Chorioretinal Lesions Presumed Secondary to Zika Virus Infection in an Immunocompromised Adult.

IMPORTANCE: Zika virus has spread rapidly throughout the Americas since 2015. The public health implications of Zika virus infection lend special importance to identifying the virus in unsuspected hosts. OBJECTIVE: To describe relevant imaging studies and clinical features of chorioretinal lesions that are presumably associated with Zika virus and that share analogous features with chorioretinal lesions reported in cases of Dengue fever and West Nile virus. DESIGN, SETTING, AND PARTICIPANTS: This is a case report from an academic referral center in Miami, Florida, of a woman in her 60s from Guaynabo, Puerto Rico, who presented with reduced visual acuity and bilateral diffuse, subretinal, confluent, placoid, and multifocal chorioretinal lesions. The patient was observed over a 5-month period. MAIN OUTCOMES AND MEASURES: Visual acuity, clinical course, and multimodal imaging study results. RESULTS: Fluorescein angiography revealed early hypofluorescence and late staining of the chorioretinal lesions. Optical coherence tomography demonstrated outer retinal disruption in the placoid macular lesions. Zika RNA was detected in a plasma sample by real-time reverse transcription polymerase chain reaction testing and was suspected to be the cause of chorioretinal lesions after other viral and infectious causes were ruled out. Three weeks after the onset of symptoms, the patient's visual acuity had improved to 20/60 OD and 20/25 OS, with intraocular pressures of 18 mm Hg OD and 19 mm Hg OS. In 6 weeks, the chorioretinal lesions had healed and visual acuity had improved to 20/25 OD and 20/20 OS. Follow-up optical coherence tomography demonstrated interval recovery of the outer retina and photoreceptors. CONCLUSIONS AND RELEVANCE: Acute-onset, self-resolving, placoid, or multifocal nonnecrotizing chorioretinal lesions may be a feature of active Zika virus chorioretinitis, as reported in other Flavivirus infections in adults. Similar findings in potentially exposed adults suggest that clinicians should consider IgM antibody or polymerase chain reaction testing for Zika virus as well as diagnostic testing for Dengue fever and West Nile virus.

Comparison of intravitreal bevacizumab followed by ranibizumab for the treatment of neovascular age-related macular degeneration.

PURPOSE: To compare outcomes after switching from intravitreal bevacizumab (Avastin) to ranibizumab (Lucentis) in patients with neovascular age-related macular degeneration (AMD). METHODS: A retrospective review was performed of patients with neovascular AMD who were switched from treatment with intravitreal bevacizumab to intravitreal ranibizumab once ranibizumab became commercially available. All reviewed patients had at least three bevacizumab injections before being switched to ranibizumab. The treatment outcomes included comparisons of visual acuity and dosing frequency while receiving both drugs. RESULTS: Eighty-four eyes met the inclusion criteria. Mean baseline visual acuity was 20/100. Mean duration of bevacizumab treatment was 7.1 months followed by 7.3 months with ranibizumab (P = 0.68). Best-obtained visual acuity during treatment was 20/63 with bevacizumab and 20/63 with ranibizumab (P = 0.5). Last mean visual acuity after receiving bevacizumab at the time of the first ranibizumab injection was 20/80. Mean visual acuity at the last ranibizumab follow-up visit was 20/80 (P = 0.49). Mean injection rates per month while receiving bevacizumab and ranibizumab were 0.66 (P = 0.98). CONCLUSION: In this subset of patients with neovascular AMD switched from bevacizumab to ranibizumab therapy, there were no apparent differences in visual acuity outcomes or injection rates. Larger prospective studies are under way to directly compare these drugs for the treatment of neovascular AMD.

Safety and efficacy of intravitreal bevacizumab (avastin) for the management of branch and hemiretinal vein occlusion.

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin, Genentech) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and hemiretinal vein occlusion (HRVO). METHODS: A retrospective review was performed of consecutive patients treated with intravitreal bevacizumab (1.25 mg) for ME secondary to BRVO/HRVO from May 2005 to August 2006 with follow-up through February 2007. Re-treatment was performed at monthly or longer intervals at the discretion of the treating physician. RESULTS: Fifty-two eyes with a BRVO and 13 eyes with an HRVO received intravitreal bevacizumab at baseline. Visual acuity improved by a mean of 12 letters at 1 month (n = 51; P < 0.001), 13 letters at 3 months (n = 61; P < 0.001), 13 letters at 6 months (n = 42; P < 0.001), 14 letters at 9 months (n = 27; P < 0.001), and 15 letters at 12 months (n = 17; P = 0.015). The mean optical coherence tomography (OCT) thickness decreased by 184 microm (P < 0.001), 131 microm (P < 0.001), 161 microm (P < 0.001), 158 microm (P = 0.002), and 205 microm (P = 0.002) at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. The mean number of injections was 1.4, 2.1, 2.7, and 3.1, and 3.3 at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. No ocular or systemic adverse events were observed. CONCLUSION: Improvements in visual acuity and OCT outcomes were observed during the first year after intravitreal bevacizumab in patients with ME secondary to BRVO and HRVO.

Long-term safety and efficacy of intravitreal bevacizumab (Avastin) for the management of central retinal vein occlusion.

