Recurrence rate and need for reoperation after surgery with or without internal limiting membrane removal for the treatment of the epiretinal membrane.

PURPOSE: To compare the recurrence rate and need for reoperation after epiretinal membrane surgery with and without removal of the internal limiting membrane. METHODS: In this retrospective study, 125 patients operated for epiretinal membrane removal were evaluated, with a minimum 6-month follow-up. Removal of the epiretinal membrane (ERM) was performed in 78 patients, while 47 had removal of the epiretinal membrane associated with internal limiting membrane peeling (ERM + ILM). RESULTS: The mean age in the ERM group was 65.8 years old, ranging from 41 to 80 years old. In the ERM + ILM group, the mean age was 67.2 years old, ranging from 52 to 82 years old. The mean preoperative visual acuity in the ERM group was 20/80p, and in the ERM + ILM group, it was 20/80. The mean postoperative visual acuity in both groups was 20/30. The mean preoperative macular thickness in the ERM group was 467 µm ranging from 281 to 663 µm; in the ERM + ILM group, the preoperative macular thickness was 497 µm, ranging from 172 to 798 µm. After surgery, a reduction in macular thickness was observed in both groups. In the ERM group, the mean macular thickness reduction was 361 ± 101. µm, whereas in the ERM + ILM group, it was 367 ± 75.2 µm. Twenty-two patients presented with a recurrence of epiretinal membrane, of which 16 (20.5%) were from the ERM group and 6 (12.8%) were from the ERM + ILM group (p = 0.39); one patient (2%) was retreated in the ERM + ILM group, whereas 5 patients (6%) where retreated in the ERM group. CONCLUSION: We postulate that ILM peeling for the treatment of epiretinal membrane is not a relevant factor either for visual recovery or macular thickness reduction, but it may reduce the recurrence and reoperation rate.

Combined branch retinal vein and artery occlusion in toxoplasmosis.

A 22-year-old man complained of low visual acuity and pain in his left eye for five days. His ophthalmological examination revealed 2+ anterior chamber reaction and a white, poorly defined retinal lesion at the proximal portion of the inferotemporal vascular arcade. There were retinal hemorrhages in the inferotemporal region extending to the retinal periphery. In addition, venous dilation, increased tortuosity, and ischemic retinal whitening along the inferotemporal vascular arcade were also observed. A proper systemic work-up was performed, and the patient was diagnosed with ocular toxoplasmosis. He was treated with an anti-toxoplasma medication, and his condition slowly improved. Inferior macular inner and middle retinal atrophy could be observed on optical coherence tomography as a sequela of ischemic injury. To our knowledge, this is the first report of combined retinal branch vein and artery occlusion in toxoplasmosis resulting in a striking and unusual macular appearance.

Combined branch retinal vein and artery occlusion in toxoplasmosis / Oclusão combinada de ramo arterial e venoso retinianos em toxoplasmose

ABSTRACT A 22-year-old man complained of low visual acuity and pain in his left eye for five days. His ophthalmological examination revealed 2+ anterior chamber reaction and a white, poorly defined retinal lesion at the proximal portion of the inferotemporal vascular arcade. There were retinal hemorrhages in the inferotemporal region extending to the retinal periphery. In addition, venous dilation, increased tortuosity, and ischemic retinal whitening along the inferotemporal vascular arcade were also observed. A proper systemic work-up was performed, and the patient was diagnosed with ocular toxoplasmosis. He was treated with an anti-toxoplasma medication, and his condition slowly improved. Inferior macular inner and middle retinal atrophy could be observed on optical coherence tomography as a sequela of ischemic injury. To our knowledge, this is the first report of combined retinal branch vein and artery occlusion in toxoplasmosis resulting in a striking and unusual macular appearance.

RESUMO Um paciente do sexo masculino, com 22 anos de idade, queixou-se de redução da acuidade visual no olho esquerdo por 5 dias. O exame oftalmológico mostrou reação de câmara anterior 2+ e uma lesão retiniana esbranquiçada, pouco definida, na porção proximal da arcada vascular temporal inferior. Foram observadas hemorragias retinianas na região temporal inferior estendendo-se à periferia, assim como ingurgitamento venoso, aumento da tortuosidade e palidez isquêmica da retina no mesmo quadrante. Exames laboratoriais corroboraram o diagnóstico de toxoplasmose ocular. O paciente melhorou lentamente após tratamento apropriado. Foi evidenciada atrofia da retina macular inferior interna e média à tomografia de coerência óptica, como sequela da isquemia retiniana. Para nosso conhecimento, este é o primeiro relato de oclusão retiniana combinada de ramo arterial e venoso em toxoplasmose ocular, levando a um aspecto fundoscópico atípico e peculiar.

