Effect of Fiber Reinforcement on the Flexural Strength of the Transitional Implant-Supported Fixed Dental Prosthesis.

PURPOSE: The aim of this in vitro study was to assess the efficacy of fiber reinforcement to enhance flexural strength of the transitional implant-supported fixed dental prosthesis (TISFDP). MATERIALS AND METHODS: One hundred and forty denture acrylic resin plates (64 mm × 12 mm × 5 mm) with two 7 mm diameter holes were fabricated using heat-polymerized type (Lucitone 199) and CAD-CAM prepolymerized type (AvaDent) materials to simulate a chair-side reconstruction of the TISFDP. Specimens were divided into 7 groups (n = 10) according to the airborne-particle abrasion of titanium cylinder (Straumann) surface and locations of fiber reinforcement ribbons (Ribbond-ULTRA). No cylinder surface abrasion and no fiber added acrylate specimens were used as the controls. The prosthetic screws were hand-tightened on a custom fixture with analogs. Specimen hole and cylinder were joined using a 50:50 mixture of chemically polymerized resin (QYK-SET; Holmes Dental) and repair resin (Dentsply Sirona). Ten acrylate specimens with no holes were fabricated from each tested material and assigned as positive controls. A modified four-point bending test (ASTM standard-D6272) was conducted using a universal testing machine and a custom fixture with a crosshead speed 1 mm/min. The maximum failure loads were recorded. Data were statistically analyzed using 2-way ANOVA and the Tukey tests at α = 0.05. RESULTS: The flexural strength values ranged from 55.4 ±8.3 to 140.9 ±15.4 MPa. The flexural strength decreased significantly when fiber was attached on the titanium cylinder surface (p < 0.05). There were no statistically significant differences in flexural strength values between specimens with and without titanium cylinder surface abrasion (p > 0.05). Statistically significant improvement in flexural strength was observed in specimens with fibers attached around the specimen holes (p < 0.05) buccally and lingually. The obtained values were not statistically significantly different from the positive controls (p > 0.05). Some fixation screw fractures were observed before catastrophic failure of specimens during testing. CONCLUSIONS: Fiber reinforcement significantly improved the flexural strength of denture acrylic resins only if placed around the specimen holes on the tension side at the site of initiation of crack propagation. Even when the specimens underwent catastrophic failure, the segments remained attached to each other with the attached fibers.

SAUSAGING AND BULBOSITIES OF THE CHOROIDAL VEINS IN CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To evaluate the caliber of the choroidal veins in central serous chorioretinopathy, a disease proposed to be associated with overloading of choroidal venous outflow. METHODS: Widefield indocyanine green angiograms of eyes with central serous chorioretinopathy were graded for sausaging defined as three or more contiguous fusiform dilations that vary by at least 50% from the narrowest to largest diameters. A bulbosity was defined as a focal 2X dilation of a blood vessel as compared with the diameter of the surrounding host vessel. The data underwent statistical analysis including the use of generalized estimating equations. RESULTS: There were 73 eyes of 41 patients with a mean age of 53.5 years. Sausaging of vessels was seen in a mean and median of three quadrants per eye. Using generalized estimating equations, the only significant risk factor for sausaging was the use of corticosteroids. The two significant predictors of subfoveal choroidal thickness using generalized estimating equations were age ( P = 0.021) and proportion of quadrants involved by sausaging ( P < 0.001). The decrease in choroidal thickness per year of age was estimated to be 3.7 µ m, while the increase with four quadrant involvement with sausaging was estimated to be 236 µ m. There were a total of 39 bulbosities in 26 eyes (35.6%), preferentially involving intervortex venous anastomoses. CONCLUSION: Variations in the venous caliber are very common in eyes with central serous chorioretinopathy and seems to be associated with pathophysiologic alterations related to increased pressure within and remodeling of the larger choroidal veins. This may lead to overloading of the choriocapillaris with leakage as one manifestation.

ASSOCIATION BETWEEN NEEDLE SIZE, POSTINJECTION REFLUX, AND INTRAOCULAR PRESSURE SPIKES AFTER INTRAVITREAL INJECTIONS.

