Serous detachment of macula in cystoid macular edema associated with latanoprost.

PURPOSE: To report serous macular detachment in two patients with cystoid macular edema (CME) associated with latanoprost. METHODS: Two eyes of two patients with CME associated with latanoprost underwent an ophthalmoscopic examination, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: In both patients, besides CME, OCT showed serous macular detachment composed of retinal elevation over a nonreflective cavity with minimal shadowing of the underlying tissues. CONCLUSIONS: This is the first case report that shows an association between serous macular detachment and CME associated with latanoprost.

Macular sensitivity in eyes with central serous chorioretinopathy.

PURPOSE: To determine macular sensitivity and fixation characteristics in eyes with central serous chorioretinopathy (CSC) using fundus-related microperimetry. METHODS: The authors reviewed 19 eyes with serous elevation within the central 10 degrees due to CSC and 15 normal healthy eyes that had undergone fundus-related microperimetry. The macular sensitivity was measured using the fundus-related microperimeter, MP-1. The bestcorrected visual acuity (BCVA), mean retinal sensitivity in the central 10 degrees (central microperimetry, cMP-1) and in the paracentral 10 degrees to 20 degrees (paracentral microperimetry, pMP-1), and fixation stability and location were determined and compared with that of control eyes. RESULTS: Eyes with CSC showed significantly lower logMAR BCVA (p<0.001), cMP-1, and pMP-1 sensitivity than control eyes (p<0.001, p<0.01, respectively). Eyes with CSC were not significantly different in fixation location (p=1.00) or fixation stability than control eyes (p=0.45). Fixation location was predominantly central in all eyes with CSC; fixation was stable in 17 (89%) and relatively unstable in 2 (11%). CONCLUSIONS: Eyes with CSC showed significantly lower retinal sensitivity not only at the central but also in the paracentral area. Even with decreased BCVA and retinal sensitivity, our patients showed central and stable fixation in their affected eyes.

Macular function by multifocal electroretinogram in diabetic macular edema after intravitreal triamcinolone acetonide injection.

PURPOSE: The purpose of this study was to assess macular function by multifocal electroretinography (mfERG) in eyes with diabetic macular edema (DME) after intravitreal triamcinolone acetonide (IVTA) injection. METHODS: Fifteen eyes of 15 patients with DME scheduled for 4 mg IVTA injection were prospectively recruited. The response to treatment was monitored functionally by visual acuity (VA) measurement and mfERG and anatomically by foveal thickness measured by optical coherence tomography (OCT). The first-order kernel P1 mfERG responses from 0 to 7 degrees (central) and 7 to 25 degrees (peripheral) were grouped and analyzed. Changes in functional parameters (VAs and the P1 mfERG response amplitudes and peak latencies) and morphometric parameters (OCT foveal thickness) in eyes with DME 1 and 3 months after IVTA injection were compared with baseline values by Student t test. RESULTS: The mean baseline logMAR value for VAs of the patients before treatment was 0.49+/-0.26. After treatment, it was 0.27+/-0.23 at 1 month and 0.26+/-0.18 at 3 months, and differences from pretreatment values were significant (for each, p<0.001). There were statistically significant decreases in the mean foveal thickness at 1 and 3 months after treatment compared with pretreatment values (for each, p<0.001). There were also statistically significant increases in the mean P1 response amplitude for both central and peripheral groups at all examinations compared with pretreatment (for each, p<0.001). The mean P1 peak latencies for both the central and peripheral groups were shortened, but not significantly. CONCLUSIONS: As well as the reduction in DME and improvement in VA, IVTA injection improves macular function as assessed by mfERG in diabetic patients.

Assessment of macular function by microperimetry in unilateral resolved central serous chorioretinopathy.

