Aim: To evaluate the efficacy and safety of triple therapy consisting single-session photodynamic therapy (PDT), intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVTA) for treatment of neovascular age-related macular degeneration (AMD) Methods: Consecutive patients with subfoveal choroidal neovascularisation (CNV) secondary to AMD were treated with PDT using a standard protocol immediately followed by 1.25 mg of IVB and 4 mg of IVTA. 1.25 mg of IVB was given at 3 months for residual leakage. Best-corrected Snellen visual acuity (BCVA) and fluorescein angiography (FA) were performed prior to treatment. BCVA, intraocular pressure (IOP) and presence of vitritis were documented at 1 and 6 weeks, 3 and 6 months. FA was repeated at 3 and 6 months. Outcome measures included visual improvement measured by logMAR equivalent, angiographic evident of leakage and safety profile. Results: 36 eyes of 33 patients, aged 76.4 (SD 10.5) years with mean follow-up of 14.7 (6.9-19.2) months were analysed. Baseline logMAR acuity was 1.22 (0.71). The mean logMAR acuity was 1.14 (0.62) and 1.18 (0.63) at 3 and 6 months respectively. At 6 months, 61.1% (22/36) showed stable or gaining vision, and 27.8% (10/36) gained three or more lines. Twentyeight eyes (77.8%) achieved CNV resolution by single session of triple therapy. One eye lost more than six lines due to retinal pigment epithelium rip, three eyes showed a significant cataract requiring surgery, and two showed persistent raised IOP at 6 months. None resulted in endophthalmitis or reported thromboembolic event. Conclusions: Short-term results of single session triple therapy suggested that it might be a useful treatment option for neovascular AMD based on its low retreatment rates, sustainable CNV eradication result and visual gain achievement. However, the risk and benefits of using intravitreal triamcinolone in addition to combined PDT and IVB warrant further evaluation.Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. It can be classified into non-neovascular (dry) and neovascular (wet) form. The neovascular form of AMD is characterised by the development of choroidal neovascularisation (CNV). It contributed to a minority of cases, approximately 10% to 20% but associated with 80% to 90% of visual loss.
We report a case of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis after phacoemulsification in a continuous ambulatory peritoneal dialysis (CAPD) patient with a history of MRSA infection. This case raised the problem of preoperative identification and subsequent management of MRSA carrier status, which might reduce the risk for sight- or life-threatening infection.
We report two rare cases of macular fold development after membrane peeling operation for epiretinal membrane. Patient 1 developed both inner and outer retinal folds, and patient 2 developed inner retinal fold; both were partial thickness macular folds. There was no evidence of retinal detachment or any preoperative macular fold. These configurations of retinal folds after macular epiretinal membrane surgery have not been reported before. In patient 1, four retinotomy sites were required to induce a complete macula detachment, as the retina was abnormally adherent than usual. In patient 2, no macular detachment was induced, and no intravitreal tamponade was used. Soft-tip cannula was used to relieve the inner retinal attachments. To the best of our knowledge, this is the first reported case using this method to successfully manage a retinal fold. This technique avoids the potential risks associated with retinotomies, macular re-detachment, and intravitreal tamponade. Both patients achieved resolution of macular folds and improvement in visual acuity.
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