Examining the efficacy of verteporfin photo-dynamic therapy (PDT) at different dose & fluence levels.

OBJECTIVES: Photodynamic therapy (PDT) is a vaso-occlusive treatment for a number of chorioretinal vascular pathologies. We aimed to retrospectively analyse efficiency and safety of PDT for different conditions (central serous retinopathy (CSR), age-related macular degeneration (AMD), macular telangiectasia type 2 and choroidal hemangioma) and with different verteporfin parameters. METHODS: Clinical parameters were ascertained from the medical records of patients undergoing PDT over a 6-year period. This included indications for PDT, dosing regimens of verteporfin PDT (which includes treatment dose of verteporfin and fluence). Response to treatment was measured by best corrected visual acuity (BCVA) and central foveal thickness (CFT) on ocular coherence tomography. Complications and side effects were recorded. RESULTS: 67.4 % (31/46) of PDT treatments performed over the last six years were for CSR. In the CSR cohort, there were significant improvements in BCVA (0.47 ± 0.24 to 0.29 ± 0.27, p < 0.05) and CFT (350.2µm ± 66.9 µm to 286.1µm ± 60.6 µm. In the AMD cohort, there was no change in BCVA (1.08 ± 0.52 to 1.07 ± 0.53, p = 0.96) but significant improvement in CFT (488.2µm ± 164.6 µm to 348.7µm ± 65.7 µm, p < 0.05). There was no significant difference in BCVA or CFT for macular telangiectasia type 2 and choroidal hemangioma. CONCLUSIONS: PDT continues to have a role in the management of medical retina conditions. Our results show PDT is most effective in improving and stabilizing visual acuity in CSR, with earlier intervention resulting in better outcomes.

An ocular presentation of familial tumoral calcinosis.

This case report presents the ophthalmic features and complications of a 56-year-old Caucasian woman with familial tumoral calcinosis. She presented to our ophthalmology clinic with a 3-month history of blurring of her vision. She had been diagnosed 14 years earlier with familial tumoral calcinosis. Ophthalmological examination revealed calcific depositions on the eyelid margins, perilimbal calcific deposits and angioid streaks. An optical coherence tomography scan of the left eye revealed a choroidal neovascular membrane. Deterioration in vision occurred secondary to subretinal haemorrhage, resulting from the angioid streak. The patient was treated with a series of three intravitreal ranibizumab injections to her left eye, which led to an improvement in her visual acuity (VA). The patient is being closely followed up with monthly appointments, and to date, after 6 months of follow-up, there has been no further deterioration in her VA or reactivation of the choroidal neovascular membrane.

Prophylaxis of diffuse lamellar keratitis with intraoperative interface steroids in LASIK.

PURPOSE: To investigate the safety and efficacy of intraoperative interface steroids for the prophylaxis of diffuse lamellar keratitis (DLK). METHODS: Two centers analyzed 1210 consecutive procedures in a prospective interventional trial. Center A irrigated the lasered stromal bed with balanced salt solution (BSS), instilled a drop of preserved dexamethasone 0.1% suspension on the stromal bed, and replaced the corneal flap. Center B replaced the flap, inserted a multiple port cannula to irrigate the stromal interface with BSS, then introduced 0.5 mL preservative-free prednisolone sodium phosphate 0.5% solution into the stromal interface with another multiple port cannula. All LASIK procedures after a fixed date received intraoperative interface steroids. Consecutive procedures immediately before this date were used as controls. RESULTS: Center A performed 405 intraoperative interface steroids procedures and contributed 405 controls. Center B performed 200 intraoperative interface steroids procedures and contributed 200 controls. Preoperative refraction and postoperative visual acuity were similar in control and intraoperative interface steroids groups. In center A, 5.7% (30% were stage II) and 2% (all only stage I) of controls and intraoperative interface steroid eyes, respectively, developed DLK; intraoperative interface steroids decreased the rate of DLK by 3.0 times (95% confidence interval: 1.3 to 6.8). In center B, 6.5% of controls developed DLK (15% were stage II); with intraoperative interface steroids, only 1 procedure (0.5%) developed DLK. In both centers, no bilateral DLK or DLK beyond stage I were noted when intraoperative interface steroids were used. CONCLUSIONS: Intraoperative interface steroids safely reduced the incidence and severity of DLK. [J Refract Surg. 2009;25:306-311.]

Clostridium perfringens endophthalmitis following perforating eye injury.

A 59-year-old man presented with endophthalmitis, following a perforating eye injury from pulling out a wire that was embedded in the ground. On presentation, his vision was perception of light (PL). Tetanus toxoid was given, and he was commenced on ciprofloxacin. A primary repair was performed. Conjunctival swabs, discharge from wound site and anterior chamber aspirate were sent for culture. The eye was tense and the anterior chamber was full of a gelatinous brown substance which precluded performance of vitrectomy. Intravitreal vancomycin and ceftazidime was given. Hourly topical fortified vancomycin and ceftazidime was given. Postoperatively, the patient's vision remained PL with no evidence of improvement. On day 2, Clostridium perfringens was cultured. The patient was commenced on intravenous benzylpenicillin and clindamycin. Intravitreal clindamycin and vancomycin was administered. The patient was NPL on day 3. There was no evidence of response to treatment and an evisceration was performed on day 6.