The Efficacy of Intravitreal Aflibercept in Submacular Hemorrhage Secondary to Wet Age-related Macular Degeneration

PURPOSE: To evaluate the efficacy of intravitreal aflibercept monotherapy in submacular hemorrhage (SMH) secondary to wet age-related macular degeneration (AMD). METHODS: This study included 25 eyes in 25 patients with SMH involving the fovea secondary to wet-AMD. All patients were treated with three consecutive monthly intravitreal aflibercept (2.0 mg/0.05 mL) injections, followed by as-needed reinjection. They were followed for at least 6 months. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and area of SMH were measured at diagnosis, as well as at 3 and 6 months after treatment initiation. RESULTS: The BCVA significantly improved from 0.79 ± 0.41 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.54 ± 0.41 logMAR at 6 months (p < 0.001). BCVA ≥3 lines and stable vision were observed in 96% of the eyes. The CFT significantly decreased from 560.8 ± 215.3 µm at baseline to 299.8 ± 160.2 µm at 6 months (p < 0.001). The area of SMH significantly decreased from 10.5 ± 7.1 mm² at baseline to 1.8 ± 6.5 mm² at 6 months (p < 0.001). The BCVA, CFT, and area of SMH at baseline, as well as duration of symptoms, all correlated with BCVA at the 6-month follow-up. CONCLUSIONS: Intravitreal injection of aflibercept is an effective treatment option for patients with SMH secondary to wet-AMD; however, there may be limited efficacy in eyes with large SMH area and cases in which treatment is delayed.

Hemorrhagic choroidal detachment after use of anti-glaucomatous eye drops: case report / Descolamento hemorrágico de coroide após o uso de colírios antiglaucomatosos: relato de caso

Eighty-two-year-old patient with a pacemaker using warfarin due to arrhythmia and having an intraocular lens in the right eye, developed spontaneous hemorrhagic choroidal detachment one day after the use of combined preparation of 0.5% timolol maleate and 0.004% travoprost, due to primary open-angle glaucoma. Hemorrhagic detachment was detected by anterior and posterior segment examination, as well as B-scan ultrasonography. After the detachment, excessive increased intraocular pressure was controlled with oral carbonic anhydrase inhibitor, cycloplegic and steroid therapy. After four months, visual acuity was 20/20 and the intraocular pressure was under control with 0.5% timolol maleate and 1% brinzolamide. Controlled reduction of the intraocular pressure should be considered, particularly in older patients under anticoagulant therapy and that had undergone prior ocular surgery.

Paciente de oitenta e dois anos de idade com marca-passo e utilizando varfarina devido à arritmia cardíaca e com uma lente intraocular no olho direito, desenvolveu descolamento de hemorrágico espontâneo de coroide um dia após o uso de colírio combinado de maleato de timolol a 0,5% e travoprosta a 0,004%, devido ao glaucoma de ângulo aberto primário. O descolamento hemorrágico foi detectado por análise do segmento anterior e posterior, bem como ultrassonografia modo B. Após o descolamento, o aumento excessivo da pressão intraocular foi controlado por inibidor da anidrase carbônica via oral, terapia cicloplégica e esteroides. Após quatro meses, a acuidade visual era 20/20 e a pressão intraocular estava sob controle com o maleato de timolol a 0,5% e brinzolamida a 1%. A redução controlada da pressão intraocular deve ser considerada, especialmente em pacientes idosos sob terapia anticoagulante e que tinham sido submetidos à cirurgia ocular prévia.

The surgical management of massive intraoperative and postoperative suprachoroidal hemorrhage: anatomic and functional outcomes / O tratamento cirúrgico da hemorragia supracoroidea massiva intraoperatória e pós-operatória: resultados anatômicos e funcionais

