Inhibition of choroidal osteoma progression using bisphosphonate and RANKL-inhibitory treatment.

Purpose: To describe the use of anti-osteoclastic medications (i.e., bisphosphonates and receptor activator of nuclear factor kappa beta (RANK) ligand inhibitors) in treating choroidal osteoma. Methods: A 42-year-old male with bilateral posterior choroidal osteomas showed extensive outer retinal atrophy in the right eye secondary to decalcification of a choroidal osteoma and progressive extension of retinal pigment epithelial atrophy in the left eye encroaching on the macula with subtle changes in the choroidal osteoma. Bisphosphonates (i.e., oral alendronate 70 mg weekly) or RANK ligand inhibitors (i.e., subcutaneous denosumab 60 mg every six months) were initiated to prevent calcium resorption. Results: After the introduction of more directed therapy, there was stabilization of the patient's condition over the next nine years while under bisphosphonate treatment, followed by a switch to RANK ligand inhibitor therapy and later bisphosphonate treatment again. This was made evident through stability in fundus photography, enhanced depth imaging optical coherence tomography, and B-scan ultrasonography regarding outer retinal layers thickness, and choroidal osteoma thickness and calcification. Conclusion: Anti-osteoclastic therapy using bisphosphonates or RANK ligand inhibitors could be a new treatment paradigm to prevent resorption of choroidal osteomas and prevent the subsequent atrophy of outer retinal layers. Summary statement: A patient with bilateral posterior choroidal osteomas was treated with bisphosphonates and RANK ligand inhibitors to prevent osteoma resorption in the better-seeing left eye. This has led to stability over six years of outer retinal layers thickness, choroidal osteoma thickness, and choroidal osteoma calcification.

Occult cause of uveitis-glaucoma-hyphema syndrome diagnosed during treatment with endocyclophotocoagulation (ECP).

Purpose: To describe uveitis-glaucoma-hyphema (UGH) syndrome secondary to a posterior chamber intraocular lens (PCIOL) within the capsular bag in which pathogenic changes to the ciliary body were observed and treated with endocyclophotocoagulation (ECP). Observations: An 85-year-old woman who had cataract surgery in her right eye four years ago presented with recurrent, unilateral, open-angle, hypertensive uveitis in her right eye. Her presentations were characterized by decreased vision, elevated intraocular pressure, corneal edema, a mixed anterior chamber reaction, and pigmented anterior vitreous cells. She had a frank vitreous hemorrhage during two episodes. Ultrasound biomicroscopy revealed a dense Soemmerring ring in her right eye without evidence of PCIOL-iris or PCIOL-ciliary body chafe. Subsequent ECP revealed whitened and atrophic ciliary processes adjacent to a tilted haptic within the capsular bag, consistent with chronic PCIOL-ciliary body chafe. ECP was applied to the affected ciliary processes, which successfully eliminated recurrences. Conclusions and importance: UGH can rarely occur due to an PCIOL within the capsular bag. In cases where ultrasound biomicroscopy (UBM) does not show abnormalities and clinical suspicion remains high, ECP can be a useful adjunct to observe and treat abnormalities of the ciliary body.

Ocular Gossypiboma: Ultrasound B-Scan Assessment of Retained Surgical Sponge After Ahmed Valve Surgery: A Case Report.

PURPOSE OF THE STUDY: To present the first documented case of an ocular gossypiboma (retained foreign body) of a mitomycin-C-soaked sponge confirmed echographically using diagnostic ultrasound B-scan after Ahmed valve surgery. PATIENTS AND METHODS: A patient who underwent phacoemulsification with Ahmed valve implantation surgery had a retained Weck-Cels sponge soaked with mitomycin-C. With the use of ocular ultrasound B-scan, the retained sponge was localized and a second procedure was performed to explant it. CONCLUSION: In cases of ocular gossypiboma the use of ultrasound modalities can be a valuable tool especially because B-scan access is common and can be cost-effective.

Endoscopic Cycloplasty (ECPL) and Lens Extraction in the Treatment of Severe Plateau Iris Syndrome.

PURPOSE: To describe the anatomic and clinical results of the treatment of severe plateau iris syndrome with lens extraction and endoscopic cycloplasty (ECPL). A secondary aim was to describe 4 novel ultrasound biomicroscopy (UBM) measurements for plateau iris syndrome. DESIGN: Prospective case series with UBM evaluation. METHODS: Included were 12 eyes of 6 patients with plateau iris refractory to laser iridotomy and iridoplasty, miotic and other glaucoma medical treatment, with appositional angle closure in at least 3 quadrants. Treatment consisted of lens extraction and ECPL, an endoscopic diode laser treatment of the ciliary processes in the superior, nasal, and inferior quadrants. UBM measurements were taken in all quadrants before and after surgery. The untreated temporal quadrants were used as controls. Measurement parameters included: anterior chamber depth (ACD), angle opening distance (AOD 500), trabecular ciliary process distance (TCPD), iris ciliary process distance (ICPD), iris depth (ID), iridocorneal angle (ICA), and sulcus angle (SA). Four novel measurements included: ciliary process thickness (CPT), ciliary process width (CPW), ciliary process area (CPA), and iris ciliary process contact length (ICPCL). Visual acuity, intraocular pressure, glaucoma medications, and complications were also followed. RESULTS: The ACD, AOD 500, and ICA all increased significantly (P<0.001). ICPD, CPT, CPW, CPA, and ICPL all decreased significantly (P<0.01). Parameters remaining unchanged were: TCPD, ID, and SA. The untreated quadrants showed similar measurements to the preoperative measurements. There were no serious complications noted. DISCUSSION: Treating the ciliary processes with diode laser using an endoscopic approach (ECPL) and lens extraction, results in opening of the anterior chamber angle and shrinkage of the ciliary processes in the treated areas. This effect seems to be primarily a result of the laser treatment in combination rather than the lens extraction alone. This effectively reverses the anatomic cause and angle closure of plateau iris syndrome.

The role of macrophages in the removal of apoptotic B-cells in the sheep ileal Peyer's patch.

In the process of generating the cells that populate the sheep's B-cell pool, the ileal Peyer's patch (PP) produces an immense number of B-cells and then destroys most of them by apoptosis. Rapid clearance of these apoptotic cells is essential for tissue homeostasis and for preventing pathology. Macrophages comprise a small percentage of cells in the follicles. They resemble macrophages found in other tissues and can be identified by the expression of MHC Class II and CD14. In this study, enriched macrophages co-cultured with apoptotic ileal PP cells showed increased DNA content as they ingested apoptotic cells. The higher the proportion of apoptotic cells in culture the greater the increase in DNA content of the macrophages. This occurred when B-cell apoptosis was initiated by a period in culture or in response to treating the animals with steroids. Thus, macrophages resident in the ileal PP follicle mediate the phagocytosis and removal of discarded B-cells.