[Vogt-Koyanagi-Harada Syndrome : An unusual case with lacquer crack-like retinal findings]. / Vogt-Koyanagi-Harada-Syndrom : Ein ungewöhnlicher Fall mit lacksprungähnlichen Netzhautbefunden.

We report the case of a 35-year-old female patient with bilateral and recurrent panuveitis. Diagnosed with Vogt-Koyanagi-Harada syndrome, the patient was treated with corticosteroids, achieving rapid improvement of functional and morphological findings. After recovery of the exudative retinal detachment, peripapillary lacquer crack-like findings were observed.

Phacoemulsification and intraocular lens implantation in eyes with long axial length.

We evaluated the results of phacoemulsification and intraocular lens implantation in 414 eyes with long axial length and classified them according to axial length (AL): Group A: AL: 25-28 mm, Group B: AL >28 mm. Intraoperative maneuvers, pre- and postoperative photocoagulation for predisposing retinal lesions and retinal detachment rates were significantly higher in Group B than Group A. Eyes with an axial length over 28 mm are prone to more problems when compared to those with an axial length between 25 and 28 mm.

Choroidal neovascularization following photodynamic therapy in a patient with chronic central serous chorioretinopathy.

PURPOSE: To present the clinical features and treatment of subfoveal choroidal neovascularization complicating photodynamic treatment (PDT) performed for chronic central serous chorioretinopathy (CSC). METHOD: A 48-year-old healthy woman who had chronic visual deterioration in her right eye due to chronic CSC was treated with standard PDT protocol. RESULTS: Three weeks after the initial PDT, she experienced recovery in her vision and neurosensory detachment subsided clinically. However, six weeks after the PDT she returned with decreased visual acuity and metamorphopsia in the right eye. Fluorescein angiogram and optic coherence tomography delineated a classic subfoveal subretinal neovascular membrane. PDT was reperformed two more times, three months apart and closure of neovascular membrane was obtained. CONCLUSION: Choroidal neovascularization might have occurred during the natural course of disease process or as a consequence of PDT. PDT seems to be effective for treating the choroidal neovascularization complicating PDT performed for CSC.

Miliary tuberculosis and bilateral multifocal choroidal involvement: place of indocyanine green angiography.

PURPOSE: To present the clinical features and angiographic findings of choroidal involvement in two cases with miliary tuberculosis. METHODS: 49-year and 23-year-old men were hospitalized for fever of unknown origin and they received a diagnosis of miliary tuberculosis following the systemic work-up. Both cases experienced mild visual acuity disturbances prior to initiation of systemic treatment. They underwent full ophthalmological examination including fluorescein and indocyanine green angiography. RESULTS: The visual acuity of first case was 20/30 in OD, and 20/25 in OS. There was trace of cells in the anterior chamber and mild vitritis OU. Visual acuity of the second case was 20/20 OU. Anterior segment was unremarkable OU. Ophthalmoscopy of both cases showed cream-colored patchy choroidal infiltrations especially located at the posterior pole OU. Fluorescein and indocyanine green angiographies were obtained with Heidelberg scanning laser ophthalmoscope. These lesions were hypofluorescent in early phases of fluorescein angiography and demonstrated gradually increased hyperfluorescence in late phases. Same lesions were hypofluorescent throughout the indocyanine green angiography and well delineated. Both patients received a systemic treatment of isoniazid, rifampicin, ethambutol and morphazinamide. Most of the choroidal lesions resolved without apparent changes whereas some healed as chorioretinal scars. CONCLUSION: In patients with miliary tuberculosis, indocyanine green angiography seems to show choroidal involvement much better than the fluorescein angiography and may be a more important diagnostic tool than fluorescein angiography during the disease course.

Staining of intraocular lenses with various dyes: a study of digital image analysis.

PURPOSE: To evaluate the interaction of various intraocular lens (IOL) materials with commonly used dyes. MATERIALS AND METHODS: One IOL of each of the five groups (polymethylmethacrylate, silicone, three-piece hydrophobic acrylic, single-piece hydrophobic acrylic and single-piece hydrophilic acrylic) was bathed in trypan blue 0.1%, fluorescein sodium 2% and indocyanine green (ICG) 0.5% for 15 min. Digital photographs of the IOLs were obtained prior to bathing and after the 15-min bath in each dye. The same IOLs were immersed in the same dye for another 15 min and digital images were reobtained to depict the 30-min dye uptake. New IOLs from the group that exhibited visible colour change after the 15-min bath were then bathed in twofold dilution and if there was still visible dye uptake, fourfold dilution was performed, repeating the 15-min bath and digital photography. The images were then processed using Adobe Photoshop 5.1 to get mean luminosity and red-green-blue values. These values were compared between the groups and the undyed control. Also, dye washout was observed in serum-containing vials. RESULTS: None of the polymethylmethacrylate, silicone and hydrophobic acrylic IOLs were stained with the dyes used. The only IOL material that changed colour was hydrophilic acrylic and did so with all dyes. The most marked colour change was with fluorescein sodium 2%, the least was with trypan blue 0.05%. Twofold dilution of trypan blue and fourfold dilutions of fluorescein sodium and ICG still stained the hydrophilic acrylic IOL; however, fourfold dilution of trypan blue did not cause a significant colour change. Trypan blue washed out within 6 h, while the IOL stained with ICG remained stained for longer than 24 h. COMMENT: Hydrophilic acrylic IOLs should be used with caution together with dyes since this material demonstrates marked dye uptake and washout may also take some time.

