Choroidal neovascularization following photodynamic therapy in a patient with chronic central serous chorioretinopathy.

PURPOSE: To present the clinical features and treatment of subfoveal choroidal neovascularization complicating photodynamic treatment (PDT) performed for chronic central serous chorioretinopathy (CSC). METHOD: A 48-year-old healthy woman who had chronic visual deterioration in her right eye due to chronic CSC was treated with standard PDT protocol. RESULTS: Three weeks after the initial PDT, she experienced recovery in her vision and neurosensory detachment subsided clinically. However, six weeks after the PDT she returned with decreased visual acuity and metamorphopsia in the right eye. Fluorescein angiogram and optic coherence tomography delineated a classic subfoveal subretinal neovascular membrane. PDT was reperformed two more times, three months apart and closure of neovascular membrane was obtained. CONCLUSION: Choroidal neovascularization might have occurred during the natural course of disease process or as a consequence of PDT. PDT seems to be effective for treating the choroidal neovascularization complicating PDT performed for CSC.

[Vogt-Koyanagi-Harada Syndrome : An unusual case with lacquer crack-like retinal findings]. / Vogt-Koyanagi-Harada-Syndrom : Ein ungewöhnlicher Fall mit lacksprungähnlichen Netzhautbefunden.

We report the case of a 35-year-old female patient with bilateral and recurrent panuveitis. Diagnosed with Vogt-Koyanagi-Harada syndrome, the patient was treated with corticosteroids, achieving rapid improvement of functional and morphological findings. After recovery of the exudative retinal detachment, peripapillary lacquer crack-like findings were observed.

Miliary tuberculosis and bilateral multifocal choroidal involvement: place of indocyanine green angiography.

PURPOSE: To present the clinical features and angiographic findings of choroidal involvement in two cases with miliary tuberculosis. METHODS: 49-year and 23-year-old men were hospitalized for fever of unknown origin and they received a diagnosis of miliary tuberculosis following the systemic work-up. Both cases experienced mild visual acuity disturbances prior to initiation of systemic treatment. They underwent full ophthalmological examination including fluorescein and indocyanine green angiography. RESULTS: The visual acuity of first case was 20/30 in OD, and 20/25 in OS. There was trace of cells in the anterior chamber and mild vitritis OU. Visual acuity of the second case was 20/20 OU. Anterior segment was unremarkable OU. Ophthalmoscopy of both cases showed cream-colored patchy choroidal infiltrations especially located at the posterior pole OU. Fluorescein and indocyanine green angiographies were obtained with Heidelberg scanning laser ophthalmoscope. These lesions were hypofluorescent in early phases of fluorescein angiography and demonstrated gradually increased hyperfluorescence in late phases. Same lesions were hypofluorescent throughout the indocyanine green angiography and well delineated. Both patients received a systemic treatment of isoniazid, rifampicin, ethambutol and morphazinamide. Most of the choroidal lesions resolved without apparent changes whereas some healed as chorioretinal scars. CONCLUSION: In patients with miliary tuberculosis, indocyanine green angiography seems to show choroidal involvement much better than the fluorescein angiography and may be a more important diagnostic tool than fluorescein angiography during the disease course.

Macular hole formation in Bietti's crystalline retinopathy. A case report.

Three years after the initial diagnosis, a 21-year-old healthy man with Bietti's crystalline retinopathy developed unilateral stage 4 macular hole with surrounding macular detachment. The mechanism of macular hole formation, which may or may not be a feature of Bietti's crystalline dystrophy, is not clear.

Bilateral megalocornea with unilateral lens subluxation.

Megalocornea refers to an enlarged cornea that measures 13 mm or more in horizontal diameter in the absence of raised intraocular pressure. We describe a five-month-old boy with bilateral megalocornea with unilateral lens subluxation. No other ophthalmological abnormality was present. In all previously reported cases with megalocornea and ectopia lentis, the lens was cataractous and the dislocation was in the inferior and posterior direction. In contrast, our case had a clear lens which was displaced superonasally.

Ocular findings in 55 patients with Down's syndrome.

