FULL DIAGNOSTIC VITRECTOMY WITH POSTERIOR VITREOUS DETACHMENT INDUCTION FOR THE DIAGNOSIS OF VITRITIS DUE TO UNCERTAIN ETIOLOGY.

PURPOSE: To report on the diagnostic outcomes and safety of full diagnostic vitrectomy (FDV) with surgical posterior vitreous detachment induction for diagnosing vitritis of uncertain etiology. METHODS: Forty-nine patients underwent primary FDV using the cassette washings for histopathological analysis. In addition, an undiluted core vitreous sample was obtained for microbial analysis in suspected infective cases. Cases were retrospectively given a diagnosis of inflammatory, infective, or neoplastic based on the results at final follow-up and the outcome of primary FDV categorized as diagnostic or nondiagnostic. The success of FDV was evaluated in relation to the final diagnosis. The need for additional intraocular biopsies and intraoperative or postoperative complications was also recorded. RESULTS: Full diagnostic vitrectomy was diagnostic in 26/49 cases (53%) and nondiagnostic in 23 (47%). The diagnostic success rate was greatest in neoplastic (16/20, 80%) and infective cases (9/13, 69%). Seven cases (14%) required additional biopsies to establish the diagnosis, and in 15/49 cases (31%), no cause of vitritis was identified. Intraoperative retinal breaks occurred in 3/49 cases (6%) and retinal detachment in 1/49 cases (2%). Three of 49 cases (6%) developed transiently elevated intraocular pressure postoperatively. CONCLUSION: Full diagnostic vitrectomy in combination with an undiluted core vitreous biopsy for suspected infections is safe and effective at securing a diagnosis in vitritis, particularly in cases of neoplasia.

Defining the limits of normal conjunctival fornix anatomy in a healthy South Asian population.

PURPOSE: Quantifying the extent of conjunctival fibrosis for documentation of progression in conjunctival scarring disease is a clinical challenge. Measurement of forniceal foreshortening facilitates monitoring of these disorders. This study aims (1) to define the limits of the normal human conjunctival fornices and how these alter with age and (2) to provide normative data for upper and lower fornix depths (FDs) and fornix intercanthal distance (FICD) within a healthy South Asian, racially distinct population. DESIGN: Epidemiologic, cross-sectional study. PARTICIPANTS: A total of 240 subjects with national origins from South Asia, with no known ocular history and normal adnexal and conjunctival examination, aged 20 to 80 years. METHODS: An FICD modification of a custom-designed fornix depth measurer (FDM) was validated and used for measurement of both lower and upper FDs together with FICDs in 480 healthy eyes with no ocular comorbidities. Data were analyzed using repeated-measures analysis of variance and presented as means with 95% confidence intervals (CIs). MAIN OUTCOME MEASURES: Mean lower and upper FDs and FICD for the entire cohort, stratified according to age decade and sex. RESULTS: For this South Asian population, the overall upper and lower FDs were 15.3 mm (95% CI, 14.9-15.6) and 10.9 mm (95% CI, 10.7-11.1), respectively, with FICD defined as 32.9 mm (95% CI, 32.5-33.4) (upper) and 31.7 mm (95% CI, 31.3-32.1) (lower). With increasing age, a progressive reduction of all measured parameters (P < 0.001) was noted, with female subjects having significantly shallower fornices (upper FD, P < 0.001; lower FD, P < 0.001; upper FICD, P = 0.081; and lower FICD, P = 0.015). CONCLUSIONS: This is the first study to define the limits of normal upper FD and FICDs in any population group. Our study demonstrates sex variations and progressive conjunctival shrinkage with age. Although it provides important, objective data for normal forniceal anatomy, further study is recommended in other populations to confirm the generalizability of these data or to enable normal comparative datasets for the assessment of conjunctival scarring disorders among all anthropological groups.

Ten-year experience of pulsed intravenous cyclophosphamide and methylprednisolone protocol (PICM protocol) in severe ocular inflammatory disease.

