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Fully automated computer algorithms were able to detect hard exudates and HMA. This paper presents encouraging results in automatic identification of important features of NPDR.

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Sickle cell retinopathy is a potentially blinding condition that affects young people in the working age group. This review looks at the past, present and future management of sickle cell retinopathy within an African context. After Sickle cell disease was first reported in 1910, some reports from Africa were pivotal in describing the retinal changes associated with the disease. It soon became obvious that there was a varied clinical picture and clinical course. Several landmark studies were carried out in Jamaica to help elucidate the complexities of the disease and outline appropriate clinical management. In most of the developed world, the clinical management of sickle cell disease has improved with concurrent improvement in outcomes. Currently resource constraints in most Sub-Saharan African countries where there is a high burden of disease means that the management of sickle cell retinopathy is fraught with numerous challenges. Future large scale trials in Africa shall hopefully help to better elucidate the mechanisms behind proliferative sickle retinopathy and help in the development of new and improved therapeutic pathways. The use of technology can help immensely in the screening of patients with sickle cell to detect early proliferative changes and if necessary treat accordingly.

Bilateral naevus of Ota with choroidal melanoma and diffuse retinal pigmentation in a dark skinned person Naevus of Ota (naevus fusculocoeruleus ophthalmomaxillaris) was described by the Japanese dermatologist, Ota, in 1939 as a dermal melanocytic hamartoma that presents as bluish hyperpigmentation along the ophthalmic, maxillary, and mandibular branches of the trigeminal nerve. It is bilateral in less than 5% cases, occurring frequently in Orientals (0.2%-1%) and darker races and rarely in white people (0.04%). Open angle glaucomas and choroidal melanoma are the rare ocular involvements. Ota's naevus is more common in Asians than white people but uveal melanoma occurs predominantly in white populations. 1 2 Dark skinned patients represent only 1% of all cases of orbital melanomas. 3 The risk of developing uveal melanoma in a patient with naevus of Ota is one in 400 patients in their lifetime. 1 2 We report a rare case of bilateral naevus of Ota with a right (RE) choroidal melanoma and left (LE) diffuse pigmentation of retina. Case report A 73 year old Anglo-Indian woman was referred with complaints of photopsia. She had black hair and light brown skin. Examination revealed a brownish-black pigmentation of the conjunctiva, episclera, and periocular skin bilaterally (fig 1). Visual acuity for distance and near was 6/6 and N5, respectively, in each eye. Heterochromia was present, the right iris being a darker brown than the left, which had a sector of light brown colour. Gonioscopy and intraocular pressure were normal. The right fundus revealed a pigmented, large, elevated choroidal mass 10 disc diameter (DD) in size, 4 DD superonasal to the disc. Drusen were overlying it. No subretinal fluid was seen. The left eye showed a patchy dark pigmentation 3 DD in size, at the temporal edge of the macula. A ridge-like pigmented elevation, 3 DD long, was also seen along the superonasal vessels. Both optic discs and maculas were normal. Ultrasound in the right eye showed a 10 mm tumour, 4.2 mm high. Fluorescein angiography confirmed its independent circulation. A systemic examination found no signs of metastasis. A diagnosis of a

AimTo compare the visual outcomes of an urban population with age-related macular degeneration (AMD) undergoing ranibizumab monotherapy to the results from major clinical trials.ProceduresProspective data was collected from 164 wet AMD patients receiving intravitreal ranibizumab. Visual acuities were obtained with the Early Treatment Diabetic Retinopathy Study chart. All patients underwent a loading phase of three monthly treatments of ranibizumab. Patients were monitored monthly using a retreatment criterion. Treatment was further individualized by sequentially lengthening follow-up intervals when stable.ResultsAt 12 and 24 months, respectively, the percentage of eyes that maintained vision was 91% and 88.6%. We found that 20.3% of eyes had improved vision at 12 months and 20% at 24 months. At 12 months, 8.3% of eyes’ vision worsened and 12% worsened at 24 months.ConclusionIndividualized ranibizumab monotherapy is effective in preserving vision in wet AMD and follows the same trends as the pivotal trials.

Aims: To compare, in a single urban population, the visual outcomes of ranibizumab monotherapy in “White” (W) and “Non-White” (NW) patients with wet age-related macular degeneration (AMD). Procedures: Prospective data was collected from 434 eyes of 217 patients with wet AMD patients receiving intravitreal ranibizumab. Baseline and monthly LogMAR visual acuities were obtained. All patients received treatment under a “treat and extend policy” consisting of three monthly injections of ranibizumab, followed by individualised sequentially lengthening follow-up intervals when stable. Results: At 24 months, the percentage of eyes that maintained or improved vision was 91% in W patients and 83% in NW patients. Correspondingly, at 24 months, the percentage of visual loss was 9% for W patients and 17% of NW patients. We found that whilst W patients required fewer overall injections (14.1) they gained an average 4 LogMAR letters of visual acuity. However, NW patients required more injections (14.6) to gain 0.5 LogMAR letters of visual acuity over the same 24 months of treatment. Conclusions: Individualised ranibizumab monotherapy is more effective in preserving vision for W compared to NW patients with wet AMD.

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