Retinal pigment epithelial tear following intravitreal injection of bevacizumab (Avastin).

PURPOSE: To report one case of retinal pigment epithelium tear following intravitreal bevacizumab injection for neovascular age-related macular degeneration. METHODS: A 59-year-old patient presented with occult choroidal neovascularization associated with a serous pigment epithelial detachment secondary to age-related macular degeneration. The patient was treated with an intravitreal injection of bevacizumab. RESULTS: The patient developed a retinal pigment epithelium tear 60 days following the intravitreal injection. CONCLUSIONS: This report describes the development of retinal pigment epithelium tear after intravitreal bevacizumab injection. Future studies should be performed to evaluate which subtypes of lesions are most susceptible to this potential devastating visual complication.

Intravitreal triamcinolone acetonide as primary treatment for diffuse diabetic macular edema: a prospective noncomparative interventional case series.

PURPOSE: To evaluate the efficacy and safety of one intravitreal injection of 25 mg of triamcinolone acetonide as primary treatment for diffuse diabetic macular edema. METHODS: Intravitreal triamcinolone acetonide injection was performed in 30 eyes with previously untreated diabetic macular edema. The main outcome measures were logMAR visual acuity (VA) and central macular thickness (CMT) at 1, 3, and 6 months. A secondary outcome was intraocular pressure progression. RESULTS: Visual acuity results for 30 eyes that had a follow-up of at least 6 months are presented. Twenty of them were followed up to 10.1+/-2.38 months. Preoperatively, VA was 0.54+/-0.27. At 1, 3, and 6 months follow-up, VA was 0.44+/-0.29 (p=0.001), 0.43+/-0.28 (p=0.001), and 0.45+/-0.29 (p=0.006), respectively. Preoperatively, CMT was 417.3+/-143.5 microm. At 1, 3, and 6 months follow-up, CMT was 277.3 +74.0 microm (p<0.0001), 279.6+/-94.4 microm (p<0.0001), and 297.07+/-114.87 microm (p=0.002), respectively. For the 20 eyes with a follow-up of 10.1+/-2.38 months, VA was 0.5+/-0.25 and 0.50+/-0.32 at baseline and at the last follow-up visit, respectively (p>0.05). Preoperatively, intraocular pressure (IOP) was 15.13+/-1.48 mmHg. IOP was 18.26+/-2.71 mmHg, 20.07+/-4.27 mmHg, and 20.4+/-6.18 mmHg, at 1, 3, and 6 months, respectively (p<0.0001). Four eyes underwent uncomplicated filtrating surgery for intractable glaucoma. CONCLUSIONS: Intravitreal triamcinolone as primary treatment effectively increases VA and reduces CMT due to diffuse diabetic macular edema. Longer follow-up and randomized clinical trial are warranted. Safety results highlight the need to further study the relationship between triamcinolone and intraocular pressure.

Intravitreal triamcinolone acetonide as primary treatment for diffuse diabetic macular edema: A prospective noncomparative interventional case series.

