Pan retinal photocoagulation for proliferative diabetic retinopathy: pattern scan laser versus argon laser.

PURPOSE OF REVIEW: Diabetic retinopathy is the leading cause of visual impairment in working-age adults worldwide. Pan retinal photocoagulation (PRP) has provided an effective treatment to decrease the risk of severe vision loss in patients with proliferative diabetic retinopathy for the past four decades. Pattern scan laser (PASCAL) was developed to minimize the side effects of PRP. The purpose of this review is to discuss the differences between the traditional argon laser and the PASCAL. RECENT FINDINGS: PASCAL can achieve comparable results with the conventional argon PRP in the treatment of patients with diabetic retinopathy. The PASCAL delivery system creates well aligned arrays of retinal lesions in a shorter period. PASCAL provides amore comfortable profile when compared to the argon laser. SUMMARY: The PASCAL is now being substituted for the conventional argon laser for PRP in many clinics. Ophthalmologists should keep in mind that adjusting the PASCAL settings (including the duration, number, and size of laser burns) might become necessary to maintain regression and eliminate recurrence of neovascularization in patients with proliferative diabetic retinopathy. Further studies are needed to determine the parameters for optimal safety and efficacy on the PASCAL.

HEMORRHAGIC OCCLUSIVE RETINAL VASCULITIS AFTER INTRACAMERAL VANCOMYCIN USE IN CATARACT SURGERY AFTER INTRAVENOUS EXPOSURE.

PURPOSE: To report a case of hemorrhagic occlusive retinal vasculitis after cataract surgery. METHODS: A 74-year-old woman presented with blurry vision and distorted vision, which started 2 days after an uncomplicated cataract surgery in the left eye. Intracameral vancomycin was injected during the case. The patient reported being treated with systemic vancomycin in the past. RESULTS: The visual acuity was 20/80 in the left eye. She had trace cells in the anterior chamber with no hypopyon and intraocular lens implant within the capsular bag in the left eye. Dilated fundus examination revealed no vitritis, There were large patches of peripheral retinal hemorrhages and retinal ischemia. The patient was diagnosed with hemorrhagic occlusive retinal vasculitis likely secondary to hypersensitivity reaction to intracameral vancomycin. The patient was started on oral prednisone, and the topical difluprednate course was escalated. Within 3 weeks, vision improved to 20/30 in the left eye. She underwent pan retinal photocoagulation targeting the ischemic areas in the periphery. CONCLUSION: The patient had previous exposure to systemic vancomycin, which may have sensitized her immune system. Later on, the hypersensitivity reaction took place after exposure to intracameral vancomycin during cataract surgery. Our hemorrhagic occlusive retinal vasculitis case had a favorable visual outcome, and recognition of this entity will ensure that vancomycin will not be used for infection prophylaxis in the fellow eye at the time of cataract surgery.

Relationship between optical coherence tomography retinal parameters and visual acuity in diabetic macular edema.

PURPOSE: To investigate the relationship between optical coherence tomography (OCT)-derived measurements of retinal morphology and visual acuity in patients with diabetic macular edema. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: A total of 67 consecutive patients (67 eyes) with diabetic macular edema (DME) who underwent Stratus OCT imaging (Carl Zeiss Meditec, Inc., Dublin, CA). METHODS: Best-corrected Snellen visual acuity was recorded for each patient. Raw exported Stratus OCT images for each patient were analyzed using custom software entitled "OCTOR," which allows the precise positioning of prespecified boundaries on individual B-scans. Thickness, volume, and intensity were calculated for neurosensory retina and subretinal fluid. In addition, photoreceptor outer segment (POS) thickness was quantified. MAIN OUTCOME MEASURES: Optical coherence tomography-derived measurements of retinal morphology and visual acuity. RESULTS: The Spearman coefficient values (r) of the correlation between OCTOR-derived measurements of central subfield thickness, intensity, subretinal fluid volume, and POS thickness and the logarithm of the minimum angle of resolution visual acuities were 0.3428 (P = 0.005), -0.2658 (P = 0.03), -0.2683 (P = 0.38), and -0.3703 (P = 0.002), respectively. Multivariate models with stepwise selection revealed a cumulative R(2) of 0.4305 in the total study population, with R(2) of 0.4999 and 0.7628 in the untreated and prior focal laser groups, respectively. CONCLUSIONS: Subanalysis and quantification of OCT features in eyes with DME seem to be of value. In particular, POS thickness seems to be an important predictor of function and visual acuity in patients with DME.

