Bilateral Subretinal Fluid Mimicking Subretinal Neovascularization Within 24 Hours After Selective Laser Trabeculoplasty.

PURPOSE: Selective laser trabeculoplasty (SLT), which is widely regarded as a safe procedure, is a frequently used treatment for open-angle glaucoma. Although it is presumed to be associated with an inflammatory cascade and possible postoperative inflammation, only 2 cases of SLT complicated by cystoid macular edema have been previously reported. Until now there are no previous reports of SLT causing subretinal fluid (SRF). METHODS/IMPORTANCE: Clinical examination, optical coherence tomography, and fluorescein angiography demonstrated a previously unreported clinical entity consisting of bilateral SRF, developing within 24 hours of bilateral inferior 180-degree SLT for open-angle glaucoma. RESULTS: Rapid bilateral, subjective loss of vision occurred within 24 hours post-SLT. This was associated with bilateral SRF resulting in 48 µm (OD) and 35 µm (OS) increase in macular thickness on optical coherence tomography. Fundus fluorescein angiography demonstrated profuse, well-demarcated subfoveal leakage. SRF resolved within 4 days, but eventual best corrected visual acuity was subjectively and objectively decreased. CONCLUSIONS: The sudden onset of loss of vision and the development of subfoveal SRF within 24 hours of SLT strongly suggests cause and effect. This previously unreported clinical entity of bilateral SRF within 24 hours of SLT may be secondary to an intraocular inflammatory cascade, similar to previous hypotheses regarding 3 cases of cystoid macular edema post-SLT. Given the dramatic initial loss of vision and compromised long-term visual outcome, clinicians and patients need to be informed of this new clinical entity of SLT associated with SRF and permanent retinal pigment epithelial changes.

Short-term intraocular tamponade with perfluorocarbon heavy liquid.

BACKGROUND: Inferior retinal detachment pathology can be difficult to manage due to inadequate tamponade with low specific gravity tamponade agents and the propensity for the development of proliferative vitreoretinopathy (PVR). We report the efficacy and adverse effects associated with the use of perfluorocarbon heavy liquid as a short-term tamponade in managing such pathologies. METHODS: Retrospective analysis of 17 eyes treated with short-term perfluoro-n-octane tamponade for complex inferior retinal pathology, including inferior detachment and PVR. Mean follow-up time was 14 months and mean tamponade duration was 7 days. RESULTS: Reattachment of the retina during the study period was achieved with a single set of operations in 13/17 (76%) eyes, with four eyes requiring a subsequent set of vitreoretinal operations. Postoperative visual acuity (VA) was equal to or better than preoperative VA in 14 (82%) of 17 eyes. Complications arising during the follow-up period included superior redetachment, atrophic macular changes, minor macular haemorrhage, cataract, elevated intraocular pressure, corneal defects, PVR, epiretinal membrane and retained perfluorocarbon heavy liquid. One case of intraocular inflammation occurred >6 months after removal of perfluoro-n-octane tamponade. CONCLUSION: Short-term perfluoro-n-octane tamponade achieved a stable reattachment rate of 76% when used to manage challenging retinal pathologies.

Tamoxifen therapy conveys increased risk of developing a macular hole.

PURPOSE: To determine etiological factors in the development of, as well as anatomic success rate and visual outcome of a large consecutive series of macular hole surgeries. METHODS: Retrospective analysis of 300 consecutive cases of macular hole surgery by a single surgeon (RDB) between 1999 and 2003. Patients' medical and surgical histories were recorded and analysed for factors involved in aetiology and visual outcome. RESULTS: There were 8 (4.12%) women, on tamoxifen in the study, two of these women had bilateral macular holes. When this study prevalence of tamoxifen therapy (4.12%) was compared to the estimated percentage of women in the same age group in the Australian population on tamoxifen (0.82%), a statistically significant difference (p value 0.0001) was found. Analysis of the number of bilateral holes in the tamoxifen group compared to the non-tamoxifen group was suggestive of an increased incidence of bilateral holes but not to a significantly significant degree. CONCLUSION: Whilst no published reports link tamoxifen and macular holes, this may be due to the low incidence of the condition. Our study demonstrates a strong link between tamoxifen use and macular holes. Patients being commenced on tamoxifen should be advised of possible ocular complications and receive prompt ophthalmic review if symptoms develop.