Colour Doppler assessment of blood flow in eyes with central retinal vein occlusion.

PURPOSE: To assess the blood flow changes in eyes with central retinal vein occlusion (CRVO) and compare these values with values of fellow eyes and eyes of normal subjects. METHODS: 25 eyes of 25 consecutive newly diagnosed patients with CRVO comprised the study group. Their fellow eyes and those of 25 healthy subjects were the control group. All patients underwent a complete ophthalmological examination. Eyes with CRVO were classified into two groups as non-ischaemic and ischaemic by fundus fluorescein angiography. Colour Doppler imaging was performed with a Toshiba Sonolayer SSH-140A and 7.5-MHz linear array probe. Maximum systolic velocity (V(max)), end-diastolic velocity (V(min)) and resistive index (R(i)) values were noted for each of the central retinal artery (CRA), central retinal vein (CRV) and ophthalmic artery (OA). These parameters were compared with those of the fellow eyes and both eyes of the control group. RESULTS: Mean ages were 63.55 and 61.45 years in the CRVO and control groups, respectively. Age and sex distributions were statistically identical in both groups. When we compared the eyes with CRVO to the control group, no statistically significant difference existed between the two groups with regard to the V(min) and R(i )values of the CRA and CRV. However, V(max ) values of the CRA and CRV were significantly lower in CRVO eyes when compared to the control group. The CRVO group and control group had similar V(max), V(min ) and R(i) values for the OA. Only the V(max) was significantly lower in the CRV in eyes with CRVO when compared to the unaffected fellow eyes. No statistically significant difference could be detected between any of the parameters of CRA, CRV and OA of the ischaemic and non-ischaemic CRVO groups. CONCLUSIONS: More data on broader series need to be obtained in order to decide on the practical use of colour Doppler imaging in the differentiation of ischaemic eyes from non-ischaemic eyes in CRVO.

Preserved human amniotic membrane transplantation in the treatment of primary pterygium.

BACKGROUND AND OBJECTIVE: To assess the outcome of simple excision with preserved human amniotic membrane transplantation in the treatment of primary pterygium. PATIENTS AND METHODS: A total of 59 eyes with primary pterygium underwent surgical excision. In Group 1, 28 eyes were treated with simple excision and preserved human amniotic membrane transplantation. In Group 2, 31 eyes were treated with bare sclera excision. These two groups were compared in recurrence, final appearance of the operation site, and complications. Patients were followed for at least 10 months. RESULTS: During a mean follow up of 14.9 months, we observed 3 (10.7%) recurrences in Group 1 and 20 (38.7%) recurrences in Group 2 (P:0.03). In Group 1, 20 (71.4%) eyes and 14 (45.2%) eyes in Group 2 had a satisfactory final operation site appearance (P:0.041). No serious complication was observed in both groups. CONCLUSION: Simple excision and preserved human amniotic membrane transplantation appears to be a safe and effective way of treating primary pterygium because of the lack of serious complications and a relatively low rate of recurrence.

Orbital varices: imaging findings and the role of color Doppler sonography in the diagnosis.

The orbital varices are infrequent intraorbital masses, which cause intermittent, positional exophthalmos. They have low venous pressure inside which causes difficulties in detection by routine protocols of nearly all imaging modalities. Color Doppler sonography is a simple procedure that can easily detect orbital varices which avoids further evaluation in non-complicated patients. We report the imaging findings of a case of orbital varix and discuss the role of color Doppler sonography in the diagnosis and follow-up.

Retinal breaks and rhegmatogenous retinal detachment in association with branch retinal vein occlusion.

