Introduction: Treat-and-extend (T&E) and pro re nata (PRN; 'as needed') regimens of intravitreal anti-vascular endothelial growth factor (VEGF) treatment have been found to reduce the injection burden on patients and improve the cost effectiveness of the treatment of macular edema. The aim of this study was to assess the effectiveness of a T&E regimen of aflibercept, in a clinical setting, in patients with diabetic macular edema (DME) who were either intravitreal anti-VEGF therapy naive or with minimal exposure to anti-VEGF (B 6 treatments) in the previous 12 months. Methods: This prospective, single arm, open label study recruited patients with DME (macular thickness of C 300 lm) and best-corrected visual acuity (BCVA) between 28-78 ETDRS letters. Participants received five loading doses of intravitreal aflibercept at 4-weekly intervals. BCVA measurements and macular optical coherence tomography were performed at each visit. If no disease activity was detected, treatment intervals were increased by 2 weeks to a maximum of 12 weeks. Outcome measures included: changes in BCVA and retinal anatomical measures (central foveal thickness [CFT] and central macular volume within 6 mm of the fovea [CSVol]) between baseline and 2 years, patient treatment intervals; and adverse events. Results: Of the 36 patients who provided informed consent to participate in the study and were screened, 26 patients (eyes) were eligible to participate in the study. After regression analysis, adjustment for repeated measures, and significant covariates, the mean BCVA increased by 3.8 letters (95% confidence interval [CI] 1.1, 6.4) and the CFT and CSVol decreased by 127.2 lm (95% CI 91.7, 162.5) and 1.6 mm 3 (95% CI 1.2, 2.0), respectively, over the course of the study. In the second year, 16 of the 25 patients still participating had their treatment intervals extended to 12 weeks. There was no evidence of any new adverse events that would require changes to the aflibercept safety profile.

Several new drugs have emerged as effective antineoplastic agents in the past 5 years. Many of these drugs cause rashes. For example, rash is one of the two most frequent adverse events that occur in cancer patients prescribed epidermal growth factor receptor inhibitors. This review discusses rash in the context of epidermal growth factor receptor inhibitors and in the context of a few other recently approved cancer drugs. It also embarks on a brief discussion of issues that investigators must face when designing clinical trials aimed at rash palliation.

A 37-year-old male was found to have a firm yellowy-white palpable mass embedded within the conjunctival surface of the tarsal plate of the left upper eyelid. This was asymptomatic and noted on a routine examination for contralateral epiphora. An excisional biopsy was performed and a “rock-like nodule” was removed with histopathology confirming the presence of mature bone. While the literature describes these lesions located in other aspects of the orbit, this is the first described case of an epibulbar osseous choristoma located in the tarsal plate of the upper eyelid.

Erlotinib used in the treatment of advanced non-small cell lung cancer (NSCLC) is a first-generation small-molecule tyrosine kinase inhibitor which reversibly inhibits the kinase domain of epithelial growth factor receptor (EGFR). The incidence of ocular toxicities as adverse effects (AE) of erlotinib is relatively common. However, post-marketing, acute anterior uveitis (AAU) has been reported in a small number of cases as a putative AE resulting from erlotinib therapy. We present a case of a 67-year-old, Caucasian woman, lifelong non-smoker with stage IV NSCLC who presents with decreased visual acuity and ‘floaters’ 6 weeks after commencing erlotinib. She was later diagnosed with erlotinib-associated bilateral AAU. This is the fifth documented case of erlotinib-associated bilateral AAU since 2010, highlighting the rarity of this AE. Thus, the possibility of AAU should always be considered in patients on EGFR-blocking therapies as significant ocular damage can occur if ophthalmic complaints are not triaged and assessed quickly.