinogram (mfERG), microperimetry, computerized visual field, and optical coherence tomography (OCT). Results. BL-AF performed using Heidelberg Retinal Angiograph II revealed a homogeneous hypoautofluorescence, surrounded by a hyperautofluorescent halo. NIR-AF showed a heterogeneous response combining an increased signal in the center of the lesion bordered by a decreased and darker signal. Electrooculogram and full-field electroretinogram were normal in both eyes. mfERG revealed only a limited area of reduced function in the right eye, which matched to location of CHRPE. The segments most functionally altered on mfERG corresponded to the area showing an increased signal in the NIR-AF, possibly reflecting the presence of increased pigment density within a more viable retinal pigment epithelium-Bruch membrane complex. Conclusions. In essence, macular CHRPE is associated with slight defect in retinal sensitivity and outer retinal dysfunction secondary to the anatomic changes characteristic of the lesion. (Eur J Ophthalmol 2010; 20: 621-4)

Purpose To evaluate the long-term clinical outcomes of subfoveal choroidal neovascularization (CNV) secondary to pathological myopia (PM) treated with intravitreal bevacizumab injections (IVBI) on variable monthly regimen guided by fluorescein angiography (FA) and optical coherence tomography (OCT) [an as per needed basis]. Methods Eyes with subfoveal myopic CNV were treated with IVBI on an as per needed basis till the end point of CNV inactivity.All patients underwent a complete ophthalmologic examination, including visual acuity assessment on ETDRS charts, optical coherence tomography, and fluorescein angiography assessment. The protocol required monthly IVBI on the basis of persistent intraretinal or subretinal fluid detected on OCT scan and on the presence of leakage on FA.Primary outcome was the change in mean best corrected visual acuity (BCVA) and the proportion of eyes improving in BCVA by 3 lines. Secondary outcome measures was the evaluation of the agreement between FA and OCT in detecting of the CNV activity. Results 30 patients completed the scheduled visits over the 24-month follow-up. At the baseline, the mean BCVA was 0.6±0.3 (LogMAR±SD); at 3 months of follow-up, the mean BCVA improved to 0.54±0.4. Subsequently, at 12 and 24-month examination, the mean BCVA was 0.54±0.4 and 0.50±0.4, respectively. No statistically significant difference was detected in any time-point in comparison to the baseline value.At the end of the follow-up, 36.6% of cases showed a visual improvement of 3 or more lines. Thirteen eyes (43.3%) gained at least 1 line, 5 (16%) showed a BCVA stabilization and 6 eyes (20%) lost at least 1 line.Inter-rater agreement examination between FA and OCT evidenced a good correlation. During the first year of follow-up, OCT and FA provided a consensus of 89% in identification of IRF/SF on OCT and of leakage on FA (kappa=0,68). The agreement increased to 98% during the second year (kappa=0,92) .No significant ocular or systemic adverse effect was reported. The mean injection rate over 2 years was 5.26. Conclusion IVBI for PM-related subfoveal administered on an as per needed basis over 24 months of follow-up shows promise in stabilization of vision. OCT and FA showed similar proprieties in the ability to detect CNV activity and to guide the re-treatment.

OBJECTIVE: To compare the effectiveness of photodynamic therapy (PDT) vs intravitreal bevacizumab injection in patients with subfoveal choroidal neovascularization (CNV) secondary to multifocal choroiditis (MC).METHODS: Patients affected by subfoveal CNV associated with MC referred for clinical evaluation from March 1, 2005, to July 31, 2008, were considered for this pilot randomized clinical trial. Twenty-seven patients were included in the study and followed up from March 15, 2005, through April 30, 2009. After randomization, patients receiving PDT were treated according to the Treatment of Age-Related Macular Degeneration With Photodynamic Therapy protocol, whereas patients receiving intravitreal bevacizumab injection, after a loading phase of 3 monthly injections, were examined monthly and re-treated on the basis of detection of fluid on optical coherence tomography and/or leakage on fluorescein angiography.MAIN OUTCOME MEASURES: The primary outcome measure was the 5- and 15-letter change on the Early Treatment of Diabetic Retinopathy Study charts at 12-month examinations compared with baseline. Secondary outcomes included central macular thickness changes.RESULTS: Thirteen and 14 patients were randomized to PDT and bevacizumab treatment, respectively. At the 12-month examination, 5 of 14 eyes treated with bevacizumab and 0 of 13 eyes treated with PDT experienced a best-corrected visual acuity gain of greater than 3 lines (P = .04). Twelve eyes in the bevacizumab group and 6 eyes in the PDT group gained more than 1 line (P = .04). The central macular thickness showed a progressive reduction in both subgroups without a significant difference compared with the baseline values.CONCLUSIONS: Greater beneficial effects can be achieved using intravitreal bevacizumab injection rather than PDT for the treatment of subfoveal CNV secondary to MC. Larger multicenter investigations are needed to confirm our preliminary results. Application to Clinical Practice Currently, there is no precise indication regarding the best therapeutic approach to subfoveal CNV secondary to MC. This investigation was designed to verify whether intravitreal bevacizumab injection has a more beneficial effect with respect to PDT.

