Autosomal Recessive Bestrophinopathy: Clinical and Genetic Characteristics of Twenty-Four Cases.

BACKGROUND: To describe ocular manifestations, imaging characteristics, and genetic test results of autosomal recessive bestrophinopathy (ARB). The study design is an observational case series. METHODS: Forty-eight eyes of 24 patients diagnosed with ARB underwent complete ophthalmic examinations including refraction, anterior and posterior segment examination, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography (FA), electroretinography (ERG), and electrooculography (EOG). Optical coherence tomography angiography (OCTA) and BEST1 gene sequencing were performed in selected patients. RESULTS: The age at onset was 4-35 years (mean: 18.6 years). The male-to-female ratio was 0.45. All patients were hyperopic, except one with less than one diopter myopia. EOG was abnormal in 18 cases with near-normal ERGs. Six patients did not undergo EOG due to their young age. Eighteen patients (75%) had a thick choroid on EDI-OCT, of which three had advanced angle-closure glaucoma, 15 patients were hyperopic, and eight of them had more than four diopters hyperopia in both eyes. Macular retinoschisis was observed in 46 eyes of 23 patients (95%) with cysts mostly located in the inner nuclear layer (INL) to the outer nuclear layer (ONL). Of the 18 patients who underwent FA, mild peripheral leakage was seen in eight eyes of four patients (22%). Subfoveal choroidal neovascularization (CNV) was seen in three eyes of two patients (6%) that responded well to intravitreal bevacizumab (IVB). Seven mutations of the bestrophin-1 (BEST1) gene were found in this study; however, only two of them (p.Gly34 = and p.Leu319Pro) had been previously reported as the cause of ARB based on ClinVar and other literature studies. CONCLUSIONS: ARB can be presented with a wide spectrum of ocular abnormalities that may not be easily diagnosed. Pachychoroid can occur alongside retinal schisis and may be the underlying cause of angle-closure glaucoma in ARB. Our study also expands the pathogenic mutation spectrum of the BEST1 gene associated with ARB.

Systemic oxygen therapy versus oral enalapril for treatment of diabetic macular ischemia: a randomized controlled trial.

The purpose of this study was to evaluate the structural and functional effects of systemic oxygen therapy and enalapril in patients with diabetic macular ischemia (DMI). This randomized clinical trial consisted of 105 eyes with DMI divided into three groups. Group I received systemic oxygen by face mask at a flow rate of 10 L/min; Group II received 5 mg enalapril daily; and Group III received placebo tablets for 3 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT) measured by optical coherence tomography (OCT), extent of foveal avascular zone (FAZ) on fluorescein angiograms, and electroretinograms (ERG) were obtained at baseline and after 3 and 6 months. Overall, 102 patients completed the study. Baseline characteristics were not significantly different among groups. Significant improvement in BCVA and decrease in CMT and FAZ occurred at months 3 and 6 in oxygen group compared to deterioration in enalapril and control groups (All P values <0.001). ERG parameters were significantly better in oxygen group compared to enalapril group at months 3 and 6 and better than those in control group at month 3. Normobaric oxygen therapy for 3 months in DMI decreased CMT and FAZ and improved BCVA and ERG parameters. Enalapril did not show any favorable effect.

Electroretinographic changes following retinal reattachment surgery.

PURPOSE: To explore functional visual recovery after retinal reattachment surgery employing full-field electroretinography (ffERG). METHODS: In this case series, scotopic and photopic ffERGs were compared 2 days before, and 1, 3 and 6 months after successful scleral buckling for total rhegmatogenous retinal detachment (RRD). Main outcome measures were changes in ERG a-and b-wave amplitudes postoperatively. RESULTS: Twenty eyes of 20 patients including 14 male and 6 female subjects with mean age of 34.7±8.2 (range, 23 to 50) years were enrolled. Preoperatively, mean a-wave amplitude in the maximal combined response was 27.5±11.7 mV which was increased to 110.7±41.9 (P<0.001), 175.7±53.1 (p<0.001) and 174.6±51.4 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative a-wave amplitude of the cone ERG response was 2.1±0.8 mV, which was increased to 2.2±0.9 (P=0.03), 5.1±1.7 (P<0.001) and 5.3±1.6 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude in the maximal combined response was 97.6±28.9 mV which was increased to 179.2±44.9 (P<0.001), 264.2±56.3 (P<0.001) and 267.8±54.2 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude of the cone ERG response was 2.9±0.9 mV which was increased to 3±0.9 (P=0.32), 9.9±1.9 (P<0.001) and 9.8±1.9 (P<0.001) mV at 1, 3 and 6 months, respectively. CONCLUSION: After retinal reattachment surgery, photoreceptor and visual function show parallel improvement. The scotopic ERG response recovered faster than the photopic response. Incomplete recovery of ERG parameters indicates that photoreceptor cell damage in retinal detachment is not completely reversible.

