Fundus autofluorescence imaging findings in retinal pigment epithelial tear.

PURPOSE: Retinal pigment epithelial (RPE) tear is a clinical and angiographic entity, which usually occurs in association with pigment epithelial detachments (PED), in the context of neovascular age-related macular degeneration (ARMD). The recording of fundus autofluorescence (FAF) has been introduced as a technique of retinal imaging, allowing the in vivo assessment of the integrity of RPE. The authors describe the FAF imaging findings in a patient with RPE tear. METHODS: Observational case report. RESULTS: A 70-year-old woman developed RPE tear after the application of photodynamic therapy for choroidal neovascularization associated with PED. The diagnosis of the RPE tear was confirmed by fluorescein angiography (FA) and indocyanine green angiography (ICGA). FAF imaging revealed absence of autofluorescence at the area which was denuded of RPE, while at the area where the RPE was rolled, a heterogeneous signal of FAF was recorded. The intensity of the signal in that area was, on average, not different from the normal background FAF signal expected in an unaffected RPE/photoreceptor complex. CONCLUSIONS: The authors report the FAF imaging findings in a patient with RPE tear. These findings can be interpreted from the ability of FAF imaging to access in vivo the integrity of RPE, and correlate well with the histopathology of this clinical entity. FAF imaging, as a fast and noninvasive technique, may be a useful modality, alternative to FA and ICGA, in the diagnosis and evaluation of such cases. Moreover, it may contribute to a more detailed phenotyping of the various clinical pictures associated with neovascular ARMD.

Advice against smoking is not effective in patients with Graves' ophthalmopathy.

Advice against smoking is one of the means frequently used in the management of patients with Graves' ophthalmopathy (GO). The objective of this study was to prospectively evaluate the efficacy of such advice. The study was performed at a referral centre. Eighty-five smokers out of 102 consecutive patients with GO, who were examined during a 1-year period, were included in the study. Severity of the disease, smoking history, and the results from a patients' self-assessment questionnaire were recorded. The behavioural intervention consisted in a standardized 2-min message from the attending ophthalmologist strongly advising each patient to quit. The main outcome measure was smoking cessation during the 1-year follow-up period. None of the 85 smokers reported smoking cessation either during the follow-up visits or at the end point of the study. The results of our study show that advice against smoking is not effective among patients with GO. Specifically designed intervention programmes may be necessary and should be evaluated in a controlled trial.

Clonazepam associated retinopathy.

PURPOSE: To report a case of retinopathy associated with the longterm intake of the antiepileptic drug clonazepam. METHODS: Case report. RESULTS: A 36-year-old woman, with a history of long-term use of the antiepileptic drug clonazepam developed subtle visual disturbances. Funduscopy revealed areas of mild depigmentation of the retinal pigment epithelium throughout the posterior pole bilaterally corresponding to transmission hyperfluorescence on fluorescein angiography. There was no history of any inherited retinal degenerative disease and no other known agent responsible for retinal toxicity had been used. CONCLUSIONS: The longstanding intake of the antiepileptic drug clonazepam may be associated with the development of toxic retinopathy.

Hypothyroidism and glaucoma. A study of 100 hypothyroid patients.

PURPOSE: To determine whether glaucoma is associated with hypothyroidism, as has previously been suggested. METHODS: This is a cross-sectional study and a noncomparative interventional case series. One hundred consecutive patients with newly diagnosed hypothyroidism were referred for complete ophthalmologic examination, including automated perimetry and examination of the optic disks, to identify the presence of glaucoma. After correction of the hypothyroidism, reexamination was performed. RESULTS: No patient had glaucoma and no correlation was found between intraocular pressure and either thyroid stimulating hormone or free tri-iodothyronine. No statistically significant difference was found between intraocular pressure levels before and after treatment of the hypothyroidism. CONCLUSION: This study does not demonstrate an association between hypothyroidism and glaucoma.

Antioxidant agents in the treatment of Graves' ophthalmopathy.

PURPOSE: To report the effect of antioxidant agents in the treatment of mild and moderately severe Graves' ophthalmopathy. METHODS: Prospective, nonrandomized, comparative study performed at a referral center. A series of 11 patients with mild or moderately severe, active, newly diagnosed Graves' ophthalmopathy were included in the study. Allopurinol (300 mg daily) orally and nicotinamide (300 mg daily) orally were used for 3 months. A complete ophthalmologic examination was performed before and 1 and 3 months after initiation of treatment. The response to treatment was estimated separately for each component of the disease and overall by its effect on a total eye score. Eleven patients with mild or moderately severe, active, newly diagnosed Graves' ophthalmopathy who received placebo were also examined at the same time points. Patients in each group were recruited consecutively. Although nonsmoking was not an exclusion criterion, all patients were cigarette smokers. RESULTS: Nine (82%) of 11 patients treated with oral antioxidants showed improvement of mild to moderately severe Graves' ophthalmopathy versus three (27%) of 11 patients in the control group (P <.05). Soft tissue inflammation was the component of the disease that responded more to treatment. No side effects of antioxidant treatment were recorded. Patients' satisfaction was high. CONCLUSIONS: This pilot study presents encouraging results in the treatment of mild and moderately severe Graves' ophthalmopathy with antioxidant agents. To evaluate these preliminary results, randomized prospec-tive studies are needed.