PURPOSE: To describe the clinical characteristics, management and treatment outcomes of patients with post-surgical suprachoroidal hemorrhage (SCH). METHODS: A retrospective cross-sectional study was conducted, in which the medical records of 9 consecutive patients with SCH admitted to the Goldschleger Eye Institute were reviewed. RESULTS: The mean age was 74 years (range 61-84) and the mean follow-up time was 38.3 ± 0.1 months (range 4-87 months). Four cases were associated with glaucoma surgeries (2 trabeculectomies and 2 Ahmed valve implantations), 3 cases with cataract surgery and 2 cases with pars plana vitrectomy. The diagnosis of SCH was ranging from intra-operative to 8 days following the primary procedure. Most patients underwent posterior sclerotomies and drainage alone or combined with pars plana vitrectomy in a mean timing of intervention of 11 ± 4 days. At one month of follow-up the visual acuity improved in 7 eyes and remained stable in 2, compared to the VA prior to the drainage operation. The mean VA improved from 2.03 to 1.285 logMAR units at 1 month following the drainage procedure (p=0.003). CONCLUSIONS: SCH still remains a challenging complication of many ophthalmological procedures. The current surgical management may improve visual acuity though the general prognosis is still poor.

OBJETIVOS: Descrever as características clínicas, manejo e desfechos do tratamento de pacientes com hemorragia supracoroidea pós-operatória. MÉTODOS: Um estudo transversal foi realizado. Neste foram revisados os prontuários médicos de nove pacientes consecutivos com hemorragia supracoroidea que foram admitidos para internação no Serviço de Oftalmologia do Goldschleger Eye Institute. RESULTADOS: A média de idade foi 74 anos (61-84) e o tempo médio de seguimento foi 38,3 ± 0,1 meses (4-87 meses). Quatro casos foram associados com cirurgias de glaucoma (2 trabeculectomias e 2 implantes de válvula de Ahmed), 3 casos com cirurgia de catarata e 2 casos com vitrectomia. O diagnóstico de hemorragia supracoroidea foi de intraoperatório até 8 dias após o procedimento primário. A maioria dos pacientes se submeteu a esclerectomia posterior e drenagem com ou sem vitrectomia via pars plana combinada. A média do tempo de intervenção foi 11 ± 4 dias. Após um mês de seguimento a acuidade visual melhorou em 7 olhos e se manteve estável em 2, comparando com a acuidade visual prévia a cirurgia de drenagem. A acuidade visual media melhorou de 2,03 para 1,285 logMAR após 1 mês de seguimento depois da drenagem por esclerectomia posterior (p=0,003). CONCLUSÕES: Hemorragia supracoroidea ainda é uma complicação desafiadora de muitos procedimentos oftalmológicos. O manejo cirúrgico atual pode melhorar a acuidade visual apesar de o prognostico desta afecção ser ainda reservado.

Spontaneous Eyeball Rupture in a 94-Year-Old Patient

PURPOSE: To report a case of spontaneous eye ball rupture without trauma in a 94-year-old patient. CASE SUMMARY: A 94-year-old female patient diagnosed with cataract in both eyes 20 years was referred to this ophthalmologic department for treatment consultation of a painful left eye with spontaneous bleeding. She has used anti-cataract eye drops and artificial tears three times a day for several years without consulting a doctor. Fifteen days prior to presentation, the patient suffered severe left eyeball pain and headache and was diagnosed with acute angle-closure glaucoma secondary to hypermature cataract. She underwnet eviceration after ocular examination and systemic evaluation. Surgical findings included a thin cornea at the inferior limbus and protruding intraocular tissues. Additionally, the eyeball was filled with a blood clot from a choroidal hemorrhage. Morganella morganii were grown in a bacterial swap culture, and a corneal biopsy revealed suppurative inflammation. CONCLUSIONS: In old age, a thin corneal limbus due to infection and complicated acute angle-closure glaucoma can cause massive suprachoroidal hemorrhage with spontaneous eyeball rupture.

Blow-in fracture of the orbital roof presenting as a case of non-resolving choroidal effusion.

A 34-year-old male patient was referred to us as a case of non-resolving suprachoroidal hemorrhage. History revealed decrease in right eye vision following trauma to forehead. B scan ultrasonography (USG) of the right eye showed a high-reflective structure indenting the globe. It turned out to be an inferiorly displaced fracture fragment from the orbital roof on computerized tomography (CT) scan. The choroidal elevation disappeared after open reduction of the fracture fragment and patient had good recovery of vision. USG and CT scan were helpful in the diagnosis and management of this case.