Fundus Autofluorescence and Spectral Domain OCT in Central Serous Chorioretinopathy.

Background. To describe the standard autofluorescence (FAF), the near infrared autofluorescence (NIA) and optical coherence tomography (OCT) patterns in central serous chorioretinopathy, correlating them with fluorescein angiography. Methods. Cross-sectional observational study, in which patients with at least seven months of CSC underwent ophthalmologic examination, fundus photography, FAF, NIA, fluorescein angiography (FA), and spectral-domain OCT. Results. Seventeen eyes of thirteen patients were included. The presentation features were a mottled hyperFAF in the detached area and areas with pigment mottling. NIA images showed areas of hyperNIA similar to FAF and localized areas of hypoNIA, which correlated with the points of leakage in the FA. OCT showed pigment epithelium detachment at the location of these hypoNIA spots. Discussion. FAF showed increased presence of fluorophores in the area of retinal detachment, which is believed to appear secondary to lipofuscin accumulation in the RPE or the presence of debris in the subretinal fluid. NIA has been related to the choroidal melanin content and there were areas of both increased and decreased NIA, which could be explained by damage ahead the retina, basically RPE and choroid. These findings, along with the PEDs found in the areas of hypoNIA, support the notion of a primary choroidal disease in CSC.

Optical coherence tomography and indocyanine green angiography findings in acute syphilitic posterior placoid choroidopathy: case report / Achados da tomografia de coerência óptica e angiografia com indocianina verde na coroidopatia placóide posterior aguda sifilítica: relato de caso

The optical coherence tomography (OCT) and indocyanine green angiography (ICGA) findings of a 58-year-old male with acute syphilitic posterior placoid chorioretinitis are reported herein. Best-corrected visual acuity was 20/150 in the right eye (OD) and 20/30 in the left eye (OS) at presentation. On funduscopy, there was a central subretinal placoid yellowish lesion in OD. VDRL and serum FTA-ABS were positive. OCT showed increased reflectance and thickening of the subfoveal RPE-choriocapillaris complex corresponding to the lesion in OD. ICGA revealed a hypofluorescent spot corresponding to the lesion in OD and confluent small dots extending to periphery, without any correspondence in fundus examination. The same dots were also seen in OS, even though no lesions could be observed clinically. Intravenous ceftriaxone 2 g daily was given for 10 days. One month after the first visit, visual acuity improved to 20/30 and marked improvement of the lesion was seen. OCT was normal in both eyes at the final visit.

Relatamos aqui os achados da tomografia de coerência óptica (OCT) e angiografia com indocianina verde (ICGA) de um paciente masculino de 58 anos com a coroidopatia placóide posterior aguda sifilítica. A acuidade visual corrigida na apresentação foi de 20/150 no olho direito (OD) e 20/30 no olho esquerdo (OE). A fundoscopia evidenciou lesão sub-retiniana placóide amarelada central no OD. As sorologias VDRL e FTA-ABS foram positivas. OCT evidenciou aumento de refletividade subfoveal e espessamento do complexo EPR-coriocapilar correspondente à lesão do OD. ICGA revelou hipofluorescência local correspondente à lesão do OD e pequenos pontos confluentes que se estendiam para a periferia, sem qualquer correspondência na fundoscopia. O mesmo também foi visto no OE, embora nenhuma lesão pode ser observada clinicamente. Ceftriaxona 2 g intravenosa diária foi administrada durante 10 dias. Um mês após a primeira visita, a acuidade visual do OD foi 20/30 e melhora acentuada da lesão foi observada. Na última visita, o OCT foi normal em ambos os olhos.

Optical coherence tomography and indocyanine green angiography findings in acute syphilitic posterior placoid choroidopathy: case report.

The optical coherence tomography (OCT) and indocyanine green angiography (ICGA) findings of a 58-year-old male with acute syphilitic posterior placoid chorioretinitis are reported herein. Best-corrected visual acuity was 20/150 in the right eye (OD) and 20/30 in the left eye (OS) at presentation. On funduscopy, there was a central subretinal placoid yellowish lesion in OD. VDRL and serum FTA-ABS were positive. OCT showed increased reflectance and thickening of the subfoveal RPE-choriocapillaris complex corresponding to the lesion in OD. ICGA revealed a hypofluorescent spot corresponding to the lesion in OD and confluent small dots extending to periphery, without any correspondence in fundus examination. The same dots were also seen in OS, even though no lesions could be observed clinically. Intravenous ceftriaxone 2 g daily was given for 10 days. One month after the first visit, visual acuity improved to 20/30 and marked improvement of the lesion was seen. OCT was normal in both eyes at the final visit.

