Unilateral Ischemic Maculopathy Associated with Cytomegalovirus Retinitis in Patients with AIDS: Optical Coherence Tomography Findings.

To describe the clinical and optical coherence tomography (OCT) characteristics of ischemic maculopathy in two patients with acquired immunodeficiency syndrome (AIDS). Two patients with AIDS and cytomegalovirus (CMV) retinitis developed ischemic maculopathy. Both patients presented with central visual loss and active granular CMV retinitis. The presence of opacification of the superficial retina in the macular area and intraretinal edema suggested the diagnosis. Fluorescein angiography changes were similar in the two cases with enlargement of the foveal avascular zone and late staining of juxtafoveal vessels. OCT changes were suggestive of retinal ischemia: Increased reflectivity from the inner retinal layer and decreased backscattering from the retinal photoreceptors due to fluid and retinal edema. Ischemic maculopathy may cause a severe and permanent decrease in vision in AIDS patients. Fluorescein angiography and OCT should be considered in any patient with AIDS and unexplained visual loss. The mechanism of ischemic maculopathy may be multifactorial.

Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: Efficacy and complications of a large single-center experience.

OBJECTIVE: This study evaluated the safety and clinical and anatomic effectiveness of endovenous laser therapy (EVLT) and microphlebectomy in the treatment of varicose veins secondary to saphenous reflux. METHODS: From January 1, 2005, to December 31, 2007, 1985 EVLT procedures were performed in 1559 eligible patients (1263 women) with a mean age of 52.8 years (range, 18-89 years). A 810-nm diode laser and microphlebectomy were used. All sites of superficial axial reflux above and below the knee were ablated. Symptoms of venous insufficiency were present in 97%, and 102 patients (6.54%) had an open ulcer when they underwent operation. Patients had clinical follow-up visits, including duplex ultrasound examination, at 1 week, 1 month, 3 months, and yearly and were assessed for deep venous thrombosis (DVT), recanalization of the ablated vein, nerve injury, ulcer healing, and resolution of symptoms. RESULTS: A total of 1652 great saphenous veins (83.22%), 285 small saphenous veins (14.36%), 40 anterolateral tributaries (2.02%), and 8 posteromedial tributaries (0.40%) were ablated. An average of 19 phlebectomies were performed per case treated (range, 1-58). The primary ablation rate at 15 and 30 months was 91.26% and 78.25% by Kaplan-Meier analysis. Recanalization occurred in 35 veins (1.76%); in this group, 15 (42.9%) exhibited symptoms of venous insufficiency and were successfully closed with a second EVLT. Body mass index >30 kg/m(2) and a vein diameter >/=8.5 mm were the only factors predictive of recanalization. Postoperatively, the 102 ulcers showed healing at a mean of 5.2 weeks (range, 2-10 weeks), and only three reopened (2.94%). No major complications occurred. Two DVT (0.13%) occurred, but no pulmonary emboli or skin burns. Local transient paresthesia at the ankle and midcalf level occurred in 38 patients (2.43%). CONCLUSIONS: EVLT of all sites of superficial axial reflux above and below the knee and microphlebectomy demonstrated that the combined approach is safe and effective at eliminating reflux, affording symptomatic relief, and healing ulcers. It offers the additional advantage of resolving varicose veins and its cause in just one visit, leading to immediate better cosmetic results.

Indocyanine green-mediated photothrombosis with and without intravitreal triamcinolone acetonide for subfoveal choroidal neovascularization in age-related macular degeneration: a pilot study.

