The Ophthalmology Open Journal

Introduction
To evaluate the density of conjunctival goblet cells (GCs) from in vivo confocal microscopy (IVCM) and impression cytology (IC) and mucin expression in ten glaucomatous patients treated with preservative-free latanoprost (Monoprost®)
Methods
Ten glaucomatous patients (10 eyes) were enrolled. Conjunctiva was examined clinically and morphologically by IVCM and IC. Both IVCM and IC were performed at baseline, and after the 1st and 4th month of Monoprost® therapy. GC density (GCD) in cells⁄mm2 was the main outcome measurement.
Results
At baseline, mean GCD was 147+/-78 cells/mm2 for IVCM and 114+/-62 cells/mm2 for IC GCD. At month one, mean GCD was 149+/-69 and 120+/-56 measured with IVCM and IC, respectively (p=0.31 for IVCM and p=0.40 for IC). At month four, GCD increased to 162+/-81 and 134+/-61 measured with IVCM and IC, respectively (p=0.02 for IVCM and p=0.02 for IC).
Conclusion
Treatment with preservative-free (PF) latanoprost was associated with an increase in conjunctival GCD in glaucomatous eyes. Further studies are mandatory to verify this finding because its validation may have important consequences in the medical management of glaucoma.

Since the emergence of coronavirus disease-2019 (COVID-19) and its declaration as a global pandemic, multiple ophthalmic manifestations secondary to this infection have been reported, ranging from conjunctivitis to more serious and vision impairing manifestations. In this case report, we present a case of transient myopic shift observed after COVID-19 infection, in an ophthalmology specialty hospital in Beirut, Lebanon, with a discussion of the possible causes based on literature review.

Introduction
Traditionally, ciliary body destruction has been used to treat uncontrolled intraocular pressure (IOP) following maximally tolerable
medical therapy. This is due to the large number of complications seen with this procedure. However, recently a new technique
of sub-threshold laser or micropulse laser, is able to provide selective destruction of the ciliary body in a controlled manner. This
avoids most of the complications seen with other modalities. We have performed a small case descriptive pilot study to assess the
effectiveness of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in lowering IOP.
Methods
This pilot study was conducted on four patients in the age range 55-70-years with intractable glaucoma. Two patients had primary angle closure glaucoma, one-each had steroid-induced glaucoma and neovascular glaucoma. Mean baseline IOP was 32±2.4
mmHg. Mean number of glaucoma medications were 2.5±1.5. All patients underwent 180° MP-TSCPC. Absolute success was
defined as IOP<20 mmHg without acetazolamide.
Results
Following the procedure the patients were followed-up at days 1,7,30 and 90. At the last follow-up of the study, mean IOP was
18.2±1.2 mmHg in all four patients. Mild anterior chamber inflammation was the only complication noted. Mean number of
glaucoma medications reduced to 1.5±1.0 following the procedure. Thus, absolute success was achieved in all patients.
Conclusion
This small pilot study validates other studies which show effectiveness of MP-TSCPC as an efficient and safe procedure to lower
IOP. This procedure can be used over a wide variety of cases, though the indications for such procedures are still evolving. More
extensive and long-term studies will clarify the position of this procedure in our glaucoma management practices.

