Morphological changes in amblyopic eyes in choriocapillaris and Sattler's layer in comparison to healthy eyes, and in retinal nerve fiber layer in comparison to fellow eyes through quantification of mean reflectivity: A pilot study.

PURPOSE: Establishing the reliability of a new method to check the mean retinal and choroidal reflectivity and using it to find retinal and choroid changes in amblyopia. METHODS: Design: Retrospective case-control. Population: 28 subjects of which 10 were healthy controls (20 eyes): 8 with refractive errors, 1 with strabismus, and 1 with both. 18 patients with unilateral amblyopia included: 7 anisometropic, 6 isoametropic, 1 strabismic, and 4 combined. Mean participants' age: 13.77 years ± 10.28. Observation procedures: SD-OCT and ImageJ. Main outcome measure: mean reflectivity of retinal and choroid layers. Amblyopic, fellow, and healthy eyes were compared. RESULTS: The method of measuring reflectivity is good to excellent reliability for all regions of interest except the fourth. The mean reflectivity of the choriocapillaris and Sattler's layer in amblyopic eyes were significantly lower than in healthy eyes (p = 0.003 and p = 0.008 respectively). The RNFL reflectivity was lower than that of fellow eyes (p = 0.025). Post-hoc pairwise comparisons showed statistically significant differences between amblyopic and healthy eyes for choriocapillaris (p = 0.018) and Sattler's (p = 0.035), and between amblyopic and fellow eyes for RNFL (p = 0.039). CONCLUSION: A decrease in reflectivity of the choriocapillaris and Sattler's in amblyopic compared to healthy eyes, and a decrease in reflectivity of the RNFL in the amblyopic compared to fellow eyes, indicate that the pathophysiology is partly peripheral and might be bilateral.

Intravitreal Adalimumab in Active Noninfectious Uveitis: A Pilot Study.

PURPOSE: To evaluate the short-term efficacy of intravitreal adalimumab (IVA) for the treatment of eyes with active noninfectious uveitis. METHODS: Consecutive eyes with active noninfectious uveitis were injected with IVA at 0, 2, then every 4 weeks for total of 26 weeks. RESULTS: Six out of 7 patients (12 of 13 eyes) completed 26 weeks of treatment. One patient (1 eye) failed treatment. Seven out of 12 eyes had improvement of ≥2 ETDRS lines. Three out of three eyes had resolution of anterior chamber cells. And 9 of 10 eyes with vitreous haze had zero haze at 26 weeks. Five out of 8 eyes with macular edema had complete resolution. Median fluorescein angiography score improved from 14 to 4 on last follow-up. CONCLUSIONS: IVA was effective in controlling the inflammation, decreasing the macular edema, and improving the best corrected visual acuity in the majority of eyes in this series.

Impact of thiazolidinediones on macular thickness and volume in diabetic eyes.

OBJECTIVE: To assess the impact of thiazolidinedione (TZDs) use on macular thickness and volume in patients with diabetes with no macular edema and no diabetic retinopathy (DR) or mild nonproliferative diabetic retinopathy (NPDR). DESIGN: Cross-sectional prospective pilot study. PARTICIPANTS: One hundred twenty patients (60 in each group) were enrolled, but 108 completed the study (59 in the TZD group and 49 in the non-TZD group). METHODS: Patients with type II diabetes mellitus were categorized into 2 groups depending on TZD intake. Those with no prior history of treatment for DR were considered for the study. Patients in both groups had assessment of visual acuity and dilated fundus examination. Only patients with no evidence of macular edema and no DR or mild-NPDR were included. Spectral-domain ocular coherence tomography (SD-OCT) was used for measurement of central retinal thickness (CRT) and macular volume. Main outcome measure was difference in mean macular volume and central thickness between the TZD and the non-TZD groups. RESULTS: Baseline demographics and characteristics were well matched between both groups. There was no significant difference in mean CRT of both groups (p = 0.13), but macular volume was significantly lower in the TZD group (p = 0.038). CONCLUSIONS: Patients with no macular edema and no DR or mild NPDR on TZDs did not show evidence of fluid retention in the macula on SD-OCT. Larger studies are needed to confirm these results.

Glycopyrrolate induced bilateral angle closure glaucoma after cervical spine surgery.

To report a case of bilateral acute angle closure glaucoma (AACG) that occurred after cervical spine surgery with the use of glycopyrolate. A 59-year-old male who presented with severe bilateral bifrontal headache and eye pain that started 12 h postextubation from a cervical spine surgery. Neostigmine 0.05 mg/kg (4.5 mg) and glycopyrrolate 0.01 mg/kg (0.9 mg) were used as muscle relaxant reversals at the end of the surgery. Ophthalmic examination revealed he had bilateral AACG with plateau iris syndrome that was treated medically along with laser iridotomies. Thorough examination of anterior chamber should be performed preoperatively on all patients undergoing surgeries in the prone position and receiving mydriatic agents under general anesthesia.

