Photodynamic therapy of symptomatic choroidal nevi

To evaluate the role of photodynamic therapy [PDT] for patients with symptomatic choroidal nevi involving the fovea or located near the fovea with subretinal fluid extending to the fovea. Retrospective review of five patients who underwent PDT for choroidal nevi at two separate centers in Ankara and Barcelona. The mean initial logMAR visual acuity was 0.5 [range: 0 to 1.5]. The mean largest tumor base diameter was 3.2 mm [range: 2.1-4.5 mm] and the mean tumor thickness was 1.1 mm [range: 0.7-1.6 mm]. The mean number of PDT sessions was 1.6 [range:1-3]. The mean final tumor thickness was 1.0 mm [range: 0-1.6 mm] at a mean follow-up of 19 months [range: 12-32 months]. The mean final logMAR visual acuity was 0.4 [range: 0-1.5]. Subfoveal fluid disappeared or decreased significantly in 4 of 5 eyes [80%] after PDT. PDT led to resolution of subretinal fluid with preservation of visual acuity in many symptomatic choroidal nevi in this study. Careful case selection is important as PDT of indeterminate pigmented tumors may delay the diagnosis and treatment of an early choroidal melanoma and thereby increase the risk for metastasis

Can the sequential use of conventional silicone oil and heavy oil be a strategy for the management of proliferative vitreoretinopathy?

<p><b>INTRODUCTION</b>Densiron is a novel long-term tamponade. Its specific gravity is 1.06 g/mL and as such it is heavier than water and provides support for the inferior retina. As proliferative vitreoretinopathy (PVR) has a propensity for the inferior retina, we used Densiron on a consecutive series of 97 cases with inferior pathology. We hypothesised that the sequential use of conventional and heavy silicone oil is a strategy for the management of PVR.</p><p><b>MATERIALS AND METHODS</b>A consecutive interventional case series involving the use of Densiron for PVR cases was studied. Patients were selected if conventional silicone oil and Densiron were used sequentially. Anatomical success was defined as total re-attachment in the absence of any tamponade agent for at least 3 months post oil removal.</p><p><b>RESULTS</b>Of the 97 patients, 10 patients fulfilled the criteria. Surgery involving Densiron was successful in re-attaching the retina in 7 of 10 cases, with one sequence of alternating light then heavy oil operation, and with one further surgery using silicone oil in the remaining 3 cases. The mean LogMAR preoperative vision was 1.57 and the postoperative vision was 0.82. In 8 of 10 patients, the final vision was 20/200 or better; in 5 of 10 patients, 20/80 or better. The mean follow-up was 19.5 months (range, 9 to 45).</p><p><b>CONCLUSIONS</b>The sequential use of conventional silicone oil and Densiron may be a strategy in reducing the number of re-operations. Our case series shows that despite multiple surgical procedures, favourable visual outcome can be achieved.</p>