Background
Retinoblastoma (Rb) is a highly angiogenic tumor, for which anti-vascular endothelial growth factor (VEGF) therapies have
shown limited success in clinical setting. Recent investigations demonstrated upregulation of ancillary axis including the plateletderived growth factor (PDGF) when VEGF is inhibited. This illustrates the need for novel therapeutics. Previous work from our
lab showed inhibition of the platelet-derived growth factor receptor-beta (PDGFR-β) by imatinibmesylate (IM), inhibited Rb
cells proliferation in vitro. Novel therapies ideally are tumor-specific, leaving normal non-cancerous cells a stroma to perform their
homeostatic functions. Rb treatments induce apoptosis of the retinal endothelial cells, causing the release of pro-inflammatory
cytokines and chemokines to the microenvironment.
Aims
We investigated the role of the PDGFR-β in the tumor microenvironment and how inhibition of this signaling pathway, as a
potential targeted therapy, impacts angiogenesis in human retinal microvascular endothelial cells (hRECs), specialized neurons
arborizing the retinal microvasculature.
Results
Our results demonstrated that inhibition of the PDGFR-β signaling pathway by IM affects the proliferation of the Rb cells, but
not hRECs. PDGFR-β signaling is not required for hRECs angiogenic activity, although it reduces the percentage of VEGF-Aproducing cells.
Conclusion
These results illustrate a lack of functional activity PDGFR-β signaling in hRECs and points to a more tumor-specific therapeutic
option. This is of critical importance as success of treatment also depends on the ability of the normal tissues to remain healthy
after sensitization and/or killing of the Rb tumor.

Purpose
The liver is the most common site of uveal melanoma (UM) metastasis with approximately 50% of UM patients being affected.
With no proven therapies that mitigate metastases the mortality rate is 85% within the first year after detection of the liver disease.
In this study, we provide a mechanistic understanding of the de-regulation of the TP53-MDM2 pathway in UM, which plays a
central role in tumor biology.
Methods
We investigated the TP53-MDM2 signaling pathway in the microenvironment of liver metastases taken from both a murine orthotopic xenograft and post-mortem metastatic UM human liver. These findings were studied in-depth using both primary and
metastatic UM cell lines treated with the MDM2 antagonist Nutlin-3a and the sirtuin inhibitor and transcriptional activator of
TP53, Tenovin-6.
Results
De-regulation of the TP53-MDM2 signaling pathway is specific to the liver microenvironment, providing a survival mechanism
for UM metastases. Tenovin-6, not Nutlin-3a, reduced UM cell survival by increasing the percentage of cell death and reducing
the percentage of proliferating cells. Tenovin-6 increased acetylation of p53, reduced ubiquitination of the protein, and acted as
a cell cycle regulator.
Conclusion
Our findings suggest that in patients with metastatic UM de-regulation of TP53-MDM2 signaling pathway promotes growth of
the liver metastases and provides pre-clinical information on the potential of targeting of the TP53-MDM2 signaling pathway via
Tenovin-6.

Purpose To make an account of published implant-related complications (IRC) by a systematic review of the literature. Methods A systematic search of Pubmed and Scopus databases and Google Scholar engine was performed with selection criteria to detect papers on IRC. We excluded unrelated papers and reviewed selected ones. We considered papers that did not explicitly state about occurrence or not occurrence of IRC as non-IRC reporting. Main outcome measures were the number of papers reporting on complications, IRC, and types of IRC. Results After the search, selection, and addition, we studied 109 papers. Incidence of IRC was 4.5%, half required explantation. While 26 implant studies found IRCs (23%), 13 case reports on surgical complications, 8 (61.5%) of them reported IRC. Frequent complications were conjunctival erosion, blockage of the tube, migration to anterior chamber or damage to surrounding tissues. Conclusion Most papers did not report on IRC. Length or nature of studies may skew finding IRC. The incidence of IRC was 4.5%. Hard and sharp implants carry a greater risk of IRC and explantation.

Glaucoma is a disease known to mankind since antiquity. The word glaucoma is derived from the Greek word “glaukos”. When we look into the pupil of an individual who has
no ocular disease, we see a black pupillary reflex. However, patients with “glaukos” are said to
have a greenish or bluish hue. Hippocrates, in his aphorisms in 400 BC, also used the term to
describe “a kind of blindness which came with aging and was associated with a glazed look of
the pupil”. However, when we critically analyze the definition of “glaukos”, we can conclude
that this glazed look could have come from glaucoma but also seen in patients with cataract.

