CENTRAL RETINAL ARTERY OCCLUSION WITH CILIORETINAL ARTERY SPARING AFTER LASER-ASSISTED IN SITU KERATOMILEUSIS.

PURPOSE: To report a central retinal artery occlusion with cilioretinal artery sparing in a 48-year-old woman after laser-assisted in situ keratomileusis surgery. METHODS: Case history and clinical examination including best-corrected visual acuity, serum markers, slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography, and optical coherence tomography. RESULTS: A 48-year-old woman underwent routine laser-assisted in situ keratomileusis surgery in both eyes. On postoperative Day 1, vision was 20/20 in both eyes with full visual fields by confrontation. Eight hours after being examined, she reported photopsias and a new visual field defect in the right eye . Visual acuity was 20/40, pinhole 20/20 in the right eye, with restriction of visual field by confrontation. Dilated fundus examination revealed retinal whitening in all quadrants with sparing of the fovea along the distribution of a perfused cilioretinal artery. Optical coherence tomography showed an intact foveal depression with inner retinal layer hyperreflectivity outside the region of the perfused cilioretinal artery. Fluorescein angiography revealed sectoral nonperfusion of the posterior pole with macular sparing along the patent cilioretinal artery. Hypercoagulable workup, carotid imaging, and magnetic resonance imaging of the brain were unremarkable. CONCLUSION: This is the first report of a central retinal artery occlusion with cilioretinal artery sparing occurring on postoperative Day 1 after laser-assisted in situ keratomileusis surgery.

Effect of intravitreal bevacizumab on intraocular pressure in a case of severe chronic hypotony.

PURPOSE: Chronic severe hypotony is associated with many serious ocular consequences, including phthisis. This case illustrates a possible new therapy for chronic hypotony. METHODS: This study is a case report of a 75-year-old man who had undergone trabeculectomy followed by multiple retinal surgeries and developed chronic hypotony in the left eye for more than 1 year. RESULTS: Treatment with intravitreal bevacizumab led to an elevation of intraocular pressure to 8 mmHg 1 week later. Hypotony returned within 2 weeks (2 mmHg) and variably remained for 2 months (0-10 mmHg) until a repeat injection of intravitreal bevacizumab resulted in another elevation in intraocular pressure, which was sustained (5-8 mmHg over 2 months). We postulate that antivascular endothelial growth factor therapy may influence aqueous production through restoration of tight junctions in the nonpigmented ciliary epithelium. Vascular endothelial growth factor and antivascular endothelial growth factor therapies have been demonstrated to modulate tight junctions in many other tissues in the body, including retinal pigment epithelium, ovarian tissue, vascular endothelium, liver, and brain vasculature. CONCLUSION: We postulate that antivascular endothelial growth factor therapy may play a role in treating hypotony by enhancing the function of tight junctions in the ciliary body and restoring aqueous production. Further studies are necessary to better clarify the influence of antivascular endothelial growth factor on intraocular pressure and aqueous production.