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Bushra Mushtaq,1 Ajay Bhatnagar,2 Helen Palmer3 1Birmingham Midland Eye Centre, City Hospital SWBH NHS Trust, Birmingham, UK; 2Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK; 3Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UKCorrespondence: Bushra MushtaqBirmingham Midland Eye Centre, City Hospital SWBH NHS Trust, Dudley Road, B18 7QH, UKTel +44 7976416571Email bushramushtaq@nhs.netAim: To investigate real-world effectiveness and safety of fluocinolone acetonide (FAc) implant over three years of treatment in eyes with diabetic macular edema (DME) in a population with large ethnic diversity.Methods: This audit of three large treatment centres in the UK involved retrospective collection of outcome data (best recorded visual acuity [BRVA] by Early Treatment Diabetic Retinopathy Study [ETDRS] letters, central retinal thickness [CRT], intraocular pressure [IOP] and use of supplementary treatments) from patients with DME treated with 0.2 μg/day FAc intravitreal implant with three-year follow-up expected.Results: A total of 96 eyes were included. Ninety (93.8%) eyes had received prior intravitreal treatment. Increases in mean BRVA were significant at one, two and three years (p< 0.05). Overall, 78.1% of eyes gained or maintained BRVA; just over 50% gained ≥ 5 letters, representing a functional response. Eleven (11.6%) patients lost ≥ 10 letters by year three. Decreases in central retinal thickness (CRT) nearing 200 μm in the first year were sustained to three years (p < 0.0001). Patients with baseline VA ≥ 60 letters maintained their BRVA throughout follow-up, while significant improvements at month 12 (p< 0.0001) in those with baseline BRVA < 60 letters were maintained through month 36 (p < 0.005). Fifty-three (55.2%) eyes required no supplementary therapy during follow-up. Increases in IOP to ≥ 30 mmHg and ≥ 25 mmHg were seen in 12 (12.5%) and 23 (24.0%) eyes, respectively.Conclusion: This study confirms the effectiveness and tolerability of FAc implant up to 36 months in a real-world setting, highlighting the importance of early treatment for sustaining functional vision for patients.Keywords: fluocinolone acetonide, DME, diabetic macular edema, real-world, observational, case series

Faye Horner, Peck Lin Lip, Bashar R Mohammed, William Fusi-Rubiano, Eesha Gokhale, Bushra Mushtaq, Randhir Chavan Birmingham & Midland Eye Centre, Birmingham, UKCorrespondence: Randhir ChavanBirmingham & Midland Eye Centre, Sandwell & West Birmingham Hospitals NHS Trust, City Hospital Dudley Road, Birmingham, B18 7QH, UKTel +44 121 5543801Fax +44 121 5076791Email rchavan@nhs.netPurpose: To compare and report the 2-year treatment outcomes from 3 different anti-VEGF treatment regimens in treating neovascular aged-related macular degeneration (nAMD): Ranibizumab pro re nata (Ranibizumab-PRN); Ranibizumab treat and extend (Ranibizumab-T&E); Aflibercept fixed first year dosing (7 injections) with treat and extend in subsequent year (Aflibercept-Fixed).Methods: All treatment-naïve nAMD patients who completed 24 months of monitoring from a single treatment center were included. Patients received the initial loading dose of three injections (4-weekly interval), followed by one of the 3 treatment regimens. Primary outcomes were changes in visual acuity (VA) and central retinal thickness (CRT). Secondary outcome was number of injections required in each year. Data analysis included last observation carried forward (LOCF) for patients with incomplete year-2 follow-up.Results: A total of 249 eyes (230 patients) were studied: 121 Ranibizumab-PRN; 65 Ranibizumab-T&E, and 63 Aflibercept-Fixed. Baseline median VA (ETDRS letters) for Ranibizumab-PRN, Ranibizumab-T&E, and Aflibercept-Fixed was 53.9, 61.1, and 54.9 letters, achieving final VA of 54.9, 65.1, and 65.1 letters, respectively. Hence, the number of letters increased at the end of 24 months for each group was +1.0 (Ranibizumab-PRN), +4.0 (Ranibizumab-T&E), highest +10.2 in Aflibercept-Fixed group. Median number of injections over 2 years (year-1/year-2) was 5/1 for Ranibizumab-PRN, 9/6 for Ranibizumab-T&E, and 7/5 for Aflibercept-Fixed. Both Ranibizumab-T&E and Aflibercept-Fixed also shared the same reduction of median CRT (115 μm), higher than Ranibizumab-PRN (83 μm).Conclusion: We report VA improvement from all three different treatment regimens with both Aflibercept-Fixed and Ranibizumab-T&E regimens achieving the same higher final VA. Aflibercept-Fixed dosing may have more favorable efficacy with the highest VA gain and comparatively lower dosing frequency whereas Ranibizumab-T&E may be more efficient than Ranibizumab-PRN regimen, according to our study.Keywords: AMD, Ranibizumab, Aflibercept, protocols, PRN, treat & extend