Vogt-Koyanagi-Harada disease (VKHD) is a defined as a bilateral granulomatous panuveitis that affects pigmented structures,
such as the eye, inner ear, meninges, skin and hair. Up until this point, the exact pathogenesis is still a matter of inquiry.
The most accepted mechanism involves autoimmune reaction among tissues that contains melanocytes. This disease
has been described to have four stages: prodromal, acute uveitic, convalescent and chronic/recurrent stage, all of which affecting
pigmented structures in the body. Early diagnosis and meticulous use of steroids has remained as the mainstay treatment,
however, poor prognosis for individuals who presented with complications in the initial consultation has been associated
with a poor final visual acuity. The main objective of presenting this classic case of Vogt-Koyanagi-Harada disease is
describing its chronic systemic course, and the possible medical and surgical management for the disease and its complications

Since the introduction of the first intraocular lens in 1949, many technological
advances have been made in order to optimize its design and construction. Owing to a number
of recent advances and developement of modern lenses, it has now become possible to not only
correct post-operative aphakia but also provide good visual acuity for far, intermediate and
near distances by decreasing or eliminating eye glasses or contact lenses in majority of cases.

This mini-review provides an overview of recent trends in our understanding of the general
structure of the cornea, the importance of corneal nerves, their function and distribution in the
different layers of the cornea based on reports obtained by imaging techniques such as in vivo
confocal microscopy (IVCM) and immunohistochemistry (IHC) analysis. Recent data on corneal
nerve status in conditions such as Dry Eye Disease (DED) and Diabetes is also discussed.
There is additional emphasis on corneal nerve damage due to injury especially during surgical
interventions and underlying disease states as well as translational research on corneal nerve
regeneration. Information on recent clinical studies on the effect of laser corneal surgery and its
impact on corneal nerves is also presented.

Gas permeable (GP) contact lenses (CL) are of paramount importance in keratoconus
patient management1 to rehabilitate vision and improve patients’ quality of life (QoL).2
Different surgical and non-surgical options are available in keratoconus management. Early
stages could be managed with conventional optical corrections (spectacles and/or soft CL),
however if disease progress, and corneal irregularity affects to visual acuity GP (conventional
or with keratoconus specific design) lenses should be necessaries to patients’ visual rehabilitation.
Other alternative CL options (piggy-back, mini-scleral, semi-scleral, scleral designs etc.)
have been, also, proposed. If patients show CL intolerance or disease progresses and/or corneal
integrity could be affected surgical techniques are required.

