Choroidal ruptures after adjuvant intravitreal injection of bevacizumab for aggressive posterior retinopathy of prematurity.

In recent times, laser treatment combined with intravitreal bevacizumab (Avastin) has been used rarely as early investigations to treat patients with aggressive posterior retinopathy of prematurity (ROP). We describe choroidal ruptures that were documented at 10 weeks after this combined treatment in a preterm infant born at 28 weeks gestation with a birth weight of 1190 g. Aggressive posterior ROP was diagnosed at the age of 6 weeks. Initial treatment included bilateral laser ablation, followed immediately by intravitreal bevacizumab (IVB, 0.75 mg) in the right eye. On day 5, a remarkable regression of plus sign and fibrovascular proliferation was noted only in the right eye. At this point, additional laser treatment combined with IVB was given in the left eye, which dramatically resolved plus disease and neovascularization. At 10 weeks after IVB in the left eye, two sites of choroidal ruptures were revealed along the posterior edges of laser scars. There was no evidence of choroidal neovascularization associated with the choroidal ruptures. Choroidal rupture may occur shortly after laser ablation plus IVB treatment for aggressive posterior ROP. This occurrence requires recognition to determine whether it is actually related to the treatment. Long-term follow-up is important for understanding the nature and progression of this potentially serious complication.

Value of electrodiagnostic assessment in nonsyndromic microcephaly.

PURPOSE: To evaluate the value of electroretinogram (ERG) and visual evoked potentials (VEP) in children with nonsyndromic microcephaly. METHODS: In this observational case series, six children with nonsyndromic microcephaly aged 8.5 to 158 months were examined. Main outcome measures included the amplitude of the flash ERG (photopic, flickering, scotopic, and dark-adapted responses), the amplitude and latency of the VEP (flash or pattern-reversal stimulus), visual acuity, slit-lamp biomicroscopy, and indirect ophthalmoscopy. RESULTS: Three children demonstrated normal fundus appearances, ERG, and VEP responses: two in this group demonstrated poor vision and brain computed tomography in the third showed schizencephaly. The remaining three children demonstrated abnormal ERG with predominant reduction in photopic amplitudes. Retinal pigmentary granularities were detected in two children in this group, one of whom has poor vision, generalized brain atrophy, and 40% reduction in VEP amplitudes. CONCLUSIONS: Abnormal ERG is not uncommon among children with nonsyndromic microcephaly. Although cone photoreceptors are affected more than rods, this does not anticipate poor vision. It appears that defects in posterior visual pathway or developmental malformations of the brain should be responsible for poor visual function in nonsyndromic microcephaly.

Neodymium:YAG laser damage threshold of foldable intraocular lenses.

PURPOSE: To determine the energy level of the neodymium:YAG (Nd:YAG) laser that induced a 50% incidence of intraocular lens (IOL) damage in 5 foldable IOL materials. SETTING: Department of Ophthalmology, Siriraj Hospital Mahidol University, Bangkok, Thailand. METHODS: To simulate the condition within the capsular bag, an IOL was sandwiched between 2 rubber membranes. The front membrane had a central opening mimicking the anterior capsulotomy; the back membrane acted as the posterior capsule. The model was submerged in a water-filled chamber. The Nd:YAG laser with an automatic focus 150 microm beyond the focus of the aiming beam was used to perform a posterior capsulotomy. Three IOLs of each of 5 foldable IOL materials were tested. One type of poly(methyl methacrylate) (PMMA) was studied as a reference. The incidence of IOL damage at various energy levels was recorded. Linear regression analysis was used to determine the 50% incidence damage threshold. RESULTS: The 6 materials tested included 1 silicone lens (SI-40NB, AMO), 1 hydrophobic acrylic lens (MA60BM, Alcon), 3 hydrophilic acrylic lenses (Haptibag Ang, IOLtech; ACR6D, Corneal; H60M, Bausch & Lomb), and 1 PMMA lens (LX10BD, Alcon). The 50% incidence damage threshold values were 0.37 mJ, 0.54 mJ, 0.58 mJ, 0.52 mJ, 0.66 mJ, and 0.68 mJ, respectively. CONCLUSIONS: The 50% incidence damage threshold in all the IOLs was below the energy level normally used to perform a posterior capsulotomy in clinical practice. However, setting the laser at the lowest possible energy, focusing the laser beam beyond the posterior capsule, and performing the capsulotomy early should minimize the risk of IOL damage.

Uveitis in a child: masquerade syndrome revisit.

We present a case of relapsing acute lymphoblastic leukemia (ALL) in the anterior chamber, uveitis masquerade syndrome, which was confirmed by anterior chamber paracentesis and aqueous fluid cytology. Three months previously, the patient developed anterior uveitis without hematologic relapse. The uveitis responded well to topical steroid. After anterior chamber paracentesis, bone marrow relapse was detected. High doses of chemotherapy were prescribed. Ocular radiation was planned but the patient developed septicemia and expired. In our opinion, paracentesis should be performed without delay when uveitis develops in ALL, regardless of systemic relapse. Ocular manifestation may be the only sign of leukemic relapse or may present several months prior to systemic relapse.

Surgical management of nondiabetic vitreous hemorrhage.

Sixty-one patients (62 eyes) with vitreous hemorrhage were studied. None were associated with diabetic retinopathy or perforating injuries and all required surgical treatment. The patients had dense vitreous hemorrhage with preoperative visual acuity of counting finger or worse in 55 eyes (88.7%). After the operation, a final visual acuity of 6/60 or better was found in 32 eyes (51.6%). The common causes of vitreous hemorrhage were subretinal neovascularization, blunt trauma, branch retinal vein occlusion, post-cataract extraction, retinal detachment with tears, and retinal vasculitis. There was no association between the postoperative visual outcome and either the preoperative visual acuity or the duration of vitreous hemorrhage. The pathological change at the macular area was the main factor which influenced the visual outcome.