Purpose To assess the efficacy and safety of intravitreal ranibizumab (IVR) in patients with sub or juxtafoveal choroidal neovascularization secondary to pathologic myopia (mCNV), naïve or unresponsive to prior photodynamic therapy (PDT) or intravitreal bevacizumab (IVB). Methods :23 eyes of 23 patients with sub or juxtafoveal mCNV treated with IVR, were retrospectively studied. Patients were divided in two groups. In group 1 (10 patients) patients were treated with three consecutive IVR performed on a monthly basis in contrast to group 2 (13 patients) that underwent a single IVR. Thereafter the need for additional injections was based on predefined retreatment criteria: persistence or increase of fluorescein leakage, new hemorrhage, persistence or appearance of sub/intraretinal fluid on OCT. Main outcome measures were changes in best corrected visual acuity (BCVA) and OCT thickness change at 12 months. Safety was tested by noting treatment-related ocular or systemic complications Results Overall, mean BCVA increased significantly from month 1 to 12. In both groups a significant decrease in OCT thickness and GLD was noted. At the end of the follow-up only 2 of the 23 patients of both groups showed a persistence of CNV, with a mean number of 1,3 IVR (range 1-2) in group 2 and 4,3 in group 1(range 3-6). Conclusions Short-term results suggested that IVR provides significant functional and important anatomical improvement with no significant adverse events in patients with sub or juxtafoveal mCNV naïve or unresponsive to prior PDT or IVB. Despite the small sample of eyes, the effectiveness of intravitreal ranibizumab was found to be encouraging. Further prospective long-term studies are necessary to evaluate safety and efficacy of intravitreal ranibizumab in the treatment of myopic CNV.

Choroidal neovascularization (CNV) is the most common vision-threatening macular complication in pathologic myopia (PM) being detectable in 4-11% of the affected eyes. Treatment of PM-related CNV is still controversial. Intravitreal injections of antivascular endothelial growth factor molecules are able to inhibit the vascular endothelial growth factor isoforms and have shown promise in the treatment of myopic CNV. The present review describes the beneficial effects of this approach both for subfoveal and juxtafoveal CNV. However, considering the lack of randomized clinical trials and the relatively short follow-up in most of the studies, a multicentric clinical trial should be necessary to validate the positive results in the long term.

Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) represent the most common causes of vision loss in patients affected by diabetes mellitus. Diabetic retinopathy (DR) needs special attention because of its high public health impact and impact on quality of life of patients. Actually, laser retinal photocoagulation is the standard of care for the treatment of DR. However, laser treatment reduces the risk of moderate visual loss by approximately 50%, without a remarkable vision recovery. Thus, new approaches in the treatment of DR have been taken into account and, more specifically, the therapy employing antivascular endothelial growth factor (anti-VEGF) drugs could play a meaningful role. VEGF is a pluripotent growth factor that functions as an endothelial cell-specific mitogen and vasopermeability factor. Through these mechanisms VEGF plays a critical role in promoting angiogenesis and vascular leakage. A high level of VEGF has been detected in eyes presenting DME and PDR, and thereby VEGF is an attractive candidate as therapeutic target of pharmacological treatment in the management of DR. In the current chapter, the concepts and results of anti-VEGF therapy in the treatment of the DME and PDR are presented.

