Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis.

PURPOSE: To establish the necessity for an early follow-up examination after an initial funduscopic examination with negative results for patients with acute, symptomatic posterior vitreous detachment (PVD). DESIGN: Retrospective case-control study and meta-analysis. METHODS: Records were reviewed of patients seeking treatment over a 4.5-year period who were diagnosed with an acute, symptomatic PVD. A MEDLINE search to identify all published observational case studies reporting vitreoretinal pathologic features after acute, symptomatic PVD. RESULTS: The incidence of retinal tears in eyes with a symptomatic PVD was 8.2%. The overall rate of retinal break in the meta-analysis portion of the study was 21.7%. In total, 1.8% of patients had retinal tears that were not seen on initial examination. Of the 29 patients with delayed-onset retinal breaks, 24 (82.8%) had at least one of the following: vitreous hemorrhage at initial examination, hemorrhage in the peripheral retina at initial examination, or new symptoms. CONCLUSIONS: If the results of an initial examination of a patient with an acute, symptomatic PVD are negative for retinal tears, the necessity of early follow-up may be best determined by the presence of pigmented cells in the vitreous, vitreous hemorrhage, or retinal hemorrhage. Most patients with symptomatic PVD may not need an early follow-up examination.

Short-term course of intraocular pressure after intravitreal injection of triamcinolone acetonide.

OBJECTIVE: To describe the natural history of intraocular pressure (IOP) within the first 30 minutes after intravitreal injection of triamcinolone acetonide (TA). DESIGN: Prospective, interventional, consecutive case series. PARTICIPANTS: Thirty-eight consecutive patients who met inclusion and exclusion criteria and underwent intravitreal injection of 0.1 ml (4 mg) of TA were studied. METHODS: Intraocular pressure was measured by Goldmann applanation tonometry at baseline; immediately after injection; and at 2, 5, 10, 20, and 30 minutes after injection. MAIN OUTCOME MEASURES: Intraocular pressure measurements at baseline; immediately after intravitreal injection; and 2, 5, 10, 20, and 30 minutes after injection, and percentage of patients with IOP < or = 24 mmHg at 30 minutes. RESULTS: Patients who did not experience vitreous reflux (30/38 [78.9%]) at the site of injection had a significant initial elevation of IOP that rapidly normalized. Patients who experienced vitreous reflux (8/38 [21.1%]) at the site of injection had either no change in IOP or a small drop in IOP that rapidly normalized. The IOP measured in millimeters of mercury immediately after injection (45.9 [no reflux], 12.6 [reflux]), 2 minutes after injection (39.9 [no reflux], 13.5 [reflux]), 5 minutes after injection (33.3 [no reflux], 13.8 [reflux]), 10 minutes after injection (26.4 [no reflux], 15.1 [reflux]), and 20 minutes after injection (21.8 [no reflux], 15.0 [reflux]) showed a statistically significant difference between the 2 groups. The difference in IOP between the 2 groups was not significant at baseline or 30 minutes after injection. At 30 minutes, 90% (95% confidence interval, 85.8%-95.2%) of patients without vitreous reflux had an IOP < 24 mmHg. CONCLUSIONS: Patients undergoing intravitreal injection of TA with no vitreous reflux have a risk of short-term elevation of IOP that rapidly normalizes over 30 minutes. In patients with vitreous reflux after the injection, the IOP declines immediately after injection and rapidly normalizes over 10 minutes.

Optical coherence tomography of idiopathic juxtafoveolar telangiectasia.

BACKGROUND AND OBJECTIVE: To document optical coherence tomography (OCT) findings in a series of eyes with group 2A idiopathic juxtafoveal telangiectasia. PATIENTS AND METHODS: This study is a retrospective review of patient charts, OCT, fundus photography, and fluorescein angiography involving 23 eyes (12 patients). Mean retinal thickness in 9 macular areas was calculated and compared to previously published measurements from normal eyes. RESULTS: OCT in 8 of 13 stage 3 eyes revealed foveal cysts without evidence of cystoid macular edema on fluorescein angiography or biomicroscopy, and 1 lamellar hole. In stage 3 eyes, mild retinal thickening was found in 7 of 9 macular areas (P < .05). CONCLUSIONS: OCT commonly reveals foveal cysts in stage 3 idiopathic juxtafoveal telangiectasia. Consistent findings of associated mild macular thickening and lack of late petaloid hyperfluorescence on fluorescein angiography suggest that these cysts differ in pathophysiology from cystoid macular

Acute endophthalmitis incidence: intravitreal triamcinolone.

OBJECTIVE: To report the incidence of acute postinjection endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA) as an office procedure. METHODS: Retrospective, noncomparative, consecutive, interventional case series of all patients who had received IVTA at 2 clinical centers between January 1, 2000, and January 30, 2004. RESULTS: A total of 1006 eyes received IVTA. None of the eyes developed acute, culture-positive, postoperative endophthalmitis in the 6 weeks following the procedure. One patient developed acute, culture-negative, postoperative endophthalmitis 4 days after receiving IVTA, resulting in an incidence of 0.10%. In this case, the presenting symptoms were decreased vision and acute conjunctival erythema. The case was notable for the absence of pain or hypopyon. CONCLUSION: Although acute postoperative endophthalmitis may follow IVTA, our experience suggests that this is a relatively uncommon event.

Toxoplasmosis retinochoroiditis and elevated intraocular pressure: a retrospective study.