PURPOSE: To evaluate the long-term safety and efficacy of intravitreal bevacizumab injections (Avastin, Genentech Inc., San Francisco, CA) for the treatment of macular edema secondary to central retinal vein occlusions. METHODS: A retrospective review was performed of eyes treated from May 2005 to August 2006 with follow-up through February 2007. The dose of bevacizumab was 1.25 mg (0.05 mL). Retreatment was performed at monthly or longer intervals at the discretion of the treating physician. RESULTS: Fifty-seven eyes received intravitreal bevacizumab at baseline. Visual acuity improved by a mean of 14 letters (N = 53; P < 0.001) at 1 month, 13 letters at 3 months (N = 53; P < 0.001), 9 letters at 6 months (N = 30; P = 0.001), 9 letters at 12 months (N = 17; P = 0.004). The mean optical coherence tomography thickness decreased by 299 microm at 1 month (N = 53; P < 0.001), 144 microm at 3 months, (N = 53; P < 0.001), 127 microm at 6 months (N = 30; P = 0.011), and 276 microm at 12 months (N = 17; P < 0.001). No ocular or systemic adverse events were observed. CONCLUSION: Improvements in visual acuity and optical coherence tomography were observed during the first year following intravitreal bevacizumab for macular edema secondary to central retinal vein occlusions. These retrospective results provide additional evidence to support the perceived safety and efficacy of intravitreal bevacizumab in this disorder.

Bilateral optic disc edema in patients with severe systemic arterial hypertension: clinical features and visual acuity outcomes.

BACKGROUND AND OBJECTIVE: To report clinical features and visual outcomes in patients with bilateral optic disc edema and severe systemic arterial hypertension. PATIENTS AND METHODS: Records were reviewed of patients with bilateral optic disc edema, severe arterial hypertension, and 3 or more months of follow-up evaluated at Bascom Palmer Eye Institute between 1982 and 2003. RESULTS: Sixteen patients (median age = 41 years; median follow-up = 31 months) were identified. Median blood pressure on initial eye examination was 220 mm Hg systolic and 126 mm Hg diastolic. Among all study eyes, median visual acuity was 20/55 on presentation. At the last follow-up examination, an acuity of 20/50 or better was achieved in 20 (63%) eyes; 12 (75%) patients achieved a final acuity of 20/50 or better in at least one eye. Posterior segment abnormalities at last follow-up included disc pallor (n = 16), macular star (n = 7), retinal pigment epithelial atrophy (n = 7), epiretinal membrane (n = 5), branch retinal vein occlusion (n = 4), and persistent disc edema (n = 2). Causes of final acuity of less than 20/50 included optic atrophy, epiretinal membrane, serous retinal detachment, macular hole, and branch retinal vein occlusion. CONCLUSION: Most patients with bilateral optic disc edema and severe arterial hypertension maintained visual acuity of 20/50 or better in at least one eye.

Foldable versus rigid intraocular lenses in conjunction with pars plana vitrectomy and other vitreoretinal procedures.

PURPOSE: To compare the results of foldable acrylic intraocular lens (IOL) implantation through a clear corneal incision with those of rigid IOL implantation in eyes having pars plana vitrectomy (PPV). SETTING: Tertiary referral-based university institute. METHODS: A consecutive retrospective comparative chart review was performed in all eyes that had PPV and foldable IOL implantation between May 15, 1999, and November 1, 2000 (n = 30), and all eyes that had PPV and rigid IOL implantation between April 1, 1996, and May 14, 1999 (n = 30). Preoperative baseline data and postoperative outcome data were recorded. Pars plana vitrectomy and associated vitreoretinal procedures were performed as indicated according to individual circumstances. A minimum of 1 week of follow-up information was available for all eyes. RESULTS: Baseline characteristics in both groups of patients, including age, sex, eye involved, and phakic state, were similar. The preoperative visual acuities were also similar, ranging from 20/30 to hand motions; the mean visual acuity was 20/200. The IOL was implanted in all eyes uneventfully and did not restrict fundoscopy. The mean follow-up was significantly longer in the rigid IOL group (20 months) than in the foldable IOL group (7 months) (P<.001), probably because of the earlier case acquisition. The mean postoperative best corrected visual acuity was 20/200 in the foldable IOL group and 20/100 in the rigid IOL group. There was no difference between the 2 groups in the rate of postoperative retinal detachment, recurrent macular hole, or repeat PPV. Elevated intraocular pressure (IOP) on the first postoperative day was more common in the rigid IOL group than in the foldable IOL group (P =.078) because more patients in the rigid IOL group had surgery for diabetic ocular complications and these patients had a greater IOP rise. CONCLUSION: Acrylic IOLs can be safely implanted in conjunction with PPV in selected cases.

Diagnosis by polymerase chain reaction of ocular posttransplant lymphoproliferative disorder after pediatric renal transplantation.

PURPOSE: To report diagnosis by polymerase chain reaction of intraocular posttransplant lymphoproliferative disorder in a pediatric renal transplant patient. DESIGN: Observational case report. METHODS: Retrospective review. RESULTS: An 11-year-old girl developed infectious mononucleosis 15 months after renal transplantation for focal segmental sclerosis. Papillitis and hypopyon uveitis developed 8 months later, followed by iris nodules. Diagnosis of intraocular posttransplant lymphoproliferative disorder was made by polymerase chain reaction of aqueous humor for Epstein-Barr virus and confirmed by histopathology of an iris biopsy specimen. Infiltrating iris lymphocytes in the biopsy specimen were positive for Epstein-Barr DNA. Polymerase chain reaction also revealed gene rearrangement of the variable region of the heavy immunoglobulin chain, consistent with a monoclonal B-lymphocyte population. Iris nodules resolved with reduction in immunosuppressive medication. CONCLUSION: Polymerase chain reaction for Epstein-Barr virus may be helpful in diagnosis of intraocular posttransplant lymphoproliferative disorder.