Purpose: To assess vascularity of the macular area in patients with glaucoma using optical
coherence tomography angiography (OCT-A) and evaluate the role of its examination in early
glaucoma diagnosis.
Materials and Methods: Thirty-eight eyes of patients with the early stage of primary open-angle
glaucoma (POAG), 27 eyes of patients with the advanced and far-advanced stages of POAG,
and 22 eyes of age-matched healthy subjects were examined using spectral-domain OCT-A
(SD-OCT-А) (RtVue xR Avanti with the AngioVue software, San Jose, CA, USA) in order to
measure retinal thickness and angio flow density (AFD) retina in macula (an area bounded by
a circle with a diameter of 3 mm), inсluding fovea and parafovea regions (superficial and deep)
of the inner retinal layers. The AFD disc and peripapillary flow density were measured in optic
nerve head (ONH) and 750-μm-wide elliptical annulus extending from the optic disc boundary.
Retrobulbar blood flow parameters, including ophthalmic artery (OA), central retinal artery
(CRA), short posterior ciliary arteries (PCAs), central retinal vein (CRV), and vortex veins
(VV), were measured by color doppler imaging (CDI). The average thickness of the ganglion
cell complex (avg GCC), retinal nerve fiber layer (RNFL), and choroid, as well as the focal loss
volume (FLV) and global loss volume (GLV) of GCC were measured by means of SD-OCT.
Automated perimetry was performed using Humphrey perimeter (Carl Zeiss Meditec, Dublin,
CA, USA). Corneal-compensated intraocular pressure (IOPcc) and corneal hysteresis (CH)
were determined using ocular response analyzer. Mean ocular perfusion pressure (MOPP) was
calculated by measuring IOP and arterial blood pressure (BP) immediately prior to OCT and
using formula: MOPP = (2/3 diastolic BP + 1/3 systolic BP) × 2/3 – IOP.
Statistical analysis was performed using SPSS version 21 and MASS library in the R language.
As a measure of the parameter’s importance in distinguishing patient groups, a value of the adjusted
standardized statistic of the Mann-Whitney test (z-value) and an area under the receiver
operating characteristic (ROC) curve (AUC) were used.
Results: Although all structural parameters and indices of retrobulbar blood flow were reduced
in early glaucoma as compared to the normal controls, the following parameters were the main
discrepancy criteria when discriminating these patient groups: macular vascular density-AFD
Retina Superficial Whole En Face (z=3.86, p<0.0001; AUC 0.8 (0.69-0.90) and macular thickness
in the inferior sector ILM-RPE (z=3.86, p<0.0001; AUC 0.8 (0.69-0.91)). In discriminating
early glaucoma from the advanced and far advanced stages of the disease, the most useful
were: AFD Disc Peripapillary Inferior Temporalis (z=5.61, p<0.0001; AUC 0.94 (0.86-1.0))
and mean flow velocity in CRA (z=4.16, p<0.0001; AUC 0.81 (0.69-0.92)).
Conclusions: The present study revealed the significance of OCT-A for the early diagnosis of
glaucoma and the priority of the investigation of the macular microcirculation and its thickness
in the inferior sector. These results allow understanding the cause of the early involvement of
the macular inner layers in the pathological process in glaucoma.

Blindness causes significant disability and is associated with tremendous financial
and social burden. Recent studies have shown an increase in the common causes of preventable
blindness including irreversible diseases such as diabetic retinopathy and glaucoma. A study
published in Lancet in 2012, highlighted the rise in Disability Affected Life Years (DALYs)
between 1990 and 2010 by 160% for age related macular degeneration and 119% for glaucoma.
In parallel, there has been a relative reduction in the ophthalmologist to population ratio
as published in a recent article in the Canadian Journal of Ophthalmology in 2007. Developing
countries face a worse situation, where the Ophthalmologist to population ratio is a dismal 1:
several million depending. The situation is further compounded by the fact that in developing
countries, nearly 70% of the population lives in rural areas while 70% of the ophthalmologists
are based in urban areas. Providing accessible eye care is therefore a challenging task.

The minute persons think of eyesight, they generally think about accuracy, as in normal, 6/6 (or
20/20) vision. However, it is much more than that as the brain really processes the visual world,
including things like symbols, pictures and distances. Faults in these brain tasks are called
visual processing disorders (VPD) or visual processing issues. Many parents and teachers find
it difficult to recognize the signs and symptoms of a VPD in their child or students. They also
often confuse them with learning disabilities. This mini review aims to provide descriptions of
visual processing issues and how to overcome through some vision, behavioral and education
therapies.

Purpose: The aim of this study was to evaluate intraocular pressure (IOP) after the application
of the nasal packing for sinonasal surgery.
Methods: A total of 40 patients who underwent sinonasal surgery were enrolled in this prospective
study. Patients were randomly assigned into two groups: gauze packing (group 1) and silicone
nasal septal splint (group 2). All participants completed a comprehensive questionnaire and
underwent an ocular examination including measurement of IOP by Goldmann applanation
tonometry (GAT). All the measurements were repeated before removing the nasal packings.
IOP measurements before the operation and during the nasal packing were compared with each
other.
Results: The study group comprised 21 males (52.5 %) and 19 females (47.5%). The mean age
was 29.10±8.18 years (median 27.50) (min-max=18-51). Twenty-three (57.5%) had silicone
nasal packing while 17 (42.5%) had gauze nasal packing. Mean nasal packing duration was
2.575±0.712 days. The post-operative increase in the intraocular pressure of the both eyes were
not statistically significant (p>0.05). IOPs of the patients’ eyes showed no significant increase,
compared to the pre-operative results according to the type of nasal packing used (p>0.05).
Conclusions: Increased intranasal pressure due to nasal packing did not increase intraocular
pressure. The type of the nasal packing also did not differ to increase the intraocular pressure.

