Publications by authors named "David R Lally"

26 Publications

  • Page 1 of 1

Early Experience With Brolucizumab Treatment of Neovascular Age-Related Macular Degeneration.

JAMA Ophthalmol 2021 Feb 25. Epub 2021 Feb 25.

Retina-Vitreous Associates of Florida, Tampa.

Importance: Outcome data are limited regarding early experience with brolucizumab, the most recently approved anti-vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (nAMD).

Objective: To report clinical outcomes after intravitreous injection (IVI) of brolucizumab, 6 mg, for nAMD.

Design, Setting, And Participants: This retrospective case series conducted at 15 private or academic ophthalmological centers in the United States included all consecutive patients with eyes treated with brolucizumab by 6 retina specialists between October 17, 2019, and April 1, 2020.

Exposures: Treatment with brolucizumab IVI, 6 mg.

Main Outcomes And Measures: Change in mean visual acuity (VA) and optical coherence tomography parameters, including mean central subfield thickness and presence or absence of subretinal and/or intraretinal fluid. Secondary outcomes included ocular and systemic safety.

Results: A total of 172 eyes from 152 patients (87 women [57.2%]; mean [SD] age, 80.0 [8.0] years) were included. Most eyes (166 [96.5%]) were not treatment naive, and 65.7% of these eyes (109 of 166) were switched from the prior anti-VEGF agent because of persistent fluid detected on optical coherence tomography scans. Study eyes received a mean (SD) of 1.46 (0.62) brolucizumab IVIs. The mean (SD) VA prior to starting brolucizumab was a 64.1 (15.9) Early Treatment Diabetic Retinopathy Study (ETDRS) letter score (Snellen equivalent, 20/50) and was a 63.3 (17.2) ETDRS letter score (Snellen equivalent, 20/63) at the last study evaluation (mean difference, 0.8; 95% CI, -2.7 to 4.3; P = .65). When analyzed by number of brolucizumab IVIs, the presence or absence of fluid prior to starting brolucizumab, or the presence or absence of intraocular inflammation after receiving brolucizumab, there was no difference in mean VA prior to starting brolucizumab compared with after brolucizumab IVIs or at the final study evaluation. The mean (SD) central subfield thickness in all eyes prior to starting brolucizumab was 296.7 (88.0) μm and was 269.8 (66.5) μm at the last study examination (mean difference, 26.9 µm; 95% CI, 9.0-44.7 µm; P = .003). Intraocular inflammation was reported in 14 eyes (8.1%) and was self-limited and resolved without treatment in almost half those eyes (n = 6). One previously reported eye (0.6%) had occlusive retinal vasculitis and severe loss of vision.

Conclusions And Relevance: In this analysis of brolucizumab IVI for nAMD, VA remained stable, with a reduction in central subfield thickness. Intraocular inflammation events ranged from mild with spontaneous resolution to severe occlusive retinal vasculitis in 1 eye.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.7085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907988PMC
February 2021

Choroidal Melanoma Simulating Adenoma of the Retinal Pigment Epithelium Arising at the Site of Congenital Hypertrophy of the Retinal Pigment Epithelium.

Ocul Oncol Pathol 2020 Jan 30;6(1):39-43. Epub 2019 Jul 30.

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Neoplasms of the retinal pigment epithelium (RPE) are rare tumors that can simulate choroidal melanoma, but clinical and imaging characteristics often differentiate these lesions. We report a 70-year-old male with an abruptly elevated pigmented lesion that arose at the site of congenital hypertrophy of the RPE and demonstrated associated exudation, as well as feeding and draining vessels, suggestive of RPE adenoma. Optical coherence tomography showed retinal elevation with serous retinal detachment adjacent to the mass, and ultrasonography revealed an abruptly elevated, moderately echodense mass of 6.4-mm thickness. Fluorescein -angiography showed early tumor hypofluorescence, late -tumor hyperfluorescence with staining and leakage, and -retinal vessels buried under the mass, suggestive of a retinal tumor. The patient was monitored with the presumed diagnosis of RPE adenoma, but 3 months later, the growth was documented and fine-needle aspiration biopsy revealed choroidal melanoma. Management with I-125 plaque radiotherapy was performed leading to tumor regression and a thickness of 4.6 mm.
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http://dx.doi.org/10.1159/000501084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984159PMC
January 2020

CLOSURE OF SMALL MACULAR HOLES USING VITRECTOMY SURGERY WITH INTERNAL LIMITING MEMBRANE PEELING WITHOUT THE USE OF INTRAOCULAR GAS TAMPONADE: BROADENING THE UNDERSTANDING OF THE MACULAR HOLE PATHOPHYSIOLOGY.