Indocyanine green-mediated photothrombosis for choroidal neovascularization in angioid streaks.

PURPOSE: To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. METHODS: Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. RESULTS: The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. CONCLUSION: Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.

Indocyanine green-mediated photothrombosis for choroidal neovascularization in angioid streaks / Fototrombose mediada por indocianina verde para o tratamento de neovascularização de coróide em estrias angióides

PURPOSE: To investigate the effect of indocyanine green-mediated photothrombosis on choroidal neovascularization secondary to angioid streaks. METHODS: Six eyes of 5 patients with an average age of 70 years were diagnosed to have subfoveal choroidal neovascularization secondary to angioid streaks. Therapy was indicated if choroidal neovascularization was considered to be active, according to evidence of fluorescein leakage on angiograms, as well as presence of intra- or subretinal fluid on optical coherence tomography. Patients received photothrombosis at baseline with retreatment as necessary at 3, 6 and 9 months follow-up. Fluorescein leakage was assessed at 3, 6 and 9 months, along with foveal thickness measured by optical coherence tomography. Indocyanine green angiography was performed initially and whenever retreatment was considered. Retreatment was performed whenever there was evidence of increased leakage on fluorescein angiograms at follow-up visits. RESULTS: The mean follow-up was 13.3 months. All eyes had at least 12 months follow-up. Two eyes underwent retreatment. Three eyes had visual acuity improvement and three eyes had stabilization. All patients showed less fluorescein leakage on final angiograms and reduced foveal thickness upon optical coherence tomography measurement. CONCLUSION: Photothrombosis is a feasible procedure for choroidal neovascularization secondary to angioid streaks. Lesion analysis showed anatomical improvement in most cases in this series. Further studies are warranted to evaluate long-term results of this treatment.

OBJETIVO: Investigar os efeitos da fototrombose mediada por indocianina verde sobre a neovascularização de coróide secundária a estrias angióides. MÉTODOS: Seis olhos de 5 pacientes com média de 70 anos de idade tinham o diagnóstico de neovascularização de coróide secundária a estrias angióides. O tratamento foi indicado para neovascularização de coróide ativa, avaliada pelo vazamento na angiofluoresceinografia e pela presença de fluido intra ou sub-retiniano pela tomografia de coerência óptica. Os pacientes receberam tratamento inicial com indocianina verde, e a seguir foram re-tratados conforme necessário com 3, 6 e 9 meses. Nessas ocasiões avaliava-se o vazamento e a espessura foveal. A angiografia com indocianina verde foi realizada inicialmente e sempre que o re-tratamento era considerado, nos casos em que havia aumento de vazamento pela angiofluoresceinografia nas visitas de seguimento. RESULTADOS: O tempo médio de seguimento foi de 13,3 meses. Todos os olhos atingiram um seguimento de pelo menos 12 meses. Dois olhos foram submetidos a re-tratamento. Três olhos apresentaram melhora e três olhos apresentaram estabilização da acuidade visual. Todos os pacientes apresentaram diminuição final do vazamento e da espessura foveal. CONCLUSÃO: Indocianina verde é procedimento factível para o tratamento de neovascularização de coróide secundária a estrias angióides. A análise das lesões mostrou melhora anatômica na maioria dos casos desta série. Mais estudos são necessários para avaliar os resultados a longo prazo deste tratamento.

Impending central retinal vein occlusion associated with cilioretinal artery obstruction.

We report a case of a patient with an impending central retinal vein occlusion (CRVO) with cilioretinal artery obstruction, which may help to understand the nature of the retinal hemodynamic changes associated with CRVO which shows direct evidence of arterial vasospasm, suggesting an increased contractility of retinal arteries. The clinical course, with initial retinal whitening along a cilioretinal artery followed by signs of venous stasis, seems to confirm the pathogenesis hypothesis concerning a primary arterial affection due to arterial vasospasm.

Effects of intravitreal triamcinolone acetonide injection with and without preservative.

