Lamellar macular hole formation in a patient with diabetic CME treated by intravitreal bevacizumab injections.

A 49-year-old woman with a diagnosis of diabetic cystoid macular edema in both eyes presented with the appearance of a macular hole in the left eye 1 month after intravitreal bevacizumab injection. Optical coherence tomography demonstrated a lamellar macular hole in the left eye. Although vitreomacular traction and epiretinal membrane are the possible underlying causes for the development of lamellar macular hole formation in eyes with cystoid macular edema, in this case previous optical coherence tomography scans revealed the complete separation of the posterior hyaloid membrane and the absence of an epiretinal membrane. The exact mechanism involved in the progression of cystoid macular edema to lamellar macular hole and the contribution of the intravitreal bevacizumab injections to this transformation remain unclear.

Safety and effectiveness of interferon alpha-2a in treatment of patients with Behçet's uveitis refractory to conventional treatments.

PURPOSE: To evaluate the intermediate-term safety and effectiveness of interferon alpha-2a (IFNalpha2a) in patients with Behçet's uveitis (BU) refractory to corticosteroids and immunosuppressive agents. DESIGN: Open, nonrandomized, uncontrolled, interventional, prospective study. PARTICIPANTS: Fifty-three patients (106 eyes) with active, vision-threatening BU who failed to respond to conventional treatments. INTERVENTION: In 53 patients, acute inflammation was suppressed with effective prednisolone dosage (1-2 mg/kg/day, tapered to 10 mg within 4-6 weeks). The patients were treated with IFNalpha2a 4.5 million international units (MIU) 3 times per week for the first 3 months followed by IFNalpha2a 3 MIU 3 times per week for the next 3 months. Observation or other treatment methods were performed according to the decision tree developed for this study. MAIN OUTCOME MEASURES: Remission and complete response (primary outcome measures), frequency of uveitis attacks, visual acuity (VA), and adverse effects (secondary outcome measures). RESULTS: During 2 years of follow-up (median 65 months, range 12-130 months), compliance with the therapy was excellent. At the end of 1-year follow-up, treatment response was obtained in 45 of 53 patients (84.9%). The mean attack rate of 3.6+/-1.1 per year (range, 2-8) decreased to 0.56+/-0.75 (range, 0-4) per year (P=0.001). Visual acuity improved (> or = 0.2 logarithm of the minimum angle of resolution units from initial VA) in 30 eyes (28.3%) and worsened in 12 eyes (11.3%). Five patients (9.4%) did not respond to the initial treatment, and 3 patients (5.6%) developed severe adverse effects, including psoriasis, epileptic seizure, and extreme tiredness. Fifteen patients (28.3%) were off treatment for all the medications and disease free for 28+/-13.1 months (range, 12-50 months). CONCLUSIONS: These results suggest that IFNalpha2a may be a valuable treatment option in BU that is refractory to corticosteroids and conventional immunosuppressive agents. The possible role of IFNalpha2a as a first-line agent in BU should be validated in randomized controlled clinical trials against newly described biologic agents. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Intravitreal bevacizumab treatment of macular edema due to optic disc vasculitis.

PURPOSE: To report the efficacy of intravitreal bevacizumab injection in treatment of macular edema in a case of optic disc vasculitis. DESIGN: Retrospective case review. METHODS: A patient diagnosed with macular edema due to optic disc vasculitis was treated with intravitreal bevacizumab injection. RESULTS: One week after injection, fundus appearance dramatically improved and macular edema regressed. The patient was followed up for 1 year after injection and there was no recurrence of macular edema. CONCLUSIONS: This case suggests that intravitreal bevacizumab treatment might be effective in the management of macular edema in patients with optic disc vasculitis.

Acute effects of cigarette smoking on pattern electroretinogram.

In this study, acute effects of cigarette smoking on the pattern electroretinogram (PERG) were investigated. First, variability of the PERG was studied in a group of young male smokers (26 right eyes of 26 subjects). Then PERGs were investigated in a group of habitual smokers (17 right eyes of 17 subjects) in separate real smoking and sham smoking sessions. On each session PERGs were recorded pre-smoking (PS), immediately after smoking (IAS) and 5 min after smoking (5th) conditions. Real smoking significantly increased P50 amplitudes and decreased N95 latencies. Regarding P50 amplitudes in the real smoking sessions, the differences were significant between PS and IAS (PS: 3.3 +/- 0.5 muV, IAS: 3.7 +/- 0.7microV, P = 0.015) and between PS-5th (PS: 3.3 +/- 0.5microV, 5th: 4.1 +/- 0.9microV, P = 0.039). There was significant difference (P = 0.024) between N95 latencies of PS (98.5 +/- 6.9 ms) and IAS (94.7 +/- 5.1 ms) in the real smoking sessions. No statistically significant difference was observed in sham smoking sessions. Our results indicated, for the first time, that cigarette smoking may influence PERG amplitude and latency significantly in habitual smokers.

Assessment of optic nerve head topographic parameters with a confocal scanning laser ophthalmoscope.

AIM: To assess the disc area, age, sex, laterality (side of the eyes) and refractive error dependent differences in optic nerve head topographic parameters in a normal population. METHODS: Optic nerve head topographic analysis of both eyes of 551 healthy Turkish subjects aged 11-75 years (1102 eyes) was performed using a confocal scanning laser ophthalmoscope, the Heidelberg Retinal Tomograph II (HRT II). The effects of disc size, sex, laterality (side of the eyes), age and refractive error on optic nerve head topographic parameters were assessed. Subjects were divided into three different age groups (<30 years, 30-60 years, >60 years) and three different disc area groups (<2.00 mm(2), 2.00-2.25 mm(2), >2.25 mm(2)). Disc area, topography standard deviation and a total of 12 topographic parameters were calculated by HRT II for each subject. Statistical analysis was performed using Student's t-test, multiple regression analysis, Tukey-HSD test, anova and Pearson's correlation coefficient. RESULTS: A total of 543 subjects (298 women and 245 men) were included in the study. The mean disc area of the subjects was 2.12 +/- 0.47 mm(2) (range 1.16-4.98 mm(2)). The mean refractive error of the subjects was -0.58 +/- 1.71 D (range -4.75 D to +4.25 D). The mean cup shape measure was -0.21 +/- 0.07 (95% confidence interval -0.07 to -0.35). The disc area was significantly correlated with all of the topographic parameters but two; namely, the cup shape measure and the height variation contour. Significant age-related differences were detected in four parameters (mean retinal nerve fibre layer [RNFL] thickness, disc area, cup-to-disc area ratio, cup area) and significant sex-related differences were detected three parameters (mean RNFL thickness, height variation contour, RNFL cross-sectional area). However, there were no significant differences in any of the parameters for laterality and refractive error. The parameter cup shape measure did not correlate with any of the five variables investigated. CONCLUSION: Cup shape measure was the only optic nerve head topographic parameter that was independent of age, sex, disc area, laterality and the refractive error. It seems to be a promising parameter in evaluation and comparison of the optic discs of normal subjects, with different disc area, age, sex, refraction error and laterality, as being independent of the main variation factors of the disc topography.