Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection.

PURPOSE: In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails to improve visual acuity, although oedema shows clinical and angiographic improvement. Side effects can include increased intraocular pressure, cataract development, and (rarely) endophthalmitis. Our purpose was to identify prognostic factors for visual acuity improvement after IVTA. METHODS: Data on patients treated by IVTA for macular oedema were retrospectively reviewed. Three months postinjection, visual acuity was rated as 'improved' (two or more Snellen lines gained) or 'nonimproved' (unchanged or worsened). Comparative demographic data and pre- and post-IVTA clinical and fluorescein angiographic findings were analysed with SPSS software. RESULTS: Of 57 eyes (57 patients), 27 (47%) improved after IVTA. Initial visual acuity ('good', 'moderate', or 'poor') and aetiology of macular oedema (diabetic, venous occlusion, or pseudophakic) did not differ between the two groups. Improvement occurred in significantly more eyes with clinical or angiographic evidence of cystoid macular oedema (CME) than in those with diffuse retinal thickening (P=0.04) or diffuse leakage on fluorescein angiography (P=0.02), respectively, and in significantly more pseudophakic than phakic eyes (P=0.046). CONCLUSIONS: Pseudophakia and clinical or angiographic CME, but not aetiology or initial visual acuity, were prognostic of visual acuity improvement after IVTA for macular oedema.

Vancomycin concentration in the vitreous after intravenous and intravitreal administration for postoperative endophthalmitis.

OBJECTIVES: To measure the concentrations of vancomycin in the vitreous of patients with postoperative endophthalmitis after administration of 1 g of vancomycin hydrochloride intravenously and injection of 1 mg of vancomycin hydrochloride into the vitreous, and to determine whether these concentrations are adequate for treatment of gram-positive infections. METHODS: Patients with acute postoperative endophthalmitis were treated with intravenous administration of 1 g of vancomycin hydrochloride followed by vitrectomy and collection of vitreous samples 1 to 5 hours later. Intravitreal vancomycin and ceftazidime were given. Vitreous samples were cultured and their vancomycin concentrations assayed. Minimal inhibitory concentrations of vancomycin for the isolated vitreal pathogens, and serum and vitreous cidal activity were determined. RESULTS: Eighteen patients with acute postoperative endophthalmitis were studied. Fourteen vitreous samples were available after intravenous vancomycin administration, and 4 vitreous samples were available after intravitreal vancomycin administration. After intravenous injection, vitreous vancomycin concentrations ranged from 0.4 to 4.5 microg/mL. Minimal inhibitory concentrations in these samples, obtained from 10 bacterial isolates, were below the therapeutic levels for most causative organisms, including staphylococci. Vitreous cidal activity values were negative at a dilution of 1:2 in 9 of 10 patients examined. After a 1-mg intravitreal injection, vancomycin concentrations in vitreous samples obtained by a second tap from 4 patients 44 to 72 hours later were 182, 138, 58, and 25 microg/mL. In 2 patients in whom measurements were obtained, vitreous cidal activity values were 1:512 and 1:32. CONCLUSION: Vitreous vancomycin concentrations for the treatment of gram-positive endophthalmitis were nontherapeutic after intravenous administration but therapeutic after intravitreal administration.

Utilizing gravity in the removal of a large intraocular foreign body.

This article describes an unconventional technique for the removal of a nonmagnetic intraocular foreign body that is too large or too smooth to be grasped by intraocular forceps and does not float on perfluorocarbon liquids. By flipping the patient to a face-down position and allowing the gravitational forces to help remove the object, one can hope to avoid further ocular damage. This approach should be considered in similar cases of very large and smooth intravitreal foreign bodies to avoid severe and irreversible damage to the retina.

Urticaria in idiopathic bilateral recurrent branch retinal arterial occlusion.

Idiopathic bilateral recurrent branch retinal arterial occlusion (IBRBRAO) is a rare syndrome characterized by migraine headaches, tinnitus, vertigo, hearing loss, and recurrent branch retinal artery occlusion of unknown etiology. Affected patients frequently undergo a wide range of medical evaluation and have no apparent pathologic findings. We present here a case of IBRBRAO, associated with urticarial rash, not described in this syndrome in previous publications.

Autosomal dominant crystalline dystrophy.

A black woman was identified with a tapetoretinal degeneration with sparkling intraretinal crystals, retinal pigment epithelial and choroidal atrophy, night blindness, color vision abnormalities, and paracentral scotomas. This constellation of findings is most consistent with the diagnosis of Bietti's crystalline dystrophy. Eight other family members were identified with intraretinal crystals similar to those seen in the proband but in varying degrees of progression. Transmission electron microscopy of circulating lymphocytes in several patients demonstrated crystals and granular osmophilic material of unknown composition contained within abnormal lysosomes. These crystals are similar in appearance and location to those seen in cholesterol ester storage disease. This family demonstrates an autosomal dominant inheritance pattern, as well as other differences from classic Bietti's crystalline dystrophy. The authors, therefore, suggest that this new entity be named autosomal dominant crystalline dystrophy.