Correlation of Fourier domain optical coherence tomography retinal nerve fiber layer maps with visual fields in nonarteritic ischemic optic neuropathy.

BACKGROUND AND OBJECTIVE: To correlate peripapillary retinal nerve fiber layer (NFL) loss and visual field defects in nonarteritic ischemic optic neuropathy (NAION). PATIENTS AND METHODS: Patients with NAION and control subjects were enrolled in a case-control study. Participants were scanned with a Fourier domain optical coherence tomography (OCT) system. Peripapillary NFL thickness was averaged in hemispheric, quadrant, and octant divisions. Standard achromatic static perimetry was used to assess visual fields. RESULTS: The reproducibility of peripapillary NFL parameters was excellent in both the healthy and NAION groups. Eyes in the NAION group showed a significant decrease of peripapillary NFL thickness in terms of the overall average, all quadrant averages, and all octants. There were statistically significant correlations between the peripapillary NFL and visual fields in terms of both overall averages and superior-inferior differences. CONCLUSION: In NAION, the visual field and peripapillary NFL losses are correlated in both severity and location. Fourier domain OCT provides reproducible measurement of the peripapillary NFL and may be useful in the assessment of NAION.

BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION: A CASE REPORT.

PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) in the setting of metastatic ovarian cancer. METHODS: In this observational case report, a 59-year-old woman presented with bilateral worsening vision and photophobia. She had been diagnosed with metastatic ovarian cancer 5 years prior for which she received Tamoxifen. Ophthalmic examination was completed followed by fluorescein angiography and optical coherence tomography (Spectralis OCT; Heidelberg Engineering). RESULTS: The visual acuity was 20/150 in both eyes. Exam demonstrated an iris pigmented lesion in the right eye, bilateral nuclear sclerotic cataracts, multiple orange lesions in the fundus, elevated pigmented uveal melanocytic tumors with diffuse choroidal thickening and multifocal early hyperfluorescence of these lesions (giraffe-like pattern) on fluorescein angiography, and exudative retinal detachment on OCT. The patient was diagnosed with BDUMP in the setting of metastatic ovarian carcinoma. Further metastatic workup demonstrated enlarged lymphadenopathy in the right axilla and inguinal regions. The patient declined chemotherapy and was initiated on plasmapheresis. CONCLUSIONS: BDUMP is a peculiar paraneoplastic syndrome in the setting of metastatic ovarian cancer, where antigens from the retinal pigment epithelium, iris and choroidal melanocytes cross-react with ovarian tumor cell antibodies that are circulating in the serum. Plasmapheresis can decrease the concentrations of the antibodies, maintain reasonable functional vision and improve the quality of life.

Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom.

PURPOSE: To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom. METHODS: Fundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count. RESULTS: Eighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities. CONCLUSIONS: Based on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome.

Delayed bilateral fibrinous anterior chamber reaction following autologous bone marrow transplant and cataract surgery.

PURPOSE: Immune reconstitution uveitis (IRU) is a well-described phenomenon that by definition occurs in patients with AIDS who undergo highly active antiretroviral therapy resulting in a rebound inflammatory response to the presence of clinically latent cytomegalovirus (CMV). We hypothesize that similar phenomena may exist in other cohorts who undergo transient immunosuppression with rapid white blood cell count recovery. OBSERVATIONS: A patient developed rebound inflammation a few months after cataract surgery with intraocular lens placement characterized by photophobia, significant anterior chamber cell and fibrinous deposits. She had a history of multiple myeloma treated with chemotherapy and a recovery of white blood cell counts following autologous bone marrow transplant. She underwent a thorough work-up for infectious etiologies, as well as the presence of intraocular CMV, which were negative. Her vision and symptoms improved to baseline with the use of topical steroids and at one year her exam remained stable. CONCLUSIONS AND IMPORTANCE: With a negative work-up for infectious etiologies, and the timing and clinical presentation, the patient's inflammation was likely the result of rapid white blood cell count recovery following iatrogenic immunosuppression similar to the mechanism described for IRU.