Faye Horner,* Peck Lin Lip,* Bushra Mushtaq, Randhir Chavan, Bashar Mohammed, Arijit Mitra Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham B18 7QH, UK*These authors contributed equally to this workCorrespondence: Peck Lin LipBirmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital Dudley Road, Birmingham B18 7QH, UKTel +44 121 5543801Fax +44 121 5076791Email pllipwoo@gmail.comPurpose: To report long-term efficacy and treatment outcomes of the combination therapy for treating macular oedema (MO) in retinal vein occlusions (RVOs) from a real-world UK practice.Methods: The initial reported 66 RVO patients with MO treated with combination therapy (initial Ranibizumab, later optional addition of Ozurdex and laser) were followed up to Year 3: visual acuity (VA) and central retinal thickness (CRT) were analysed against baseline and previous Year 1 results. Safety and adverse events were also recorded.Results: Baseline LogMAR VA of 0.71 (Snellen 6/30) improved to 0.48 (Snellen 6/18) at Year 3 (p= 0.006); 63% experienced VA improvement (40% improved ≥ 3 lines), 27% had worse vision. Stability of mean VA (6/18) was already achieved at first post-loading phase review and was maintained in each subsequent year. Statistically significant CRT improvement was noted in each year (Year 3 median CRT=264μm) compared to baseline (median CRT=531μm). There was a reduction in the mean number of total injections to 2.5 in Year 3 (vs 5.5 in Year 1). Comparing Year 3 against Year 1, mean Ranibizumab injection frequency was 2.1 vs 4.3; mean Ozurdex injection frequency was 0.2 vs 1.1. In Year 3, 39.6% of patients did not require any form of injections, laser frequency was also reduced to 22.9% (vs 81.8% in Year 1). There was no endophthalmitis in the cohort, one progressed to neovascular glaucoma in Year 2 and mortality rate was recorded as 6%.Conclusion: Our real-world clinical practice for RVO patients using a combined therapy is associated with good long-term VA and anatomical outcomes with less intravitreal re-treatment rates.Keywords: RandOL protocol, Ozurdex, ischaemia, laser, mortality, aspirin

Faye Horner, Peck-Lin Lip, Hannah Clark, Randhir Chavan, Ambreen Sarmad, Bushra Mushtaq Birmingham and Midland Eye Centre, Birmingham, UKCorrespondence: Bushra MushtaqBirmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham B18 7QH, UKEmail bushramushtaq@nhs.netPurpose: To report the long-term clinical outcomes for patients with neovascular age-related macular degeneration (nAMD) who received anti-vascular endothelial growth factor (anti-VEGF) therapy as part of a standardised treatment protocol in a real-world setting.Patients and methods: This is a retrospective audit of all treatment-naïve patients with nAMD who commenced a pro re nata (PRN) treatment regimen of intravitreal Ranibizumab from January to December 2009 and completed 8 years of follow-up in one single-treatment centre. Electronic medical notes were reviewed to evaluate the outcome measures. Outcome measures included progression of visual acuity (VA), central retinal thickness (CRT) and treatment frequency.Results: 95 eyes from 86 patients had complete data for 8 years of follow-up. Baseline median CRT was 295μm [IQR 254–349] and improved to 209μm [IQR 182–254] in year 8 (p

