Retinal vascular occlusions and macular thinning in fibromuscular dysplasia.

PURPOSE: To report retinal findings in a patient with fibromuscular dysplasia. METHODS: A retrospective case report. RESULTS: A 36-year-old female patient with fibromuscular dysplasia and a history of cerebrovascular events presented with painless vision loss in the left eye. Ophthalmologic evaluation demonstrated retinal vascular occlusive disease and secondary macular thinning. CONCLUSION: This case demonstrates that fibromuscular dysplasia can affect the retinal vasculature and lead to macular ischemia and vision loss.

Charles Bonnet syndrome: a review.

PURPOSE OF REVIEW: The aging of the population and the resultant increase in the number of patients with low vision due to age-related macular degeneration and other ocular diseases necessitate an increase in awareness of the Charles Bonnet syndrome among ophthalmic care providers. RECENT FINDINGS: The clinical features of Charles Bonnet syndrome have been described by several different authors as formed visual hallucinations due to disturbances of the visual system in patients who are otherwise mentally normal. Theories regarding the causes underlying the Charles Bonnet syndrome are multifaceted and offer insight into the function of the visual system. The incidence of the Charles Bonnet syndrome varies among different population groups, but is underdiagnosed in most settings. Recent case reports of treatment options involve varied pharmacologic interventions, but visual improvement and patient reassurance remain the mainstays of treatment. SUMMARY: As Charles Bonnet syndrome becomes more prevalent as the population ages, all physicians who care for low vision or elderly patients should be aware of its clinical characteristics and treatment options. Understanding of this syndrome by caregivers will lead to decreased anxiety among the patients who experience it. Further exploration of treatment options will be necessary in the future.

Long-term follow-up results of ilm peeling during vitrectomy surgery for premacular fibrosis.

PURPOSE: To evaluate the outcomes of surgical removal of premacular fibrosis (PMF) with peeling of the internal limiting membrane (ILM). Determination of factors associated with favorable outcomes (visual acuity between 20/20 and 20/40). METHODS: Retrospective chart review, evaluating visual outcomes in 38 patients who underwent pars plana vitrectomy (PPV) and triamcinolone-assisted ILM peeling by a single surgeon between December 2003 and December 2004. Data collected included visual acuity before and 3 months after surgery, and at final follow-up, as well as complications (cataract formation, endophthalmitis, retinal detachment, vitreous hemorrhage, retinal or subretinal hemorrhage, macular hole formation, cystoid macular edema [CME], and PMF recurrence). RESULTS: Pretreatment visual acuity averaged at 20/90. Vision improved or was unchanged in 89.5% of operated eyes with ILM peeling. Average follow-up was 20.2 months. The average improvement in visual acuity was 2.2 lines. The most common complication was cataract formation. There were no other complications until patients underwent cataract extraction. Two patients developed CME within 4 weeks of cataract surgery. Biomicroscopic recurrence of PMF was an asymptomatic and rare event with an incidence of 2.6% (n = 1 of 38 patients). No adverse outcomes were noted in patients with higher levels of visual acuity and these were in fact the patients with best final visual acuity. CONCLUSION: ILM peeling may not have the harmful consequences previously attributed to it. Stripping of the ILM may reduce reformation rates of PMF. Surgical removal of PMF with ILM peeling was not associated with unfavorable outcomes in our group of patients.

Intravitreal bevacizumab for choroidal neovascularization in ocular histoplasmosis.

PURPOSE: To define the role of intravitreal bevacizumab in individuals with choroidal neovascularization (CNV) resulting from Ocular Histoplasmosis syndrome (OHS). DESIGN: Retrospective chart review of a surgical therapy. METHODS: We reviewed the course of 28 eyes of 28 patients who underwent intravitreal injection of bevacizumab for treatment of CNV secondary to OHS. Outcome was measured by pretreatment and posttreatment visual acuity (VA). RESULTS: The average pretreatment logarithm of the minimum angle of resolution (logMAR) VA was 0.65 (Snellen equivalent of 20/88). Mean follow-up was 22.43 weeks with an average of 1.8 intravitreal injections. Average final logMAR VA was 0.43 (Snellen equivalent of 20/54). Twenty eyes (71%) experienced an increase in central VA, whereas four eyes (14%) were unchanged and four eyes (14%) experienced a decrease in vision. CONCLUSIONS: Intravitreal bevacizumab may improve or stabilize VA in a significant majority of patients with neovascular complications of OHS (24 eyes [85.7%] in our study population).