PURPOSE: To compare the effect of 30-gauge versus 32-gauge needle size on postinjection reflux and immediate postinjection intraocular pressure (IOP(immed_post)) spikes in eyes injected with anti-vascular endothelial growth factor agents. METHODS: This was a prospective interventional case series of 65 eyes of 54 consecutive patients in a clinical practice setting who received intravitreal anti-vascular endothelial growth factor therapy. All eyes had preinjection IOP, IOP(immed_post), postinjection reflux, and axial lengths recorded. RESULTS: There was a higher incidence of postinjection reflux in eyes injected with 30-gauge (53%) compared with those injected with 32-gauge (13%, P = 0.0007). Among 34 eyes injected with 30-gauge, 16 eyes without appreciable postinjection reflux had mean IOP(immed_post) of 44.3 ± 7.48 mmHg and mean IOP(immed_post) elevation of 29.6 ± 2.10 mmHg, which was significantly higher than the 18 eyes with reflux (mean IOP(immed_post) of 18.8 ± 7.15 mmHg and mean IOP(immed_post) elevation of 4.5 ± 1.74 mmHg, P < 0.0001). Among 31 eyes injected with 32-gauge, 27 eyes without appreciable postinjection reflux had mean IOP(immed_post) of 44.4 ± 10.82 mmHg and mean IOP(immed_post) elevation of 29.5 ± 1.99 mmHg, which was significantly higher than the 4 eyes with reflux (mean IOP(immed_post) of 21.3 ± 8.54 mmHg and mean IOP(immed_post) elevation of 9.5 ± 4.05 mmHg, P < 0.001). The differences in reflux and IOP between the two groups were unrelated to axial lengths (P = 0.451). CONCLUSION: Eyes receiving injections with 32-gauge needles had a lower incidence of postinjection reflux and higher mean IOP immediately after injection.

The "pitchfork sign" a distinctive optical coherence tomography finding in inflammatory choroidal neovascularization.

PURPOSE: To report four examples of a novel optical coherence tomography finding, which appears to be characteristic of inflammatory choroidal neovascularization. METHODS: Retrospective observational case series. RESULTS: Four eyes of four patients were diagnosed clinically with inflammatory choroidal neovascularization and underwent optical coherence tomography. In each case, imaging revealed multiple, distinctive finger-like projections extending from the area of active choroidal neovascularization into the outer retina-the "pitchfork sign"--a finding not typically seen in Type 2 neovascularization due to other etiologies. CONCLUSION: The pitchfork sign may help distinguish inflammatory choroidal neovascularization from other causes of Type 2 neovascularization.

Digital indocyanine green videoangiography and choroidal neovascularization. 1992.

This report describes a new system for digital indocyanine green videoangiography (ICGV) that provides enhanced imaging of the choroidal circulation. This newly assembled system was used to study a consecutive series of 129 patients with exudative age-related macular degeneration (AMD), and ill-defined or occult choroidal neovascularization (CNV). Overall, 39% of the patients in this study with occult CNV could be reclassified as having well-delineated or so-called classic CNV by virtue of the additional findings provided by ICGV. In this series, ICGV was particularly useful in identifying occult CNV in eyes with a large, serous pigment epithelial detachment (PED) and in eyes with recurrent CNV after previous laser photocoagulation treatment. Some of these patients were selected for laser photocoagulation of the abnormal choroidal vessels in order to evaluate the feasibility of this form of treatment on the basis of combined clinical, fluorescein angiographic, and ICGV findings. The results of this study suggest that ICGV is an important adjunct in the evaluation, classification, and laser treatment of patients with occult CNV secondary to AMD.

Focal retinal phlebitis.

