Purpose To describe the efficacy of intravitreal aflibercept on 12-month visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) recalcitrant to prior monthly intravitreal bevacizumab or ranibizumab. Methods Non-comparative case series of 21 eyes of 21 AMD patients with evidence of persistent exudation (intraretinal fluid/cysts, or subretinal fluid (SRF), or both) on spectral domain OCT despite Z6 prior intravitreal 0.5 mg ranibizumab or 1.25 mg bevacizumab (mean 29.8±17.1 injections) over 31.6±17.4 months who were transitioned to aflibercept. Results At baseline, best-corrected visual acuity (BCVA) was 0.42 ± 0.28 logarithm of minimum-angle of resolution (logMAR), central foveal thickness (CFT) was 329.38 ± 102.67 mm and macular volume (MV) was 7.71±1.32 mm 3 . After 12 months of aflibercept (mean 10.2±1.2 injections), BCVA was 0.40±0.28 logMAR (P ¼ 0.5), CFT decreased to 292.71 ± 91.35 mm (P ¼ 0.038) and MV improved to 7.33 ± 1.27 mm 3 (P ¼ 0.003). In a subset of 15 eyes with a persistent fibrovascular or serous pigment epithelial detachment (PED), mean baseline PED greatest basal diameter (GBD) was 2350.9±1067.6 mm and mean maximal height (MH) was 288.7±175.9 mm. At 12 months, GBD improved to 1896.3 ± 782.3 mm (P ¼ 0.028), while MH decreased to 248.27 ± 146.2 mm (P ¼ 0.002). ConclusionIn patients with recalcitrant AMD, aflibercept led to anatomic improvement at 12 months, reduction in proportion of eyes with SRF and reduction in PED, while preserving visual acuity.

Purpose To determine recent trends for and sociodemographic/comorbid conditions associated with penetrating (PK) and lamellar keratoplasties (LK) in keratoconus (KCN). Methods KCN patients and subsequent PK and LK procedures were identified using ICD-9 and CPT billing codes. The change in surgical rates was calculated over a decade and multivariate analysis demonstrated factors associated with having surgery. Results 21588 KCN patients had 1306 PK’s and 109 LK’s during the study period. Individuals were significantly less likely to undergo PK from 2009–2012 compared to 2001–2008 (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.47–0.68, p <0.001). Multivariate analysis revealed the factors that increased the likelihood of PK alone and included age 20–40 (OR 1.90, 95% CI 1.19–3.04, p <0.001), black race (OR 1.36, 95% CI 1.06–1.74, p = 0.01), and education less than a bachelor degree or a high school diploma only (OR 1.94–2.84, p <0.001 for all comparisons). Female gender (OR 0.74, 95% CI 0.63–0.88, p <0.001) and household net worth either between 150 and 249K (OR 0.64, 95% CI 0.48–0.84, p <0.001) or more than $500,000 (OR 0.71, 95% CI 0.51–0.99, p = 0.03) were traits associated with a decreased odds of PK. No significant associations for LK were observed. Conclusion The rate of PK in KCN is decreasing in the United States. The 3rd or 4th decade of life, male gender, black race, lower education, and greater household net worth are associated with increased odds of PK.

A new, binocular computerized pupillometer provides an automated method for the quantitative assessment of the afferent pupillary response. The intereye asymmetry in the pupil response correlates strongly with asymmetry in visual function, as measured by SAP, in patients with glaucoma.

Somnambulism, or sleepwalking, has always been of interest to theologians, writers, philosophers, physicians, and others fascinated by unusual behaviors. This parasomnia, which was defined less precisely in the past than it is today, has long been featured in medical dissertations and books of medicine. Further, Shakespeare, Bellini, and Brown, among others, incorporated it into their plays, operas, and novels. Because some somnambulists turned violent and committed other acts detrimental to society, sleepwalking also demanded attention from legal systems, and guidelines were set for whether somnambulists could be held responsible for their actions. This historical review focuses on these developments pertaining to somnambulism through the seventeenth, eighteenth, and nineteenth centuries.