Wide-Field Fluorescein Angiography in Patients with Idiopathic Acute Anterior Uveitis.

PURPOSE: To elucidate whether wide-field fluorescein angiography (WFFA) can yield additional information in patients with newly diagnosed idiopathic acute anterior uveitis (AAU). METHODS: The WFFA was performed in patients with idiopathic AAU, and the findings were analyzed according to the scoring system by Angiography Scoring for Uveitis Nomenclature. RESULTS: Forty-four eyes of 30 patients (22 eyes of 13 patients in the pediatric group and 22 eyes of 17 patients in the adult group) were studied. The mean age was 12.41 ± 3.92 (range, 5-18) years in the pediatric group and 42.36 ± 32.07 (range, 24-68) years in the adult group. Thirteen eyes (59%) of pediatric patients and 12 eyes (54%) of adult patients showed some evidence of posterior segment activity on the WFFA (p = .764).     Systemic treatment was administered in 53.8% of the pediatric and 5.9% of adult patients, depending on the disease severity. CONCLUSION: Pediatric patients with idiopathic AAU may have subtle posterior segment manifestations more than adult patients, and posterior segment findings may affect the treatment preferences of physicians.

Clinical characteristics of full thickness macular holes that closed without surgery.

PURPOSE: To ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH). METHODS: Retrospective collaborative study of FTMH that closed without surgical intervention. RESULTS: A total of 78 patients (mean age 57.9 years) included 18 patients with blunt ocular trauma, 18 patients that received topical or intravitreal therapies and 42 patients with idiopathic FTMH. Mean±SD of the initial corrected visual acuity (VA) in logMAR improved from 0.65±0.54 to 0.34±0.45 (p<0.001) at a mean follow-up of 33.8±37.1 months. FTMH reopened in seven eyes (9.0%) after a mean of 8.6 months. Vitreomacular traction was noted in 12 eyes (15.8%), perifoveal posterior vitreous detachment in 42 (53.8%), foveal epiretinal membrane in 10 (12.8%), cystoid macular oedema (CME) in 49 (62.8%) and subretinal fluid (SRF) in 20 (25.6%). By multivariate analysis, initial VA correlated to the height (p<0.001) and narrowest diameter of the hole (p<0.001) while final VA correlated to the basal diameter (p<0.001). Time for closure of FTMH (median 2.8 months) correlated to the narrowest diameter (p<0.001) and the presence of SRF (p=0.001). Mean time for closure (in months) was 1.6 for eyes with trauma, 4.3 for eyes without trauma but with therapy for CME, 4.4 for eyes without trauma and without therapy in less than 200 µm in size and 24.7 for more than 200 µm. CONCLUSION: Our data suggest an observation period in new onset FTMH for non-surgical closure, in the setting of trauma, treatment of CME and size <200 µm.

Safety of 6000 intravitreal dexamethasone implants.

PURPOSE: To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. METHODS: Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. RESULTS: A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. CONCLUSION: This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.

Bilateral Severe Sterile Inflammation with Hypopyon after Simultaneous Intravitreal Triamcinolone Acetonide and Aflibercept Injection in a Patient with Bilateral Marked Rubeosis Associated with Ocular Ischemic Syndrome.

We report the clinical course of a diabetic patient with bilateral cataract and rubeosis in association with ocular ischemic syndrome and initially treated him with simultaneous intravitreal 2 mg aflibercept and 2 mg triamcinolone acetonide injection at the same setting prior to planned cataract surgery and further photocoagulation. However, sterile anterior segment inflammation characterized by hypopyon occurred four days apart in OU. Right eye developed the sterile inflammation at the third postinjection day and the left eye developed the sterile inflammation at the seventh postinjection day (two days after the uneventful cataract surgery with intraocular lens implantation) without any pain or significant redness. Vitreous biopsy taken during the right phacovitrectomy was negative for any microbial contamination. Both eyes were treated successfully with intensive topical prednisolone acetate with a relatively good visual outcome. It is likely that underlying ocular ischemic syndrome might have facilitated the formation of sterile inflammation as blood-aqueous barrier disruption and flare have already been present.