OBJECTIVE: To compare the effects on visual acuity of laser treatment (LT), photodynamic therapy (PDT) with verteporfin, and intravitreal bevacizumab treatment in patients with juxtafoveal choroidal neovascularization secondary to pathologic myopia.METHODS: This prospective randomized clinical investigation enrolled 54 patients, who were divided into 3 groups receiving PDT, LT, or intravitreal bevacizumab treatment. The anti-vascular endothelial growth factor group received 1.25 mg of intravitreal bevacizumab at baseline; retreatment was performed if persistent intraretinal or subretinal fluid evaluated on optical coherence tomography or if choroidal neovascularization progression was detected on fluorescein angiography. The PDT group received treatment following the Verteporfin in Photodynamic Therapy Study Group guidelines. The LT group was submitted to direct LT and received PDT treatment if subfoveal recurrence or progression was detected on fluorescein angiography. A change in best-corrected visual acuity was the primary outcome.RESULTS: The mean best-corrected visual acuity in the PDT group decreased from 0.52 logMAR (SD, 0.24 logMAR) at baseline to 0.72 logMAR (SD, 0.25 logMAR) at the end of the study (P = .002). The LT group showed substantial stabilization from mean baseline visual acuity (mean, 0.45 logMAR [SD, 0.27 logMAR]) to the 24-month (mean, 0.56 logMAR [SD, 0.34 logMAR) examination values. The mean best-corrected visual acuity in the anti-vascular endothelial growth factor group increased from 0.6 logMAR (SD, 0.3 logMAR) at baseline to 0.42 logMAR (SD, 0.35 logMAR) at the end of the study (P = .006).CONCLUSIONS: Overall, bevacizumab treatment offers the best functional results during a 2-year follow-up. In view of the small size of the sample in this study and the relatively low frequency of juxtafoveal choroidal neovascularization secondary to pathologic myopia, a multicentric clinical trial is necessary to validate our results.

Purpose To report visual acuity change and central retinal thickness (CRT) variation after intravitreal injections of bevacizumab (IVB) in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods 18 eyes of 18 patients with ME secondary to BRVO were retrospectively reviewed. Mean disease duration was 14.3 months. Four patients were refractory to previous laser treatment or intravitreal injection of triamcinolone acetonide, 14 had not received previous treatments. All patients underwent a complete examination including ETDRS visual acuity measurement, fluorescein angiography and OCT. The patients received 3 monthly consecutive IVB, followed by repeated injections, laser treatment or no treatment on the basis of OCT parameters and angiographic patterns over the 12-month follow-up. Results Mean best corrected visual acuity (BCVA) was 0.94 ± 0.49 LogMar at baseline, 0.84 ± 0.45 logMar at three-month follow-up and 0.7 ± 0.42 LogMar at 1 year follow up. CRT was 536 ± 194 µm at baseline, 436 ± 167 µm at three-month follow-up and 471 ± 175 LogMar at 1 year follow up. No complications related neither to injection procedure nor to drug occurred. Seven eyes did not receive any further treatment, 4 eyes were treated with laser photocoagulation, 6 eyes were reinjected with bevacizumab (1 eye had one reinjection, 3 eyes three reinjections, 2 eyes six reinjections), 1 eye received one reinjection and laser treatment. Conclusions IVB alone or associated with laser photocoagulation is effective in improving BCVA and CRT in patients with ME secondary to BRVO over a12-month follow-up. The use of IVB in ME secondary to BRVO is promising. However, further studies are needed to assess the best treatment regimen and real efficacy.

Purpose To assess the efficacy and safety of intravitreal injection of ranibizumab (IVR) in patients with retinal angiomatous proliferation (RAP) Methods 22 eyes of 22 patients with RAP were retrospectively enrolled in the study. Patients were divided into 2 groups depending on prior treatment history: 12 eyes with newly diagnosed RAP, treatment naïve were included in group A, and 10 patients who had undergone previous therapy (intravitreal bevacizumab/triamcinolone acetonide monotherapy or combined with photodynamic therapy) were included in group B. All patients underwent visual acuity (VA) measurement using Snellen charts (converted into LogMAR for statistical analysis), complete ophthalmic examination, fluorescein and indocyanine-green angiography (FA and ICGA), and optical coherence tomography (OCT) at baseline, 3 and 5 months. All patients received three consecutive IVR (0.5 mg) on a monthly basis. The need for additional injections was based on the presence or recurrence of fluorescein leakage, evidence of RAP on ICGA, persistent or recurrent intra/subretinal fluid on OCT, new hemorrhage. Main outcome measures were changes in VA and central retinal thickness (CRT) on OCT. Results Baseline VA was 0.68±0.48 LogMAR (mean±SD) in group A and 0.74±0.33 LogMAR in group B. Eyes in group A exhibited a mean visual improvement of 0.08±0.16 LogMAR (p=0.11) and 0.07±0.19 LogMAR (p=0.25) at 3 and 5 months FU, compared to a mean variation of 0.0±0.27 LogMAR (p=1.0) and 0.01±0.28 LogMAR (p=0.91) in group B. In both groups changes in VA were not significant. Baseline CRT, 398±150 µm and 389±110 µm in group A and B respectively, decreased significantly in both groups (p