Intravitreal bevacizumab vs. sham treatment in acute branch retinal vein occlusion with macular edema: results at 3 months (Report 1).

BACKGROUND: The goal of this work is to compare the visual and anatomical (central macular thickness; CMT) outcomes of intravitreal bevacizumab (IVB) injections relative to sham treatment in eyes with acute (less than 3 months in duration) branch retinal vein occlusion (BRVO). METHODS: In a double-masked randomized clinical trial (RCT), patients with acute BRVO were randomly assigned to one of two treatment groups: IVB (two injections of 1.25 mg IVB 6 weeks apart) or sham treatment. Primary outcome measures included changes in best-corrected visual acuity (BCVA) and CMT in optical coherence tomography (OCT) during follow-up (FU) examinations. Any complications secondary to injections were considered secondary outcomes. FU results after 6 and 12 weeks are reported. RESULTS: Eighty-one eyes (43 OD) of 81 patients (47 females) were enrolled in the study. Forty-two patients were enrolled in the IVB group, and 39 patients were enrolled in the sham group. Visual acuity and CMT improved in the IVB group after week 6 (two Snellen lines and 262 µm, respectively) and week 12 (three Snellen lines and 287 µm, respectively). After week 6, visual improvements in the IVB group were significantly increased relative to that of the sham group. However, visual improvements at week 12 were not significantly different between the two groups (1.5 Snellen lines visual improvement in the sham group at week 12). CONCLUSIONS: In acute BRVO, two IVB injections resulted in significant improvement of vision and CMT at 6 weeks relative to the sham group. However, the visual improvements in the IVB group were not significantly different from those in the sham group at 12 weeks. IVB injections accelerate an initial improvement of visual acuity but do not have any significant effects on vision after 12 weeks.

Electroretinogram Changes following Silicone Oil Removal.

PURPOSE: To evaluate electroretinogram (ERG) changes after silicone oil removal. METHODS: Scotopic and photopic ERGs, and best-corrected visual acuity (BCVA) were checked before and shortly after silicone oil removal in eyes that had previously undergone vitrectomy and silicone oil injection for complex retinal detachment. Pre- and postoperative ERG a- and b-wave amplitudes were compared. RESULTS: Twenty-eight eyes of 28 patients including 20 male and 8 female subjects with mean age of 39.3 ± 0.06 (range, 12 to 85) years were studied. Mean interval from primary vitreoretinal surgery to silicone oil removal was 21.04 ± 0.52 (range, 7 to 39) months. Mean duration from silicone oil removal to second ERG was 13.04 ± 1.75 (range, 10 to 16) days. Before silicone oil removal, mean a-wave amplitudes in maximal combined response, rod response and cone response ERGs were 27.4 ± 19.9, 7.2 ± 4.5 and 5.5 ± 3.4 µv, respectively. These values increased to 48.8 ± 31.9, 15.1 ± 14.4 and 17.4 ± 22.2 µv, respectively after silicone oil removal (P < 0.001). Mean b-wave amplitudes in the same order, were 69.41 ± 51, 41.2 ± 30.4 and 25.1 ± 33.9 µv before silicone oil removal, increasing to 165.6 ± 102.5, 81.7 ± 53.7 and 44.7 ± 34.1 µv respectively, after silicone oil removal (P < 0.001). Mean BCVA significantly improved from 1.10 ± 0.34 at baseline to 1.02 ± 0.33 logMAR after silicone oil removal (P < 0.001). CONCLUSION: The amplitudes of ERG a- and b-waves under scotopic and photopic conditions increased significantly shortly after silicone oil removal. An increase in BCVA was also observed. These changes may be explained by the insulating effect of silicone oil on the retina.

Childhood pars planitis; clinical features and outcomes.

