The Injection Practice Patterns of Retina Specialists in Managing Exudative Age-Related Macular Degeneration: A Retrospective Study.

Purpose: To compare the PRN anti-VEGF injection patterns of four retina specialists with respect to the visual and anatomic outcomes in the management of wet age-related macular degeneration (AMD). Methods: Medical records of patients who received bevacizumab, ranibizumab, and aflibercept anti-VEGF injections (years 2010-2020) by four retina specialists were reviewed for frequency, injection intervals, best corrected visual acuity (BCVA), and central macular thickness, center involved (CMT) for statistical analysis. Outcomes measured were change in logMAR BCVA and CMT from the first to last injection visit. Results: Out of 137 AMD patients, 172 eyes were injected by four retina specialists in PRN fashion. Although all four specialists started the injection at similar baseline BCVA and CMT (p > 0.1), significant differences in mean injection number (9.0, p = 0.0001), injection intervals (5.06 weeks, p = 0.001), and total length of treatments (53.3 weeks, p = 0.0001) were observed. The mean change in logMAR BCVA between the first and last injection was -0.05, -0.22, 0.07, and 0.06 for the four specialists, respectively (p = 0.031), and the mean change in CMT was -53.3, -41.4, -72.7, and -21.9 µm (p = 0.41), respectively. Conclusion: Despite similar baseline criteria for injections by the retina specialists, different anti-VEGF injection regimens were practiced resulting in variations in BCVA and CMT outcomes. This suggests a need in establishing a universally adoptable injection regimen with possible integration of the confounding factors to reduce burden on both patients and retina specialists.

MULTIMODAL IMAGING OF AN INTRARETINAL TUBERCULAR GRANULOMATOUS NEURORETINITIS.

PURPOSE: To report a rare case of an intraretinal tuberculoma and associated neuroretinitis. METHODS: The patient was evaluated with various imaging modalities including fundus photography, fluorescein angiography, magnetic resonance imaging, and optical coherence tomography; her extensive laboratory workup returned positive for tuberculosis. RESULTS: After initially presenting with no light perception, 13 weeks of antitubercular therapy allowed for visual acuity recovery to 20/30. CONCLUSION: We demonstrate the spectral domain optical coherence tomography characteristics of an intraretinal tuberculoma.

PRN Treatment of Neovascular AMD with Cycles of Three Monthly Injections.

PURPOSE: To report the one and two year outcome of cycles of three, monthly anti-VEGF injections given upon reactivation of the disease in eyes with neovascular age-related macular degeneration (nAMD). METHODS: Retrospective study of naïve nAMD cases with more than one year of follow-up, treated with a protocol of cycles of three monthly injections of anti-VEGF drugs upon reactivation. Visual acuity (VA) and central macular thickness (CMT) are the main outcome measures. RESULTS: Twenty-six patients with a mean age of 78.15 ± 9.29 years (57.7% female) were included. The mean follow-up was 30.89 ± 6.95 months. Treatment started with bevacizumab in all patients but in six patients was switched to aflibercept due to inadequate response to intravitreal bevacizumab injection. The mean VA at baseline and at 12 and 24 months was 53.87 ± 21.84, 60.54 ± 21.13, and 53.68 ± 27.16 ETDRS letters, respectively. Patients gained a mean of 6.67 ± 13.7 (p = 0.013, 95% CI= 0.60 to 12.65) and 0.77 ± 15.21 (p = 0.4, 95% CI: -5.65 to 7.2) letters at 12 and 24 months. CMT at baseline, 12, and 24 months was 403.55 ± 147.59, 323.95 ± 79.58, and 298.59 ± 77.161 µm, respectively. The number of injections in the first and second years were 7.65 ± 2.64 and 5.52 ± 3.01, respectively. Three eyes (12.5%) lost > 15 letters at 24 months. CONCLUSION: This protocol can stabilize or improve vision in 87.5% of nAMD patients and can reduce the number of visits.

Development of focal choroidal excavation in non-neovascular age related macular degeneration with pachy-choroid features.

PURPOSE: To present a documented case of development of focal choroidal excavation (FCE) in non-neovascular age related macular degeneration (AMD). METHODS: An 86-year-old female with pachy-choroid was followed clinically for non-neovascular AMD. Successive optical coherence tomography (OCT) scans were reviewed with tracking software. RESULTS: Over the course of follow-up development of a FCE adjacent to a pachy-vessel along with disappearance of the pachy-vessel was documented in OCT. CONCLUSIONS: This case is a documented development of FCE in an eye with pachy-choroid features. The possible mechanism in this scenario may be thrombosis of pachy-vessels.

Intranasal Corticosteroids and Central Serous Chorioretinopathy: A Report and Review of the Literature.

A 43-year-old male with a history of allergic rhinitis on chronic intranasal corticosteroids presented with complaints of a "black band" in his right eye visual field. On examination, he had subretinal fluid and lab tests and imaging studies including optical coherence tomography (OCT) and fluorescein angiography (FA) did not show any evidence of inflammatory, degenerative, or malignant process. He was diagnosed with central serous chorioretinopathy (CSCR). Symptoms improved and the subretinal fluid resolved after the discontinuation of intranasal corticosteroid medication. Intranasal corticosteroids are rarely associated with CSCR. Patients and providers should be aware of the potential risk of vision loss caused by intranasal corticosteroids.

Adverse reactions to fluorescein angiography: A comprehensive review of the literature.

We reviewed literature on adverse reactions to intravenous fluorescein angiography using PubMed and found 78 articles in English from 1961 to 2017. The reported rates of adverse reactions were overall 0.083-21.69%, separated into mild (1.24-17.65%), moderate (0.2-6%), and severe (0.04-0.59%). There were 1:100,000 to 1:220,000 deaths. Fluorescein concentration, volume injected, speed of injection, temperature, and contaminants were not correlated with the incidence of reactions. Patient characteristics including other comorbid diseases, allergy history, age, race, and gender showed only an increased rate of reaction in patients with a history of reaction to fluorescein. Although a number of studies examine techniques to reduce adverse reactions to intravenous fluorescein angiography, to date, the only proven method is reviewing allergy history, specifically a history of previous reaction to fluorescein.

Corrigendum to "Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon".

[This corrects the article DOI: 10.1155/2017/9805145.].