Idiopathic retinal vasculitis, aneurysms and neuroretinitis case report.

PURPOSE: To report a case of idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) in a young woman. OBSERVATIONS: A 21-year-old white female patient was referred to retina clinic with decreased vision in the left eye. On examination, best corrected visual acuity was 20/20 in the right eye and counting fingers in the left eye. Fundus examination revealed bilateral optic disc edema, peripapillary and macular exudates, retinal arterial aneurysms, and venous beading. In the left eye, there was a large focus of exudative material in the central macula. Examination of the peripheral retina was unremarkable, bilaterally. Fluorescein angiography demonstrated arterial aneurysms and venous beading in both eyes, with optic nerve activity and vascular sheathing noted on late frames in both eyes. In the left eye, there was a large central area of blockage corresponding to hard exudates surrounding a more central area of hyperfluorescence with leakage, representing retinal neovascularization. Review of systems and extensive laboratory workup were negative. The patient was diagnosed with IRVAN. She was observed, and her exam at 6-month follow-up revealed low grade inflammation for which the patient was started on oral prednisone. CONCLUSIONS AND IMPORTANCE: Management of IRVAN remains challenging because of its idiopathic nature and the lack of controlled clinical trials for such a rare entity. Bilateral involvement in IRVAN is variable and close follow up is crucial.

Facilitating Glaucoma Diagnosis With Intereye Retinal Nerve Fiber Layer Asymmetry Using Spectral-Domain Optical Coherence Tomography.

PURPOSE: To test whether increased intereye retinal nerve fiber layer (RNFL) asymmetry may be indicative of glaucoma. To determine the best statistical methods and intereye RNFL cutoffs for differentiating between normal and glaucoma subjects to better alert clinicians to early glaucomatous damage. METHODS: Sixty-six primary open-angle glaucoma (OAG) and 40 age-matched normal subjects had both eyes imaged at the Massachusetts Eye and Ear Infirmary with a commercially available spectral-domain optical coherence tomography (OCT) machine. Statistical methodologies were used to find cutoffs that achieved the best sensitivities and specificities for differentiating OAG from normal subjects. RESULTS: Intereye RNFL asymmetry for global average, all quadrants, and all sectors was significantly greater in OAG than normal subjects. Intereye RNFL asymmetry for global average showed the greatest statistical difference (P<0.001) between OAG (23.64 ± 14.90 µm) and normal eyes (3.58 ± 3.96 µm), with 6.60 times greater asymmetry in OAG eyes. The inferior quadrant showed the second greatest difference, with 3.91 times greater asymmetry in OAG eyes. Using a statistically determined cutoff of 6.0 µm as abnormal, intereye RNFL asymmetry for global average achieved a sensitivity of 74.24% and specificity of 90% in differentiating between normal and OAG subjects, achieving a better combination of sensitivity and specificity than intereye RNFL asymmetry of any quadrant or sector. CONCLUSIONS: Intereye RNFL asymmetry may be a useful clinical OCT measurement to provide quantitative assessment of early glaucomatous damage. Newly developed algorithms for intereye RNFL asymmetry may improve the ability to detect glaucoma.

Characterization of Choroidal Layers in Normal Aging Eyes Using Enface Swept-Source Optical Coherence Tomography.