PURPOSE: To report three cases of solitary, focal retinal phlebitis. METHODS: An observational case series. RESULTS: Three eyes in three patients were noted to have unilateral decreased vision, macular edema, and a focal retinal phlebitis, which was not at an arteriovenous crossing. All three patients developed a branch retinal vein occlusion at the site of inflammation. These patients had no other evidence of intraocular inflammation, including vitritis, retinitis, retinal vasculitis, or choroiditis, nor was there any systemic disorder associated with inflammation, infection, or coagulation identified. CONCLUSION: Focal retinal phlebitis appears to be an uncommon and unique entity that produces macular edema and ultimately branch retinal vein occlusion. In our patients, the focal phlebitis and venous occlusion did not occur at an arteriovenous crossing, which is the typical site for branch retinal venous occlusive disease. This suggests that our cases represent a distinct clinical entity, which starts with a focal abnormality in the wall of a retinal venule, resulting in surrounding exudation and, ultimately, ends with branch retinal vein occlusion.

Unilateral acute idiopathic maculopathy. 1991.

This is a report of nine patients who experienced sudden, severe, unilateral central vision loss following a flulike illness. Each patient had an exudative detachment of the macula. All patients experienced a spontaneous resolution of the acute macular manifestations with near-complete recovery of vision. A characteristic "bull's-eye" appearance in the macula persisted. The acute manifestations of the disorder did not recur in any of the patients during the period of follow-up. The constellation of findings was suggestive of an inflammatory disease of the retinal pigment epithelium, but a specific causative agent could not be identified. The acute clinical and angiographic features, the natural course, and the residual pigment epithelial derangement were not consistent with any previously described disorder.

Macular hemorrhage in neovascular age-related macular degeneration after stabilization with antiangiogenic therapy.

PURPOSE: To study patients with neovascular age-related macular degeneration (AMD) who experienced a macular hemorrhage after stabilization with intravitreal antivascular endothelial growth factor (anti-VEGF) agents to improve current treatment regimens and prevent disease progression. METHODS: Retrospective chart review of six patients. The main outcome measures included time between last intravitreal anti-VEGF treatment and date of hemorrhage, time between last office visit and date of hemorrhage, and visual acuity before and after hemorrhage. RESULTS: Three of 6 eyes had a macular hemorrhage within 4 weeks of a stable examination. One eye had optical coherence tomography (OCT) that demonstrated no fluid 1 day before the macular hemorrhage. The average time between the date of the last injection and macular hemorrhage was 16.8 weeks (range, 7.3-28.9 weeks). The average time between the last stable examination and an event was 4.2 weeks (range, 1 day to 7.3 weeks). Three of six patients had a persistent decline in vision after the hemorrhage. Among the 4 patients, who had better than 20/200 vision before the macular hemorrhage, 2 dropped to 20/200 or worse. CONCLUSION: Sight-threatening macular hemorrhages from AMD can occur within days to weeks after a stable examination and absence of fluid on OCT. Regimens that treat "as needed" based on clinical findings and OCT may not be appropriate for certain patients.

Evaluation of safety for bilateral same-day intravitreal injections of antivascular endothelial growth factor therapy.

PURPOSE: To explore the incidence of complications after bilateral same-day intravitreal injections of antivascular endothelial growth factor pharmacotherapies in this retrospective interventional case series. METHODS: An electronic review of billing records was performed to identify all bilateral same-day intravitreal antivascular endothelial growth factor injections performed within a single group retina practice between January 6, 2006 and June 1, 2009. The charts were reviewed to identify the complications of endophthalmitis, intraocular inflammation, retinal tear, and retinal detachment. RESULTS: A total of 1,534 bilateral intravitreal injections (326 bevacizumab and 1,208 ranibizumab: 3,068 injections total) were performed in 367 patients. Three complications were identified. Two cases of unilateral culture-proven endophthalmitis occurred after bilateral intravitreal ranibizumab, and one case of unilateral acute intraocular inflammation occurred after bilateral intravitreal bevacizumab. In all three of these eyes, visual acuity returned to its preinjection level. No cases of retinal tear or retinal detachment were identified. The incidence of culture-proven endophthalmitis was 0.065%, and the incidence of acute intraocular inflammation was 0.033%. CONCLUSION: The complication rates after bilateral same-day intravitreal antivascular endothelial growth factor injections seem to be similar to those after unilateral injections. Severe acute intraocular inflammation can occur unilaterally after same-day bilateral injections of bevacizumab.

MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH SUBRETINAL DEPOSITS.

PURPOSE: To describe the multimodal imaging findings of transient subretinal deposits occurring in multiple evanescent white dot syndrome (MEWDS). METHODS: The multimodal imaging characteristics of transient subretinal deposits occurring in MEWDS were investigated with ultra-widefield color and fundus autofluorescence, cross-sectional and en-face optical coherence tomography (OCT), en face OCT-angiography, and quantitative autofluorescence. RESULTS: A 28-year-old woman presented with photopsia and temporal visual field loss in her right eye. Her best-corrected visual acuity was 20/20 in her right eye and 20/25 in her left eye. Funduscopic examination showed characteristic peripapillary hyperautofluorescent white dots of MEWDS corresponding to ellipsoid zone disruption on OCT. These lesions became confluent throughout the posterior fundus over the next 4 weeks. As the patient's symptoms were resolving, a second type of transient hyperautofluorescent lesion was noted which corresponded to hyperreflective subretinal deposits on cross-sectional and en face structural OCT. These subretinal deposits were most evident at 10-week follow-up and had nearly resolved at 14-week follow-up. Quantitative autofluorescence showed that, unlike the acute MEWDS lesions, the hyperautoflurescence of the subretinal deposits persisted after photobleaching. At multiple time points over 14 weeks of follow-up, OCT angiography showed no evidence of retinal or choroidal flow abnormalities. CONCLUSION: Transient subretinal deposits may develop during MEWDS in areas of previous diffuse outer retinal disruption. As these deposits remain hyperautoflurescent on quantitative autofluorescence after photobleaching, they may represent accumulations of debris originating from damaged photoreceptor outer segments.

Effect of venting and seating techniques on the cementation of complete coverage restorations.

STATEMENT OF PROBLEM: The incomplete seating of crowns resulting from cementation phenomena is a universal problem for clinicians. This seating error may lead to disturbances in the occlusion, proximal contacts, reduced retention and open margins. Various cementation protocols are practiced, with no established standard that maximizes crown seating and marginal fit. PURPOSE: This study investigated the effect of various combinations of venting and cementation seating techniques with the routine use of die relief on the seating of complete gold crowns. MATERIAL AND METHODS: Fifty human molars were prepared with a mounted handpiece for complete coverage crowns with a featheredge finish line and six degrees of taper, according to Tylman. Impressions were made, stone dies fabricated, die spacer was applied and the crowns were waxed and cast in type III gold. The respective crowns were placed on the teeth and preloaded. The distance between reference marks on the tooth and crown were measured at four points around each tooth. Zinc phosphate cement was mixed and the crowns were cemented in the following groups: (1) vented, tapping the crown into place with a mallet, (2) non-vented, tapping the crown into place, (3) vented static seating with a 25 kg load, (4) non-vented dynamic seating, (5) non-vented static loading with a 25 kg load. A 25 kg load was then maintained on the crowns during the cement setting time. Distances between reference marks were then measured and the change in post-cementation distances calculated. RESULTS: ANOVA (F = 14.995, p < .0001) and multiple range tests revealed significant differences between the groups. The mean increased post-cementation distances for the seating groups were (microm): 1) 132 +/- 20, 2) 372 +/- 26, 3) 367 +/- 59, 4) 239 +/- 35, 5) 537 +/- 45. CONCLUSIONS: The vented tapping technique produced the best seating. The non-vented tapping seating group produced seating not significantly different from the vented static method. The non-vented static group had the worst seating, with a gap four times greater than the vented tapping group.

Sequenced combined intravitreal triamcinolone and indocyanine green angiography-guided photodynamic therapy for retinal angiomatous proliferation.

