This study investigated the “real-world” use of ranibizumab for neovascular age-related macular degeneration (nAMD) in Taiwan and assessed the visual outcome. We reviewed the medical records at National Cheng Kung University Hospital, Taiwan, during 2012–2014 for 264 consecutive eyes of 229 patients with nAMD, who applied for ranibizumab covered by national health insurance. A total of 194 eyes (73.5%) in 179 patients (65.5% men; mean ± standard deviation age 69.4 ± 10.7 years) were pre-approved for treatment. Applications for treatment increased year by year, but approval rates decreased during this time. The major causes of rejection for funding were diseases mimicking nAMD, including macular pucker/epiretinal membrane, macular scarring, dry-type AMD, and possible polypoidal choroidal vasculopathy. After completion of three injections in 147 eyes, visual acuity significantly improved, gaining ≥1 line in 51.8% of eyes and stabilising in 38.3% of 141 eyes in which visual acuity was measured. The 114 eyes approved with only one application had a better visual outcome than the 27 eyes approved after the second or third applications. In conclusion, ranibizumab is effective for nAMD; however, approval after the second or third application for national health insurance cover is a less favourable predictor of visual outcome.

This paper investigated the incidence and risk of newly diagnosed glaucoma after the initiation of maintenance dialysis in Taiwan. A case–control study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan. There were 3949 patients with dialysis in the study group and 78,980 non-dialysis subjects matched by age and sex in the comparison group. The incidence of newly diagnosed glaucoma after the initiation of maintenance dialysis was analyzed based on the diagnostic code for glaucoma. Patients with dialysis had a higher risk of glaucoma (adjusted hazard ratio (aHR): 1.270; 95% confidence interval (CI): 1.035–1.560) than patients without dialysis. The incidence rate of glaucoma was 8.18 per 10,000 person months in the dialysis group, which was higher than that in the non-dialysis group (5.01 per 10,000 person months). Patients with dialysis exhibited a significantly higher risk of angle-closure glaucoma (ACG) (aHR: 1.550; 95% CI: 1.074–2.239). In contrast, there was no significant risk of developing open-angle glaucoma or normal-tension glaucoma in dialysis patients. Our data suggest that dialysis patients are more susceptible to ACG. Regular ophthalmic examinations may be useful in patients with dialysis to identify high-risk individuals with glaucoma, and preventive measures can be applied to avoid permanent vision loss as soon as intraocular pressure (IOP) elevation is identified.

A case of choroidal rupture caused by airbag-associated blunt eye trauma and complicated with massive subretinal hemorrhage and vitreous hemorrhage that was successfully treated with intravitreal injection of expansile gas and bevacizumab is presented. A 53-year-old man suffered from loss of vision in his right eye due to blunt eye trauma by a safety airbag after a traffic accident. On initial examination, the patient had no light perception in his right eye. Dilated ophthalmoscopy revealed massive subretinal hemorrhage with macular invasion and faint vitreous hemorrhage. We performed intravitreal injection of pure sulfur hexafluoride twice for displacement, after which visual acuity improved to 0.03. For persistent subretinal hemorrhage and suspicion of choroidal neovascularization (CNV), intravitreal bevacizumab (1.25 mg/0.05 mL) injection was administered. After 3 weeks, the visual acuity of his right eye recovered to 0.4. For early-stage choroidal rupture-induced subretinal hemorrhage and complications of suspected CNV, intravitreal injection of expandable gas and intraocular injection of antiangiogenesis drugs seem to be an effective treatment.

Wir stellen hier den Fall einer Aderhautruptur vor, die durch ein Airbag-assoziiertes stumpfes Augentrauma verursacht und durch massive subretinale und Glaskörperblutungen kompliziert wurde; die Behandlung mittels intravitrealer Injektion von Expansionsgas und Bevacizumab verlief erfolgreich. Ein 53-jähriger Mann klagte über Sehverlust im rechten Auge, nachdem er bei einem Autounfall ein stumpfes Augentrauma durch einen Sicherheitsairbag erlitt. Bei der initialen Untersuchung hatte der Patient keine Lichtwahrnehmung im rechten Auge. In der dilatierten Ophthalmoskopie zeigten sich massive subretinale Blutungen mit Makulainvasion und schwacher Glaskörperblutung. Wir nahmen 2 intravitreale Injektionen von reinem Schwefelhexafluorid mit dem Ziel der Verdrängung vor, danach verbesserte sich die Sehschärfe auf 0,03. Wegen persistierender subretinaler Blutung und Verdacht auf choroidale Neovaskularisation (CNV) wurde Bevacizumab (1,25 mg/0,05 ml) intravitreal injiziert. Nach 3 Wochen hatte sich die Sehschärfe im rechten Auge des Patienten wieder auf 0,4 verbessert. Bei früher Aderhautruptur-induzierter subretinaler Blutung und Verdacht auf CNV als Komplikation scheint die intravitreale Injektion von Expansionsgas in Verbindung mit der intraokularen Injektion von Angiogenesehemmern ein wirksames therapeutisches Vorgehen zu sein. Übersetzung aus Case Rep Ophthalmol 2017;8:13-20 (DOI:10.1159/000452652)

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