Indocyanine green-mediated photothrombosis combined with intravitreal triamcinolone for the treatment of choroidal neovascularization in serpiginous choroiditis.

PURPOSE: To report a case of peripapillary choroidal neovascularization (CNV) complicating serpiginous choroiditis that was treated by a single indocyanine green (ICG)-mediated photothrombosis session combined to intravitreous triamcinolone acetonide (TA) injection. METHODS: Interventional case report. A 48-year-old patient with peripapillary CNV was submitted to a laser-dye-mediated technique that uses ICG and low-intensity 810-nm light for continuous laser application; TA was then injected into the vitreous cavity 1 hour later, and prospective evaluation with fluorescein and ICG angiography as well as optical coherence tomography (OCT) was performed. RESULTS: At 2 weeks after treatment, best-corrected visual acuity improved from 20/200 to 20/50, with further improvement to 20/20-1 in the subsequent 10 weeks. Absence of fluorescein leakage from the CNV and OCT evidence of resolved retinal oedema was observed at that time. Clinical stabilization was maintained up to 1 year of follow-up. There was no significant complication related to the procedure. CONCLUSION: Combined ICG-mediated photothrombosis and intravitreous TA induced rapid and significant visual acuity recovery in this particular case of peripapillary CNV complicating serpiginous choroiditis. Accordingly, angiographic and OCT findings demonstrated neovascular lesion regression and restoration of the macular architecture.

Visual field defects in children with congenital glaucoma.

PURPOSE: To determine visual field defects in a cohort of children with congenital glaucoma. METHODS: Monocular visual fields were measured in 24 meridians for targets V4e, I4e, I2e, and I1e, using a Goldmann perimeter in a group of 13 children between the ages of 4 and 14 years with congenital glaucoma and 10 age-matched healthy children. Localized visual field defects (eg, paracentral scotoma, nasal step, and arcuate scotoma) were determined by abnormal findings or shape of the eye in at least one of each of the targets presented. RESULTS: Visual field extent for target 12e was significantly constricted for unilateral and bilateral cases of congenital glaucoma when compared with control eyes. A post-hoc procedure (Tukey Test) showed significant differences between unilateral cases and normal control eyes, and between bilateral cases (best outcome eye) and normal control eyes. Stimuli V4e and 14e results were comparable for patients and normals. Stimulus I1e showed significantly different total extent visual field for bilateral and normal controls. Specific visual field defects were found only in bilateral cases. Paracentral scotoma was found in 1 of 12 eyes with bilateral congenital glaucoma. Nasal steps were found in 6 of 12 eyes with bilateral congenital glaucoma. Arcuate scotoma were found in 4 of 12 eyes with bilateral congenital glaucoma. CONCLUSION: Localized visual fields were found in 37.5% of eyes with congenital glaucoma. Early treatment for congenital glaucoma provided better visual field outcome.

Blood pressure disturbance in diabetes mellitus.

BACKGROUND: Arterial hypertension and, less often, postural hypotension are frequently associated with diabetes mellitus, and with diabetic complications and death. AIM: To review data on the relationship between hypertension and nephropathy in diabetes mellitus. METHODS: We reviewed data on both retinopathy and nephropathy in hypertensive diabetic patients. Data suggesting that vasopressin levels might affect blood pressure in upright patients with postural hypotension due to cardiocirculatory diabetic neuropathy were also examined. Antihypertensive treatment during different phases of diabetic nephropathy in insulin-dependent diabetes was reviewed. RESULTS: The data showed that hydrochlorothiazide and nitrendipine reduce urinary protein excretion in parallel with a reduction in blood pressure. However, the decreases in urinary protein excretion induced by captopril are not correlated with a reduction in blood pressure and may be related to decreases in intraglomerular pressure found in patients with mild renal failure taking furosemide. Domperidone, a peripherally acting dopaminergic antagonist is an additional therapeutic option for the treatment of diabetic postural hypotension.

