INTRAVITREAL OCRIPLASMIN IN CLINICAL PRACTICE: Predictors of Success, Visual Outcomes, and Complications.

PURPOSE: To investigate predictors of success, visual outcomes, and complications of intravitreal ocriplasmin for the treatment of symptomatic vitreomacular adhesion in a clinical care setting. METHODS: Retrospective chart review of 49 consecutive eyes of 47 patients who received intravitreal ocriplasmin. Spectral domain optical coherence tomography scans were examined for vitreomacular traction (VMT) release, full-thickness macular hole (FTMH) closure, and other changes in retinal anatomy. RESULTS: Pharmacologic VMT release occurred in 41% of eyes; positive predictors included age ≤75 years (P = 0.001), phakic status (P = 0.016), VMT width ≤750 µm (P = 0.001), and absence of retinal comorbidities (P = 0.035). Pharmacologic FTMH closure occurred in 25% of cases; positive predictors included successful VMT release (P = 0.042), better preinjection best-corrected visual acuity (P = 0.036), and smaller FTMH aperture width (P = 0.033). Eyes that achieved VMT release and did not undergo surgery attained significant improvement in best-corrected visual acuity (P = 0.015). Complications included subfoveal lucency (33%), ellipsoid zone disruption (33%), and FTMH base enlargement (75%). Only FTMH base enlargement resulted in worse visual outcomes (P = 0.024). Subgroup analysis of 14 eyes with ideal characteristics (all positive predictors listed above) yielded a 93% VMT release rate. CONCLUSION: Proper case selection may facilitate successful pharmacologic vitreolysis with ocriplasmin, improve visual outcomes, and minimize potential complications.

The Impact of Electronic Reading Devices on Reading Speed and Comfort in Patients with Decreased Vision.

Background/Aims. To evaluate the impact of back-illuminated and nonilluminated electronic reading devices on reading speed and comfort in patients with decreased vision. Methods. A prospective study involving a convenience sample of 167 patients at a single retina practice from January 2011 to December 2012. Participants were asked to read five different excerpts on five different media in a randomly assigned order. Media included a printed book at 12-point font (12PF), iPad2 at 12PF, iPad2 at 18-point font (18PF), Kindle2 at 12PF, and Kindle2 at 18PF. Reading speed in words per minute (WPM) and medium preference were recorded and stratified by visual acuity (VA). Results. Mean reading speeds in WPM: iPad2 at 18PF (217.0), iPad2 at 12PF (209.1), Kindle2 at 18PF (183.3), Kindle2 at 12PF (177.7), and printed book at 12PF (176.8). Reading speed was faster on back-illuminated media compared to nonilluminated media. Text magnification minimized losses in reading performance with worsening patient VA. The majority of participants preferred reading on the iPad2 at 18PF. Conclusions. Back-illuminated devices may increase reading speed and comfort relative to nonilluminated devices and printed text, particularly in patients with decreased VA.

Infectious Ulcerative Keratitis Following Retinopathy of Prematurity Treatment.

PURPOSE: To report the complication of infectious ulcerative keratitis after laser photocoagulation and pars plana vitrectomy (PPV) for retinopathy of prematurity (ROP). METHODS: A retrospective chart review of infants treated for ROP with plus disease between 2004 and 2013 at University Hospital, Newark, New Jersey. RESULTS: Of the 110 eyes (55 patients) that underwent treatment for ROP, 8 (7.27%) eyes were noted to develop infectious ulcerative keratitis in 4 neonates (4 eyes after laser photocoagulation and 4 eyes after PPV). All 8 eyes that developed ulcerative keratitis had a preceding corneal epithelial defect followed by corneal stromal haze. Seven of 8 eyes developed epithelial defect within 8 days of the procedure. All epithelial defects progressed to ulcerative keratitis within 7 days. A total of 10 (9.1%) eyes developed postoperative epithelial defects, and 8 (80%) of these eyes were ultimately diagnosed as having ulcerative keratitis. Four (4.08%) of 98 eyes treated with laser photocoagulation alone developed infective ulcerative keratitis, compared to 4 (33.33%) of 12 eyes treated with PPV. Because keratitis healed, corneal opacification ensued and covered 10% to 90% of the corneal surface area. Five of the 8 eyes had positive culture of corneal scrapings: 2 grew coagulase-negative Staphylococcus and Stenotrophamonas; 1 grew coagulase-negative Staphylococcus; 1 grew Streptococcus viridans, and 1 grew Staphylococcus hominis, Streptococcus mitis, and Streptococcus viridans. All 8 eyes were treated with antibiotic eye drops. CONCLUSIONS: Infectious ulcerative keratitis developed in a small, but significant, percentage of patients undergoing treatment for ROP. Postoperative corneal epithelial defects with subsequent corneal haze appear to be involved in the progression to ulcerative keratitis.

Acute exudative polymorphous vitelliform maculopathy in a young man: a case report.

PURPOSE: To describe ocular findings consistent with acute exudative polymorphous vitelliform maculopathy in a healthy 34-year-old man. METHODS: Observational case report of a patient presenting with blurred vision in the left eye greater than the right eye. RESULTS: Funduscopic examination and fluorescein angiography were consistent with acute exudative vitelliform maculopathy, a rare exudative macular disorder. Five months after presentation, the patient was diagnosed with metastatic melanoma. CONCLUSION: A case is reported in a young man with no diagnosis of primary neoplasm at the time of presentation, and no other symptoms overall, who was later diagnosed with a metastatic malignancy.