Retinal neovascularization in the setting of CALR-mutation positive essential thrombocythemia.

Patients with Calreticulin (CALR) mutation positive essential thrombocythemia are often thought of as having a "low-risk" of thrombotic complications. This report examines a case of a patient with CALR-mutation positive essential thrombocythemia presenting with peripheral retinal ischemia and subsequent retinal neovascularization. This patient had a 2-year documented history of CALR-mutation positive essential thrombocythemia with a maximum platelet count of over 800,000 cells/µL. Fluorescein angiogram showed significant leakage in the areas of the vascular lesions with peripheral vascular nonperfusion consistent with neovascularization. The patient was treated with photocoagulation to the areas of avascular retina. At 6-month follow-up, some regression of neovascularization was noted with no signs of progression in the retinopathy. Furthermore, essential thrombocythemia patients can present with neovascularization secondary to retinal ischemia due to microvascular thrombotic events. Identification of these changes is important for guiding medical and procedural interventions in order to preserve vision.

Intravitreal Adalimumab in Active Noninfectious Uveitis: A Pilot Study.

PURPOSE: To evaluate the short-term efficacy of intravitreal adalimumab (IVA) for the treatment of eyes with active noninfectious uveitis. METHODS: Consecutive eyes with active noninfectious uveitis were injected with IVA at 0, 2, then every 4 weeks for total of 26 weeks. RESULTS: Six out of 7 patients (12 of 13 eyes) completed 26 weeks of treatment. One patient (1 eye) failed treatment. Seven out of 12 eyes had improvement of ≥2 ETDRS lines. Three out of three eyes had resolution of anterior chamber cells. And 9 of 10 eyes with vitreous haze had zero haze at 26 weeks. Five out of 8 eyes with macular edema had complete resolution. Median fluorescein angiography score improved from 14 to 4 on last follow-up. CONCLUSIONS: IVA was effective in controlling the inflammation, decreasing the macular edema, and improving the best corrected visual acuity in the majority of eyes in this series.

Uveitis in the Aging Eye: Incidence, Patterns, and Differential Diagnosis.

Uveitis is a vision threatening inflammation of the eye that carries considerable morbidity. It is responsible for 10% of legal blindness in the United States and up to 25% in the developing world. Uveitis in patients more than 60 years of age is less common. The aging body has a changing response of the immune system, which might reflect a different pattern of uveitis in the elderly population. In this paper we review the incidence and patterns of uveitis in the elderly as reported in the literature and discuss changes with time. We also delineate a thorough differential diagnosis of de novo uveitis in the elderly.

One-step transepithelial photorefractive keratectomy with mitomycin C as an early treatment for LASIK flap buttonhole formation.

PURPOSE: To assess the efficacy and safety of early one-step transepithelial photorefractive keratectomy (PRK) with mitomycin C as treatment for buttonhole formation during LASIK. METHODS: Eight patients who developed a buttonhole during LASIK with mechanical or femtosecond flap creation underwent one-step transepithelial PRK a few days after the formation of the buttonhole. The re-treatment procedure was performed after complete epithelial healing and smooth epithelial fluorescein profile were ensured. Postoperative manifest refraction, uncorrected and corrected distance visual acuity, and haze formation were assessed during 6 months of follow-up. RESULTS: Mean duration of the re-treatment procedure after buttonhole formation was 5 days (range: 4 to 7 days). Mean manifest refractive spherical equivalent and cylinder refraction were -0.05 ± 0.18 and -0.18 ± 0.22 diopters, respectively, at 6 months postoperatively. Uncorrected distance visual acuity was 20/20 in all patients after 3 months of follow-up. No haze formation was detected. CONCLUSIONS: Early one-step transepithelial PRK with mitomycin C seems to be a safe and effective treatment for LASIK buttonhole complication.