Extensive unilateral visual field loss due to peripapillary arteriovenous malformation.

We report on a case of extensive unilateral visual field loss due to a peripapillary arteriovenous communication. Interventional case report. A 27-year-old Caucasian woman who was initially managed for retrobulbar optic neuritis underwent fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) 6 months later that revealed an unusual course of the central retinal vein with focal dilatation and co-existent aneurysmal distention of the adjacent large choroidal vein. Subsequent colour Doppler flow imaging of the dilated area confirmed the existence of arterial flow suggesting a "vascular steal" phenomenon resulting in choroidal and optic disc ischaemia. Brain magnetic resonance imaging (MRI) revealed small focal capillary vessel abnormalities in the parietal cortex. The present case highlights the important role of ICGA and FFA in the assessment of patients with optic disc pallor and visual field loss. In our case an unusual ocular vascular abnormality was attributed to a congenital malformation and therefore an unnecessary therapeutic intervention was avoided.

Evolution of lamellar macular hole studied by optical coherence tomography.

PURPOSE: To study the natural course of lamellar macular hole (LMH) as examined by optical coherence tomography (OCT) in a noncomparative observational case series. METHODS: Forty-one eyes of 41 patients with LMH were included in this analysis. Baseline and final OCT findings related to LMH diameter, foveal thickness and visual acuity (VA) were collected and compared. Mean follow-up was 37.1 months. Main outcome measures were best-corrected visual acuity (BCVA), diameter of the LMH opening, foveal thickness, epiretinal membrane (ERM), posterior vitreous detachment (PVD) and vitreoretinal traction. RESULTS: The diameter of the LMH increased by an average of 13.7%. A statistically significant association was found between the LMH diameter increase and the presence of ERM. The mean foveal thickness depicted a statistically significant decrease between the initial and the final examination. The decrease of the foveal thickness showed to correlate with visual acuity deterioration. BCVA was stable in 30 (78%) and deteriorated in 11 (22%) cases. In eight of the 11 cases, the visual acuity deterioration ranged from 2 to 15 letters. CONCLUSION: We identified an increase of LMH diameter related to the presence of ERM and a decrease of the foveal thickness within a period of observation which ranged from 24 to 54 months (mean 37.1 months).

Disseminated hydatid disease in a child: albendazole treatment of orbital cyst.

PURPOSE: Orbital hydatid cyst is rare and represents a small percentage of all echinococcal systemic locations. It is usually a primary echinococcosis. A new case of orbital hydatid cyst with asymptomatic coexistent lung and liver cysts is described in a child. METHODS AND RESULTS: The patient underwent surgical excision of the lung and liver cysts and successful application of albendazole treatment for orbital echinococcal cyst without evidence of recurrence after a 4-year follow-up. CONCLUSIONS: Hydatid cyst should be included in the differential diagnosis of unilateral exophthalmos in patients from countries where echinococcosis is endemic.

Spontaneous resolution of vitreomacular traction following ranibizumab (Lucentis) injection.

PURPOSE: Spontaneous resolution of vitreomacular traction syndrome in diabetic patients is a rare phenomenon that has been poorly described in the literature. METHODS: Case presentation. RESULTS: The authors present a case of spontaneous resolution of vitreomacular traction following intravitreal administration of ranibizumab. CONCLUSIONS: In patients with vitreomacular traction syndrome and diabetic macular edema, the combination of the possible vitreous liquefaction and mechanical increase of vitreous volume caused by an intravitreal injection with a degree of reduction in retinal thickness caused by the effect of vascular endothelial growth factor inhibition could play a role in the resolution of vitreomacular traction.

Intravitreal ranibizumab in a patient with choroidal neovascularization secondary to multiple evanescent white dot syndrome.

PURPOSE: To report the effect of a single intravitreal injection of ranibizumab in a patient with choroidal neovascularization (CNV) secondary to multiple evanescent white dot syndrome (MEWDS). METHODS: A 65-year-old woman with visual acuity (VA) 20/40, mild vitreous inflammation, optic disc edema, and white deep retinal round lesions in the right eye underwent fluorescein angiography, indocyanine green angiography, and optical coherence tomography. The diagnosis of MEWDS with peripapillary CNV was made and a single injection of ranibizumab (0.5 mg) was administered. RESULTS: At the 6-month follow-up visit, the VA in the right eye was 20/20, the CNV completely regressed, and the MEWDS findings disappeared. CONCLUSIONS: Intravitreal ranibizumab appears to be a safe and effective treatment option in cases of CNV secondary to MEWDS, resulting in fast resolution of the macular edema and regression of the CNV. On the other hand, it is unclear whether the administration of ranibizumab contributed to a prompt regression of MEWDS.

