Bilateral Idiopathic Sclerochoroidal Calcifications.

BACKGROUND: Sclerochoroidal calcification (SCC) is a rare and benign condition found mostly in middle-aged and elderly Caucasian men, characterized by multiple yellow-white lesions seen most commonly in the temporal regions of the fundus. While they may be concerning for benign tumors, primary neoplasias or metastases, SCCs most commonly present as asymptomatic findings during routine ophthalmologic testing and have a very good prognosis as they rarely cause visual deficits. OBJECTIVE: To report and describe the findings in a case of bilateral idiopathic sclerochoroidal calcifications. METHODS: A retrospective case report. RESULTS: Repeated ophthalmological exams, including fundoscopic examination, ultrasonography, optical coherence tomography and fluorescein angiography, were all consistent bilateral idiopathic sclerochoroidal calcifications. CONCLUSION: While most cases of idiopathic sclerochoroidal calcifications represent a benign ophthalmological condition, there are known associations with other systemic conditions, such as hyperthyroidism, hyperparathyroidism, Bartter's syndrome and Gitelman's syndrome. It is for this reason that these patients warrant a full systemic work-up in addition to careful ophthalmological monitoring.

Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy.

PURPOSE: To evaluate the visual outcomes, choroidal neovascular complex status, and adverse events in patients with visually significant cataract and neovascular age-related macular degeneration (AMD) who had cataract surgery. SETTING: Private practices, Beverly Hills, California, and New London, Connecticut, USA. DESIGN: Case series. METHODS: Data were abstracted from the medical records of patients with neovascular AMD treated by anti-vascular endothelial growth factor (anti-VEGF) therapy who had cataract surgery. The main outcome measures were Snellen corrected distance visual acuity (CDVA), perioperative adverse events, and status of the choroidal neovascular complex. RESULTS: The study enrolled 30 eyes of 28 patients. The CDVA was 20/40 or better in 10% of eyes preoperatively and 40% postoperatively; 20/50 to 20/100 in 53% and 33%, respectively; and 20/200 or worse in 37% and 27%, respectively. The change in CDVA from preoperatively to postoperatively was statistically significant, with a mean change of 0.22 logMAR ± 0.27 (SD) at 2 months (P<.0001), 0.22 ± 0.36 logMAR at 6 months (P=.001), and 0.17 ± 0.54 logMAR at the last follow-up (P=.01). Patients received a mean of 0.32 injections per month postoperatively compared with 0.49 injections per month preoperatively. Perioperative macular adverse events did not occur in any eye. CONCLUSIONS: With regular evaluations and appropriate treatment with anti-VEGF agents, cataract surgery did not appear to be associated with an increased incidence of perioperative complications or macular adverse events.

Large submacular hemorrhage following PDT with verteporfin in patients with occult CNVM secondary to age-related macular degeneration.

A review of the charts for all patients who developed large submacular hemorrhages following photodynamic therapy for choroidal neovascular membranes secondary to age-related macular degeneration yielded three patients who met the criteria for a large submacular hemorrhage. All three patients were treated for exudative age-related macular degeneration and were taking warfarin for chronic anticoagulation. Before photodynamic therapy, the international normalized ratio ranged from 1.2 to 1.6. All three patients had received at least one previous verteporfin treatment in the study eye. All three hemorrhages were not noted immediately after photodynamic therapy and were documented within 1 to 2 weeks following the procedure. Patients with age-related macular degeneration who are receiving warfarin therapy and undergoing repeat verteporfin treatments appear to be at risk for submacular hemorrhages.

Triple therapy of intravitreal triamcinolone, photodynamic therapy, and pegaptanib sodium for choroidal neovascularization.

PURPOSE: To report the six-month results of subfoveal choroidal neovascularization that had been treated with combined therapy of high-dose intravitreal triamcinolone acetonide (HDIVTA), photodynamic therapy (PDT), and pegaptanib sodium injection. DESIGN: Retrospective, interventional case series study. METHODS: Medical files of 16 patients with this treatment were reviewed (22 eyes); 13 eyes had had previous treatment with HDIVTA and PDT; nine eyes were newly diagnosed choroidal neovascularization. Patients were treated with an injection of HDIVTA (10 mg), followed by PDT and pegabtanib sodium injection at two-week intervals. The main outcome variables were visual acuity (VA) and macular thickness by optical coherence tomography (OCT). RESULTS: The mean VA improved 2.2 lines (P = .013 in the new treatment group); the previous treatment group (HDIVTA + PDT) improved only 0.7 lines (P = 0.55, Wilcoxon ranked test). The mean of macular thickness before and after treatment was statistically significant in both groups. CONCLUSION: This combination therapy showed improvement and/or stabilization in VA, particularly when used as first-line therapy.

Preliminary results of combined simultaneous transpupillary thermotherapy and ICG-based photodynamic therapy for choroidal melanoma.