Retin Cases Brief Rep 2020 ;14(2):104-109

Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

Purpose: To determine whether small macular hole closure can be achieved with 25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or facedown positioning.

Methods: 25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or positioning was performed on 20 eyes with a small (<400-µm diameter), full-thickness macular hole.

Results: In 17 of 20 eyes (85%), the hole had closed. Three holes had closed by Postoperative Day 1, 13 holes by Postoperative Week 1, 16 holes by Postoperative Week 2, and 17 holes by Postoperative Week 6. At Postoperative Month 1, vision improved in 16 of 17 eyes in which the macular hole had closed. One hole that had not closed at the first postoperative week and two holes that had not closed at the third postoperative week required follow-up surgery with intraocular gas tamponade and facedown positioning, after which the hole closed. The mean preoperative visual acuity was 0.626 logMAR (20/85), and the mean postoperative visual acuity after 1 month was 0.392 logMAR (20/50) (P < 0.001).

Conclusion: Vitrectomy surgery with internal limiting membrane peeling without the use of gas tamponade or positioning can achieve closure of small macular holes.
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http://dx.doi.org/10.1097/ICB.0000000000000919DOI Listing
February 2021

Choroidal Effusions Secondary to Carotid Cavernous Fistula.

Ophthalmol Retina 2017 May - Jun;1(3):226. Epub 2017 May 1.

Ophthalmic Consultants of Boston, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.oret.2016.11.009DOI Listing
May 2017

Expanded spectral domain-OCT findings in the early detection of hydroxychloroquine retinopathy and changes following drug cessation.

Int J Retina Vitreous 2016 18;2:18. Epub 2016 Jul 18.

Vitreoretinal Service, Departments of Ophthalmology, New England Eye Center, Tufts University School of Medicine, 260 Tremont Street, Boston, MA 02116 USA ; Vitreoretinal Service, Ophthalmic Consultants of Boston, Boston, MA USA.

Purpose: To report expanded SD-OCT findings of HCQ retinopathy that may assist the clinician in earlier diagnosis. To characterize structural changes of HCQ retinopathy with SD-OCT after drug cessation.

Methods: Setting: Private practice and academic institution. Patient Population: Patients at New England Eye Center and Ophthalmic Consultants of Boston in Boston, MA diagnosed with HCQ retinopathy and followed after drug cessation. Retrospective clinical data review by the Boston Image Reading Center. Main Outcome Measures: SD-OCT findings suggestive of HCQ retinopathy before parafoveal ellipsoid disruption. Change in SD-OCT morphological appearance and retinal thickness of each of the nine subfields corresponding to the Early Treatment of Diabetic Retinopathy Study areas.

Results: Thirty eyes with HCQ retinopathy were followed with SD-OCT after drug cessation. Findings before disruption of the parafoveal EZ included parafoveal outer nuclear layer (ONL) thinning, disruption of the parafoveal interdigitation zone, and reduced reflectivity of the parafoveal EZ. In early toxicity, 75 % developed progression after drug cessation, including disruption of the parafoveal EZ and retinal pigment epithelium and thinning of the ONL. Eyes with obvious toxicity had greater inferior outer ring thinning 12 months after drug cessation compared to early toxicity (p = 0.002, 95 % CI -2 to -8 μm). In obvious toxicity, the nasal inner subfield showed more thinning than the temporal inner subfield at 12 months after drug cessation (p = 0.018, 95 % CI -1 to -8 μm).

Conclusions: Once HCQ retinopathy is diagnosed and the medication is discontinued, structural retinal changes commonly occur.
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http://dx.doi.org/10.1186/s40942-016-0042-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088472PMC
July 2016

Vascular endothelial growth factor and diabetic macular edema.

Surv Ophthalmol 2016 Nov - Dec;61(6):759-768. Epub 2016 Apr 1.

Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. Electronic address:

Diabetes mellitus is a major global health epidemic, and diabetic macular edema is the leading cause of vision loss in this population. Macular focal and/or grid laser photocoagulation applied to microaneurysms and thickened retina had long been primary therapy for diabetic macular edema. Chronically elevated serum glucose is known to cause breakdown in the inner and outer retinal blood barrier resulting in upregulation of vascular endothelial growth factor (VEGF). Intravitreal anti-vascular endothelial growth factor agents, including ranibizumab, bevacizumab, and aflibercept, have been shown in randomized clinical trials to be superior to macular laser for the treatment of clinically relevant diabetic macular edema. The READ-2, RISE/RIDE, and RESTORE trials established ranibizumab's superiority to macular laser, whereas the BOLT trial demonstrated bevacizumab's superiority to laser. The DRCR.net Protocol T results showed that intravitreal aflibercept, bevacizumab, and ranibizumab were all effective in reducing retinal thickness secondary to diabetic edema and in improving vision. When the presenting vision was 20/40 or better, visual improvement was equivalent. With eyes presenting with 20/50 or worse vision, aflibercept was superior with respect to visual improvement. Intravitreal anti-VEGF therapy can be burdensome for the patient and health care system, often requiring monthly treatment visits. To reduce burdens, anti-VEGF strategies are in development to lengthen the treatment interval.
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http://dx.doi.org/10.1016/j.survophthal.2016.03.010DOI Listing
May 2017

Optical Coherence Tomography Angiography for Detecting Choroidal Neovascularization Secondary to Choroidal Osteoma.

Ophthalmic Surg Lasers Imaging Retina 2016 Jan;47(1):69-72

Choroidal osteoma is an ossifying tumor that is found predominantly in the peripapillary and macular areas. It typically affects otherwise healthy females. Vision loss may occur secondary to the development of choroidal neovascularization (CNV). Fluorescein angiography (FA) remains the gold standard for diagnosing CNV; however, the use of optical coherence tomography angiography (OCTA) as an adjunct to FA is growing. In this report, a 16-year-old female with a large, unilateral peripapillary choroidal osteoma presented with blurred vision. Exam revealed scattered intraretinal hemorrhage, but FA was unable to detect CNV overlying the tumor. OCTA detected abnormal flow in the outer retina corresponding to a type 2 CNV. Following intravitreal anti-vascular endothelial growth factor therapy, the CNV regressed, the hemorrhage resolved, and there was less fluid. OCTA may be helpful in detecting CNV noninvasively in eyes in which FA is equivocal, such as those with choroidal osteoma.
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http://dx.doi.org/10.3928/23258160-20151214-10DOI Listing
January 2016

A UNIQUE POSTERIOR SEGMENT PHENOTYPIC MANIFESTATION OF COXSACKIE VIRUS INFECTION.

Retin Cases Brief Rep 2016 ;10(3):278-82

*Vitreous-Retina-Macula Consultants of New York, New York, New York; †The LuEsther T. Mertz Retinal Research Center, New York, New York; ‡Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Australia; §Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; ¶New York Eye and Ear Institute, New York, New York; **Good Samaritan Hospital, Suffern, New York, New York; ††Rockland Retina, New City, New York; ‡‡Department of Ophthalmology, New York University School of Medicine, New York, New York; and §§Manhattan Eye, Ear and Throat Hospital/Northshore Long Island Jewish Hospital, New York, New York.

Purpose: To report a posterior segment phenotypic manifestation of Coxsackie virus infection that has not been previously appreciated.

Methods: The clinical course and multimodal imaging findings, including spectral domain optical coherence tomography, fluorescein angiography, near infrared reflectance, and fundus autofluorescence of two patients with Coxsackie virus infections were documented.

Results: A neurosensory macular detachment was present in both patients on baseline examination. Fluorescein angiography demonstrated pooling within this lesion and spectral domain optical coherence tomography identified thickening of the retinal pigment epithelial band with variable degrees of attenuation of the ellipsoid zone and interdigitation zone. Fundus autofluorescence and near infrared reflectance imaging revealed multiple satellite lesions adjacent to the neurosensory detachment. These lesions were not seen on fluorescein angiography or color photography. Satellite lesions were hyporeflective on near infrared reflectance imaging and hyperautofluorescent on fundus autofluorescence imaging. The satellite lesions correlated with sites of ellipsoid disruption on spectral domain optical coherence tomography. Both patients were observed and their condition improved over the course of time. There was total resolution of satellite lesions, reconstitution of the ellipsoid zone and interdigitation zone, and return of retinal pigment epithelial thickness to the normal range. A bull's eye pattern of macular retinal pigment epithelial disturbance persisted on color and near infrared reflectance images, despite good visual acuity.