PURPOSE: To characterize qualitative and quantitative features of the choroid in normal eyes using enface swept-source optical coherence tomography (SS-OCT). METHODS: Fifty-two eyes of 26 consecutive normal subjects were prospectively recruited to obtain multiple three-dimensional 12 x 12 mm volumetric scans using a long-wavelength high-speed SS-OCT prototype. A motion-correction algorithm merged multiple SS-OCT volumes to improve signal. Retinal pigment epithelium (RPE) was segmented as the reference and enface images were extracted at varying depths every 4.13 µm intervals. Systematic analysis of the choroid at different depths was performed to qualitatively assess the morphology of the choroid and quantify the absolute thicknesses as well as the relative thicknesses of the choroidal vascular layers including the choroidal microvasculature (choriocapillaris, terminal arterioles and venules; CC) and choroidal vessels (CV) with respect to the subfoveal total choroidal thickness (TC). Subjects were divided into two age groups: younger (<40 years) and older (≥ 40 years). RESULTS: Mean age of subjects was 41.92 (24-66) years. Enface images at the level of the RPE, CC, CV, and choroidal-scleral interface were used to assess specific qualitative features. In the younger age group, the mean absolute thicknesses were: TC 379.4 µm (SD ± 75.7 µm), CC 81.3 µm (SD ± 21.2 µm) and CV 298.1 µm (SD ± 63.7 µm). In the older group, the mean absolute thicknesses were: TC 305.0 µm (SD ± 50.9 µm), CC 56.4µm (SD ± 12.1 µm) and CV 248.6µm (SD ± 49.7 µm). In the younger group, the relative thicknesses of the individual choroidal layers were: CC 21.5% (SD ± 4.0%) and CV 78.4% (SD ± 4.0%). In the older group, the relative thicknesses were: CC 18.9% (SD ± 4.5%) and CV 81.1% (SD ± 4.5%). The absolute thicknesses were smaller in the older age group for all choroidal layers (TC p=0.006, CC p=0.0003, CV p=0.03) while the relative thickness was smaller only for the CC (p=0.04). CONCLUSIONS: Enface SS-OCT at 1050 nm enables a precise qualitative and quantitative characterization of the individual choroidal layers in normal eyes. Only the CC is relatively thinner in the older eyes. In-vivo evaluation of the choroid at variable depths may be potentially valuable in understanding the natural history of age-related posterior segment disease.

En face imaging of the choroid in polypoidal choroidal vasculopathy using swept-source optical coherence tomography.

OBJECTIVE: To define morphologic features of polypoidal choroidal vasculopathy (PCV) using en face images from swept-source optical coherence tomography (SS OCT). DESIGN: Prospective cross-sectional study. METHODS: The study included 10 eyes from 6 patients with PCV and 10 eyes from 5 age-matched normal subjects. All subjects were prospectively scanned with a prototype SS OCT system. A motion correction algorithm was applied to correct and merge scans into a single volumetric dataset. En face images were generated at intervals of 4.13 µm (1 pixel) relative to the Bruch membrane. RESULTS: Age ± standard deviation for the normal group was 62.4 (±12.1) years and for the PCV group was 68.3 (±5.2) years. En face SS OCT imaging of PCV eyes demonstrated the relationship between larger pigment epithelial detachments (PEDs) and small adjoining PEDs that correlated with the polypoidal lesions seen on indocyanine green angiography in all PCV eyes. En face SS OCT demonstrated choroidal vascular abnormalities in 7 out of 7 eyes with PCV, and in 2 out of 3 enrolled fellow eyes in patients with unilateral PCV. Out of 7 PCV eyes, focal choroidal vascular dilation was noted in 3 eyes and diffuse choroidal vascular dilation was noted in 1 eye. In addition, a branching vascular network was noted above the Bruch membrane in 1 eye, below the Bruch membrane within the choriocapillaris in 1 eye, and in the larger choroidal vascular layer in 1 eye. CONCLUSIONS: En face SS OCT provides an in vivo tool to visualize the pathologic features and the choroidal vasculature in PCV.

Spectral-domain and swept-source OCT imaging of asteroid hyalosis: a case report.

A 72-year-old man with diabetes was referred to the retina clinic for diabetic retinopathy. Detailed funduscopic examination of the left eye was limited by prominent asteroid hyalosis. Spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT) were utilized to examine the vitreous, vitreoretinal interface, and the morphology of the retina. Asteroid hyalosis induced artifacts of the OCT images, which resolved when the appropriate imaging protocols were applied. SS-OCT may show superior diagnostic and preoperative capabilities when compared to SD-OCT in the settings of asteroid hyalosis-induced media opacity.

Correlation of retinal nerve fiber layer thickness and visual fields in glaucoma: a broken stick model.