An 83-year-old woman affected by nasal branch retinal vein occlusion with macular star underwent treatment with intravitreal triamcinolone acetonide injection followed by laser treatment addressed to the leaking vascular lesions. Visual acuity improved from 20/200 to 20/40 with a remarkable reduction of the macular exudates and resolution of dye leakage on fluorescein angiography over a 2-year follow-up. Nasal branch retinal vein occlusion may rarely occur with macular edema and macular star. Intravitreal triamcinolone acetonide injection and laser treatment of the leaking vascular lesions can result in visual function improvement over a 2-year follow-up.

Purpose To assess the effects of intravitreal bevacizumab (Avastin) injections in the treatment of choroideal neovascularization (CNV) associated with multifocal choroiditis (MC). Methods Prospective interventional case series. Patients with MC complicated by subfoveal CNV underwent a complete ophthalmologic examination, including ETDRS visual acuity, optical coherence tomography (OCT), fluorescein angiography, and indocyanine green angiography. The protocol required 3 monthly consecutive injections, followed by repeated injections as needed. The planned follow-up was 12 months. Results Ten patients were enrolled in the study and prospectively followed up. Mean visual acuity and mean foveal thickness (FT) at the baseline were 0.58±0.48 (logMAR±SD) and 290±92µm SD, respectively. At the 3-month examination, mean visual acuity improved to 0.42±0.48 and mean FT decreased to 298±172µm SD. At the 12-month examination, mean visual acuity was 0.40±0.49, and mean FT was 255±163µm. No side-effect or complication was registered. Conclusion Intravitreal bevacizumab is a safe and beneficial treatment for CNV associated with MC in a short-term follow-up. A longer follow-up and a larger sample of patients are required to validate the results.

PURPOSE. To propose a possible treatment for symptomatic serous pigment epithelium detachment (SPED) in the setting of dry age-related macular degeneration. METHODS. A 60-year-old woman presented with a SPED, subfoveal in location, enlarging in size and with gradually worsening vision over 1 year of follow-up, without any evidence of choroidal neovascular membrane or neurosensory detachment until it was treated with subthreshold micropulse laser. RESULTS. The last follow-up showed complete resolution of the SPED with restoration of visual function. CONCLUSIONS. Subthreshold micropulse laser could serve as a useful therapeutic modality for the treatment of symptomatic SPED. (Eur J Ophthalmol 2009; 19: 887-9)

BACKGROUND: Drusen are amorphous yellowish deposits beneath the sensory retina. People with drusen, particularly large drusen, are at higher risk of developing age-related macular degeneration (AMD). The most common complication in AMD is choroidal neovascularisation (CNV), the growth of new blood vessels in the centre of the macula. The risk of CNV is higher among patients who are already affected by CNV in one eye.It has been observed clinically that laser photocoagulation of drusen leads to their disappearance and may prevent the occurrence of advanced disease (CNV or geographic atrophy) associated with visual loss.OBJECTIVES: To examine the effectiveness and adverse effects of laser photocoagulation of drusen in AMD.SEARCH STRATEGY: We searched CENTRAL, MEDLINE and EMBASE on 14 November 2008.SELECTION CRITERIA: Randomised controlled trials (RCTs) of laser treatment of drusen in AMD in which laser treatment had been compared with no intervention or sham treatment. Two types of trials were included. Some trials studied one eye of each patient (unilateral studies); other studies recruited patients with bilateral drusen and randomised one eye to photocoagulation or control and the fellow eye to the other group.DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies and extracted data. We pooled data from unilateral and bilateral studies using a random-effects model. For the bilateral studies, we estimated the within-patient correlation coefficient from one study and assumed it was valid for the others.MAIN RESULTS: We found nine studies which randomised 2216 people: four unilateral trials, three bilateral trials and two trials that included both a unilateral and a bilateral study arm.Overall, the studies were of moderate quality. Only half of the trials reported adequate allocation sequence generation, allocation concealment and masking of visual acuity outcome assessors.Although two (of the nine) studies reported significant drusen disappearance at two years, photocoagulation did not appear to affect the development of CNV at two years follow up (nine studies, 1767 people followed up, odds ratio (OR) 1.04, 95% CI 0.71 to 1.51) or the loss of three or more lines of visual acuity (six studies, 1628 people followed up, OR 1.17, 95% CI 0.75 to 1.82).AUTHORS' CONCLUSIONS: The trials included in this review confirm the clinical observation that laser photocoagulation of drusen leads to their disappearance. However, there is no evidence that this subsequently results in a reduction in the risk of developing CNV, geographic atrophy or visual acuity loss.

