Aqueous humor polymerase chain reaction in uveitis - utility and safety.

BACKGROUND: To study the value and safety of aqueous humor polymerase chain reaction (PCR) analysis for Herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus and Toxoplasma gondii in patients with uveitis. METHODS: Records of 45 consecutive patients with anterior and posterior uveitis who underwent AC paracentesis with PCR were reviewed. The main outcome measure was frequency of PCR positivity. Secondary outcomes were alteration of treatment, safety of paracentesis, and correlation of keratitic precipitates with PCR positivity, RESULTS: The overall PCR positivity was 48.9 % (22/45). Therapy was changed because of the PCR results in 14/45 patients (37.7 %). One patient experienced a paracentesis related complication (1/45, 2.2 %) without long-term sequelae. CONCLUSION: Aqueous PCR altered the diagnosis and treatment in over a third of our patients and was relatively safe. Aqueous PCR should be considered for uveitis of atypical clinical appearance, recurrent severe uveitis of uncertain etiology, and therapy refractory cases.

Diagnostic Dilemma in Sequential Branch Retinal Vein and Artery Occlusion.

PURPOSE: To report on an unusual case of a branch retinal vein occlusion followed by occlusion of the respective branch retinal artery of the same eye 7 years later, in a young, otherwise healthy man with marginal elevation of antiphospholipid antibodies. CASE REPORT: On first presentation, a 30-year-old male patient was diagnosed as having a branch retinal vein occlusion with the sole risk factor of slightly increased diastolic pressure. On second presentation, 7 years later, a transient occlusion of the respective branch retinal artery was diagnosed on the same patient. Extensive ophthalmologic and general medical evaluations were performed including cardiovascular, coagulation, and immunology testing. Coagulopathy screening revealed slightly elevated titers of anticardiolipin IgM and anti-beta 2 glycoprotein-I IgM antibodies, and aspirin prophylaxis was initiated. CONCLUSIONS: Retinal vascular occlusions are typically associated with well-defined, classical risk factors in older people. In younger, otherwise healthy patients, further autoimmune hypercoagulable disorders are often causal. Our case suggests the contribution of slightly elevated antiphospholipid IgM antibodies, although this remains to be proven.

Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: Clinical experience in 16 patients.

OBJECTIVE: Central retinal artery occlusion (CRAO) is a rare disease with poor visual prognosis. We evaluated clinical effectiveness of in situ fibrinolysis with original angiographic scores describing the aspect of carotid siphon, proximal ophthalmic artery, and choroid blush. METHODS: Retrospective study of 16 consecutive cases of CRAO between 2007 and 2013. Fourteen underwent in situ fibrinolysis, two were excluded due to pre-occlusive internal carotid stenosis on pre-procedural diagnostic angio-CT. Fibrinolysis was performed with rt-PA (average injected dose: 35 mg), with an average onset delay of 8hours (4-17h). We reported angiographic scores pre- and post-fibrinolysis, visual acuity (VA) before and after treatment, and VA improvement evaluated by ophthalmologist 6 to 12 months after thrombolysis. RESULTS: Six patients (43%) recovered post-fibrinolysis VA significally improved, superior or equal to 1/10 (1/10 to 8/10). An irregular carotid siphon (2 cases) appeared as a predictive factor of failure. Fibrinolysis procedure led to a significant improvement of angiographic permeability of proximal ophthalmic artery (P=0.0498), but this result was not accompanied by any VA improvement. The aspect of choroid blush showed no correlation with the management of thrombolysis. CONCLUSION: In situ fibrinolysis was more effective than medical treatments or natural evolution of CRAO (VA improvement was respectively 40% and 20%). However, the benefit/risk ratio must be discussed, and an angio-CT of supra-aortic trunks could be systematically performed before thrombolysis, to assess the potential VA recovery compared with complications such as ischemic stroke.

[Drug-induced toxicity and ophthalmology]. / Toxicité médicamenteuse et ophtalmologie.

