RETINAL AND CHOROIDAL VASCULAR OCCLUSION FOLLOWING AQUEOUS MISDIRECTION SYNDROME IN A PATIENT WITH SICKLE CELL TRAIT.

PURPOSE: To report a patient with retinal and choroidal vascular occlusion as a presenting sign of sickle cell trait following the development of aqueous misdirection syndrome. METHODS: Retrospective chart review. RESULTS: A patient treated for bilateral chronic angle-closure glaucoma with sequential EX-PRESS glaucoma filtration device surgery developed sequential bilateral aqueous misdirection syndrome. The left eye developed retinal arterial and localized choroidal vascular occlusions subsequent to an acute elevation in intraocular pressure and possibly the use of oral acetazolamide. The patient was subsequently found to have sickle cell trait. The right eye developed aqueous misdirection with acute elevation of intraocular pressure as well, but the patient was not treated with oral acetazolamide and did not develop vascular occlusion. CONCLUSION: Retinal and choroidal vascular occlusions can be the presenting sign of a patient with sickle cell trait. Sickle cell screening may be beneficial in African American or Middle Eastern patients after an acute rise in intraocular pressure, particularly before initiation of treatment with oral carbonic anhydrase inhibitors.

Combined Central Retinal Vein and Branch Retinal Artery Occlusion Post Intense Physical Activity.

We report a case of combined central retinal vein occlusion and branch retinal artery occlusion. A previously healthy 47-year-old male presented with decreased vision in the right eye after completing a half marathon. A fundus exam and retinal imaging revealed a combined central retinal vein and branch retinal artery occlusion. In the present report, we review the literature and discuss the possible mechanisms behind combined retinal vessel occlusions. To our knowledge, this is the first reported case of combined central retinal vein occlusion and branch retinal artery occlusion following intense exercise.

Full-thickness macular hole formation associated with central serous chorioretinopathy.

PURPOSE: To report a case of full-thickness macular hole (FTMH) formation associated with central serous retinopathy (CSC). RESULTS: A 63-year-old woman with history of CSC diagnosed 8 years ago presented with vision loss. Clinical examination and optical coherence tomography found FTMH. Seven months following successful surgical repair of the macular hole, the patient presented with decreased vision, and was found to have CSC with closed macular hole. DISCUSSION: Based on the hydration theory of macular hole formation, CSC and the associated retinal pigment epithelium and choriocapillaris dysfunctions may promote the progression of FTMH.

Cilioretinal arteries in diabetic eyes are associated with increased retinal blood flow velocity and occurrence of diabetic macular edema.

PURPOSE: The main purpose was to investigate the relationship between occurrence of cilioretinal arteries and macular edema in diabetic eyes in terms of retinal blood flow characteristics revealed by the Retinal Function Imager (RFI). Other standard imaging techniques such as fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography/scanning laser ophthalmoscopy were also used along with the RFI. The additional purpose was to look for the evidence of cilioretinal-retinal collaterals using the RFI. METHODS: Patients with a diagnosis of diabetic retinopathy were included. All patients underwent fundus photography, fluorescein angiography, spectral-domain optical coherence tomography, and imaging using RFI. The presence of cilioretinal artery (CilRA) was recognized using color/red-free fundus photographs, fluorescein angiography, and RFI. There were two groups according to the presence (CilRA group) or absence (NoCilRA group) of cilioretinal artery or arteries in the study eye. RESULTS: Thirty-nine eyes with diabetic retinopathy were included. Cilioretinal artery was identified in 15 eyes (38%). In the CilRA group, spectral-domain optical coherence tomography evidence of macular edema was observed in 13 of 15 eyes (87%), whereas in the NoCilRA group, macular edema was observed on spectral-domain optical coherence tomography in 7 of 24 eyes (29%). Mean blood flow velocities in retinal arteries and veins were significantly higher in diabetic eyes with cilioretinal artery (P = 0.04 and P = 0.005, respectively). Mean blood velocity in cilioretinal arteries was significantly higher in comparison with the mean arterial blood velocity (P = 0.03). In the CilRA group, cilioretinal-retinal collaterals, assessed by RFI, were detected in 4 of 15 eyes (27%) with cilioretinal arteries. In the NoCilRA group, mean blood velocity in retinal veins was significantly higher in eyes with macular edema in comparison with those without macular edema (P = 0.03). CONCLUSION: Using the RFI in conjunction with standard fundus imaging techniques, the presence of cilioretinal artery in diabetic eyes was found to be associated with increased retinal blood flow velocity and increased occurrence of diabetic macular edema. The occurrence of cilioretinal-retinal collaterals was also noted; however, the pathophysiologic significance of this finding requires further investigation.

Comparative study of intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) in the treatment of neovascular age-related macular degeneration.

AIMS: To compare the safety and efficacy of 2 anti-vascular-endothelial-growth-factor agents - bevacizumab (Avastin) versus ranibizumab (Lucentis) - in the treatment of patients with neovascular age-related macular degeneration (AMD). METHODS: Retrospective analysis of patients who received intravitreal injections of bevacizumab or ranibizumab for neovascular AMD. Primary outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT) assessed by Spectral Domain scanning laser ophthalmoscope-optical coherence tomography (SD-OCT). A secondary outcome measure was the report of any adverse events in the 2 groups. RESULTS: The number of injections in the bevacizumab group was 184 (average of 4.7 per eye) compared to 187 in the ranibizumab group (average of 5.5 per eye). The mean logMAR equivalent of BCVA at 1 month after the injection improved by 0.18 in the bevacizumab group (p = 0.009) and by 0.13 in the ranibizumab group (p = 0.004). The average SD-OCT CFT decreased from 325 + or - 72 to 300 + or - 69 microm in the bevacizumab group (p = 0.016) and from 307 + or - 57 to 289 + or - 56 microm in the ranibizumab group (p = 0.017). In the bevacizumab group, there was 1 event of lower extremity pain (0.54%) and 1 event of increased arterial blood pressure (0.54%). In the ranibizumab group, there were 2 events of transiently increased intraocular pressure (1.1%) and 1 event (0.53%) of intraocular inflammation following injection. CONCLUSIONS: Bevacizumab and ranibizumab treatments resulted in similar gains in visual acuity and reduction in macular thickness, documented each month following injection. Intravitreal bevacizumab appears to be as safe and effective as intravitreal ranibizumab in the treatment of exudative AMD.

Argon laser peripheral iridoplasty for topiramate-induced bilateral acute angle closure.

PURPOSE: To report a case of a topiramate-induced bilateral acute angle closure that was treated successfully by argon laser peripheral iridoplasty (ALPI). METHODS: A 59-year-old healthy woman taking oral topiramate developed bilateral acute angle closure. B-scan ultrasonography, ultrasound biomicroscopy, and slit-lamp adapted ocular coherence tomography were performed. RESULTS: The patient had shallow anterior chambers and total angle closure for 360 degrees OU. Ocular imaging showed circumferential ciliochoroidal effusions with anterior displacement of the iris-lens diaphragm. ALPI relieved the angle closure. CONCLUSIONS: ALPI should be considered as initial therapy for topiramate-induced acute angle closure.