Transpupillary thermotherapy of occult choroidal neovascularization in age-related macular degeneration.

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) in management of occult subfoveal choroidal neovascularization (CNV) in exudative age-related macular degeneration (AMD). METHODS: Retrospective chart review of eyes that were treated with TTT and had at least 12 weeks of follow-up. Base-line and final ETDRS visual acuity and fluorescein angiography (FA) were compared. RESULTS: For the 48 eyes which met inclusion criteria, mean pre-operative visual acuity was 20/128 (range: 20/50-20/500). Average follow-up was 27 weeks (range: 12 weeks-55 weeks). At 3 months after treatment, 12 eyes (25%) improved 2 lines or more, 18 eyes (37.5%) had no change or 1 line of visual improvement, and 18 eyes (37.5%) worsened 1 or more lines. No significant adverse event was noted during treatment. Three eyes developed large submacular hemorrhage within 2 months of treatment. Based on clinical examination and FA, 61% of the eyes appeared to have reduction of subretinal fluid compared to pre-operative evaluations. CONCLUSION: Visual acuity was stable or improved in 62.5% of eyes in our series and the treatment was well tolerated. Longer follow up and larger number of patients would be required to evaluate the ultimate benefit of TTT in management of occult CNV due to AMD.

Exophiala werneckii endophthalmitis following cartaract surgery in an immunocompetent individual.

A case of infectious endophthalmitis caused by the saprophyte Exophiala werneckii is reported. This has not been recognized as a pathogen for ocular infections previously. The infection followed uncomplicated cataract surgery involving phacoemulsification and IOL implant. Clinical presentation was that of an indolent endophthalmitis with relatively acute onset. Pars plana vitrectomy, fungal stains, and culture established the diagnosis. Initial management consisted of empirical intravitreal injection of vancomycin, ceftazidime, and amphotericin B. Treatment was supplemented with a 3-week course of systemic fluconazole and topical therapy with natamycin, atropine, ciprofloxacin, and diclofenac. The visual acuity returned to 20/20-2 with no recurrence of infection. The source of the infection could not be determined. Fungal endophthalmitis has to be considered as a rare, though important, complication following ophthalmic surgery. Specific fungal stains and cultures are helpful for establishing the diagnosis early in the course of disease. E werneckii should be considered in the differential diagnosis of fungal endophthalmitis.

Reptilian melanomacrophages function under conditions of hypothermia: observations on phagocytic behavior.

Melanomacrophages (MMs) were removed from livers of turtles of three North American families and cultured. J774 mammalian macrophages were similarly cultured and the MMs were exposed to E. coli(fluor) at approximately 2, 7, 27, and 37 degrees C. At least one third of the MMs continued to function at the low temperatures where less than 2% of the mammalian cells incorporated bacteria deeply into the cytoplasm. In most instances, when the bacteria were not internalized deeply into the cytoplasm, they became stationary just inside, or within, the cell membrane. The MMs were significantly less efficient than the mammalian cells at 37 degrees C and significantly more efficient at 2 and 7 degrees C. In general, it appears that MMs are never as efficient as mammalian macrophages under the most ideal temperatures for the cell but they are capable of functioning at reasonable levels at temperature extremes. The observations are suggestive of a genetic mechanism functioning in the MMs that is rarely expressed in J774 cells under conditions of hypothermia. MMs in vitro and probably in vivo consume bacteria, fungi, attach to helminth eggs, and consume old erythrocytes.