PURPOSE: To evaluate the demographic and clinical features of childhood pars planitis, and to determine the therapeutic and visual outcomes of the disease. METHODS: Medical records of pediatric patients (less than 16 years of age at diagnosis) with pars planitis and at least 6 months of follow-up who were referred to Labbafinejad Medical Center, Tehran, Iran over a 22 year period were reviewed. RESULTS: Overall, 117 eyes of 61 patients including 51 (83.6%) male subjects were included. Mean age at the time of diagnosis was 7.8±3.2 (range, 3-16) years. Mean best corrected visual acuity (BCVA) was 0.88±0.76 logMAR at presentation which improved to 0.39±0.51 logMAR at final visit (P<0.001). Endotheliitis was present in 23 (19.6%) eyes and was significantly more prevalent in subjects younger than 9 years (P=0.025). Cataract formation (41.9%) and cystoid macular edema (19.7%) were the most prevalent complications. Univariate regression analysis showed that better baseline visual acuity (OR=0.38, 95%CI 0.21-0.70, P=0.002), age older than 5 years at disease onset (OR=0.36, 95%CI 0.14-0.9, P=0.029), absence of endotheliitis (OR=0.39, 95%CI 0.15-0.99, P=0.047) and female gender (OR=3.77, 95%CI 1.03-13.93, P=0.046) were significantly associated with final BCVA of 20/40 or better. CONCLUSION: Childhood pars planitis was much more common among male subjects. Endotheliitis may be a sign of inflammation spillover and is more prevalent in younger patients. Visual prognosis is favorable in most patients with appropriate treatment.

Outcomes of retinal detachment surgery in eyes with chorioretinal coloboma.

PURPOSE: To report the anatomical and functional outcomes of surgery for retinal detachment associated with chorioretinal colobomas. METHODS: In this retrospective interventional case series, 28 eyes of 28 patients (including 18 male subjects) who had undergone surgery for retinal detachment associated with chorioretinal colobomas were evaluated regarding the type of intervention, final visual acuity and anatomical outcomes, as well as complications. Cases with less than 3 months of follow-up were excluded. RESULTS: Primary surgery included vitrectomy in 25 (89.3%) and scleral buckling in 3 (10.7%) eyes. The internal tamponade used in eyes undergoing vitrectomy was silicone oil in 23 (92%) eyes and 20% sulfur hexafluoride (SF6) in 2 (8%) eyes. Silicone oil was removed in 11 eyes (45.8%). The mean number of operations per eye was 1.57±0.74, mean follow-up was 40±36 months, and the retina remained attached in 26 eyes (92.9%) at final follow-up. Mean preoperative visual acuity was 2.33±0.55 (range, 1.15-2.9) logMAR which significantly improved to 1.72±0.9 (range, 0.09-3.1) logMAR postoperatively (P < 0.001), however, final median visual acuity was counting fingers at 2 m. The most common complications were cataracts (100%) and ocular hypertension (46.4%). CONCLUSION: The most prevalent surgical procedure for treatment of retinal detachment associated with chorioretinal coloboma was pars plana vitrectomy and the most frequently used tamponade was silicone oil. Although anatomical success was satisfactory, functional outcomes were not encouraging which reflects the complexity of the condition and associated abnormalities.

Effect of oral prednisolone on visual outcomes and complications after scleral buckling.

PURPOSE: To evaluate the effect of oral prednisolone on visual outcomes and complications of scleral buckling (SB) in phakic eyes with acute rhegmatogenous retinal detachment (RRD). METHODS: In a randomized double-blind placebo-controlled trial, patients with acute RRD underwent SB. The treatment group received 1 mg/kg oral prednisolone for 10 days while the control group received placebo. Outcome measures included visual acuity (VA), retinal redetachment (re-RD), cystoid macular edema (CME), proliferative vitreoretinopathy (PVR), and other possible postoperative complications. Outcome measures were compared between groups with McNemar test. RESULTS: Overall, 52 eyes of 52 subjects were enrolled into the study, which included 25 and 27 eyes in the treatment and placebo groups, respectively. Preoperatively, the extent and location of RD and rate of hypotony was comparable between the study groups. VA improvement (logMAR) was 0.75+/-0.61 overall: 0.85+/-0.62 in the treatment group versus 0.65+/-0.61 in the placebo group (p=0.36). Postoperative complications in the treatment and placebo groups included choroidal detachment, 3 versus 4 eyes (p=0.45), significant PVR, 1 versus 3 (p=0.33), and CME, 3 versus 5 eyes (p=0.39), respectively. CONCLUSIONS: Postoperative oral prednisolone does not seem to improve the visual outcomes and complications of scleral buckling in simple phakic RRD.

Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema.

PURPOSE: To compare the results of intravitreal bevacizumab (IVB) injection alone or in combination with intravitreal triamcinolone acetonide (IVT) versus macular laser photocoagulation (MPC) as a primary treatment of diabetic macular edema (DME). DESIGN: Randomized 3-arm clinical trial. PARTICIPANTS: A total of 150 eyes of 129 patients with clinically significant DME and no previous treatment. METHODS: The eyes were randomly assigned to 1 of the 3 study arms: the IVB group, patients who received 1.25 mg IVB (50 eyes); the IVB/IVT group, patients who received 1.25 mg of IVB and 2 mg of IVT (50 eyes); and the MPC group, patients who underwent focal or modified grid laser (50 eyes). Retreatment was performed at 12-week intervals whenever indicated. MAIN OUTCOME MEASURES: Change in best-corrected visual acuity (VA) at week 24. RESULTS: VA changes among the groups were statistically significant at 6 (P<0.001) and 24 (P = 0.012) weeks. The significant treatment effect was demonstrated in the IVB group at all follow-up visits and in the IVB/IVT group at 6 and 12 weeks. VA changes +/- standard deviation at 36 weeks were -0.28+/-0.25, -0.04+/-0.33, and +0.01+/-0.27 logarithm of minimum angle of resolution in the IVB, IVB/IVT, and MPC groups, respectively (P = 0.053). Significant central macular thickness (CMT) reduction was observed in all groups only up to 6 weeks; however, CMT changes were not significant among the groups in all visits. Overall, retreatment was required for 27 eyes up to 36 weeks (14 in the IVB group, 10 in the IVB/IVT group, and 3 in the MPC group). In the IVB group, in which a greater VA improvement was observed, only 1 injection was required in 72% of the cases. VA improvement >2 Snellen lines at 36 weeks was detected in 37%, 25%, and 14.8% of patients in the IVB, IVB/IVT, and MPC groups, respectively. CONCLUSIONS: Intravitreal bevacizumab injection in patients with DME yielded a better visual outcome at 24 weeks compared with macular photocoagulation. A change in CMT beyond the 6-week time point that corresponded to the vision change was not detected. No adjunctive effect of IVT was demonstrated. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Clinical features and surgical outcomes of pediatric rhegmatogenous retinal detachment.

PURPOSE: To evaluate the clinical features and functional and anatomical outcomes after surgical intervention in pediatric rhegmatogenous retinal detachment. METHODS: In this retrospective case series, pediatric patients with rhegmatogenous retinal detachment who had surgical intervention were included. Cases were categorized into five main etiology groups: congenital or developmental (48 eyes); trauma (54 eyes); myopia alone (12 eyes); previous intraocular surgery (10 eyes); and miscellaneous (3 eyes). Patients' demographic, clinical, and surgical outcomes, as well as fellow eye findings were evaluated. RESULTS: One hundred twenty-seven eyes of 108 patients (mean age: 12.1 +/- 4.1 year, 80.6% male) were included. Scleral buckling was the initial procedure in 31% of eyes and vitrectomy in 63%. Mean follow-up was 34 +/- 21 months (median 33 months). Retinal reattachment at last follow-up was achieved in 74.9% of eyes. Visual acuity was >/=20/200 in 14% of eyes preoperatively and in 47.9% of eyes at final follow-up (P = 0.001). Retinal pathologies (mostly lattice degeneration) were noted in 82.2% of fellow eyes. CONCLUSION: Trauma and congenital-developmental anomalies were the leading etiologies in pediatric rhegmatogenous retinal detachment in this review. Despite the complexity of rhegmatogenous retinal detachment and presence of vision-threatening anomalies, anatomic and functional outcomes were acceptable. Regular ophthalmoscopy of the sound eye is recommended for children at risk.

Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy.

