Clinical Characteristics, Treatment, and Outcome of Trochleitis.

BACKGROUND AND PURPOSE: To study the clinical characteristics, treatment options, and outcome of patients with trochleitis in our population. METHODS: Retrospective review of 59 patients diagnosed with trochleitis in the Ramon y Cajal Hospital Emergency Service between 2003 and 2010. Demographic data and trochleitis features were described. The relationship between outcome and treatment options was analyzed by SPSS. RESULTS: The estimated prevalence rate of trochleitis in our area was 12 per 100,000. The average age of patients was 43±18 years. The majority of cases were women (86%). One case was bilateral. Patients' chief complaints were continuous pain (66%), pain only with ocular movements (25%), or pain only with palpation (8%). Ocular movement limitations were presented in 14%. Diplopia was observed in 12%, and 19% complained of headache. Oral non-steroidal anti-inflammatory drugs (NSAIDs) were the first option for treatment in 85% of cases, associated with oral steroids in 8% of patients. Oral steroids were the first and only option for treatment in 3%. Symptoms completely resolved in 80%, with the worst responses seen in cases with motility disturbances. Peritrochlear triamcinolone acetonide was injected in 14% of cases, achieving a good response in 62%. CONCLUSIONS: The prevalence of trochleitis in our area is low, and this pathology is more frequent in females. Oral NSAIDs are efficient to resolve isolated pain, but the response is partial if diplopia or motility limitations are associated. Some non-responders achieved good results with peritrochlear triamcinolone. Successful management provides a good prognosis for most patients.

Retinoschisis and macular detachment associated with acquired enlarged optic disc cup.

We describe a case of maculopathy consisting of macular retinoschisis and serous macular detachment occurring in a patient with an acquired enlarged optic disc cup, similar to the maculopathy observed in congenital optic nerve abnormalities, mainly optic nerve pits and colobomas, without vitreomacular traction nor angiographic leak. Pars plana vitrectomy with argon laser endophotocoagulation and gas tamponade was found to be useful. Traction from membranes covering deep optic disc cups may create small retinal dehiscences, as described in congenital optic nerve abnormalities, which will enable the liquefied vitreous to pass, leading to retinoschisis with or without associated neurosensory detachment. Vitrectomy, photocoagulation, and gas tamponade may be a useful therapy for this entity.

Efficacy of bevacizumab against interface neovascularization after deep anterior lamellar keratoplasty.

PURPOSE: We report a case of neovascularization at the interface after a deep anterior lamellar keratoplasty and its regression after a single bevacizumab injection. METHODS: Case report. RESULTS: We present a case of neovascularization and bleeding at the interface 2 days after a deep anterior lamellar keratoplasty for herpetic disease that was completely reversed by a single injection of bevacizumab at the interface. CONCLUSIONS: Corneal neovascularization is a typical sign of herpetic disease and one of the most important risk factors that can contribute to corneal graft failure. Close follow-up of patients at risk is necessary to detect and treat this complication as soon as possible to achieve a good outcome. Bevacizumab seems to be a successful and safe therapeutic option.

Persistent subretinal fluid due to central serous chorioretinopathy after retinal detachment surgery.

BACKGROUND: The causes of persistent submacular detachment after successful rhegmatogenous retinal detachment (RRD) surgery remain unknown. Its presence is associated with poor postoperative visual acuity, but due to its spontaneous resolution no additional therapeutic or diagnostic procedure is recommended. CASE REPORT: A case of central serous chorioretinopathy (CSC) that simulated persistent subfoveal fluid after RRD surgery is presented. CONCLUSION: To the authors' knowledge, no other case of visual impairment after successful retinal detachment surgery due to CSC has been reported in the PubMed database. In view of this report, CSC should be considered in the differential diagnosis of persistent subretinal fluid after successful retinal detachment surgery.

Retrobulbar ocular blood flow changes after orbital decompression in Graves' ophthalmopathy measured by color Doppler imaging.

PURPOSE: To evaluate if decompression surgery produces changes in retrobulbar blood flow parameters in Graves' ophthalmopathy (GO). METHODS: Retrobulbar blood vessels of 26 eyes (14 patients) that underwent orbital bone decompression between June 2009 and May 2010 were measured prospectively using color Doppler ultrasound before and after surgery. The disease was inactive in all patients enrolled according to the European Group on Graves' Orbitopathy. Patients were classified with mild, moderate-to-severe, or sight-threatening disease. All patients underwent a full ophthalmic examination including intraocular pressure and Hertel measurement. An age-matched control group included 20 eyes of 20 healthy volunteers. RESULTS: The resistance indexes (RIs) in the central retinal artery (CRA) and ophthalmic artery (OA) were significantly higher in patients with GO preoperatively than in the control group (P < 0.001, P = 0.001 respectively). After decompression surgery, a significant decrease in RIs occurred in the CRA (5%) and OA (6%) (P = 0.002, P < 0.001 respectively). Proptosis was decreased a median of 6 mm (range, 4-7). Three-wall decompression surgery resulted in a significantly greater reduction in exophthalmos (median 7 mm) compared with two-wall surgery (median 5 mm) and one-wall surgery (2.5 mm). Although no significant correlation was found, the RIs decreased more with major reductions in exophthalmos. CONCLUSIONS: In inactive moderate-to-severe GO, the RIs of the CRA and OA are higher than in normal subjects. The authors hypothesized that increased RIs of inactive GO may be due to orbital extrinsic compression of vascular structures because decompression surgery leads to decreases in the RIs of both the CRA and OA.