Prevalence of Vitreoretinal Interface Abnormalities on Spectral-Domain OCT in Healthy Participants over 45 Years of Age.

PURPOSE: To assess the prevalence of vitreoretinal interface abnormalities in a general population of healthy adults ≥45 years of age. DESIGN: Cross-sectional study carried out at 17 ophthalmology services throughout Spain. PARTICIPANTS: Between September 2015 and March 2016, all consecutive healthy persons aged ≥45 years who were accompanying patients to ophthalmology services were invited to take part in the study. Exclusion criteria were known retinal disease, uveitis, history of ocular trauma or previous intraocular surgery (including cataract surgery and intravitreal injections), severe myopia (>-6 dioptres), and poor ocular media transparency. METHODS: Spectral-domain OCT or swept-source OCT was performed on all participants. Diseases of the vitreomacular interface were classified according to the OCT-based anatomic classification system of the International Vitreomacular Traction Study Group. All pathologic and borderline images as well as doubtful cases were evaluated blindly in a central reading center. MAIN OUTCOME MEASURES: Prevalence of vitreomacular interface abnormalities (vitreomacular traction epiretinal membrane, lamellar hole). RESULTS: The study included 2257 participants with a mean age of 59.5 years (range 45-90), and a total of 4490 eyes (right eyes 2242, left eyes 2248). Vitreoretinal interface abnormalities were detected in 70 eyes, with a prevalence of 1.6%. Vitreomacular adhesion was observed in 1317 eyes (29.3%). Results of spectral-domain OCT or swept-source OCT examination were unrevealing in 3103 eyes. Vitreoretinal interface abnormalities were found in 61 participants, with a prevalence in the study population of 2.7%. Vitreomacular traction was observed in 14 participants (0.6%), epiretinal membrane in 44 (1.9%), and lamellar macular hole in 3 (0.1%). The prevalence of both vitreomacular traction and epiretinal membrane increased significantly with age. The presence of vitreoretinal interface abnormalities was unrelated to concomitant diabetes mellitus or hypertension. CONCLUSIONS: An important percentage of healthy participants from the general population ≥45 years of age showed vitreoretinal interface abnormalities. Screening with OCT is advisable at any first routine consultation or preoperative assessment, particularly in older participants.

INTRAVITREAL DEXAMETHASONE IMPLANT FOR RADIATION MACULOPATHY SECONDARY TO PLAQUE BRACHYTHERAPY IN CHOROIDAL MELANOMA.

PURPOSE: To evaluate the efficacy of intravitreal dexamethasone implant 0.7 mg (Ozurdex) in radiation maculopathy secondary to plaque brachytherapy in choroidal melanoma. METHODS: Twelve eyes diagnosed of radiation maculopathy secondary to plaque brachytherapy and treated with intravitreal dexamethasone implant were included. Visual acuity, foveal thickness using spectral domain optical coherence tomography, and grade of macular edema, using Horgan classification, were evaluated. RESULTS: Mean age was 65.5 ± 28 years (range, 40-82 years). Mean follow-up was 8.2 ± 7.8 months (range, 2-28 months). Mean visual acuity before treatment was, in logarithm of the minimum angle of resolution scale, 1 ± 0.58 (range, 0.4-2) and mean final visual acuity 0.8 ± 0.58 (range, 0.2-2), showing a nonsignificant trend to improvement (P = 0.091; Wilcoxon's test). Foveal thickness before treatment was 416 ± 263 µm (range, 222-725 µm) and final foveal thickness 254 ± 170 µm (range, 145-750), showing a significant decrease (P = 0.016; Wilcoxon's test). Referring to Horgan classification, a significant reduction in grades before and after treatment was demonstrated (P = 0.007; Wilcoxon's test). CONCLUSION: Ozurdex is a useful treatment for radiation maculopathy associated to plaque brachytherapy for uveal melanoma, with a significant decrease in foveal thickness and a significant improvement in Horgan classification. This anatomical improvement was correlated with a moderate improvement in visual acuity.

Epimacular brachytherapy for wet AMD: current perspectives.

Age-related macular degeneration (AMD) is considered the most common cause of blindness in the over-60 age group in developed countries. There are basically two forms of presentation: geographic (dry or atrophic) and wet (neovascular or exudative). Geographic atrophy accounts for approximately 85%-90% of ophthalmic frames and leads to a progressive degeneration of the retinal pigment epithelium and the photoreceptors. Wet AMD causes the highest percentage of central vision loss secondary to disease. This neovascular form involves an angiogenic process in which newly formed choroidal vessels invade the macular area. Today, intravitreal anti-angiogenic drugs attempt to block the angiogenic events and represent a major advance in the treatment of wet AMD. Currently, combination therapy for wet AMD includes different forms of radiation delivery. Epimacular brachytherapy (EMBT) seems to be a useful approach to be associated with current anti-vascular endothelial growth factor agents, presenting an acceptable efficacy and safety profile. However, at the present stage of research, the results of the clinical trials carried out to date are insufficient to justify extending routine use of EMBT for the treatment of wet AMD.

Severe visual loss in a breast cancer patient on chemotherapy.