PURPOSE: To evaluate the efficacy and safety of one intravitreal injection of 25 mg of triamcinolone acetonide as primary treatment for diffuse diabetic macular edema. METHODS: Intravitreal triamcinolone acetonide injection was performed in 30 eyes with previously untreated diabetic macular edema. The main outcome measures were logMAR visual acuity (VA) and central macular thickness (CMT) at 1, 3, and 6 months. A secondary outcome was intraocular pressure progression. RESULTS: Visual acuity results for 30 eyes that had a follow-up of at least 6 months are presented. Twenty of them were followed up to 10.1+/-2.38 months. Preoperatively, VA was 0.54+/-0.27. At 1, 3, and 6 months follow-up, VA was 0.44+/-0.29 (p=0.001), 0.43+/-0.28 (p=0.001), and 0.45+/-0.29 (p=0.006), respectively. Preoperatively, CMT was 417.3+/-143.5 micronm. At 1, 3, and 6 months follow-up, CMT was 277.3 +74.0 micronm (p<0.0001), 279.6+/-94.4 micronm (p<0.0001), and 297.07+/-114.87 micronm (p=0.002), respectively. For the 20 eyes with a follow-up of 10.1+/-2.38 months, VA was 0.5+/-0.25 and 0.50+/-0.32 at baseline and at the last follow-up visit, respectively (p>0.05). Preoperatively, intraocular pressure (IOP) was 15.13+/-1.48 mmHg. IOP was 18.26+/-2.71 mmHg, 20.07+/-4.27 mmHg, and 20.4+/-6.18 mmHg, at 1, 3, and 6 months, respectively (p<0.0001). Four eyes underwent uncomplicated filtrating surgery for intractable glaucoma. CONCLUSIONS: Intravitreal triamcinolone as primary treatment effectively increases VA and reduces CMT due to diffuse diabetic macular edema. Longer follow-up and randomized clinical trial are warranted. Safety results highlight the need to further study the relationship between triamcinolone and intraocular pressure. (Eur J Ophthalmol 2006; 16: 129-33).

Branch retinal artery occlusion combined with branch retinal vein occlusion in a patient with hepatitis C treated with interferon and ribavirin.

PURPOSE: To report a case of a combined branch retinal artery and vein occlusion in a patient with hepatitis C treated with interferon and ribavirin. METHODS: A 29-year-old man with a 1-week history of sudden visual field defect and decrease of central visual acuity was examined. RESULTS: Ophthalmoscopy and fluorescein angiography demonstrated an ischemic whitening of the inferior hemi-retina involving part of the macular region, numerous intraretinal hemorrhages, and a significant delay in arterial and vein filling of the dye. CONCLUSIONS: The findings of a retinopathy associated with interferon and ribavirin treatment of hepatitis C are important. The symptomatic permanent visual field defect and decrease of central visual acuity developing following a branch retinal artery and vein occlusion event emphasizes the need for careful and regular ocular monitoring of patients receiving interferon for hepatitis C.

Molecular genetics of autosomal dominant retinitis pigmentosa (ADRP): a comprehensive study of 43 Italian families.

Retinitis pigmentosa is the most common form of retinal degeneration and is heterogeneous both clinically and genetically. The autosomal dominant forms (ADRP) can be caused by mutations in 12 different genes. This report describes the first simultaneous mutation analysis of all the known ADRP genes in the same population, represented by 43 Italian families. This analysis allowed the identification of causative mutations in 12 of the families (28% of the total). Seven different mutations were identified, two of which are novel (458delC and 6901C-->T (P2301S), in the CRX and PRPF8 genes, respectively). Several novel polymorphisms leading to amino acid changes in the FSCN2, NRL, IMPDH1, and RP1 genes were also identified. Analysis of gene prevalences indicates that the relative involvement of the RHO and the RDS genes in the pathogenesis of ADRP is less in Italy than in US and UK populations. As causative mutations were not found in over 70% of the families analysed, this study suggests the presence of further novel genes or sequence elements involved in the pathogenesis of ADRP.

Intravitreal triamcinolone in the treatment of serous pigment epithelial detachment and occult choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: To report two cases of occult choroidal neovascularization (CNV) and serous pigment epithelial detachment (PED) treated with intravitreal triamcinolone (IVT) injections. METHODS: Interventional case reports. RESULTS: Both patients showed an increase in visual acuity and a complete flattening of the PED at 10 months (Case 1) and 4 months (Case 2) after IVT injections. No complications or adverse effects are reported. CONCLUSIONS: Future studies should be designed to investigate if IVT can effectively influence the clinical and functional outcome of eyes with serous PED and occult CNV secondary to age-related macular degeneration, for which at the moment no treatment has been shown to be effective.

Multiple bilateral choroidal metastatic tumors from a small-cell neuroendocrine carcinoma of unknown primary site.

