Ruthenium-106 brachytherapy and intravitreal bevacizumab for retinal capillary hemangioma.

The purpose of this study is to report a case of retinal capillary hemangioma treated with ruthenium-106 brachytherapy combined with intravitreal bevacizumab. A 58-year-old woman presented with blurred vision in her left eye for 15 days. Best-corrected visual acuity (BCVA) was counting fingers at 3 m in her left eye. Examination showed a peripheral endophytic retinal capillary hemangioma, with associated macular edema and diffuse hard exudates in a macular star pattern. B-scan ultrasonography revealed a solid, highly reflective retinal tumor measuring 7.1 × 7.5 mm in basal dimension and 3.5 mm in thickness. The hemangioma and macular edema were treated with ruthenium-106 brachytherapy (500 Gy) followed 1 month later with an intravitreal injection of 1.25 mg (0.05 ml) bevacizumab. After 10 months of follow-up, examination demonstrated involution of the hemangioma, resolution of the macular edema, less hard exudates, and improvement of BCVA to 20/25. Ruthenium-106 brachytherapy combined with intravitreal bevacizumab was associated with significant involution of the choroidal hemangioma with resolution of the macular edema and improvement in visual acuity.

Lamellar macular hole following intravitreal pegaptanib sodium (Macugen) injection for diabetic macular edema.

To report on a patient who developed a lamellar macular hole 1 month after an intravitreal pegaptanib sodium injection. Interventional case report. A 66 year old patient developed a lamellar macular hole 1 month after an intravitreal pegaptanib sodium injection for diabetic macular edema (DME). The pathogenesis of the lamellar macular hole in our case can be attributed to the intravitreal injection that may have induced vitreous incarceration, causing vitreoretinal traction at the macula and development of a lamellar macular hole. Alternatively or in association, pegaptanib itself may have caused the lamellar macular hole by inducing sudden reduction of the DME and exacerbation of tangential traction of the posterior vitreous on the overlying macular retina. Lamellar macular hole seems to be a potential complication of pegaptanib injection even in patients without pretreatment clinically detectable vitreomacular traction.

Intravitreal avastin for choroidal neovascularization associated with stargardt-like retinal abnormalities in pseudoxanthoma elasticum.

The aim of the study was to describe a patient with pseudoxanthoma elasticum (PXE), showing Stargardt-like retinal abnormalities, who underwent treatment with intravitreal bevacizumab for subfoveal choroidal neovascularization (CNV) of the right eye (RE). A 57-year-old woman with diagnosis of angioid streaks, retinal flecks, and chorioretinal Stargardt-like atrophy due to PXE was referred to our department for sudden decreased vision in her RE (20/160). Upon a complete ophthalmologic examination, including fluorescein angiography (FA), and optical coherence tomography (OCT), the patient was diagnosed with subfoveal CNV of the RE. Owing to the subfoveal localization of the CNV, the patient was submitted to intravitreal bevacizumab injection. At the 1-month follow-up, visual acuity (VA) improved (20/40), and FA and OCT revealed the CNV closure. Twelve months after the treatment, the patient's VA remained stable with no recurrence of active CNV. On the basis of our findings, a single intravitreal bevacizumab injection seems to induce total regression of CNV complicating PXE, in a patient showing Stargardt-like retinal abnormalities. Further investigations are required to confirm our results.

Very Large Bilateral Lesions Obscuring Diagnosis of Adult-Onset Foveomacular Vitelliform Dystrophy.

Adult-onset foveomacular vitelliform dystrophy (AFVD) is a clinically heterogeneous and pleomorphic disease originally described by Gass as bilateral with symmetrical, solitary, round or oval, slightly elevated, yellowish subretinal lesions, one third to one disc diameter in size, often with a central pigmented spot. A possible AFVD patient showing very large bilateral macular lesions was reported.