OBJECTIVE: To study sequenced combined therapy using intravitreal triamcinolone acetonide followed by photodynamic therapy for the treatment of retinal angiomatous proliferation. METHODS: Patients newly diagnosed as having retinal angiomatous proliferation underwent intravitreal triamcinolone injection to reduce intraretinal and subretinal exudation, followed 7 to 14 days later by indocyanine green angiography-guided photodynamic therapy with verteporfin. Complete ocular examination, fluorescein angiography, indocyanine green angiography, and optical coherence tomography were performed at baseline and at standard intervals thereafter. RESULTS: Twenty-seven eyes of 26 patients underwent this sequenced combined treatment and were followed up for 12 months. The triamcinolone injection reduced the cystoid edema before photodynamic therapy. Complete resolution of the angiographic leakage was achieved in 89% of eyes. Visual acuity improved in 37% and was stable in 52% of eyes. Eight eyes developed recurrent leakage after 3 to 11 months. Complete resolution of leakage was observed after subsequent treatment. CONCLUSIONS: This sequenced combined treatment in patients with retinal angiomatous proliferation was effective in reducing or eliminating the edema, achieving rapid regression of neovascularization, and stabilizing or improving visual acuity. To our knowledge, no study to date has achieved such promising results in the management of retinal angiomatous proliferation. A randomized clinical trial is under way to compare sequential and simultaneous combined therapy.

Verteporfin infusion-associated pain.

PURPOSE: To determine if oral hydration decreases the incidence of verteporfin infusion-associated pain and to find out if other factors play a role in predisposing to this undesired complication. METHODS: Nonrandomized clinical trial. We prospectively examined 250 consecutive patients who have been diagnosed with subfoveal choroidal neovascularization secondary to age-related macular degeneration and received photodynamic therapy using verteporfin. One hundred twenty-five patients were assigned to receive 500 ml of water orally administered 30 minutes before beginning the verteporfin infusion, and the remaining 125 consecutive patients were used as controls. Historical and clinical factors in these patients were evaluated for their association with the presence of verteporfin infusion-associated pain. RESULTS: Out of 125 patients receiving water before treatment 12 (9.6%) experienced verteporfin infusion-associated pain. Among the 125 patients who did not get hydration before therapy 12(9.6%) experienced verteporfin infusion-associated pain. There was no statistical difference between the incidence of pain in the two groups (P = 1.0). No statistically significant association was evidenced between the presence of pain and participant's baseline characteristics, except for pain on previous administration of verteporfin (P < .001). Out of 250 total patients 24 (9.6%) developed verteporfin infusion-associated pain. Back pain was the most common and occurred in 21 (8.4%) patients, but other sites included leg, groin, chest, buttock, arm, and shoulder pain concurrently or independently. All patients had resolution of their pain, including chest pain, on cessation of the infusion. CONCLUSIONS: Verteporfin infusion-associated pain may be more common than has been previously reported and is not limited to the back area. It appears to be an idiosyncratic reaction to the drug. It does not seem to be prevented by oral hydration before infusion of verteporfin, and no baseline characteristics, other than a history of pain on previous infusion, seem to be predictive of verteporfin infusion-associated pain.

Adaptive optics imaging of cone mosaic abnormalities in acute macular neuroretinopathy.

BACKGROUND AND OBJECTIVE: To assess the cone photoreceptor mosaic in acute macular neuroretinopathy (AMN) using adaptive optics (AO) imaging. PATIENTS AND METHODS: Four patients with AMN were evaluated retrospectively by near-infrared reflectance (IR) confocal scanning laser ophthalmoscopy (SLO), spectral-domain optical coherence tomography (SD-OCT), and a flood-illuminated retinal AO camera. Microperimetry was performed in one patient. RESULTS: The cone photoreceptor density was decreased at the level of the AMN lesions. The cone mosaic disruption appeared heterogeneous and more widespread than the lesion detected in the IR-SLO and SD-OCT images. The areas of cone loss correlated with SD-OCT and microperimetry. After resolution of the AMN lesion on IR-SLO, there was incomplete recovery of the cone photoreceptor mosaic. CONCLUSION: Cone photoreceptor damage and reconstitution were documented in vivo at the cellular level in AMN using AO imaging. AO imaging appeared more sensitive than combined IR-SLO and SD-OCT to detect and follow photoreceptor damage in patients with AMN.