Microalbuminuria, arterial blood pressure and retinopathy in insulin dependent diabetes

In order to evaluate the relationship between urinary albumin excretion, arterial blood pressure and diabetic retinopathy in insulin dependent diabetics we examined 55 patients without clinical proteinuria and whose disease had started before the age of 30. Each patient was asked to collect at least one overnight timed urine sample for albumin analysis by an ELISA method. Normoalbuminuria was defined as urinary albumin excretion (UAE) of < 20 mug/min (n = 32) and microalbuminuria as 21-200 mug/min (n = 23). Patients with microalbuminuria showed higher levels of blood pressure, serum creatinine and glicosylated haemoglobin as compared to normoalbuminuric patients. Significant correlation was observed between diastolic blood pressure and UAE (r = 0.52; p < O.001).Preproliferative and proliferative diabetic retinopathy was detected in 9 patients (l6.4 per cent). All of them had diabetes for more than 10 years, elevated UAE and diastolic blood pressure equal or higher than 85 mmHg. In our population of insulin dependent diabetics we found a high prevalence of microalbuminuria which is considered to be predictive of the latter development of diabetic nephropathy. Microalbuminuria is associated with elevated blood pressure and diabetic retinal lesions. We conclude that urinary albumin excretion should be monitored in patients with insulin dependent diabetes to detect those who should be considered at risk of developing nephropathy and retinopathy.

Pars plana and ora serrata anatomotopographic study of fetal eyes.

Morphology and topographic anatomical relations of pars plana, pars plicata and ora serrata were examined in 15 globes of fetuses, obtained from autopsy. The mean value of pars plana size was: nasal meridian = 1.15 +/- 0.32 mm; temporal meridian = 1.20 +/- 0.34 mm; superior meridian = 1.19 +/- 0.34 mm; inferior meridian = 1.15 +/- 0.34 mm. The mean value of the distance between the sclerocorneal limbus and the ora serrata was: nasal meridian = 3.22 +/- 0.30 mm; temporal meridian = 3.33 +/- 0.35 mm; superior meridian = 3.23 +/- 0.36 mm; and inferior meridian = 3.27 +/- 0.37 mm. A significant difference between the mean sizes of the pars plana in the superior meridian was found compared to the nasal and inferior meridian. The distances from Schwalbe's line to the ora serrata in the 4 meridians did not vary significantly. A positive, significant correlation between the antero-posterior diameter and the distances from the sclerocorneal limbus to the ora serrata was demonstrated in the 4 meridians.

Ultrasonic fragmentation of cataract in uveitis.

Thirty-nine eyes with uveitis from various causes, and complicated by cataract and vitreous opacification, underwent pars plana lensectomy and vitrectomy by ultrasonic fragmentation. Anatomical results were excellent, with clearing of all lens and vitreous opacities in all eyes. Visual results showed that there was no exacerbation and no recurrence of uveitis. Visual results depended mainly on the presence of previous damage of the uveitis to the retina and optic nerve. Visual results did not depend on the presence of uveitis activity at the time of the surgery. Complications that occurred were cystoid macular edema, which was present in 17.94% of the eyes and diagnosed in some eyes at the surgery, retinal detachment in one eye (2.56%), sterile hypopyon in one eye (2.56%), and ultrasonic lesion of the retina in one eye (2.56%). Visions of 20/20 to 20/40 were obtained in 23% of the eyes, 20.5% had vision between 20/50 and 20/80, and 56.4% had vision of 20/100 or less. The good results justify the surgical intervention in cases of cataracts associated with uveitis. Pars plana lensectomy and vitrectomy appears to be the procedure of choice in removal of cataracts secondary to uveitis.

Involution without disciform scarring of subretinal neovascularization in presumed rubella retinopathy. A case report.

A 28-year-old woman with a picture of presumed congenital rubella retinopathy presented with a subretinal neovascular membrane in the macular region which involuted spontaneously without treatment, without disciform scarring and with normal final visual acuity. The roles of the retinal pigment epithelium an of Bruch's membrane are discussed in the appearance of such a neovascular membrane.

Choroidal granuloma caused by 'Paracoccidioides brasiliensis'. A clinical and angiographic study.

A 48 year-old-female with a choroidal granuloma presented a systemic picture of paracoccidioidomycosis proven by rhinopharyngeal biopsy. The clinical picture, the differential diagnosis and the therapeutic test are discussed. This is the first time that the fluorescein angiography is described in such cases.