AIMS: To evaluate the effects of intravitreal injection of preservative-free triamcinolone acetonide (PFTA) and TA containing preservative (KE). METHODS: A retrospective review was conducted of 646 intravitreal 4 mg/0.1 ml steroid injections in 471 eyes. A total of 577 intravitreal injections of PFTA and 69 injections of KE were administered in non-randomised eyes. No supernatant removal from KE was performed. Non-infectious endophthalmitis was defined as pseudohypopyon/hypopyon with or without an inflammatory reaction that regressed after steroid eye drop instillation. Ocular hypertension was defined as more than 23 mm Hg with Goldman applanation tonometry. Patients were followed and examined 1, 7 and 28 days, and 3, 4, 6 and 12 months after injection and annually thereafter. Statistical analysis was performed using Fisher's exact test and Chi(2) test. p Values <0.05 were considered significant. RESULTS: Both groups did not differ in demographics (p>0.05). Follow-up ranged from 6 to 57 months (mean 13, SD 7.5). Ocular hypertension was present in 127 eyes (20%), but both groups did not differ significantly (p = 0.167). Four eyes (3.15%) required trabeculectomy. Non-infectious endophthalmitis developed in 12 eyes (1.9%) and varied significantly in both groups (p = 0.005). One eye developed bacterial endophthalmitis (0.15%). CONCLUSIONS: Non-infectious endophthalmitis was observed significantly more often after KE injections (7.3%) than after PFTA injections (1.2%) (p<0.05). An inflammatory reaction was more clinically relevant in the KE group than in the PFTA group.

Intravitreal bevacizumab for exudative age-related macular degeneration after multiple treatments.

BACKGROUND: Photodynamic therapy with verteporfin (PDT) significantly reduces the risk of vision loss in patients with exudative age-related macular degeneration (AMD). Indocyanine green-mediated photothrombosis (IMP) and trans-pupillary thermotherapy (TTT) may also be beneficial for selective cases of exudative AMD. However, a substantial subset of patients responds poorly to these treatments. Intravitreal bevacizumab (IVB) has been recently used in the treatment of exudative AMD, showing both visual and anatomic improvement in the majority of cases. METHODS: This interventional retrospective case series reports the effects of IVB in 17 eyes with subfoveal neovascular AMD that had undergone repeated PDT (combined or not with triamcinolone acetonide) or PDT followed by either IMP or TTT with poor results. The main outcome measures were visual acuity and tomographic signs of intra/subretinal fluid, as well as central retinal thickness. RESULTS: Most patients received a single IVB injection. The mean follow-up was 4.47 months. The mean logMAR visual acuity changed from 1.17 +/- 0.40 to 1.06 +/- 0.44 (P = 0.17). The mean central retinal thickness decreased from 404.05 +/- 245.26 to 280.23 +/- 143.14 microm (P = 0.032). At the end of the study, lack of tomographic signs of intra/ subretinal fluid was noted in four (23.5%) eyes. No ocular or systemic side effects were identified. CONCLUSIONS: Short-term results with IVB for the treatment of exudative AMD have been promising. However, the chronic retinal and pigment epithelium changes frequently present in eyes that underwent multiple previous treatments may limit complete visual recovery. To our knowledge, this is the first report on the use of IVB for this particular group of AMD patients.

Pulsed-field gel electrophoresis in the identification of the origin of bacterial keratitis caused by Pseudomonas aeruginosa.

PURPOSE: To report the use of pulsed-field gel electrophoresis (PFGE) in the investigation of the origin of infectious keratitis. METHODS: A 19-year-old girl presented with infectious keratitis in the left eye. She was a soft contact lens wearer, and was noncompliant with the proper cleaning methods proposed by the manufacturer. Microbiological assessment was performed by means of culture and PFGE. RESULTS: The patient was treated successfully with topical cefalotin and gentamicin drops. Cultures were positive for Pseudomonas aeruginosa in the cornea and conjunctiva, and in the contact lens, its case and the cleaning solution. PFGE showed identical patterns of banding in each. CONCLUSION: In this case of bacterial keratitis, PFGE proved to be very useful in identifying how the contamination occurred.

STRATUS optical coherence tomography in unilateral colobomatous excavation of the optic disc and secondary retinoschisis.

PURPOSE: To report the STRATUS optical coherence tomography (STRATUSOCT) findings in a patient with unilateral coloboma-like excavation of the optic disc without pit but secondary retinoschisis, as well as to discuss the possible involved pathophysiologic mechanisms. METHODS: Observational case report. STRATUSOCT findings in a 66-year-old woman with a coloboma-like excavation of the optic disc without pit but secondary retinoschisis encompassing the macular region, along with evidence of a mild epiretinal membrane superonasal to the disc were evaluated. RESULTS: STRATUSOCT showed signs of a connection between the perineural space and the inner retinal layers on the temporal optic disc border, as well as schisis-like changes extending from the disc to the macula, with cystoid degeneration and two lamellar holes in their nasal portion. CONCLUSION: The use of third generation OCT afforded an enhanced visualization of retinal structures, revealing signs of fluid at several distinct levels, as well as deep and superficial inner breaks apart from the schisis cavity. We are unaware of such previous reports, and could find no reference to them in a computerized search using MEDLINE. In addition, our study supports a common pathomechanism for the development of macular complications in optic pits and colobomas.