Fundus autofluorescence and photoreceptor bleaching in multiple evanescent white dot syndrome.

The authors present three cases of multiple evanescent white dot syndrome (MEWDS) with characteristic fundus autofluorescence (FAF) findings, including one patient without any visible white dots on funduscopic examination and another with many more hyperautofluorescent lesions than seen ophthalmoscopically. Additionally, the findings support an alternative mechanism for the hyperautofluorescent lesions in MEWDS, whereby photoreceptor loss causes unmasking of normal underlying retinal pigment epithelium autofluorescence. This hypothesis is demonstrated in two cases by optical coherence tomography showing clear ellipsoid zone attenuation with registration to hyperautofluorescent lesions. It is further supported in two cases by photoreceptor bleaching in successive FAF images captured in the same session leading to diminished autofluorescence intensity of the characteristic dots.

Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia.

IMPORTANCE: With the advent of more sophisticated imaging systems, such as spectral domain optical coherence tomography (SD-OCT), disruption of the inner segment/outer segment (IS/OS) band, and thinning of the outer nuclear layer (ONL) have been identified in association with acute macular neuroretinopathy (AMN). OBJECTIVES: To characterize a new SD-OCT presentation of AMN as a paracentral acute middle maculopathy and to describe multimodal imaging findings that implicate an underlying pathogenesis related to retinal capillary ischemia. DESIGN, SETTING, AND PARTICIPANTS: Retrospective observational case series (January 1, 2012, to January 1, 2013) reviewing clinical and imaging data from 9 patients (11 eyes) with AMN at 6 tertiary referral centers. Lesions were classified as type 1 or 2 in relation to the SD-OCT location of the lesion above (type 1) or below (type 2) the outer plexiform layer (OPL) at 6 tertiary referral centers. RESULTS: Of the 9 patients, 5 were female and 4 were male (mean age, 47.6 years; range, 21-65 years). All patients presented with an acute paracentral scotoma and demonstrated a classic dark gray paracentral lesion with near-infrared imaging. Visual acuity ranged from 20/15 to 20/30. Six eyes (5 patients) had type 1 SD-OCT lesions, also referred to as paracentral acute middle maculopathy, and 5 eyes (4 patients) had type 2 SD-OCT lesions. Although type 1 lesions lead to inner nuclear layer (INL) thinning, type 2 lesions resulted in ONL thinning. Type 2 lesions were always associated with significant outer macular defects, including disruption of the inner segment/outer segment and outer segment/retinal pigment epithelium bands, whereas type 1 lesions spared the outer macula. CONCLUSIONS AND RELEVANCE: Paracentral acute middle maculopathy may represent a novel variant of AMN that affects the middle layers of the macula above the OPL as diagnosed with SD-OCT imaging. Two types of AMN lesions may be seen with SD-OCT occurring above and below the OPL. Type 1 refers to hyperreflective bands in the OPL/INL region with subsequent INL thinning. Type 2 is hyperreflective bands in the OPL/ONL region with subsequent ONL thinning. Type 2 lesions may be associated with concomitant defects of the inner segment/outer segment layer. We propose that each of these lesions may be explained by occlusion of either the superficial capillary plexus (type 1) or deep capillary plexus (type 2) located in the innermost and outermost portion of the INL, respectively, immediately adjacent to each corresponding lesion type.

An atypical white dot syndrome after traumatic subretinal hemorrhage.