La degenerazione maculare legata all'età (detta anche degenerazione maculare senile ovvero AMD) è attualmente la prima causa di cecità o di ipovisione nei Paesi occidentali. In Italia si calcola che siano affetti da AMD oltre 765.000 individui (altre stime indicano un milione di persone); ogni anno si verificano tra i 63mila e i 91mila casi. Il volume tratta un documento di consensus elaborato tra i più autorevoli esponenti dell'oftalmologia nazionale

Purpose : To assess the effects of intravitreal bevacizumab (Avastin) injections in the treatment of choroideal neovascularization (CNV) associated with pattern distrophy (PD) of the retinal pigment epithelium. Methods Prospective interventional case series. Patients with PD complicated by CNV were considered. All patients underwent a complete ophthalmologic examination, including ETDRS visual acuity, electroretinogram, electrooculogram, optical coherence tomography, fluorescein angiography, and indocyanine green angiography. The protocol required 3 monthly consecutive injections, followed by repeat injections over the 12-month follow-up on the basis of OCT parameters, angiographic features, visual acuity response. Results Eight patients were enrolled in the study and prospectively followed up. Mean visual acuity and mean foveal thickness (FT) at the baseline were 0.74±0.42 (logMAR±SD) and 277±117µm SD, respectively. At three-month examination, mean visual acuity improved to 0.51±0.31 and mean FT decreased to 225±88µm SD. At 12-month examination, mean visual acuity was 0.49±0.26, and mean FT 222±87µm. No side-effect or complication was registered. Conclusions Intravitreal bevacizumab seems to be a beneficial treatment for CNV associated with PD in a short term follow-up. However, a longer follow-up is necessary to validate our results, bearing in mind that CNV related to PD is a quite rare association, and that a randomized clinical trial on this topic is unlikely.

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for anterior segment neovascularizations (ASNVs) in patients affected by ischaemic form of central retinal vein occlusion (CRVO).METHODS: Prospective non-comparative case series including 10 consecutive patients (10 eyes) affected by ischaemic CRVO. Main outcome measure was the obliteration of ASNV.RESULTS: One month after PDT, biomicroscopic examination showed partial obliteration of iris new vessels and complete closure of angle neovascularization. Iris fluorescein angiography performed 1 week after treatment showed partial closure of the iris new vessels with no evidence of leakage in the late phases. During the subsequent examinations, a partial reopening of the iris and angle new vessels in association with dye leakage on fluorescein angiography was evident. In any case, the fluorescein leakage turned out to be still reduced with respect to the baseline aspects.CONCLUSIONS: Our results show that PDT with verteporfin can partially obliterate ASNVs in eyes affected by ischaemic CRVO preventing from the evolution towards advanced stages of neovascular glaucoma, but is not effective in cases with complete angle synechial closure.

