Intravitreal alemtuzumab penetrates full-thickness retina in rabbit eyes.

PURPOSE: The purpose of this study was to assess whether alemtuzamab, a large antibody of 150 kDa, would be able to penetrate through the full-thickness retina of Dutch-belted rabbits. METHODS: Four Dutch-belted rabbits had intravitreal injections of alemtuzumab (1.5 mg in 0.05 mL). One rabbit each was killed at Day 1, Day 8, Day 15, and Day 29. The eyes were examined under frozen section and graded by immunostaining techniques for the degree of penetration of alemtuzumab into the retina. The degree of retinal staining was graded from 0 (no stain) to 4+ (marked stain). RESULTS: All study eyes showed antibody staining of the full-thickness retina as follows: 4+ at Day 1, 4+ at Day 8, 3+ at Day 15, and 2+ at Day 29. CONCLUSION: A 1.5-mg intravitreal dose of alemtuzumab was able to penetrate full-thickness retina throughout the full 29-day course of the study. Retinal toxicity studies are required before clinical use.

The safety of intraocular methotrexate in silicone-filled eyes.

BACKGROUND: Intraocular methotrexate has been safely used in eyes with primary CNS lymphoma (PCNSL), and in eyes with uveitis and proliferative diabetic retinopathy. Dosing in silicone-filled eyes was reduced from a standard 400 microg intravitreal injection due to concerns of toxicity. The present study reports the visual results of non-PCNSL, silicone-filled eyes treated with intravitreal methotrexate using cumulative dosages ranging from 200 microg to 1,200 microg. METHOD: In this retrospective case series, all patients with silicone-filled eyes who received intraocular methotrexate were included. Patients were observed with serial ophthalmic examinations. Best-corrected visual acuity was measured by Snellen acuity. Pretreatment acuities were compared to those obtained at last follow-up. RESULTS: The cohort included 12 patients (13 eyes) with disease other than PCNSL. The cumulative dose of intraocular methotrexate in any one patient ranged from 200 microg to 1,200 microg. Mean follow-up was 9 months (median, 10 months; range, 2 weeks to 16 months). Best-corrected vision at last follow-up was either stable or improved from pretreatment acuity in 12 of 13 eyes. CONCLUSION: Preservation of acuity in 12 of 13 study eyes suggests that intravitreal methotrexate in a cumulative dose of up to 1,200 microg is safe in silicone-filled eyes.

Intraocular methotrexate in ocular diseases other than primary central nervous system lymphoma.

PURPOSE: To investigate whether intravitreal methotrexate could be safely administered and improve vision in patients with ocular disease other than primary central nervous system lymphoma (PCNSL). DESIGN: A retrospective, small-case series. METHODS: Patients with various clinical conditions were treated with intravitreal methotrexate (cumulative dose < or =400 microg). Visual acuity and clinical examination were recorded to assess the safety and efficacy of the injection. RESULTS: Of 16 study eyes, final visual acuity was improved in seven, remained stable in five, and decreased in four. There was no observed toxicity attributable to methotrexate in any case. CONCLUSION: Preservation of visual acuity in 12 of 16 study eyes suggests that a 400-microg intravitreal injection is safe in ocular disease other than PCNSL. The loss of acuity in four eyes with advanced preexisting pathology may be just as likely attributable to the natural history of the disease as to intraocular methotrexate.

Preventing recurrent opacification of the visual pathway after pediatric cataract surgery.

PURPOSE: To determine the rate of secondary opacification of the visual pathway following pediatric cataract surgery in children between the ages of 10 months and 7 years. METHODS: The medical records of children less than 7 years old who underwent lens aspiration, posterior chamber intraocular lens (IOL) implantation, primary pars plana posterior capsulectomy, and anterior vitrectomy were reviewed retrospectively. Twenty-six eyes in 19 children were included in the study. All procedures were performed by an anterior segment surgeon and a vitreoretinal surgeon. Main outcome measures were the prevalence of re-opacification of the visual pathway and of early postoperative complications. RESULTS: The visual pathway remained clear in 25 of 26 eyes (96%) after pediatric cataract surgery combined with primary pars plana posterior capsulectomy and anterior vitrectomy. The mean age at surgery was 46 +/- 23 months (+/-SD). Secondary opacification of the visual pathway occurred in one eye (4%), requiring another surgical procedure. At last follow-up (mean, 26 months; range, 6 to 79 months), the visual pathway was clear in all 26 eyes (100%). No cases of clinically significant IOL displacement or of retinal detachment were noted. CONCLUSIONS: For children undergoing pediatric cataract surgery between the ages of 10 months and 7 years, IOL implantation combined with primary pars plana posterior capsulectomy and anterior vitrectomy is effective in preventing re-opacification of the visual pathway.

Forgotten exogenous corticosteroid as a cause of central serous chorioretinopathy.

Central serous chorioretinopathy (CSCR) is an idiopathic ocular condition - first described in 1866 - that is well known to ophthalmologists. It is less well known to other practitioners. Glucocorticoids have been strongly implicated as a pathogenic factor. We report three patients who developed CSCR following exogenous administration of corticosteroid. Because our patients did not suspect the use of corticosteroid to be important or causative, they did not volunteer the historical detail, and admitted to exogenous corticosteroid injection only with intensive questioning. For their part, physicians should be cognizant of the risk of corticosteroid-induced CSCR, particularly in patients with a prior history of the potentially sight-threatening disease. The development of CSCR is an important iatrogenic and often unrecognized side effect of exogenously administered corticosteroid.