Unilateral Acute Anterior Ischemic Optic Neuropathy in a Patient with an Already Established Diagnosis of Bilateral Optic Disc Drusen.

Optic disc drusen (ODD) are calcific deposits that form in the optic nerve head secondary to abnormalities in axonal metabolism and degeneration. Anterior ischemic optic neuropathy, central retinal artery, and vein occlusion are among the rare vascular complications of disc drusen. We reported the clinical course of a 51-year-old patient with a unilateral acute nonarteritic anterior ischemic optic neuropathy (NAION) who received the diagnosis of bilateral optic disc drusen five years earlier and thereby reiterated the association of ODD and acute NAION.

Dexamethasone implant (ozurdex) in a case with unilateral simultaneous central retinal vein and branch retinal artery occlusion.

Simultaneous branch retinal artery and vein occlusion is a rare condition that may cause severe visual loss, and its treatment is often unrewarding. Herein, we report a case with simultaneous central retinal vein and branch retinal artery occlusion; it was successfully treated with a single dexamethasone intravitreal implant. The affected eye attained a visual acuity level of 20/25 from the visual acuity of hand motions at presentation with a residual, but relatively diminished, altitudinal scotoma during a follow-up period of 6 months.

Single intravitreal aflibercept injection for unilateral acute nonarteritic ischemic optic neuropathy.

Acute nonarteritic ischemic optic neuropathy (ANAION) is the most common optic neuropathy in the elderly population without a well-established treatment. A 67-year-old man with a sudden painless visual loss in his left eye of one-day duration was diagnosed to have left ANAION. Next day, 2 mg aflibercept injection was injected intravitreally in OS. Visual acuity improved to 7/10 from 1/10 a week after the injection. Mean retinal nerve fiber layer thickness (RNFLT) was reduced to 159,7 µm from 182,4 µm at the first week. Visual fields improved dramatically during the follow-up of three months. The aim of this study is to present a case having ANAION treated with a single intravitreal aflibercept injection and discuss the place of intravitreal anti-VEGF injections in the treatment of armamentarium of ANAION.

The long-term effect of intravitreal ranibizumab on retinal nerve fiber layer thickness in exudative age-related macular degeneration.

The aim of this study was to evaluate the long-term effect of intravitreal ranibizumab on the retinal nerve fiber layer (RNFL) in exudative age-related macular degeneration (AMD). Patients with treatment naive neovascular AMD in one eye were enrolled into the study. Following 3 monthly intravitreal ranibizumab injections, the patients were evaluated according to disease activity and re-injections were performed according to "treat and extend" protocol. During the follow-up, peripapillary nerve fiber layer thickness measurements were compared with normal fellow eyes. Forty-four eyes of 11 women and 11 men with the mean age of 66.3 ± 8.8 years (50-80) were enrolled into the study. All patients had completed at least 12 months of follow-up time. Patients received an average of 4.7 (3-11 injections) intravitreal injections. At baseline, no significant difference was observed between two groups for RNFL thickness, which was assessed as quadrants (p = 0.250-0.944) and globally (p = 0.814). In each group, there was a significant RNFL thinning (p = 0.009 and 0.022) after the third month, whereas no significant difference was observed between treated and untreated eyes. Patients were also classified according to the number of injections, and RNFL thickness showed no difference between eyes treated with less or more than five intravitreal injections (p = 0.757-0.973). Although there was no statistically significant difference in RNFL thickness between study and control eyes during 12 months of follow-up, a significant thinning was recorded in both groups compared with baseline values. Cross-sectional images with higher resolutions and precise segmentation opportunities are needed to investigate the hypothesis "VEGF neutralization and inhibition of cell maintenance" in detail.

Bilateral intravitreal ranibizumab injection and panretinal photocoagulation in a 16-year-old girl with severe vaso-occlusive lupus retinopathy.