Conclusion: Posterior segment Coxsackie virus infection may concurrently express the clinical characteristics of acute idiopathic maculopathy and multifocal retinitis. The visual prognosis in this variant is usually favorable. The multimodal imaging features that characterize this entity should be recognized to avoid confusion with other diseases that have a similar presentation.
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http://dx.doi.org/10.1097/ICB.0000000000000250DOI Listing
March 2017

Retinal Pigment Epithelial Adenocarcinoma Presenting as an Amelanotic Mass.

Ophthalmic Surg Lasers Imaging Retina 2015 Mar;46(3):369-72

Retinal pigment epithelium (RPE) neoplasms are extraordinarily rare and have been infrequently described in the literature. Most RPE tumors are pigmented and may simulate choroidal melanoma. The best management of RPE tumors has not yet been elucidated. In the current case, a 36-year-old man presenting with visual disturbance is found to have biopsy-proven RPE adenocarcinoma with subfoveal fluid. He is treated with grid laser over the lesion with complete resolution of fluid. RPE adenocarcinoma can present as an amelanotic mass, and grid laser over the lesion may represent a novel approach for treating associated subretinal fluid.
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http://dx.doi.org/10.3928/23258160-20150323-12DOI Listing
March 2015

Confirmation of Choroidal Varix Through Divot Sign on Spectral-Domain Optical Coherence Tomography.

Ophthalmic Surg Lasers Imaging Retina 2015 May;46(5):582-4

Enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT) provides a rapid and easily accessible measure to evaluate suspicious choroidal lesions. A 60-year-old woman was referred for evaluation of an inferotemporal slightly pigmented lesion that showed a large hyporeflective elevation in the deep choroid on EDI SD-OCT. After applying pressure to the globe, repeat EDI SD-OCT showed flattening of the lesion with a prominent depression or "divot" within the choroid of the center of the lesion. If noted on imaging, this divot sign is an additional reproducible diagnostic finding that can correctly identify a suspicious choroidal lesion as a benign choroidal varix.
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http://dx.doi.org/10.3928/23258160-20150521-12DOI Listing
May 2015

Oculocutaneous albinism.

JAMA Ophthalmol 2015 Mar 12;133(3):e143518. Epub 2015 Mar 12.

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http://dx.doi.org/10.1001/jamaophthalmol.2014.3518DOI Listing
March 2015

Natural history of Valsalva-induced subhyaloid hemorrhage.

JAMA Ophthalmol 2015 Feb 12;133(2):e143268. Epub 2015 Feb 12.

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http://dx.doi.org/10.1001/jamaophthalmol.2014.3268DOI Listing
February 2015

Bilateral cystoid macular edema with giant retinal achromic patch in a patient with tuberous sclerosis.

Ophthalmic Surg Lasers Imaging Retina 2014 Nov-Dec;45(6):602-5

Retinal astrocytic hamartoma is the most common retinal finding in tuberous sclerosis and has been reported in association with cystoid macular edema. A retinal achromic patch is the second most common retinal finding in tuberous sclerosis. The authors report the first case of bilateral cystoid macular edema in which one the eyes does not have an identifiable retinal astrocytic hamartoma. They also describe a new retinal finding in tuberous sclerosis termed giant retinal achromic patch.
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http://dx.doi.org/10.3928/23258160-20141118-19DOI Listing
May 2015

Bilateral central serous chorioretinopathy associated with estrogen modulator diindolylmethane.

Ophthalmic Surg Lasers Imaging Retina 2014 Nov-Dec;45(6):589-91

Central serous chorioretinopathy (CSCR) is an idiopathic disease associated with states of hypercortisolism that causes fluid to collect under the retina resulting in visual impairment. The authors describe an otherwise healthy female patient who presented with headaches and blurry vision after a 2-month history of excessive daily consumption of diindolylmethane (DIM), an over-the-counter estrogen modulator medication used to treat facial acne. Imaging demonstrated asymmetric, bilateral CSCR with active leakage in the left eye. She was instructed to discontinue DIM and reported that visual improvement began 2 weeks after, with resolution to baseline after 8 weeks.
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http://dx.doi.org/10.3928/23258160-20141118-16DOI Listing
May 2015

Images in clinical medicine. Ectopia lentis in Marfan's syndrome.

