Systemic considerations with pigmented fundus lesions and retinal pigment epithelium hamartomas in Turcot syndrome.

PURPOSE OF REVIEW: To illustrate retinal pigment epithelium hamartomas (RPEHs) in a patient with known Turcot syndrome and to demonstrate the significance of these lesions in other colonic polyposis syndromes. RECENT FINDINGS: The presence of multiple, bilateral RPEHs is a specific marker for familial adenomatous polyposis (FAP). Recent studies have noted RPEHs in associated syndromes including Gardner and Turcot syndromes. Herein, we illustrate an 18-year-old male patient with known brain medulloblastoma who was documented 7 years later to have asymptomatic RPEHs in both eyes, demonstrating hypo-autofluorescence. SUMMARY: This patient with previous medulloblastoma and known Turcot syndrome was later found to have typical RPEHs, a feature that is important in family screening. Confirmation of RPEHs related to Turcot syndrome was made, and genetic evaluation confirmed germline mutation in the adenomatous polyposis coli (APC) gene. Observation was advised. Due to the fairly rapid progression to colorectal cancer if untreated, ophthalmologists should be aware that RPEHs can be the first extracolonic manifestation of FAP, Gardner syndrome, and Turcot syndrome.

Intravitreal bevacizumab (avastin) and ranibizumab (lucentis) for choroidal neovascularization overlying choroidal osteoma.

PURPOSE: To report the effect of anti-vascular endothelial growth factor (VEGF) therapy for choroidal neovascularization overlying choroidal osteoma. METHOD: In an interventional case report, intravitreal anti-VEGF therapy was used for tumor-related choroidal neovascularization. RESULTS: A 34-year-old woman with bilateral choroidal osteoma had a decrease in visual acuity in the right eye from 20/30 to 20/100. Ophthalmoscopy revealed partially decalcified circumpapillary, macular choroidal osteoma with overlying subretinal hemorrhage and choroidal neovascular membrane. Intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) resulted in membrane regression and visual acuity improvement to 20/50 at 6 weeks. Further therapy with intravitreal ranibizumab (Lucentis; Genentech, Inc.) resolved persistent subretinal fluid, and visual acuity improved to 20/30 at the 6-month follow-up. CONCLUSIONS: Therapy with intravitreal anti-VEGF medications might be an alternative for patients with choroidal neovascularization overlying choroidal osteoma.

Retinal complications of cataract surgery.

Cataract surgery, like any surgical procedure, has associated complications. Acute retinal complications include globe perforation, dislocated lens fragments, hemorrhagic choroidal detachment, and endophthalmitis. Late retinal complications include retinal detachment, cystoid macular edema, and exacerbation of diabetic retinopathy and other retinal conditions. Proper and timely management of retinal complications from cataract surgery is crucial in maximizing visual outcomes. Many of the complications and current management strategies will be outlined in this review.

The risk of fellow eyes in patients with rhegmatogenous retinal detachment.

PURPOSE OF REVIEW: A review of the current literature regarding the risk of nontraumatic rhegmatogenous retinal detachment in the fellow eye and prophylaxis of predisposing lesions is presented. RECENT FINDINGS: Although reports vary in study design and inclusion/exclusion criteria, the risk of retinal detachment in fellow eyes is similar to prior findings. Studies on prophylactic therapy also treated different cohorts. This makes drawing definitive conclusions difficult. SUMMARY: Rhegmatogenous retinal detachment poses a significant threat to the fellow eye. Risk factors specifically relevant to the fellow eye are discussed. There is insufficient evidence to recommend prophylactic therapy for prevention of retinal detachment in the fellow eye. To date, no prospective, randomized clinical trial on the prevention of retinal detachment in the fellow eye has been published.

Determination of the incidence and clinical characteristics of subsequent retinal tears following treatment of the acute posterior vitreous detachment-related initial retinal tears.

PURPOSE: To determine the incidence of subsequent retinal tears (SRT) in patients who were previously treated for acute posterior vitreous detachment (PVD)-related retinal tears. DESIGN: Retrospective chart review. METHODS: A retrospective chart review of 155 eyes of 137 consecutive patients treated for acute PVD-related retinal tears was performed. RESULTS: During a median follow-up of 13 months (range 3 to 157 months) after treatment, SRT developed in 19 (12.2%) of 155 treated eyes. Most of the SRT occurred during the first 6 months (12 of 19 eyes) after initial treatment. Subsequent vetinal tears developed within the first 12 months in 15 of 19 treated eyes, however only six of 15 of these eyes were symptomatic. Of those patients who developed SRT after 12 months, all had new visual symptoms. CONCLUSION: Patients who present with acute PVD-related retinal tears are at a low but significant risk for developing SRT. A significant number of patients treated for PVD-associated retinal tears present within 1 year with SRT without symptoms.

Rhegmatogenous retinal detachment in the fellow phakic eyes of patients with pseudophakic rhegmatogenous retinal detachment.

PURPOSE: To determine the risk and clinical characteristics of rhegmatogenous retinal detachment (RD) in the fellow phakic eyes of patients with a pseudophakic retinal detachment (PPRD) in one eye. METHODS: The authors conducted a computer-generated chart review to find 64 consecutive patients with a PPRD in one eye and were phakic in the fellow eye. The clinical information was collected on all patients to investigate the risk and clinical characteristics of RD in the fellow eyes while still phakic. Information was also obtained on the fellow eyes that underwent cataract surgery and developed a PPRD. RESULTS: Sixty-four patients with a PPRD in one eye were phakic in the fellow eye. During an average follow-up of 57.4 months, five (7.8%) fellow eyes developed retinal detachment while still phakic. In addition to the five eyes with a phakic RD, 10 originally phakic fellow eyes underwent cataract surgery. Of these, one (10%) suffered an RD. CONCLUSION: Fellow eyes of patients with a PPRD have a significant risk of RD even if they do not undergo cataract surgery.