A video study of drop instillation in both glaucoma and retina patients with visual impairment.

PURPOSE: To compare self-administration of drops in both visually impaired glaucoma subjects and retina subjects. DESIGN: Prospective, observational study. SETTING: Distinct glaucoma and retina practices. STUDY POPULATION: Subjects with glaucoma or retinal diseases with visual acuity of 20/60 or worse in 1 eye, significant field loss, or both. OBSERVATION PROCEDURES: Subjects were video recorded self-instilling a drop onto the worse eye. MAIN OUTCOME MEASURE: Proper instillation of eye drop onto ocular surface. RESULTS: We included 409 subjects (205 glaucoma, 204 retina). Differences between the groups included the following: glaucoma subjects included fewer females (P = .05), included fewer white persons (P < .005), had worse visual acuity (P < .005), had less self-reported arthritis (P < .05), were younger (P < .005), and had more previous exposure to drop use (P < .005). Glaucoma subjects had more bilateral impairment (60% vs 42%; P < .0005). Retina subjects instilled more drops (1.7 vs 1.4; P = .02) and more frequently touched the bottle to the eye (47% vs 33%; P = .003). Of subjects claiming not to miss the eye, nearly one third from each group (P = .32) actually missed. Approximately one third of each group could not get a drop onto the eye (30% retina vs 29% glaucoma; P = .91). Among subjects placing 1 drop onto the eye without touching the adnexae, there was a trend for glaucoma patients to perform better, although both groups did poorly (success, 39% glaucoma vs 31% retina; P = .09). CONCLUSIONS: Among visually impaired subjects, regardless of cause, drop administration was a problem. Both groups wasted drops, contaminated bottles, and had inaccurate perception of their abilities. This has implications for future therapeutic delivery systems.

Nodular sclerochoroidopathy simulating choroidal malignancy.

A 55-year-old man who had multiple subretinal and choroidal yellowish lesions and episcleral nodules for 1.5 years was diagnosed as having nodular sclerochoroidopathy after developing classic features of posterior scleritis with choroidal and serous retinal detachment. Long-term therapy with steroids in combination with mycophenolate mofetil resulted in regressed posterior scleritis and nodular lesions, as well as improved visual acuity. Nodular sclerochoroidopathy should be suspected in patients with subretinal and choroidal lesions and should be distinguished from choroidal neoplasm.

Reduction of intraocular pressure with anecortave acetate in eyes with ocular steroid injection-related glaucoma.

OBJECTIVE: To evaluate the intraocular pressure (IOP)-lowering potential of anecortave acetate (AA) in eyes with steroid-related ocular hypertension inadequately controlled with the maximal tolerated or appropriate medical therapy. DESIGN: Uncontrolled case series. METHODS: A total of 8 eyes of 7 subjects with medically uncontrolled IOP following intravitreal or sub-Tenon injections of triamcinolone acetonide were included. All received an 0.8-mL anterior juxtascleral depot of 3% AA solution (24 mg) under topical anesthesia. The IOP was assessed weekly for the first month, then monthly for a minimum of 1 year. RESULTS: The mean baseline IOP was 39.9 mm Hg. After 1 week, the mean IOP decreased 12 mm Hg (29%; P = .005) and by 1 month, the mean IOP had decreased 14.1 mm Hg (34.5%; P = .003) from baseline. Four eyes required surgical intervention despite a decrease in IOP because of markedly elevated initial IOP and the degree of preexisting glaucomatous optic neuropathy. We observed no adverse events. CONCLUSIONS: An anterior juxtascleral depot of AA lowers IOP substantially in some eyes with medically uncontrolled steroid-related ocular hypertension. Further study is warranted to clarify the role of AA in treating this condition as well as other forms of glaucoma.