Retinal detachment after primary pneumatic retinopexy.

PURPOSE: To describe the characteristics and outcome of patients who required retinal reattachment surgery after pneumatic retinopexy for rhegmatogenous retinal detachment. METHODS: Retrospective review of patients who underwent retinal reattachment surgery after pneumatic retinopexy at a multioffice retina practice. Patients with <6 months follow-up were excluded. RESULTS: Two hundred eighty-nine eyes from 289 patients underwent pneumatic retinopexy and 50 eyes of 50 patients were included in this study. The mean follow-up time was 28 +/- 20.4 months (range, 6-76 months). The most common cause of detachment was development of a new retinal detachment (72%) associated with the development of a new retinal break (75%). Increased or persistent subretinal fluid associated with the original detachment was the cause of detachment in 28% of eyes. The mean number of procedures for retinal reattachment was 1.4 +/- 0.9 (range, 1-5) with the majority (72%) reattached with 1 surgery. The mean visual acuity on presentation was 20/125 (range, 20/20-hand movements) and at the final visit was 20/50 (range, 20/20-counting fingers). CONCLUSION: Retinal reattachment surgery after pneumatic retinopexy is successful with anatomic and functional improvement. The most common cause of detachment is the formation of new inferior retinal detachment caused by a new break.

Effect of expanding the treatment zone of the Nidek EC-5000 laser on laser in situ keratomileusis outcomes.

PURPOSE: To evaluate the effect of expanding the treatment zone of the Nidek EC-5000 laser on postoperative visual acuity as well as night glare and halos after laser in situ keratomileusis (LASIK) using 4 ablation zone diameters. SETTING: Division of Ophthalmology, Evanston Northwestern Healthcare and Northwestern University Medical School, Glenview, Illinois, USA. METHODS: This prospective study comprised 301 eyes of 154 consecutive patients who had LASIK in 1 or both eyes using the Nidek EC-5000 laser by 1 surgeon with experience in keratomileusis and excimer laser refractive surgery. A 6.5 mm optical zone was used with a transition zone 1.0 mm larger than the pupil under scotopic conditions (7.5, 8.0, 8.5, or 9.0 mm). Targeted correction was calculated according to a customized clinical nomogram. All patients were queried about glare and halos preoperatively and 3 months postoperatively using a questionnaire assigning numeric values to the degree of perceived visual disturbance (0 = no glare or halos, 1 = minimal, 2 = moderate, 3 = severe). RESULTS: The baseline uncorrected visual acuity (UCVA) was 20/200 or worse in 293 eyes. The baseline best spectacle-corrected visual acuity was 20/20 or better. The mean preoperative refractive sphere was -6.33 diopters (D) +/- 2.80 (SD) (range -1.00 to -16.25 D) and the mean preoperative refractive cylinder, 0.86 +/- 0.83 D (range 0 to +3.25 D). Three months postoperatively, 78% of eyes had a UCVA of 20/20 and 99%, of 20/40 or better. Preoperatively, 94 eyes (31%) had glare and halos. At 3 months, glare, halos, or both were present in 19 eyes of 11 patients (6.3%) (P<.0001); in 14 eyes, patients reported less severe glare and halos postoperatively than preoperatively. CONCLUSIONS: The use of a peripheral transition zone 1.0 mm larger than the pupil under scotopic conditions resulted in a low incidence of glare and halos postoperatively and did not adversely affect visual acuity. There was no increase in postoperative complications including corneal ectasia.

Ocular rosacea can mimic trachoma: a case of cicatrizing conjunctivitis.

PURPOSE: To report the case of a patient with upper eyelid chronic cicatrizing conjunctivitis and entropion, presumably secondary to ocular rosacea. METHODS: Case report and review of medical literature. RESULTS: The patient has a history of chronic cicatrizing conjunctivitis since 1999. Despite an extensive workup for other possible causes, the patient's known history of acne rosacea is the most substantive explanation for her ocular disease. CONCLUSION: The presence of chronic cicatrizing conjunctivitis affecting mainly the upper eyelids, previously thought to be unique to trachoma, can be associated with ocular rosacea.

Chronic central serous chorioretinopathy responsive to rifampin.

PURPOSE: The purpose of this was to describe the clinical improvement of chronic central serous chorioretinopathy in a patient treated with rifampin for tuberculosis. METHODS: A 54-year-old Hispanic man with a distant history of pulmonary tuberculosis presented with reduced vision in the right greater than left eye for over 1 year. He had diffuse chorioretinopathy in both eyes and a serous retinal detachment in his right eye. The findings were most consistent with chronic central serous chorioretinopathy, although tuberculosis -related choroiditis could not be excluded. Treatment with multidrug antituberculosis medications, including rifampin, resulted in the reduction in leakage and resolution of subretinal fluid. Fluid recurred on cessation of all medications and resolved again with retreatment. Monotherapy with rifampin maintained the absence of fluid. DISCUSSION: This case represents the first report of chronic central serous chorioretinopathy responding to systemic therapy with rifampin. We hypothesize that the clinical response observed is secondary to induction of cytochrome P450 with increased hepatic metabolism of endogenous corticosteroids and a reduction in systemic cortisol levels.

Cytomegalovirus acute retinal necrosis in an immunocompetent patient after sub-tenon triamcinolone injection.

PURPOSE: To report a case of cytomegalovirus acute retinal necrosis after a sub-Tenon injection of triamcinolone acetonide in an immunocompetent patient. METHODS: A 77-year-old man received a sub-Tenon injection of triamcinolone acetonide for treatment of iritis unresponsive to topical steroids. He subsequently developed unilateral acute retinal necrosis. RESULTS: Vitreous biopsy with polymerase chain reaction analysis was positive for cytomegalovirus. Implantation of a sustained-release ganciclovir device resulted in disease stabilization. CONCLUSION: Cytomegalovirus can be a causative agent of both anterior uveitis and acute retinal necrosis. A potential complication of a sub-Tenon steroid injection may be viral reactivation causing acute retinal necrosis secondary to localized immunosuppression.

Endogenous nocardial chorioretinitis in an immunocompetent patient.

PURPOSE: To describe the presentation and management of an immunocompetent patient with endogenous Nocardia chorioretinitis. METHODS: A previously healthy 55-year-old woman presented with reduced vision and metamorphopsia after accidental inhalation of Nocardia organisms from planting soil. She developed systemic nocardiosis with pulmonary and cerebellar involvement as well as bilateral chorioretinitis. Ocular infection resulted in choroidal neovascularization, which was successfully treated with intravitreal triamcinolone and thermal laser photocoagulation. DISCUSSION: This patient is one of only a few immunocompetent individuals to develop endogenous nocardial chorioretinitis. Systemic antibiotic treatment and local laser therapy for subsequent choroidal neovascularization were effective in management of this case.