Long-term follow-up of standard photodynamic therapy with standardized small spot size for diffuse retinal pigment epitheliopathy.

PURPOSE: To evaluate the long-term efficacy and safety of standard-fluence photodynamic therapy (PDT) with verteporfin using the minimum PDT spot size in patients with diffuse retinal pigment epitheliopathy (DRPE). METHODS: This is a retrospective study of 67 DRPE cases treated with PDT using a standardized minimum spot size of 850 µm. Indocyanine green angiography (ICGA) was used to guide and determine the outcome of PDT treatment. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), recurrences, and adverse events were recorded and analyzed. RESULTS: The mean follow-up period of the study was 35.8 ± 16.6 months. There was a statistically significant difference in BCVA between baseline and the end of the follow-up (p<0.001). The BCVA improved in 41 eyes (61.2%), remained stable in 20 eyes (29.9%), and deteriorated in 6 eyes (9%). Accordingly, there was a statistically significant difference in CRT between the baseline and the last follow-up visit (p<0.001). The recurrence rate was 13.4% and only one eye presented a recurrence at the same site as the laser treatment. No adverse events were noted. CONCLUSIONS: Application of ICGA-guided standard PDT, with a laser spot size of minimum diameter, on the site of active leakage seems to be effective and safe in a long-term follow-up period, presenting improvement in BCVA, decrease in CRT, and low rate of recurrence.

Resolution of vitreomacular traction following intravitreal ranibizumab in cases of ocular toxoplasmosis with choroidal neovascularization.

PURPOSE: To present the occurrence of the resolution of vitreomacular traction following intravitreal ranibizumab in two patients with inflammatory choroidal neovascular (CNV) membrane with a background of ocular toxoplasmosis. METHODS: Interventional case report. RESULTS: A 21-year-old Caucasian woman and a 52-year-old Caucasian man both presented with vitreomacular traction with coexistent classic CNV membrane and a background of ocular toxoplasmosis. They both received an intravitreal injection of ranibizumab in an effort to control the underlying CNV membrane. A resolution of the vitreomacular traction was observed within 1 week of the intravitreal injection in both cases. CONCLUSION: To the best of our knowledge, this is the first reported case of vitreomacular traction resolution in two patients with ocular toxoplasmosis following ranibizumab administration. Of course, further studies are needed in order to adequately support this association.

Idiopathic retinal vasculitis, arteriolar macroaneurysms and neuroretinitis: clinical course and treatment.

BACKGROUND: The purpose of the study is to describe the clinical course and treatment of idiopathic retinitis, vasculitis, aneurysms and neuroretinitis. The study utilized non-randomized, retrospective and interventional case series. The eight eyes of six patients were analysed. Testing included wide fluorescein angiography, indocyanine green angiography and systemic evaluation. Treatment involved observation, panretinal laser photocoagulation (PRP) for peripheral retinal ischemia, grid laser for macular oedema and focal laser on the macroaneurysms. The main outcome measures were initial visual acuity (VA), initial stage at diagnosis, clinical course, surgical intervention, final VA, final stage and complications of disease. RESULTS: Five out of eight eyes with retinal ischemia in more than two quadrants that were treated with PRP and grid laser for macular oedema maintained excellent VA and demonstrated no progression of retinal ischemia during follow-up. The two eyes which exhibited retinal ischemia in less than two quadrants and macular oedema were treated with grid laser and focal laser on the macroaneurysms, but did not undergo PRP. VA improved by two lines of the Snellen chart, and there was no progression of retinal ischemia during the 3 and 4 years of follow-up. One eye with neither retinal ischemia nor macular oedema was not treated, and the clinical picture remained stable during the follow-up. CONCLUSION: Early PRP may be considered in the presence of angiographic evidence of peripheral retinal non-perfusion. However, treatment could be withheld until the patient develops retinal ischemia in more than two quadrants.

Intravitreal ranibizumab for the treatment of inflammatory choroidal neovascularization.

