Single-session photodynamic therapy combined with intravitreal bevacizumab for retinal angiomatous proliferation.

PURPOSE: To evaluate the efficacy of single-session photodynamic therapy (PDT) combined with intravitreal bevacizumab (IVB) in the treatment of retinal angiomatous proliferation (RAP) in age-related macular degeneration. METHODS: In this pilot study, eight patients with RAP underwent indocyanine green angiography (ICGA)-guided single-session verteporfin PDT followed by intravitreal bevacizumab (1.25 mg) within a 0-day +/- 1-day interval. All patients were naïve to treatment. Best-corrected visual acuity (BCVA), fluorescein angiography, ICGA, and optical coherence tomography (OCT) were performed at baseline and at each follow-up visit. All patients received three consecutive monthly IVB injections; thereafter, retreatment with bevacizumab was performed in the case of worsening BCVA or a deterioration of angiographic or OCT findings. RESULTS: All patients had 9 months of follow-up. Complete resolution of angiographic leakage was achieved in all eyes at 9 months. A significant improvement in the mean BCVA was observed at 1 month, 3 months, 6 months, and 9 months after combined treatment (P = 0.004). Visual acuity improved in 62.5% and was stable in 37.5% of cases. No patients had a decrease in BCVA of three or more lines during follow-up. Mean central macular thickness was significantly reduced in all patients (P < 0.0001) as controlled at 1-month, 3-month, 6-month, and 9-month intervals from initial treatment. The mean number of injections for the 9 months were 3.2 +/- 0.4. No ocular complications or systemic events developed. CONCLUSION: Sequenced combined treatment with single-session PDT and IVB injections may be useful in treating RAP, reducing or eliminating retinal edema, and improving or stabilizing visual acuity. Further investigations are warranted to outline the appropriate treatment paradigm for combination therapy.

Acute bilateral vitreo-retinal hemorrhages following oxygen-ozone therapy for lumbar disk herniation.

PURPOSE: To describe a case of acute bilateral intraocular hemorrhages occurring after injection of oxygen-ozone (O(2)O(3)) mixture. DESIGN: Observational case report. METHODS: A 45-year-old woman complained about acute bilateral visual loss after intradiscal and periganglionic injection of gas mixture (O(2)O(3)) for lumbar disk herniation. Detailed ophthalmologic examination; magnetic resonance imaging (MRI) of brain and spinal cord; and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser membranotomy in the left eye was performed. RESULTS: Ophthalmoscopy revealed a premacular hemorrhage involving the left macula. In the right eye multiple, flat, retinal hemorrhages around the optic disk and the posterior pole were observed. The MRI scan for intracranial hemorrhage was unremarkable. Drainage of the left premacular hemorrhage by pulsed Nd:YAG laser was obtained a few weeks later. CONCLUSIONS: Retinal hemorrhages seem to be an uncommon but significant complication of intradiscal O(2)O(3) infiltration, and we suggest that it should be carefully considered when recommending this procedure.

Posterior capsule opacification after phacoemulsification: silicone CeeOn Edge versus acrylate AcrySof intraocular lens.

PURPOSE: To compare the rates and morphologic features of posterior capsule opacification (PCO) after small-incision phacoemulsification and in-the-bag implantation of 2 foldable intraocular lenses (IOLs) over an 18-month follow-up. SETTING: Departments of Ophthalmology, Hospital of Conegliano, Conegliano, and Maggiore Hospital of Bologna, Bologna, Italy. METHODS: In an open clinical study, 78 cataract patients were randomly selected to have implantation of a silicone CeeOn Edge (Pharmacia) or acrylate AcrySof (Alcon) IOL after phacoemulsification cataract surgery. All the patients were operated on using a standard technique and in-the-bag IOL implantation. One eye in each patient was studied. Morphologic evaluation of PCO was performed using Evaluation of Posterior Capsule Opacification software. RESULTS: At 18 months in the CeeOn Edge group, 36 eyes (90%) had a clear posterior capsule and 4 (10%) had PCO that did not affect visual acuity. In the AcrySof group, 26 eyes (68%) had a clear posterior capsule, 11 (29%) had PCO that did not affect visual acuity, and 1 (3%) had PCO with a decrease of 2 or more lines of visual acuity that required a neodymium:YAG laser capsulotomy. No eye developed Elschnig pearls or stretched folds in the bag. The postoperative best corrected visual acuity ranged from 0.8 to 1.0 in 96% in the CeeOn Edge group and in 92% in the AcrySof group. No IOL haze or discoloration was observed in the CeeOn Edge group. Mild IOL decentration and tilting occurred in 4 AcrySof eyes; however, no glistenings were found any AcrySof IOL. CONCLUSIONS: Both the CeeOn Edge and AcrySof groups had a low incidence of PCO after an 18-month follow-up. The CeeOn Edge group had significantly less PCO than the AcrySof group. These results confirm that IOLs with square truncated edges create a barrier effect at the optic edge, reducing the overall incidence of PCO.