N Engl J Med 2014 Nov;371(19):e28

Wills Eye Hospital, Philadelphia, PA

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http://dx.doi.org/10.1056/NEJMicm1314140DOI Listing
November 2014

Regression of choroidal metastasis from breast carcinoma treated with gamma knife radiosurgery.

JAMA Ophthalmol 2014 Oct;132(10):1248-9

New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamaophthalmol.2014.1974DOI Listing
October 2014

Subretinal drusenoid deposits associated with complement-mediated IgA nephropathy.

JAMA Ophthalmol 2014 Jun;132(6):775-7

Department of Ophthalmology, New England Eye Center, Vitreoretinal Service, Tufts University School of Medicine, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamaophthalmol.2014.387DOI Listing
June 2014

Pulmonary nocardiosis initially manifesting as endogenous endophthalmitis.

Can J Ophthalmol 2014 Apr;49(2):e59-62

The Retina Service of Wills Eye Institute, MidAtlantic Retina, Jefferson Medical College. Electronic address:

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http://dx.doi.org/10.1016/j.jcjo.2014.02.003DOI Listing
April 2014

Foveal injury from a red laser pointer.

JAMA Ophthalmol 2014 Mar;132(3):297

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http://dx.doi.org/10.1001/jamaophthalmol.2014.34DOI Listing
March 2014

Muscle cramping over the diagnosis.

Surv Ophthalmol 2014 Jan-Feb;59(1):128-31. Epub 2013 Apr 19.

Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.

A 44-year-old man with hypogonadism and adrenal insufficiency presented with transient blurred vision and halos around lights. Visual acuity was 20/20 in both eyes, and he had mild bilateral optic disk edema. Brain imaging was unremarkable, and lumbar puncture showed an opening pressure of 28.5 cm H2O with elevated protein. He also complained of muscle cramping, and magnetic resonance imaging of the spine demonstrated a heterogenous bone marrow signal. Bone survey showed a mixed lytic and sclerotic lesion within the left femur that proved to be a plasmacytoma. Serum protein electrophoresis had a small IgA spike, and plasma vascular endothelial growth factor (VEGF) was elevated. He was diagnosed with POEMS syndrome and underwent radiation to the plasmacytoma. Two years later he had a stable neuro-ophthalmologic exam with no signs of multiple myeloma. POEMS syndrome is a rare paraneoplastic syndrome from a plasma cell dyscrasia that may cause optic disk edema.
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http://dx.doi.org/10.1016/j.survophthal.2012.12.005DOI Listing
June 2014

Occult intraorbital conjunctival inclusion cyst discovered almost 70 years after strabismus surgery.

J Pediatr Ophthalmol Strabismus 2013 Apr 2;50 Online:e15-7. Epub 2013 Apr 2.

Department of Pediatric Genetics, Wills Eye Institute, Philadelphia, PA 19107, USA.

Orbital conjunctival epithelial inclusion cysts are a rare complication of strabismus surgery. A subconjunctival cystic mass with translucent fluid is the most common presentation. The authors describe a case of an epithelial inclusion cyst presenting as an occult orbital mass during reoperation strabismus surgery almost 70 years after strabismus surgery.
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http://dx.doi.org/10.3928/01913913-20130326-02DOI Listing
April 2013

Occult intraorbital conjunctival inclusion cyst discovered almost 70 years after strabismus surgery.

J Pediatr Ophthalmol Strabismus 2013 Apr 2;50 Online:e15-7. Epub 2013 Apr 2.

Orbital conjunctival epithelial inclusion cysts are a rare complication of strabismus surgery. A subconjunctival cystic mass with translucent fluid is the most common presentation. The authors describe a case of an epithelial inclusion cyst presenting as an occult orbital mass during reoperation strabismus surgery almost 70 years after strabismus surgery.
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http://dx.doi.org/10.3928/01913913-20130326-02DOI Listing
April 2013

Occult intraorbital conjunctival inclusion cyst discovered almost 70 years after strabismus surgery.

J Pediatr Ophthalmol Strabismus 2013 Apr 2;50 Online:e15-7. Epub 2013 Apr 2.

Orbital conjunctival epithelial inclusion cysts are a rare complication of strabismus surgery. A subconjunctival cystic mass with translucent fluid is the most common presentation. The authors describe a case of an epithelial inclusion cyst presenting as an occult orbital mass during reoperation strabismus surgery almost 70 years after strabismus surgery.
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http://dx.doi.org/10.3928/01913913-20130326-02DOI Listing
April 2013

Preferred therapies for neovascular age-related macular degeneration.

