Is systemic infliximab therapy effective for retinal cavernous hemangioma?

A 10-month-old infant with the diagnosis of retinal cavernous hemangioma involving the macula presented with an outward deviation of the right eye that has been noticed by her parents. Examination revealed a clearing vitreous hemorrhage, and grape-like clusters filled with blood in the posterior pole. After 4 cycles of intravenous infliximab over the period of 3 months, no evident change was noted on the size of the cavernous hemangioma

Evolving strategies in the management of diabetic retinopathy

Diabetic retinopathy [DR], the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Tight glycemic and blood pressure control has been shown to significantly decrease the risk of development as well as the progression of retinopathy and represents the cornerstone of medical management of DR. The two most threatening complications of DR are diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]. Focal/grid photocoagulation and panretinal photocoagulation are standard treatments for both DME and PDR, respectively. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with DME. Currently, most experts consider combination focal/grid laser therapy and pharmacotherapy with intravitreal antivascular endothelial growth factor agents in patients with center-involving DME. Combination therapy reduces the frequency of injections needed to control edema. Vitrectomy with removal of the posterior hyaloid seems to be effective in eyes with persistent diffuse DME, particularly in eyes with associated vitreomacular traction. Emerging therapies include fenofibrate, ruboxistaurin, renin-angiotensin system blockers, peroxisome proliferator-activated receptor gamma agonists, pharmacologic vitreolysis, and islet cell transplantation

Advances in the treatment of diabetic retinopathy

Diabetic retinopathy, the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy remain the standard care for diabetic retinopathy. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with diabetic macular edema and should be considered as the first-line therapeutic option. The current evidence suggests that intravitreal triamcinolone acetonide or anti-vascular endothelial growth factor agents result in a temporary improvement of visual acuity and a short-term reduction in central macular thickness in patients with refractory diabetic macular edema and are an effective adjunctive treatments to laser photocoagulation or vitrectomy. However, triamcinolone is associated with risks of elevated intraocular pressure and cataract. Vitrectomy with the removal of the posterior hyaloid without internal limiting membrane peeling seems to be effective in eyes with persistent diffuse diabetic macular edema, particularly in eyes with associated vitreomacular traction. Emerging therapies include islet cell transplantation, fenofibrate, ruboxistaurin, pharmacologic vitreolysis, rennin-angiotensin system blockers, and peroxisome proliferator-activated receptor gamma agonists

Tuberculous uveitis

In recent years, ocular involvement due to TB has re-emerged. Tuberculous uveitis is a readily treatable disease and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patient with unexplained chronic uveitis and this will be influenced by the socio-economic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids resolves inflammation without recurrences after medical therapy

Differential diagnosis of retinal vasculitis

Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings

correlation between optical coherence tomography features and visual acuity in macular edema associated with retinal venous occlusion

To investigate the correlation between the features of optical coherence tomography [OCT] and central macular thickness [CMT], and the best-corrected visual acuity in macular edema complicating retinal vein occlusion. In a prospective study, OCT was performed in 37 eyes of 37 patients with macular edema secondary to retinal vein occlusion. Twenty five eyes had central retinal vein occlusion [CRVO], and 12 eyes had branch retinal vein occlusion [BRVO]. The OCT features were categorized into: type 1, sponge-like retinal swelling; type 2, cystoid macular edema; and type 3, serous retinal detachment. Visual acuity at presentation correlated with CMT [r = 0.650, P <0.0001]. OCT type 1 showed the least CMT [P <0.0001] and the best visual acuity [P <0.0001]. A serous retinal detachment [type 3] undetectable by slit-lamp biomicroscopy and fundus fluorescein angiography was identified in 23 eyes [62.2%] using OCT. Our analysis showed that eyes with OCT type 3 had the worst visual acuity [P <0.0001] and the thickest CMT [P <0.0001]. There was a significant correlation between CMT and OCT patterns of macular edema and visual acuity at presentation

Uveitic macular edema: Quantitative assessment using optical coherence tomography and correlation with visual acuity

To evaluate the correlation between improvement in visual acuity [VA] and the reduction in central macular thickness [CMT] after treatment in uveitic macular edema. Twenty-nine eyes of 19 consecutive patients were studied prospectively. Inclusion criteria were: [1] verification of macular edema by optical coherence tomography [OCT], [2] adequate media clarity for fundus visualization, and [3] absence of coexisting ocular disease limiting visual potential. All patients had the following ophthalmic examination: best-corrected Snellen VA, slit-lamp examination, indirect ophthalmoscopy, fundus biomicroscopy, OCT, and fluorescein angiography. There were 11 males and 8 females with a mean age of 40.58 +/- 9.5 years [range, 22 to 54 years]. Eleven patients had presumed intraocular tuberculosis, four had BehAet's disease, three had pars planitis, and one had ankylosing spondylitis. At baseline, the mean logarithm of the minimum angle of resolution [logMAR] V.A. was 0.6841 +/- 0.5186 [Snellen equivalent, 20/100], and mean CMT was 419.5 +/- 105.9 mm. All patients received adequate immunosuppressive treatment and patients with presumed intraocular tuberculosis received in addition antituberculous therapy. After a mean follow-up period of 4.3 +/- 2.8 months, the mean logMAR VA was 0.231 +/- 0.178 [Snellen equivalent, 20/30] and the mean CMT was 250.9 +/- 41.9 mm. The improvement in VA and the reduction of CMT were significant [p <0.0001 for both comparisons]. OCT is useful in monitoring the efficacy of treatment in patients with uveitic macular edema

Reversal of visual loss due to optic neuropathy and exudative retinal detachment after closure of a traumatic carotid-cavernous fistula

To report a case of traumatic carotid-cavernous fistula [CCF] in whom loss of vision was reversed after closure of the fistula. Case report. A 15-year-old female had a 12-day history of visual loss, proptosis, and redness in the right eye after sustaining trauma to the head in a road traffic accident. Examination revealed the presence of optic neuropathy and exudative retinal detachment. Angiography demonstrated a CCF. Vision was completely restored and exudative retinal detachment resolved after closure of the fistula. Although CCFs frequently are associated with permanent visual loss, a subset of patients demonstrates reversible ocular findings