Subinternal limiting membrane hemorrhage post-Ahmed glaucoma valve in vitrectomized eye.

Glaucoma drainage devices are mostly used for refractory glaucoma. Early postoperative complications include flat anterior chamber, choroidal effusion, and suprachoroidal hemorrhage. An 8-year-old male patient with a prior history of vitreous surgery for traumatic vitreous hemorrhage, presented to us with angle recession glaucoma in his right eye. His intraocular pressure (IOP) was 44 mmHg despite maximum antiglaucoma medication. Ahmed glaucoma valve (AGV) surgery was performed to control his IOP. In the early postoperative period, the patient developed premacular subinternal limiting membrane (ILM) hemorrhage, which did not resolve even after 4 weeks. Vitreoretinal intervention involving removal of the thickened ILM and sub-ILM bleed had to be performed. To the best of our knowledge, no case has been reported with sub-ILM bleed post aqueous humor shunts. Here, we report a case of premacular sub-ILM bleed following AGV in vitrectomized eye.

PERIPHERAL RETINAL DEGENERATIONS AND RHEGMATOGENOUS DETACHMENT IN PRIMARY CONGENITAL GLAUCOMA.

BACKGROUND: To determine the prevalence of peripheral retinal degenerations (PRD) and rhegmatogenous retinal detachment in patients with primary congenital glaucoma (PCG). METHODS: Records of all patients with PCG operated from year 2000 onwards were evaluated to look for the prevalence of rhegmatogenous retinal detachment. Of these, those children who were old enough to cooperate and had sufficient medial clarity were screened with an indirect ophthalmoscopy in a cross-sectional evaluation from 2010 to 2014. Peripheral retina was examined, and prevalence of PRD was estimated in this subset. For statistical purposes, only one eye of each patient was considered in this cross-sectional analysis. RESULTS: Of the 310 eyes (180 patients with PCG) operated from the year 2000 onwards, a rhegmatogenous retinal detachment was noted in 13 eyes (4%). Mean axial length of these eyes was 26.3 ± 3.2 mm (range, 19.8-34.7 mm). Among the eyes screened for PRD (n = 60), prevalence of pathologic PRD (lattices with/without atrophic holes and isolated holes/tears) was 15%. The average follow-up between glaucoma filtering surgery and the date of last examination was 8.55 ± 3.98 years (range, 5-20 years) in this subset. Mean axial length was significantly greater in eyes with pathologic PRD than in those without (28.1 ± 3.3 mm vs. 25.8 ± 2.6 mm; P = 0.01). For axial length ≥ 26 mm, the odds of having a pathologic PRD were 14.4 times more than those with axial length < 26 mm (P < 0.001; 95% confidence interval, 1.7-120.5). CONCLUSION: Prevalence of PRD among eyes with PCG is high. Peripheral retinal screening should be performed in eyes with PCG, especially those with axial lengths ≥ 26 mm.

The Presence of Intra- or Subretinal Fluid during the Loading Phase in the Treatment of Exudative Age-Related Macular Degeneration with Intravitreal Ranibizumab Assessed by Optical Coherence Tomography.

PURPOSE: To assess intra- and subretinal fluid during the loading phase with intravitreal ranibizumab in exudative age-related macular degeneration and to quantify the accuracy of crosshair scan spectral-domain optical coherence tomography with regard to retinal fluid. METHODS: This is a retrospective study of 31 treatment-naive patients who received 3 monthly intravitreal ranibizumab injections. Visual acuity and the presence of retinal fluid were assessed at each visit using volume and crosshair scan protocols. RESULTS: Visual acuity improved and central retinal thickness decreased significantly during the loading phase. However, retinal fluid persisted in two thirds of the patients. The accuracy of the crosshair scan to detect fluid was 93%. CONCLUSIONS: A substantial proportion of eyes had persistent fluid after 3 months of ranibizumab injections. However, visual improvement was independent of residual fluid. MESSAGE: Crosshair scans detect relevant collections of retinal fluid accurately and may be sufficient in daily clinical practice.

Sub-internal limiting membrane cavity in anaemic retinopathy evident on spectral domain optical coherence tomography.

