Initial results of QuantiFERON-TB Gold testing in patients with uveitis.

PURPOSE: To describe the use of the second-generation QuantiFERON-TB Gold (QFT-G) test in a series of patients in an ophthalmic practice. METHODS: The charts of all patients who had QFT-G tests ordered by Mayo Clinic ophthalmologists in the past 3 years were reviewed. RESULTS: A total of 27 QFT-G tests were ordered. Thirteen (48%) tests were negative, six (22%) were indeterminate, two (7%) tests were re-ordered after a lab accident or an improper cancellation, four (15%) were positive and represented infection, and two (7%) were positive but negative when re-tested. Of the four truly positive cases, three were treated for tuberculosis (TB): one had tuberculous iritis, one had retinal vasculitis and haemorrhage, and one had asymptomatic TB but was on immunosuppressive therapy. The fourth patient had previously been treated for latent infection. CONCLUSIONS: In a series of selected patients with uveitis, the QFT-G test was able to detect TB infection in 15% of the patients, though it does not differentiate between active and latent TB infection. QFT-G should be considered in place of purified protein derivative testing in those with uveitis that have had prior BCG vaccination and in immunocompromised patients. Patients with a positive QFT-G, but who have little risk for TB infection and a negative systemic work-up, should be re-tested.

Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab.

PURPOSE: To assess the intraocular pressure (IOP) changes, within the first 30 min after intravitreal injection of 0.1 ml (4 mg) triamcinolone, 0.09 ml (0.3 mg) pegaptanib, and 0.05 ml (1.25 mg) bevacizumab. METHODS: Records of patients who received intravitreal triamcinolone, pegaptanib, and bevacizumab and who had their IOP measured post-injection were reviewed. RESULTS: A total of 212 injections were performed (76 bevacizumab in 63 patients, 42 triamcinolone in 41 patients, 94 pegaptanib in 74 patients). At 10 min, over 87% of eyes receiving each drug had an IOP of less than 35 mmHg. Three of the 42 eyes receiving intravitreal triamcinolone were treated with IOP-lowering drops for pressures of 44, 46, and 60 mmHg. No patients treated with intravitreal bevacizumab or pegaptanib received IOP-lowering drops. The number of eyes in each injection group that had an IOP rise >10 mmHg within 30 min after injection was 27.6% of eyes receiving bevacizumab, 33.3% of eyes receiving triamcinolone, and 36.2% of eyes receiving pegaptanib. At 10 min, eyes with glaucoma were less likely to have an IOP<35 mmHg, but this difference became less marked with time. CONCLUSION: In our series, most patients receiving intravitreal injections did not require IOP-lowering drops after injection, and none required a paracentesis.

Changes in fundus autofluorescence of choroidal melanomas following treatment.

PURPOSE: We have previously shown that fundus autofluorescence (FAF) associated with pigmented choroidal lesions can be attributed to mainly lipofuscin (orange pigment) but also to hyperpigmentation, drusen, or fibrous metaplasia. The purpose of this study is to describe the effects of treatment on FAF in choroidal melanomas after plaque radiotherapy alone or in combination with transpupillary thermotherapy (TTT). METHODS: Retrospective chart review of eight consecutive patients with choroidal melanoma treated with plaque radiotherapy alone or in combination with TTT who underwent FAF photography before and after treatment. The correlation between FAF patterns and foci of orange pigment, hyperpigmentation, drusen, or fibrous metaplasia was evaluated. RESULTS: The median follow-up time was 4 (range 2-9) months. Foci of orange pigment and hyperpigmentation became larger and more numerous after treatment. Fibrous metaplasia was also increased. A complete correlation between increased FAF and orange pigment was found in all eight tumours (100%) before and after treatment. No correlation between hyperpigmentation and increased FAF was found before treatment but a partial correlation was found in all eyes after treatment. Before treatment, correlation between fibrous metaplasia was present in three eyes and increased FAF was partial in two eyes with no correlation in one case. After treatment, this correlation was partial in all presenting eyes (7). CONCLUSIONS: Following treatment, choroidal melanomas may show increased FAF, mainly due to an increase in the amount of lipofuscin (orange pigment) and hyperpigmentation.