BACKGROUND: Vitreous concentration of vascular endothelial growth factor (VEGF) rises significantly during proliferative diabetic retinopathy (PDR). Bevacizumab (Avastin) is a humanized monoclonal antibody to VEGF. Intravitreal administration of bevacizumab (IVB) has recently been shown to be effective in some ocular neovascularizations, including PDR. In this study we evaluate the efficacy of IVB in eyes with active, progressive PDR. METHODS: In an interventional prospective case series, eyes with active, progressive PDR underwent one to three IVB injections (1.25 mg) at intervals of either 6 or 12 weeks. Complete ophthalmic examinations and color fundus photography were performed at baseline and 1, 6, 12, and 20 weeks after the first injection. Fluorescein angiography (FA) was performed before injection and 20 weeks after. The primary outcome measures were clearing of vitreous hemorrhage (VH) and regression of active fibrovascular tissue (FVT). The secondary outcomes were any change in best-corrected visual acuity (BCVA) and any incidence of adverse events. RESULTS: Thirty eight eyes of 38 patients with a mean age of 54.7 +/- 10.1 years were included in the study. VH resolved significantly after 1 week (P = 0.014), 12 weeks (P = 0.0001), and 20 weeks (P = 0.002). The vascular component of FVT regressed, though the FVT area did not change. Mean BCVA improved significantly compared to baseline at all follow-up examinations. Two cases showing moderate fibrous proliferation developed traction retinal detachment (TRD). CONCLUSIONS: IVB has significant therapeutic effect on eyes with active, progressive PDR: the treatment causes a significant amount of VH resolution and neovessel regression. At the same time, this procedure may increase the risk of TRD in eyes with fibrous proliferation.

Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled, randomized clinical trial.

PURPOSE: To evaluate the effect of three intravitreal injections of bevacizumab (IVB) alone or combined with triamcinolone (IVT) in the first injection for treatment of refractory diabetic macular edema (DME). METHODS: In this prospective, placebo-controlled, randomized clinical trial, 115 eyes of 101 patients with refractory DME were included. Subjects were randomly assigned to one of the three study arms: 1) three injections of IVB (1.25 mg/0.05 ml) at 6-week intervals, 2) combined IVB and IVT (1.25 mg/0.05 ml and 2 mg/0.05 ml respectively) followed by two injections of IVB at 6-week intervals, and 3) sham injection (control group). The primary outcome measure was change in central macular thickness (CMT). Secondary outcome measures were change in best-corrected logMAR visual acuity (BCVA ) and incidence of potential adverse events. RESULTS: Central macular thickness was reduced significantly in both the IVB and IVB/IVT groups. At week 24, CMT change compared to the baseline was -95.7 microm (95% CI, -172.2 to -19.26) in the IVB group, -92.1 microm (95% CI, -154.4 to -29.7) in the IVB/IVT group, and 34.9 microm (95% CI, 7.9 to 61.9) in the control group. There was a significant difference between the IVB and control groups (P = 0.012) and between the IVB/IVT and control groups (P = 0.022). Improvement of BCVA was initiated at weeks 6 and 12 in the IVB/IVT and IVB groups respectively. In terms of BCVA change compared to the baseline at 24 weeks, the differences between the IVB and control groups (P = 0.01) and also between the IVB/IVT and control groups (P = 0.006) were significant. No significant differences were detected in the changes of CMT and BCVA between the IVB and IVB/IVT groups (P = 0.99). Anterior chamber reaction was noticed in eight (19.5%) and seven (18.9%) eyes respectively in the IVB and IVB/IVT groups the day after injection, and it resolved with no sequel. Elevation of IOP occurred in three eyes (8.1%) in the IVB/IVT group. CONCLUSION: Three consecutive intravitreal injections of bevacizumab had a beneficial effect on refractory DME in terms of CMT reduction and BCVA improvement. Addition of triamcinolone in the first injection seemed to induce earlier visual improvement; however, it did not show any significant additive effect later during follow-up.

Intravitreal bevacizumab (avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment of diabetic macular edema.

