Conjunctival Pigmentation at the Sclerotomy Site following 23 G Vitrectomy with Silicone Oil Injection.

54-year-old gentleman undergoing 23 Gauge vitrectomy with silicone oil injection developing conjunctival pigmentation at one of the entry sites of trocar and cannula 1 week postoperative. The conjunctival tissue was biopsied at the time of silicone oil removal and correlated histopathological. Biopsy of the conjunctival tissue showed intracellular and stromal melanin pigments. This report highlights conjunctival pigmentation in suture less entry site and silicone oil as intraocular tamponade than earlier published reports of with or without intraocular gas tamponade.

Cost analysis of vitrectomy under local versus general anesthesia in a developing country.

PURPOSE: To report cost reductions of vitrectomy under local anesthesia. PATIENTS AND METHODS: This was a retrospective cohort study using medical records of consecutive patients undergoing vitrectomy surgery for retinal detachment under general or local anesthesia. Data of patient's fulfilling the inclusion criteria were included in the study. The patients were divided into two groups: Group 1 (local anesthesia) and Group 2 (general anesthesia). The preoperative data were checked and validated by a peer group consisting of two ophthalmologists, two internists, and two anesthesiologists independently in a blind manner. The calculation of the cost was done using the cost minimization analysis. The cost data were obtained from the finance division of the hospital for each individual treatment. The cost data included unit cost of laboratory tests, surgery, and medications. RESULT: There were 100 subjects (50 subjects in each group) assessed by peer groups and declared eligible to undergo surgery under either local or general anesthesia. Both groups were equal. The total average cost for vitreous surgery under general anesthesia for each patient was $322.17, whereas for local anesthesia it was $220.57. The mean difference was $101.60 (46.06%) saving on local anesthesia. CONCLUSION: Vitrectomy surgery under local anesthesia can reduce the cost by almost half that of general anesthesia. The present study showed that the type of anesthesia determined the ultimate cost for the surgery. Hence, surgery under local anesthesia appears affordable and cost-effective, especially in a developing country like Indonesia.

Favorable outcome after choroidal drainage for postoperative kissing suprachoroidal hemorrhage following trabeculectomy in a high myopic vitrectomised eye.

A 39-year-old lady with past history of vitreoretinal surgery for retinal detachment and cataract surgery with Intraocular lens implantation was diagnosed as uncontrolled glaucoma. She had high myopia. She underwent Trabeculectomy and following which she presented with massive suprachoroidal hemorrhage in the first postoperative day with severe loss of vision. This case depicts the risk of suprachoroidal hemorrhage in a high myopic vitrectomised eye following glaucoma filtration surgery. It also demonstrates a favorable outcome following intervention for postoperative Suprachoroidal hemorrhage. At present, there is no evidence in literature of such event in a high myopic Vitrectomised eye following Trabeculectomy.

Multiple extrafoveal macular holes following internal limiting membrane peeling.

OBJECTIVE: Internal limiting membrane (ILM) peeling has been the standard of treatment for macular holes. Besides, causing retinal nerve fiber layer surface abnormality, postoperative extrafoveal multiple retinal holes is a rare phenomenon following ILM peeling. We report an unusual complication of eight extrafoveal macular holes occurring following ILM peeling. CASE PRESENTATION: A 60-year-old male presented with complaints of decreased and distorted vision in the right eye. He was diagnosed as having epiretinal membrane with lamellar macular hole. He underwent 23G pars plana vitrectomy, brilliant blue assisted ILM peeling and fluid gas exchange. Intraoperatively, ILM was found to be adherent to the underlying neurosensory retina. One month after cataract surgery, he underwent YAG capsulotomy in the right eye. He complained of visual distortion. His fundus evaluation in the right eye showed multiple (eight) extrafoveal retinal holes temporal to the macula clustered together. CONCLUSION: This case demonstrated that peeling of ILM, especially when it is adherent to the underlying neurosensory retina, may cause unwanted mechanical trauma to the inner retina. Glial apoptosis and neuronal degeneration may presumably play a role in delayed appearance of multiple (eight) extrafoveal macular holes, which has not been reported earlier.

Volcano like pattern in optical coherence tomography in chronic diabetic macular edema.

In this article we herein report an interesting vitreo-macular interface abnormality associated with chronic diabetic cystoid macular edema. It is an observational case study of three diabetic patients examined in the diabetic clinic. All the patients had proliferative diabetic retinopathy with chronic macular edema. A serial cross sectional OCT examination and tracking of both the longitudinal progression of macular thickening and vitreo-macular interface revealed cystoid macular edema with a characteristic hyperreflective vitreous shadow emerging from the vitreofoveal interface. All the patients had dehiscence of inner retinal layers. This particular morphological feature at the vitreo-foveolar interface, which we name as "volcano sign", has not been described earlier. The probable mechanism of such a finding probably could be due to slow progressive leakage of chronic cytoid fluid into the vitreous with condensation of the overlying vitreous. Vitreo-macular traction followed by posterior vitreous detachment probably would have contributed to such a morphological event.

Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment.

To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG-assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE.

The future implications and indications of anti-vascular endothelial growth factor therapy in ophthalmic practice.

In the last few years anti-vascular endothelial growth factor (VEGF) therapy has changed the paradigm in the treatment of neovascular age-related macular degeneration (ARMD). Besides, its potential use in the treatment of diabetic retinopathy and other possible proliferative vascular disorders has also shown promise. Clinical trial results have shown tremendous beneficial effect of ranibizumab in ARMD. Off-label use of bevacizumab has also shown similar benefit but long-term and clinical trial results do not exist. Some of the potential questions in the use of anti-VEGF are recurring cost, possible long-term effect on physiological function of VEGF and determination of endpoint of treatment. Overall, the use of anti-VEGF therapy in ocular angiogenesis has proven to be beneficial at least now.