Affecting primarily the anterior part of the eye, all the structures of ophthalmological body may however be reached in case of drug- induced toxicity: eyelids and the conjunctiva for example in the syndromes of Lyell and Steven-Johnson, cornea with cornea verticillata related to amiodarone, ciliary muscle (accommodation) or pupil related to antidepressants, lens with glucocorticoid-induced cataract, retinal toxicity of anti malarial synthesis or optical neuropathy with ethambutol. Unfortunately often underrated because of their usual benignity, drug side effects affecting the eye yet can be severe. Simple, conscientious and planned monitoring however allowes for a large majority of our patients to minimize the risk of visual function impairment, thus preserving optimal visual function over time.

[The management of diabetic retinopathy and diabetic macular edema; joint forces fight for sight]. / Prise en charge de la rétinopathie diabétique: un combat pour la vue.

Despite the considerable progress in prevention and treatement options since the first big epidemiologic studies in the 80's, diabetic retinopathy still represents the primary cause of blindness in the working age population. The intensified prevention efforts that took place recentyears did show hopeful results as the incidence of diabetic retinopathy seems to decline. However a still considerable number of patients does not meet metabolic or treatment recommandations. In the aftermath of an ongoing globalisation and growing urbanisation of the society, there is an even bigger need of understanding the disease as well as improving prevention and treatment guidelines.

Chorioretinal Toxicity of Perfluorooctane (Ala Octa): Results From 48 Surgical Procedures in Geneva.

PURPOSE: To compare outcomes of patient who underwent surgery using perfluorooctane (PFO; C8F18; Ala Octa) with those who underwent surgery with perfluorodecalin (F-Decalin). DESIGN: Retrospective, consecutive, comparative, interventional case series. METHODS: A total of 48 eyes that underwent vitrectomy with PFO were compared to 29 eyes that underwent vitrectomy with perfluorodecalin. Two experienced surgeons performed vitrectomies at the Geneva University Eye Clinic. Visual acuity before, at 8 and 24 weeks after surgery, was documented, and spectral domain optical coherence tomography (SD-OCT) images were analyzed for abnormalities. RESULTS: Two patients experienced severe retinal toxicity, including 1 with severe vision loss. However, no statistical differences in VA were observed between the PFO and perfluorodecalin patients. Analysis of SD-OCT images showed differences in occurrence of several abnormalities, for example, inner segment-outer segment alterations were found in 60.4% of eyes treated with PFO and in 10.3% of perfluorodecalin-treated eyes; retinal atrophic areas were found in 41.7% of PFO and in none of the perfluorodecalin eyes; inner limiting membrane contraction was found in 58.4% of PFO and in none of perfluorodecalin eyes; inner retina cystic alterations were found in 58.3% of PFO eyes and 17.2% of perfluorodecalin eyes; outer retina cystic alterations were found in 39.6% of PFO eyes and 13.8% of perfluorodecalin eyes; retinal holes were found in 14.6% of PFO eyes and in none of the perfluorodecalin eyes; and outer retinal inclusions were found in 20.8% of PFO eyes and in 3.45% of perfluorodecalin eyes. CONCLUSIONS: Perfluorooctane caused significantly more toxic damage than perfluorodecalin. Special consideration should be given to develop a central European Union (EU) control agency for medical devices and to reevaluate safety procedures currently accepted by the EU and International Organization for Standardization for intraocular surgery.

Traumatic retinal detachment--the difficulty and importance of correct diagnosis.

Accurate characterization of a retinal detachment as traumatic is often difficult, but is important because it may instigate a careful search for occult coexistent traumatic pathology, affect the prognosis and the treatment of both eyes, influence insurance coverage benefits and medical-legal determinations, and is essential for epidemiologic studies. We review the epidemiology and pathophysiology of traumatic retinal detachment, common obstacles to correct diagnosis, diagnostic guidelines, and outline categories of traumatic causal relationships. Because there is no generally accepted definition of traumatic retinal detachment, we offer a practical one. Categorization as traumatic should be based on the particular history and physical examination rather than epidemiologic criteria.