ABSTRACT
PURPOSE: To report a case of adult-onset Coats' disease with secondary retinal vasoproliferative tumor managed with dexamethasone intravitreal implant and retinal photocoagulation. METHODS: Case study. RESULTS: A 41-year-old female with counting finger vision was diagnosed with Coats' disease with secondary retinal vasoproliferative tumor in right eye. Fundus examination revealed exudative retinopathy involving posterior pole and a retinal tumor located in the inferotemporal quadrant. Optical coherence tomography scan confirmed massive exudative neurosensory detachment and fundus fluorescein angiography showed areas of telangiectatic vessels with capillary non-perfusion. Intravitreal injection of dexamethasone implant was done initially followed by laser photocoagulation when the detachment resolved. There was significant improvement in patient's visual acuity with no further recurrence of exudation. CONCLUSION: Intravitreal dexamethasone implant Ozurdex(®) (Allergan, Inc., Irvine, Calif., USA) may be an effective initial therapeutic approach for Coats' disease with massive exudation.
Subject(s)
Dexamethasone/administration & dosage , Laser Coagulation/methods , Retina/pathology , Retinal Telangiectasis/therapy , Visual Acuity , Adult , Dose-Response Relationship, Drug , Drug Implants , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Glucocorticoids/administration & dosage , Humans , Intravitreal Injections , Retinal Telangiectasis/diagnosis , Tomography, Optical Coherence , UltrasonographyABSTRACT
PURPOSE: To describe the clinical characteristics of eyes with secondary angle-closure glaucoma following combined phacovitrectomy. METHODS: Retrospective case series. RESULTS: Nine eyes developed angle-closure glaucoma due to iris posterior synechiae with an incidence rate of 1.82% (95% CI: 0.64 - 3%) among 493 eyes following phacovitrectomy. PDR with TRD was the most common surgical indication. Single piece IOL insertion and silicone oil were present in all cases. Fibrin in the anterior chamber was found in six eyes postoperatively. Mean degree of iris bombe was 310±79.37° at 3.55±1.87 weeks with a mean IOP of 32.56±5.89 mm of Hg. Systemic diabetes and grade of cataract were the only significant risk factors (r2 =1; p= 0.016 and 0.049, respectively). Nd:YAG laser PI relieved the angle-closure attack in all cases. CONCLUSION: Systemic diabetes and advanced grade of cataract are significant risk factors for secondary angle-closure glaucoma following combined phacovitrectomy.
Subject(s)
Glaucoma, Angle-Closure/etiology , Iris Diseases/complications , Phacoemulsification/adverse effects , Postoperative Complications/etiology , Vitrectomy/adverse effects , Adult , Aged , Female , Humans , Iris Diseases/etiology , Male , Middle Aged , Regression Analysis , Retrospective Studies , Vitrectomy/methods , Young AdultABSTRACT
The purpose of this study is to evaluate the clinical outcomes of double membrane (ERM & ILM) peeling and the effect of combined cataract surgery and SF6 gas injection in vitreoretinal interface (VRI) disorders. This is a retrospective interventional study. Seventy-two eyes with idiopathic vitreoretinal interface abnormalities that underwent 23 gauge pars plana vitrectomy with "double stain and double peel" technique were reviewed. SD-OCT was used to classify VRI disorders into following 4 groups: 44 in ERM type, 17 in VMTS type, 7 in macular pseudohole (MPH) type, and 4 in lamellar macular hole (LMH) type. ERM was a common association in all types. Mean preoperative BCVA improved from 0.58 ± 0.14 logMAR to 0.27 ± 0.16 logMAR units (p = 0.001). Mean CFT reduced from 409.17 ± 122.31 µm preoperatively to 277.28 ± 0.16 µm postoperatively (p < 0.0001). Among the VRI subtypes, visual improvement was significant except in LMH variety (ERM type, p = 0.0029; VMTS type, p = 0.0281; MPH type, p = 0.05; and LMH type, p = 0.7926). Mean change in CFT from baseline was least in LMH cases (p = 0.0093). There was no significant difference in BCVA and CFT in the group who had combined phacovitrectomy versus pseudophakic group (p > 0.05). Use of intraocular SF6 gas tamponade did not show any added benefits among the groups (p > 0.05). Improvement in foveal contour was seen in all groups. Simultaneous removal of ILM along with ERM during surgery for VRI disorders helps in restoring normal foveal contour with a favorable visual outcome. Combined cataract extraction or use of intraocular SF6 gas injection does not affect the surgical results.
