Pars plana vitrectomy with internal limiting membrane peeling for diabetic macular edema.

PURPOSE: To evaluate anatomic and visual acuity (VA) results of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for diffuse diabetic macular edema (DME), and to review the literature on the topic. METHODS: Retrospective noncomparative case series of patients who underwent PPV with ILM peeling for diffuse DME between January 1, 2000, and December 1, 2005, performed by three surgeons at Bascom Palmer Eye Institute. Main outcome measures included pre- and postoperative optical coherence tomography (OCT) and visual acuity. Mean follow-up period was 8 months (range, 43 days-2 years). RESULTS: Twenty-four eyes of 23 patients meeting the criteria were evaluated. Duration of DME ranged from 1 to 93 months. Mean preoperative logMAR vision was 0.782 (range, 0.30-1.82). Mean logMAR visual acuity at final follow-up was 0.771 (range, 0.10-2.00). At last follow-up, 25% of eyes had > or =2 line increase in VA from baseline, 54% of eyes had no improvement in VA, and 21% of eyes had > or =2 line decrease in VA. Of 9 eyes with pre- and postoperative OCT, there was an overall reduction in central macular thickness of 141 microm at postoperative month 3 and 120 microm at last follow-up. Postoperative complications included progression of cataract in 6 (60%) of 10 phakic eyes, postoperative intraocular pressure > or =30 mmHg in 6 (24%) eyes, and postoperative vitreous hemorrhage in 2 (8%) eyes. CONCLUSIONS: Pars plana vitrectomy with ILM peeling was associated with a reduction in DME when measured by OCT in the majority of eyes, but visual acuity outcomes showed minimal improvement compared to baseline. These results suggest the efficacy of PPV with ILM peeling for eyes with DME has not been well established and should be reserved for therapy with selected cases.

Is it safe to have an ophthalmic emergency in July?

BACKGROUND AND OBJECTIVE: To deter-mine whether house staff experience affects the quality of acute ophthalmic care delivered in an emergency room at one teaching hospital. PATIENTS AND METHODS: The medical records of 360 patients who were seen by first-year ophthalmology residents in the Bascom Palmer Eye Institute emergency department were retrospectively reviewed. Records reviewed included 180 patients seen between July 15, 2002, and August 14, 2002 (the beginning of the training year), and 180 patients seen between June 1, 2003, and June 30, 2003 (the end of the training year). RESULTS: The rate of unscheduled return visits to the emergency department at the beginning and end of the training year was 6.1% (11 of 180) and 5.0% (9 of 180), respectively (P = .82). Agreement between initial and final diagnoses occurred in 96% of patients (108 of 113) at the beginning of the training year and 98% of patients (84 of 86) at the end of the training year (P = .70). CONCLUSION: There was no difference in the quality of medical care delivered by first-year ophthalmology residents at the beginning and end of the training year.

Atypical mild enhanced S-cone syndrome with novel compound heterozygosity of the NR2E3 gene.

PURPOSE: To report mild enhanced s-cone syndrome (ESCS) associated with a novel heterozygous mutation of the NR2E3 gene. DESIGN: Observational case report. METHODS: Clinical examination, optical coherence tomography (OCT), electroretinography (ERG), genetic analysis, and protein homology modeling. RESULTS: Examination of a 9-year-old girl with acute visual loss of the left eye showed visual acuity of 20/30 in the right eye and 20/200 in the left eye; OCT revealed a choroidal neovascular membrane (CNVM) in the left fovea and cystic maculopathy in the right eye. Full-field ERG showed supranormal s-cone responses, reduced rod response, and characteristic ESCS waveform in photopic cone response but not in scotopic bright-flash response. Sequence analysis revealed heterozygous mutations in the NR2E3 gene, c.767C-->T yielding a substitution p.Ala256Val, and a mutation in the splice site before exon 2, c.119-2 A-->C. CONCLUSIONS: The p.Ala256Val mutation affects the ligand binding domain of the NR2E3 nuclear receptor only, resulting in modestly impaired ESCS ERG results.

Use of the multifocal electroretinogram in the evaluation of a patient with central areolar choroidal dystrophy.

PURPOSE: To assess the multifocal electroretinogram and full-field electroretinogram findings in a patient with advanced central areolar choroidal dystrophy. DESIGN: Observational case report. METHODS: A 53-year-old man with central areolar choroidal dystrophy underwent multifocal electroretinogram and full-field electroretinogram testing. RESULTS: The multifocal electroretinogram demonstrated relative preservation of foveal function compared with the severely depressed retinal function of the perifoveal macula corresponding to the location of the retinal and retinal pigment epithelium atrophy. The full-field electroretinogram was normal for both photopic and scotopic responses. CONCLUSION: Despite a normal full-field electroretinogram, the multifocal electroretinogram demonstrated significant macular dysfunction with relative preservation of foveal function in a patient with central areolar choroidal dystrophy.