High-Definition OCT Findings in Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

The authors report a case of acute posterior multifocal placoid pigment epitheliopathy evaluated by autofluorescence, fluorescein angiography, indocyanine green angiography, high-definition optical coherence tomography, and microperimetry in both the acute and the post-acute phase. Based on the integrated findings, the authors believe that acute posterior multifocal placoid pigment epitheliopathy is an inflammatory disease that primarily affects the choroid and that the retinal pigment epithelium is secondarily involved in the course of the disease.

Bevacizumab compared with macular laser grid photocoagulation for cystoid macular edema in branch retinal vein occlusion.

INTRODUCTION: To evaluate the outcome of cystoid macular edema treated with intravitreal injections of bevacizumab and macular grid laser photocoagulation (GLP), in patients with perfused branch retinal vein occlusion. METHODS: Thirty eyes of 30 consecutive patients with cystoid macular edema secondary to nonischemic branch retinal vein occlusion were assigned to either GLP group or to intravitreal bevacizumab (IB) group. Complete ophthalmologic examinations were performed just before GLP and IB injection at 1, 3, 6, and 12 months after treatment. Changes in logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), central macular thickness (CMT) shown by optical coherence tomography-3 were evaluated. RESULTS: Baseline BCVA (logMAR) and CMT were, respectively, 0.89 +/- 0.13 and 650 +/- 140 microm for the GLP group, 0.87 +/- 0.16 and 690 +/- 120 microm for the IB group. After the treatment, at 1, 3, 6, and 12 months in the GLP group, BCVA had improved by 0.19, 0.22, 0.21, and 0.20 logMAR, CMT had decreased by 40%, 41.3%, 40.5%, and 42%. In the IB group, BCVA had improved by 0.31, 0.32, 0.30, and 0.31 logMAR and CMT had decreased by 59.5%, 59%, 60%, and 60.3%. The group receiving bevacizumab had better BCVA and lower CMT values at all time points (P < 0.05). CONCLUSION: Intravitreal bevacizumab injection improves BCVA and reduces CMT more than GLP. Intravitreal bevacizumab injection was well tolerated and could be used as primary treatment in patients with cystoid macular edema secondary to perfused branch retinal vein occlusion.

Intravitreal pegaptanib sodium (Macugen) for refractory cystoid macular edema in pericentral retinitis pigmentosa.

The purpose of this paper was to describe a patient with pericentral retinitis pigmentosa (RP) and cystoid macular edema (CME) refractory to oral acetazolamide alone who was successfully treated with adjunctive pegaptanib sodium. A 33-year-old man presented with decreased vision and a best-corrected visual acuity (BCVA) in his left eye of 20/200 due to CME secondary to RP. Although he had been treated daily for 1 month with 500 mg of oral acetazolamide, the edema was unresponsive. When informed of the available treatment options, the patient requested adjunctive intravitreal pegaptanib sodium. One month after receiving an injection of pegaptanib sodium 0.3 mg and continued daily acetazolamide, the patient's BCVA had improved to 20/40. At the 4-month follow-up visit, no recurrence of CME was found on fundus biomicroscopy, fundus-related perimetry, and optical coherence tomography. We conclude that intravitreal pegaptanib sodium combined with daily doses of acetazolamide appears to provide benefits in CME refractory to oral acetazolamide alone with regards to the improvement of visual acuity.

Residual bubble of oxane hd: a study by optical coherence tomography and fundus-related perimetry.

PURPOSE: Oxane HD is a mixture of silicone oil and a mixed fluorinated and hydrocarbonated olefin. The authors report a complication of Oxane HD as internal tamponade after removal of all visible heavy silicone oil. METHODS: A 71-year-old man who underwent vitrectomy with Oxane HD presented with adherence of a residual bubble of Oxane HD in the macula after removal of all visible heavy silicone oil. In this patient OCT displayed an optical artifact due to the residual bubble, and fundus-related perimetry revealed a predominantly eccentric and relatively unstable fixation and very low macular sensitivity. RESULTS: After surgical removal of the residual bubble, metamorphopsia resolved, sensitivity improved as revealed by fundus-related perimetry, and fixation became predominantly central and more stable. CONCLUSION: The authors suggest a way to manage this rare complication of Oxane HD as internal tamponade after removal of all visible heavy silicone oil.