PURPOSE: To report one case of multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary. METHODS: The case of a 30-years-old white female who developed multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary is presented. RESULTS: The patient had a disseminated disease and died 6 months after. The oncologic work-up, including physical examination, laboratory and radiographic study, fails to identify the primary site. CONCLUSIONS: Intraocular involvement from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary has not yet reported. We describe this case together with a review of the literature.

Multiple bilateral choroidal metastatic tumors from a small-cell neuroendocrine carcinoma.

PURPOSE: To report one case of multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary. METHODS: The case of a 30-years-old white female who developed multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary is presented. RESULTS: The patient had a disseminated disease and died 6 months after. The oncologic work-up, including physical examination, laboratory and radiographic study, fails to identiy the primary site. CONCLUSIONS: Intraocular involvement from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary has not yet reported. We describe thic case together with a review of the literature. (Eur J Ophthalmol 2005; 15: 148-52).

Branch retinal artery occlusion combined with branch retinal vein occlusion in a patient with hepatitis C treated with interferon and ribavirin.

PURPOSE: To report a case of a combined branch retinal artery and vein occlusion in a patient with hepatitis C treated with interferon and ribavirin. METHODS: A 29-year-old man with a 1-week history of sudden visual field defect and decrease of central visual acuity was examined. RESULTS: Ophthalmoscopy and fluorescein angiography demonstrated an ischemic whitening of the inferior hemi-retina involving part of the macular region, numerous intraretinal hemorrhages, and a significant delay in arterial and vein filling of the dye. CONCLUSIONS: The findings of a retinopathy associated with interferon and ribavirin treatment of hepatitis C are important. The symptomatic permanent visual field defect and decrease of central visual acuity developing following a branch retinal artery and vein occlusion event emphasizes the need for careful and regular ocular monitoring of patients receiving interferon for hepatitis C.

Intravitreal triamcinolone in the treatment of serous pigment epithelial detachment and occult choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: To report two cases of occult choroidal neovascularization (CNV) and serous pigment epithelial detachment (PED) treated with intravitreal triamcinolone (IVT) injections. METHODS: Interventional case reports. RESULTS: Both patients showed an increase in visual acuity and a complete flattening of the PED at 10 months (Case 1) and 4 months (Case 2) after IVT injections. No complications or adverse effects are reported. CONCLUSIONS: Future studies should be designed to investigate if IVT can effectively influence the clinical and functional outcome of eyes with serous PED and occult CNV secondary to age-related macular degeneration, for which at the moment no treatment has been shown to be effective.

Choroidal hemangioma treated with photodynamic therapy using verteporfin: report of a case.

PURPOSE: To report the results of treatment of circumscribed choroidal hemangioma with a single application of photodynamic therapy (PDT) with verteporfin according to the Treatment of Age-related Macular Degeneration with Photodynamic Therapy study. METHODS: A 44-year-old man with unilateral decreased vision and macular subretinal fluid secondary to a circumscribed choroidal hemangioma diagnosed by fluorescein and indocyanine green angiography and ultrasonography underwent PDT with verteporfin therapy. RESULTS: One year after PDT, subretinal fluid was absent and visual acuity improved. CONCLUSIONS: The results obtained in this case are in keeping with previously reported results; however, future randomized studies are necessary to evaluate and standardize different infusion times in order to obtain maximum efficacy of treatment.

A human placental polydeoxyribonucleotide (PDRN) may promote the growth of human corneal fibroblasts and iris pigment epithelial cells in primary culture.

The optimal concentration of a human placental polydeoxyribonucleotide (PDRN) preparation (100 microg/ml) enhances the growth of human corneal fibroblasts in primary culture depending upon the donor age. In particular, this effect is very consistently reproducible with donors over 60 years of age (p = 0.0028), suggesting a selective benefit of PDRN in the tissue culture of senescent cells. Moreover, this drug may promote the development of human iris pigment epithelium (IPE) cells with much lower concentrations of fetal bovine serum than those suitable for the culture of IPE. Lastly, the use of a 'gauze disk' on the pieces of the corneal explants improves the efficiency of growth of the control fibroblast primary cultures.

