Anterior segment ischemia with rubeosis iridis after a circular buckling operation treated successfully with an intravitreal bevacizumab injection: a case report and review of the literature.

PURPOSE: To report a case of anterior segment ischemia (ASI) with rubeosis iridis after circular buckling surgery in a highly-myopic patient which was successfully treated with a second intravitreal bevacizumab injection. METHODS: Case report and review of the literature. DISCUSSION: ASI is a rare but potentially serious complication of posterior segment surgery. Finally it leads to neovascular glaucoma as a result of rubeosis iridis. An encircling band can compromise anterior segment circulation in different ways: by manipulation or disinsertion of the recti muscles, by occlusion of the vortex veins through compression or by changes in the blood supply of iris and ciliary body. This patient developed rubeosis iridis secondary to ASI. There was a remarkable regression of rubeosis iridis one month after a second intravitreal bevacizumab injection. Other case reports of bevacizumab use in neovascular glaucoma have shown clinical improvements of these patients, with intraocular pressure control and reduction of the neovascularization process. CONCLUSION: We describe a highly-myopic patient who developed ASI with rubeosis iridis after a circular buckling operation. Slit-lamp examination and gonioscopy can show very little rubeosis iridis and can be misleading. Iris fluorescein angiography is the most sensitive technique for evaluation of iris vessel abnormalities and is of considerable value in the early detection of rubeosis iridis. This report demonstrates the rapid resolution of rubeosis iridis on iris fluorescein angiography after a second intravitreal injection of bevacizumab. How long this regression will persist is unknown and repeated injections of bevacizumab may be necessary if rubeosis reappears.

Floating pigmented vitreous cyst.

Case report of a floating pigmented vitreous cyst.

Laser-induced retinal injury following a recreational laser show: two case reports and a clinicopathological study.

BACKGROUND: Two patients who attended a dance festival with an audience-scanning laser show presented in our department with a decrease in visual acuity from a direct laser hit in one eye. Ophthalmoscopy showed a similarly sized retinochoroidal coagulation spot, which had led to a retinal hemorrhage in both patients. Because the organizers of the show concluded that the retinal injury was caused by powerful, handheld laser pointers in the crowd, we were interested in determining if these laser pointers could cause this kind of acute retinopathy. METHODS: A 44-year-old man with an extrafoveal, temporal choroidal melanoma was scheduled for enucleation. The eye (visual acuity 20/20) had a healthy-appearing macula. Prior to enucleation, the retina was exposed to eight different durations (0.5-64 seconds) of laser beam from a commercially available, handheld, class 3B green laser pointer (500 mW). RESULTS: Histologic analysis was unable to identify any abnormalities in the choriocapillaris, the photoreceptors or the retinal pigment epithelium (RPE). CONCLUSION: The use of powerful laser appliances (class 4 lasers) directed into the audience (audience-scanning laser show) can cause significant retinal injuries with lifelong visual consequences. It is unlikely that laser pointers, even those of class 3B, can cause these ocular injuries.

Preoperative eye disinfection in vitrectomy surgery using antibiotic or antiseptic eyedrops.

PURPOSE: To determine the efficacy of preoperative eye disinfection by comparing antibiotic and antiseptic eye drops. DESIGN: Prospective, randomized double-masked comparative study with three study arms: untreated, antibiotic treated and antiseptic treated. METHODS: Patients that were scheduled for vitrectomy were asked to use an antibiotic or antiseptic eye drop 4 times a day, 5 days before the surgery. Conjunctival smear was cultured at the onset of the surgery. Culture results for each study arm were compared. RESULTS: Comparable results were found in the patients treated with an antibiotic or antiseptic eye drop. CONCLUSIONS: Since an antiseptic eye drop will cause less bacterial resistance than an antibiotic eye drop, and both treatments have a similar antibacterial effect, this study indicates that prophylactic antiseptic eye drops may be preferred over antibiotic treatment, when prophylaxis is needed.

Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review.

BACKGROUND: The enzyme hyaluronidase (HA) is an adjunctive in retrobulbar anaesthesia (RA) that is used during ophthalmic surgery to improve the efficacy and speed of nerve blocks. Although uncommon, HA has been shown to be a potential cause of allergic responses. CASE REPORTS: We describe three patients who experienced an allergic reaction to HA following ocular surgery in our department and provide an extensive overview of the literature on HA in RA. CONCLUSIONS: Although rare and mostly benign, allergy to HA should be included in the differential diagnosis when chemosis, proptosis and restriction of eye movements occur after parabulbar or retrobulbar anaesthesia. The authors feel that the beneficial effect of HA in small volumes of RA warrants its use despite this potential complication.

Serpiginous choroiditis treated in a stepladder approach.

We present a case of serpiginous choroiditis in a 46-year-old graphic designer. The development of multiple scotomata urged the use of immunosuppressants although his visual acuity remained 20/20. A successful combination of corticosteroids, azathioprine and methotrexate was used in a stepladder approach. No new retinal lesions developed until the end of follow-up (18 months). Thanks to his profession, the patient enabled us to give an unique representation of his visual symptoms.

Acute visual field constriction in optic disc drusen: report of an unusual case.

We describe a case of an acute symptomatic and non-progressive visual field constriction in one eye of a 19-year-old female with optic disc drusen. The fellow eye showed slowly progressive visual field defects. A limited or retrolaminar infarction of the optic nerve head seems a plausible cause of the acute visual field loss. The slow progression in the fellow eye is most probably due to mechanical compression by the drusen. The case is documented with Humphrey perimetry during a follow-up of 11 years and with Color Doppler Imaging (CDI) of the optic nerve.

Clinical symptoms and complications of pars planitis in childhood.

UNLABELLED: Pars planitis is the idiopathic form of intermediate uveitis; it most commonly affects persons between 5 and 40 years of age. In childhood, the disease is largely asymptomatic until in a well advanced stage with markedly reduced vision. Lack of early diagnosis and treatment may lead to permanent visual loss and amblyopia. AIM: To report on the clinical symptoms, complications, treatment and visual outcome of pars planitis in childhood. MATERIALS AND METHODS: Ten patients (8 boys and 2 girls) all younger than 16 years were diagnosed with and treated for pars planitis at our clinic between January 1993 and August 2004.