Combination therapy of intravitreal injection of bevacizumab [avastin] and photodynamic therapy with verteporfin in the treatment of idiopathic polypoidal choroidal vasculopathy with choroidal neovascular membrane

To report the efficacy of intravitreal bevacizumab followed by PDT with verteporfm in idiopathicIPCV with CNVM and exudation involving posterior pole. Prospective interventional case study. A 48-year-old consented Indian male patient underwent intravitreal bevacizumab followed by PDT with verteporfin after one month in the left eye. Base line complete ophthalmic examination, fundus photography, fluorescein and indocyanine green angiography and optical coherence tomography were done and selected tests were repeated - 1 week, 1 month, 2 months, 3 months and 4 months after treatment. There was reduced exudation from the lesions with flattening of the posterior pole within 4 weeks after intravitreal bevacizumab with vision improving to 6/24 from 6/60 at the end of one month. After one month he underwent PDT according to standard protocol and vision further improved to 6/24 to 6/12 by 2 weeks after therapy and maintained the same till the end of four months of treatment. Treatment of PCV is not well established; in this case combination therapy was effective in the management of IPCV complicated by CNVM. Intravitreal injection of bevacizumab probably led to rapid decrease in exudation of the lesion thus enabling in successful ablation of the CNVM by PDT

Vasculopatia polipoidal idiopática da coróide: aspectos extremos da evolução da doença em um paciente - Relato de caso / Idiopathic polypoidal choroidal vasculopathy: its extreme aspects in one patient - Case report

O artigo descreve um caso de vasculopatia polipoidal idiopática da coróide (VPIC) e demonstra o papel relevante da indocianinografia no diagnóstico diferencial com outras causas de neovascularização subretiniana, particularmente degeneração macular relacionada à idade (DMRI), bem como avalia os aspectos extremos na evolução da doença em um único paciente. Paciente de 54 anos, sexo masculino, cor parda, com queixas de baixa de acuidade visual súbita em OD, foi submetido a exame oftalmológico, pelo qual se constatou hemorragia vítrea em OD e, posteriormente, descolamento sero-hemorrágico do epitélio pigmentário da retina em OE. A angiofluoresceinografia e indocianinografia mostraram quadro compatível com vasculopatia polipoidal idiopática da coróide. O paciente foi submetido a vitrectomia via pars plana em OD e foi acompanhado por período de 5 meses, evoluindo com perda de visão secundária a descolamento de retina e cicatriz macular disciforme em OD. No olho contralateral, ocorreu involução da vasculopatia com preservação de acuidade visual 20/25. A vasculopatia polipoidal idiopática da coróide é entidade clínica cujas anormalidades do fundo de olho se sobrepõem às manifestações da degeneração macular relacionada à idade exsudativa. A indocianinografia é de vital importância no diagnóstico diferencial entre as duas doenças que tem evolução e prognóstico distintos. Além disso, consideramos este caso muito ilustrativo pelas diferentes nuances com que a doença se manifestou e evoluiu em um único paciente.

Vasculopatia polipoidal idiopática da coróide / Idiopathic polypoidalchoroidal vasculopathy

Objetivo: Descrever os achados da tomografia de coerência óptica, angiofluoresceinografia e indocianinografia na vasculopatia polipoidal idiopática da coróide. Métodos: Realizou-se análise criteriosa dos exames complementares de angiofluoresceinografia e indocianinografia, comumente utilizados para o diagnóstico, assim como da tomografia de coerência óptica, em quatro olhos de uma série de três pacientes com vasculopatia polipoidal idiopática da coróide. Resultados: Os quatro olhos motraram lesöes subretinianas vermelho-alaranjadas, sendo que dois casos apresentaram descolamento hemorrágico do epitélio pigmentado da retina, além de manifestaçöes exsudativas e hemorrágicas associadas. A angiofluoresceinografia revelou dilataçöes aneurismáticas em ramificaçöes anormais de vasos da coróide em apenas 1 caso, ao contrário da indocianinografia que claramente demonstrou as lesöes em todos os casos. A tomografia de coerência óptica confirmou o descolamento hemorrágico espontâneo do epitélio pigmentado da retina em 2 casos. Conclusäo: A indocianinografia é o exame de escolha no diagnóstico da vasculopatia polipoidal da coróide, mas em alguns casos a associaçäo com a tomografia de coerência óptica e angiofluoresc einografia pode ser útil no diagnóstico e seguimento.

