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Background Our aim was to examine the long term anatomical and functional outcomes in patients with refractory diabetic macular oedema (DMO) undergoing treatment switch from ranibizumab to aflibercept. Methods Retrospective review of patients with DMO undergoing treatment switch from ranibizumab to aflibercept at a single centre between 2015 and 2017. Primary outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT). Results 57 eyes from 44 patients were included. Following switch to aflibercept, median (IQR) BCVA improved to 73 (64–77) letters at 3 months (p = 0.0006), to 73 (61–78) letters at 6 months (p = 0.0042), to 73 (65–77) at 9 months (p = 0.0006), and to 73 (63–75) letters at 18 months (p = 0.0444). At 36 months following switch, 12 eyes had gained > 10 letters, 5 eyes had gained 5–9 letters, 25 remained stable (± 5 letters), 7 eyes lost 5–9 letters and 8 eyes lost > 10 letters. A significant reduction in CMT at all trimesters following treatment switch was found except at month 24. Conclusions We provide real world data suggesting a sustained anatomical and functional benefit of switching from ranibizumab to aflibercept in the treatment of refractory DMO.

Purpose To evaluate the socioeconomic status of patients undergoing Trabeculectomy surgery. Methods The study population consisted of all individuals who underwent Trabeculectomy surgery (TS) recorded on the Medisoft electronic database. Socioeconomic status was investigated by correlating each individual's postal address with the 2015 Index of Multiple Deprivation (IDM) decile from the UK national database. The IDM decile is a combination of seven indices; income, employment, education skills and training, barriers to housing services, crime, living environment, health and disability, where decile 1 is ranked as the most deprived. In order to account for the socioeconomic status of the population served by our unit, patients that underwent cataract surgery (CS) were used as controls. Results 582 individuals that were recorded as having TS from Nov 2008 to Apr 2017; Male:Female 1.02:1, mean age 70.9 (SD 11.9) were compared to 39,805 individuals who underwent CS from Jul 2004 to Apr 2017; Male:Female 1:1.51, mean age 76.4 (SD 10.2). The percentage of the population of TS patients belonging to IDM decile 5 and below was 32.82% compared to 39.62% of CS patients. The percentage of TS patients belonging to IDM deciles 1 to 3 was lower than that of CS patients, but higher In IDM deciles 6 to 10. More specifically the percentage of TS patients belonging to decile 1(3.26%) and 2(4.64%) are significantly lower compared to CS patients of the decile 1(6.20%)*** and 2(6.85%)** (***p < 0.01, **p < 0.05, two‐tailed z‐test). Conclusions Our results show that more deprived patients are less likely to have a TS compared to CS. This might indicate either that the more deprived individuals present with glaucoma late and cannot be treated surgically, or that the less deprived patients are more concerned about their vision or both.

Purpose To report a case series involving two cases of acute retinal necrosis (ARN) presenting after treatment and resolution of herpes simplex virus (HSV) encephalitis. In neither case was antiviral prophylaxis after initial episode of encephalitis used. Literature review is presented to evaluate the benefit of prophylaxis in such cases. Methods Two case reports are described and fundus photos presented of patients presenting to the Ophthalmology Department of Queen Alexandra Hospital, Portsmouth, UK within the last 3 years. PubMed was used to conduct the literature review. Results A 67‐year‐old female presented with rapid painful unilateral visual loss. She had had a history of HSV encephalitis 6 years before, treated successfully with no recurrences. Clinical assessment was in keeping with ARN. She was admitted for intravenous acyclovir for 8 days followed by long‐term oral antiviral treatment. Her vision remained poor with a best‐corrected visual acuity (BCVA) of 6/60 in the affected eye. A 66 year‐old male presented with a 10‐day history of painful unilateral visual loss. He had had a history of HSV encephalitis 6 months before and a relapse 2 months later treated successfully with acyclovir. Clinical assessment demonstrated a panuveitis and retinitis in keeping with ARN. He was admitted for intravenous acyclovir then kept on long‐term oral treatment of 400 mg twice‐daily. The BCVA in his affected eye has remained at 5/60. Conclusions HSV encephalitis has been widely documented as a risk factor for ARN and has been reported to occur up to 20 years after initial illness. The virus may reach the eye via a trans‐axonal route and reside in a reservoir awaiting re‐activation within retinal neurons. We propose that prophylaxis with long‐term low‐dose antivirals is necessary after all cases of HSV encephalitis to reduce the risk of ARN.

Purpose To investigate the correlation of biopsy proven temporal arteritis with clinical symptoms and inflammatory markers. Methods Retrospective study of all patients (n = 89) referred for temporal artery biopsy (TAB) over a 30‐month period. Ten patients were excluded due to inconclusive biopsy or insufficient data. Correlation of presenting symptom (localised headache LH, jaw claudication JC, pain over temporal artery PTA, constitutional symptoms CS) and inflammatory marker level (ESR, CRP) with histological outcome (presence of giant cells) were assessed using a two‐tailed unpaired t‐test. Results 50 cases had a negative (−ve) biopsy result and 29 positive (+ve). Mean age (SD) for each group was 71 yrs (10) and 77 yrs (6) respectively. No significant correlation was found between presenting symptom and biopsy result (−ve:+ve LH 88%:79%, PTA 46%:62%, CS 40%:59%) except for jaw claudication (36%:62%, p < 0.05). Inflammatory marker result was found to significantly correlate with biopsy outcome. Mean ESR (SD) was 23 (21) in the −ve and 34 (24) in the +ve (p < 0.05) and mean CRP (SD) was 33 (40) in the −ve and 98 (81) in the +ve group, (p < 0.001). Mean ESR+CRP (SD) was 55 (52) in the −ve and 132 (87) in the +ve (p < 0.0001). There were no significant differences in duration of steroid treatment prior to TAB or time to TAB between the two groups. One patient had normal ESR and CRP with a positive biopsy result.Treatment with steroids was continued for 48% of patients with −ve biopsy on clinical grounds. Conclusions Elevated ESR and CRP are strongly predictive of positive TAB outcome. Combining ESR+CRP increases the significance of the correlation. Further studies with larger patient numbers may identify an appropriate cut‐off level which, combined with age and clinical features, may provide a clinical score to aid decision making regarding which patients require TAB.