Evaluation of sub-Tenon triamcinolone acetonide injections in the treatment of scleritis.

PURPOSE: To suggest that sub-Tenon triamcinolone acetonide (TA) injections may be a helpful supplement in patients with scleritis. DESIGN: Retrospective, interventional case series. METHODS: A retrospective chart review was conducted of all patients at our institution receiving sub-Tenon TA injections for scleritis between August 2001 and August 2007. Outcome measures included subjective improvement, presence of inflammation, and adverse events. RESULTS: Eleven patients (12 eyes) were included in this study. The mean age was 50 years; 2 patients were male and 9 female. Six patients had systemic autoimmune disease. All patients were receiving systemic medications for scleritis at the time of injection. Mean initial follow-up time was 3 weeks. Ten of 11 patients reported subjective improvement, and 10 patients had improvement in objective inflammation. Three patients had adverse side effects, including ocular hypertension, worsening of cataract, and subconjunctival hemorrhage with periorbital ecchymosis. CONCLUSIONS: Sub-Tenon TA injections may be a useful adjunct to achieving transient, partial improvement of subjective pain and objective inflammation in patients with scleritis while awaiting systemic medications to take effect. Adverse events were manageable in this small series.

Persistent corneal epithelial defect associated with erlotinib treatment.

PURPOSE: To report a case of persistent corneal epithelial erosion in a patient undergoing treatment with erlotinib for her lung cancer. METHODS: Report of a 79-year-old woman who presented with a persistent corneal epithelial defect associated with infectious keratitis that waxed and waned for 5 months despite treatment. She had been diagnosed with lung cancer and was being treated with erlotinib, a reversible epidermal growth factor receptor (EGFR) inhibitor. RESULTS: The keratitis required a biopsy to establish the diagnosis of Staphylococcus epidermidis keratitis. The infectious keratitis was successfully treated; however, her pain and the epithelial defect persisted. She discontinued the erlotinib treatment. Within 2 weeks, the abrasion healed and had no recurrence. CONCLUSIONS: This report is, to our knowledge, the first description of a nonhealing corneal erosion and infectious keratitis possibly associated with erlotinib toxicity. EGFR is expressed in basal epithelial cells across the cornea and limbal basal cells; it is considered imperative for corneal epithelial cell proliferation and wound healing. Erlotinib is mediated through inhibition of EGFR, which is a highly promising area in molecularly targeted chemotherapies. It will become increasingly important for ophthalmologists to recognize and treat side effects of chemotherapies interfering with the epithelial growth factor pathway.

The rate of retinal vessel dilation in severe retinopathy of prematurity requiring treatment.

PURPOSE: To assess whether the rate of change of retinal vessel diameter can help identify infants at the highest risk for severe retinopathy of prematurity (ROP). DESIGN: Thirty-five infants at risk for ROP were included in this prospective, longitudinal study. METHODS: Images were obtained using the NIDEK NM200D noncontact camera (NIDEK Inc, Aichi, Japan) at the time of ROP examinations in the intensive care unit. Vessel diameters were measured from digital fundus photographs of right eyes in a masked fashion using VesselMap image analysis software (IM-EDOS GmbH, Weimar, Germany). The rate of change of vessel diameter was calculated based on the linear regression slope and was compared between eyes in which type 1 ROP requiring treatment developed and in controls without ROP or with ROP less severe than type 1. RESULTS: Multivariate analysis showed that the group of eyes in which type 1 ROP developed had a greater increase in diameter over time in the inferior temporal veins (P = .01), superior temporal veins (P < .0001), mean temporal veins (P < .0001), superior temporal arteries (P = .02), and mean temporal arteries (P = .004). The area under receiver operator characteristic curve for venous diameter change was 0.96 for the superior temporal vein, 0.86 for the inferior temporal vein, and 0.96 for the mean temporal vein. CONCLUSIONS: On average, the rate of retinal vessel change was greater in eyes with type 1 ROP requiring treatment than in control eyes. The rate of venous diameter change had the best discriminative ability to differentiate between the 2 groups.

Quantitative analysis of retinal vessel diameter reduction after photocoagulation treatment for retinopathy of prematurity.

PURPOSE: To evaluate the feasibility of using semiautomated analysis of digital fundus images to quantify effects of photocoagulation on retinal vessel diameter in retinopathy of prematurity (ROP). DESIGN: Case series. METHODS: Fourteen eyes of seven patients with threshold ROP and 12 eyes of six controls were included. Fundus images were captured before and after photocoagulation, or one to three weeks apart in controls, using an NM200D camera (Nidek, Inc, Aichi, Japan). VesselMap software (Imedos, Jena, Germany) measured vessel diameter. The t test analysis was used to assess vessel changes. RESULTS: The authors observed a significant reduction in average largest retinal vein diameter of -18% +/- 16% (+/-1 standard deviation). The average largest artery diameter trended down by -12% +/- 16%. Compared with controls, diameter reduction was significant in veins (P = .014) and arteries (P = .016). CONCLUSIONS: The diameter of retinal vessels decreases after photocoagulation. VesselMap analysis of digital images is feasible and may be helpful in quantifying treatment effects.

Semiautomated analysis of retinal vessel diameter in retinopathy of prematurity patients with and without plus disease.

PURPOSE: To determine the feasibility of using semiautomated analysis of digital fundus images to quantify the differences in retinal vascular diameter between retinopathy of prematurity (ROP) patients with and without plus disease. DESIGN: Case-control study. METHODS: Thirty eyes of 15 patients with ROP were included in this study. Fourteen eyes of seven patients had plus disease and 16 eyes of eight patients had no evidence of plus disease. Digital fundus images were captured using an NM200D (Nidek, Inc, Aichi, Japan) camera. Vessel diameters were determined using VesselMap software (Imedos, Jena, Germany). The Student t test analysis was used to compare diameters of vessels with and without plus disease. RESULTS: We found that the average venous diameter is significantly larger by 15% in the group with plus disease. CONCLUSIONS: VesselMap analysis of digital images is feasible. This method is able to distinguish between veins with and without plus disease, and may be useful in telemedicine screening strategies.