Glaucoma is a neurodegenerative disease of the optic nerve characterized by progressive loss of
retinal ganglion cells (RGCs), which can lead to irreversible blindness. Numerous factors have
been implicated in the disease, with high intraocular pressure (IOP), coupled with advanced
age, being major risk factors. Other factors include ischemia, generation of reactive oxygen
species, a genetic pre-disposition and neurotrophin deprivation in the retina or optic nerve
(Figure 1).1 The pathogenesis of glaucoma is challenging to understand since it is a multifactorial
neurodegenerative disease.2,3 It is even more confounding what causes normal tension
glaucoma (NTG). Despite a normal IOP, patients still suffer optic nerve degeneration. The
immune system is a probable player in both high tension glaucoma (HTG) and normal tension
glaucoma (NTG). Findings from numerous studies support the notion that both the innate and
adaptive immune responses are involved in the pathogenesis of glaucoma.1,3-18 Yet, the precise
mechanisms of immune responses and the specific cell interactions contributing to the disease
process are still not fully understood. Many questions remain about the role of the immune
system in glaucoma.

Contact lenses (CLs) are safe and commonly used method to correct the refractive errors. Rigid
gas permeable (RGP) CLs are the first option in visual rehabilitation of patients with irregular
cornea, helping to further delay surgical treatment and improve patients’ quality of life (QoL).
Although, the practice of CLs in patients with irregular cornea must be based on evidence, there
is a lack of Clinical Practice Guidelines (CPGs) developed and assessed under high standards
as recommended by the Appraisal of Guidelines for Research and Evaluation (AGREE) (http://
www.agreetrust.org/). Current fitting guidelines provided by researchers, practitioners, entities
or manufacturers, are generally supported with relatively small clinical studies or cohort studies
with owner-designs, providing no-objective pathways to conduct the CL fitting that generally
require steep learning curve and practitioners with long experience in CL practice. These
recommendations are usually not clinically validated to prove the quality and applicability
in new clinical scenarios. CL practitioners require evidence-based guidelines and CPGs that
include an objective pathway to choose the CL characteristics like design, geometry, material,
etc., with clinically validated support of the recommendations to calculate lens parameters
such as back optic zone radius, lens diameter and lens geometry. This practice should be based
on clinical research with prospective, randomized and well-designed studies (case-control,
cohort, or clinical trials studies) that have been developed and assessed under high standards
(AGREE). These new evidence-based guidelines or CPGs will not only improve the safety and
transparency of CL fitting procedures, but also guarantee the best patient care with less cost to
patients with irregular cornea requiring RGP, improving their vision and QoL.

A number of studies have mentioned high incidence of asymptomatic dry eye syndrome before
cataract surgery and more specifically refractive surgery with Excimer Láser. Ocular surgeries
play an important role that can trigger or exacerbates this condition.1

