Safety testing of indocyanine green in an ex vivo porcine retina model.

PURPOSE: To assess retinal toxicity of indocyanine green (ICG) in a porcine ex vivo perfusion organ culture model, and to measure intraretinal penetration of ICG applied to the retinal surface. METHODS: The retinal surface of fresh porcine retinal tissue was exposed to ICG 0.1% and 1% dissolved in glucose 5% for 1 and 30 minutes with and without concomitant illumination. Specimens were then kept in perfusion organ culture for 24 hours before examination by light microscopy and the TUNEL technique. Tissue samples treated with DNAse served as positive controls, and samples exposed to saline served as negative controls. Fluorescence microscopy was used to localize ICG at 1 minute, 60 minutes, 2 hours, and 3 hours after a 1-minute exposure of the retinal surface to ICG 1%. RESULTS: No increase in TUNEL-positive cells was observed after exposure to ICG 0.1% for 1 minute. Moderate apoptosis was found after 1-minute exposure to ICG 1% and 30-minute exposure to ICG 0.1%, and severe apoptosis was found after 30-minute exposure to ICG 1%. Concomitant application of light did not influence the degree of apoptosis. No signs of cell necrosis were found. After 1-minute exposure of the retinal surface, ICG 1% gradually penetrated the entire retina. CONCLUSIONS: ICG induced apoptosis but not necrosis in all nuclear retinal layers in a dose-dependent manner. Brief exposure to ICG 0.1% for 1 minute and illumination for 3 minutes simulated the intraoperative use of ICG. No retinal apoptosis or necrosis was observed. ICG briefly applied to the retinal surface gradually penetrated the entire retina.

Chameleon-like appearance of immunotactoid keratopathy.

PURPOSE: To demonstrate 5 different patterns of immunotactoid keratopathy (ITK) in monoclonal gammopathy of undetermined significance (MGUS) that can mimic hereditary and degenerative disorders. First follow-up of 1 female patient was performed. METHODS: Colored slit-lamp photodocumentation of 6 MGUS light kappa patients with different types of ITK, one patient with a follow-up of 7 years. Systemic and serological examinations of all 6 patients were performed. RESULTS: The systemic and serological examinations disclosed an MGUS light kappa in all 6 patients. The 7-year follow-up of case 2 showed a reduction of lattice-like opacity to moderate diffuse corneal opacity. Corneal opacity patterns of the 6 patients were as follows: pattern 1, crystalline-like; pattern 2, lattice-like; pattern 3, peripheral granular-like; pattern 4, peripheral band-like; and patterns 5 and 6, peripheral patch-like. CONCLUSIONS: ITK of MGUS can mimic cystinosis, Schnyder corneal dystrophy (CD), pre-Descemet CD, lattice CD, granular CD, arcus lipoides, lecithin-cholesterol acyltransferase deficiency, gelatinous drop-like CD, and Salzmann nodular degeneration. ITK can be the first symptom of MGUS. An annual internal check of MGUS is recommended because of occurrence of a systemic monoclonal gammopathy in 20% of cases.

Franceschetti hereditary recurrent corneal erosion.

PURPOSE: To describe new affected individuals of Franceschetti's original pedigree of hereditary recurrent erosion and to classify a unique entity called Franceschetti corneal dystrophy. DESIGN: Observational case series. METHODS: Slit-lamp examination of 10 affected individuals was conducted. Biomicroscopic examinations were supplemented by peripheral corneal biopsy in 1 affected patient with corneal haze. Tissue was processed for light and electron microscopy and immunohistochemistry was performed. DNA analysis was carried out in 12 affected and 3 nonaffected family members. RESULTS: All affected individuals suffered from severe ocular pain in the first decade of life, attributable to recurrent corneal erosions. Six adult patients developed bilateral diffuse subepithelial opacifications in the central and paracentral cornea. The remaining 4 affected individuals had clear corneas in the pain-free stage of the disorder. Histologic and immunohistochemical examination of the peripheral cornea in a single patient showed a subepithelial, avascular pannus. There was negative staining with Congo red. DNA analysis excluded mutations in the transforming growth factor beta-induced (TGFBI) gene and in the tumor-associated calcium signal transducer 2 (TACSTD2) gene. CONCLUSION: We have extended the pedigree of Franceschetti corneal dystrophy and elaborated its natural history on the basis of clinical examinations. A distinctive feature is the appearance of subepithelial opacities in adult life, accompanied by a decreased frequency of recurrent erosion attacks. Its clinical features appear to distinguish it from most other forms of dominantly inherited recurrent corneal erosion reported in the literature.

The outcome of early surgical repair with vitrectomy and silicone oil in open-globe injuries with retinal detachment.

