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The use of intravitreal triamcinolone in ophthalmology continues to increase. A number of indications for its use have now been documented. One of the significant side effects of it is non‐infectious endophthalmitis. Maia and coworkers in a retrospective study document that this complication (non‐infectious endophthalmitis) was significantly more likely to occur when triamcinolone was used with preservatives than without. They suggest that triamcinolone should be used without preservatives.
See pages 1099 and 1122
Ophthalmologists are well aware of the vascular changes that occur in the retina as the result of diabetes. Recently evidence has accumulated that damage to neural and glial cells may occur in the retina even in the absence of significant retinopathy. Verbraak and coworkers measured the retinal thickness in a group of diabetic patients with minimal retinopathy. Paracentral retinal thickness was significantly decreased in these patients suggesting that intraretinal neural tissue loss is an early stage of diabetic ocular pathology.
See page 1135
The use anti‐vascular endothelial growth factor (anti‐VEGF) therapy for the treatment of neovascular age related macular degeneration (AMD) is widespread although carefully controlled large trials have yet to be completed. Takeda and coworkers performed a systematic review of the current randomised controlled trials (RCTs) of these drugs that are currently available. Only three studies of ranibizumab and only two of pegaptanib met their inclusion criteria. The results of this review suggest that both drugs appear to slow or stop the progression of neovascular AMD. No data are available to judge whether pegaptanib is superior to ranibiszumab or how the two of them fair in reference to unlicensed drugs (Avastin). Head to head RCTs with economic evaluations are imperative so that ophthalmologists can make informed decisions about the use of these promising medications.
See page 1177
Although the use of photodynamic therapy has decreased because of the introduction of anti‐vascular endothelial growth factor (anti‐VEGF) medications its use for some circumstances in choroidal neovascular membranes continues. Grifanti and coworkers studied choroidal neovascular membranes that underwent treatment with photodynamic therapy. They found a temporary decrease in matrix metalloproteinases 2 and 3 in the RPE/Bruch's membranes, vessels and stroma in these specimens. However, at longer intervals, MMP/9 may be associated with the recurrence of the angiogenic process as the result of induction of endostatin.
See page 1183
A complete understanding of the pathophysiology of retinal vein occlusion has yet to be established. Williamson reports a prospective comparative interventional study of 19 patients with central retinal vein occlusion. In this study colour Doppler imaging of the central retinal artery and vein in the region of the lamina cribosa was performed. The author concludes that constriction of the vein in the region of the lamina cribosa can be inferred because of higher blood velocities seen at this site posterior to the lamina. Neurotomy did not affect these measurements.
See page 1190
The association of Behcet's disease and the old Silk Trail is well known to ophthalmologists. It is not surprising therefore that a large study of optic nerve disease associated with Behcet's disease is reported by Berker and coworkers in Ankara, Turkey. In this study hormone replacement therapy (HRT) was used to investigate the optic disc. The authors note that there was a relationship between the severity of the ocular Behcet's disease and optic disc topography. Eyes with smaller optic discs were more likely to have a more severe course of the uveitis and with more frequent relapses than in those patients with larger optic discs. This is an interesting variation on the theme of the small disc “at risk”.
See page 1199
The oculoglandular syndrome may be related to a number of pathogens. One of the more uncommon agents responsible for it is tularemia. Padeshki describe a tularemia outbreak in Bulgaria in which four cases of tularemia were seen with oculograndular syndrome. In one case the diagnosis was established from a conjunctiva swab specimen from a patient who was otherwise sero‐ negative. The use of PCR evaluation in suspected tularemia patients is endorsed by these authors.
See page 1206
Despite the fact that its use for the treatment of age‐related macular degeneration is “off‐labelled”, Avastin is being widely used by ophthalmologists. Raftery addresses the question of how much better Lucentis would need to be in order to justify its 50‐fold higher price. Comprehensive modelling of cost effectiveness leads the author to conclude that it is highly unlikely that Lucentis will be a cost‐effective alternative to Avastin. A direct head to head comparison of these two drugs needs to be completed so that ophthalmologists can make an appropriate cost‐effective decision in choosing the appropriate therapy.
See page 1244