Purpose: To study the clinical spectrum of pediatric optic neuritis in Indian children at a tertiary
care centre.
Methods: A retrospective study of patients diagnosed with optic neuritis below 20 years of
age at a tertiary care centre in India over a 3 year period were reviewed. The ophthalmological
examination findings, Goldmann perimetry, electrophysiological tests and magnetic resonance
imaging (MRI) were reviewed.
Results: The study reviewed 28 patients (44 eyes) and found a mean age of 12.6±4.9 years
(2-20 years) having a follow-up record for a mean period of 6.3±4.9 months (0.3-38 months).
32.1% were females (F: M-0.47). Six patients (20.7%) had a viral prodrome and 12 (42.9%)
complained of painful ocular movements. The mean baseline visual acuity (VA) was 1.80±0.6
logMAR units (Range=0.2-3.0 logMAR units) and the last best visual acuity was 0.43±0.4 log
MAR units (Range=0-1.79 logMAR units). Thirty six eyes (81.8%) had a visual acuity at or
below 3/60 and 40 eyes (90.9%) of 6/60 or lower of the snellen chart at the time of presentation.
The mean contrast sensitivity at presentation was 1.02±0.46 (range=0-1.65). 16 pts (57.1%)
had a bilateral presentation and 20 patients (71.4%) had either unilateral or bilateral papillitis.
All the patients were given pulse dexamethasone (3-5 mg/kg/d) for three consecutive days
followed by oral prednisolone (1-1.5 mgKg/day) for 11 days. At 1 week, 21 out of 44 eyes
(47.7%) had a visual acuity ≥6/18 of the snellen chart. Three patients showed demyelination
suggestive of multiple sclerosis (MS) on MRI brain and were diagnosed as probable MS.
A total of 9 eyes (20.5%) of 6 patients (20.7%) had a recurrence. Those below 10 years of
age presented more commonly with papillitis compared to teenagers (p value=0.01). All the
parameters were similar in males and females.
Conclusion: Pediatric optic neuritis patients are associated with a good visual outcome and a
faster recovery. There are no gender differences in either the presentation or the visual recovery.
Papillitis was more often seen in the children below 10 years of age. None of the patients
developed clinically definite multiple sclerosis.

Purpose: To compare the baseline visual and anatomical parameters between the woman and
men with diabetic macular edema (DME) who underwent intravitreal ranibizumab treatment.
Materials and Methods: This was a retrospective case-control study. Treatment naïve DME
patients who were newly diagnosed and completed a follow time of 12 months in our clinic
were included. All the patients were prescribed to receive a loading dose of three consecutive
monthly injections. Then the patients were followed monthly, and treated on a pro-re-nata
treatment regimen. Primary outcome measures of this study was the baseline best corrected
visual acuity (BCVA) and central retinal thickness (CRT) in the female and male patients at
the baseline. Secondary outcome measures were the change in BCVA and CRT during the 12
months follow-up period.
Results: Sixty-three eyes of 44 women, and 110 eyes of 76 men were included in the study.
The mean baseline BCVA of the women was 0.72±0.44 (range 0.1-2.0) LogMAR, and the
men was 0.49±0.31 (range 0.0-2.0) which was statistically significant between the two groups
(p<0.0001). The mean baseline CRT of the women was 484±117 microns (range 312-759),
and the men was 467±100 microns (range 320-704) (p=0.3). The mean visit number in women
and men groups were 4.6±0.9 and 4.5±1.0, respectively (p=0.5). The mean injection number in
women and men groups were 4.1±1.6 and 3.8±1.4, respectively (p=0.2).
Conclusion: Our results revealed that there may be a significant difference in baseline BCVA
between women and men with DME at the first admittance. Perhaps we should be more sensitive
in periodic ophthalmology consultations of women with DME and warn the general health
care practitioners, internal medicine specialists and endocrinologists in this regard.