BACKGROUND AND OBJECTIVE: To report the incidence and clinical characteristics of retinal breaks and/or rhegmatogenous retinal detachment (RRD) in patients with branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: We reviewed the clinical records of 230 eyes of 214 patients with BRVO and identified eyes with retinal breaks and/or RRD. Patients had at least 6 months of follow-up. RESULTS: Seven of 230 eyes (3%) had retinal breaks and 3 eyes (1.3%) had RRD. One of the eyes with RRD had subclinical retinal detachment. All 7 eyes had ischemic disease documented by fluorescein angiography. Two of 7 eyes had concurrent retinal neovascularization. Four eyes with breaks, but without RRD, and the eye with subclinical RRD were managed by argon green laser. Two eyes with RRD were managed successfully with scleral buckling surgery and postoperative supplemental argon green laser. The mean follow-up period was 14.8 +/- 8.3 months. CONCLUSIONS: Patients with BRVO should be monitored closely for possible retinal break formation and RRD development.

Neurofibromatosis type I and unilateral ophthalmic artery occlusion.

Etiological investigation of a 15-year-old boy with left ophthalmic artery occlusion led us to a diagnosis of neurofibromatosis type I as there were numerous large cafe-au-lait spots, axillary freckling, and brain MRI changes consistent with a hamartoma. In light of the present case, ophthalmic artery occlusion may be a rare feature of neurofibromatosis type I besides more commonly described cerebrovascular changes.

Pars plana vitrectomy with pars plana tube implantation in eyes with intractable glaucoma.

AIMS: Intractable glaucoma is glaucoma resistant to medical therapy and conventional surgical procedures. In this study, a planned surgical technique is discussed for controlling the increased intraocular pressure in selected cases with intractable glaucoma. METHODS: Total pars plana vitrectomy with pars plana tube implantation was performed in 17 eyes of 17 cases with intractable glaucoma. Patients with neovascular glaucoma were not included in this study. The mean age of these patients (seven men, 10 women) was 44.6 (SD 22.1) years and mean follow up period was 30.3 (15.5) months (range 4-71). Drainage implants with a disc were used in 16 cases, whereas, a tube with scleral buckle (Schocket surgery) was preferred in one case. An intraocular pressure below or equal to 20 mm Hg without any adjunctive medication or with only one type of antiglaucomatous drop was considered as an adequate operative outcome. RESULTS: 16 out of 17 eyes maintained adequate pressure control. Only three out of these 16 eyes required prophylactic antiglaucomatous medications. One patient underwent reoperation for pressure control. The most severe complications observed postoperatively were intravitreal haemorrhage (one case), choroidal detachment (one case), implant failure (one case), total retinal detachment (two cases), and corneal endothelial decompensation (five cases). CONCLUSION: Pars plana placement of drainage tube following pars plana vitrectomy should be considered as an alternative method for controlling increased intraocular pressures in selected patients with intractable glaucoma.

Butterfly-like pattern dystrophy and unilateral choroidal neovascularization.

PURPOSE: To report a case with butterfly-like pattern dystrophy and unilateral subretinal neovascular membrane. RESULTS: We examined a 62-year-old woman with occult subretinal neovascular membrane in the right eye and butterfly-like yellowish figure in the retina confined to the posterior pole in the left eye. Electro-oculogram was subnormal bilaterally. Her 32-year-old daughter also had hypopigmented bilateral macular changes with subnormal electro-oculogram. CONCLUSION: This case demonstrates a rare complication of subretinal neovascular membrane formation in butterfly-like pattern dystrophy.

Combined central retinal artery and vein occlusion in a child with systemic non-Hodgkin's lymphoma.

PURPOSE: To report on a case of systemic non-Hodgkin's lymphoma and unilateral combined central retinal artery and vein occlusion. METHOD: We examined a 14-year-old boy who experienced a sudden unilateral visual loss five months after the initial diagnosis of systemic non-Hodgkin's lymphoma. RESULT: Visual loss was due to combined central retinal artery and vein occlusion in association with tumoral optic nerve involvement. CONCLUSION: Although very rare systemic non-Hodgkin's lymphoma may present with central retinal artery and vein occlusion prior to overt central nervous system involvement.

Macular hole formation in Bietti's crystalline retinopathy. A case report.

Three years after the initial diagnosis, a 21-year-old healthy man with Bietti's crystalline retinopathy developed unilateral stage 4 macular hole with surrounding macular detachment. The mechanism of macular hole formation, which may or may not be a feature of Bietti's crystalline dystrophy, is not clear.

Bilateral megalocornea with unilateral lens subluxation.

Megalocornea refers to an enlarged cornea that measures 13 mm or more in horizontal diameter in the absence of raised intraocular pressure. We describe a five-month-old boy with bilateral megalocornea with unilateral lens subluxation. No other ophthalmological abnormality was present. In all previously reported cases with megalocornea and ectopia lentis, the lens was cataractous and the dislocation was in the inferior and posterior direction. In contrast, our case had a clear lens which was displaced superonasally.