A 16-year-old girl with fever of unknown origin and bilateral vaso-occlusive retinopathy with retinal neovascularization, preretinal hemorrhage, and serous macular detachment was treated with single bilateral 0.5 mg intravitreal ranibizumab injection prior to aggressive PRP with success. No systemic steroids or immunosuppressive therapy was employed at that time. She received the diagnosis of "systemic lupus erythematosus" five years after this episode with further systemic symptoms. In certain cases with vaso-occlusive type of lupus retinopathy, anti-VEGF agents may be administered in addition to panretinal photocoagulation to achieve better visual and anatomic outcome.

Effect of silicone oil removal on central corneal thickness.

AIM: To evaluate the effect of silicone oil removal(SOR) on central corneal thickness(CCT) in aphakic and pseudophakic eyes prospectively. METHODS: Patients who underwent SOR surgery between June 2005 - August 2007 were included in this study. Silicon oil was actively removed behind the posterior capsule through the pars plana sclerotomy site (posterior approach) in pseudophakic eyes and through the pupil and the corneal tunnel incision (anterior approach) in aphakic eyes with the 18-gauge cannula. CCT was assessed with Orbscan II corneal topography system preoperatively and at one month and three months postoperatively. A total of 34 eyes of 34 patients (26 males, 8 females) comprised the study group. Mean age was (55.6±12.3) years (Range: 25-80 years). Twenty-six eyes (76.5%) were pseudophakic and 8 (23.5%) aphakic. Mean time between silicone oil injection and removal was (15.1±13.6) months (Range: 5-54 months). At baseline, CCT was 576.4±46.0µm in pseudophakic eyes and 611.6±36.2µm in aphakic eyes. RESULTS: At the first postoperative month CCT was (573.3±40.1)µm and (630.9±72.9)µm in pseudophakic and aphakic eyes respectively. At the third postoperative month, CCT was (582.7±49.5)µm and (614.5±82.4)µm in pseudophakic and aphakic eyes respectively. There was no statistically significant difference in CCT measurements one month and 3 months after SOR when compared to preoperative values in both aphakic and pseudophakic eyes (P>0.05). CONCLUSION: Active SOR either by anterior or posterior approach did not affect the CCT.

Sympathetic ophthalmia following vitreoretinal surgery.

The objective is to discuss the characteristics of three patients who developed sympathetic ophthalmia following vitreoretinal surgery. The first case was a 29-year-old man who underwent placement of an encircling band, pars plana vitrectomy, foreign body removal, endolaser photocoagulation, transscleral cryotherapy, and silicone oil injection due to a retained foreign body 3 months after a corneoscleral rupture repair. He experienced visual loss in the fellow eye 2 months after the vitrectomy. An extensive exudative detachment was detected in the fellow eye. Sympathetic ophthalmia was diagnosed and systemic steroids together with azathioprine were initiated. The injured eye was enucleated as there was no useful vision. The other two cases were operated for rhegmatogenous retinal detachments. One underwent placement of an encircling band, pars plana vitrectomy, silicone oil injection, and endolaser photocoagulation with good anatomic outcome. However, 4 months later, the fellow eye experienced severe visual loss with disc swelling and hyperemia and exudative retinal detachment. Systemic steroid was sufficient to reverse the process and the visual acuity recovered. The other case underwent placement of an encircling band, subretinal fluid drainage, SF(6) injection and 360 degrees indirect laser photocoagulation. Two years later, he noted a sudden visual decrease in the fellow eye in which we detected a Harada-like extensive exudative detachment. Systemic steroid without immunosuppressive therapy rendered regression of the detachment and recovery of good visual acuity. Sympathetic ophthalmia may occur following vitreoretinal surgery either for trauma-related problems or rhegmatogenous retinal detachment. Since it may present with relatively mild anterior segment findings and mainly posterior segment involvement; any visual disturbance in the fellow eye of a patient with a history of perforating trauma or vitreoretinal surgery should be thoroughly evaluated for sympathetic ophthalmia.

Ocular findings in children with nonsyndromic cleft lip and palate.

