SURGICAL MANAGEMENT OF FULL-THICKNESS MACULAR HOLE SUPERIMPOSED ON EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

BACKGROUND/PURPOSE: We describe a case of full-thickness macular hole formation in a patient with exudative age-related macular degeneration after an intravitreal ranibizumab injection and its surgical management. METHODS: This case is a retrospective, interventional case report. RESULTS: A 77-year-old woman with bilateral exudative age-related macular degeneration and pre-existing retinal pigment epithelium tear developed a full-thickness macular hole after intravitreal ranibizumab. The macular hole was repaired successfully with pars plana vitrectomy, internal limiting membrane peel, and 16% C3F8 gas fill. CONCLUSION: To the best of our knowledge, this is the first reported case of full-thickness macular hole after a retinal pigment epithelium tear repaired successfully with vitrectomy, resulting in improved visual acuity.

Context for Protons as Adjunctive Therapy in Neovascular Age-Related Macular Degeneration: A Review.

In the last few years we have witnessed increasing availability of proton therapy in the United States and worldwide. As a result, proton therapy is considered as either a primary or adjunctive approach for numerous indications where conventional radiation therapy shows promise but is accompanied by toxicities. Age-related macular degeneration (AMD) remains the leading cause of adult blindness in industrialized nations, and third worldwide, following cataract and glaucoma. Current standard therapy is intravitreal injection of anti-vascular endothelial growth factor agents. While this treatment shows improvement and stabilization in visual acuity for 40% of patients, 60% still experience disease progression. These injections are costly, necessitate repeated office visits, and carry the risk of endophthalmitis. The pathophysiology underlying neovascular AMD (nAMD) underscores the need to simultaneously target multiple pathways to retain useful vision. Radiation can be antiangiogenic, anti-inflammatory, and antiproliferative. Early photon therapy clinical trials were heterogeneous, and a Cochrane review of data demonstrated usefulness in treatment of nAMD but recommended further studies. Advantages of proton therapy over photon therapy include the ability to deliver a focal dose to the target while minimizing dose to normal structures, which is enhanced by unique treatment planning software that uses fluorescein angiography to verify target location and allows conformation of dose to the irregular shape and thickness characteristic of choroidal neovascular membranes, the pathognomonic finding in nAMD. Preliminary data suggest a potential role for proton therapy in the treatment of nAMD. In this article we review previous treatments for AMD, including those with both photon and proton radiation, and recommend future directions for clinical investigations to evaluate the role of proton therapy as an adjunct to antiangiogenic therapy, the current standard of care in this challenging setting.

Choroidal metastases of choriocarcinoma.

PURPOSE: We present here a patient with choroidal metastases of choriocarcinoma; her clinical and pathologic findings are described. METHODS: Retrospective case study with fundus photographs. A 23-year-old woman presented with a dense vitritis, retinal detachment, and underlying chorioretinal lesions. Systemic workup revealed choriocarcinoma with disseminated metastases. RESULTS: This patient's underlying malignancy was unrecognized at initial presentation to ophthalmology. This case reaffirms the importance of thorough systemic investigation for atypical intraocular lesions. CONCLUSION: Adult intraocular neoplasms are most commonly metastases from distal primary malignancies. The same holds true for uveal malignancies. In many uveal malignancies, the intraocular lesion is a harbinger for an, as yet, undiscovered underlying systemic malignancy.

Posterior segment involvement in Castleman disease.

PURPOSE: We present here a patient with Castleman disease, a rare lymphoproliferative disorder, involving the vitreous. Her clinical findings are described. METHODS: Retrospective case study with slit-lamp photographs. A 28-year-old woman with known Castleman disease presented with visual complaints. Her ophthalmic findings are described. RESULTS AND CONCLUSION: Based on literature searches, this is the first reported patient with Castleman disease having putative involvement of the vitreous body.

Exudative retinal detachment as a presenting sign in Philadelphia chromosome-positive acute lymphoblastic leukemia.

PURPOSE: We present here a case of bilateral exudative retinal detachments in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia and describe the patient's response to induction chemotherapy and clinical course. METHODS: A retrospective case study with fundus photographs and optical coherence tomography. A 46-year-old woman presented with bilateral exudative retinal detachments. A systemic evaluation revealed acute lymphoblastic leukemia. RESULTS AND CONCLUSION: This is an exceptional case in that the exudative retinal change so closely parallels systemic response to remission and relapse in a hematologic malignancy, and suggests that the clinical course of exudative retinal change may be a legitimate proxy for efficacy-or failure-of systemic therapy.