Intravitreal bevacizumab in the management of neovascular age-related macular degeneration: effect of baseline visual acuity.

PURPOSE: To study prospectively the safety and efficacy of intravitreal bevacizumab for eyes with neovascular age-related macular degeneration with baseline visual acuity better than 70 letters (Snellen equivalent better than 20/40). METHODS: Patients with treatment-naive neovascular age-related macular degeneration were categorized prospectively into three groups according to baseline visual acuity: Group 1 (better than 70 letters), Group 2 (70 to 61 letters), and Group 3 (60 to 51 letters). Best-corrected visual acuity and central retinal thickness using optical coherence tomography were measured at baseline and at each follow-up visit. Intravitreal bevacizumab was administered according to an as-needed optical coherence tomography-guided regimen. Main outcome measure was mean best-corrected visual acuity for each group at 12 months. RESULTS: Each group included 30 patients (30 eyes). Improvement in central retinal thickness was similar among the 3 groups (P = 0.964). Mean letter gain in visual acuity at 12 months was +0.4, +3.8, and +4.2 for Groups 1, 2, and 3, respectively (P = 0.42). Mean best-corrected visual acuity at 12 months was 78.4 letters for Group 1, 70.0 letters for Group 2, and 61.1 letters for Group 3 (P < 0.001). All eyes in Group 1 (100%) avoided losing 15 letters of best-corrected visual acuity versus 83.3% in Group 2 and 80.0% in Group 3. This difference was significant only between Group 1 and Group 3 (P = 0.02). CONCLUSION: Intravitreal bevacizumab for eyes with neovascular age-related macular degeneration and baseline visual acuity better than 70 letters was safe and able to maintain this vision over 12 months.

Macular ultrastructural features in amblyopia using high-definition optical coherence tomography.

PURPOSE: To study macular morphology in amblyopic eyes using high-definition spectral domain optical coherence tomography (SD-OCT) and to compare the findings with fellow eyes. METHODS: This was a prospective institutional study of patients ≥6 years of age with unilateral amblyopia. Enhanced high-definition single line macular scans of amblyopic eyes were obtained using SD-OCT and compared with fellow eyes. Scans were evaluated qualitatively for structural differences. Central foveal thickness was measured and areas of the different retinal layers were computed within 500 µm from the foveal centre nasally and temporally. RESULTS: Forty-five patients with unilateral amblyopia were included: 25 with strabismic and 20 with anisometropic amblyopia with a mean age of 24.8 years. Qualitatively, the bulge in the inner segment/outer segment junction of the central fovea was noted to be attenuated or absent in 60% of amblyopic eyes compared with 29% of normal eyes, p=0.02. Also, amblyopic eyes demonstrated a shallow foveal pit compared with normal fellow eyes. Mean foveal thickness was significantly increased in amblyopic (228.56 µm) versus fellow eyes (221.72 µm), p=0.03. Upon exploring different retinal layers, the temporal inner nuclear layer area was increased (p=0.04) while the outer nuclear layer area was decreased (p=0.04) in amblyopic eyes compared with fellow eyes. CONCLUSIONS: Using enhanced high-definition SD-OCT, amblyopic eyes demonstrated qualitative and quantitative differences in macular features, possibly representing signs of immaturity compared with normal fellow eyes.

Combination of intracameral and intrastromal voriconazole in the treatment of recalcitrant Acremonium fungal keratitis.

We present a report of a 28-year-old female with fungal keratitis due to Acremonium that was unresponsive to full medical therapy over 3 weeks. The patient was treated with superficial keratectomy, intrastromal and intracameral voriconazole injections. There was a marked clinical improvement beginning on day 3 post-therapy that was sustained until the last follow-up at 6 months. This is the first case of fungal keratitis due to Acremonium treated by a combination of intrastromal and intracameral voriconazole. This cost-effective treatment modality proved to be significant in impeding the progression of this potentially blinding disease and improving visual prognosis.

Fixed-interval versus OCT-guided variable dosing of intravitreal bevacizumab in the management of neovascular age-related macular degeneration: a 12-month randomized prospective study.

