Topical interferon therapy in uveitic macular edema

Purpose: To evaluate efficacy of topical interferon alfa?2b (IFN) in the treatment of uveitic macular edema (UME). Methods: This is a prospective, interventional case study of patients with UME. Injection IFN was reconstituted into eye drops and a four times/day (QID) application was prescribed. Central macular thickness (CMT) on optical coherence tomography (OCT) scan was evaluated. Improvement in CMT by ?50 ?m from the baseline was studied in eyes with presenting CMT ?400 ?m. Results: Twenty eyes of 20 patients with UME were studied: anterior uveitis (n = 3), anterior + intermediate uveitis (n = 5), posterior uveitis (n = 3), retinal vasculitis (n = 3), and panuveitis (n = 6). Mean CMT at the presentation was 423.3 ?m (range: 270–604 ?m), which improved at 1 month (n = 16), 2 months (n = 10), and ?3 months (n = 11) follow?up, to 415.3 ?m (range: 247–579 ?m) (P = 0.411), 364.4 ?m (range: 258–566 ?m) (P = 0.099), 344 ?m (range: 258– 484 ?m) (P = 0.001), respectively. Twelve eyes of 12 patients had presenting CMT ?400 ?m. In these cases, decrease in CMT by ?50 ?m was seen in 4/10, 4/5, and 5/6 eyes at 1 and 2 months and ?3 months follow?up. Mean follow?up was 4 months (range: 1–17 months). Complete resolution of UME was seen only in three eyes. No ocular or systemic side effects were observed. Conclusion: Topical IFN therapy in QID doses is safe but may have limited role in UME. Long?term therapy may improve its efficacy. Larger studies with dose modification, combination with other drugs, and with homogeneous uveitis population are recommended.

Intensive topical interferon therapy in uveitic macular edema

Purpose: To evaluate the efficacy of intensive topical interferon alfa-2b (IFN) therapy in uveitic macular edema (UME). Methods: This is a prospective, interventional case study of eyes with UME. Commercially available injection IFN for subcutaneous use was reconstituted to form eye drops and a dose of 6 times/day for 2 weeks, 5 times/day for next 2 weeks, followed by 4, 3, 2, 1 taper per month was prescribed. Optical coherence tomography (OCT) and clinical examination was done at 0, 2, 4, 8 weeks, and further as required. Results: Nine eyes of 9 patients with UME were studied. Mean central macular thickness (CMT) at presentation was 522.2 ?m (range: 408–803 ?m). At 2-week, 1-month, and 2-month follow-up, mean CMT decreased to 451.6 ?m (range: 322–524 ?m), 375.8 ?m (range: 287–480 ?m), and 360.3 ?m (range: 260–485 ?m), respectively. Four eyes which showed inadequate response to previous topical IFN therapy (4 times/day) showed significant improvement with intensive therapy at 1 month follow-up. In 4 eyes, UME resolved completely with mean CMT 285.5 ?m (range: 260–312 ?m) at 7.5 weeks (range: 4–12 weeks). Study exit was seen in 2 cases due to inadequate response and relapse of uveitis. Mean follow up was 3.38 months (range: 1–5 months). Conclusion: Intensive topical IFN therapy can be an alternative therapeutic option in the treatment of UME. Study of intraocular penetration, combination with other drugs, and the efficacy of IFN separately for different uveitic entities may explore new avenues in treatment of UME.

Jet stream related iatrogenic retinal breaks during vitreo-retinal surgery

Purpose: To evaluate the causes of jet stream injury (JSI)?related iatrogenic retinal breaks (IRBs) during vitreoretinal surgery (VRS). Methods: The precise surgical environment, which includes the indication and type of surgical procedure, retina status, details of instrumentation and fluidic parameters, and characteristics of the jet responsible for the IRB, was noted from case records. The nature of IRB and its healing and impact on anatomical and visual outcomes were analyzed. Results: Five eyes of five patients with complete documentation of both the JSI and the IRB were included. Two cases were operated for macular hole, and one each for vitreous hemorrhage, retinal detachment, and endophthalmitis. One case had infusion?fluid?related JSI, while four developed it because of injection of surgical adjuncts (drugs, PFCL, and dye). JSI developed in two cases when the vitreous cavity was filled with fluid, while it was air?filled in three cases. In four cases, the fluid migrated into subretinal space, necessitating further maneuvers following which the breaks healed, but were directly responsible for vision loss in two cases. Conclusion: JSI related IRBs are rare but may be directly responsible for vision loss if they impact the macula. The balance between jet stream velocity, its distance from the retinal surface, the intervening media (vitreous cavity), and retinal health play an important role. It can occur because of both infusion as well as injection jets. Precautions must be taken in cases vulnerable to complications with suggested modifications in the surgical technique.

Retinal Oximetry: The Indian Experience in Healthy and Diseased Eyes.

To study the alterations in retinal oxygen saturations in healthy and diseased eyes. Patients presenting to our hospital underwent an additional non-invasive procedure to measure oxygen saturation in their retinal vessels. After dilatation, oximetry was done using the Oxymap T1 retinal oximeter (Oxymap hf, Reykjavik, Iceland). Normal patients and patients with arteriolar and venous occlusions, retinal dystrophies and glaucoma, were evaluated. Arteriolar, venous and arteryvenous saturation difference (AVSD) values were determined for each of the groups. In the normal subjects (n = 98), the average arteriolar saturation was 90.3 ± 6.5, and the venous saturation was 56.9 ± 6.3. The average AVSD was 33.4 ± 5.0. In arterial occlusions (n = 10), we have seen an initial fall in arteriolar (85.8%) and venous (49.7%) saturations in the acute stage in eyes with central retinal artery occlusion with subsequent increase in saturations. In venous occlusions (n = 18), there was an initial increase in all global saturation parameters in the acute stage (arteriolar: 105.8%, venous: 62.7%, AVSD: 43.3%), followed by a gradual decrease in saturations in the chronic stage (arteriolar: 99.8%, venous: 60.1%, AVSD: 39.8%). Eyes with retinitis pigmentosa (n=62) showed higher saturations (104.15%) and higher AVSD (44.15%) compared to macular dystrophies (n = 23) (96.7% and 41.61%) and normal controls (90.6% and 33.3%). Macular dystrophies showed higher global arteriolar values and AVSD but comparable venous values to the control group. In glaucoma (n = 44), we have seen raised arteriolar and AVSD values. Oximetry is sensitive in picking up changes in diseased eyes that are distinct from normal values. In the future, it may prove to be useful in pre-clinical screening studies and in therapeutic decision making.

Infestation of the lacrimal sac by Rhinosporidium seeberi: A clinicopathological case report.

features of idiopathic orbital inflammatory disease in a young male patient. Clinical features, pathophysiology, and management of lacrimal sac rhinosporidiosis have been discussed.