Intravitreal bevacizumab for macular oedema secondary to branch retinal vein occlusion.

PURPOSE: To report short-term results of intravitreal bevacizumab (IVB) injection for macular oedema (ME) associated with branch retinal vein occlusion (BRVO). METHODS: Retrospective interventional case series of 12 eyes of 12 consecutive patients. IVB injections (1.25 mg/0.05 ml) were given as needed based on the presence of ME on optical coherence tomography. Changes in Snellen visual acuity (VA) and central macular thickness (CMT) were analysed using the Student's paired t-test. RESULTS: At a mean follow-up of 9.8 months (range: 6-17 months), the mean number of IVB injections given was 4 (range: 1-6). No ocular or systemic side effects were noted. The differences in logMAR VA between baseline and 1 month, between baseline and 6 months, and between baseline and final follow-up were statistically significant (P<0.05). The differences in CMT between baseline and 1 month, baseline and 6 months, and between baseline and final follow-up were also statistically significant (P<0.05). CONCLUSION: Short-term results indicate that IVB is useful in decreasing ME and improving VA in eyes with BRVO.

Clinical features and outcomes of cytomegalovirus retinitis after transplantation.

Cytomegalovirus (CMV) infection of the retina is a rarely encountered end-organ disease after transplantation. In order to describe the clinical characteristics and outcomes of CMV retinitis after hematopoietic stem cell and solid organ transplantation, we performed a retrospective review of all cases of CMV retinitis at the Mayo Clinic (Rochester, Minnesota) during 1990-2004. During this 15-year period, CMV retinitis was diagnosed in 14 eyes of 9 patients who had received kidney (n=5), liver (n=2), heart (n=1), and autologous hematopoietic stem cell transplant (n=1). The mean age of the patients was 58 (standard deviation+/-11) years; 6 were male. The median time to diagnosis of CMV retinitis was 9 months (range, 4 months to 13 years) after transplantation. Four (44%) patients had concomitant pneumonitis or hepatitis. Five (55%) patients had bilateral retinitis. Retinal involvement was 10% but 50% in 2 eyes. All patients received induction therapy with intravenous ganciclovir (n=8) or foscarnet (n=1) for a median of 43 days (range, 14-100 days) followed by maintenance therapy with intravenous or oral ganciclovir for a median of 88 days (range, 36-943 days) in 6 (67%) patients. One patient developed bilateral immune recovery uveitis during treatment, and later on progressed to develop rhegmatogenous retinal detachment. During the mean follow-up period of 20 months, visual acuity improved in 4 (28.5%), was stable in 4 (28.5%), and worsened in 6 (43%) eyes. CMV retinitis recurred in 2 patients. In conclusion, CMV retinitis is a rare, progressive, and highly morbid infectious complication of transplantation. The severity of clinical disease at the time of diagnosis may predict poor outcome. Hence, early intervention may be crucial to prevent its progression to irreversible visual loss.

The use of 31-gauge needles and syringes for intraocular injections.

PURPOSE: To describe the use of disposable 31-gauge needles for intraocular injections. METHODS: Description of the technique and photographs of the needles. RESULTS: Patients feel the injection less and a smaller postinjection bleb is noted. CONCLUSION: Consideration should be given to the use of disposable 31-gauge needles or syringes for intraocular injections.

Photodynamic therapy for maculopathy due to radiation retinopathy.

BACKGROUND/AIMS: To describe the clinical outcomes of four eyes with macular oedema due to radiation retinopathy treated with verteporfin photodynamic therapy (PDT). METHODS: Interventional Case Series. Four charts of four patients who underwent PDT for macular oedema due to radiation retinopathy were reviewed. Snellen visual acuities, clinical examination and fundus photographs were performed before and after PDT. Main outcome measures were visual acuity, clinical examination before and after PDT. RESULTS: All four eyes had a marked reduction in hard exudates. Three of four eyes had an improvement in vision following the PDT. CONCLUSION: PDT may have a role in the treatment of macular oedema due to radiation retinopathy.