PURPOSE: To determine the functional and anatomic outcome of early surgical repair with vitrectomy and silicone oil in open-globe injuries with retinal detachment (RD). DESIGN: Retrospective consecutive interventional case series. METHODS: All patients with open-globe injuries with RD treated between 1997 and 2007 underwent primary repair including vitrectomy with silicone oil within 8 hours after presentation. For data analysis, patients were divided into 3 groups according to the BETT classification: Group 1, intraocular foreign body; Group 2, penetrating injury; Group 3, globe rupture. Outcome measures were final reading visual acuity (0.4 logMAR or better), final ambulatory visual acuity (1.6 logMAR or better), endophthalmitis, and postoperative proliferative vitreoretinopathy (PVR). RESULTS: Eighty-eight patients were included (Group 1, n = 13; Group 2, n = 36; Group 3, n = 39). Mean follow-up was 22 months (standard deviation [SD] = 23, range 6-107 months). Eight percent of patients retained reading vision without significant difference between the 3 groups. Fewer patients in Group 3 than in Group 1 or 2 retained ambulatory visual acuity (Group 1, 62%; Group 2, 64%; Group 3, 33%, P = .024). Endophthalmitis occurred in 3.4% of eyes (1 eye in each group). PVR grade B-C, type 1-3 developed in 44% of patients without significant difference between the 3 groups. Re-RD occurred in 38% of eyes. CONCLUSIONS: Few patients achieved reading vision while 50% of patients retained ambulatory visual acuity. Final visual outcome is related to the severity of the injury. The frequency of postoperative endophthalmitis is low. Postoperative development of advanced PVR is avoided in most patients.

Bilateral posterior scleritis: an idiopathic painless presentation.

PURPOSE: To describe a presentation of painless posterior scleritis. METHODS: This study was an interventional case report. An 18-year-old boy was admitted to the authors' clinic with symptoms of low degree of vision and no ocular pain. Ophthalmologic examination, ocular ultrasonography, magnetic resonance imaging, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), thoracic radiography, abdominal sonography, and laboratory testing were carried out and the results were evaluated. RESULTS: OCT revealed bilateral exudative retinal detachment. Diffuse bilateral posterior scleral thickening and serous retinal detachment were found in B-scan ultrasonography, suggesting posterior scleritis. Laboratory findings and imaging disclosed no systemic disease. The patient responded to oral prednisolone 60 mg once daily. CONCLUSIONS: The case reported here indicates that pain is not always present in posterior scleritis.

Contact lens-induced regression of Lisch epithelial corneal dystrophy.

PURPOSE: To describe the use of soft contact lenses (CL) to reduce the epithelial opacities of Lisch epithelial corneal dystrophy (LECD). First presentation of confocal microscopy in LECD. METHODS: Two unrelated female patients with LECD demonstrated a central gray opacity with distinct visual impairment. The first patient wore a daily hydroxyethlmethacrylate (HEMA) CL for 3 months and the second, a daily silicone hydrogel CL for 1 month. Pre-CL and post-CL appearances of the cornea were photodocumented at the slit lamp. Additionally, in the second patient, a confocal microscopic evaluation of LECD was performed. RESULTS: In both patients, the wearing of CL resulted in a distinct reduction of central corneal opacification with a visual improvement. Discontinued wearing of CL induced again a progression of opacity. The confocal microscopy disclosed the typical intracytoplasmatic vacuolization of the involved epithelial cells. CONCLUSIONS: Wearing CL for a longer duration causes a significant regression of corneal opacities in LECD. The etiology of this phenomenon is interpreted as a CL-induced thinning of corneal epithelium and reduction of epithelial layers.

Surgical removal of idiopathic epiretinal membrane with or without the assistance of indocyanine green: a randomised controlled clinical trial.

PURPOSE: To carry out a prospective investigation of the functional and morphological outcome of idiopathic epiretinal membrane (IEM) surgery with or without the assistance of indocyanine green (ICG) in a randomised controlled clinical trial. METHODS: Sixty patients who underwent vitrectomy with removal of IEM combined with cataract surgery were randomly allocated to two groups: 27 patients were operated on with ICG 0.1% in glucose 5%, 33 patients without ICG. Functional outcome was assessed 3-4 months postoperatively with improvement of best-corrected visual acuity (BCVA), Amsler grid test, and automated and kinetic perimetry. Postoperative residual or recurrent IEM was assessed with bio-microscopy, and macular oedema with optical coherence tomography (OCT). Improvement in BCVA was the main outcome measure. RESULTS: BCVA improved in 49 patients, remained unchanged in five and decreased in five. Improvement in BCVA and reduction of macular oedema were statistically significant within both groups (P < 0.01). Improvement in BCVA was not statistically significantly different whether ICG was used or not [0.17 (logarithm of minimum angle of resolution; logMAR) with ICG and 0.24 (logMAR) without ICG] (P = 0.59). There was no statistically significant difference in preoperative or postoperative BCVA, reduction of macular oedema, postoperative Amsler grid test, or incidence of residual or recurrent IEM between the two groups. Visual field defects were detected in two patients operated on with ICG. CONCLUSIONS: Removal of IEM with or without the assistance of ICG equally improved visual function and macular morphology.