Chemotherapy-Induced Retinopathy in a Diabetic and Hypertensive Patient With Stage 4 Metastatic Pancreatic Adenocarcinoma.

Purpose: To describe a case of presumed Purtscher-like retinopathy in association with 2 chemotherapies. Methods: A retrospective chart review was performed. Results: A 40-year-old Black woman was diagnosed with pancreatic adenocarcinoma with metastasis to the liver. Cotton-wool spots and microaneurysms (dot/blot hemorrhages) were found on a routine examination 1 month after the patient started gemcitabine/paclitaxel. An increase in cotton-wool spots was noticed after she stopped gemcitabine/cisplatin therapy and started 5-fluorouracil/irinotecan/leucovorin therapy. These retinal changes were observed until the time of death. Conclusions: We believe that the Purtscher-like retinopathy began with gemcitabine toxicity but that the irreversible damage was the result of cisplatin chemotherapy. The patient's uncontrolled hypertension and type II diabetes likely put her at greater risk for developing this retinopathy.

Large submacular hemorrhage following PDT with verteporfin in patients with occult CNVM secondary to age-related macular degeneration.

A review of the charts for all patients who developed large submacular hemorrhages following photodynamic therapy for choroidal neovascular membranes secondary to age-related macular degeneration yielded three patients who met the criteria for a large submacular hemorrhage. All three patients were treated for exudative age-related macular degeneration and were taking warfarin for chronic anticoagulation. Before photodynamic therapy, the international normalized ratio ranged from 1.2 to 1.6. All three patients had received at least one previous verteporfin treatment in the study eye. All three hemorrhages were not noted immediately after photodynamic therapy and were documented within 1 to 2 weeks following the procedure. Patients with age-related macular degeneration who are receiving warfarin therapy and undergoing repeat verteporfin treatments appear to be at risk for submacular hemorrhages.

Triple therapy of intravitreal triamcinolone, photodynamic therapy, and pegaptanib sodium for choroidal neovascularization.

PURPOSE: To report the six-month results of subfoveal choroidal neovascularization that had been treated with combined therapy of high-dose intravitreal triamcinolone acetonide (HDIVTA), photodynamic therapy (PDT), and pegaptanib sodium injection. DESIGN: Retrospective, interventional case series study. METHODS: Medical files of 16 patients with this treatment were reviewed (22 eyes); 13 eyes had had previous treatment with HDIVTA and PDT; nine eyes were newly diagnosed choroidal neovascularization. Patients were treated with an injection of HDIVTA (10 mg), followed by PDT and pegabtanib sodium injection at two-week intervals. The main outcome variables were visual acuity (VA) and macular thickness by optical coherence tomography (OCT). RESULTS: The mean VA improved 2.2 lines (P = .013 in the new treatment group); the previous treatment group (HDIVTA + PDT) improved only 0.7 lines (P = 0.55, Wilcoxon ranked test). The mean of macular thickness before and after treatment was statistically significant in both groups. CONCLUSION: This combination therapy showed improvement and/or stabilization in VA, particularly when used as first-line therapy.

Photodynamic therapy for choroidal neovascular membrane secondary to optic nerve drusen.

The authors describe the use of photodynamic therapy with verteporfin for subfoveal choroidal neovascular membrane secondary to optic nerve drusen. A 28-year-old woman had a peripapillary choroidal neovascular membrane secondary to optic nerve drusen with significant metamorphopsia. Photodynamic therapy using verteporfin was performed. Visual acuity improved to 20/20 with resolution of metamorphopsia and absence of leakage on fluorescein angiography a few weeks after verteporfin therapy. The patient's condition remained stable for 16 months with 20/20 vision. Photodynamic therapy with verteporfin may be a useful treatment option in patients with choroidal neovascular membranes secondary to optic nerve drusen.

A cluster of patients with acute-onset endophthalmitis following cataract surgery.

BACKGROUND AND OBJECTIVE: To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery. PATIENTS AND METHODS: Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated. RESULTS: Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis, aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%). CONCLUSIONS: Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes.

Preliminary results of combined simultaneous transpupillary thermotherapy and ICG-based photodynamic therapy for choroidal melanoma.

BACKGROUND AND OBJECTIVE: To evaluate whether the combination of simultaneous hyperthermia by transpupillary thermotherapy and indocyanine green-based photodynamic therapy is an effective treatment for small and medium choroidal melanomas. PATIENTS AND METHODS: Twenty-five patients with small and medium choroidal melanomas were treated with combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy. RESULTS: The median age of the 25 patients was 64 years (range, 35 to 88 years). The pretreatment volume of the tumors ranged from 15.9 to 653.5 mm3 (mean, 118.7 +/- 146.6 mm3). After a mean of 2.4 treatments (range, 1 to 5 treatments), all of the tumors but one showed a significant volume reduction without clinical evidence of recurrences. The follow-up ranged from 6 to 59 months (mean, 12 +/- 14 months). Complications included retinal vascular occlusions, edema and superficial scarring of the macula, and rhegmatogenous retinal detachment. CONCLUSIONS: The effects of combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy appears to be effective in achieving local tumor control in selected small and medium choroidal melanomas.