Optical coherence tomography findings in autosomal dominant macular dystrophy.

The authors report a case of autosomal dominant cystoid macular dystrophy in which optical coherence tomography outlined the pathology and assisted in determining the etiology of the patient's macular edema.

Combined photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: effect of initial visual acuity on treatment response.

PURPOSE: To evaluate visual outcomes in combination therapy with photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVTA) for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD). METHODS: Charts of 39 eyes from 38 patients with exudative AMD treated with PDT and 4 mg of triamcinolone acetate injected intravitreally were reviewed retrospectively. Visual data, angiographic lesion type, prior PDT exposure, number of treatments, and follow-up were recorded. Snellen visual acuities were converted to LogMAR for all calculations. Lines of vision lost or gained pertain to calculated ETDRS lines of vision (via LogMAR). RESULTS: Twenty-two of the choroidal neovascular membranes were occult, and 17 were classified as predominantly classic. Mean follow-up was 43 weeks. The average number of treatments was 2.23. At final follow-up, 11 eyes (28.21%) experienced improved visual acuity, 8 eyes (20.51%) were stable, and 20 eyes (51.28%) had worsened. No significant difference in treatment response was found between angiographic subtypes (p > 0.59). Lack of previous PDT exposure did not improve treatment outcomes (p > 0.77). Pre-treatment visual acuity (PTVA) was determined as a strong predictor of treatment outcome in our study cohort. Visual acuity of 20/200 or worse was associated with a 40.9% chance of some improvement and a 35.75% chance of three or more lines of improvement. Visual acuity better than 20/200 was associated with an 89.4% chance of no improvement and a 58.8% chance of three or more lines of visual loss. CONCLUSION: Counter to previously reported results with combination therapy, the majority of our patients (72%) did not demonstrate improved vision and 51% lost vision. When PTVA was accounted for, selected patients benefitted significantly from treatment. PTVA may be a useful and simple patient selection tool for combination treatment with PDT and IVTA.

Intravitreal pharmacotherapy: applications in retinal disease.

Intravitreal pharmacotherapies have been used with increasing frequency in the treatment of retinal disease. Indications for their use include choroidal neovascular membranes, diabetic macular edema, ischemic neovascularization, inflammatory and infectious processes, and neoplasia. Complications of intravitreal therapies include cataract formation, glaucoma, and endophthalmitis. Recent developments of pharmacologic agents administered intravitreally and the new applications of systemic medications in retinal disease present the practitioner with expanded treatment options. Current and emerging data will help guide therapy in order to maximize the benefits and limit the systemic and ocular complications of these new treatment options.

The role of Fas-FasL in the development and treatment of ischemic retinopathy.

PURPOSE: Define a role for Fas-FasL in oxygen-induced retinopathy and explore the mechanism of pigment-epithelium-derived growth factor (PEDF) inhibition in this model. METHODS: Seven-day-old mice C57BL/6J (B6), FasL-defective (B6-gld), or Fas-defective (B6-lpr) mice were exposed to 75% oxygen for 5 days (postnatal day [P]7-P12) and returned to room air. On day P17, vascular architecture was assessed microscopically after perfusion with FITC-dextran, and preretinal nuclei were quantified by PAS and hematoxylin staining. In some experiments, mice were treated intraperitoneally with PEDF. Vascular architecture and preretinal nuclei counts were compared with those in PBS-treated control animals. RESULTS: Oxygen-induced retinopathy was significantly increased in FasL-defective gld mice compared with wild-type B6 animals. This was manifested by an increase in the number of microaneurysms, neovascular tufts, and preretinal nuclei. PEDF treatment prevented retinopathy in B6, B6-gld, and B6-lpr mice. CONCLUSIONS: Fas-FasL interactions regulate the extent of oxygen-induced retinal neovascularization. The inhibition of neovascularization in B6 gld, and B6-lpr mice by PEDF suggests that Fas-FasL interactions are probably not the mechanism for inhibition in this model.