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Giant cell arteritis is a systemic vasculitis affecting large to medium sized arteries. Ocular symptoms in patients with giant cell arteritis are often related to acute blindness, which may occur in significant numbers of patients. The disorder is reasonably common in North America and Europe. A study from Saudi Arabia by Chaudhry and coworkers suggests that the disorder is uncommon in an Arab population. Only 6.8% of a 102 patients who underwent temporal artery biopsy had biopsy proven giant cell arteritis. None of the untreated patients with a negative biopsy developed other symptoms typical of giant cell arteritis.
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Considerable controversy still surrounds the question of the ideal surgical approach and post‐operative management to prevent endopthalmitis in the cataract patient. Recent reports have suggested that clear‐cornea, unsutured wounds increase the risk for endopthalmitis. Whether pre‐operative or post‐operative antibiotics are effective in preventing endopthalmitis remains extremely controversial. Thoms and coworkers report a retrospective consecutive case series of 815 consecutive cataract procedures performed by a single cataract surgeon. In this study, five cultured positive post‐operative endophthamits cases occurred. Because the study group and effected group are small, definitive conclusions cannot be drawn, but the authors suggest that the incidence of endopthalmitis after cataract surgery may be reduced by suturing corneal incisions and initiating antibiotic eye drops post‐operatively.
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Cystoid macular is known to occur in a certain subset of patients with retinitis pigmentosa. The use of either oral or topical carbonic‐anhydrase inhibitors has been described as potentially useful for the treatment of these patients. However, a recurrence or rebound of macular oedema in these patients with a continued use of oral medication has been reported. Fishman and Apushkin report on the treatment of eight patients with retinitis pigmentosa and foveal cystic‐appearing lesions. These patients were treated with topical carbonic‐anhydrase inhibitors. Three of the eight patients should an improvement in their visual acuity. A recurrence or rebound of cystoid macular edema was observed in two patients. The authors conclude that sustained beneficial effects from continued treatment of topical carbonic‐anhydrase inhibitors may occur in some patients with cystoid macular edema associated with retinitis pigmentosa.
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Although PDT monotherapy for age related macular degeneration has been replaced by newer anti‐ VEGF therapy, its efficacy is still an important issue. Because of the cost differential PDT may still be utilized in some patients under some circumstances. Potter and Szabo report a prospective interventional cohort study of 108 individuals treated with PDT. They observed recurrences in 36 of 108 eyes over a period of 18 months following the cessation of PDT. Twenty‐three of the 36 recurrences were clinically meaningful. The authors suggest that recurrence rates with PDT monotherapy remains significant at eighteen months follow‐up.
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Surgical excision is the preferred method of removing eye lid tumours as it is the only technique in which margins can be examined. However, previous studies have shown that residual tumours are found in the margin of excised specimens in about 50% of surgical basal cell carcinoma excisions. In many centres, Mohs' micrographic surgery has provided a high rate of cure and tissue conservation. Dhingra and coworkers report a new surgical technique involving excision of the eye‐lid basal cell carcinoma with a safety margin of 4mm. A 1mm strip was excised along the whole perimeter from the margin of the freshly excised specimen. Utilizing this technique, the authors report that in 28 eye lid basal cell carcinomas, twenty‐two specimens were clear of tumour. In the other six cases, further management involved observation, additional surgical excisions, and/ or Mohs' surgery.
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Vascular endothelial growth factor has been implicated in corneal neovascularisation. This raises the possibility that the use of new anti‐ VEGF compounds may be effective in treating corneal neovascularistion. Manzano and coworkers report the results of an experimental model in rats in which the use of Bevacizumab appeared to inhibit the degree of corneal neovascularisation induced by cauterisation.
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Bevacizumab is an antiangiogenic compound originally developed to target tumour vessels. However, ophthalmologists are currently using it off‐label in the treatment of age related macular degeneration. Peters and coworkers describe a porcine endothelial cell model in which they evaluated bevacizumab therapy. In this model, bevacizumab significantly reduced VEGF induced permeability and proliferation of choroidal endothelial cells. Freezing and thawing of bevacizumab had a moderate effect on its biological activity.
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