Strabismus with Ocualr Motility Disturbance after Molteno Implant

PURPOSE: We experienced a case of ocular motility disturbance with esotropia and hypotropia, following implantation of Molteno to the superotemporal quadrant. METHODS: The patient recovered to orthophoria after removal of implant and fibrotic scar tissue with recession and resection. RESULTS: Multiple complications have been reported in association with Molteno implantation, including hypotony, cataract, choroidal hemorrhage, retinal detachment, endophthalmitis, hyphema, phthisis. However ocular motility disturbances have been documented in only a few cases and never in Korea to our knowledge. Therefore, we report this case with the review of related literatures.

Suprachoroidal haemorrhage. Secondary management.

We report a case of successful management of expulsive suprachoroidal haemorrhage following cataract surgery. This case study highlights the strategy of adequate management.

Patología de coroides / Choroidal pathology

La coroides o tracto uveal es una estructura vascular, densamente pigmentada en el ojo, siendo su principal función la de proporcionar el aporte nutrición a esta estructura. La coroides es susceptible de enfermedades vasculares, inflamación (uveítis) y de otros agentes nocivos locales o sistémicos. El ultrasonido es un método diagnóstico no invasivo con el cual es posible caracterizar procesos inflamatorios, grosor coroideo, tumores o infiltraciones tisulares, membranas ciclíticas, desprendimiento de coroides y otras alteraciones incluídas en este trabajo

Hemorragia expulsiva espontânea durante crise hepertensiva: relato de dois casos / Spontaneous expulse hemorrhage during hypertensive crisis: report of two cases

Hemorragia expulsiva espontânea é um evento desastroso e incomum, geralmente associado ao glaucoma. Neste artigo, relatamos dois casos ocorridos durante episódios de crise hipertensiva arterial, uma associaçäo que ainda näo havia sido discutida na literatura. Acreditamos que a pressäo arterial gravemente elevada possa desempenhar um papel direto na patogênese dessa condiçäo

Drainge vs. Nondrainage of Suvretinal Fluid in Scleral Buckling Procedure

Whether or not to drain the subretinal fluid in retinal detachment surgery remains controversial. The primary advantage of nondrainage procedure is the avoidance of the possible complications associated with transchoroidal drainage, such as choroidal hemorrhage, retinal perforation and loss of formed vitreous. Does the drainage of subretinal fluid itself affect the outcome of surgery? If any, what is the mandatory indication? The authors compared the surgical results of drainate vs. nondrainage of subretinal fluid in scleral buckling procedure to answer these questions. We reviewed preand postoperative characteristics of retinal detachments and the course of subretinal fluid absorption in the 66 eyes of 65 patients who received scleral buckling procedure and were followed up at least 6 months. Retinal reattachment was achieved in 23 eyes of SRF drained 26 eyes(88.4%) and 32 eyes of SRF non-drained 40 eyes(80.0%) after primary operation. The average of time for complete resorption of SFR was 8.04 significant difference was observed between the two groups. Complications associated with drainage were 2 cases of localized subretinal hemorrhage and one case of retinal perforation but did not disturb reattachment of retina. On the basis of these results, we think that placing the buckle correctly is more essential than drainage for successful retinal detachment surgery.

Subretinal Hemorrhages in High Myopia

Ocular changes such as crescents, posterior staphyloma, retinochoroidal degeneration, lacquer cracks and subretinal or choroidal hemorrhage are common In myopia. We examined 13 patients(13 eyes) who had refractive errors of -6.0 Diopter or more and subretinal hemorrhages at initial visit. According to fluorescein angiographic finding, subretinal hemorrhages in high myopia were divided into two groups: 6 eyes without choroidal neovascularization(CNV) and 7 eyes with choroidal neovascularization. Subretinal hemorrhage without choroidal neovascularization was frequent in patients aged 15-32 years(mean, 23.7 years) and choroidal neovascularization was common in patients aged 34-60 years(mean 47.6 years). In the eyes without choroidal neovascularization, the subretinal hemorrhage disappeared spontaneously after a few months and the visual acuity of these patients was variable at the initial visit(range, 5/200-20/30), and was unchanged or improved during the follow-up period. In the eyes with choroidal neovascularization, the visual acuity was less than 0.1 at the initial visit, except 2 cases, and was unchanged or worsened during the follow-up peroid. It will be helpful to divide the high myopia with subretinal hemorrhage into with or without choroidal neovasculrization according to the flourescein angiography to assess the prognosis.