[Choroidal melanoma treated with 810 nm diode laser and indocyanine green. A case report]. / Reporte de caso. Melanoma de coroides fotocoagulado con láser de diodo 810 nm coadyuvado con verde de indocianina.

CASE REPORT: A 35 year-old female with a pigmented choroidal tumor in the inferotemporal quadrant, of 3.31 x 7.64 x 5.46 mm. The patient received an intravenous injection of 25 mg of indocyanine green previous to photocoagulation of the lesion with an 810 nm diode laser. After one year follow-up the tumor showed involution demonstrated by clinical and ultrasonographic evaluation. DISCUSSION: Indocyanine green allows maximal absortion of light energy delivered by diode laser, enhancing its action by making the deepest tissues vulnerable to photocoagulation and reducing time of exposure and number of sessions.

Postoperative endophthalmitis caused by Candida parapsilosis: clinical features and treatment outcomes.

Three consecutive patients with postoperative Candida parapsilosis endophthalmitis presented from a single surgeon and surgery center after uncomplicated cataract surgery. All patients were treated with pars plana vitrectomy (PPV), intraocular lens removal, total capsulectomy, and intraoperative injection of intravitreal antifungal agent. Intraoperative cultures of undiluted vitreous and lens capsule were all positive for the fungus. All patients also received oral antifungal agents postoperatively. Two of these patients received several serial intravitreal antifungal injections after PPV. Following these treatments, all infections were resolved and vision outcomes were favorable at last follow-up.

Utilizaçäo de um novo perfluoroquímico líquido na cirurgia vítreo-retiniana: estudo experimental / Use of a new liquid perfluorochemical for the vitreo-retinal surgery: an experimental study

Um novo perfluoroquímico chamado Aflunox, foi testado como provável substituto vítreo. Esse óleo tem excelente estabilidade, química e térmica, gravidade específica de 1,9 g/ml, e viscosidade variando de 68 a 1400 centistokes, de acordo com o tipo utilizado. A espectroscopia com ressonância magnética demonstrou que o produto praticamente livre de contaminantes. O composto foi testado na cavidade vítrea de coelhos, que foram divididos em 2 grupos: o grupo I foi submetido à vitrectomia e injeçäo de 1 ml de Aflunox na cavidade vítrea; o grupo II foi submetido apenas à vitrectomia servindo como grupo de controle. Os animais foram examinados semanalmente, durante 30 dias, com biomicroscopia e oftalmoscopia indireta. Ao fim deste período, foram realizados eletrorretinogramas escotópicos e retinografias. Os animais foram, entäo sacrificados para estudos histopatológicos. Nenhum dos exames realizados demonstrou sinais de toxicidade ocular, quando comparados aos controles. Esses resultados indicam que este produto pode servir como um bom substituto vítreo-transitório

Experimental intraoperative use of perfluorotributylamine, perfluorodecaline, and perfluoropolyether

Perfluorocarbonos líquidos (PFCLs) säo compostos com uma gravidade específica maior que a água e utilizados como adjuntos no tratamento cirúrgico de casos complicados de descolamento de retina. 32 coelhos pigmentados foram submetidos a vitrectomia com injeçäo de PFCL dentro da cavidade vítrea: 8 receberam perfluorotributilamino (PFTA); 8 receberam perfluorodecalino (PFDC); 8 receberam perfluoropoliéter (PFPE); os restantes 8 olhos que serviram de controle, receberam soluçäo salina. Uma hora depois das injeçöes foi realizada troca PFCL/soluçäo salina. Os animais foram entäo sacrificados, os olhos enucleados e processados para exames histológicos. A microscopia óptica nenhuma diferença significativa foi demonstrada entre os olhos com PFCLs comparando com os controles. A microscopia óptica nenhuma diferença significativa foi demonstrada entre os olhos com PFCLs comparado com os controles. A microscopia eletrônica revelou somente pequenas alteraçöes, consistindo de alguns defeitos irregulares na forma dos segmentos externos dos fotorreceptores no grupo do PFTA, PFPE e PFDC, pelo menos em nosso modelo animal, näo é associado com nenhuma patologia retiniana significativa

Hialuronato de sódio como veículo para gentamicina intraocular: estudo "in vitro" / Sodium hyaluronate as a carrier for intraocular gentamicin: \"in vitro\" study

Com o propósito de se obter um novo veículo para a injeçäo de antibióticos intraoculares no tratamento da endoftalmite, os autores avaliaram a açäo do hialuronato do sódio com e sem gentamicina sobre 3 tipos de bactérias (S.epidermidis, S.aureus e P.aeruginosa). Observaram o crescimento dessas 3 baxtérias em 6 diferentes meios de cultura e demonstraram que o hialuronato de sódio tem um efeito inibidor sobre estes 3 microorganismos. Observaram, ainda, a atividade anti-bacteriana da gentamicina com e sem hialuronato de sódio e, verificaram que as concentraçöes inibitórias mínimas (CIM) do antibiótico com e sem o referido veículo säo as mesmas 24 horas após a inoculaçäo da bactéria. Entretanto, 72 horas após a CIM é 2 vezes menor quando a gentamicina está associada a hialuronato de sódio a 0,4%. Estes resultados sugerem que o hialuronato de sódio pode ser um bom veículo para a injeçäo de antibióticos intraoculares.