We report the case of a 44-year-old woman with breast cancer who experienced visual loss and altered color vision after two cycles of chemotherapy with 5 fluorouracil, epirubicin, and cyclophosphamide. She was referred to our Ophthalmology department with suspicion of toxic optic neuropathy. Clinical examination revealed altered color perception in the right side along with a central scotoma on visual field testing. Electrophysiological tests including visual evoked potentials were normal. Funduscopic examination was compatible with bilateral serous retinal detachment. Optical coherence tomography (OCT) demonstrated serous detachment of the retina bilaterally associated with small detachments of the pigment epithelium. Additionally, fluorescein angiography (FA) revealed multiple sites of fluorescein leakage. After 2 months, the clinical findings remained unchanged. An oncological consultation revealed that the patient had received two cycles of intravenous dexamethasone (4 mg) for 3 days in order to treat chemotherapy-induced nausea and vomiting. A diagnosis of steroid-induced central serous chorioretinopathy was then made. At the last follow-up visit, the patient's visual acuity, color vision, OCT, and FA were back to normal. To our knowledge, this is the first reported case of bilateral severe visual loss secondary to corticosteroid-induced central serous chorioretinopathy in a patient on breast cancer therapy. With the increase use of anti-emetic drugs in cancer chemotherapy, we have to be aware of this possible visual complication.

Pars plana vitrectomy for vitreoretinal complications of ocular toxoplasmosis.

PURPOSE: Ocular toxoplasmosis is associated with vitreoretinal complications that can potentially cause severe visual loss. The aim of this study is to report the preoperative, intraoperative, and postoperative outcomes of vitreous surgery in eyes with vitreoretinal complications secondary to ocular toxoplasmosis. METHODS: This retrospective study included 15 eyes of 15 patients (8 men, 7 women; mean age at surgery, 37.2 years, range 18-57 years) who had undergone vitreoretinal surgery for vitreoretinal complications secondary to ocular toxoplasmosis. Visual acuity was compared between the last preoperative visit and the most recent follow-up visit. Intraoperative and postoperative complications were also analyzed. RESULTS: Indications for surgery were retinal detachment in 8 eyes (53.3%), epiretinal membrane in 2 eyes (13.3%), persistent vitreous opacities in 2 eyes (13.3%), choroidal neovascularization in 1 eye (6.6%), vitreous hemorrhage secondary to vasoproliferative retinal tumor in 1 eye (6.6%), and hemorrhagic vasculitis with premacular hemorrhage in 1 eye (6.6%). At last examination, visual acuity improved in 11 eyes (73.3%) by 2 lines or more. Postoperative events that might be related to the surgery included 1 localized retinal detachment, 2 cataracts, and 1 glaucoma. CONCLUSIONS: Pars plana vitrectomy for treatment of vitreoretinal complications secondary to ocular toxoplasmosis can be safely performed and may result in improved visual acuity.

Ocular syphilis--back again: understanding recent increases in the incidence of ocular syphilitic disease.

PURPOSE: The clinical findings and outcomes of 12 cases of luetic uveitis are reported. METHODS: Review of clinical records. RESULTS: Patients included 10 men and 2 women; 7 were homosexual, 9 HIV-positive. Six patients presented a medical history suggestive of syphilis. All patients presented with iritis and vitritis. Visual acuity improved in 11 patients after treatment. CONCLUSIONS: Syphilis has reemerged in developed countries. This may be related to the post-AID S/HAART era, with a growing pool of HIV-positive men who oftenly practice unsafe sex. We underscore the importance of a high index of suspicion of ocular syphilis in patients with these characteristics.

Tuberculous uveitis after treatment with etanercept.

BACKGROUND: Etanercept is a tumor necrosis factor (TNF) inhibitor that has been licensed in the United States for the treatment of adult and juvenile rheumatoid arthritis as well as psoriatic arthritis. Reactivation of tuberculosis is a complication of its use. We report the first case of tuberculous uveitis due to etanercept. METHODS: We performed a clinical chart review. CASE: A 58-year-old Caucasian woman was referred to our hospital for chronic unilateral granulomatous panuveitis of the right eye (RE). She was on etanercept and methotrexate for rheumatoid arthritis. Since the patient was immunosuppressed with etanercept and since the uveitis was granulomatous we considered tuberculosis as a possible etiology. An aqueous humor tap was performed and sent for polymerase chain reaction analyses of Herpes simplex, Herpes zoster, and Mycobacterium tuberculosis (MT). This last test was positive. Another aqueous humor sample was taken and sent for microscopic examination of sputum for acid-fast bacilli and culture, both of which were positive for MT. A diagnosis of tuberculous uveitis was established; the patient was treated with rifampin, isoniazid pyrazinamide, and ethambutol and etanercept was stopped. Four months later there were no cells in the anterior chamber and the vitreous was clear. DISCUSSION: To our knowledge this is the first reported case of tuberculous uveitis following treatment with etanercept. This etiology has to be considered in patients taking this drug who present with intraocular inflammation.

Frontalis muscle flap advancement with a pulley in the levator aponeurosis in patients with complete ptosis and deep-set eyes.

PURPOSE: To offer an alternative to frontalis sling techniques to achieve a more horizontal traction vector force with the frontalis muscle flap. The proposed technique avoids malpositions such as pulling the upper eyelid in an anterior plane during maximum opening and ptosis of the eyelashes. METHODS: The technique, performed in 5 patients with complete unilateral ptosis and an absence of levator function, consisted of advancing a flap of frontalis muscle and creating a pulley with the aponeurosis of the levator muscle. Mean follow-up was 12 months. RESULTS: Ptosis was corrected in all 5 patients, with good aesthetic outcome. There were no cases of anterior eyelid advancement, entropion, or eyelash ptosis. The only complication was 1 case of lagophthalmos with corneal erosion. CONCLUSIONS: In this preliminary series, the technique was safe and effective for correcting severe blepharoptosis, with good aesthetic and functional results even in patients with deep-set eyes and without the eyelid malpositions that commonly occur in frontalis sling techniques.