IntroductionTo determine visual and anatomical outcomes of diabetic macular oedema (DMO) patients in a tertiary centre following conversion to aflibercept having been refractory to previous treatment with bevacizumab/ranibizumab.MethodsA retrospective case series of patients with a diagnosis of DMO undergoing aflibercept intravitreal therapy for at least 6 months who had previous treatment with three consecutive bevacizumab/ranibizumab injections pre-switch. Exclusion criteria included other procedures affecting visual outcome performed within the treatment period. Outcomes measured included visual acuity (VA), central macular thickness (CMT) and injection frequency.ResultsEighteen eyes of 13 patients were included. Mean VA pre-switch was 61.5 ± 13.8 letters and CMT was 433.2 ± 101.4. Mean number of prior bevacizumab/ranibizumab treatments was 11.3 ± 7.2. Mean follow-up post-switch was 22.5 months (SD 7.9). Mean VA improved from baseline by 4.8 letters at 6 months (p = 0.005), by 6.1 letters at 12 months (p = 0.006), by 7.9 letters (p = 0.004) at 18 months and by 6.4 letters (p = 0.1) at 24 months. Mean CMT decreased from baseline by 108.6 μm at 6 months (p = 0.01), 117.7 μm at 12 months (p = 0.0003), 158.0 μm at 18 months (p = 0.005) and by 123.3 μm at 24 months (p = 0.02).ConclusionSwitching to aflibercept in treatment-resistant DMO produces significant improvements in visual and anatomical outcomes, with eventual maintenance of VA levels.

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Purpose To determine visual and anatomical outcomes of Age‐Related Macular Degeneration (ARMD) patients, in a tertiary centre, following conversion to Aflibercept having been refractory to previous treatment with Bevacizumab and/or Ranibizumab and to make international comparisons. Methods A retrospective chart review of patients with a diagnosis of neovascular AMD (nvAMD) undergoing Aflibercept intravitreal therapy for at least six months who had previous treatment with three consecutive Bevacizumab ± Ranibizumab injections prior to switch. Exclusion criteria included any other procedures affecting visual outcome performed within the treatment period. Outcomes measured included visual acuity (VA), central macular thickness (CMT) and injection frequency. Results Sixty eyes of 52 patients were included, 25 of which were male. Mean BCVA pre‐switch was 55 ± 15 letters and CMT was 285 μm ± 77. Eyes received a mean of 14 ± 8 prior Bevacizumab/Ranibizumab. The mean follow up post switch was 13.2 months (SD = 5.5). Mean BCVA improved by two letters at six months (SD = 6.6, p < 0.05), by four letters at 12 months (SD = 6, p < 0.01). The mean VA at 18 and 24 months was unchanged from baseline VA. The mean CMT decreased by 44 μm at six months (SD = 73.5, p < 0.0001), 48.4 μm at 12 months (SD = 88.1, p < 0.01), 48 μm at 18 months (SD = 22.39, p < 0.001). The mean number of injections in the six months pre‐switch was 2.8 (SD = 0.8), this increased to a mean of 4 injections (SD = 0.94) in first six months post switch then decreased to 2 injections (SD = 1) in each six month period thereafter (p = 0.002).There were no significant systemic or ocular adverse events. Conclusions Switching to Aflibercept in patients with treatment resistant AMD produces statistically significant improvements in visual and anatomical outcomes with eventual maintenance of visual acuity levels at one year post switch.

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Aims To review the distribution of histopathological diagnoses and visual outcome of orbital biopsy in an Irish tertiary referral centre over a 10-year period. Methods This was a retrospective, clinical-histopathological case series. Clinical records of all patients who underwent orbital biopsy between January 2008 and January 2018 in the Mater Misericordiae University Hospital were reviewed using data collected from theatre logbooks and hospital-based medical records. Results A total of 83 orbital biopsies in 77 patients were included for analysis in this study. The mean age was 55.7 ± 18.41 years. The mean follow-up period was 1.87 ± 2.097 years. The most common presenting symptoms and signs were pain (22.3%) and proptosis (27.6%). Most lesions were located in the extraconal space (65%), with incisional biopsy (65%) being the most common technique used to gain a sample for histopathological diagnosis. Histopathology analysis of the biopsies revealed malignant tumours (27, 32.5%), benign tumours (7, 8.4%), inflammation (26, 31.3%), and other diagnoses (23, 27%). Excluding patients who underwent exenteration procedures, no study patients suffered visual loss following orbital biopsy. Conclusions Orbital biopsy serves as a safe diagnostic tool in managing orbital diseases. The breakdown of diagnosis in our patients is in line with international studies. No patients in our series suffered vision loss as a result of their orbital biopsy. This emphasises its use as a safe procedure in the diagnosis and management of patients with the orbital disease. Our data provides helpful guidance to clinicians when counselling patients for orbital biopsy.