Progressive outer retinal necrosis associated with occlusive vasculitis in acquired immunodeficiency syndrome.

A 45-year-old man, a case of acquired immunodeficiency syndrome, received a highly active antiretroviral therapy at the outpatient service for 4 years without regular follow-up. He experienced progressively blurred vision for 6 months and a cutaneous zoster on his back 3 months ago. He was diagnosed with progressive outer retinal necrosis by polymerase chain reaction-restriction fragment length polymorphism using an aqueous humor sample, which revealed an existence of varicella zoster virus. He was given a combination of systemic, intravitreal antiviral and a highly active antiretroviral therapy. Occlusive vasculitis, an unusual finding for progressive outer retinal necrosis, developed in both eyes 1 week after the secondary intravitreal injection. Unfortunately, his vision deteriorated to no light perception in both eyes within 2 weeks. Progressive outer retinal necrosis is characterized clinically as showing minimal or no inflammation in the aqueous and vitreous humors, absence of retinal vasculitis, and patches of yellowish spots located deep in the retina. Physicians should pay attention to this rare case of progressive outer retinal necrosis associated occlusive vasculitis with very poor prognosis in spite of aggressive treatment.

Visual performance after excimer laser photorefractive keratectomy for high myopia.

PURPOSE: To evaluate the efficacy, safety, predictability, and visual performance of excimer laser photorefractive keratectomy (PRK) for myopia greater than -8 diopters (D). METHODS: Fifty-four patients (104 eyes) with myopia from -8D to -13D and cylinder up to -4D received surface ablation technique with the Allegretto wave version 1009-1 excimer laser to correct their refractive error. The patients were examined on days 1, 3, 7, and 14 and 1, 3, 6, and 12 months postoperatively. Visual acuity, manifest refraction, corneal haze, topography, intraocular pressure, contrast sensitivity, and wavefront aberration were evaluated. RESULTS: Twelve months postoperatively, 95% of eyes were within 1D of the intended correction. In addition, 94% of eyes had attained uncorrected distance visual acuity of 20/25 or better, and 98% of eyes had improved or remained their corrected distance visual acuity. All eyes exhibited barely detectable corneal haze which peaked during the 1st month with a gradual reduction in the 3rd month. Ninety-five percent of patients had no or only mild degree of night glare. CONCLUSIONS: Excimer laser PRK is an effective and predictive treatment for high myopia greater than -8D with or without astigmatism up to -4D. The incidence of complication is low. All patients who are candidates for laser in situ keratomileusis can be candidates for surface ablation, especially those with preoperative thinner cornea or higher risk of corneal flap complications.

Long-term efficacy of half-dose photodynamic therapy on chronic central serous chorioretinopathy.

BACKGROUND: To evaluate the long-term efficacy and complications of half-dose photodynamic therapy (PDT) for treating chronic central serous chorioretinopathy (CSC). METHODS: A retrospective, interventional case series of patients with chronic CSC (symptoms ≧3 months) receiving half-dose PDT (3 mg/m(2) verteporfin). Optical coherence tomography, fundus short-wave autofluorescence and near-infrared autofluorescence (SW-AF and NIR-AF) were taken at each visit. Central foveal thickness (CFT) and relative CFT (RCFT) were measured manually. Outcome measures included best-corrected visual acuity (BCVA), resolution of subretinal fluid (SRF), CFT and RCFT, and changes of SW-AF and NIR-AF. RESULTS: 56 eyes of 56 patients (45 male and 11 female patients; mean age 45 years) were included in this study. The anatomic resolution was obtained in 100% at 1 year and at the last follow-up, respectively. Four cases developed recurrence of SRF after one session of PDT. The mean session of PDT was 1.00. The mean follow-up was 55.5 months. Final CFT and RCFT showed a positive correlation with final BCVA. Complications included enlargement of retinal pigment epithelial atrophy in one case and choroidal neovascularisation in another two cases at 12 and 14 months after PDT. CONCLUSIONS: PDT with half-dose verteporfin has a long-term efficacy and safety profile in chronic CSC. However, complications may still happen despite the reduced dosage. TRIAL REGISTRATION NUMBER: The CCH IRB No. 131007.

Nonparaneoplastic autoimmune retinopathy presenting with peripheral retinal vasoocclusion: case report.

PURPOSE: To report a case of nonparaneoplastic autoimmune retinopathy presenting with severe peripheral retinal vasoocclusion. METHODS: Interventional case report. CASE REPORT: A 44-year-old woman complained of blurred vision and photopsia in both eyes. She has no history of cancer or autoimmune disease. Best-corrected visual acuity was 20/40 in the left eye and 20/30 in the right eye. Constriction of the visual field sparing central vision was found. Fluorescein angiography revealed severe peripheral retinal vasoocclusion, panretinal degeneration, and cystoid macular edema. Optical coherence tomography demonstrated intraretinal fluid. Electroretinography showed decreased amplitude of a- and b-waves in both scotopic and photopic tests. The implicit time was generally within normal limits. The amplitude of flicker response was also diminished. Multifocal electroretinography showed declined signal all over the macular region. Systemic workup including whole body positron emission tomography/computed tomography for cancer screening showed negative results. Only antirecoverin antibody was positive. Under the impression of nonparaneoplastic autoimmune retinopathy, systemic and local immunosuppressive therapy was given and showed improvement. CONCLUSION: Nonparaneoplastic autoimmune retinopathies are uncommon retinal degenerations with visual loss associated with unique clinical symptoms and findings and with serum antiretinal autoantibodies. Severe peripheral retinal vasoocclusion was not reported. Early detection and timely treatment with immunosuppression could result in clinical improvement.

Different refractive errors in triplets with retinopathy of prematurity treated with bevacizumab.

The authors report refractive errors possibly resulting from intravitreal bevacizumab injection. Triplet A presented with stage 3 retinopathy of prematurity, was treated with intravitreal bevacizumab, and high refractive errors were noted. Triplet B presented with stage 2 retinopathy of prematurity in the right eye and stage 3 retinopathy of prematurity in the left eye, which regressed spontaneously. Triplet C presented with stage 2 retinopathy of prematurity in the right eye and stage 3 retinopathy of prematurity in the left eye, which were treated with intravitreal bevacizumab.

Scleral fixation intraocular lens as a barrier for silicone oil in traumatic aphakia, aniridia, and recurrent retinal detachment:case report.

PURPOSE: We report a patient with recurrent retinal detachment complicated with traumatic aniridia and aphakia, which was successfully managed by scleral fixation polymethyl methacrylate posterior chamber intraocular lens (PMMA PCIOL) and vitrectomy with silicon oil tamponade. METHOD: Interventional case report. RESULTS: A 35-year-old man with traumatic aniridia, aphakia, and recurrent retinal detachment who received the combined surgery of scleral fixation PMMA PCIOL and vitrectomy with silicon oil tamponade. The patient had favorable visual outcome. The retina was reattached and the cornea remained clear without silicon oil in the anterior chamber after 1 year. CONCLUSION: The scleral fixation PMMA PCIOL can retain the silicone oil in the vitreous cavity for reattaching the retina and can also protect the corneal endothelium from contact with the silicone oil in the case of aniridia, aphakia, and retinal detachment.