CENTRAL RETINAL VEIN OCCLUSION FOLLOWING BNT162B2 (PFIZER-BIONTECH) COVID-19 MESSENGER RNA VACCINE.

PURPOSE: Coronavirus disease 2019 has had a wide-ranging public health impact, contributing to at least five million deaths globally at the time of this report. Although thromboembolic events following coronavirus disease 2019 vaccination have been an ongoing concern, only a limited number of ophthalmic manifestations have been reported to date. METHODS: A detailed history, hypercoagulable workup, best-corrected visual acuity (BCVA), Humphrey visual field, dilated fundus examination, and multimodal imaging including optical coherence tomography, fundus fluorescein angiography, and fundus photography were obtained. RESULTS: A 27-year-old woman was diagnosed with central retinal vein occlusion a few days after her first dose of the BNT162b2 (Pfizer-BioNTech) coronavirus disease 2019 vaccine. Detailed elicitation of her history and a full hypercoagulable workup did not reveal any primary risk factors that could have explained her disease process. After the patient received the second dose, her symptoms deteriorated significantly and worsening peripapillary hemorrhage were seen on dilated fundus examination. The patient was treated with intravitreal injections of ranibizumab and followed closely, which showed improvement in her central retinal vein occlusion. CONCLUSION: Given the chronology of the patient's condition, it is believed that the central retinal vein occlusion that occurred as a result of the first dose was exacerbated by an intense immunological reaction after the second dose. The severity of this complication, despite its rarity, must be emphasized and weighed in but should not preclude the extensive benefits of vaccination.

TUBERCULOUS CHOROIDITIS IN PATIENT WITH VOGT-KOYANAGI-HARADA DISEASE.

PURPOSE: To describe a novel case of intraocular tuberculosis (TB) arising in a patient undergoing treatment for Vogt-Koyanagi-Harada disease, and to highlight the use of spectral domain optical coherence tomography for helping confirm the diagnosis and monitor treatment response. METHODS: Case report of a patient with Vogt-Koyanagi-Harada disease on prednisone, with acute clinical changes suspicious for bilateral tuberculous choroiditis. Spectral optical coherence tomography, fundus photography, and B-scan ultrasonography were all used to capture the acute lesions, and to monitor their responses after initiation of anti-TB therapy. RESULTS: New subretinal lesions arose bilaterally, as characterized by spectral domain optical coherence tomography, and appeared to regress after a first round of anti-TB therapy, thereby helping confirm the presumed diagnosis of intraocular TB. A new peripheral choroidal lesion arose shortly after temporary cessation of antimicrobial treatment, and again regressed once four-drug therapy was instituted, with no recurrent lesions thereafter. CONCLUSION: The use of multimodal imaging was instrumental in the management of a rare case of intraocular TB arising in the setting of underlying Vogt-Koyanagi-Harada disease.

Comparison of Ranibizumab 0.5 mg Versus 1.0 mg for the Treatment of Patients With Clinically Significant Diabetic Macular Edema: A Randomized, Clinical Trial.

BACKGROUND AND OBJECTIVE: To compare ranibizumab (Lucentis; Genentech, South San Francisco, CA) 0.5 mg and 1.0 mg for the treatment of clinically significant diabetic macular edema (CSDME). PATIENTS AND METHODS: This was a 12-month, prospective, single-masked, randomized clinical trial. Patients with CSDME secondary to diabetic retinopathy were randomized to receive 0.5 mg or 1.0 mg of ranibizumab by intravitreal injection once monthly for 3 months and then once every other month as needed. RESULTS: Patients received a mean of 6.5 injections in each group during the course of this 12-month study. The mean change in Early Treatment Diabetic Retinopathy Study visual acuity from baseline to month 12 was +3.8 letters in the ranibizumab 0.5-mg group (n = 23) and +7.9 letters in the 1.0-mg group (n = 23; P = .92 vs. 0.5 mg). Central foveal thickness (CFT) significantly decreased from baseline to month 12 in both dose groups. CONCLUSION: Treatment of CSDME with ranibizumab resulted in a statistically significant improvement in visual acuity (ranibizumab 1.0 mg) and decrease in CFT and macular volume (ranibizumab 0.5 mg and 1.0 mg) from baseline to 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:536-543.].

Sutureless 25-gauge vitrectomy for retinal detachment repair in a patient with osteogenesis imperfecta.

PURPOSE: The purpose of this study was to report the successful repair of retinal detachment in a patient with osteogenesis imperfecta with sutureless 25-gauge vitrectomy. METHODS: This was a single case report. RESULTS: A patient with osteogenesis imperfecta and a retinal detachment was successfully repaired without complication using 25-gauge vitrectomy with a final visual acuity of 20/20. CONCLUSION: In light of abnormal and thin sclera in patients with osteogenesis imperfecta, small-gauge sutureless vitrectomy should be considered for the repair of retinal detachment in this subset of patients.

Preservative-free low-dose dexamethasone for the treatment of chronic ocular surface disease refractory to standard therapy.

PURPOSE: To evaluate the short-term safety and efficacy of topical preservative-free dexamethasone 0.01% for the treatment of ocular surface disease and/or tearing refractory to conventional treatments. METHODS: Retrospective chart review of all patients who received topical unpreserved dexamethasone 0.01% (Leiters Pharmacy, San Jose, CA). Follow-up visits were reviewed for subjective responses to the formulation and intraocular pressure. Responses were graded as significant/complete resolution of symptoms (50%-100% improvement), mild (25%-50% improvement), or no improvement. RESULTS: Thirty-one patients received topical unpreserved dexamethasone 0.01% for the treatment of ocular surface disease. Follow up ranged from 4 to 60 months (average, 11.5 weeks). Twenty patients (65%) reported moderate or complete resolution of ocular symptoms. Seven patients (22%) had mild improvement in their symptoms. Four patients (13%) had no change in ocular symptoms. No patient in our series developed an elevation of intraocular pressure greater than 5 mm Hg above baseline intraocular pressure. No patient developed intraocular pressure greater than 22 mm Hg. CONCLUSIONS: Topical nonpreserved 0.01% dexamethasone could be an effective therapy for recalcitrant chronic ocular surface disease.