Vitrectomy and Vitrector Port Needle Biopsy of Choroidal Melanoma for Gene Expression Profile Testing Immediately before Brachytherapy.

PURPOSE: Transvitreal and transscleral needle biopsy can result in complications including vitreous hemorrhage and retinal detachment. This study evaluated a technique using 25-gauge vitrectomy as an adjunct to needle biopsy immediately before brachytherapy to minimize these complications and preserve good visual acuity. DESIGN: Retrospective, observational case series. PARTICIPANTS: Fifty-seven consecutive eyes of 57 patients with treatment-naïve medium choroidal melanomas without extraocular extension from July 2012 through September 2015. METHODS: Fifty-seven consecutive eyes of 57 patients with a clinically diagnosed choroidal melanoma underwent complete 25-gauge posterior vitrectomy followed by transvitrector port fine-needle aspiration biopsy of the tumor immediately before implantation of a radioactive iodine 125 plaque as treatment for the tumor. Cytopathologic analysis was not performed on the tumor aspirates in this study. MAIN OUTCOME MEASURES: Best-corrected postoperative visual acuity, postoperative complications of the reported technique, implantation tumor development, local tumor recurrence, presence of metastatic disease after surgery, and sufficiency of the tumor aspirates obtained by the reported technique for successful gene expression profile testing and prognostic classification. RESULTS: Mean preoperative and postoperative visual acuities were similar (20/60 vs. 20/80, respectively). Mean tumor thickness was 5.0 mm (range, 2.5-10 mm) and mean tumor basal diameter was 13.1 mm (range, 7-22 mm). Only 1 of 57 eyes (1.8%) showed a transient vitreous hemorrhage, biopsy yield was 100% for genetic analysis, and no patients showed recurrence or implantation tumor at the vitrector site. CONCLUSIONS: Combined 25-gauge posterior vitrectomy and 25-gauge trans-vitrector port needle aspiration biopsy immediately before brachytherapy is excellent for obtaining tumor aspirate for gene expression profiling while controlling for hemostasis, resulting in few complications.

Intravitreal bevacizumab (Avastin) prevention of panretinal photocoagulation-induced complications in patients with severe proliferative diabetic retinopathy.

PURPOSE: To evaluate the efficacy of intravitreal injection of bevacizumab (Avastin) (IVA) in preventing panretinal photocoagulation (PRP)-induced macular thickening and visual dysfunction in eyes with severe proliferative diabetic retinopathy. METHODS: A retrospective review of 60 consecutive eyes (30 patients) with severe proliferative diabetic retinopathy whose visual acuity was 20/30 or better (<0.18 in logarithm of the minimum angle of resolution acuity) and average foveal thickness (FT) was 280 microm or less, and whose retinopathy was bilateral and symmetrical, was performed. In all eyes, PRP was performed in two sessions. In the interventional group, 1.25 mg of IVA was injected to each eye 1 week before initiation of PRP. Foveal thickness was measured by optical coherence tomography before treatment, and the clinical course was monitored by best corrected visual acuity (BCVA) and FT for 24 weeks after beginning PRP. RESULTS: Before treatment, mean BCVA and FT was 0.073 +/- 0.071 microm and 278.8 +/- 29.5 microm in the IVA-injected group and 0.069 +/- 0.076 microm and 273.5 +/- 27.7 microm in the control group, respectively. After the IVA injection and PRP completion, FT in the IVA-injected eyes was significantly decreased, with a mean FT of 257.2 microm at 12 weeks and 264.3 microm at 24 weeks. In the control group, FT increased dramatically and reached 307.3 microm at 12 weeks and 298.2 microm at 24 weeks. The difference in final FT between groups was significant (P = 0.001). Best corrected visual acuity in the control group decreased with time to 0.149 +/- 0.113 at 24 weeks; in contrast, BCVA in the IVA-injected eyes improved over time to 0.039 +/- 0.054 at 24 weeks. This difference in BCVA was statistically significant (P< or =0.0001). Seven eyes (23.3%) in the control group had worse vision by > or =2 lines and increased FT by > or =50 microm at 24 weeks, whereas none of the eyes in the IVA group had either worse vision or a significant increase in FT (P = 0.011). CONCLUSIONS: A single IVA injection given before standard PRP may be beneficial in preventing PRP-induced visual dysfunction and foveal thickening in eyes with severe proliferative diabetic retinopathy and good vision.

Optic neuritis is nothing to sneeze at.

A 36-year-old man developed acute visual loss, mimicking an optic neuritis in the left eye. Cranial magnetic resonance imaging revealed a sphenoid sinus mucocele with extension into the anterior clinoid process abutting the left optic nerve. Endoscopic marsupialization of the mucocele led to marked improvement of vision. Sphenoid sinus mucocele is discussed, as is the differential diagnosis of optic neuritis.

Statin use and ocular inflammatory disease risk.