PURPOSE: To determine the retinal nerve fiber layer (RNFL) thickness at which visual field (VF) damage becomes detectable and associated with structural loss. DESIGN: Retrospective cross-sectional study. METHODS: Eighty-seven healthy and 108 glaucoma subjects (1 eye per subject) were recruited from an academic institution. All patients had VF examinations (Swedish Interactive Threshold Algorithm 24-2 test of the Humphrey Visual Field Analyzer 750i) and spectral-domain optical coherence tomography RNFL scans. Comparison of RNFL thickness values with VF threshold values showed a plateau of VF threshold values at high RNFL thickness values and then a sharp decrease at lower RNFL thickness values. A broken stick statistical analysis was used to estimate the tipping point at which RNFL thickness values are associated with VF defects. The slope for the association between structure and function was computed for data above and below the tipping point. RESULTS: The mean RNFL thickness value that was associated with initial VF loss was 89 µm. The superior RNFL thickness value that was associated with initial corresponding inferior VF loss was 100 µm. The inferior RNFL thickness value that was associated with initial corresponding superior VF loss was 73 µm. The differences between all the slopes above and below the aforementioned tipping points were statistically significant (P < .001). CONCLUSIONS: In open-angle glaucoma, substantial RNFL thinning or structural loss appears to be necessary before functional visual field defects become detectable.

Inadvertent filtering bleb due to corneal stromal wick syndrome.

We report a unique case in which an inadvertent filtering bleb was created after a complicated cataract surgery through an unusual mechanism: an internal fragment of corneal stroma, which was still attached at one end of the clear corneal wound, was pushed into the anterior chamber, became inadvertently entrapped in the wound, and served as a wick to prevent complete healing.

Optical coherence tomography in pediatric ophthalmology: current roles and future directions.

The application of existing optical coherence tomography (OCT) technology to the pediatric population is limited in both the design specification of the device and its hardware. However, the potential of OCT in the pediatric population has not been fully realized. The authors review the literature, highlighting the currently available spectral-domain OCT technology and summarizing the reported normal pediatric OCT parameters for retinal nerve fiber layer and macular thickness. They also review the pediatric ophthalmological conditions in which OCT has been used and discuss advancements in OCT design and their potential applications to the pediatric population. The use of OCT in pediatric populations is likely to increase greatly in the coming years, aiding clinical decision-making and providing new insights into pediatric disease pathophysiology.

Analysis of normal retinal nerve fiber layer thickness by age, sex, and race using spectral domain optical coherence tomography.

PURPOSE: To determine the effects of age, sex, and race on the retinal nerve fiber layer (RNFL) in the normal human eye as measured by the spectral domain optical coherence tomography (SD-OCT) Spectralis machine (Heidelberg Engineering). METHODS: Peripapillary SD-OCT RNFL thickness measurements were determined in normal subjects seen at a university-based clinic. One randomly selected eye per subject was used for analysis in this cross-sectional study. Multiple regression analysis was applied to assess the effects of age, sex, ethnicity, and mean refractive error on peripapillary RNFL thickness. Results are expressed as means±SD wherever applicable. RESULTS: The study population consisted of 190 healthy participants from 9 to 86 years of age. Of the 190 participants, 62 (33%) were men, 125 (66%) Caucasians, 26 (14%) African Americans, 14 (7%) Hispanics, 16 (8%) Asians, and 9 (5%) other races. The mean RNFL thickness for the normal population studied was 97.3 ± 9.6 µm. Normal RNFL thickness values follow the ISNT rule with decreasing RNFL thickness values starting from the thickest quadrant inferiorly to the thinnest quadrant temporally: inferior quadrant (126 ± 15.8), superior quadrant (117.2±16.13), nasal quadrant (75 ± 13.9), and temporal quadrant (70.6 ± 10.8 µm). Thinner RNFL measurements were associated with older age (P<0.001); being Caucasian, versus being either Hispanic or Asian (P=0.02 and 0.009, respectively); or being more myopic (P<0.001). For every decade of increased age, mean RNFL thickness measured thinner by approximately 1.5 µm (95% confidence interval, 0.24-0.07). Comparisons between ethnic groups revealed that Caucasians had mean RNFL values (96 ± 9.2 µm) slightly thinner than those of Hispanics (102.9 ± 11 µm; P=0.02) or Asians (100.7 ± 8.5 µm; P=0.009). African Americans RNFL values (99.2 ± 10.2 µm) were not significantly different when compared with Caucasians. There was no relationship between RNFL thickness and sex. CONCLUSIONS: The thickest RNFL measurements were found in the inferior quadrant, followed by the superior, nasal, and temporal quadrants (ISNT rule applied to the RNFL). Thinner RNFL measurements were associated with older age and increasing myopia. Caucasians tend to have thinner RNFL values when compared with Hispanics and Asians. SD-OCT analysis of the normal RNFL showed results similar to time domain OCT studies.

