The edition · Ophthalmology
One intravitreal bevacizumab dose kept trabeculectomies working at three years
A double-masked trial found a single intraoperative injection alongside mitomycin C improved trabeculectomy survival to 36 months. Also: PAMM on OCT separates giant cell arteritis from NAION, phaco-GATT against phacotrabeculectomy, and HOTV charts for preschool screening.
The edition in brief
A single-centre, double-masked, placebo-controlled trial randomised 131 patients having trabeculectomy or phacotrabeculectomy with mitomycin C to one intravitreal bevacizumab 1.25 mg injection or saline. At 36 months, with 85% follow-up, surgical survival was higher with bevacizumab (hazard ratio for complete success failure 0.17) and fewer eyes needed drops. A retrospective neuro-ophthalmology study found paracentral acute middle maculopathy on OCT in 28% of 80 biopsy-proven giant cell arteritis patients and none of 179 with non-arteritic ischaemic optic neuropathy, including in patients without visual symptoms and after steroids. A non-randomised Indian study of 152 eyes found phaco-GATT and phacotrabeculectomy gave similar one-year pressure reduction and medication freedom, with more hyphaema after GATT and hypotony after trabeculectomy. A Shanghai study of 995 children tested both charts in random order and found HOTV gave better acuity and fewer false referrals than tumbling E in preschool children, with the gap closing by age 8.
PAMM on OCT: seen in a quarter with giant cell arteritis, none with NAION
In ischaemic optic neuropathy, PAMM on macular OCT strongly favours giant cell arteritis over the non-arteritic form.
Phaco-GATT matched phacotrabeculectomy at one year, with different complications
Phaco-GATT is a reasonable bleb-free alternative to phacotrabeculectomy for moderate open-angle glaucoma with cataract, pending longer and randomised data.
HOTV charts cut false referrals in preschool vision screening
Use HOTV rather than tumbling E for vision screening in children under 8 to reduce false referrals.
Ischaemic optic neuropathy over 50: take the blood before you take the history home
In ischaemic optic neuropathy over 50, check inflammatory markers the same day and do not delay steroids when arteritis is suspected.
A single intravitreal bevacizumab dose improved trabeculectomy survival at 3 years
Consider one intravitreal bevacizumab dose at trabeculectomy with mitomycin C to improve long-term surgical success.
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