Fifty-five patients with Down's syndrome were examined to evaluate the characteristics and frequency of ocular findings. Of these patients, 29 (52.7%) were hypermetropes, 7 (12.7%) were emmetropes, and 7 (12.7%) were myopes; astigmatism of more than 3.00 diopters was present in 7(12.7%) patients. Strabismus was observed in 12 (21.8%) patients. All but one of these 12 patients also had esotropia. Congenital nasolacrimal duct obstruction was present in 12 subjects (21.8%). Blepharitis was found in 19 (34.5%) cases. Nystagmus occurred in 7 (12.7%) patients. Brushfield spots were detected in only 20 (36.3%) of the patients and were more common in light-colored irides. Lens opacities were diagnosed in 11 (20%) patients, and two underwent successful cataract surgery. On fundus examination, an increased number of retinal vessels crossing the optic nerve head was detected in 21 (38.1%) cases. One of the patients had a retinal detachment. Significant but correctable ocular problems are present in patients with Down's syndrome and may interfere with the quality of life of the patient and with binocular vision. Surgical intervention may be needed for strabismus and for cataracts.

Neurofibromatosis type I and unilateral ophthalmic artery occlusion.

Etiological investigation of a 15-year-old boy with left ophthalmic artery occlusion led us to a diagnosis of neurofibromatosis type I as there were numerous large cafe-au-lait spots, axillary freckling, and brain MRI changes consistent with a hamartoma. In light of the present case, ophthalmic artery occlusion may be a rare feature of neurofibromatosis type I besides more commonly described cerebrovascular changes.

Pars plana vitrectomy with pars plana tube implantation in eyes with intractable glaucoma.

AIMS: Intractable glaucoma is glaucoma resistant to medical therapy and conventional surgical procedures. In this study, a planned surgical technique is discussed for controlling the increased intraocular pressure in selected cases with intractable glaucoma. METHODS: Total pars plana vitrectomy with pars plana tube implantation was performed in 17 eyes of 17 cases with intractable glaucoma. Patients with neovascular glaucoma were not included in this study. The mean age of these patients (seven men, 10 women) was 44.6 (SD 22.1) years and mean follow up period was 30.3 (15.5) months (range 4-71). Drainage implants with a disc were used in 16 cases, whereas, a tube with scleral buckle (Schocket surgery) was preferred in one case. An intraocular pressure below or equal to 20 mm Hg without any adjunctive medication or with only one type of antiglaucomatous drop was considered as an adequate operative outcome. RESULTS: 16 out of 17 eyes maintained adequate pressure control. Only three out of these 16 eyes required prophylactic antiglaucomatous medications. One patient underwent reoperation for pressure control. The most severe complications observed postoperatively were intravitreal haemorrhage (one case), choroidal detachment (one case), implant failure (one case), total retinal detachment (two cases), and corneal endothelial decompensation (five cases). CONCLUSION: Pars plana placement of drainage tube following pars plana vitrectomy should be considered as an alternative method for controlling increased intraocular pressures in selected patients with intractable glaucoma.

Orbital varices: imaging findings and the role of color Doppler sonography in the diagnosis.

The orbital varices are infrequent intraorbital masses, which cause intermittent, positional exophthalmos. They have low venous pressure inside which causes difficulties in detection by routine protocols of nearly all imaging modalities. Color Doppler sonography is a simple procedure that can easily detect orbital varices which avoids further evaluation in non-complicated patients. We report the imaging findings of a case of orbital varix and discuss the role of color Doppler sonography in the diagnosis and follow-up.

Extraocular muscle imbalance after scleral buckling.

Postoperative muscle imbalance was prospectively evaluated in 44 patients who underwent conventional scleral buckling operations. Strabismus was present in 27 of 44 patients (61%). Heterotropia resolved spontaneously during the first six postoperative months in nine of 27 patients (33%). Diplopia persisted in six patients (13.6%) and limitation of ductions occurred in 22 of 44 patients (50%). The risk of developing postoperative strabismus was 2.5 times longer if an implant was placed under a rectus muscle. Otherwise, presence, degree, and direction of the duction deficits did not correlate with placement of a local implant under the corresponding rectus muscles or their antagonists. Reoperation, preoperative detachment of macula and size of the local implant were not statistically correlated with extraocular muscle imbalance. We believe that decrease in postoperative swelling and increase in visual acuity that allows phoria adaptation are the main causes of spontaneous resolution.