PURPOSE: To compare the efficacy of as-needed or variable dosing of intravitreal bevacizumab to continuous fixed-interval dosing in the management of neovascular age-related macular degeneration (AMD). DESIGN: Prospective, open-label, randomized clinical study. METHODS: One hundred twenty eyes of 120 patients with treatment-naïve subfoveal neovascular AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. Eyes were randomized (1:1) to fixed-interval dosing (every 4 to 6 weeks) or variable dosing with intravitreal bevacizumab (1.25 mg/0.05 mL). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) using optical coherence tomography (OCT) were measured at baseline and at each follow-up visit. Presence or recurrence of fluid on OCT was the main indicator for retreatment in variable dosing. Main outcome measure was improvement in BCVA and CRT at 12 months. RESULTS: Compared to baseline, variable dosing had a mean improvement in BCVA of 11.0 letters after 12 months vs 9.2 letters for fixed-interval dosing (P = .81). Similarly, CRT decreased after 12 months by 80.7 µm for variable dosing vs 100.5 µm for fixed-interval dosing (P = .37). The average number of injections over 12 months was higher for fixed-interval dosing than variable dosing (9.5 vs 3.8 injections, P < .001). CONCLUSIONS: Fixed-interval and variable dosing regimens of intravitreal bevacizumab improved visual acuity and anatomic outcomes after 12 months in eyes with neovascular AMD. However, variable dosing had a reduced treatment burden. Larger trials are needed to confirm these results.

Exogenous endophthalmitis in diabetic patients: a systemic review.

Diabetes mellitus is a systemic disease that increases the risk of infections. Exogenous endophthalmitis is an inflammatory disease to which diabetic patients are more predisposed to than nondiabetic patients undergoing any intraocular intervention. This might be because of the change in the immune and inflammatory factors that intervene in wound healing and in the bacterial flora of the ocular adnexa. We conducted a literature review to assess the risk of exogenous endophthalmitis in diabetic patients undergoing cataract extraction, pars plana vitrectomy, and intravitreal injections and to check whether its treatment differ from in non-diabetics. We found that diabetic patients are more predisposed to virulent organisms and that the incidence of ophthalmic symptoms was not substantially different in diabetic versus nondiabetic patients. Regarding treatment, all patients with light perception should receive pars plana vitrectomy, while those with hand motion and better vision should be given an intravitreal antibiotics injection. Some authors recommend vitrectomy to diabetic patients with even counting figure vision.

Bevacizumab and neovascular age related macular degeneration: pathogenesis and treatment.

The pathogenesis of neovascular age related macular degeneration (AMD) is multifactorial including inflammation and angiogenesis leading to choroidal neovascularization (CNV). Therapy against vascular endothelial growth factor (VEGF) has revolutionized the treatment of neovascular AMD. Intravitreal off-label use of bevacizumab proved to be safe. This literature review was conducted to study improvement in visual acuity, change in central retinal thickness (CRT), safety, pharmacodynamics, and possible resistance to intravitreal bevacizumab over a one-year period in eyes with neovascular AMD. We reviewed articles between 1997 and January 2010 that included at least 30 patients with AMD who received intravitreal bevacizumab monotherapy for at least 1 year. The mean number of letters gained, decrease in CRT, and number of injections were 8 letters, 125.3 µm, and 4.3 injections, respectively. Further, randomized prospective clinical trials are needed to determine the efficacy and safety of intravitreal bevacizumab in the treatment of neovascular AMD.

Ranibizumab monotherapy versus single-session verteporfin photodynamic therapy combined with as-needed ranibizumab treatment for the management of neovascular age-related macular degeneration.

PURPOSE: To compare verteporfin photodynamic therapy combined with intravitreal ranibizumab (combination therapy) versus ranibizumab monotherapy for management of neovascular age-related macular degeneration. METHODS: Thirty patients (40 eyes) with neovascular age-related macular degeneration were prospectively allocated to combination therapy or monotherapy. In monotherapy, the induction phase consisted of 3 consecutive monthly ranibizumab injections (0.5 mg), while the combination therapy had a single session of photodynamic therapy with intravitreal ranibizumab. Follow-up treatment for either group consisted only of additional as-needed ranibizumab injections. The main outcome measure was that a proportion of eyes losing <15 letters of visual acuity after 12 months. RESULTS: Except for 1 eye in combination therapy, all eyes in both groups lost <15 letters of visual acuity. At 12 months, there was a mean gain of +12 letters and +3.2 letters for monotherapy and combination therapy, respectively (relative percent change of 32% vs. 7%, P = 0.03). Anatomical improvement was similar in both groups. After induction, the time until ranibizumab retreatment was longer for combination therapy (P = 0.002) while ranibizumab injections were required more frequently with monotherapy (P = 0.015). CONCLUSION: Ranibizumab monotherapy showed greater improvement in visual acuity versus combination therapy. However, combination therapy required fewer ranibizumab injections. Larger trials need to confirm the findings of this pilot study.