The mixed leukocyte reaction may promote the growth of human pericorneal fibroblasts in primary culture.

Keratitis of the cornea is believed to be the leading cause of loss of vision due to external eye disease in the United States and in Europe. At present, primary and secondary cell cultures obtained from corneal explants are the most suitable system to study the role of drug-resistant viruses in severe recurrences of infections leading to irreversible corneal scarring. In this work, the growth of human pericorneal fibroblasts in primary and secondary cultures has been obtained by cocultivation with a mixed leukocyte reaction.

Grid laser treatment of occult choroidal neovascularization in age related macular degeneration.

Laser photocoagulation treatment of occult choroidal neovascularization (CNV) in age related macular degeneration has been up to now discouraging. We report a randomized clinical trial comparing 'grid' laser treatment versus the natural course in 24 eyes with this kind of neovascularization. In 12 eyes a low energy scatter photocoagulation was applied to the areas of presumed CNV and abnormal retinal pigment epithelium, sparing the fovea. The follow-up ranged from 1 to 3 years. At the three months follow-up visit, the subretinal exudation appeared reduced in 40% of the treated eyes and in none of the control eyes. During the period of follow-up the occult CNV turned to classic CNV in 4 treated and in 4 untreated eyes. At the last examination (average follow-up 18 months), anatomical and functional conditions were not significantly different in the two groups. Our data fail to show a beneficial long-term effect of grid laser treatment for occult CNV; no iatrogenic complications were seen in our series.

Fundus angiography with fluorescein-labelled peptide fraction from bovine factor VIII: correlation with histologic findings.

A peptide fraction (VUEFFE) obtained from bovine factor VIII, with a high affinity for vessel endothelium, was bound to fluorescein and used for angiography in rabbits. Several eyes had undergone laser photocoagulation on the retina. The location of the dye was studied histologically with fluorescence microscopy on the enucleated, freeze-dried eyes. The angiographic and histologic findings were compared with findings obtained using sodium fluorescein. Fluorescein-labelled VUEFFE gave a longer lasting fluorescence of the retinal vessels with histologic evidence of dye deposition on the vessel wall. It also showed marked affinity for the photocoagulated tissues, giving intense and prolonged staining of the laser burns. Possible clinical applications are discussed.

A new therapeutical approach to central serous retinopathy, a hypothesis.

The authors report two cases of patients affected by Central Serous Retinopathy (C.S.R.) lasting few days; they were immediately started with an antiviral therapy (Acycloguanosine) for few days and in both cases the regression of symptoms and a flat retina were observed after a very shorter time than the spontaneous course. A fluorescein angiography confirmed a healing of the leaking points very few days after the therapy was discontinued. The authors discuss their finding in relation to the latest hypothesis on C.S.R. pathogenesis.

[New occult choroidal vessels in age-related macular degeneration]. / Néovaisseaux choroïdiens occultes au cours de la dégénérescence maculaire liée à l'âge.

We studied the clinical characteristics and the natural course of occult choroidal new vessels (CNV) in 78 eyes with age-related macular degeneration (AMD). Cases were included in 2 groups characterized respectively by ill-defined subretinal ooze (group 1) and serous detachment of the retinal pigment epithelium (RPE) with adjacent areas of mottled pigmentation (group 2). Both these forms of occult CNV showed to have a slower evolution compared to the classic CNV occurring in AMD, but they also led to disciform scar and severe visual loss. Occult CNV of group 2, contrary to those of group 1, were often multifocal and extrafoveal. They had a greater tendency to hemorrhages and a faster and less gradual progression to fibrovascular scarring and visual loss. Fluorescein angiography showed choroidal filling delay in the macular region of 47% of eyes of group 1. A perfusion defect of the macular choroid could be the basis of the low perfusion pressure and the consequent low activity of CNV with the angiographic pattern of ill-defined ooze.