Delayed onset chloroquine retinopathy presenting 10 years after long-term usage of chloroquine

Chloroquine retinopathy is a known complication of long-term use of chloroquine. This retinopathy can appear even after usage of chloroquine has stopped. The present case report describes the history and clinical features of chloroquine retinopathy developing a decade after discontinuing the drug

Delayed, spontaneous conversion of type 2 closure to type 1 closure following surgery for traumatic macular hole associated with submacular hemorrhage

A 45-year-old man presented with diminution of vision in the left eye following a firecracker injury. Best corrected visual acuity [BCVA] was 20/20 in the right eye and 20/125 in the left eye. Fundus examination revealed vitreous hemorrhage, a macular hole, and submacular hemorrhage in the left eye. The patient underwent vitrectomy, tissue plasminogen activator [tPA]-assisted evacuation of the submacular hemorrhage, internal limiting membrane [ILM] peeling, and 14% C3F8 gas insufflation. After two months, the BCVA remained 20/125 and optical coherence tomography [OCT] showed type 2 macular hole closure. On a follow-up, seven months after surgery, BCVA improved to 20/80, N6, with type 1 closure of the macular hole. The clinical findings were confirmed on OCT. Delayed and spontaneous conversion of the traumatic macular hole could occur several months after the primary surgery and may be associated with improved visual outcome. Larger studies are required to better understand the factors implicated in such a phenomenon

Short-term results of intravitreal dexamethasone implant [OZURDEX[registered sign]] in treatment of recalcitrant diabetic macular edema: a case series

Dexamethasone Posterior-Segment Drug Delivery System is a novel, biodegradable, sustained-release drug delivery system [OZURDEX[registered sign]] for treatment of macular edema following retinal vein occlusion and posterior uveitis. However, its potential role in management of diabetic macular edema has not been reported yet. The aim was to evaluate the safety and efficacy of [OZURDEX[registered sign]] in patients with recalcitrant diabetic macular edema [DME]. A retrospective, interventional case series from a tertiary eye care center in India is presented. Inclusion criteria comprised patients presenting with recalcitrant DME, 3 or more months after one or more treatments of macular laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor [VEGF] injections. Exclusion criteria included history of corticosteroid-responsive intraocular pressure [IOP] rise, cataract extraction, or other intraocular surgery within 3 months. The main outcome measure was visual acuity at 1 and 4 months after OZURDEX[registered sign] injection. Secondary outcome measures included change in central macular thickness on Optical coherence tomography [OCT] and changes in IOP following intravitreal OZURDEX[registered sign] implant. Of 18 eyes [17 patients] with recalcitrant diabetic macular edema that underwent OZURDEX[registered sign] implant, three eyes [two patients] had follow-up of more than 3 months post-injection. Mean age of patients was 56 years. Mean duration of diabetes mellitus was 16.6 years. Systemic control of DM was good as assessed by FBS/PPBS and HbA1c. The pre-operative mean central macular thickness was 744.3 micro m and improved to 144 and 570 micro m at months 1 and 4, respectively. Preoperative mean BCVA was 0.6 logMAR units and improved to 0.3 and 0.46 logMAR units at month 1 and 4, respectively. The mean follow-up was 4.3 months [range 4-5 months]. OZURDEX[registered sign] appears efficacious in management of recalcitrant diabetic macular edema. The results of the ongoing POSURDEX[registered sign] study will elaborate these effects better

Hemorrhagic intraretinal macrocyst: Differential diagnoses and report of an unusual case

Retinal 'cysts' may be single or multiple, ranging from two-to-ten disc diameters in size, and occur in eyes with longstanding retinal detachment. The authors describe a retinal macrocyst larger than ten disc diameters, with a blood-filled cavity, and its ultrasound findings. Improved retinal nourishment following retinal reattachment gradually reverses the process responsible for cystic degeneration, with the eventual collapse of the cyst [within days or weeks]. Surprisingly, this giant cyst did not collapse for almost three years despite retinal reattachment. The internal mobile echogenic contents were suggestive of blood. The possible reason of blood in the cyst could be rupture of the retinal blood vessels in the cyst cavity. This could be a recurrent phenomenon, which did not allow the cyst to collapse. The Hemorrhagic Intraretinal Macrocyst needs to be differentiated from mimicking clinical conditions, namely, retinoschisis, choroidal melanoma, subretinal abscess, choroidal hemangioma, and the like. It could take up to a few years to collapse spontaneously, following successful retinal reattachment

Can retinal microtrauma by internal limiting membrane peeling cause retinal angiomatosis proliferans?

A 32-year-old male presented with decreased vision in right eye since 1 month following trauma with plastic ball. Best-corrected visual acuity [BCVA] was 20/160 in right eye and 20/20 in left. Right eye examination revealed angle recession, choroidal rupture, and macular hole. He underwent vitrectomy, internal limiting membrane [ILM] peeling, and 14% C3F8 gas injection. After 6 weeks, BCVA was 20/30; fundus showed macular hole closure. Six months after surgery, fundus revealed retinal vascular lesions suggestive of stage I RAP-like lesions; vision was maintained. Clinical findings were confirmed on Video ICGA, FFA, and OCT. The patient was periodically reviewed and lesions were nonprogressive until last follow-up, 13 months after surgery. It seems quite probable that ILM peeling may have caused retinal microtrauma leading to the formation of RAP-like lesions. What factors lead to such an event is as yet not clearly understood. Hence, larger studies with a longer follow-up are warranted to better understand these findings

Combined scleral buckling and phacoemulsification

To analyze the outcome of combined scleral buckling and phacoemulsification for primary rhegmatogenous retinal detachment and visually significant cataract. Retrospective, interventional case series. Retrospective review of patients with primary rhegmatogenous detachment with or without proliferative vitreoretinopathy [PVR] changes and visually significant cataract who underwent combined scleral buckling and phacoemulsification with or without intraocular lens [IOL] implantation between 1991 and 2006. Of the ten eyes, all underwent phacoemulsification and five eyes had posterior chamber Intraocular lens [PC IOL] implantation. All eyes underwent scleral buckling with solid silicone explant combined with #240 encircling band. Subretinal fluid [SRF] drainage was done in five eyes Four eyes improved to better than 6/12 at a mean follow-up of 9 months. Anatomical success was achieved in all eyes [100%]. Combined scleral buckling and phacoemulsification is a safe and effective procedure that spares the patient the burden of repeated surgeries. It may be considered as a treatment option in selected cases of rhegmatogenous retinal detachment with significant cataract with/without early PVR