PURPOSE: To evaluate the effectiveness of macular grid laser photocoagulation (MGLP) in obtaining the reabsorption of exudative retinal detachment (ERD) in patients with ischemic branch retinal vein occlusion (BRVO).METHODS: Prospective, randomized clinical trial including 31 patients with ERD secondary to ischemic BRVO, who were randomized either to MGLP or to observation. A complete ophthalmologic examination was performed within 7 days of treatment, and was arranged to be repeated regularly every 6 months for 24 months. MGLP was performed using a krypton laser with a spot size of 100 microm at 0.1 second. The main outcome measure was the number of eyes that had gained at least 15 letters at the 24-month examination in the two groups.RESULTS: By the month 24 visit, 40% of the patients in the MGLP group had gained at least three lines of visual acuity as opposed to no patient in the control group. The mean best-corrected visual acuity passed from 20/160 to 20/125 Snellen equivalent in the MGLP group, and from 20/160 to 20/400 Snellen equivalent in the control group at month 24. The difference in the mean reabsorption time was statistically significant (P < 0.001) comparing the treated group with the controls (9.1 versus 15.8 months).CONCLUSION: Natural history of ERD secondary to ischemic BRVO is poor, and MGLP is able to prevent visual acuity deterioration through a 24-month follow-up.

PURPOSE: To describe changes in the retinal pigment epithelium (RPE) induced by photodynamic therapy (PDT) in eyes with subfoveal choroidal neovascularization (CNV) associated with pathological myopia (PM).METHODS: We carried out an open-label, prospective, interventional case series including 26 patients affected by subfoveal CNV in PM who underwent PDT with a 12-month follow-up. Particular attention was paid to the detection of changes at the RPE level in the areas exposed to the laser compared with baseline conditions.RESULTS: The median age of the patients was 58.5 years and the median duration of symptoms was 2 weeks. A pigmentary zone was present before PDT in 20 eyes (77%), incompletely encircling the CNV in all but two of the 20 eyes. At the end of the follow-up, the CNV in all eyes was seen to be completely or incompletely encircled by a band of hyperpigmentation, which was surrounded by RPE alterations, including depigmentation in all cases and atrophic changes in 14 eyes.CONCLUSIONS: After PDT, alterations in the RPE develop in myopic eyes. These include accentuation of the pigmentary zone surrounding the CNV and progressive atrophic changes. Further studies are needed to correlate post-PDT RPE damage with longterm visual outcome.

BACKGROUND: The objective was to report a case of pseudoxanthoma elasticum associated with type 2A idiopathic juxtafoveolar telangiectasis (T2AIJT) complicated by bilateral subretinal neovascular membranes (SRNVM).METHODS: The right eye with juxtafoveal SRNVM and the left eye with subfoveal SRNVM underwent laser photocoagulation and photodynamic therapy respectively. The follow-up duration was 48 months.RESULTS: Best corrected visual acuity was 20/32 in both eyes at baseline, and 20/32 in the right eye and 20/200 in the left eye at the end of the follow-up. Atrophic changes in the retinal pigment epithelium developed around the SRNVM treated with photodynamic therapy (PDT).CONCLUSIONS: Pseudoxanthoma elasticum may be associated with T2AIJT complicated by bilateral SRNVM. Further studies are needed to assess both efficacy and appropriate PDT regime in T2AIJT-related SRNVM, especially if associated with other conditions.

Purpose To evaluate the effectiveness of the therapy with subthreshold grid laser treatment with infrared micropulse 810 nm diode laser for clinically significant macular edema in diabetic retinopathy (DR). Methods Prospective interventional case series, including 11 patients (11 eyes) with macular edema in DR. All the patients were treated with infrared subthreshold (no intraoperative visible endpoint) grid laser treatment. The laser was applied in the area of edema in a grid pattern over the leaking or capillary occlusion area while sparing the central of the foveal avascular zone. The patients underwent an ophthalmologic examination icluding best-corrected visual acuity (BCVA) with ETDRS charts, contrast sensitivity with Pelli-Robson chart, digital stereo fundus photography, and foveal thickness measurements by Optical coherence tomography. The planned follow-up was 12 months. Results Mean BCVA improved from 20/40 at baseline to 20/32 at 1 year control. Mean foveal thickness changed from 416µ initially to 301µ, and total macular volume from 8,45mm3 to 7,75 mm3. At the end of the follow-up 3 patient (27%) maintained the initial VA, six (55%) obtained improvement of at least 1 line, with two of them gaining two lines (18%). Conclusions Subthreshold grid laser treatment with infrared micropulse 810 nm diode laser is an effective treatment in improving and maintaining visual function in patients affected by macular edema in diabetic retinopathy for 1 year follow-up. Randomized controlled trials with longer follow up and larger number of patients are necessary to compare the effectiveness as against conventional grid laser photocoagulation.