BackgroundTo evaluate the relative efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) agents for the treatment of neovascular age-related macular degeneration (AMD).MethodsSystematic literature review identifying RCTs comparing anti-VEGF agents to another treatment published before June 2016. Efficacy assessed by mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline at up to 2 years followup. Safety assessed by proportions of patients with death, arteriothrombotic and venous thrombotic events, and at least one serious systemic adverse event at up to 2 years of followup.ResultsFifteen RCTs selected for meta-analysis (8320 patients). Two trials compared pegaptanib, and three trials compared ranibizumab versus control. Eight trials compared bevacizumab with ranibizumab. Two trials compared aflibercept with ranibizumab. There were no significant differences between bevacizumab and ranibizumab for BCVA at 1 or 2 years (weighted mean difference = − 0.57, 95% CI − 1.55 to 0.41, P = 0.25 and weighted mean difference = − 0.76, 95% CI − 2.25 to 0.73, P = 0.32, respectively). Ranibizumab was more effective in reducing CMT at 1 year (weighted mean difference = 4.49, 95% CI 1.13 to 7.84, P = 0.009). Risk ratios comparing rates of serious systemic adverse events at 1 and 2 years were slightly out of favour for bevacizumab. Aflibercept compared with ranibizumab demonstrated similar mean change in BCVA, reduction in CMT, and safety at 1 year.ConclusionsBevacizumab and ranibizumab had equivalent efficacy for BCVA, while ranibizumab had greater reduction in CMT and less rate of serious systemic adverse events. Aflibercept and ranibizumab had comparable efficacy for BCVA and CMT. This provides information to balance comparable effects on vision and risk of adverse events between anti-VEGF agents.

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Background Offering breast reconstruction (BR) at the time of mastectomy is standard of care in Australia with proven quality‐of‐life benefits. Previously BR rates in Australia have been low compared to similar countries. Accurate up‐to‐date information is needed to promote equity in access to BR and inform future planning of services. This study analysed recent trends and variations of BR uptake in Australia. Method Data from the BreastSurgANZ Quality Audit (BQA) were used to identify patients who underwent mastectomy with or without reconstruction for invasive or in situ breast carcinoma from 2010 to 2019. The association between BR uptake and the variables of jurisdiction (state or territory), age, hospital type and remoteness, and remoteness of patients' home addresses were analysed. Results A total 41 880 women underwent mastectomy between 2010 to 2019. The national BR rate steadily increased from 12.8% in 2010 to 29% in 2019, with a 10‐year national average of 21.3%. Statistically significant differences in BR uptake (P < 0.001) were found between states with higher rates in New South Wales and Victoria, with BR more likely in private hospitals and in younger women (P < 0.001), and less likely in remote areas (P < 0.001). Conclusion The Australian BR rate has increased over the 10‐year period, but significant variation still exists between states. BR is lower in older women and those living in regional and remote areas. While the steady increase in BR uptake is encouraging, barriers that exist to equitable provision of reconstructive surgical services for all women living with breast cancer still need to be corrected.

CDE is 28.87% less, and VOs are significantly improved, in denser cataracts in the CPS compared with the IPS. The authors recommend the CPS for cases with denser nuclei.

IV.

Implementation of a preoperative prophylaxis protocol that used PI 10% with a 3-minute exposure time can be performed in clinical practice. The 3-minute exposure time had no adverse sequelae.

Aortoduodenal fistula 2 years after elective endovascular repair of an abdominal aortic aneurysm Aortoenteric fistula (AEF) is a rare complication after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). 1 An AEF is a pathological connection between the aorta and gastrointestinal tract that is invariably life-threatening. Primary AEFs occur de novo due to mechanical factors, aortic inflammation or infection. Secondary AEFs commonly involve a previously placed aortic graft. Almost all secondary AEF occur after open AAA repair but cases following EVAR are reported. 1-6 We present our experience with this rare complication, which is unique because it was only identified at time of operation. An 85-year-old female with a history of chronic lymphocytic leukaemia on ibrutinib and atrial fibrillation on rivaroxaban was referred to a vascular surgeon with a 38 × 30 mm incidental saccular infrarenal aortic aneurysm. There was no clinical evidence that the aneurysm was mycotic. She underwent an uncomplicated endovascular graft repair using a Gore Excluder AAA Endograft (W. L. Gore & Associates, Inc.; Newark, Delaware, US). Follow-up duplex ultrasound at 24 months post-operatively demonstrated a patent stent graft with no evidence of endoleak. Twenty-five months post-operatively, the patient developed left lower quadrant abdominal pain, night sweats and constipation. She denied any gastrointestinal bleeding. Investigation of her abdominal pain including a colonoscopy did not identify a cause. She

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