Vitreomacular traction syndrome with an outer macular hole.

PURPOSE: To describe a patient with a large idiopathic partial-thickness macular hole involving the outer layers of the retina. METHODS: We performed complete ophthalmologic examination, including fluorescein angiography, B-scan ultrasonography, and optical coherence tomography, on an 81-year-old woman who was referred to our department with the clinical suspicion of a stage 3 full-thickness macular hole in the left eye. RESULTS: After complete ophthalmologic examination, the patient was diagnosed with vitreomacular traction syndrome due to a prefoveal partial posterior vitreous detachment causing tangential outward traction on the fovea. In this case, vitreomacular traction was associated with macular detachment and was complicated by retinoschisis and an idiopathic partial-thickness macular hole, in the absence of either high myopia or an optic nerve pit. CONCLUSION: To our knowledge, this is the first reported case of a large idiopathic partial-thickness macular hole sharing common features with macular schisis, in the absence of either high myopia or an optic disk pit.

Retinal toxicity of indocyanine green.

PURPOSE: To describe a case of scattered toxicity of indocyanine green on the outer retina and retinal pigment epithelium (RPE) after indocyanine green (ICG) assisted membrane peeling for macular pucker. METHODS: A 61-year-old woman was examined by slit-lamp biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT), 1 month and 1 year after ICG assisted membrane peeling for macular pucker. RESULTS: In the absence of significant fundoscopic changes, we have noted on FA and ICGA an occurrence of scattered unusual outer retinal and pigment epithelial changes at the 1- and the 12-month follow-up, probably due to the enhanced phototoxicity associated with the use of ICG at a high concentration (0.5%). CONCLUSIONS: Retinal toxicity of ICG in macular surgery depends on many factors. In our patient, the retinal changes seem to have been caused by a combination of all the toxic factors. This is the first reported case describing both the angiographic and OCT patterns of diffuse scattered toxicity of ICG on outer retinal layers and pigment epithelium after ICG assisted membrane peeling for macular pucker.

Morphologic and functional changes in solar retinopathy: a study by optical coherence tomography and fundus-related perimetry.

PURPOSE: Solar retinopathy is caused by macular exposure to solar radiation and is mediated by photochemical and thermal mechanisms. Ultrastructural examination shows the retinal pigment epithelium (RPE) and the outer segments of the photoreceptors as the most susceptible to solar insult. The authors describe the optical coherence tomography (OCT-3 Stratus) and the fundus-related perimetry (MP-1 microperimeter) findings of the disease. METHODS: The authors performed a complete ophthalmologic examination in three patients with solar retinopathy, including two new, highly sensitive diagnostic tools, the OCT-3 and the MP-1, soon after solar exposure and again up to 18 months after diagnosis. RESULTS: Symptoms and macular changes were similar in these three patients despite different exposures to solar radiation. On initial visit, the OCT scans revealed in all three patients an irregular inner high-reflective layer (I-HRL) that appeared fragmented and interrupted. In addition, the OCT images showed a hyperreflective lesion, which, in one patient, involved the full foveal thickness, and in two patients was confined to the outer half of the foveal layers. In two patients there was an associated reduced reflectiveness of the outer high-reflective layer (O-HRL). These OCT signs disappeared as early as 1 month follow-up. Fundus-related perimetry demonstrated, at the first visit, a significant reduction of retinal sensitivity in all patients, which was no longer evident at 1-month follow-up. CONCLUSIONS: OCT may be an effective tool in diagnosing the acute phase of solar retinopathy and in differentiating it from other maculopathies. Fundus-related perimetry would seem to be a useful adjunctive method to better characterize the functional aspect of the disease.