Immediate Natural Course of IOP after IVTA and The Effect of Preoperative Ocular Massage

PURPOSE: We determined immediate natural course of intraocular pressure (IOP) at different time points after intravitreal injection of triamcinolone acetonide (IVTA), and evaluated the effect of preoperative ocular massage to lower the immediate IOP spike after IVTA. METHODS: This prospective randomized comparative case-series study comprised sixty three eyes of 60 patients with macular edema. Thirty three eyes of 28 patients underwent IVTA (group A), and thirty eyes of 27 patients underwent IVTA with preoperative ocular massage (group B). Anterior chamber paracentesis was not performed in any of the eyes. The IOPs before and after massage, and the IOPs after IVTA (immediately, 10 minutes, 20 minutes, 30 minutes, and 1 hour, 2 hours after IVTA) were measured, respectively. RESULTS: Mean IOP reached a significant peak immediately after IVTA, and rapidly declined at 10 minutes, and then normalized after 20 minutes. Although Mean IOP was significantly lowered preoperatively by ocular massage, the IOP increment at any time point after IVTA was not significantly different between two groups. CONCLUSIONS: The significant IOP spike immediately after IVTA was rapidly normalized over 20 minutes. Preoperative ocular massage was not significantly effective in diminishing the immediate IOP elevation and its persistence after IVTA.

Cancer-associated Nummular Loss of the Retinal Pigment Epithelium

PURPOSE: To report a case of cancer-associated nummular loss of the retinal pigment epithelium. METHODS: A 47-year-old man with a history of hepatocellular carcinoma presented with three weeks of bilateral visual loss. His best-corrected visual acuity was 20/40 in each eye. He had multiple round confluent grayish-brown patches at the level of retinal pigment epithelium, and no pigmented choroidal lesions. Fluorescein angiography showed circular areas of transmission defect and indocyanine green angiography showed early hyperfluorescence, corresponding with the multiple round confluent patches. CONCLUSIONS: We report a case of visual paraneoplastic syndrome which showed nummular loss of the pigment epithelial cells which distinguishes the clinical component of BDUMP syndrome.