Intravitreal preservative-free triamcinolone acetonide for the treatment of macular oedema.

PURPOSE: To report the use of commercially available preservative-free intravitreal triamcinolone acetonide for the treatment of macular oedema due to retinal vascular diseases. DESIGN: Retrospective interventional case series. METHODS: Charts of eyes that received 4 mg preservative-free intravitreal triamcinolone acetonide for the treatment of persistent macular oedema due to retinal vascular diseases were reviewed. Patients were included if they had a follow-up of at least 3 months. Visual acuity, intraocular pressure, presence of an anterior chamber reaction, and mean macular thickness on optical coherence tomography (OCT) were recorded. RESULTS: A total of 10 eyes of 10 patients were identified. Visual acuity improved by a mean of 1.1 Snellen lines at 1 month and 1.3 lines at 3 months. Macular thickness on OCT decreased by a mean of 183.5 microm at 1 month (P<0.0001). Intraocular pressure increased from a mean of 13.5 mmHg at baseline to 15.3 at 1 month, and 14.5 at 3 months. Only the 1-month change in intraocular pressure was statistically significant (P=0.0274). There were no cases of endophthalmitis, anterior chamber reaction, or retinal detachment. CONCLUSION: In this small retrospective, noncomparative series, commercially available preservative-free intravitreal triamcinolone acetonide had no adverse outcomes. Macular oedema was noted to decrease following treatment.

Ocular malformations, moyamoya disease, and midline cranial defects: a distinct syndrome.

PURPOSE: To report a 10-year-old girl with developmental anomalies of both optic disks, a chorioretinal coloboma, sphenopharyngeal meningoencephalocele, and moyamoya disease. METHODS: A full ophthalmologic examination, cranial magnetic resonance imaging and magnetic resonance angiography, and cerebral angiography were performed. RESULTS: The patient had a morning glory disk anomaly and microphthalmos of the right eye and optic nerve hypoplasia and retinochoroidal coloboma in the left eye. She had a midfacial cleft and an episode of seizures and a stroke. Magnetic resonance imaging showed a sphenopharyngeal meningoencephalocele. Magnetic resonance angiography and cerebral angiography demonstrated a pattern consistent with moyamoya disease. CONCLUSIONS: This patient had a distinct syndrome of optic disk, retinochoroidal, and carotid circulation anomalies with midline cranial defects. The recognition and treatment of the vascular abnormalities and cranial defects may prevent complications such as strokes that may occur during or after general anesthesia.

Quality of life outcomes following dacryocystorhinostomy: external and endonasal laser techniques compared.

AIMS/BACKGROUND. Endonasal laser dacryocystorhinostomy (ELDCR) has recently become established as an alternative technique to conventional external DCR (EXDCR) for relief of epiphora. The aim of this study was to compare quality of life and symptomatic outcomes in patients treated by these two methods. METHODS. A postal questionnaire was sent to 204 ELDCR and 78 EXDCR patients who had undergone surgery under our care more than 6 months previously. The questionnaire included the validated 18-item Glasgow Benefit Inventory (GBI) and 5 further questions addressing ocular symptomatology. RESULTS. Fully completed questionnaires were received from 156 ELDCR and 50 EXDCR patients. Mean GBI scores of +16.8 (ELDCR) and +23.2 (EXDCR) were obtained (Mann-Whitney U test = NS). Ocular symptom scores were +33 (ELDCR) and +54 (EXDCR) (p=0.005). CONCLUSION. Patients undergoing either ELDCR or EXDCR experience significant benefit in their healthcare status as detected by the GBI. There is no significant difference between the scores obtained by the two groups of patients. There were improvements in ocular symptom scores in both groups, with patients who had EXDCR scoring significantly better than the ELDCR group.

Endonasal laser-assisted dacryocystorhinostomy.

Endonasal laser-assisted dacryocystorhinostomy allows relief of epiphora caused by nasolacrimal duct obstruction. It can be performed as a day-case procedure and has many advantages over conventional approaches. This article reviews conventional, endoscopic and laser-assisted dacryocystorhinostomy and describes the technical steps of an endonasal procedure.