To assess the noninferiority of the treat-and-extend (T&E) and fixed bimonthly regimens of 0.5 mg intravitreal ranibizumab as compared with the pro re nata (PRN) in na€ ıve patients with neovascular age-related macular degeneration (nAMD). Methods: Phase IV, randomized, 12-month, multicentre trial. Patients aged ≥50 years with nAMD and visual impairment [best-corrected visual acuity (BCVA) between 23 and 78 Early Treatment Diabetic Retinopathy Study (ETDRS) letters] were eligible. Patients (one eye per patient) were randomized to bimonthly, n = 103, T&E, n = 99 or PRN, n = 104. Noninferiority was established at five letters ETDRS. Results: The mean (95% CI) difference in BCVA at 12 months was 7.2 (4.2-10.2), 6.4 (2.9-9.8), and 8.0 (51.1-11.0) in the bimonthly, T&E and PRN, respectively. The bimonthly or T&E regimens were not inferior to the PRN scheme. All regimens were associated with a significant reduction of central subfield thickness and volume. The mean (95% CI) number of injections in the bimonthly regimen (7.6, 7.5-7.7) was similar as compared with the PRN regimen (7.4, 6.7-8.0) (p = 0.159) but lower than in the T&E regimen (9.3, 8.9-9.7) (p < 0.001). Conclusion: At 12 months, bimonthly and T&E ranibizumab were noninferior to PRN in na€ ıve nAMD. Key words: best-corrected visual acuity-fixed bimonthly-intravitreal anti-VEGF-neovascular age-related macular degeneration-pro re nata-ranibizumab-treat-and-extend † The In-Eye Study Group members are listed in Appendix 1.

To assess the effect of fluid status at baseline (BL) and at the end of the loading phase (LP) of three different ranibizumab regimens: treat-and-extend (T&E), fixed bimonthly (FBM) injections and pro re nata (PRN), in patients with neovascular age-related macular degeneration (nAMD).Design: Post hoc analysis of the In-Eye study (phase IV clinical trial). Methods: Patients were randomized 1:1:1 to the three study arms and were treated accordingly. The presence and type of fluid, intraretinal fluid (IRF) or subretinal fluid (SRF) and the anatomical and visual outcomes were analysed.Main outcome measures: Best-corrected visual acuity (BCVA), the mean change from baseline BCVA (BL BCVA), and the proportion of eyes gaining more than 15 letters or losing more than five letters were analysed. Morphological characteristics including the subtype of choroidal neovascular membrane and the development of atrophy and fibrosis were also evaluated. Results:Patients with SRF at LP had better visual outcomes than patients with IRF. The persistence of SRF did not affect the mean change from BL BCVA among the three treatment regimens. However, in patients with IRF mean change from BL BCVA was significantly lower in the FBM group. The presence of IRF at BL and at the end of the loading phase was associated with the development of fibrosis at the end of the study; this result was contrary to that observed for patients with SRF.Conclusions: While SRF is compatible with good visual and anatomical outcomes, IRF leads to worse results in patients with nAMD; our results suggest that patients with IRF have better outcomes when individualized treatment regimens are used (PRN or T&E) in contrast with a FBM regimen.

A computational fluid dynamics (CFD) model of the air flow generated by an air-assisted sprayer equipped with two axial fans was developed and validated by practical experiments in the laboratory. The CFD model was developed by considering the total air flow supplied by the sprayer fan to be the main parameter, rather than the outlet air velocity. The model was developed for three air flows corresponding to three fan blade settings and assuming that the sprayer is stationary. Actual measurements of the air velocity near the sprayer were taken using 3D sonic anemometers. The workspace sprayer was divided into three sections, and the air velocity was measured in each section on both sides of the machine at a horizontal distance of 1.5, 2.5, and 3.5 m from the machine, and at heights of 1, 2, 3, and 4 m above the ground The coefficient of determination (R2) between the simulated and measured values was 0.859, which demonstrates a good correlation between the simulated and measured data. Considering the overall data, the air velocity values produced by the CFD model were not significantly different from the measured values.

Changes in the cornea can influence outcomes in patients with primary open-angle glaucoma (POAG). We aimed to evaluate the relevance of changes in corneal biomechanics and intraocular pressure (IOP) in patients undergoing non-penetrating deep sclerectomy (NPDS) with the Esnoper V2000 implant® (AJL Ophthalmic S.A., Gasteiz, Spain). We included 42 eyes of 42 patients with POAG scheduled for NPDS with the Esnoper V2000 implant. Biomechanical properties were measured by Ocular Response Analyzer® G3 (ORA; Reichert Inc., Depew, NY, USA). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg) were measured the day before surgery and on day 1, 7, and 30 and 2 and 3 months after surgery. CH initially increased, fell below the presurgical value at 30 days after the surgery, and increased again at 2 and 3 months. CRF, IOPcc, and IOPg decreased on the first day after surgery, then followed a trend of increasing but stayed below pre-surgery levels. All values reached statistical significance. While observed changes in corneal biomechanics after NPDS and Esnoper V2000 implant were significant, more studies are needed if we are to understand their influence on corneal biomechanics and their clinical relevance in POAG.

Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings, such as macula layer thickness, the peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS, using optical coherence tomography (OCT); it also aims to monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: once before treatment, and again after six months of treatment. In mild–moderate patients, where retinal swelling had been demonstrated, retinal thicknesses decreased [fovea (p = 0.026), as did inner ring macula (p = 0.007), outer ring macula (p = 0.015), and macular volume (p = 0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p < 0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help to monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment.

PurposeTo describe a case of interlamellar keratitis induced by elevated intraocular pressure (IOP) in a patient with a history of LASIK surgery and the importance of having a strong diagnostic suspicion for establishing adequate treatment.MethodsIntraocular pressure‐induced interlamellar keratitis is one of the potential complications of LASIK refractive surgery. The cases described generally occur a few months after surgery although there are some cases that have been described several years after surgery, usually in a context of uveitis and corticosteroid treatment or silent glaucoma. We present a case of 43‐year‐old woman who came to the emergency room with visual acuity (VA) impairment in the left eye in the setting of elevated intraocular pressure‐induced interlamellar keratitis secondary to the intravitreal corticosteroid implant in her left eye due to a diabetic retinopathy. She underwent LASIK surgery 14 years ago.ResultsThe treatment was based on lowering the intraocular pressure. Oral acetazolamide and topical timolol, bimatoprost and brinzolamide were used. The patient recovered her baseline VA and the IOP were properly controlled posteriorly.ConclusionsThis case shows the importance of considering this diagnosis in patients with corneal haze, elevated intraocular pressure and a history of LASIK surgery to establish an adequate treatment. A full recovery is expected.Bibliography1. Galal A, Artola A, Belda J, (2006) Interface corneal edema secondary to steroid‐induced elevation of intraocular pressure simulating diffuse lamellar keratitis. Journal of refractive surgery.2. Lee V, Sulewski M, Zaidi A (2010) Elevated Intraocular Pressure–Induced Interlamellar Stromal Keratitis Occurring 9 Years After Laser In Situ Keratomileusis. Corneal Journal.3. Lyle W, Jin G, Jin Y (2003) Interface fluid after laser in situ keratomileusis. Journal of refractive surgery.4. Tourtas T, Kopsachilis N, Meiller R, et al. (2010). Pressure‐Induced Interlamellar Stromal Keratitis After Laser In Situ Keratomileusis. Corneal Journal.

Purpose: To report a case of pituitary adenoma showing the prognostic correlation between retinal nerve fibre layer analysis by OCT and the final postoperative visual result. Methods: A 55‐year‐old female patient with loss of visual acuity in the right eye. During the clinical study a pituitary adenoma was found. OCT showed greater involvement of the retinal nerve fibre layer of the right eye. It was decided to perform surgery to remove the adenoma. Results: A greater improvement is obtained in the left eye than in the right eye after surgery. This result was expected according to the range of involvement shown in the pre‐surgical OCT. Conclusions: OCT is a rapid, non‐invasive, quantitative and objective method for measuring this parameter, which is why this tool has been shown to be fundamental in the follow‐up of these patients and in making decisions such as the appropriate time to operate. The greater the involvement of the retinal nerve fibre layer, the worse the visual prognosis of each eye.

Purpose: Optic disc pit (ODP) is a rare congenital disorder that affects one in 10 000 people. Serous detachment of macula is the most common complication and the natural history of untreated ODP maculopathy is a gradual deterioration with significant visual loss. A multitude of interventions have been designed for the treatment but none has been established as the treatment of choice. Pars plana vitrectomy is one of the most commonly used procedure in recent years. We present a case report with surgical treatment and management of complications. Methods: An interventional case report of a 63‐year‐old man who attended the emergency room due to sudden visual loss and best corrected visual acuity (BCVA) of 20/200 in the right eye (RE). Upon his arrival, a visual field was performed in which complete abolition of the right field was observed, severely affecting the central area. A papillary pit was found in the eye fundus. Optical coherence tomography (OCT) revealed a serous retinal detachment (RD) with macular involvement and surgical management was decided. Results: A successful pars plana vitrectomy (PPV) with peeling of the internal limiting membrane and application of an endolaser was performed. Three months later, he came back with a higher serous RD and a worsening of BCVA. We performed a second PPV with sulfur hexafluoride (SF6) with good anatomical results. One year later, cataract and an inferior rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) was treated with intraocular lens implantation and PPV with silicone oil. Five months later, supero‐temporal retina was detached, so a new PPV was carried out with silicone oil again. One year later, the silicone oil was removed and a retinal detachment was noted 3 months later. Finally, the last surgery was performed practicing encircling band, PPV, application of endolaser and again using silicone oil. Conclusions: Surgical management of serous retinal detachment caused by papillary pit continues being a challenge for retinal specialists. Complications of surgery are no usually publish in literature and this case report make us take into account. Since it ranges from observation to surgical approach using different techniques and procedures without any showing clear superiority.