Ultra-Widefield Fluorescein Angiographic Patterns, Retinal Microvascular Anomalies and Retinal Ischemic Index in Branch Retinal Vein Occlusions with Established Retinal Neovascularization.

PURPOSE: To share the experience of using ultra-widefield fluorescein angiography (UWF-FA) in recognizing the potential signs for retinal neovascularizations (NVE) development in branch retinal vein occlusions (BRVO). METHODS: Reporting angiographic findings in 60 BRVO eyes presenting with NVE and vitreous hemorrhage using UWF-FA investigation. Angiographic retinal ischemic index (ARI) was also calculated from UWF-FA as the ratio of digitally mapped ischemic retina area against area of optic disc, termed unit of disc diameter (DD). RESULTS: We observed emerging angiographic features common to these patients: pattern of a localized non-perfused retina at early phase of UWF-FA remaining non-perfused at the late phase (black retinal ischemia, black-RI) (100%); presence of retinal microvascular anomalies (RMAs) at the "water-shed-border" of black-RI (100%); site of NVEs observed at either the same "water-shed-border" (42%) or from the main vessel branch within the black-RI (30%), or from both sites (28%); multiple NVEs were observed in all eyes except two with single active NVE. Median ARI size was 114 DD (SD 80 DD), range 5-354 DD. CONCLUSION: We report a recurring angiographic pattern common to eyes with active BRVO-NVEs from UWF-FA, and NVEs in this clinical group can develop from varied ARI sizes. Further studies would be needed to establish the role of UWF-FA in predicting angiographic risk factors for BRVO-NVE.

Use of cyanoacrylate glue for temporary tarsorrhaphy in children.

PURPOSE: Congenital anophthalmia and postenucleation socket contracture are difficult conditions that require serial socket expansion with the use of hydrogel expanders and custom-made conformers along with temporary tarsorrhaphy. METHODS: The authors undertook a part prospective case review of all children undergoing temporary tarsorrhaphy using cyanoacrylate glue over a 3-year period at a tertiary specialist children's hospital. RESULTS: They report a series of 7 children undergoing temporary tarsorrhaphy with cyanoacrylate glue instead of the conventional suturing technique. Indications were socket expansion (n = 4), fornix deepening (n = 2), prosthesis reposition, and prolapsed conjunctiva following enucleation (n = 1).The age range was 3 weeks to 14 years (mean, 2.7 years). The glue tarsorrhaphy lasted between 0.5 and 13 weeks (mean, 4.5 weeks). There were no adverse outcomes, and the glue tarsorrhaphy was tolerated well in all cases, with relative ease of reapplication of glue in clinic. CONCLUSIONS: Their study demonstrates that this technique allows quick and efficient temporary tarsorrhaphy with relative ease of reapplication in a clinic setting, avoiding the need for multiple general anesthetics.

Fibrous tumor of the superior oblique tendon in Proteus syndrome.

Proteus syndrome is a disorder of patchy, or mosaic, postnatal overgrowth. Mosaic somatic mutation of the AKT1 gene has been identified in over 90% of individuals meeting the diagnostic criteria for Proteus syndrome. Onset occurs in infancy and can involve any tissue of the body. The connective tissue and bone, skin, central nervous system, and the eye are commonly involved. Epibulbar tumors, strabismus, and posterior segment involvement have previously been reported. However, there have not been any reports of lesions affecting the extraocular tendons. We report a case of Proteus syndrome patient presenting with vertical strabismus secondary to a fibrous tumor within the superior oblique tendon. The tumor was successfully excised with complete resolution of the strabismus.