Intravitreal triamcinolone with transpupillary therapy for subfoveal choroidal neovascularization in age related macular degeneration. A randomized controlled pilot study [ISRCTN74123635].

BACKGROUND: To assess the effect of intravitreal triamcinolone acetonide (iTA) as an adjunctive treatment to transpupillary therapy (TTT) for new subfoveal choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD). METHODS: This prospective randomized controlled pilot study comprised 26 patients scheduled to receive TTT, due to either absent indications for photodynamic therapy or financial issues. Patients were assigned into; Group A (n = 14) received TTT alone and Group B (n = 12) received iTA (4 mg) followed by TTT within one week. Follow ups were at 2 weeks, and 1, 3 and 6 months for; best-corrected visual acuity (BCVA) by ETDRS chart at 4 meters, intraocular pressures (IOP), fluorescein angiography (FAG), and central foveal thickness by optical coherence tomography (OCT). RESULTS: All 26 patients completed 6 months of follow ups. The average age for both groups was 74 years. Occult CNV formed 64% and 41%; classis/predominately classic 21% and 16.6%; and minimally classic 15% and 42.4% of group A and B respectively. At baseline; the mean BCVA was 0.045 for group A and 0.04 for group B; mean CNV size was 6.15 disc diameter (DD) and 2.44 DD; mean OCT foveal thickness was 513 um and 411 um for group A and B respectively with no statistical differences (P = 0.8, 0.07, and 0.19). At six months the proportion of patients gained > or = 1 lines was 14% and 25% (P = 0.136) and stabilization was 86% and 66% (P = 0.336); the mean size of the CNV was 5.63 DD and 2.67 DD (P = 0.162); rate of CNV closure was 64% and 83% (P = 0.275); and the mean OCT central foveal thickness was 516.36 um and 453.67 um (P = 0.341), for group A and B respectively. CONCLUSION: The use of iTA as an adjunctive to TTT for new subfoveal CNV in AMD showed a tendency towards better functional results. However due to the small sample size of the study a statistically significant results could not be reached.

Pars plana vitrectomy and lamina cribrosa puncture in absolute glaucoma.

Two patients with refractory end-stage glaucoma who had no light perception underwent pars plana vitrectomy and lamina cribrosa puncture to relieve pain and decrease intraocular pressure. The patients presented with blind, painful eyes and high intraocular pressure (> 40 mm Hg). After the procedure, the pain was relieved and the intraocular pressure was lowered in both cases. The patients remained asymptomatic. Pars plana vitrectomy and lamina cribrosa puncture might be related to the decrease of intraocular pressure, probably by facilitating drainage of aqueous humor through the optic nerve.

Perfluorocarbon-perfused vitrectomy using a transconjunctival 25-gauge system.

PURPOSE: To describe the feasibility of perfluorocarbon-perfused vitrectomy (PCPV) using a 25-gauge system in complicated retinal detachment cases. METHODS: Thirteen nonconsecutive patients with complicated retinal detachment (either tractional secondary to proliferative diabetic retinopathy or rhegmatogenous) who would not normally be selected for 25-gauge vitrectomy were included in the study. Vitrectomy using 25-gauge ports and perfluorocarbon perfusion was performed. Real vitrectomy time, amount of perfluorocarbon liquid (PCL) used, instrument bending, feasibility of surgical maneuvers using an arbitrary scale, and anatomical and visual results were evaluated. RESULTS: Real vitrectomy time ranged from 6.2 minutes to 17.1 minutes (mean, 10.3 minutes). Amount of PCL ranged from 8 mL to 40 mL (mean, 24.38 mL). Instruments never bent even when using a wide-angle sutured contact lens. All desired maneuvers could be performed and were facilitated by PCL. All retinas were reattached, with two cases of mild recurrent vitreous hemorrhage. Visual acuity improved in 76.9% of eyes. CONCLUSIONS: PCPV using a 25-gauge system can be performed, even in complicated cases.

Retinal vascular occlusion following ocular contusion.

PURPOSE: To describe an unusual fundus abnormality in eyes after trauma and its pathophysiologic basis. METHODS: Prospective, observational case series of five consecutive male patients who suffered retinal vascular occlusions after ocular contusion. RESULTS: We present five cases of retinal vascular occlusions following ocular contusion, found on routine fluorescein angiography in otherwise healthy individuals. CONCLUSIONS: Different patterns of retinal vascular occlusions can occur in ocular trauma. The pathogenesis of these occlusions may be related to direct damage to the endothelium.