Treatment of choroidal neovascularization associated with Best's disease in children.

The development of secondary choroidal neovascularization in Best's disease is rare in the pediatric population. A retrospective review of pediatric patients with choroidal neovascularization secondary to Best's disease was performed. The patients' courses and treatments were recorded. Three patients with choroidal neovascularization were identified. All had decreased vision and were treated in an individual manner. Vision improved after treatment in all patients. Treatment may hasten resolution of choroidal neovascularization and improve vision.

Retinal breaks observed during pars plana vitrectomy.

PURPOSE: To quantitate the frequency and features of retinal breaks discovered at the time of vitrectomy and to evaluate the outcomes with prophylactic treatment. DESIGN: A consecutive, single-surgeon, retrospective, observational case series from a two-year period. METHODS: Medical records were reviewed for all patients who underwent primary, standard, three-port pars plana vitrectomy (PPV) between January 1, 2000, and December 31, 2001. Intraoperative findings recorded included the number, location, and categorization of retinal breaks and their method of management. Postoperative features recorded included the presence or absence of a retinal detachment (RD). RESULTS: There were 65 retinal breaks found in 48 (11.6%) of 415 eyes and included 30 (7.2%) eyes with definite breaks, nine (2.2%) with suspicious breaks, and nine (2.2%) with probably preexisting breaks. Breaks that were described as being large (n = 5) were more commonly associated with the right-hand sclerotomy (P = .041), although other categories of breaks were not. After surgery, the overall incidence of RD was 2.2% (nine of 415 eyes). The rate of RD among the 48 eyes with retinal breaks (of any category) was also 2.1% (one eye). All RDs in this series occurred more than three months after initial vitrectomy and, accordingly, were probably unrelated to retinal breaks that occurred during surgery. CONCLUSIONS: Recognition of retinal breaks and intraoperative treatment with retinopexy and air-fluid exchange during vitrectomy reduces the postoperative risk of RD to that among eyes without observed intraoperative retinal breaks.

Development of multiple subretinal hemorrhages during diode laser supplementation for retinopathy of prematurity.

A premature infant had subretinal hemorrhages in one eye after laser ablation for threshold retinopathy of prematurity. We postulate that subretinal hemorrhages occur from trauma to the microvasculature secondary to globe manipulation during scleral depression at the time of laser treatment.

Clinical applications of optical coherence tomography for the diagnosis and management of macular diseases.

Optical coherence tomography provides high-resolution cross-sectional images of macular pathology in vivo. Owing to its noninvasive noncontact nature and use of near-infrared illumination of the fundus, it is well tolerated by patients. The images can be obtained without dilation and are highly reproducible,quantifying retinal thickness with an axial resolution of 10 microm. These qualities make OCT a powerful diagnostic tool complementary to fluorescein angiography, photography, and biomicroscopy. Optical coherence tomography has proved to be particularly useful for the clinical evaluation of vitreoretinal interface disorders and alterations of the structural anatomy of the macula, such as from edema, choroidal neovascularization, and detachment of the neurosensory retina or RPE. The information obtained from high-resolution evaluation of retinal anatomy allows the diagnosis of conditions that are difficult to establish with biomicroscopy or angiography and improves the clinician's ability to make the optimal treatment decision. The quantitative assessment of OCT allows an objective means to monitor disease progression and therapeutic response.A logical application of this technology is the evaluation of underlying macular pathology in patients considering cataract extraction. Uncovering vitreomacular traction, epiretinal membranes, occult choroidal neovascular membranes with minimal CME, subretinal fluid accumulation, and RPE detachments greatly impacts the clinical management of cataract patients and the weighing of surgical risks and benefits. OCT is a uniquely powerful means of visualizing retinal morphology and pathology that may not be revealed using current techniques of biomicroscopy, fluorescein angiography, or B-scan ultrasonography, and serves as the newest adjunct in diagnostic technology.

Extended Endotamponade with Perfluoro-n-Octane in Pediatric Retinal Detachment.

The use of perfluoro-n-octane (PFnO) for extended endotamponade in an infant with X-linked retinoschisis and complex tractional retinal detachments associated with proliferative vitreoretinopathy (PVR) was reported. The patient had undergone multiple vitrectomy surgeries with silicone oil tamponade. After extensive retinectomy, slippage of the retina produced folds that were flattened under extended PFnO tamponade. The retinas of both eyes remained anatomically reattached 11 months after exchange of PFnO for silicone oil.

Anterior segment ischemia following laser therapy for threshold retinopathy of prematurity.

PURPOSE: To report on the clinical characteristics and outcomes of premature infants developing signs of anterior segment ischemia after laser therapy for threshold retinopathy of prematurity treated or referred to a university institution. METHODS: A retrospective review of the medical records of premature infants with a primary diagnosis of retinopathy of prematurity undergoing laser therapy for threshold disease from January 1, 2001, to June 1, 2006. RESULTS: A total of 10 eyes in six patients were identified that developed signs of anterior segment ischemia for which a 1-year follow-up was available. The mean gestational age of patients developing anterior segment ischemia was 26.1 weeks. The mean weight was 855 g. The mean gestational age when laser photoablation was initiated was 36.3 weeks. All infants developing ischemia were treated with intermittent dense laser pattern using the diode laser. No infants treated thus far with confluent laser pattern have developed anterior segment ischemia. CONCLUSION: Confluent laser pattern in our experience does not predispose to anterior segment ischemia. Anterior segment ischemia primarily affects premature infants less than 28 weeks gestational age with low birthweights, less than 1,075 g. Intravitreal steroids at the time of pars plana vitrectomy and lensectomy may be beneficial in selected patients.

One-year safety and efficacy of intravitreal triamcinolone acetonide for the management of macular edema secondary to central retinal vein occlusion.

PURPOSE: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) as treatment for macular edema associated with central retinal vein occlusion (CRVO). METHODS: A retrospective review was performed of data for 40 consecutive patients (40 eyes) with CRVO and macular edema treated with IVTA at the Bascom Palmer Eye Institute (Miami, FL). RESULTS: Median duration of symptoms before the first injection was 3 months (range, 1 day to 8 years). Median Snellen visual acuity was 20/400 at baseline (range, 20/60 to light perception; n = 40), 20/300 at 1 month (P = 0.010; n = 37), 20/300 at 3 months (P = 0.007; n = 33), 20/400 at 6 months (P = 0.726; n = 28), and 8/200 at 1 year (P = 0.569; n = 17). Vision improved by > or =3 lines in 21% of eyes at 1 month, 27% at 3 months, 14% at 6 months, and 12% at 1 year. Visual acuity was unchanged from baseline in 71% of eyes at 6 months and 1 year. By 1 year, 50% of eyes received more than one injection (mean = 1.6 injections; range 1-4 injections). Overall, intraocular pressure increased by > or =10 mmHg in 24% of eyes at 1 year. Trabeculectomy was performed on 2 of 12 eyes with preexisting open-angle glaucoma. CONCLUSION: IVTA can substantially improve vision in some patients, but most patients have stable visual acuity compared with baseline at 1 year despite repeated injections.