A 25-year-old woman was diagnosed with anaemic retinopathy following Plasmodium falciparum malaria. The serial clinical and spectral domain optical coherence tomography (SD-OCT) changes are described, including sub-internal limiting membrane (sub-ILM) haemorrhage at the macula with the formation of a corresponding sub-ILM cavity evident on SD-OCT. The patient was managed conservatively and showed complete recovery of fundus and SD-OCT changes after one year. To the best of our knowledge, this is the first documentation of formation of a temporary sub-ILM cavity following anaemic retinopathy.

Congenital ectropion uveae with iris coloboma and telecanthus.

Congenital ectropion uveae (CEU) is a rare, non progressive anomaly characterised by the presence of iris pigment epithelium on the anterior surface and is frequently associated with anterior iris insertion, dysgenesis of the drainage angle and glaucoma. This paper describes an unusual case of bilateral congenital ectropion uveae with iris coloboma and telecanthus. The anterior chamber angle was normal and there was no evidence of glaucoma. To the best of our knowledge, this association has not been reported previously.

Role of intravitreal bevacizumab in the management of Eales' disease.

PURPOSE: To evaluate the role of intravitreal bevacizumab in the treatment of Eales' disease. Study design Retrospective, interventional case series. METHODS: Two patients with proliferative Eales' disease were managed with an intravitreal injection of bevacizumab (1.25 mg). The presence of persistent retinal neovascularization despite adequate laser photocoagulation caused recurrent episodes of vitreous hemorrhage in the first patient. The second patient had florid retinal and disc neovascularization with a dispersed vitreous bleed, which prevented laser therapy. Both patients were followed up for 6 months. RESULTS: Rapid regression of the retinal neovascularization and clearing of the vitreous hemorrhage were observed in both cases following intravitreal bevacizumab therapy, allowing laser photocoagulation. In both patients, the visual acuity improved, and no signs of recurrence were observed 6 months post-treatment. CONCLUSION: Intravitreal bevacizumab injections may be effective as an adjunctive or alternative treatment of retinal neovascularization in Eales' disease, where inadequate visualization precludes laser photocoagulation. This approach may also be useful in avoiding vitreoretinal surgical intervention in certain cases. Intravitreal bevacizumab was well tolerated by our patients, and no adverse effects were observed.

Acute bilateral vision loss as the presenting feature of subacute sclerosing panencephalitis.

A 12-yr-old boy with an atypical presentation of subacute sclerosing panencephalitis (SSPE) is described. Bilateral macular chorioretinitis preceded the neurological symptoms by 3 weeks. Both visual and neurological features had an acute onset. Clinicians need to be aware that macular chorioretinitis in a child may be the heralding feature of SSPE.

Intraoperative retinoscopy for intraocular lens power estimation in cases of combined phacoemulsification and silicone oil removal.

PURPOSE: To study the application of intraoperative retinoscopy for intraocular lens (IOL) power calculation in combined cataract extraction and silicone oil removal. SETTINGS: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: This study comprised patients with silicone oil-filled eyes and visually significant cataract who had combined cataract extraction by phacoemulsification and silicone oil removal by a standard method through the pars plana route. Retinoscopy was performed with a streak retinoscope, standard vertex distance of 13.0 mm, and distance of 50.0 cm. All eyes had in-the-bag implantation of a foldable IOL with an A-constant of 118.4. The IOL power was calculated using the Ianchulev formula as follows: R x 2.01449. Postoperative refraction was performed at 3 months, and the spherical equivalent was calculated. RESULTS: Twelve eyes of 12 patients were evaluated. The mean emmetropic power calculated by intraoperative retinoscopy was 20.46 diopters (D) +/- 3.4 (SD) (range 13.09 to 25.18 D) and the mean refractive error, -0.45 +/- 0.63 D (range -1.00 to +1.00 D). The postoperative refractive error was within +/-0.50 D in 4 eyes (33.3%) and within +/-1.00 D in all eyes. Ten eyes (83.33%) had a postoperative refractive error in the range of 0.00 to -1.00 D using IOL power based on intraoperative retinoscopy. CONCLUSION: Intraoperative retinoscopy for IOL power calculation in combined cataract extraction and silicone oil removal gave satisfactory refractive outcomes, although further studies with more patients are required to confirm its usefulness and determine whether there are disadvantages.

Case report: bilateral simultaneous central retinal vein occlusion in Waldenström's macroglobulinemia.

