The effect of photodynamic therapy on retrobulbar blood flow parameters.

PURPOSE: To investigate the effect of photodynamic therapy (PDT) on retrobulbar blood flow parameters. METHODS: Twenty-four patients with choroidal neovascular membrane of at least four MPS disc area in one eye due to age-related macular degeneration scheduled for PDT were recruited. Peak systolic and end diastolic velocity of ophthalmic, central retinal and posterior ciliary artery of both eyes were measured with colour Doppler imaging and resistivity index were computed before, at the first and fourth weeks following PDT. RESULTS: Following PDT, the mean peak systolic velocity of posterior ciliary artery increased significantly to a value of 31.90 +/- 13.44 at the first (P = 0001), then returned to an insignificant value of 29.95 +/- 13.03 at the fourth week (P = 0.360), when compared with pre-PDT mean measurement (30.16 +/- 13.15). Resistivity index of posterior ciliary artery also increased significantly to a value of 0.740 +/- 0.77 at the first (P = 0.046), then returned to an insignificant value of 0.666 +/- 0.14 at the fourth week (P = 0.407), when compared with pre-PDT mean measurement (0.709 +/- 0.90). All the other measured data (peak systolic velocity, end diastolic velocity, resistivity index of ophthalmic and central retinal artery; end diastolic velocity of posterior ciliary artery of the treated eyes; all colour Doppler imaging measurements of untreated eyes) did not show any significant change at the first and fourth week following PDT, when compared with the pre-PDT values. CONCLUSION: The peak systolic velocity and resistivity index of the posterior ciliary artery appear to increase in the first week and return to their baseline values at the fourth week following PDT.

Retinal nitric oxide and malonyldialdehyde levels following photodynamic therapy.

BACKGROUND: To determine the retinal nitric oxide (NO) and malonyldialdehyde (MDA) levels following photodynamic therapy (PDT). MATERIALS AND METHODS: Seven Dutch-belted rabbits received dextrose, while seven others received 2 mg/kg verteporfin infusion over a period of 15 minutes in a dim-lit room. Irradiation to a 1.5 mm diameter intact chorioretinal area in the right eye of verteporfin-infused rabbits, was started 5 minutes after the end of infusion. Three groups were control (dextrose infusion), infusion with verteporfin (left eyes were not irradiated), and irradiation after verteporfin injection (right eyes were irradiated). On the fifth day of the experiment, the eyes were enucleated. The retinas were subsequently frozen and homogenized. Nitrite, a stable end-product of NO and MDA, was measured using the spectrophotometer. Protein concentrations were measured by the Lowry method. Tissue NO and MDA levels were expressed as µmol/gprt and nmol/mgprt, respectively. RESULTS: The mean retinal NO and MDA levels of the control, infusion, and irradiation groups were 24.67 ± 6.66, 0.11 ± 0.02; 45.90 ± 15.52, 0.21 ± 0.09; and 84.43 ± 14.96 µmol/gprt, 0.58 ± 0.14 nmol/mgprt, respectively. The mean retinal NO levels were significantly elevated in the infusion and irradiation groups compared with the control group ( p :0.004; p :0.001). The mean retinal MDA levels were significantly elevated in the infusion and irradiation groups compared to the control one ( p :0.026; p :0.001). Also the mean retinal NO and MDA levels in the irradiation group were found to be significantly higher than the infusion group ( p :0.018; p :0.018). CONCLUSION: Not only PDT, but also verteporfin infusion alone resulted in NO and MDA level increments in the retina, which might be toxic.

Phthriasis palpebrarum mimicking lid eczema and blepharitis.

Phthiriasis palpebrarum (PP) is a rare eyelid infestation caused by phthirus pubis. We report a case of PP mimicking lid eczema and blepharitis. A 68-year-old woman had moderate itching in both eyes. Her initial diagnosis was considered to be lid eczema or blepharitis because of findings similar to exfoliative lesions and color changes in eyelids and to excretions over eyelashes. Careful observation revealed many lice and translucent nits, protuberances and hyperpigmentary changes, and the buried lice in both eyelids. No hyperemia or secretion was observed on the lids and in the conjunctiva in both eyes. The patient was treated with pilocarpine hydrochloride 4% drops. At the end of the first week, no louse or nit was present. Although it was known that PP is a rare cause of blepharoconjunctivitis, it might observe as an isolated infestation of the eyelids and this condition can easily be misdiagnosed as lid eczema and blepharitis.