Evolution of retinal pigment epithelium detachment after photodynamic therapy for choroidal neovascularization in age-related macular degeneration.

PURPOSE: To report a case of pigment epithelium detachment (PED) which appeared after photodynamic therapy (PDT) and was followed up for 50 months. METHODS: Case report. RESULTS: A 71-year-old woman with occult choroidal neovascular membrane due to age-related macular degeneration (ARMD) developed PED 48 hours after PDT. The patient was studied with fluorescein angiography (FA) and optical coherence tomography (OCT). Fluorescein angiographic evidence of PED remained essentially unchanged during the follow-up period of 50 months. Although OCT initially gave clear evidence of PED, in the last 12 months of follow-up the PED appears to have resolved. CONCLUSIONS: Photodynamic treatment could be involved in the occurrence of PED in occult choroidal neovascular membrane due to ARMD. In this particular case OCT could be considered since it offers useful information in the pretreatment and the post-treatment follow-up period.

Angiographic and OCT features of retinal angiomatous proliferation.

BACKGROUND: To propose a classification system for retinal angiomatous proliferation (RAP) on the basis of the indocyanine green angiography (ICG). METHODS: Retrospective chart review of 55 eyes of 55 patients presenting with RAP. Fluorescein angiography (FA), ICG and optical coherence tomography (OCT) were used to evaluate the patients. RESULTS: All RAP lesions appeared as occult or minimally classic CNV on FA without clear evidence of pigment epithelium detachment (PED). We were able to identify five different patterns of RAP on the basis of ICG. These were focal (27.2%), irregular (21.8%), circular (21.8%), multifocal (18.2%), and combined (10.9%) hyperfluorescence. The sudden termination of retinal vessel course sign was observed in 14 of 55 eyes (25.4%), which had a circular or irregular pattern on the ICG. Only the circular RAP exhibited a late hypofluorescence ('wash out') with staining of the surrounding tissue on the ICG. Forty eight of 55 eyes (86%) had PED according to the OCT. Out of these 48 eyes, 19 had intraretinal fluid (IRF) alone, and the rest had IRF and subretinal fluid. The eight eyes (14%) without PED belonged to the focal hyperfluorescence group and the fluid was located intraretinally in cystic spaces. In addition, in four eyes (7%) with coexisting CNV a band of tissue beneath the RAP protruding in the PED was observed. CONCLUSION: We propose a classification system for RAP on the basis of ICG and present the angiographic and OCT findings of these lesions. These data may further aid in the early diagnosis of RAP and can be also used for prognosis and clinical course documentation.

Ocular manifestations of systemic lupus erythematosus: a clinical review.

Although the eye itself is regarded an 'immune-privileged' organ, systemic lupus erythematosus (SLE) can affect every ocular structure, leading, if left untreated, to significant visual loss or even blindness. Since ocular inflammation in SLE can antedate the diagnosis of the systemic disease and cause significant morbidity, prompt diagnosis and treatment of the underlying systemic autoimmune disease is imperative.

[Experimental hypertony caused by obstruction of the anterior chamber angle ab interno (author's transl)]. / Experimentelle Hypertonie durch Verschluss des Kammerwinkels ab interno

In 30 rabbits, separated into 3 groups (A, B and C), the entire area (A), three quarters (B) half of the anterior chamber angle (C) was experimentally obstructed by means of a homologous scleral graft. In groups A and B a statistically significant change of the intraocular pressure and of the cornea diameter was shown as compared with the control eye and group C. This change is due to the obstructed area of the angle. The increased intraocular pressure lasted for some months. The graft was well tolerated by the tissue of the angle and the obstruction of the angle was total, as was confirmed by means of the histological preparations.

Cyst formation in optic disc pit maculopathy.

PURPOSE: To evaluate the presence and the evolution of cyst formation in optic disc pit maculopathy. METHODS: In this prospective study, 18 cases with optic disc pit maculopathy were studied. Five of them showed cyst formation in the fovea at the initial examination. The fundus findings were documented with slit-lamp biomicroscopy, indirect ophthalmoscopy, and stereoscopic photography of the posterior pole. All 5 patients were treated with a macular scleral buckle procedure. RESULTS: The presence of cysts in the elevated macula depends on the grade of the disease. Cyst formation can develop not only in the later stage of the disease but also quite early. In all 5 patients cyst formation gradually decreased and finally disappeared after the surgical procedure. CONCLUSIONS: Cyst formation is an entity which accompanies the macular detachment associated with optic disc pit. The development of the cysts has been noticed after the establishment of the schisis-like separation and before or in conjunction with the formation of a lamellar macular hole which usually accompanies the optic disc pit maculopathy.