DELINEATION OF CHOROIDAL AND RETINAL LESIONS IN POSTERIOR UVEITIS BY MULTISPECTRAL WIDE-FIELD SCANNING LASER OPHTHALMOSCOPY.

PURPOSE: To investigate whether wide-field multispectral scanning laser ophthalmoscopy could assist in determining depth of chorioretinal pathology in posterior uveitis. METHODS: Cross-sectional retrospective review of patients with birdshot chorioretinopathy (BCR; 42 eyes of 21 patients) or active primary vitreoretinal lymphoma (PVRL; 18 eyes of 10 patients) who had multispectral wide-field scanning laser ophthalmoscopy (Optos) images. Images acquired with 532 nm and 635 nm lasers were analyzed separately using Optos V Vantage Pro Review software. RESULTS: All 42 eyes with birdshot chorioretinopathy and 8/18 eyes with active primary vitreoretinal lymphoma had lesions on 635 nm imaging, while 26/42 of the birdshot chorioretinopathy eyes and 18/18 eyes with active primary vitreoretinal lymphoma had lesions on 532 nm imaging. The difference between the 2 groups on both 635 nm and 532 nm was statistically significant (P < 0.05). CONCLUSION: Retinal and choroidal lesions in patients with posterior uveitis can be differentially visualized with Optos 532 nm and 635 nm lasers, respectively, allowing determination of depth of pathology.

Retinal vein occlusion in patients with primary angle closure: a prospective case-control study.

OBJECTIVE: To compare the prevalence of angle closure in eyes with retinal vein occlusion (RVO) with control eyes and assess the possible association between angle-closure and RVO. PATIENTS AND METHODS: This prospective, blinded case-control study included patients with a history of RVO (cases) and control individuals matched for age and refractive error. Clinical characteristics and angle-based structures derived from anterior-segment optical coherence tomography (AS-OCT) were analyzed. RESULTS: Eighty-eight patients (44 per group) were included. The average age of the RVO and control groups was 59.8 ± 11.6 years and 60.8 ± 9.0 years, respectively (p = 0.667). There were no significant differences in terms of clinical characteristics between the 2 groups, including intraocular pressure (p = 0.837) and Shaffer gonioscopy grading (p = 0.620). None of the AS-OCT-derived angle characteristics were significantly different between the 2 groups. The number of angle-closure diagnoses between the RVO group (1 primary angle closure and 7 primary angle-closure suspects) and the control group (6 primary angle-closure suspects) did not differ significantly (p = 0.560). Anterior-chamber depth (ACD) was shallower in RVO eyes (2.72 ± 0.31 mm) than in the contralateral non-RVO eyes (2.76 ± 0.31 mm; p = 0.014). CONCLUSIONS: This prospective, blinded, matched case-control study did not evidence any significant differences in clinical and AS-OCT-derived structural measures between RVO and control eyes. However, RVO eyes, compared with their contralateral non-RVO eyes, had a slightly shallower ACD. These findings collectively suggest that an association between primary angle-closure mechanisms and RVO is unlikely. However, the shallower ACD in RVO eyes could potentially put them at higher risk for intermittent or permanent pupillary block.

Evolution of Geographic Atrophy in Participants Treated with Ranibizumab for Neovascular Age-related Macular Degeneration.

PURPOSE: To evaluate the risk factors, incidence, and rate of progression of geographic atrophy (GA) in eyes with neovascular age-related macular degeneration (nAMD) treated with ranibizumab. DESIGN: Post-hoc analysis of a prospective clinical study. PARTICIPANTS: 69 participants with nAMD in at least one eye. METHODS: Participants were prospectively treated in the study eye with 0.5 mg intravitreal ranibizumab. Study eyes received 4 monthly injections followed by pro re nata injections until a fluid-free macula was achieved on optical coherence tomography. Risk factors assessed included baseline demographics, treatment, and ocular characteristics on imaging. Eyes were evaluated on fundus autofluorescence (FAF) for GA. The rate of GA area growth in study and fellow eyes was analyzed by linear regression of square-root transformed areas. MAIN OUTCOME MEASURES: Development of new-onset GA and rate of GA area growth measured on ocular imaging, including FAF images of the study eyes. RESULTS: Sixty-nine participants (mean age 78.8±7.8 years) with an average of 40.0±13.6 months of follow-up were analyzed. Twenty-two of 69 study eyes (32%) were treatment naïve. During their first year of the study, participants received an average of 9.2±3.3 injections in the study eye. Of 63 study eyes with quality baseline images, 22 (35%) had pre-existing GA. Of the remaining 41 eyes, 7 (17%) developed new-onset GA during study follow-up. Those who developed new GA were older (all ≥79 years old) and had received fewer study injections on average (6.9 vs. 10.4 injections at 1 year) compared to those who did not develop new GA. Of the 12 treatment naïve study eyes without GA at baseline, 1 (8.3%) developed new GA during the study. In 21 study eyes with quantifiable GA area, eyes with GA present at baseline (16/21) enlarged by 0.34±0.26 mm/year, compared to 0.19±0.12 mm/year in eyes developing new-onset GA (5/21). CONCLUSIONS: While 17% of study eyes without GA present at baseline receiving ranibizumab developed new GA, the role of ranibizumab in the development of GA is unclear. Further prospective longitudinal studies are required to determine the eyes most at risk of developing GA in the setting of anti-VEGF treatment.

Partial third cranial nerve palsy: clinical characteristics and surgical management.

PURPOSE: Incomplete recovery from injury to the third cranial nerve results in ocular misalignment and associated diplopia. Our aim in this study was to describe and evaluate strabismus surgery strategies aimed at restoring functional, single binocular vision in this population. DESIGN: Retrospective review. PARTICIPANTS: We studied 12 adult patients with acquired partial third cranial nerve palsy who underwent strabismus surgery. METHODS: The 12 consecutive patients with residual third nerve palsy were selected from among the patients seen between 2000 and 2010 in the clinical practice of 1 strabismologist (M.F.). Complete pre- and postoperative ophthalmologic and orthoptic examinations were performed in each patient. The patients presented with isolated hypotropias (n = 7) and exohypotropias (n = 5). Strabismus surgery included: contralateral superior rectus recession, ipsilateral inferior rectus recession, vertical transposition of horizontal recti, horizontal rectus muscle surgery, or combined horizontal and vertical muscle surgery. Complete surgical success was defined as postoperative alignment within 5 prism diopters (PD) of orthotropia and the absence of diplopia in functional positions of gaze. The average follow-up was 23 months (range, 7 to 81 months). RESULTS: The mean preoperative vertical and horizontal deviations were 19 PD hypotropia (8-40 PD) and 19 PD exotropia (6-40 PD), respectively. The mean postoperative deviations were 2 PD hypotropia (0-8 PD) and 1 PD exotropia (0-6 PD). Complete surgical success was achieved in 7 of 12 patients. Partial success was attained in 5 of 12 patients, who experienced significant improvement but required postoperative use of a prism. CONCLUSIONS: This study indicates that patients with incomplete third cranial nerve paralysis may enjoy good functional and cosmetic outcomes with strabismus surgery.