Corneal angiography for guiding and evaluating fine-needle diathermy treatment of corneal neovascularization.

PURPOSE: To investigate the outcome of selective occlusion of the afferent vessel of corneal neovascular complexes (CoNVs), using angiographically guided fine-needle diathermy (FND). DESIGN: Retrospective interventional case series. SUBJECTS: Patients with CoNV unresponsive to topical steroid therapy. METHODS: Visual acuity, color images, and fluorescein angiography and indocyanine green angiography were measured before and after FND with a minimum of 3 months of follow-up. The number of afferent vessels crossing the limbus, time to fluorescein leakage, area, and geometric properties of the CoNV were determined using an in-house automated program written in numerical computing language (MatLab R14; The MathWorks Inc., Natick, MA). The location of the afferent vessel was identified from the angiographic images and marked at the slit lamp using a needle to make a cut to the depth of the vessel. We then applied FND using an electrolysis needle. MAIN OUTCOME MEASURES: Area of CoNV. RESULTS: Thirty patients underwent FND for CoNV that had not responded to treatment with topical steroids. The CoNV was associated with previous microbial keratitis (n = 26), intrastromal corneal ring segments (n = 2), ectodermal dysplasia (n = 1), and corneal choristoma (n = 1). Duration of CoNV was >6 months in 23 patients (77%), between 3 and 6 months in 3 patients (10%), and <3 months in 5 patients (13%). The number of afferent vessels per CoNV ranged from 1 to 3, with a mean diameter of 40 µm (standard deviation [SD], 10 µm) and mean time to leakage from apical vessels was 44.22 seconds (minimum, 27.43 seconds; maximum, 63.59 seconds). The number of FND treatments that were required was 1 for 20 patients (66.6%), 2 for 8 patients (26.6%), and 3 for 2 patients (6.6%). After FND, the area of CoNV reduced by 1.80 mm(2) (SD, 1.40 mm(2)), from 2.42 (SD, 1.59) to 0.62 mm(2) (SD, 0.73 mm(2)) up to 12 weeks postoperatively (P < 0.01). CONCLUSIONS: The differentiation of afferent and efferent vessels using corneal angiography enables treatment to be selectively applied to the afferent vessels; there are usually 1 to 2 for each CoNV complex.

Clinical outcomes in Caucasian patients with polypoidal choroidal vasculopathy.

PURPOSE: To describe treatment outcomes in a cohort of Caucasian patients with polypoidal choroidal vasculopathy (PCV). METHODS: Clinical charts from 48 eyes of 45 Caucasian patients with PCV were retrospectively reviewed. All cases were diagnosed with indocyanine green angiography. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) imaging were analyzed at baseline and final follow-up. RESULTS: Eyes were treated with a combination of verteporfin photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) (n = 24), or PDT monotherapy (n = 9), or anti-VEGF monotherapy (n = 8), or no treatment (n = 7). Aflibercept was the anti-VEGF agent in 30 out of 32 eyes. Sixteen out of 24 eyes in the combination treatment group received initial PDT at diagnosis. All treatments led to stabilization of BCVA at final visit with a trend for better visual acuity in the anti-VEGF monotherapy group. There was a substantial reduction in central retinal thickness associated with resolution of subfoveal fluid and improvement in retinal pigment epithelial detachment in all treatment groups. BCVA and OCT findings remained stable in eyes which received no treatment. The use of PDT was associated with 0.5 fewer intravitreal injections per annum, which was not statistically significant. CONCLUSIONS: In the largest series of Caucasian patients with PCV presented to date, anti-VEGF monotherapy, PDT, or their combination preserved visual acuity and improved subfoveal exudative changes. Combination treatment was not superior to anti-VEGF monotherapy.

Polypoidal choroidal vasculopathy: a common type of neovascular age-related macular degeneration in Caucasians.

AIMS: To describe the prevalence of polypoidal choroidal vasculopathy (PCV) in a Caucasian population with neovascular age-related macular degeneration (NAMD). METHODS: All patients referred to a city AMD service over a 2-year period underwent imaging including Indocyanine Green Angiography at baseline. A panel of experts confirmed the patients with NAMD and diagnosed the lesion type including PCV. The proportion of Caucasian patients with PCV was identified. Two authors independently reviewed clinical imaging and recorded data of patients with PCV on lesion characteristics. Further information including treatments received and visual acuity at different time points was analysed. RESULTS: A total of 492 patients were diagnosed with NAMD during the 2-year study period. Of these patients, 204 had occult lesions (41.5%). PCV was identified in 45 patients (22.1% of occult NAMD and 9.1% of all NAMD). 23 patients received anti-vascular endothelial growth factor (VEGF) monotherapy, 8 received verteporfin photodynamic therapy (PDT) monotherapy and the remaining 14 patients were managed with combined PDT and anti-VEGF treatment. CONCLUSIONS: The prevalence of PCV in Caucasians is higher than previously reported. Indocyanine Green Angiography should be a standard investigation for all new patients with NAMD, particularly those with occult NAMD, to avoid missing this important subset.

Benign Recurrent Sixth (Abducens) Nerve Palsy following Measles-Mumps-Rubella Vaccination.

Benign, isolated, recurrent sixth nerve palsy is rare in children. It may be associated with febrile viral illness and vaccination in exceptional circumstances although this is a diagnosis of exclusion. Here, we present the case of a 2-year-old Caucasian girl who developed recurrent 6th nerve palsy following vaccination with the measles-mumps-rubella (MMR) vaccine. No underlying pathology was identified following extensive investigations and followup. There is limited data available on the pathophysiology of vaccination-related nerve palsies. As with all previous reports of cranial nerve palsies following vaccination, there was complete resolution in this case. Long term followup with repeated physical examination and investigations is warranted to avoid missing severe pathology and operating unnecessarily.

Treatment of age-related distance esotropia with unilateral lateral rectus resection.

PURPOSE: To report the results of a series of patients who underwent lateral rectus resection of a single muscle using nonadjustable sutures to correct acquired concomitant esotropia (age-related distance esotropia). METHODS: The medical records of patients with symptomatic age-related distance esotropia who were treated by unilateral lateral rectus resection were retrospectively reviewed. Pre- and postoperative near and distance prism diopter measurements were compared. RESULTS: The average age of the patients was 79.8 years (range, 68-90 years). The mean lateral rectus resection was 4.9 ± 1.3 mm. All patients had complete resolution of diplopia after surgery. Median distance esotropia measurements in primary gaze were reduced from 16.0(Δ) preoperatively to 0(Δ) postoperatively (P < 0.005) at final follow-up. Any preoperative near esotropia was also completely resolved. CONCLUSIONS: In this patient cohort, age-related distance esotropia was effectively managed solely with unilateral lateral rectus resection.