PURPOSE: To evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis) on visual acuity and central foveal thickness in patients with choroidal neovascular membrane (CNV) associated with various ocular inflammatory clinical entities. METHODS: Our study was a retrospective, noncomparative, interventional, and observational case series. Sixteen eyes of 15 consecutive patients diagnosed with inflammatory CNV treated with repeated intravitreal injections of ranibizumab were evaluated. The underlying diagnoses were toxoplasmosis (n = 4), serpiginous choroidopathy (n = 2), punctate inner choroidopathy (n = 5), multifocal choroiditis (MFC, n = 3), and scleroderma (n = 2). All patients underwent monthly optical coherence tomography (OCT) scans and fluorescein angiography/indocyanine green angiography every 1 month after every injection and then every 3 months. Optical coherence tomography scans and fluorescein angiography were performed by the same experienced physician. Repeated intravitreal injections were performed when persistent/recurrent fluid on OCT and/or signs of active CNV on angiography were present. Changes in Early Treatment Diabetic Retinopathy Study visual acuity and central foveal thickness were statistically analyzed. RESULTS: The mean follow-up time was 70.4 ± 24 weeks (17.6 months; range, 44-116 weeks [11-29 months]). The mean number of injections performed was 2.3, and the mean best-corrected visual acuity improved from 55 Early Treatment Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution, 0.9 ± 0.4 [mean ± SD]) at baseline to 70.3 Early Treatment Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution, 0.6 ± 0.4) at the end of the follow-up, a statistically significant change compared with baseline (P < 0.0001). The mean letter gain was 15.3 letters, and best-corrected visual acuity improved in 14 of 16 patients (88%) and remained stable in 2 patients (12.5%) without any patient demonstrating deterioration. The mean central foveal thickness (although not excessively increased at baseline) improved from 285 ± 20 µm at baseline to 233 ± 21 µm (statistically significant compared with baseline, P < 0.0001) at the end of the follow-up. At the end of the follow-up, all patients demonstrated CNV regression, and retinal pigment epithelial atrophy surrounding the regressed CNV was developed in 11 of the 16 eyes (68.8%). During the same period, no CNV recurrence was observed and no injection-related complications such as cataract, retinal detachment, endophthalmitis, or exacerbation of uveitis were noted. CONCLUSION: Overall, our findings suggest that intravitreal injections of ranibizumab have shown promising results in visual acuity improvement and a decrease in macular thickness in patients with inflammatory CNV. Of course, further studies are needed to confirm the exact benefit and standardize the optimal treatment regimen.

Allergy skin testing in predicting adverse reactions to fluorescein: a prospective clinical study.

PURPOSE: To evaluate allergy skin testing as a diagnostic tool of adverse reactions to fluorescein and whether allergy and previous sodium fluorescein angiography (SFA) act as predisposing factors. METHODS: Patients with adequate indication for fluorescein angiography and normal skin responsiveness were subjected to allergy skin-prick and intradermal tests for fluorescein, followed by SFA. During SFA, adverse reactions were monitored and classified as mild, moderate or severe. Previous SFAs and adverse reactions as well as the presence of atopy were also registered. RESULTS: One thousand and thirty-seven patients were enrolled in the study and 1284 SFAs were executed. Forty-four patients (4.3%) developed 55 adverse reactions; among them 50 (3.8%) were mild, three (0.2%) moderate and two (0.16%) severe. None of the reactors produced positive skin tests to fluorescein. Patients with atopy and previous SFAs were not more susceptible to adverse reactions. CONCLUSION: The vast majority of adverse reactions to fluorescein are mild and not attributed to immunological mechanisms. Allergy skin tests cannot predict non-immunological reactions but their utility remains substantial in predicting anaphylaxis during SFAs and must be performed in patients reporting risk factors in their past medical history.

Intravitreal ranibizumab (Lucentis) for branch retinal vein occlusion-induced macular edema: nine-month results of a prospective study.

PURPOSE: The purpose of this study was to evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis, Genentech, South San Francisco, CA) on visual acuity and central foveal thickness (CFT) for branch retinal vein occlusion-induced macular edema. METHODS: This study was a prospective interventional case series. Twenty-eight eyes of 28 consecutive patients diagnosed with branch retinal vein occlusion-related macular edema treated with repeated intravitreal injections of ranibizumab (when CFT was >225 microm) were evaluated. Optical coherence tomography and fluorescein angiography were performed monthly. RESULTS: The mean best-corrected distance visual acuity improved from 62.67 Early Treatment of Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution = 0.74 +/- 0.28 [mean +/- standard deviation]) at baseline to 76.8 Early Treatment of Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution = 0.49 +/- 0.3; statistically significant, P < 0.001) at the end of the follow-up (9 months). The mean letter gain (including the patients with stable and worse visual acuities) was 14.3 letters (2.9 lines). During the same period, 22 of the 28 eyes (78.6%) showed improved visual acuity, 4 (14.2%) had stable visual acuity, and 2 (7.14%) had worse visual acuity compared with baseline. The mean CFT improved from 349 +/- 112 microm at baseline to 229 +/- 44 microm (significant, P < 0.001) at the end of follow-up. A mean of six injections was performed during the follow-up period. Our subgroup analysis indicated that patients with worse visual acuity at presentation (

Retinal angiomatous proliferation (RAP) in a 42-year-old woman with syphilitic retinitis.