BACKGROUND AND OBJECTIVE: To evaluate whether the combination of simultaneous hyperthermia by transpupillary thermotherapy and indocyanine green-based photodynamic therapy is an effective treatment for small and medium choroidal melanomas. PATIENTS AND METHODS: Twenty-five patients with small and medium choroidal melanomas were treated with combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy. RESULTS: The median age of the 25 patients was 64 years (range, 35 to 88 years). The pretreatment volume of the tumors ranged from 15.9 to 653.5 mm3 (mean, 118.7 +/- 146.6 mm3). After a mean of 2.4 treatments (range, 1 to 5 treatments), all of the tumors but one showed a significant volume reduction without clinical evidence of recurrences. The follow-up ranged from 6 to 59 months (mean, 12 +/- 14 months). Complications included retinal vascular occlusions, edema and superficial scarring of the macula, and rhegmatogenous retinal detachment. CONCLUSIONS: The effects of combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy appears to be effective in achieving local tumor control in selected small and medium choroidal melanomas.

A cluster of patients with acute-onset endophthalmitis following cataract surgery.

BACKGROUND AND OBJECTIVE: To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery. PATIENTS AND METHODS: Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated. RESULTS: Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis, aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%). CONCLUSIONS: Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes.

Photodynamic therapy for choroidal neovascular membrane secondary to optic nerve drusen.

The authors describe the use of photodynamic therapy with verteporfin for subfoveal choroidal neovascular membrane secondary to optic nerve drusen. A 28-year-old woman had a peripapillary choroidal neovascular membrane secondary to optic nerve drusen with significant metamorphopsia. Photodynamic therapy using verteporfin was performed. Visual acuity improved to 20/20 with resolution of metamorphopsia and absence of leakage on fluorescein angiography a few weeks after verteporfin therapy. The patient's condition remained stable for 16 months with 20/20 vision. Photodynamic therapy with verteporfin may be a useful treatment option in patients with choroidal neovascular membranes secondary to optic nerve drusen.

Noninfectious endophthalmitis associated with intravitreal triamcinolone injection.

BACKGROUND: Intravitreal injection of triamcinolone has been advocated to treat exudative macular diseases such as macular edema and choroidal neovascularization. OBJECTIVE: To describe 7 patients who developed a clinical picture simulating endophthalmitis after intravitreal triamcinolone injection. METHODS: Intravitreal triamcinolone injections were performed to treat refractory cystoid macular edema or diffuse macular edema associated with diabetic retinopathy, macular pucker, branch retinal vein occlusion, or pseudophakia. One patient received an injection in an attempt to treat exudation associated with occult choroidal neovascularization. RESULTS: Preinjection visual acuity ranged from 20/50 to 20/400. An extensive inflammatory response developed 1 to 2 days after injection in all 7 eyes. Five eyes had previously undergone vitrectomy. Four eyes had a layered hypopyon. All 7 eyes had an anterior chamber cellular reaction and vitritis. Visual acuity ranged from 20/400 to hand movements. The first 6 patients were treated for presumed endophthalmitis with vitreous cultures and intravitreal injections of antibiotics. All 6 cultures were negative for any organisms, and the eyes resolved their inflammatory response, with recovery to preinjection visual acuity or better. The seventh patient was treated with topical prednisolone without antibiotic therapy, and the inflammation resolved, with resolution of the macular edema seen before the intravitreal triamcinolone injection. CONCLUSION: It may be appropriate to closely observe noninfectious, toxic endophthalmitis in patients treated with intravitreal triamcinolone before assuming it to be infectious, especially in the absence of eye pain.

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease.

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.

Vitreous floaters following use of dermatologic lasers.

BACKGROUND: Laser eye protection has been designed to protect operators and patients from severe eye injuries. OBJECTIVE: To describe two cases in which lasers used for cutaneous therapy may have been associated with the induction of vitreous floaters, a subacute eye injury, in physicians operating these devices, and to review the theoretical feasibility of such injuries, prior reports of the same, and strategies for minimizing risk. METHODS: Report of two cases and review of the literature. RESULTS: Given the circumstantial evidence, it is possible that subacute vitreous injuries may be sustained by the operators of dermatologic lasers. Ex vivo experiments and previous case reports have demonstrated the possibility of laser-induced vitreous injury, including changes in vitreous conformation and vitreous hemorrhage, in the absence of permanent retinal deficits. It may be speculated that vitreous floaters are a milder manifestation of such subacute injuries. CONCLUSION: To the extent that vitreous floaters can multiply and presage the onset of severe retinal injury, the risk of their induction by dermatologic lasers should be minimized. Simple strategies and further research can help achieve this goal.

Combined cataract surgery and vitrectomy for breakthrough vitreous hemorrhage from age-related macular degeneration.

PURPOSE: To report combined cataract extraction (CE), posterior chamber intraocular lens (PCIOL) implantation, and pars plana vitrectomy (PPV) for concurrent cataract and breakthrough vitreous hemorrhage from age-related macular degeneration (AMD). METHODS: Retrospective case series. RESULTS: Six eyes were included in the study. The postoperative follow-up interval ranged from 3 to 22 months (mean 8 months). Preoperative visual acuity (VA) ranged from 20/400 to hand motion. Postoperatively, 5/6 eyes had 2 or more lines of visual improvement. Three eyes were better than 20/200. CONCLUSIONS: Combined CE, PCIOL insertion, and PPV in selected patients with cataract and breakthrough vitreous hemorrhage from AMD was successful in improving VA in the majority of patients.