Winfried Amoaku,1 Konstantinos Balaskas,2,3 Tomas Cudrnak,4 Louise Downey,5 Markus Groppe,6 Sajjad Mahmood,7 Hemal Mehta,8 Quresh Mohamed,9 Bushra Mushtaq,10 Philip Severn,11 Athanasios Vardarinos,12 Yit Yang,13 Saad Younis14 1Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK; 2NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and University College of London Institute of Ophthalmology, London, UK; 3University of Manchester, Manchester, UK; 4Royal Eye Infirmary, University Hospitals Plymouth NHS Trust, Plymouth, UK; 5Hull and East Yorkshire Eye Hospital, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK; 6Ophthalmology, Stoke Mandeville, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK; 7Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; 8Royal Free London NHS Foundation Trust, London, UK; 9Gloucestershire Eye Unit, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK; 10Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK; 11South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK; 12Eye Treatment Centre, West Suffolk Hospital, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK; 13Wolverhampton Eye Infirmary, The Royal Wolverhampton NHS Trust, Wolverhampton, UK; 14Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK Abstract: The treatment of neovascular (wet) age-related macular degeneration (AMD) with ranibizumab is now very well established in terms of efficacy and safety. Recent clinical trials and real-world studies have demonstrated the advantages of a Treat-and-Extend (T&E) regimen, and many hospital departments are now in the process of adopting this new regimen in favor of the pro re nata regimen for initiating and continuing ranibizumab therapy for patients with wet AMD. The comprehensive spectrum of issues related to implementation of the regimen is covered qualitatively in ten didactic topics provided by a group of clinicians with direct experience of this regimen in their department. The topics include definition, new and previously treated eyes, management of high-frequency injections, maximum extensions, discontinuing T&E, bilateral cases, clerical, audit, and patient counseling. This article aims to provide a useful resource for the implementation of the T&E regimen. A quantitative summary of the visual outcomes in key publications is also provided in this article. This article should be a valuable resource for staff training. Keywords: ranibizumab, age-related macular degeneration, nAMD, Treat and Extend, anti-VEGF treatment

Peck Lin Lip,1 Huzaifa Malick,1 Kenan Damer,1 Samer Elsherbiny,1 Kanupriya M Darrad,1 Bushra Mushtaq,1 Arijit Mitra,1 Panagiota Stavrou,1 Yit Yang1,2 1Birmingham and Midland Eye Centre, City Hospital, 2School of Health and Life Sciences, Aston University, Birmingham, UK Background: The purpose of this study was to investigate the 12-month outcome of macular edema secondary to both chronic and new central and branch retinal vein occlusions treated with intravitreal bevacizumab in the real-life clinical setting in the UK.Methods: Retrospective case notes analysis of consecutive patients with retinal vein occlusions treated with bevacizumab in 2010 to 2012. Outcome measures were visual acuity (measured with Snellen, converted into logMAR [logarithm of the minimum angle of resolution] for statistical calculation) and central retinal thickness at baseline, 4 weeks post-loading phase, and at 1 year.Results: There were 56 and 100 patients with central and branch retinal vein occlusions, respectively, of whom 62% had chronic edema and received prior therapies and another 32% required additional laser treatments post-baseline bevacizumab. Baseline median visual acuity was 0.78 (interquartile range [IQR] 0.48–1.22) in the central group and 0.6 (IQR 0.3–0.78) in the branch group. In both groups, visual improvement was statistically significant from baseline compared to post-loading (P

Bushra Mushtaq,1,* Niall J Crosby,1,* Antonios T Dimopoulos,1 Peck Lin Lip,1 Panagiota Stavrou,1 Samer El-Sherbiny,1 Yit Yang2 1Birmingham and Midland Eye Centre, City and Sandwell National Health Service Trust, Birmingham, West Midlands, UK; 2Life and Health Sciences, Aston University, Birmingham, West Midlands, UK*These authors contributed equally to this workPurpose: To investigate whether eyes with diabetic macular edema (DME) and central retinal thickness (CRT) >400 µm had better visual and anatomical outcomes compared to eyes with a CRT 400 µm) had significantly more injections than group 1 (CRT

In this paper, we will study the Lorentz symmetry breaking down to its subgroup. A two-form gauge theory is investigated in the Lorentz violating background and it will be shown that this symmetry violation affects the structure of this gauge theory. In particular, we will study the gaugeon formalism and FFBRST for such a theory in this broken spacetime. In addition to Kugo-Ojima type condition, a thorough evaluation of quantum gauge freedom and gaugeon modes is carried out. We will explicitly demonstrate that in Lorentz broken spacetime, our reducible gauge theory fully depicts the physical aspects of gaugeon fields. [ABSTRACT FROM AUTHOR]

In this paper, we will analyze a supersymmetric field theory deformed by generalized uncertainty principle and Lifshitz scaling. It will be observed that this deformed supersymmetric field theory contains non-local fractional derivative terms. In order to construct such a deformed N = 1 supersymmetric theory, a harmonic extension of functions will be used. However, the supersymmetry will only be preserved for a free theory and will be broken by the inclusion of interaction terms. [ABSTRACT FROM AUTHOR]