PURPOSE: To determine macular sensitivity and fixation characteristics in patients with unilateral resolved central serous chorioretinopathy (CSC) using fundus-related microperimetry. METHODS: We reviewed 15 eyes with resolved CSC and 15 normal healthy eyes that had undergone fundus-related microperimetry. The macular sensitivity was measured using the recently introduced fundus-related microperimeter, MP-1. The best-corrected visual acuity (VA) (BCVA), mean retinal sensitivity in the central 10 degrees (central microperimetry, cMP-1) and in the paracentral 10-20 degrees (paracentral microperimetry, pMP-1), and fixation stability and location were determined and compared with measurements in control eyes. RESULTS: BCVA at the time of this study was 20/20 in all the affected eyes, and fundus examination and optical coherence tomography findings revealed no serous detachment. Eyes with CSC showed statistically significantly lower cMP-1 sensitivity and lower, but not significantly, pMP-1 sensitivity than control eyes (P<0.001, P=0.11, respectively). Eyes with CSC were not significantly different from control eyes in fixation location (P=1.00) or fixation stability (P=0.91). Fixation location was predominantly central in all eyes with CSC; fixation was stable in 12 (80%) and relatively unstable in 3 (20%). CONCLUSION: Our study shows that eyes with resolved CSC can have lower retinal sensitivity in the central macula than control eyes, even after good VA has been obtained.

Intravitreal triamcinolone acetonide in Vogt-Koyanagi-Harada syndrome.

PURPOSE: To report the results of intravitreal triamcinolone acetonide in two eyes of a patient with Vogt-Koyanagi-Harada syndrome. METHODS: A 24-year-old woman with Vogt-Koyanagi-Harada syndrome was treated with a single 4-mg dose of intravitreal injection of triamcinolone acetonide in both eyes. RESULTS: On the seventh day after injection, visual acuity improved from 20/50 to 20/20 in the right eye and from 20/100 to 20/32 in the left. One month after injection, visual acuity was 20/20 in the right eye and 20/32 in the left, and fluorescein angiography showed that serous detachment had almost completely resorbed. The ocular examination remained stable during the 8-month follow-up period. CONCLUSIONS: In this study, a prompt improvement in the clinical picture of a patient with Vogt-Koyanagi-Harada syndrome after intravitreal triamcinolone acetonide injection was described. The results suggest that intravitreal triamcinolone acetonide injection may be an additional tool in the treatment of Vogt-Koyanagi-Harada syndrome.

Optical coherence tomography findings in branch retinal artery occlusion.

PURPOSE: To report the optical coherence tomography (OCT) findings in a 35-year-old man with acute inferior branch retinal artery occlusion. METHODS: OCT findings in acute branch retinal artery occlusion were evaluated. RESULTS: OCT disclosed diffuse thickening of the neurosensory retina in the inferior perifoveolar area. Increased reflectivity was noted in the inner retinal layers rom the surface of the retina to the photoreceptor layers. Decreased reflectivity was observed from the photoreceptor layers and the retinal pigment epithelium secondary to the shadowing effect. Foveolar depression, photoreceptor layer in the fovae, and retinal pigment epithelium underneath the fovea were normal. OCT findings in the superior perifoveolar area were also normal. CONCLUSIONS: In the retinal artery occlusion, denaturation and breakdown of the normally transparent intracellular protein and an increase in the intracellular fluid cause ischemic whitening of the retina. Otherwise there is no retinal thickening secondary to the accumulation of serous fluid escaping from retinal capillaries into the extracellular space. The OCT findings support these descriptions.

Intravitreal triamcinolone as a primary therapy in diabetic macular oedema.

PURPOSE: To evaluate the effect of intravitreal triamcinolone in eyes with diabetic macular oedema that had no previous laser treatment. METHODS: In all, 12 eyes of 12 patients with diabetic retinopathy, aged 47-70 years (mean 59.2), made up the study. All the eyes had persistent diabetic macular oedema despite having received medical treatment for at least 3 months. In this consecutive case series, none of the eyes received previous laser photocoagulation. Intravitreal injection of 0.1 ml (4 mg) triamcinolone acetonide was offered to treat macular oedema. The visual and anatomic responses were observed as well as complications related to the injection procedure and corticosteroid medication. RESULTS: The follow-up period was between 6 and 10 months (mean 7.9 months) and all eyes completed 6 months of follow-up. Macular oedema was documented for an average of 3.5 months (ranged 3-5 months) before intravitreal corticosteroid injection. Baseline mean central macular thickness was 448.6 microm. At 1 month follow-up, a reduction in mean central macular thickness of 40.8% from 448.6 microm to 265.4 microm was obtained. At 3 and 6 months follow-up, mean central macular thicknesses, were 310 mum and 294.5 mum, respectively. No eyes lost vision at 1 month and 10 eyes (83.2%) showed improvement. At 3 months, no eyes lost vision from baseline and 8 eyes (66.6%) showed improvement. At 6 months, again no eyes lost vision from baseline and 10 eyes (83.2%) maintained improved visual acuity. CONCLUSIONS: Intravitreal triamcinolone is a promising therapeutic method in eyes with diabetic macular oedema without previous application of laser treatment. Further study with longer follow-up and large series is warranted to assess the long-term efficacy and safety and the need for retreatment.

Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up.

PURPOSE: The authors evaluated the effect of laser photocoagulation for persistent central serous retinopathy (CSR). METHODS: The authors evaluated 45 eyes of 38 patients who had been offered laser photocoagulation for CSR that did not resolve after 4 months of observation. Sixteen eyes of 14 patients who did not accept laser photocoagulation were followed as the control group. The remaining 29 eyes of 24 patients comprised the study group. Argon green laser photocoagulation was performed on 9 eyes, dye-yellow laser photocoagulation was performed on 12 eyes, and dye-orange laser photocoagulation was performed on 8 eyes. Mean follow-up was 4.8 years (range, 1-7 years). RESULTS: In the group that received laser treatment, duration of the serous detachment was shorter (P < 0.0001) and final best-corrected visual acuity (BCVA) was better (P = 0.006) than those of the control group. Although none of the eyes in the laser photocoagulation group had a recurrence, seven eyes in the control group had one or more recurrences during the mean follow-up period of 4.8 years (P = 0.0003). Although the duration of the serous detachment was shorter in the dye-yellow laser photocoagulation subgroup than in the argon green laser treatment subgroup (P = 0.01), there were no other differences between the laser photocoagulation subgroups with respect to the duration of the serous detachments or the final BCVA. CONCLUSION: Direct laser photocoagulation of the leakage site(s) for CSR that persists for 4 months is safe and effective to shorten the duration of the serous detachment, to improve final BCVA, and to decrease the incidence of recurrence.

Associated ocular findings in pericentral pigmentary retinopathy.

Macular complications occurred in two isolated patients who had pericentral pigmentary retinopathy. One patient demonstrated bilateral bull's-eye maculopathy and a unilateral full-thickness macular hole. Later, she developed central retinal artery occlusion in the fellow eye. The second patient had a rhegmatogenous retinal detachment that was reattached by scleral buckling surgery, but a full-thickness macular hole was found 3 months postoperatively. In both patients, foveal ischemia may have played a role for the development of macular hole, resulting in poor visual prognosis in pericentral pigmentary retinopathy.

Treatment of diabetic macular edema: a comparison between argon and dye lasers.

To compare the efficacy of argon green and dye yellow photocoagulations, 85 eyes of 85 diabetic patients with diffuse macular edema were included in a prospective randomized clinical trial. One year after treatment, visual acuity was unchanged or better in 85.1% of eyes treated with an argon and 89.5% of eyes treated with a dye laser. A reduction of macular edema was accomplished in 67.3% of eyes in the argon-laser group and in 71.1% of eyes in the dye-laser group. No statistically significant differences were observed between the two groups in regard to visual acuity results or the reduction of macular edema.

Retinal toxicity of 6-methoxypurine arabinoside (ara-M). A new selective and potent inhibitor of varicella-zoster virus.

The toxicity of a new antiviral agent, 6-methoxypurine arabinoside (ara-M), as a selective and potent inhibitor against varicella-zoster virus, was investigated after intravitreal injection in rabbit eyes. Intravitreal doses of ara-M ranging from 20 micrograms to 400 micrograms produced no retinal toxicity, as assessed by electroretinography and light and transmission electron microscopy. These data suggest a potential role for intravitreal ara-M in the antiviral treatment of varicella-zoster viral retinitis.