Acute Myopic Shift after a Single Dose of Acetazolamide: A Case Report and Review of the Literature.

We report the case of a 32-year-old male who presented with an acute myopic shift as a result of uveal effusion following a single administration of 250 mg acetazolamide. The drug was discontinued and following cycloplegia and topical steroid therapy, we observed progressive deepening of the anterior chamber, reopening of the iridocorneal angle, and complete resolution of the myopic shift after 5 days. A literature review since 1956 identified 23 cases, including ours, which developed a myopic shift after a median time of 24 h (3 - 24) following a median dose of 500 mg (125 - 1000) acetazolamide, with about a third complicated by angle closure ocular hypertension. This presumed idiosyncratic reaction can occur without prior drug exposure and independent of the phakic status. Treatment options include systematic drug withdrawal associated with cycloplegia, anti-glaucomatous agents, and/or corticosteroids. Full recovery is achieved within about 5 days (2 - 14). Given the widespread use of acetazolamide, awareness of this idiosyncratic reaction is crucial to avoid complications of acute angle-closure glaucoma.

Glaucoma Drainage Device Surgery Outcomes in Children With Uveitic Glaucoma.

PURPOSE: To evaluate outcomes of glaucoma drainage device (GDD) implantation children with uveitic glaucoma. DESIGN: Retrospective interventional case series. METHODS: Success was defined as intraocular pressure (IOP) ≥5 and ≤21 mm Hg. Failure was defined at final follow-up when the IOP was outside the success criterion, and visual function was no perception of light or if further glaucoma surgery (excluding removal of intraluminal stent suture or needling) was required. RESULTS: Fifty eyes of 36 children with uveitic glaucoma underwent GDD implantation. Mean age at surgery was 10.1±3.1 years (range 5-17) with a mean follow-up of 113±61 months (range 8-228). Mean cumulative probabilities of success (95% CI) were 0.98 (0.86-1.00) at 1 year, 0.87 (0.73-0.94) at 5 years, and 0.59 (0.32-0.78) at 15 years. Fourteen tubes were classified as failed, with 12 due to uncontrolled IOP (11 eyes required a second GDD); 1 eye, removal of the tube due to plate exposure; and 1 eye, lost light perception. Postoperative complications occurred in 36% of patients and included hypotony (22%), tube exposure (6%), tube obstruction (4%), corneal decompensation (2%), and cystoid macular edema (2%). Visual acuity remained stable (preoperation 0.35±0.42 vs postoperation 0.45±0.67, P = .49). IOP was significantly reduced from 31.4±7.5 mm Hg to 14.4±5.1 mm Hg (P < .0001) as were the number of glaucoma medications 3.5±1.0 vs 1.1±1.3 (P < .0001). CONCLUSIONS: Refractory pediatric uveitic glaucoma can be treated successfully by GDD implantation. Further interventions to manage consequences of glaucoma or the underlying disease are common, and visual function is maintained in the majority of cases.

Simultaneous Penetrating Keratoplasty and Implantation of a New Scleral-Fixated, Sutureless, Posterior Chamber Intraocular Lens (Soleko, Carlevale): A Novel Technique.

PURPOSE: To describe a novel technique of combined penetrating keratoplasty (PKP) with implantation of a new scleral-fixated, sutureless, posterior chamber intraocular lens (PC-IOL) (Soleko, Carlevale). METHODS: New surgical approach description. RESULTS: We describe a novel technique for the management of PKP graft failure and posttraumatic aphakia with repeat-PKP and simultaneous implantation of a new scleral-fixated, sutureless PC-IOL. The postoperative course was uneventful, and the patient reported marked improvement in his vision. Up to 6 months postoperatively, the graft showed no signs of failure or rejection, the intraocular lens remained well-positioned, and no complications were observed. CONCLUSIONS: The favorable final outcome of our patient suggests that simultaneous PKP and implantation of this new scleral-fixated, sutureless PC-IOL may represent an efficient and effective method for the management of aphakia combined with corneal scarring.

Emerging roles for antiangiogenesis factors in management of ocular disease.

The first antivascular endothelial growth factor (anti-VEGF) was developed as an anticancer drug for colonic carcinomas. Since then, anti-VEGFs have developed in scope and indications. They have revolutionized the treatment of exudative macular degeneration and have had a major impact on treatment of several other conditions. This has resulted in an increased number of patients seeking treatment with new treatment options and has had a considerable financial impact on health care resources. Anti-VEGFs have been used in the treatment of all age groups of the population ranging from infants where it is used for treatment of retinopathy of prematurity to the elderly where it is used in exudative macular eegeneration.