Acute Posterior Multifocal Placoid Pigment Epitheliopathy With Associated Papillitis.

The purpose of this study was to report the rare presentation of bilateral acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and unilateral papillitis treated successfully with corticosteroid therapy. The methods used in this study include fundus photography and fluorescein angiography. A 40-year-old female presented to the emergency room with decreased vision, headache, and photophobia with fundus examination findings of bilateral creamy placoid lesions in the posterior pole and unilateral papillitis, macular edema, and disc hemorrhages. Fluorescein angiography demonstrated early hypofluorescence corresponding to the placoid lesions followed by late, irregular hyperfluorescent staining. Optical coherence tomography revealed peripapillary and macular edema of the left eye. The patient was treated with two retrobulbar corticosteroid injections and a course of oral prednisone with improvement in fundus findings and visual acuity at follow-up examination six weeks from the presentation. The presence of optic nerve and macular edema in APMPPE suggests severe chorioretinal inflammation for which systemic and local corticosteroids are a reasonable treatment option.

Nitroglycerin as a Treatment Modality for Recurrent Isolated Paracentral Acute Middle Maculopathy: A Case Report.

Paracentral acute middle maculopathy (PAMM) is a condition characterized by ischemia affecting the deep capillary plexus layer of the macula, often resulting in a paracentral visual scotoma. PAMM has been reported in association with retinal vascular diseases or as an isolated phenomenon in young and healthy individuals. There is currently no treatment for PAMM. We report a case in which sublingual nitroglycerin reversed developing visual scotomas, or blind spots, in a patient with known recurrent episodes of PAMM.  This case describes a male patient with previously documented evidence of PAMM in both eyes following episodes of extreme physical activity or dehydration. These episodes would often last days without ultimate resolution. After one such occurrence in his right eye, the patient was treated with a sublingual nitroglycerin tablet immediately after the development of new visual scotomas.  The patient's visual symptoms improved within minutes of administering sublingual nitroglycerin, and completely resolved within hours.

Nonfamilial vitreous amyloidosis diagnosed by portable sutureless vitrectomy.

PURPOSE: To describe a case of primary nonfamilial vitreous amyloidosis and a novel technique for expediting vitreous biopsy. DESIGN: Interventional case report. CASE: A 43-year-old man presented with progressive deterioration of vision and was found to have bilateral vitreous opacities. A systemic medical workup including family history was noncontributory. Given a high clinical suspicion of vitreous amyloidosis, the decision was made to obtain a vitreous biopsy for ultrastructural study. An office-based pars plana sutureless vitrectomy was performed. Pathologic study of the vitreous specimen confirmed the diagnosis of amyloidosis. CONCLUSION: Vitreous amyloid deposition may occur with neither systemic involvement nor family history. Sutureless pars plana vitrectomy may facilitate diagnosis while saving time and expense for both the physician and the patient.

Office-based sutureless transconjunctival pars plana vitrectomy.

PURPOSE: This is a preliminary report to describe our technique of office-based vitrectomy (OVIT) and to report the incidence of complications over a 6-year period. METHODS: In a retrospective, noncomparative case series, OVIT was performed on 225 patients in four participating offices. Each patient was operated on with a 23-gauge vitreous cutter that the authors have developed. They have also developed a 23-gauge transconjunctival infusion needle device. Diagnoses included endophthalmitis, uveitis, intravitreal lens fragments, ghost cell glaucoma, and rhegmatogenous retinal detachment. RESULTS: The surgical goal was accomplished in all cases, but supplemental office procedures were required for two eyes, and a scleral buckle was necessary in one eye. There were 15 complications in 14 eyes: "fish-egg" gas bubbles (one eye), intraocular hemorrhage (nine eyes), choroidal detachment (two eyes), new retinal breaks (one eye), retinal detachment (one eye), and temporary elevation of intraocular pressure (one eye). The hemorrhages, choroidal detachments, and fish-egg bubbles all resolved spontaneously. CONCLUSION: Office-based sutureless transconjunctival pars plana vitrectomy, with infusion when needed, is an effective operation for selected diseases of the posterior segment. In a multicenter series of 225 eyes, there were 15 complications in 14 (6%) eyes. Two of the complications were successfully managed with additional office procedures; one was managed in the operating room; and 12 resolved spontaneously.

Acute postoperative endophthalmitis caused by Actinomyces neuii.

PURPOSE: To describe a case of acute postoperative endophthalmitis caused by Actinomyces neuii after uncomplicated phacoemulsification with posterior chamber intraocular lens implant. METHODS: Interventional case report. A 58-year-old male underwent phacoemulsification, right eye, with posterior chamber intraocular lens implant. On postoperative day 6, he presented with pain, redness, and decreased visual acuity, right eye, and was found to have endophthalmitis. RESULTS: Vitreous cultures revealed the gram-positive, anaerobe Actinomyces neuii. After appropriate intraocular, periocular, topical, and systemic therapy, the infection cleared, but the vision of the patient never improved as a result of a central vein occlusion. CONCLUSION: Actinomyces species can rarely cause postoperative endophthalmitis, and it should be considered in cases of severe postoperative intraocular inflammation.