BACKGROUND: This study aims to evaluate the effect of oral statin medication use on the subsequent development of ocular inflammatory disease (OID). A retrospective nested case-control study was carried out on patient records from the Birmingham Veterans Affairs Medical Center. All male patients with a new diagnosis of OID over a 5-year period were included. Ten control subjects (without OID) were age-matched to each OID case. Prescription files of all subjects were queried for statin use. Information on selected comorbid medical conditions was also obtained. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of OID development in the context of statin use, controlling for comorbid conditions. RESULTS: Ninety-two incident cases of OID were identified. A trend toward a reduction in the risk of new OID development was found in patients that used statins compared to those that did not (OR 0.50, 95% CI 0.20 to 1.23, p = 0.13). The longer the duration of statin use, the greater is the effect. CONCLUSIONS: Use of oral statins may be associated with a reduced risk for the development of OID. This reduced risk increases with increasing duration of use. Larger clinical studies would be required to definitively establish the effectiveness of statins in lowering the incidence of OID.

Proliferative retinopathy as a complication of dyskeratosis congenita.

OBJECTIVES: To describe a patient with dyskeratosis congenita (DC) who developed retinal neovascularization (RNV) and discuss this novel association. METHODS: A 10-year-old boy with DC was referred for evaluation of possible retinal vascular disease. He underwent ophthalmologic examination, as well as fluorescein angiography. RESULTS: Fluorescein angiography demonstrated proliferative retinopathy with capillary nonperfusion in the temporal retina of both eyes. The patient underwent further evaluation with an examination with anesthesia and indirect ophthalmoscopic laser photocoagulation to areas of capillary nonperfusion. CONCLUSION: Although various ocular complications of both acquired aplastic anemia and inherited aplastic anemia due to DC have been previously described, to the authors' knowledge, this is the first reported case of either disease to exhibit RNV consistent with proliferative retinopathy. Ophthalmologists need to be aware of this potential complication in DC that could threaten vision, to provide prompt laser photocoagulation therapy.

Acute posterior multifocal placoid pigment epitheliopathy and thalamic infarction.

OBJECTIVES: To report a patient with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) who developed a thalamic infarction and to discuss this unusual presentation. DESIGN: Interventional case report and literature review. METHODS: A 23-year-old man with APMPPE presented with acute confusion and memory loss. He underwent complete ophthalmologic and neurologic examination, with neuroimaging including magnetic resonance angiography (MRA). MAIN OUTCOME MEASURES: Clinical course and angiographic findings. RESULTS: Magnetic resonance imaging (MRI) showed a left posteromedial thalamic infarction, with a corresponding filling defect of the left posterior communicating artery demonstrated by MRA. The patient underwent further treatment with intravenous corticosteroids followed by continued oral therapy with taper over several weeks. CONCLUSION: Although the association of APMPPE and cerebral vasculitis has been described, this patient is unique due to the subtle clinical presentation and anatomic location. This case emphasizes the importance of appropriate counseling of patients with APMPPE, as well as prompt recognition of clinical symptoms to enable timely intervention and treatment.

Incidence of acute onset endophthalmitis following intravitreal bevacizumab (Avastin) injection.

PURPOSE: To report the incidence of acute endophthalmitis as a complication of intravitreal bevacizumab (Avastin) (IVB) injection in a tertiary vitreoretinal group practice. METHODS: A retrospective chart review of 5,233 consecutive eyes that underwent IVB injection at Retina Consultants of Alabama (RCA) from October 1, 2005, to August 31, 2007, was performed to identify cases of acute endophthalmitis. RESULTS: During the 23-month study interval, the overall incidence rate of postinjection endophthalmitis was 0.019% (1/5,233). In the single case of acute endophthalmitis, bacterial cultures revealed coagulase-negative Staphylococcus (CNS) species. Visual acuity after treatment for endophthalmitis was improved (baseline 4/400) to 20/400 at two months after the initial IVB injection. CONCLUSIONS: Acute endophthalmitis is a rare potential complication of IVB. Prophylaxis with topical povidone-iodine and adherence to aseptic technique minimizes the risk of postinjection infection. SUMMARY STATEMENT: A retrospective review of 5,233 consecutive intravitreal injections of bevacizumab (Avastin) revealed only a single case of acute endophthalmitis. Adherence to aseptic technique and the use of povidone-iodine prophylaxis minimizes the risk of postinjection intraocular infection.

Unusual presentation of gastric adenocarcinoma metastatic to the orbit.

A 69-year-old woman with no history of malignant disease presented with complaints of ptosis, diplopia, and left upper eyelid fullness. Computed tomography showed soft tissue infiltration of the left superior orbit. Biopsy was performed through an anterior orbitotomy. Histopathology revealed a mucinous adenocarcinoma. Subsequent systemic evaluation included esophagogastroduodenoscopy, which revealed a primary gastric malignancy.