OBJECTIVES: To report the prevalence of abnormal intraocular pressure (IOP) in patients with toxoplasmosis retinochoroiditis and to determine risk factors for such abnormality. METHODS: In a retrospective clinic-based chart review, the IOP levels of 61 patients with active retinochoroiditis were recorded. Patients were separated into groups with elevated IOP, equal IOP, and lower IOP. The time taken for normalization of IOP was also recorded. Additionally, age, gender, visual acuity, anterior chamber and vitreous inflammatory activity, presence of macular lesions, keratoprecipitates, synechiae, toxoplasmosis antibody titers, and required medical and surgical treatments were noted. The IOP in 61 patients with active retinochoroiditis were also compared with the IOP in 59 age- and gender-matched control patients with unilateral anterior uveitis. RESULTS: Thirty-eight percent of patients (23/61) with active retinochoroiditis had elevated IOP > 21 mm Hg, demonstrated IOP difference > 4 mm Hg between involved and uninvolved eyes, or received on IOP-lowering medications. In the equal IOP category, 55.7% (34/61) of patients had an IOP < or = 21 mm Hg in the actively inflamed eye and had an IOP difference of < or = 3 mm Hg between the active and inactive eyes. Only 6.6% (4/61) of patients with active ocular toxoplasmosis had a decreased IOP in the affected eye. The mean IOP in patients with active retinochoroiditis was 21.2 mm Hg (SD 11.5) and 15.6 mm Hg (SD 2.9) in involved and uninvolved eyes, respectively. A statistically significant average IOP difference of 5.8 mm Hg (SD 11.6) was found between the involved and uninvolved eyes (P < 0.001 by two-tailed student T test). Of the patients with abnormal IOP, 20 patients had IOP > 21 mm Hg, 10 of whom had IOP > 30 mm Hg, 6 of whom had IOP > 40 mm Hg, and 2 of whom had IOP > 50 mm Hg. In the elevated IOP group, the average time from onset of symptoms until presentation for their IOP measurement was 13 days (median: 7 days; range: 1 to 100) with resolution of abnormal IOP occurring in 32 days (median: 28 days; range: 1 to 84 days). The average time of onset of symptoms in the normal to low IOP category was 70 days (median: 17.5 days; range: 2 to 330 days). Elevated IOP was more common in active retinochoroiditis, 23/61 (38%), when compared with anterior uveitis control group, 6/59 (10%) (odds ratio of 5.3; P < 0.001). No statistically significant predictor of elevated IOP was identified, though a trend associating anterior chamber cells with elevated IOP (P = 0.08, r = 0.25 Spearman rank correlation coefficient) was seen. CONCLUSION: Abnormal IOP is a feature in almost half of patients with active toxoplasmosis retinochoroiditis. Elevated IOP occurs in 38% and low IOP occurs in 6.6% of affected eyes. Patients with elevated IOP due to active toxoplasmosis present for earlier evaluation than patients with normal or low IOP. The IOP elevation is generally transient and concurs with the uveitic episode. Medical management of IOP is usually sufficient to treat this generally transient eye pressure rise though chronic administration of eye pressure lowering drops or glaucoma surgery may be necessary in a small proportion of patients.

Hypotonus maculopathy: magnetic resonance appearance.

PURPOSE: To report the magnetic resonance appearance of hypotonus maculopathy. DESIGN: Observational case report. METHODS: A 48-year-old man with a long history of glaucoma and subsequent trabeculectomy in the right eye developed hypotonus maculopathy. Visual acuity continued to decrease in both eyes of a relatively young individual with severe primary open angle glaucoma. A magnetic resonance image was requested to look for a compressive optic neuropathy. RESULTS: Magnetic resonance imaging showed an abnormal plaquelike thickening of the macula and flattening of the posterior globe. CONCLUSION: To our knowledge, this is the first case report of the magnetic resonance appearance of hypotonus maculopathy.

Orbital and periorbital myofibromas in childhood: two case reports.

PURPOSE: Infantile myofibromatosis is an uncommon tumor that occurs rarely in the periorbit and orbit. This article reports two cases of infantile myofibromatosis of the orbital adnexa and describes the associated clinical, histopathologic, and immunohistochemical findings. DESIGN: Two retrospective, interventional case reports with clinicopathologic correlation. INTERVENTION: Treatment consisted of excision of the tumors. MAIN OUTCOME MEASURES: Histologic and immunohistochemical evaluation and clinical evaluation for tumor recurrence. RESULTS: The first patient was a newborn male with a large tumor extending from his eyelid that was excised at day 2 of life. Histologic and immunohistochemistry analyses were used to make a diagnosis of infantile myofibromatosis. He remains disease free at age 7 years. The second case was a 6-year-old boy with a 1-month history of proptosis resulting from an orbital mass. Incisional biopsy revealed a tumor consistent with infantile myofibromatosis. He remains tumor free 12 months after complete gross surgical resection. CONCLUSIONS: Infantile myofibromatosis is an uncommon tumor that is rare in the orbit. Differential diagnosis can be difficult based solely on histologic analysis. Immunohistochemistry evaluation demonstrating cytoplasmic actin filaments within neoplastic spindle cells confirms the diagnosis. As soon as the diagnosis is made, chest and abdominal imaging is of value to define the prognosis and to direct further treatment. After the diagnosis of nonvisceral infantile myofibromatosis, complete gross resection, if possible, is the treatment of choice.