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Purpose: To optimize the aflibercept treat‐and‐extend protocol in wet age‐related macular degeneration (wAMD). Methods: A prospective randomized clinical trial consisting of 52 eyes from 52 patients with treatment‐naïve wAMD. Patients received three monthly aflibercept injections and were then randomized 1:1 to two different dosing protocols. In treat‐and‐extend protocol with moderate extensions (T&Em), after the loading phase the treatment interval was extended 1 week at a time up to 12 weeks and then by 2 weeks up to 16 weeks. In treat‐and‐extend protocol with rapid extensions (T&Er), the interval was first extended to 8 weeks and then by 2 weeks at a time up to 16 weeks. Main outcome measure was the number of given aflibercept injections. Results: Fifty (96%) patients completed the 1‐year follow‐up. Patient and ophthalmic baseline variables were comparable between the study groups. At 1 year, central subfield macular thickness reduced by 194.3 ± 153.6 μm in T&Em protocol, compared with 194.2 ± 176.6 μm in T&Er (p = 0.997). Eyes with T&Em gained 10.3 ± 11.5 letters from baseline and eyes with T&Er 11.4 ± 10.6 letters (p = 0.434), and dry macula was observed in 72% of eyes with T&Em compared to 68% with T&Er (p = 0.758). At 1 year, the treatment interval was 8.5 ± 2.2 weeks in T&Em and 10.3 ± 2.8 weeks in T&Er (p = 0.017), and the total number of injections 8.64 ± 1.58 and 6.96 ± 0.79, respectively (p < 0.001). In the rapid extensions protocol, 48% of eyes reached a 12‐week treatment interval or beyond at 1 year. Conclusions: At one year, the anatomical and functional responses were comparable between the moderate and rapid extensions protocols, with fewer aflibercept injections in the rapid extension protocol. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide (TA) with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery. Methods: This prospective non‐randomized controlled clinical trial analysed 101 eyes of 101 patients having an elective cataract surgery at Kymenlaakso Central Hospital, Kotka, Finland. Fifty eyes received conventional postoperative care with dexamethasone 1 mg/ml eye drops (DEX), and 51 eyes received a perioperative 20 mg subconjunctival injection of TA. None of the eyes received postoperative topical antibiotic prophylaxis. The main outcome measures were aqueous flare, central retinal thickness (CRT), corrected distance visual acuity (CDVA) and intraocular pressure (IOP) measured at 7, 28 and 90 days after surgery. Results: Central retinal thickness (CRT) increased in DEX but not in TA‐treated eyes at 7 days (+1.2 ± 20.1 μm and −9.2 ± 24.8 μm, p = 0.031), at 28 days (+23.8 ± 62.6 μm and −3.3 ± 27.7 μm, p = 0.008) and at 90 days (+8.5 ± 24.4 μm and −5.5 ± 33.4 μm, p = 0.026). Aqueous flare increased from baseline in both groups but remained higher in DEX eyes at 90 days (+3.3 ± 9.9 photons/ms and −0.2 ± 6.6 photons/ms, p = 0.021). Corrected distance visual acuity (CDVA) and IOP changes were similar, and ocular tolerance was good in both groups. No serious adverse events were observed. Conclusions: Perioperative subconjunctival TA was effective in preventing ocular inflammation and macular oedema after cataract surgery. Subconjunctival TA combined with intracameral cefuroxime provides a noteworthy option for dropless postoperative care in modern cataract surgery. [ABSTRACT FROM AUTHOR]

Objectives: The benefits of prophylactic carotid endarterectomy (CEA) together with best medical treatment (BMT) are well-established. Early initiation of proper medical treatment reduces the risk of new strokes as waiting periods for CEA operation can be considerably long. We investigated: (1) preoperative medical treatment of CEA patients at our hospital and (2) how well the present medical treatment coheres with national and international secondary prevention guidelines and other CEA cohorts., Methods: A retrospective study cohort of 135 consecutive patients planned for CEA in a tertiary center because of symptomatic (n = 100) or asymptomatic (n = 35) carotid artery stenosis during a 14-month period (2007-2008)., Results: One hundred and twenty-six of 135 (93.3%) patients received antiplatelet therapy at the time of surgery, 125/135 (92.6%) were on statin, and 121/135 (89.6%) used antihypertensive medications. Ten of the 100 symptomatic patients had recurrence or progression in their ischemic symptoms while waiting for the operation, with a median time of 8.5 days (range 1-30 days)., Discussion: Carotid artery stenosis patients are considered high-risk patients regardless of symptomatology. The high proportion of medication use exceeds the use in the past proof-of-concept randomized controlled trials on the benefit of CEA+BMT over BMT. Nevertheless, there is room for improvement.