The protective role of Visudyne eyeglass against VEGF synthesis after photodynamic therapy with verteporfin.

PURPOSE: We aimed to determine the extent of protection provided by Visudyne eyeglass against vascular endothelial growth factor (VEGF) synthesis following photodynamic therapy (PDT). METHODS: Three groups with 14 rabbits in each were established. These consisted of a control (dextrose infusion) group, an infusion (verteporfin infusion) group and an irradiation (verteporfin infusion + irradiation) group. One eye in each animal was closed with Visudyne eyeglass and the other by eyelid sutures. The rabbits were exposed to daylight for 30 mins at 2 and 48 hours after the infusion was administered. Half the animals in each group were killed on day 5. The remaining animals were killed on day 10. Levels of VEGF in homogenized retina and choroids were analysed with an ELISA (enzyme-linked immunosorbent assay). RESULTS: Mean VEGF levels, in pg/mg protein, on days 5 and 10 in the control + glass, control + suture, infusion + glass, infusion + suture, irradiation + glass and irradiation + suture subgroups were, respectively: 1.69 +/- 0.67, 1.91 +/- 0.44; 1.75 +/- 0.69, 1.93 +/- 0.53; 2.30 +/- 0.77, 3.47 +/- 2.02; 1.90 +/- 1.00, 2.93 +/- 0.16; 4.39 +/- 2.74, 13.63 +/- 5.25; 3.38 +/- 1.05, 7.37 +/- 2.12. On day 10, VEGF levels were significantly higher in the infusion and irradiation groups compared with the control group (p < 0.05). There were no statistically significant differences between glass and suture samples on days 5 and 10 in the infusion group, or on day 5 in the irradiation group. However, on day 10, the mean VEGF level in eyes closed with Visudyne eyeglass in the irradiation group was significantly higher than in sutured eyes (p = 0.011). CONCLUSIONS: Visudyne eyeglass offers full protection against VEGF increases caused by verteporfin infusion but is only partially protective in eyes exposed to sensitizing light.

Presumed nasolacrimal endometriosis.

A 13-year-old girl was admitted with a complaint of cyclic bleeding from the left inferior punctum with menstruation. Crusted hemorrhage was noticed in the tear meniscus of the left eye and just inferior to the left caruncle. With gradient-echo magnetic resonance imaging, the hemorrhagic tissue in the nasolacrimal canal was demonstrated and the diagnosis of nasolacrimal endometriosis was made. Nasolacrimal endometriosis is a rare ocular condition. Its management and histologic diagnosis remain challenging.

Coats-like retinitis pigmentosa: Reports of three cases.

PURPOSE: Describing the ophthalmic findings of an exudative vasculopathy called as Coats-like retinitis pigmentosa on three patients. The etiology of the Coats-like retinitis pigmentosa is obscure. The principal theories have been discussed in this article. METHODS: Three observational case series have been discussed. Complete ophthalmic examinations and color fundus photos, visual field, and fluorescein angiography have been performed. RESULTS: We have identified 3 patients who have some typical clinical features of Coats-like retinitis pigmentosa; peripheral serous retinal detachment, telangiectasia, prominent lipid deposition, pigmentary changes in peripheral retina, and loss of vision. None of the three patients had positive family history. All of the patients have had symptoms of nyctalopia, decreased central vision, and two of them have had constriction of visual field. All of the patients have had cataracts and two of them underwent cataract surgery. Fundus examination and fluorescein angiography of patients revealed typical retinitis pigmentosa with Coats-type changes in bilateral inferiotemporal quadrants. CONCLUSION: A better understanding of clinical features and genetic etiology of Coats-type retinitis pigmentosa will aid diagnosis and development of new therapies. If sufficient conditions arise, genetic factors that influence the expression of CRB1 mutations in Coats-like retinitis pigmentosa should be detected.