AIMS: Severe ocular inflammation is a blinding ophthalmological emergency. This study evaluates the efficacy and patient tolerance of a validated regime of pulsed intravenous cyclophosphamide and methylprednisolone ('PICM protocol') for these patients. METHODS: 26 patients with severe inflammatory eye disease (43 eyes: 22 uveitis, 21 scleritis/sclerokeratitis; median age 52 years (IQR 40.25-62.25)) presenting to a regional tertiary referral centre were recruited over a 10-year period (January 2002-December 2011) into the PICM protocol, comprising intravenous cyclophosphamide 15 mg/kg, intravenous methylprednisolone 10 mg/kg, maximum nine pulses over 20 weeks supplemented with low-dose continuous oral prednisolone. Data were captured pretreatment and at 6 and 12 months follow-up. Primary outcome measures were control of inflammation according to standard criteria and reduction in systemic glucocorticoid to ≤10 mg prednisolone/day. RESULTS: A median of six pulses (IQR 5-6) were administered over a median of 3 months (IQR 2.25-4). In the scleritis/sclerokeratitis group, 15/21(71%) achieved success or partial success at 6 and 12 months versus 9/22 (41%) for the same time points in the uveitis group (χ(2)=4.058, p=0.044). Two patients had adverse events requiring treatment withdrawal. CONCLUSIONS: This PICM protocol is a well-tolerated regimen for managing severe ocular inflammation and appears particularly useful in patients with scleritis/sclerokeratitis.

Sequential surgical repair of a macular hole-related retinal detachment in a hyperopic patient.

PURPOSE: To report a case of macular hole-related retinal detachment in a hyperopic patient and a sequential surgical approach to repair. METHODS: Case report. PATIENTS: A single patient with acute macular hole-related retinal detachment. CONCLUSION: Retinal detachment secondary to macular hole typically occurs in highly myopic patients and is rare in patients with hypermetropia. Surgical repair may involve a combined or sequential approach to close the macular hole.

Dome-shaped macula: a compensatory mechanism in myopic anisometropia?

The purpose of this article was to describe a patient with dome-shaped macula in the setting of mild myopic anisometropia and to speculate regarding the role of this feature as a compensatory mechanism in ocular development. The clinical records of a 49-year-old woman with this condition were reviewed. Spectral-domain optical coherence tomographic images revealed evidence of a dome-shaped macula. B-scan ultrasonography measured axial lengths of 23.8 mm in the right eye and 22.8 mm in the left eye. Spherical equivalents were -1.375 and +0.375 in the right and left eyes, respectively. Examination of the left eye was unremarkable. Dome-shaped macula has previously only been described in patients with high myopia. These findings support the hypothesis that myopic anisometropia, rather than absolute refractive status, is central to the development of dome-shaped macula and that this feature represents a protective mechanism aimed at reducing the effects of anisometropia.

Microperimetry and optical coherence tomography in acute macular neuroretinopathy.

PURPOSE: To report optical coherence tomography and microperimetry findings in acute macular neuroretinopathy. METHODS: Case report. PATIENTS: A single patient with acute macular neuroretinopathy. CONCLUSION: Scotomata reported by a patient with acute macular neuroretinopathy correspond with findings of disruption of the photoreceptor inner segment-outer segment junction on optical coherence tomography and congruent decreased retinal function demonstrated with microperimetry.

Three-haptic intraocular lens for myopia: early results.

PURPOSE: To report the intraoperative experience and early postoperative results of implantation of an intraocular lens (IOL) developed specifically for myopic eyes. SETTING: Wolverhampton Eye Infirmary, Wolverhampton, United Kingdom. METHODS: This retrospective study evaluated consecutive highly myopic eyes having implantation of a Bigbag IOL from November 2003 to December 2007. Before IOL placement, a 2.8 mm clear corneal incision was created and phacoemulsification performed. The IOL was implanted using the dedicated folder and injector supplied by the manufacturer. RESULTS: The study evaluated 67 eyes (48 patients) with a mean follow-up of 8.5 months (range 0.75 to 31 months). Intraoperative complications were IOL haptic damage from the injector system (3 eyes; 4.5%) and posterior capsule tear (1 eye; 1.5%). Postoperative complications were posterior capsule opacification (29 eyes; 43%), retinal detachment (1 eye; 1.5%), and iritis (1 eye; 1.5%). The postoperative corrected distance visual acuity was 0.10 logMAR or better in 24 eyes (35.8%) and 0.18 to 0.48 logMAR in 32 eyes (47.8%). Forty-three eyes (64.2%) were within +/-1.00 diopter of the intended refractive outcome. CONCLUSION: Preliminary results indicate that this 3-haptic IOL is safe and appropriate for use in highly myopic patients having cataract surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Infectious crystalline keratopathy treated with intrastromal antibiotics.

An 84-year-old white female with nonprogressive conjunctival scarring developed infectious crystalline keratopathy (ICK) recalcitrant to topical therapy. After determination of the causative organism's antibiotic sensitivities, superficial keratectomy was performed with intrastromal corneal infiltration of cefuroxime into the affected cornea. Postoperatively, the ICK resolved completely, leading to an improvement in visual acuity and a reduction in ocular irritation. This case highlights the importance of a surgical approach in ICK and also demonstrates the possible benefit of a novel use of intracorneal antibiotics as an adjunct.