The aim of this study was to evaluate ocular findings in children with nonsyndromic cleft lip and palate. Fifty-seven consecutive patients with cleft lip and/or palate seeking orthodontic treatment during 2006 were examined prospectively from an ophthalmological standpoint. Mean age of the patients was 9.2 years (range: 15 days to 18 years). Of the 57 children in total, five cases (8.7%) had cleft lip, six cases (10.5%) had isolated cleft palate and 46 cases (80.7%) had both cleft lip and palate. Thirty-seven of 46 cases with cleft lip and palate were unilateral and 20 were bilateral. Eleven of the 57 patients (19.1%) had ocular findings including congenital nasolacrimal duct obstruction (5 patients), ptosis (1 patient), bilateral iris coloboma (1 patient), dermoid tumor (1 patient), vernal conjunctivitis (1 patient), and esophoria (1 patient). Twenty patients (35%) had one or more systemic abnormalities such as motor mental retardation, hearing loss, syndactylia, growth retardation, double urinary tract, vesicoureteral reflux, penile nevus, hypospadias, non-redundant testis, inguinal hernia, mitral valve prolapsus, ventricular septal defect, complete right bundle branch block, and hirsutism. Though not very often, cleft lip and palate patients may have several associated ocular changes, and these patients should also be examined by ophthalmologists.

Intravitreal triamcinolone acetonide injection for acute non-arteritic anterior ischaemic optic neuropathy.

Non-arteritic anterior ischaemic optic neuropathy is the most common optic neuropathy of the elderly, characterised by unilateral, sudden, painless visual loss. No effective treatment has been proven to reverse or limit the course of this disease. We evaluated the role of intravitreal triamcinolone acetonide injection in eyes with non-arteritic anterior ischaemic optic neuropathy (NAION). Four eyes of four patients with acute NAION received a single intravitreal injection of triamcinolone acetonide (4 mg). The time between visual loss and intravitreal injection varied between four and 10 days. Mean age of patients was 57.25 years (range, 44 to 77 years). All patients experienced some visual gain. No complications related to the injection were observed during the following three months. Intravitreal triamcinolone injection may offer help in limiting the damage in this small group of patients with a relatively short history of visual loss due to NAION.

Acute vitreomacular traction syndrome after uneventful phacoemulsification.

We prospectively evaluated 59 eyes following uneventful phacoemulsification and intraocular lens implantation with optic coherence tomography at one and seven postoperative days (POD). Acute vitreomacular traction was observed in two eyes (3.3%) at the first POD. Spontaneous resolution occurred in both eyes within one week. The temporary visual loss associated with acute vitreomacular traction syndrome may go unnoticed as visual acuity rapidly improves.

The effect of various alpha1-adrenergic receptor antagonists on pupillary dilation.

We prospectively evaluated the effect of various systemic alpha1 adrenergic receptor antagonists on pupillary dilation in patients with benign prostatic hyperplasia. Patients who are at risk for intraoperative floppy iris syndrome cannot be elucidated simply by judging preoperative dilation.

Oculocerebrocutaneous syndrome.

The authors describe a patient with oculocerebrocutaneous syndrome, also called Delleman-Oorthuys syndrome. This patient is the first reported case in Turkey. The 19-month-old boy had characteristic features of oculocerebrocutaneous syndrome, such as unilateral orbital cyst, skin tags and skin hypoplasia, hypoplastic left cerebellar hemisphere, Dandy-Walker variant anomaly, corpus callosum agenesis, and left cerebral hemispheric diffuse migration anomaly.

Intravitreal triamcinolone acetonide injection in CRVO associated with Wegener's granulomatosis.

A 33-year-old man developed unilateral non-ischemic central retinal vein occlusion associated with systemic Wegener's granulomatosis. Four milligrams of triamcinolone acetonide was injected intravitreally twice 6 months apart in conjunction with ongoing systemic immunosuppressive therapy. No change was made in the systemic immunosuppressive regimen. Wegener's granulomatosis should be considered in the differential diagnosis of central retinal vein occlusion in the young age group and intravitreal triamcinolone acetonide is a good adjunct to systemic immunosuppressive therapy that eliminates the need for modifying the systemic treatment regimen.