Comparison of half-dose photodynamic therapy and 689 nm laser treatment in eyes with chronic central serous chorioretinopathy.

PURPOSE: To compare visual and anatomical outcomes between half-dose photodynamic therapy (hd-PDT) and 689 nm laser therapy (689-LT) in chronic central serous chorioretinopathy (CSC). METHODS: Forty eyes of 40 patients with symptomatic chronic CSC were randomized in a 1:1 ratio to receive either hd-PDT or 689-LT delivering 95 J/cm2 via an intensity application of 805 mW/cm2 over 118 s. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography findings were compared between the two treatment groups. RESULTS: Mean CSC duration was 17.1 ± 6.66 weeks and 18.7 ± 7.46 weeks in the hd-PDT and 689-LT groups respectively. Both groups showed significant BCVA improvements, as well as reductions in central retinal and subfoveal choroidal thickness. Although hd-PDT led to a faster reduction in central retinal thickness, no significant differences were recorded between groups for any other measured parameter at any time point. Complete photoreceptor recovery was observed in eight and seven eyes in the hd-PDT and 689-LT groups respectively. CONCLUSIONS: Both hd-PDT and 689-LT were effective at treating chronic CSC. Further studies are warranted to evaluate long-term safety and efficacy.

REDUCTION OF VITREOUS PROSTAGLANDIN E2 LEVELS AFTER TOPICAL ADMINISTRATION OF INDOMETHACIN 0.5%, BROMFENAC 0.09%, AND NEPAFENAC 0.1.

PURPOSE: To assess vitreous concentrations of nonsteroidal anti-inflammatory drugs (NSAIDs) and prostaglandin E2 (PGE2) in patients treated with NSAIDs before vitrectomy for macular pucker. METHODS: A prospective, investigator-masked, randomized study was performed in 64 patients scheduled to undergo vitrectomy. The patients were randomized 1:1:1:1 to receive indomethacin 0.5%, bromfenac 0.09%, nepafenac 0.1%, or placebo three times a day. NSAIDs and PGE2 levels were evaluated in vitreous samples collected at the beginning of surgery. RESULTS: Mean (SD) vitreous concentrations of the study drugs were 503.13 (241.1) pg/mL for indomethacin, 302.5 (91.03) pg/mL for bromfenac, and 284.38 (128.2) pg/mL for nepafenac. Mean (SD) vitreous PGE2 levels were 247.9 (140.9) pg/mL for indomethacin, 322.12 (228.1) pg/mL for bromfenac, 448.8 (261.1) pg/mL for nepafenac, and 1,133 (323.9) pg/mL for placebo. All three NSAIDs reduced vitreous PGE2 levels to a statistically significant extent, without a significant difference among them. CONCLUSION: All assessed NSAIDs penetrated the vitreous and lowered basal PGE2 levels. A greater penetration was associated with pseudophakic eyes. The important inhibition of prostaglandins in the retina may have a clinical effect on the management of inflammatory retina diseases.

Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

OBJECTIVES: To evaluate the efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE). DESIGN: Case series with chart review. SETTING: Academic tertiary center. PATIENTS: The study included 26 consecutive patients who underwent Endo-DCR for ADLSE between August 2005 and December 2013. MAIN OUTCOME MEASURES: The success of the procedure was defined as complete complaint relief and DCR patency. Data on the time from referral to surgery, postoperative complications, and revision surgery are also reported. RESULTS: The present patient series included 4 males (15.4%) and 22 females (84.6%) (mean age, 66 years). The mean time between referral and surgery was 0.88 days and the mean follow-up time was 29 months. All patients showed immediate relief from symptoms, with no ADLSE recurrences. Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful. The only perioperative complication (3.8%) was epistaxis in a patient who required revision surgery under general anesthesia. The definitive success rate was 96.2% after primary and revision surgery. CONCLUSIONS: Endo-DCR enables rapid resolution of ADLSE with a very high success rate. Immediate surgery may reduce the risk of skin fistulization and/or orbital complications. DCR shrinkage and lacrimal obstruction are unlikely with Endo-DCR since the procedure is performed on an enlarged sac. The main advantage of Endo-DCR, compared with external DCR, is the absence of a skin incision in an inflamed and infected field.

Gonioscopic findings in patients with type 1 neurofibromatosis (Von Recklinghausen disease).

PURPOSE: Based on the known neurocristopathic etiology of type 1 neurofibromatosis (NF1) and the neuroectodermal embryologic derivation of the iridocorneal angle, we examined a sample of young patients affected with NF1 to see if they have evidence of underdevelopment of the angular region. PATIENTS AND METHODS: We designed a case-controlled clinical study. Forty-two consecutive patients (42 eyes), 24 male and 18 female, affected with NF1 were recruited for the study. Forty-two eyes of 42 consecutive young patients (19 male and 23 female) served as a control group for the iridocorneal angle features studied. Indirect gonioscopy was performed by the means of a Goldmann lens. The intraocular pressure was measured with a Goldmann applanation tonometer. Photographs were taken of the anterior segment and of all the four quadrants of the iridocorneal angle to record the presence of abnormalities. The iridocorneal angle was graded according to the classification proposed by Spaeth. Evaluation of the angle also included the gonioscopic width of ciliary body band (CBB). RESULTS: In this study we found that 29 of 42 eyes (69%) of the NF1 group had mild anteriorization, even if within normal limits, of the iris insertion and abundant basal iris processes. The CBB was either invisible (54.84%) or very narrow (21.4%). Three NF1 patients had bilateral juvenile congenital glaucoma. CONCLUSIONS: It seems that patients affected with NF1 often have characteristic gonioscopic findings consistent with underdevelopment of the iridocorneal angle.