Curr Opin Ophthalmol 2012 May;23(3):182-8

Retina Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.

Purpose Of Review: This report reviews the current treatment strategies and the most recent clinical trials in the treatment of neovascular age-related macular degeneration.

Recent Findings: The functional and anatomic outcomes achieved in the pivotal ranibizumab trials with monthly injections set the standard for comparison. Since then, various modified dosing regimens with the aim of lessening the treatment burden associated with monthly injections have been investigated. Additionally, level I evidence now exists for the noninferiority of bevacizumab, as compared to ranibizumab, in the treatment of neovascular age-related macular degeneration (AMD) through 1 year of follow-up. Aflibercept has emerged as a new anti- vascular endothelial growth factor (VEGF) therapy showing encouraging treatment results at 1 year. Novel treatments combined with anti-VEGF agents such as localized radiation are currently being investigated.

Summary: Anti-VEGF monotherapy remains the preferred therapy for the management of neovascular AMD at the present time. Aflibercept is a new, FDA-approved, effective, anti-VEGF agent available for clinical use. Ongoing clinical trials will help determine the optimal dosing regimens for all of these agents, as well as the long-term efficacy and safety of combination therapy modalities.
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http://dx.doi.org/10.1097/ICU.0b013e328352411cDOI Listing
May 2012

Metastasis of uveal melanoma millimeter-by-millimeter in 8033 consecutive eyes.

Arch Ophthalmol 2009 Aug;127(8):989-98

Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, 840 Walnut St, Ste 1440, Philadelphia, PA 19107, USA.

Objective: To determine the rate of metastasis of uveal melanoma on the basis of tumor thickness in millimeters.

Methods: Retrospective medical record review.

Results: The mean (median) patient age was 58 (59) years. A total of 8033 eyes were examined. Of the 285 eyes with iris melanoma, the mean tumor thickness was 2.7 mm and metastasis occurred in 0.5%, 4%, and 7% at 3, 5, and 10 years, respectively. Of the 492 eyes with ciliary body melanoma, the mean tumor thickness was 6.6 mm and metastasis occurred in 12%, 19%, and 33% at 3, 5, and 10 years, respectively. Of the 7256 eyes with choroidal melanoma, the mean tumor thickness was 5.5 mm and metastasis occurred in 8%, 15%, and 25% at 3, 5, and 10 years, respectively. For all uveal melanoma, metastasis at 5, 10, and 20 years was 6%, 12%, and 20% for small melanoma (0-3.0 mm thickness), 14%, 26%, and 37% for medium melanoma (3.1-8.0 mm), and 35%, 49%, and 67% for large melanoma (>8.0 mm). More specifically, metastasis per millimeter increment at 10 years was 6% (0-1.0 mm thickness), 12% (1.1-2.0 mm), 12% (2.1-3.0 mm), 16% (3.1-4.0 mm), 27% (4.1-5.0 mm), 28% (5.1-6.0 mm), 29% (6.1-7.0 mm), 41% (7.1-8.0 mm), 50% (8.1-9.0 mm), 44% (9.1-10.0 mm), and 51% (>10.0 mm). Clinical factors predictive of metastasis by multivariate analysis included increasing patient age, ciliary body location, increasing tumor diameter, increasing tumor thickness, having a brown tumor, and the presence of subretinal fluid, intraocular hemorrhage, or extraocular extension.

Conclusion: Increasing millimeter thickness of uveal melanoma is associated with increasing risk for metastasis.
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http://dx.doi.org/10.1001/archophthalmol.2009.208DOI Listing
August 2009

Pigmented free-floating vitreous cyst in a child.

J Pediatr Ophthalmol Strabismus 2008 Jan-Feb;45(1):47-8

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

An 8-year-old asymptomatic boy was referred for a pigmented fundus lesion in his left eye that was suspected to be a possible choroidal melanoma. Visual acuity was 20/20 in each eye. Ocular examination in the upright position revealed a pigmented lesion measuring 4 mm in diameter and 3 mm in thickness located inferior to the fovea. Following supine positioning, the mass floated to the superior macular region. UI-trasonography confirmed a cystic vitreous mass. Observation of the benign vitreous cyst was advised. A free-floating pigmented cyst can resemble a pigmented intraocular tumor, particularly if it is immediately preretinal.
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http://dx.doi.org/10.3928/01913913-20080101-13DOI Listing
May 2008