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photocoagulation as a treatment option. The result of submacular surgeries for choroidal neovascular membranes has been disappointing. 3 In our patient, the CNV responded well over a 6-month period to the two injections of Avastin. The result suggests the use of intravitreal Avastin as monotherapy and merits further investigation for CNV complicating traumatic choroidal rupture. We recently established the proportion of patients presenting with pathology and visual impairment, deemed as a visual acuity worse than 6/12, in the fellow eye.A retrospective case note review of 166 patients with wet AMD was performed. Parameters recorded include diagnosis in the fellow eye and visual acuity at presentation. Of those with bilateral wet AMD, the index eye was determined as the most recently referred eye.Of the 166 patients, 99 (60%) were female and 67 (40%) male. Of these, 45 (27%) had no abnormality in the fellow eye at presentation. Therefore, 121 patients had fellow eye pathology. Of those with pathology, the majority (86/121, 71%) had dry AMD, and 26 patients (21%) had wet AMD. The remaining nine patients had amblyopia (4/121), myopic degeneration (4/121) or previous rhegmatogenous retinal detachment (1/121).Fifty-six (34%) patients presented with a visual acuity worse than 6/12 in the fellow eye. The commonest condition associated with visual impairment was dry AMD (29/56, 48.3% of all impairment), comprising 34% of all cases of dry AMD. Wet AMD was the second commonest (19/56, 34%), comprising 73% of all cases of wet AMD.Although the majority of patients had fellow eye pathology, a relatively small proportion presented with an associated visual impairment. The preliminary recommendations from NICE would have excluded over 60% of treatable lesions, that is, those with wet AMD and visual impairment in index eye, but no visual impairment in the fellow eye. Importantly, of the patients ineligible for treatment, 15% (16/110) developed CNV in the fellow eye while under the care of the macular clinic. We welcome the NICE final appraisal document, which recommends treatment for all treatable lesions with acuities worse than 6/12, regardless of fellow eye visual acuity. References

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Coronary artery bypass graft (CABG) patients often have cerebrovascular disease and pre-operative brain magnetic resonance angiography (MRA) frequently reveals cerebral vasculature stenosis. This study was designed to investigate whether pre-operative MRA findings correlated with regional cerebral oxygen saturation (ScO(2)) in 120 patients undergoing on-pump or off-pump CABG. Following MRA examination, patients were divided into six groups of 20 patients each based on MRA findings (no stenosis, mild stenosis or severe stenosis) and procedure (on-pump or off-pump CABG). Mean ScO(2) values over 3 min were determined at seven periods during surgery. Patients with severe cerebrovascular stenosis showed significantly lower ScO(2) than other groups during off-pump CABG. During on-pump CABG, ScO(2) decreased significantly during cardiopulmonary bypass in all groups and was significantly lower in the severe stenosis group. Pre-operative MRA and intra-operative ScO(2) monitoring may help to identify patients at increased risk of brain damage during or following CABG.