PURPOSE: To determine the feasibility, safety, and clinical effect of treating patients with subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with indocyanine green (ICG)-mediated photothrombosis (IMP) with and without intravitreal triamcinolone acetonide (TA). METHODS: Fifteen patients (19 eyes) participated in the study. Nine eyes of seven patients were treated with IMP immediately followed by an intravitreal injection of 4 mg of TA (Group A), and 10 eyes of 8 patients were treated with IMP only (Group B). Patients had a mean follow-up of 6.9 months (range: 3 to 12 months). Patients underwent single or two sessions of IMP. RESULTS: In Group A, visual acuity (VA) showed stability in 6 eyes (66.7%), improvement of VA in 2 eyes (22.2%), and worsening of VA in 1 eye (11.1%). Group B presented VA stability in 9 eyes (90%), and improvement in 1 eye (10%). In total, of the 15 patients (19 eyes) with IMP with or without intravitreal TA, 3 eyes (15.8%) showed improvement, 15 eyes (78.9%) stability, and 1 eye (5.3%) showed worsening of VA. A significant regression of the CNV and diminishing of subretinal fluid was demonstrated with fluorescein angiography and optical coherence tomography in both groups. No patient in Group A required retreatment. Four of 10 eyes (40%) in Group B required one retreatment during the study period. CONCLUSIONS: ICG-mediated photothrombosis with and without intravitreal TA may provide stability or improvement in visual acuity and fundus findings in subfoveal CNV in AMD. Further evaluation in a multicenter, randomized, placebo-controlled clinical trial with longer follow-up is needed to accurately assess the safety and efficacy of this new treatment modality.

Optical coherence tomography characteristics of choroidal metastasis.

PURPOSE: To report 4 patients (7 eyes) with choroidal metastasis (primary: breast [2], lung [1], and unknown [1]) visualized with optical coherence tomography (OCT). DESIGN: Retrospective case series. PARTICIPANTS: Four patients (7 eyes) with choroidal metastasis participated in the study. METHODS: Clinical examination, ultrasonography, fluorescein angiography, and OCT were performed in all cases. MAIN OUTCOME MEASURES: Optical coherence tomography characteristics. RESULTS: Three patients suffered a gradual onset of blurred vision in both eyes. The fourth presented a unilateral decrease in visual acuity. Bilateral choroidal lesions with various degrees of exudative retinal detachment (RD) were present in 3 of our 4 patients, and there was 1 case of a unilateral unifocal choroidal lesion. Optical coherence tomography revealed anterior displacement of the photoreceptor layer by subretinal fluid (hyporeflective space) overlying a hyperreflective thickened retinal pigment epithelium-choriocapillaris complex. Subretinal deposits with several degrees of hyperreflectivity were seen, as well as loss of normal retinal architecture with intraretinal splitting, identified as regions of low reflectance within the neurosensory retina. After chemotherapy, OCT demonstrated improvement of the serous RD and reduction of the lesion's size with recovery of the normal retinal architecture. CONCLUSIONS: Optical coherence tomography in patients with choroidal metastasis allows evaluation of secondary retinal-retinal pigment epithelial changes. In addition, the technique is useful in the follow-up of lesions after treatment. However, some limitations result from the choroidal location of the metastasis. Further studies with clinicopathological correlation are needed to confirm our observations.

Anterior segment inflammation and hypotony after posterior segment surgery.

Recent advances in the instrumentation and surgical techniques for posterior segment surgery permit better anatomic and functional outcomes. Nevertheless, these procedures may be associated with complications involving the anterior segment, including postoperative inflammation and hypotony. One must differentiate infectious from noninfectious inflammation to initiate appropriate therapy promptly. Hypotony is a frustrating problem because it is difficult to reverse. The exclusion of eyes with other known causes of hypotony is important before establishing the putative mechanism of tractional ciliary body detachment caused by epiciliary proliferative tissue.

Photodynamic therapy with verteporfin for subfoveal choroidal neovascular membranes in highly myopic eyes after laser in situ keratomileusis.

The authors describe the management of subfoveal choroidal neovascular membranes in highly myopic eyes after laser in situ keratomileusis with photodynamic therapy. Five cases of choroidal neovascular membrane after laser in situ keratomileusis for the correction of myopia (mean, 13.3 diopters; range, -8.00 to -16.25 diopters) treated with single or multiple sessions of photodynamic therapy with verteporfin are presented. Two cases had improved visual acuity (2 to 5 lines) after photodynamic therapy, two cases remained the same, and one case lost 4 lines of visual acuity. Photodynamic therapy with verteporfin seems to increase the chance of stabilizing or improving vision in patients with subfoveal choroidal neovascular membrane after laser in situ keratomileusis in highly myopic eyes.