The economic implications of the use of anti-vascular endothelial growth factor drugs in age-related macular degeneration

Age-related macular degeneration (ARMD) is the most common cause for visual impairment in the elderly in western countries. Recently several anti-vascular endothelial growth factor (VEGF) drugs like pegaptanib sodium (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin) are available for use in the management of wet ARMD. A major limitation of these drugs is that they require multiple intravitreal injections, every 4 to 6 weeks interval for a period of 2 years. Moreover, most of these drugs are too expensive for the general masses to afford in developing nations. Avastin, though used "off-label", offers a comparable result at affordable cost, however, long term results are awaited. The drug industry should review the entire pricing policy of these drugs in developing countries like India, and develop affordable alternative compounds. The article reviews the economic burden and affordability issues of these Anti-VEGF drugs in ARMD

Retinal nerve fiber layer changes following primary retinal detachment repair with silicone oil tamponade and subsequent oil removal

Purpose: To evaluate the correlation between the retinal nerve fiber layer (RNFL), particularly the temporal RNFL (TRNFL), and visual outcomes following surgery for rhegmatogenous retinal detachment (RRD). Methods: This retrospective study was performed at a tertiary center; 32 patients underwent single and successful vitrectomy for total RRD using silicone oil as tamponade. Data were collected after oil removal. RNFL thickness and central foveal thickness (CFT) were measured using spectral domain optical coherence tomography. RNFL thickness and CFT of normal eyes were acquired as a control to calculate percentage changes in the affected eyes. The correlation between postoperative best-corrected visual acuity (BCVA) and TRNFL changes was the primary outcome measure. Results: Postoperative BCVA correlated negatively with retinal detachment (RD) duration (Pearson coefficient 0.56, P = 0.001) and percentage loss in TRNFL thickness (Pearson Coefficient 0.41, P = 0.02). The macula lost the maximum RNFL thickness (26%). The mean percentage loss of TRNFL was significantly higher in patients with postoperative BCVA 6/60 (17.5 days) (P = 0.026). Conclusion: When eyes with RRD are successfully repaired using silicone oil tamponade, the thickness of the RNFL decreases, particularly in the macula, and less macular neuronal loss is associated with better visual outcomes

Posterior segment nucleotomy for dislocated sclerotic cataractous lens using chandelier endoilluminator and sharp tipped chopper

<b>AIM:</b>To describe a new surgical technique for managing dislocated sclerotic cataractous lens.<b>METHODS:</b>Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre and analyzed retrospectively. After standard 3 port 23 G pars plana vitrectomy and perfluorocarbon liquid (PFCL) injection, the dislocated white cataract was held with occlusion using phaco fragmatome and then chopped into smaller pieces with a sharp tipped chopper using 25 G chandelier endoilluminator. Each piece was emulsified individually. Following aspiration of PFCL, Fluid Air Exchange was done in all the cases and surgery completed uneventfully.<b>RESULTS</b>:Best corrected visual acuity (BCVA) in all the patients was better than 6/12 after one month of follow up. No serious complications were noted till minimum 6mo of follow up.<b>CONCLUSION</b>:Four port posterior segment nucleotomy with a chandelier endoilluminator, fragmatome and a chopper appears to be a safe, easy and effective procedure for managing dislocated sclerotic cataractous nuclei. Ultrasonic energy used and adverse thermal effects of the fragmatome on the sclera may be lesser