PURPOSE: To obtain normative values of angle kappa in a normal population by synoptophore and Orbscan II and to compare the reliability of these devices. METHODS: Three hundred consecutive healthy individuals were enrolled in the study. A complete orthoptic and ophthalmologic examination was performed. Synoptophore and Orbscan II corneal topography were used to measure angle kappa. To evaluate the association of the angle kappa and refraction measures, individuals were further classifi ed according to the degree of myopia and hyperopia. The spherical equivalent error measures were grouped into six categories: уϪ3.00 diopters (D); Ϫ2.75 to Ϫ1.50 D; Ϫ1.25 to Ϫ0.50 D; ϩ0.50 to ϩ1.25 D; ϩ1.50 to ϩ2.75 D; and уϩ3.00 D. Paired t test and Pearson's correlation test were used for statistical analysis.

Intraocular silicone oil has several important indications in vitreoretinal surgery, particularly the repair of complicated retinal detachments. Emulsification is a clinically significant complication of using silicone oil tamponade. There are several factors that can promote or prevent silicone oil emulsification after retinal detachment repair, including protein surfactants, contaminants, and shear forces. However, the duration of tamponade remains the most significant one. After emulsification has occurred, keratopathy and glaucoma are the most common complications. However, recent work has shown that emulsification can also affect the retina, optic nerve, and even extraocular structures. Limiting the amount of time the silicone oil remains in the eye is the most important factor in reducing its complications.

Photodynamic therapy resulted in a significantly better outcome at the end of the follow-up, whereas the patients who received ranibizumab or PDT and ranibizumab experienced a stabilization of the disease.

All groups resulted in stabilization of the disease, while a significant trend towards better visual acuity and anatomic restoration of the affected area was observed in the intravitreal triamcinolone & PDT group.

IMPORTANCE Although radiotherapy has been used more frequently in past decades for the management of large melanomas, long-term efficacy of proton beam irradiation (PBI) of large choroidal melanomas has not been reported.OBJECTIVE To evaluate long-term outcomes in patients who underwent PBI for the treatment of large choroidal melanomas. DESIGN, SETTING, AND PARTICIPANTSData were obtained at a single Boston, Massachusetts, academic tertiary referral practice for this retrospective cohort study. In total, 336 patients with large tumors treated over a 13-year period from January 1, 1985, to December 31, 1997, and followed up until the end points were reached or until December 31, 2008, were included. Data analyses were initially completed in February 2017 and finalized in July 2017. Large tumors were those with a height 10 mm or greater or a longest linear diameter greater than 16 mm or a height greater than 8 mm when the optic nerve was involved.INTERVENTION Proton beam irradiation (total 70 Gy) delivered in 5 equal fractions. MAIN OUTCOMES AND MEASURESThe primary outcomes of rates of visual acuity retention, eye retention, tumor recurrence, and melanoma-related mortality were calculated using Kaplan-Meier estimates, and Cox proportional hazards regression analyses were completed to evaluate risk factors for tumor recurrence and melanoma-related mortality. RESULTSIn this cohort of 336 patients with large tumors, 150 were women and 329 were white; mean (SD) age was 60.0 (14.0) years. Of 178 patients without optic nerve involvement (tumor >1 disc diameter from optic nerve), the mean (SD) largest basal diameter was 18.1 (1.9) mm and mean height was 8.2 (2.7) mm. Optic nerve involvement and tumors greater than 8 mm were observed in 109 patients (32.4% of the cohort). Baseline visual acuity of 20/200 or better was observed in 244 patients (72.6%), and worse than 20/800 in 52 (15.5%). Ten-year rates of visual acuity retention were 8.7% (95% CI, 4.1%-15.6%) for at least 20/200 and 22.4% (95% CI, 15.4%-30.4%) for at least counting fingers. Ten years after PBI therapy, the eye was retained (70.4%; 95% CI, 61.5%-77.6%) and tumor controlled (87.5%; 95% CI, 76.8%-93.5%) in most patients. The 10-year all-cause mortality rate was 60.7% (95% CI, 55.5%-65.9%). Approximately half of the patients died of metastatic uveal melanoma (10-year rate, 48.5%; 95% CI, 43.0%-54.4%). CONCLUSIONS AND RELEVANCEThis study demonstrates that eye conservation is possible in most cases, with ambulatory vision retained in a small proportion of patients 10 years after PBI. Tumor recurrence rates were low and mortality rates were comparable to those observed after enucleation.

BackgroundThe purpose of this study was to determine if eyes with diabetic macular edema (DME) unresponsive to ranibizumab or bevacizumab would benefit from conversion to aflibercept.MethodsThis study was conducted as a retrospective chart review of subjects with DME unresponsive to ranibizumab and/or bevacizumab and subsequently converted to aflibercept.ResultsIn total, 21 eyes from 19 subjects of mean age 62±15 years were included. The majority of subjects were male (63%). The median number of ranibizumab or bevacizumab injections before switching to aflibercept was six, and the median number of aflibercept injections after switching was three. Median follow-up was 5 months after the switch. Mean central foveal thickness (CFT) was 453.52±143.39 mm immediately prior to the switch. Morphologically, intraretinal cysts were present in all cases. Mean CFT after the first injection decreased significantly to 362.57±92.82 mm (Wilcoxon signed-rank test; P<0.001). At the end of follow-up, the mean CFT was 324.17±98.76 mm (P<0.001). Mean visual acuity was 0.42±0.23 logMAR just prior to the switch, 0.39±0.31 logMAR after one aflibercept injection, and 0.37±0.22 log-MAR at the end of follow-up. The final visual acuity was significantly better than visual acuity before the switch (P=0.04).ConclusionEyes with DME unresponsive to multiple ranibizumab/bevacizumab injections demonstrate anatomical and visual improvement on conversion to aflibercept.

No abstract

No abstract