Bilateral exudative retinal detachments as the presenting features of idiopathic orbital inflammation.

Idiopathic orbital inflammation, also known as orbital pseudotumour, is a term describing a spectrum of idiopathic, non-neoplastic, non-infectious, space-occupying orbital lesion without identifiable local or systemic cause. This disease occurs mainly in young adults and typically presents with acute proptosis, chemosis and limited extraocular movement. Herein an unusual case of idiopathic orbital inflammation presenting with bilateral exudative retinal detachment in a 9-year-old girl is described. It demonstrates that prompt diagnosis and corticosteroid treatment can yield good clinical response and significant visual recovery.

Ocular screening in severe acute respiratory syndrome.

PURPOSE: To investigate the ocular manifestations of patients with severe acute respiratory syndrome (SARS) and to monitor the possible ocular complications arising from the treatment regimen with high-dose systemic corticosteroid drugs. DESIGN: Prospective, observational cohort case series. METHODS: Ninety eyes from 45 patients with the diagnosis of SARS during an epidemic outbreak in Hong Kong were analyzed. Relevant medical and ophthalmic histories were taken. Ophthalmic examinations, including best-corrected visual acuity, intraocular pressure, slit-lamp, and indirect ophthalmoscopy examination, were performed at baseline and at 2-month and 3-month follow-up. SETTING: Faculty practice in university hospital. RESULTS: Only two patients had mild elevated intraocular pressure at baseline and at subsequent follow-up. There was no loss of visual acuity, cataract progression, or increased cup-disk ratio. Fundus examinations were unremarkable in all patients. CONCLUSIONS: Our study did not demonstrate any ocular manifestations in patients with SARS. The treatment regimen of high-dose corticosteroid also did not show any significant ocular complications. Routine ocular screening of patients with SARS for diagnosis or for complications might not be indicated.

Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling.

BACKGROUND: To compare the anatomical and visual outcome in primary idiopathic macular hole surgery with or without indocyanine green (ICG) stained internal limiting membrane (ILM) peeling. METHODS: The medical records of the last 40 consecutive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and analysed. All eyes had a follow-up period of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non-ILM peeling group). The subsequent 18 eyes underwent surgery with ICG-stained ILM peeling (ILM peeling group). RESULTS: The primary anatomical closure rates were 88.9% and 59.1% in the ILM peeling group and non-ILM peeling group, respectively. The difference was statistically significant (Fisher's exact test, P = 0.038). Improvement in visual acuity was more marked in the ILM peeling group than in the non-ILM peeling group, with a mean improvement of 3.6 and 1.3 lines, respectively (two-tailed t-test, P = 0.036). There were significantly more cases with improvement of two or more lines of visual acuity after surgery, with 66.7% in the ILM peeling group and 31.8% non-ILM peeling group (Chi-square test P = 0.028). However, there was no significant difference in the final postoperative logMAR best-corrected visual acuity between the two groups (two-tailed t-test, P = 0.073). CONCLUSIONS: Based on this study, ICG-stained ILM peeling seems to improve the anatomical and visual outcome in primary idiopathic macular hole surgery. Further studies in this aspect are warranted.

Treatment of choroidal neovascularization in central serous chorioretinopathy by photodynamic therapy with verteporfin.

PURPOSE: To evaluate the safety and efficacy of photodynamic therapy (PDT) with verteporfin in the treatment of patients with choroidal neovascularization (CNV) secondary to central serous chorioretinopathy (CSC). DESIGN: Open-label, two-center, noncomparative, prospective interventional case series. METHODS: Consecutive patients with subfoveal or juxtafoveal CNV secondary to CSC were recruited and treated with a standard regimen of PDT with verteporfin. At regular 3-month follow-up examinations, re-treatment was considered if fluorescein angiography showed evidence of leakage. Outcome measures included the proportion of patients who had improvement (gained 2 more lines), stable, or loss (dropped in 2 or more lines) in vision at the final follow-up and the changes in best-corrected visual acuity (BCVA) from baseline. RESULTS: Ten eyes of 10 patients were recruited into the study. The mean age of the patients was 57.3 years with a mean follow-up duration of 12.6 months. At the last follow-up, six (60%) eyes gained 2 or more lines of BCVA with four (40%) patients having final BCVA of within 1 line. No patient lost 2 or more lines of BCVA. The mean logarithm of the minimal angle of resolution BCVA improvement after PDT was 2.4 lines (Wilcoxon signed-rank test, P =.013). No patient suffered serious ocular or systemic complications from PDT. CONCLUSIONS: Photodynamic therapy with verteporfin therapy is a safe and well-tolerated treatment in patients with CNV associated with CSC. A randomized, controlled trial with a longer follow-up period is warranted to further study the efficacy of PDT in the management of CNV secondary to CSC.