PURPOSE: To report the efficacy of a single intravitreal bevacizumab injection alone or in combination with intravitreal triamcinolone acetonide versus macular laser photocoagulation (MPC) as primary treatment of diabetic macular edema (DME). METHODS: In this randomized, three-arm clinical trial, 103 eyes of 97 patients with clinically significant DME and no previous treatment were enrolled. The eyes were randomly assigned to one of three study arms: the intravitreal bevacizumab (IVB) group, patients who received 1.25 mg of intravitreal bevacizumab (37 eyes); the IVB/IVT group, patients who received 1.25 mg of intravitreal bevacizumab and 2 mg of intravitreal triamcinolone (33 eyes); and the MPC group, patients who underwent focal or modified grid laser (33 eyes). Primary outcome measure was change in visual acuity. RESULTS: Visual acuity changes +/- SD at 12 weeks were -0.22 +/- 0.23, -0.13 +/- 0.31, and + 0.08 +/- 0.31 logarithm of the minimal angle of resolution in the IVB, IVB/IVT, and MPC groups, respectively. The marginal regression model based on generalized estimating equation analysis demonstrated that the visual acuity changes in the groups were statistically significant at both 6 weeks (P < 0.0001) and 12 weeks (P = 0.024). The significant treatment effect was demonstrated at both 6 weeks and 12 weeks in the IVB group and only at 6 weeks in the IVB/IVT group. Significant central macular thickness (CMT) reduction was observed in eyes in the IVB and IVB/IVT groups only up to 6 weeks; however, CMT changes were not significant in the groups. CONCLUSION: Up to 12 weeks, intravitreal bevacizumab treatment of patients with DME yielded better visual outcome than laser photocoagulation, although it was not associated with a significant decrease in CMT. No further beneficial effect of intravitreal triamcinolone could be demonstrated. Further clinical trials with longer follow-up are required to evaluate the long-term visual outcomes and complication profiles after primary treatment with such medications.

Single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone for neovascular age-related macular degeneration.

BACKGROUND: To evaluate the efficacy of triple therapy consisting of single-session photodynamic therapy (PDT), intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVT) as initial pulse therapy followed by repeat intravitreal bevacizumab injections for maintenance treatment in neovascular age-related macular degeneration (AMD). METHODS: In a prospective interventional case series, patients with subfoveal choroidal neovascularization (CNV) secondary to AMD underwent pulse therapy with single-session PDT according to the standard protocol followed by 1.25 mg IVB and 2 mg IVT 48 hours later. Best corrected visual acuity (BCVA) was assessed and optical coherence tomography (OCT) and fluorescein angiography (FA) were performed prior to treatment. BCVA and OCT measurements were repeated at 6 week intervals and FA was obtained after 12 weeks and when necessary thereafter. Repeat injections of IVB were performed based on fluorescein angiographic evidence of CNV leakage. RESULTS: This series included 17 eyes of 17 patients with mean age of 67.6 +/- 7.2 years. Mean follow up duration was 50.4 +/- 15.5 weeks. Mean BCVA prior to treatment was 0.74 +/- 0.33 logMAR which improved to 0.52 +/- 0.36 logMAR after 12 weeks (P = 0.012) and 0.41 +/- 0.38 logMAR after 24 weeks (P = 0.001). Mean pretreatment central macular thickness (CMT) was 395 +/- 181 micro which was significantly reduced to 217 +/- 69 micro (P = 0.005), 231 +/- 79 micro (P = 0.028) and 221 +/- 87 micro (P = 0.05) six, twelve and twenty-four weeks after initial treatment respectively. Visual acuity improvement and CMT reduction was maintained during the follow-up period. IVB injections were repeated once, twice and three times in 10, 7 and 2 eyes at a mean interval of 20.2 +/- 10.1, 19 +/- 13.7 and 15 +/- 1.4 weeks after initial therapy, respectively. CONCLUSION: Initial pulse triple therapy consisting of single-session PDT combined with IVB and IVT improves vision and reduces CMT in neovascular AMD. Repeat IVB injections maintain the visual gain from the initial combination therapy.

Surgical management of retinal detachment in highly myopic eyes with macular hole.

BACKGROUND AND OBJECTIVES: To evaluate the visual and anatomical outcomes of surgery for retinal detachment due to macular hole in highly myopic eyes with pronounced posterior staphyloma. PATIENTS AND METHODS: Data for all patients with high myopia who underwent surgery for retinal detachment resulting from macular hole from 1993 to 2002 in one hospital were evaluated. Patient characteristics, best-corrected visual acuity preoperatively and at last examination, surgical technique, anatomical success, and follow-up period were extracted and analyzed statistically. RESULTS: Twenty-six of the 27 patients (28 eyes) were female (96%) with a mean age of 59.8 years; mean follow-up was 17.3 months. Mean axial length was 29.1+/-2.74 mm; mean myopia was -16.4 +/- 3.1 diopters. Marked posterior staphyloma was detected in 71%. Seven eyes had undergone failed scleral buckling as the primary procedure; intravitreal SF6 injection was the primary procedure in 12 eyes. Twenty-three eyes underwent deep vitrectomy with use of high viscosity silicone oil. Overall anatomical success was achieved in 92.9% (26 of 28 eyes); 78.6% had visual improvement. CONCLUSIONS: Vitreous surgery combined with other necessary adjunct procedures such as membrane peeling and use of retinal tamponade, as a primary or a secondary procedure, seems to be successful in achieving retinal reattachment in eyes with macular hole and posterior staphyloma.