Renal cell carcinoma metastasis to the ciliary body responds to proton beam radiotherapy: a case report.

INTRODUCTION: We report an unexpected presentation of metastatic renal cell carcinoma (RCC) to the ciliary body and an interesting response to proton beam radiotherapy. CASE PRESENTATION: We encountered a case of angle-closure glaucoma as the initial presentation of ocular metastasis to the ciliary body in a 65-year-old Caucasian man who had undergone right radical nephrectomy for RCC 15 years earlier. He underwent YAG (yttrium aluminium garnet) laser peripheral iridotomy while further metastatic workup took place. His condition was eventually diagnosed as stage IV metastatic RCC of the clear cell type and involved multiple sites, including the ciliary body, brain, lungs, liver, and pancreas. The progression of RCC metastasis to the ciliary body was studied for 16 months. The ciliary body mass continued to grow despite systemic treatment with temsirolimus and interleukin-2 and intravitreal injections of bevacizumab. The tumor size peaked at 6.11 × 6.06 mm before the start of proton therapy, which reduced the tumor size to 5.07 × 4.39 mm. CONCLUSIONS: RCC can produce metastases involving unusual sites many years after resection of the primary tumor. Proton therapy was found to be effective in treating RCC metastasis to the ciliary body in settings in which other treatment modalities failed.

Purtscher-Like Retinopathy: Optical Coherence Tomography and Visual Field Findings.

A 30-year-old male presented with decreased vision in the right eye after a recent hospitalization for acute pancreatitis. On presentation, his visual acuity was 20/100 right eye (OD) and 20/20 left eye (OS). The funduscopic examination findings were consistent with Purtscher-like retinopathy (PLR). Cirrus HD-OCT (Spectral Domain Technology, Zeiss) of the right eye showed retinal nerve fiber layer swelling and significant subretinal fluid. Humphrey visual field (Central 24-2) revealed generalized defect on the right and inferior nasal step on the left. During the next 6 months, the patient had improvement in visual acuity (20/30 OD and 20/20 OS) and normalization of optical coherence tomography (OCT) findings. However, the visual field (VF) worsened bilaterally suggesting that the injuries induced by micro-infarctions at the level of the retinal nerve fiber layer (RNFL) were not reversible. To our knowledge, there have been no reports in the literature that compare high-resolution OCT and VF findings in patients with PLR.

Intravitreal bevacizumab in the treatment of neovascular glaucoma secondary to central retinal vein occlusion: a case report.

INTRODUCTION: Every eye with central retinal vein occlusion (CRVO) is at risk for developing neovascular glaucoma (NVG). Vascular endothelial growth factor (VEGF) has been shown to play a key role in the development of NVG in CRVO. Bevacizumab (Avastin; Genentech, San Francisco, CA) is a recombinant monoclonal antibody binding all isoforms of VEGF. Several studies have demonstrated intravitreal bevacizumab-induced regression of iris and angle neovascularisation associated with NVG. CASE PRESENTATION: A 74 year old female presented with acute onset decreased vision in the right eye. Ophthalmic exam revealed acute non-ischemic CRVO in the right eye. A month later, follow up exam showed progression into ischemic CRVO and secondary NVG, which was successfully treated with intravitreal Bevacizumab followed by pan retinal photocoagulation (PRP). CONCLUSION: Our case report highlights the use of intravitreal Bevacizumab in combination with PRP for the treatment of NVG secondary to CRVO.