BACKGROUND: We report a case of bilateral simultaneous central retinal vein occlusion (CRVO) in Waldenström's macroglobulinemia. METHODS: We report the case of a 60-year-old woman who presented with decreased vision in both eyes. RESULTS: Ophthalmoscopic examination showed scattered retinal hemorrhages and venous tortuosity with macular edema bilaterally. The patient had a history of hypertension and was under investigation for lethargy, recurrent epistaxis, and fainting episodes. Serum protein electrophoresis showed an M-spike in the gamma region. Bone marrow trephine biopsy confirmed the diagnosis of Waldenström's macroglobulinemia. The patient was treated with plasmapheresis and subsequent chemotherapy, resulting in improvement of ocular and systemic symptoms. CONCLUSIONS: We report this case to emphasize that in any case of bilateral CRVO, hyperviscosity should be suspected. Serum electrophoresis along with coagulation profiles should be performed as a standard practice in patients with bilateral simultaneous CRVO.

Intravitreal bevacizumab for subfoveal choroidal neovascularization secondary to age-related macular degeneration in an Indian population.

PURPOSE: To investigate the 6-month safety profile and clinical outcomes of intravitreal bevacizumab for treating subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD). METHODS: We performed a prospective nonrandomized interventional study of 40 consecutive patients (40 eyes) with subfoveal CNV due to AMD. Patients underwent standard ophthalmic examination, optical coherence tomography, and fundus fluorescein angiography. All patients were administered one or more intravitreal injections of bevacizumab (1.25 mg) as primary therapy. Outcomes were also analyzed in subgroups based on lesion type (classic or occult) and lesion size (< or =3000 microm or >3000 microm). RESULTS: At the 6 months' follow-up, mean best-corrected visual acuity (BCVA) improved from 20/160 to 20/100 (P = 0.014), and the mean contrast sensitivity improved from 0.38 to 0.62 (P = 0.001). The mean greatest linear diameter and mean central macular thickness significantly decreased from 3.79 mm to 2.4 mm (P = 0.0001) and from 438.5 microm to 363 microm (P = 0.0001), respectively. Visual acuity gain of 15 letters or more was seen in 20% of patients, and the gain was more in the small-lesion subgroup (31.5%) than in the large-lesion subgroup (9.5%). No significant adverse effects were observed. CONCLUSION: Intravitreal bevacizumab is a safe and effective modality for treatment of CNV secondary to AMD. A significant improvement in BCVA with intravitreal bevacizumab was observed for all lesion types.

Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment.

PURPOSE: This study aimed to compare the results of primary vitrectomy and conventional scleral buckling procedures (conventional retinal detachment surgery) in phakic rhegmatogenous retinal detachment (RRD). METHODS: We carried out a randomized, prospective, clinical controlled trial of 61 consecutive phakic eyes with primary RRD, not complicated by proliferative vitreoretinopathy >or= grade C. Subjects were randomized to either scleral buckling (group 1) or pars plana vitrectomy (group 2). RESULTS: At 6 months follow-up, the primary reattachment rate was 80% (24/30 cases) in group 2 and 80.6% (25/31 cases) in group 1; the difference between the two groups was not statistically significant (p = 0.213). Best corrected visual acuity improved significantly from a preoperative median of 1.78 (1/60) (mean 1.73 +/- 0.91, range 0.3-3) to a median of 0.6 (6/24) (mean 0.689 +/- 0.35, range 0.18-1.48) in group 2 and from a preoperative median of 1.48 (2/60) (mean 1.43 +/- 0.92, range 0-3) to a median of 0.6 (6/24) (mean 0.608 +/- 0.36, range 0-1.78) in group 1; the difference between the two groups was not statistically significant (p = 0.376). Cataract developed in five cases (17%) in the vitrectomy group (group 2), with a statistically significant difference of p = 0.018. CONCLUSIONS: Although primary vitrectomy can achieve anatomical and functional success rates comparable with those achieved by scleral buckling in uncomplicated forms of phakic RRD, the major drawback of the procedure is the high incidence of postoperative cataract formation. Moreover, visual rehabilitation takes place earlier with scleral buckling than with vitrectomy. Scleral buckling should thus be used as the primary surgical modality in the treatment of uncomplicated RRD where the media are sufficiently clear.