Preserved human amniotic membrane transplantation in the treatment of primary pterygium.

BACKGROUND AND OBJECTIVE: To assess the outcome of simple excision with preserved human amniotic membrane transplantation in the treatment of primary pterygium. PATIENTS AND METHODS: A total of 59 eyes with primary pterygium underwent surgical excision. In Group 1, 28 eyes were treated with simple excision and preserved human amniotic membrane transplantation. In Group 2, 31 eyes were treated with bare sclera excision. These two groups were compared in recurrence, final appearance of the operation site, and complications. Patients were followed for at least 10 months. RESULTS: During a mean follow up of 14.9 months, we observed 3 (10.7%) recurrences in Group 1 and 20 (38.7%) recurrences in Group 2 (P:0.03). In Group 1, 20 (71.4%) eyes and 14 (45.2%) eyes in Group 2 had a satisfactory final operation site appearance (P:0.041). No serious complication was observed in both groups. CONCLUSION: Simple excision and preserved human amniotic membrane transplantation appears to be a safe and effective way of treating primary pterygium because of the lack of serious complications and a relatively low rate of recurrence.

Magnetic resonance imaging in the evaluation of eyes treated with silicone oil.

BACKGROUND AND OBJECTIVE: To evaluate the sensitivity of magnetic resonance imaging (MRI) in detecting retinal detachment (RD) in eyes filled with silicone oil, and to determine the MRI characteristics of silicone oil in vivo. PATIENTS AND METHODS: Seven eyes of seven patients with RD and eight eyes of eight patients without RD after silicone oil surgery were included in the study. All of the patients had clear media. MRI was performed in these patients. The results of ophthalmic examinations were compared with MRI findings. RESULTS: MRI detected six of the seven detached retinas. The multiplanar imaging capability of MRI helped in showing the RDs in various locations. The chemical shift artifact exaggerated the retinal thickness and made the detached retina visible. Fat suppressed images showed the silicone oil-corneal contact clearly. CONCLUSION: MRI is an effective technique for demonstrating RD in eyes filled with silicone oil and can be used successfully in eyes with opaque media.

Retinal breaks and rhegmatogenous retinal detachment in association with branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To report the incidence and clinical characteristics of retinal breaks and/or rhegmatogenous retinal detachment (RRD) in patients with branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: We reviewed the clinical records of 230 eyes of 214 patients with BRVO and identified eyes with retinal breaks and/or RRD. Patients had at least 6 months of follow-up. RESULTS: Seven of 230 eyes (3%) had retinal breaks and 3 eyes (1.3%) had RRD. One of the eyes with RRD had subclinical retinal detachment. All 7 eyes had ischemic disease documented by fluorescein angiography. Two of 7 eyes had concurrent retinal neovascularization. Four eyes with breaks, but without RRD, and the eye with subclinical RRD were managed by argon green laser. Two eyes with RRD were managed successfully with scleral buckling surgery and postoperative supplemental argon green laser. The mean follow-up period was 14.8 +/- 8.3 months. CONCLUSIONS: Patients with BRVO should be monitored closely for possible retinal break formation and RRD development.

Phacoemulsification and intraocular lens implantation in eyes with long axial length.

We evaluated the results of phacoemulsification and intraocular lens implantation in 414 eyes with long axial length and classified them according to axial length (AL): Group A: AL: 25-28 mm, Group B: AL >28 mm. Intraoperative maneuvers, pre- and postoperative photocoagulation for predisposing retinal lesions and retinal detachment rates were significantly higher in Group B than Group A. Eyes with an axial length over 28 mm are prone to more problems when compared to those with an axial length between 25 and 28 mm.

Zinc in tears.

The tear and serum zinc (Zn) levels were determined simultaneously by atomic absorption spectrophotometry in 11 healthy subjects. The mean tear Zn level was found to be 1.537 +/- 0.146 (SEM) ppm while the mean serum Zn level was found to be 1.03 +/- 0.046 (SEM) ppm.