PURPOSE: To present a case of a young individual with retinal angiomatous proliferation (RAP) on the background of syphilitic retinitis. METHODS/DESIGN: Interventional case report. RESULTS: A 42-year-old Caucasian with confirmed diagnosis of syphilitic retinitis in both eyes revealed the existence of RAP in the RE that responded well to one session of intravitreal triamcinolone acetonide and photodynamic therapy. CONCLUSION: To the best of our knowledge this is the first report of RAP in such a young individual. Further research is required in order to examine the possibility of inflammation playing a role in the pathophysiology of RAP.

Intravitreal ranibizumab (Lucentis) for treatment of central retinal vein occlusion: a prospective study.

BACKGROUND/PURPOSE: To evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis) on visual acuity (VA) and central foveal thickness (CFT) for central retinal vein occlusion (CRVO)-induced macular edema. METHODS: Our study was a prospective interventional case series. Twelve eyes of 12 consecutive patients diagnosed with CRVO-related macular edema (nine perfused, three ischemic CRVO) treated with repeated (when CFT was >220 microm) intravitreal injections of ranibizumab as a monotherapy within 3 months of onset were evaluated. Optical coherence tomography (OCT) and fluorescein angiography (FA) were performed monthly and every 3 months respectively. Changes in VA (ETDRS) and CFT were analyzed using the student's paired t-test. RESULTS: The mean time from diagnosis until injection was 80 days (2.7 months; range, 63-90 days) and the follow-up time was 12 months. In total, 89 injections were performed (mean 7.4). The mean CFT improved from 480 +/- 166 microm at baseline to 230 +/- 33 microm (P < 0.001) at the end of the follow-up. During the same period, of the 12 eyes, eight demonstrated improved VA (>0.3 LogMAR change, >15 letters), three stable VA and one worse VA as compared to baseline. None of the nine patients with perfused CRVO were converted to ischemic at 12 months, and one of the three eyes with ischemic CRVO developed iris neovascularization despite two ranibizumab injections. No ocular or systemic side-effects were noted. CONCLUSION: Individualized repeated intravitreal injections of ranibizumab have shown promising results in VA improvement and decrease in CFT in patients with macular edema associated with CRVO. Further studies are needed in order to elucidate the role of intravitreal lucentis in the ischemic form of CRVO, and its efficacy in preventing conversion from the perfused to the ischemic form of the disease.

Skin testing and adverse reactions in fluorescein: a prospective study.

Sodium fluorescein (SF) is widely used to assess chorioretinal disorders. Adverse reactions are well documented but the underlying mechanism is still uncertain. The aim of this study was the evaluation of skin testing to predict SF reaction, the identification of possible predisposing factors, and the objective record of the reported reactions. All patients with adequate indication for SF angiography (SFA) during an 18-month period were evaluated as follows: (a) detailed personal history of atopy, diabetes, previous SFA, and/or diagnostic procedures with radiocontrast media (RCM) and possible side effect; (b) skin testing with SF 10% diluted preparations; (c) SFA with 5 mL of SF, objective record of any reaction. Two hundred twenty-four patients (108 men and 116 women) with a mean age of 65.2 years (SD, 12.86; range, 16-92 years) underwent SFA. The overall rate of adverse reactions was 3.6% (8/224), which consists of 5 (2.2%) individuals with transient mild nausea; 2 (0.9%) subjects with face and upper trunk flushing that appeared in one case after 60 minutes and in the other case 24 hours later and both resolved without treatment, and I subject with transient bilateral frontal headache and dizziness. None of the 224 patients had positive skin or intradermal testings. One hundred thirty-six of 224 (60.7%) patients stated no previous SFA and 74.1% had not performed RCM injection. None of the recorded variables correlated with increased risk of reaction. SFA is a safe procedure with minor adverse effects. Although in vivo testing can not identify reactors it may help to exclude an underlying IgE-mediated mechanism in susceptible individuals.