Optical coherence tomographic evaluation of macular infarction following dapsone overdose.

A 16-year-old girl had decrease in vision following dapsone overdose. This case demonstrated optical coherence tomography (OCT) evaluation of macular infarction following dapsone poisoning. OCT showed characteristic serial changes as Stage 1: Cystic macular edema, Stage 2: Resolving cystic change and Stage 3: Foveal atrophy. Hence, OCT could show the progression of foveal atrophy from cystic macular edema following dapsone poisoning.

Ultrasonographic characteristics and treatment outcomes of surgery for vitreous hemorrhage in idiopathic polypoidal choroidal vasculopathy.

PURPOSE: To describe the ultrasonographic characteristics and treatment outcomes of surgery in vitreous hemorrhage (VH) associated with idiopathic polypoidal choroidal vasculopathy (IPCV). DESIGN: Retrospective interventional and observational case series. METHODS: Clinical, ultrasound, and surgical data of 10 consecutive patients operated for VH due to IPCV in a tertiary eye institute was studied by chart review. Data were analyzed to determine the clinical features, ultrasonographic characteristics, and surgical outcomes. An additional five patients with IPCV without VH were evaluated by ultrasound in various stages of the disease. RESULTS: Between January 1998 and March 2005, 10 eyes of 10 patients underwent vitreous surgery for VH associated with IPCV. Characteristic ultrasonographic features that helped the diagnosis preoperatively included focal choroidal thickening without excavation or acoustic hollowing with associated low reflective echoes of dispersed VH, or diffuse choroidal thickening and low-intensity echoes of dispersed hemorrhage on either side of the retinal spike, often without vitreous detachment spike. Oral corticosteroids were provided preoperatively to patients with associated exudative retinal detachment. Indocyanine green angiography (ICGA) confirmed IPCV postoperatively. Focal lesions were treated with laser photocoagulation. Anatomical success was seen in nine of 10 eyes. Visual acuity improved in five of 10 eyes but was limited by macular pathology in other five eyes. The most common complication was iatrogenic tears. Some eyes had recurrent IPCV lesions in follow-up. CONCLUSIONS: Characteristic ultrasonographic features could identify IPCV in eyes with VH. Anatomical and visual outcomes of our management approach were encouraging and need further study.

Persistent choroidal thickening despite photodynamic therapy for circumscribed choroidal hemangioma.

A 19-year-old man presented with blurred vision in the right eye, which was diagnosed as a circumscribed choroidal hemangioma. The choroidal thickening on B-scan ultrasonography persisted after receiving repeat photodynamic therapy with verteporfin, although there was regression of the tumor.

Role of photodynamic therapy in polypoidal choroidal vasculopathy.

PURPOSE: To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. MATERIALS AND METHODS: We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. RESULTS: Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. CONCLUSION: PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.

Comparison of mean macular thickness using optical coherence tomography and visual acuity in diabetic retinopathy.

BACKGROUND: The purpose of the present study was to quantitatively assess the mean macular thickness in diabetic patients using optical coherence tomography and its correlation with visual acuity. METHODS: A prospective case series study was undertaken of consecutive diabetic patients referred to a tertiary eye care centre for an eye check up from January 2003 to June 2003. One hundred and five eyes from 55 patients with varying degree of diabetes underwent optical coherence tomography examination. The study patients were divided into four groups: group I, non-proliferative diabetic retinopathy (NPDR); group II, NPDR with clinically significant macular oedema (CSME); group III, proliferative diabetic retinopathy (PDR); and group IV, PDR with CSME. RESULTS: The mean macular thickness of the entire group was 256.0 +/- 129.7 microm. A positive correlation (r = 0.424, P < 0.0001) was evident between mean macular thickness and visual acuity. CONCLUSION: Optical coherence tomography is a useful tool for objectively monitoring macular thickness in patients with diabetic retinopathy. Mean macular thickness correlates with visual acuity.

Retinal detachment in south India-presentation and treatment outcomes.

BACKGROUND: Although the presentation and treatment outcomes of retinal detachments in wealthy countries are well known, much less is known about retinal detachment in the developing world. This study reports the presentation and outcomes of 433 rhegmatogenous retinal detachments in South India. METHODS: Retrospective analysis was undertaken of all operated cases of retinal detachment in a tertiary care centre, from 1 January 2000 to 31 December 2000. RESULTS: Retinal detachments were treated in 433 eyes of 417 patients; 67 (16.1%) patients were children below 16 years and 60 (14.4%) patients were blind (visual acuity <6/60). The duration of symptoms was over 1 month in 192 (46.6%) eyes and, in 376 (86.8%), the macula was detached at presentation. Referral diagnosis was incorrect in 69 (22.4%) eyes. Cataract surgery was the predisposing factor in 152 (35.1%) eyes. Primary surgery included pars plana vitrectomy procedures in 235 eyes (53.9%) and scleral buckling in 197 (45.8%). The retina was re-attached with one operation in 281 eyes (71%) and with one or more operations in 333 (87%). Visual acuity of 6/60 or better was achieved in 260 (67.7%) eyes. CONCLUSIONS: The profile of retinal detachments in a tertiary eye care centre in south India includes many paediatric cases, late presentations and macula-off detachments, commonly related to cataract surgery. Despite complex pathology, two thirds of eyes regain useful vision after one or more surgical interventions.

Optical coherence tomographic evaluation of foveal pseudocyst in the formation of macular hole.

Optical coherence tomographic documented progression of foveal pseudocyst in a vitrectomised eye to full thickness macular hole is reported. Muller cell alteration and other centrifugal forces are possible pathomechanisms.