Suprachoroidal hemorrhage following combined glaucoma-cataract surgery causing total but reversible loss of vision

Suprachoroidal hemorrhage or effusion is a common complication of intraocular surgery. Visual outcome depends on the extent and duration of the detachment, severity of ocular disease and effectiveness of the surgical intervention. We present a case of a middle aged man who regained partial vision, following complete loss of light perception, after tapping of a hemorrhagic choroidal detachment

Informe de un caso de hemorragia intraventricular espontánea en un recién nacido a término

Se informa de un caso de un recién nacido con hemorragia intraventricular, a quien se le confirmó con estudios neuroradiológicos, hemorragia de los plexos coroides, sin que se pudiera demostrar factores de riesgo asociados a este evento.

Expulsive choroidal haemorrhage.

Expulsive choroidal haemorrhage is a dramatic and serious complication of cataract surgery that occurred in five patients out of ten thousand consecutive cataract surgeries performed by the author during the year 1989 and 1990. Report about this dreaded complication after cataract surgery are scanty and as far as I can remember I have not seen any report in Indian ophthalmic literature recently. Since cataract surgery forms the major part of intra ocular surgeries performed in our country, I thought it would be appropriate to report about this rare complication which may occur to all of us. Out of five cases 3 were males and 2 were females in the age group ranging between 45-72 years. Two eyes regained vision up to 6/12 after intra operative expulsive haemorrhage. All the eyes were salvaged by doing anterior sclerotomy. Diabetes, hypertension, glaucoma and myopia are the commonest predisposing factors.

17 casos de efusión supracoroidea intraoperatoria aguda en 1.303 casos de cirugía de catarata / 17 cases of acute intraoperative choroidal effusion in 1.303 cases of cataract surgery

Se ha reconocido la complicación de efusión o hematoma coroideo localizado en 16 de 1.303 operaciones extracapsulares de catarata con implante planeado de lente intraocular, equivalente a un porcentaje de 1.227%. Además, en la misma serie, se presentó una sola hemorragia expulsiva, lo que da una incidencia adicional de 0,076%; y que sumadas equivalen una incidencia total de 1,3%. Tanto uno como el otro valor concuerdan con las incidencias medias mencionadas en la mayoría de las publicaciones. Se corrobora en esta serie numerosa la tendencia manifestada en la literatura mundial en el curso de los últimos años en el sentido de desechar la esclerotomía posterior como medida salvadora de esta emergencia quirúrgica, y se enfatiza, en cambio, que el cierre urgente de la herida operatoria es la medida prioritaria ante cualquiera otra consideración. En los 16 casos, por así llamarlos "menores", es decir, hemorragias o efusiones localizadas, se logró llevar a feliz término la intervención planeada, esto es el implante de LIO en 10 de las intervenciones en el mismo tiempo quirúrgico, y en 4 se realizó la implantación en forma secundaria en plazos variables, de modo que, tarde o temprano, el implante de LIO se efectuó en 13 de los 17 casos. Todos, menos dos, alcanzaron visión final corregida entre 0,5 y 1,0. Hemos querido alertar acerca de esta complicación, que nos parece muchas veces subdiagnosticada en sus estadios más benignos. Se insiste en el hecho que los factores predisponentes, tanto oculares como sistémicos son multifactoriales. Se da a conocer la experiencia en cuanto al oportuno reconocimiento de la complicación, el manejo intraoperatorio de ella y el destino anatómico y funcional de los ojos que la sufrieron. Finalmente, se entregan recomendaciones en caso de tener que intervenir el ojo contralateral