These short-term results support the use of intravitreal bevacizumab for the management of CNV in patients with PXE. Continued experience with intravitreal bevacizumab in this population will help establish its longer-term efficacy and better define the potential need for serial injections to maintain these results.

These long-term results support the use of intravitreal antivascular endothelial growth factor therapy for the management of choroidal neovascularization in patients with pseudoxanthoma elasticum. Continued experience with intravitreal bevacizumab or ranibizumab in this population will help establish long-term efficacy and better define optimal dosing strategies.

No abstract

Ketoconazole lowered endogenous cortisol after 4 weeks of 600 mg daily. While median visual acuity, lesion height, and greatest linear dimension remained unchanged during the month of drug treatment, there may have been a delayed therapeutic response seen at 8 weeks.

Ranibizumab therapy was associated with significant improvements in mean visual acuity and central macular thickness for the group of all patients. Patients who had received bevacizumab treatment within 3 months before initiating ranibizumab treatment had stability of, but no improvement in, visual acuity.

The addition of IVTA to PRP in the treatment of eyes with high-risk PDR and CSMO may prevent PRP-induced foveal thickening and loss of vision.

Sir,Vitreoretinal surgery under local anaesthesia: missed fellow eye pathologyWe thank Mr West for his useful comments about our paper. 1 We are aware of the different criteria used by vitreoretinal surgeons to treat fellow eye pathology. This has also been alluded to in our paper. In our study, the criteria for significant pathology was based on the policy for treating fellow eyes prevalent in our unit at the time of this study. However, we would still recommend that general anaesthesia be considered if the preoperative examination of the fellow eye was inadequate. May I thank Banerjee et al 1 for their interesting paper pointing out the more thorough examination of fellow eyes allowed under general anaesthetic (GA) in patients who are difficult to examine for various reasons, and that missed retinal pathology is often found compared to a preoperative examination. As they say, symptomatic recent retinal tears are the main indication for prophylaxis and the body of opinion is in favour of treating these. Rarely does a patient have symptomatic pathology in the fellow eye at the time of retinal detachment repair and many would argue about the benefits of treatment of the pathology they found which I presume was asymptomatic. The argument for GA in treatment of retinal detachment must be balanced against the significant advantages of local anaesthetic (LA) over general, especially in the elderly male patients prone to urinary retention following the latter. As in all clinical decisions, a balance has to be struck between the advantages and disadvantages of one means of treatment against another. I would suggest in many PVD detachments easily treated under LA the advantages of local over general anaesthetic outweigh that of finding pathology for which prophylaxis is of no proven benefit. Also, it would be of interest to know how many of the operated detachments in the study were detachments without PVD, that is, due to round holes or dialysis, where GA would be the norm, and where this applies to fellow eye missed pathology. Reference

Pascal dynamic contour tonometry gives readings that are highly correlated with Goldmann applanation tonometry, but on average 5 mmHg higher in eyes after vitrectomy surgery with air, gas or silicone oil tamponades. The difference between Goldmann and Pascal readings does not appear to be altered by the presence of a scleral buckle, or the size of the intraocular gas bubble.