Intracorneal hematoma after canaloplasty in glaucoma.

PURPOSE: To report a case of an intracorneal hematoma after canaloplasty. METHODS: Interventional case report of a surgical method used to resolve an intracorneal hematoma complication after canaloplasty. RESULTS: A 45-year-old man with uncontrolled pigmentary open-angle glaucoma underwent canaloplasty for glaucoma in the left eye. The patient previously underwent radial keratotomy for myopia in the same eye in 1997. Visual acuity was 20/20 without corrective lenses; intraocular pressure was 25 mm Hg with maximal medical therapy. During the surgical procedure, the canaloplasty microcatheter encountered an obstacle at the 6-o'clock position. During catheterization, a high-weight viscoelastic substance is normally injected in the canal. This probably caused a limited detachment of the Descemet membrane. On the day after surgery, slit-lamp biomicroscopy showed a large intracorneal hematoma that threatened the visual axis. A partial-thickness paracentesis was then performed on day 2 to remove the hematoma. CONCLUSIONS: Intracorneal hematoma is a rare complication of canaloplasty for glaucoma. The blood can be removed without interrupting the Descemet membrane by partial-thickness paracentesis.

Short-term effect of intravitreal injection of Ranibizumab (Lucentis) on intraocular pressure.

PURPOSE: To investigate short-term effect on intraocular pressure (IOP) after intravitreal injection of ranibizumab (Lucentis) (IVIL). MATERIALS AND METHODS: This prospective study included 1 eye of 54 patients (64+/-12 y) with wet age-related macular degeneration treated with IVIL. IOP measurements with TonoPen were taken: immediately before and 5 seconds, 5, 10, 15, 30, 60 minutes, and 1 day after IVIL. Axial length (with ultrasound biometry) was assessed in 24 eyes. The analysis included IOP difference at various time points and between phakic and pseudophakic eyes and the relationship between axial length and IOP increases after 5 seconds. RESULTS: Mean IOP were 16.3+/-3.0 mm Hg (range: 12.0 to 21.3), 44.1+/-10.6 (22.0 to 59.3), 29.0+/-9.6 (15.0 to 49.0), 25.8+/-7.9 (16.0 to 45.0), 23.7+/-6.6 (15.7 to 39.0), 21.9+/-5.6 (14.7 to 37.0), 18.8+/-6.1 (10.0 to 35.0), and 16.1+/-3.0 (11.0 to 21.0), respectively, for time points immediately before, 5 seconds, 5, 10, 15, 30, 60 minutes, and 1 day after IVIL. Differences between before IVIL and after IVIL IOP were statistically significant after 5 seconds, 5, 10, 15, and 30 minutes (P=0.0001); however, were not significant after 1 hour (P=0.064) and 1 day (P=0.449). Differences between phakic and pseudophakic eyes were not significant (P>0.05). The relationship between shorter axial length and IOP increase after 5 seconds was significant (linear regression analysis; R=0.28, P=0.007). CONCLUSIONS: IVIL causes a considerable short-term transient rise in IOP. The IOP increase after IVIL can be statistically significant at 0 to 30 minutes after injection in both phakic and pseudophakic eyes, and tends to be greater in shorter eyes.