The edition · Ophthalmology
Nine years after ranibizumab or laser for ROP, vision and refraction were similar
A small randomised cohort followed to school age found no difference in acuity or refraction, with some structural differences of uncertain meaning. Plus the yield of 30-2 fields in neuro-ophthalmic referrals, a generic acetazolamide supplement, erectile dysfunction treatment and glaucoma, and an eye drop for dim-light vision.
The edition in brief
In a single-centre trial that randomised 50 infants with zone II ROP to ranibizumab or laser in 2014, 29 children were examined at nine years. Mean spherical equivalent (−1.90 vs −1.22 D) and visual acuity (0.21 vs 0.15 logMAR) did not differ significantly; ranibizumab-treated eyes had thinner lenses, steeper corneas and thinner central retinas. Loss to follow-up was large and uneven. In a central Indian tertiary centre, reliable 30-2 visual fields were abnormal in 58% of neurological referrals, and confirmed neurological disease in 52%, against 2% of other referrals. The FDA lists a supplement to a generic acetazolamide application, an administrative action. In UK primary care data on 218,056 men with glaucoma and 876,872 controls, prescribed erectile dysfunction medication was associated with slightly higher glaucoma risk (OR 1.17 to 1.29). In the phase 3 LYNX-1 trial, phentolamine 0.75% drops improved mesopic low-contrast acuity in 21% versus 3% on placebo at day 15.
30-2 visual fields confirmed neurological disease in half of neuro referrals
Use a reliable 30-2 field in unexplained visual loss, and image the brain when the defect respects the vertical meridian.
FDA: supplement to a generic acetazolamide application
Treat this as an administrative update; prescribing acetazolamide does not change.
Erectile dysfunction treatment was linked to slightly higher glaucoma risk
Consider erectile dysfunction as a vascular risk marker; it is not a reason to change its treatment.
Phentolamine drops improved dim-light vision in a phase 3 trial
Note pupil-narrowing drops as an emerging option for dim-light symptoms, pending longer data and local availability.
Acetazolamide: check potassium, kidneys and sulfonamide allergy
Check allergy, kidneys and potassium when using acetazolamide, and plan for it to be short term.
Ranibizumab and laser for ROP gave similar vision at nine years
Choose ROP treatment on zone, access and follow-up needs; in this small cohort, vision at nine years did not differ.
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