Aim: To evaluate microperimetry as a tool for visual field assessment in optic neuritis and compare it with standard automated perimetry.
Methods: A case-control study was conducted at a tertiary eye care centre in India. Ten cases of unilateral optic neuritis and 10 healthy controls underwent a detailed ophthalmic evaluation and visual field testing at presentation and 1 month and 3 months follow-up. Visual fields were charted using both the standard automated perimeter (10-2 and 30-2 programs) and microperimeter (central 20 degree program) at each visit.
Results: The visual acuity at presentation of the affected eye, fellow eye and control eyes was 0.27±0.19, 0.93±0.14 and 0.94±0.17 respectively. The affected eye visual acuity improved significantly to 0.89±0.24 (p<0.001) at the 3 months follow-up visit. The mean sensitivity thresholds of 10-2 visual field test at presentation were 14.16±11.51, 30.40±1.98 and 31.04±1.95 respectively of which the affected eye showed a significant improvement over 3 months to 28.90±8.36 (p<0.001). The mean sensitivity thresholds of 30-2 visual field test at presentation were 12.88±10.32, 26.03±2.59 and 27.99±2.31 respectively of which the affected eye and fellow eye showed a significant improvement over 3 months to 26.02±7.54 (p<0.001) and 27.86±1.77 (p<0.03) respectively. The mean sensitivity thresholds of microperimetry 20 degree visual fields at presentation were 5.60±7.32, 16.54±1.46 and 17.30±1.64 respectively of which the affected eye showed a significant improvement over 3 months to 16.41±4.87 (p<0.001). Microperimetry
fields did not improve completely at 1 month unlike the 10-2 fields and correlated strongly with visual recovery. The 30-2 fields were the most sensitive to determine subclinical affliction of the fellow eyes in optic neuritis.
Conclusion: Microperimetry is a sensitive test to evaluate visual fields in optic neuritis and corresponds with visual recovery. The larger 30 degree module is still indispensible for visual field assessment in optic neuritis.

Aims: To evaluate the effectiveness and safety of Posterior Sub-Tenon (PST) Triamcinolone Acetonide (TA) injection for persistent macular oedema associated with non-ischemic Central Retinal Vein Occlusion (CRVO) or Branch Retinal Vein Occlusion (BRVO) in non-vitrectomized
eye.
Methods: Fourteen consecutive eyes of 14 patients characterized by macular oedema lasting more than 3 months and with a visual acuity of less than 20/40 were enrolled. Six eyes presented with BRVO, 8 eyes with CRVO. PST injection of 40 mg TA was performed in topical anaesthesia. All patients were phakic, and followed for at least 6 months. Snellen visual acuity converted to LogMAR units and anatomic responses were evaluated before, and at 1, 3, 6, and 12 (if required) months after injections and re-injection considered.
Results: In the BRVO group, mean foveal thickness was 548.2±49.50 μm preoperatively, and 452.8±56.2 μm and 280.8±62.5 μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements
(p<.05, paired t test) 3 months after injections. Improvement of visual acuity by at least 0.2 LogMAR was seen in 3(50%) of the 6 eyes. No re-injection was needed. In the CRVO group, mean foveal thickness was 543.7±34.4 μm preoperatively, and 283.0±29.0 μm and 234.8±23.6
μm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (p<.05, paired t test). Improvement of visual acuity by at least 0.2 LogMAR was seen in 7 eyes (88%). Mean number of re-injection
was of 2.1±0.3. Intraocular pressure elevation of 22 mm Hg or higher was found in 2/14 eyes (14%). Cataract progression was noted in 5/14 eyes (36%).
Conclusions: PST injection of TA appears to be as safe and effective treatment for chronic macular oedema associated due to both non-ischemic BRVO or CRVO, with a better efficacy in BRVO.

Purpose: To report the effectiveness of combined surgery for neovascular glaucoma. Methods: Six eyes of six consecutive patients with neovascular glaucoma underwent the combined surgery: trabeculectomy with Mitomycin C, Pars Plana Vitrectomy (PPV), endolaserpanretinal photocoagulation, intravitreal and intracameral injection of bevacizumab. Results: The intraocular pressure returned to normal range soon after operation. The neovascularization of iris regressed in a few days. Mild hyphema developed in three patients. All six patients had improved or stable visual acuity, and achieved normal intraocular pressure without antiglaucoma medications three months after operation. Conclusions: This combined surgery may break the vicious cycle of neovascularglaucoma and preserve useful vision in these patients.

The socio-economic burden of age-related macular degeneration (AMD) has strongly increased in public health importance due to the aging of the general population, and in clinics because of the world-wide use of anti-vascular endothelial growth factor (anti-VEGF) drugs in patients with neovascular AMD (NV-AMD).