PURPOSE: The purpose of this report was to describe a case of an atypical white dot syndrome that developed 10 weeks after a traumatic subretinal hemorrhage. METHODS: Retrospective chart review. RESULTS: A 24-year-old woman presented 2 days after being punched in her right eye. A subretinal hemorrhage was present along the inferotemporal vascular arcades of the affected eye. The hemorrhage was slowly resolving until 10 weeks later when the patient noticed a new superonasal scotoma and floaters in her right eye. Deep retinal and retinal pigment epithelial gray-white spots were present inferotemporally around the hemorrhage. These spots were identifiable on fundus autofluorescence photography, fluorescein angiography, and indocyanine green angiography. A subretinal inflammatory mass was identified adjacent to the subretinal hemorrhage. In addition, there was mild vitritis, acute papillitis, retinal vasculitis, and photoreceptor disruption visible on spectral domain optical coherence tomography. The patient was started on oral prednisone with subsequent improvement in signs and symptoms. CONCLUSION: Ocular trauma with subretinal hemorrhage may induce a white dot syndrome sharing some features with Multiple Evanescent White Dot Syndrome and Multiocal Choroiditis and Panuveitis.

Sustained increased intraocular pressure related to intravitreal antivascular endothelial growth factor therapy for neovascular age-related macular degeneration.

PURPOSE: To describe a series of previously normotensive eyes experiencing sustained elevated intraocular pressure (IOP) associated with long-term intravitreal antivascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: Clinical data were reviewed for 25 eyes of 23 patients with neovascular AMD who had increased IOP while receiving interval doses of intravitreal ranibizumab and/or bevacizumab. All eyes had tolerated multiple anti-VEGF injections in the past without IOP elevations. RESULTS: After a mean of 20.0 anti-VEGF injections (range, 8-40 injections), the mean IOP was 29.8 mm Hg (range, 22-58 mm Hg), compared with a baseline of 16.9 mm Hg (range, 14-21 mm Hg). The mean highest IOP while receiving intravitreal anti-VEGF therapy was 35.8 mm Hg (range, 23-58 mm Hg). Overall, 23 of 25 cases required IOP management. In the remaining 2 cases, anti-VEGF dosing was switched from regular interval dosing to an optical coherence tomography-guided variable regimen, with subsequent improvement in IOP without antiglaucoma treatment. CONCLUSIONS: Serial injections of anti-VEGF agents may lead to persistent IOP elevations that require glaucoma therapy. The clinician should recognize this phenomenon, as it can occur even if the patient has tolerated multiple prior injections without IOP elevation. Further exploration of the relationship between anti-VEGF therapy and IOP is needed.

The expanded spectrum of focal choroidal excavation.

OBJECTIVE: To describe the clinical and imaging findings in patients with focal choroidal excavation. METHODS: Retrospective observational case series. The medical records of 12 patients (13 eyes) with focal choroidal excavation were reviewed. Clinical histories and imaging findings (including color photography, fundus autofluorescence imaging, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and enhanced depth imaging spectral-domain optical coherence tomography) were analyzed. RESULTS: The mean age of the patients was 45 years (range, 22-62 years). Four patients were Asian. Mean visual acuity was 20/31 (range, 20/20 to 20/100). Mean refractive error was -3.54 diopters (D) (range, 6.00 to -8.00 D). One patient had bilateral involvement. All patients manifested varying degrees of foveal pigmentary changes that were usually hypoautofluorescent on fundus autofluorescence images. Fluorescein angiographic findings varied with degree of retinal pigment epithelial alterations. Indocyanine green angiography revealed relative hypofluorescence. In 7 eyes, spectral-domain optical coherence tomography revealed outer retinal layers conforming to retinal pigment epithelial alterations within the excavation. In the other 6 eyes, spectral-domain optical coherence tomography revealed a separation between the outer retina and the retinal pigment epithelium within the excavation. In 7 eyes studied with enhanced depth imaging spectral-domain optical coherence tomography, there was no evidence of scleral ectasia. Mean choroidal thickness of the uninvolved choroid was thicker than normal at 319 µm (range, 244-439 µm). All lesions remained stable except for in 1 eye, which had findings of central serous chorioretinopathy and secondary type 2 (subretinal) neovascularization. CONCLUSION: Focal choroidal excavation is a newly described idiopathic entity in eyes having 1 or more focal areas of choroidal excavation. In some patients, there may be an association with central serous chorioretinopathy. Although most lesions remain stable, secondary choroidal neovascularization may occur.