Surgical management of non-metallic and non-magnetic metallic intraocular foreign bodies.

BACKGROUND AND OBJECTIVE: To identify clinical features and evaluate outcomes of vitreoretinal surgery in eyes with retained non-metallic and non-magnetic metallic intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: Retrospective chart review. Thirty-two eyes (28 patients) with non-metallic and non-magnetic metallic IOFBs underwent removal of IOFBs with intraocular forceps, either via the pars plana in 30 eyes (93.9%) or a limbal approach in 2 eyes (6.25%). The main outcome measures were postoperative visual acuity, rate of retinal break formation, development of retinal detachment, and type of IOFB. RESULTS: IOFBs were non-metallic in 22 eyes (68.7%) and non-magnetic metallic in 10 eyes (31.1%). The average follow-up period was 7.5 months. Overall, final visual acuity was 20/40 or better in 10 eyes (31.1%) and 5/200 to 20/50 in 10 eyes (31.1%). A higher incidence of retinal break formation posterior to the sclerotomy was seen with glass IOFBs (P = .02). Retinal detachment was observed preoperatively in 4 eyes (12.5%) and postoperatively in 2 eyes (6.25%). CONCLUSION: Final visual outcome was independent of size and type of IOFB. Pars plana extractions may be associated with a higher rate of retinal break formation and subsequent retinal detachment, particularly with glass IOFBs.

Management of magnetic intravitreal foreign bodies in 71 eyes.

BACKGROUND AND OBJECTIVE: To evaluate the management of a series of eyes with magnetic intravitreal foreign bodies. PATIENTS AND METHODS: This retrospective review examined consecutive cases of ocular injury associated with intraocular foreign bodies; 71 eyes included had a single metallic intraocular foreign body (< 5 mm) located in the vitreous cavity removed by external magnet or intraocular forceps. Variables included preoperative and postoperative visual acuity, retinal break formation, retinal detachment, presence of an afferent pupillary defect, intraocular pressure, entrance site, foreign body size, method of extraction, and time between occurrence and surgical extraction. RESULTS: Factors predictive of good visual outcome (visual acuity > 20/200) were: shortest interval between trauma and foreign body extraction, preoperative visual acuity of 20/200 or better, and absence of afferent pupillary defect. CONCLUSIONS: In this nonrandomized study, good visual results could be obtained in eyes undergoing prompt foreign body removal, especially those with good preoperative visual acuity and no afferent pupillary defect.

Surgical management of retinal detachment secondary to acute retinal necrosis: clinical features, surgical techniques, and long-term results.

PURPOSE: To describe the clinical features of complicated retinal detachment secondary to acute retinal necrosis (ARN) and to present the long-term results of vitreous surgery in these cases. METHODS: A retrospective study was conducted on 16 immunocompetent patients (18 eyes). The average follow-up period was 60 months. RESULTS: Proliferative vitreoretinopathy (PVR) grade C, with the predominance of anterior PVR, and characteristic changes in the vitreous base area were present in all cases before surgery. All eyes underwent vitrectomy, membrane peeling, endolaser photocoagulation, and intraocular tamponade without scleral buckling. Additional procedures were performed in 13 eyes. Retinal reattachment was achieved in the 18 eyes (100%) in the short term. Variable degrees of reproliferation occurred in all cases after surgery. Other delayed complications included ocular hypotony, macular pucker, peripheral retinal neovascularization, and severe preretinal fibrosis. Improvement of visual acuity occurred in 13 eyes (72.2%). Eleven eyes (61.1%) achieved final ambulatory visual acuity of 5/200 or better. CONCLUSIONS: Rhegmatogenous retinal detachment secondary to ARN has characteristic clinical features. Severe proliferative vitreoretinopathy with the predominance of anterior PVR develops rapidly. Reproliferation is the most important late postvitrectomy complication necessitating multiple surgical procedures in these cases. The visual results remain unfavorable due to the destructive nature of ARN.