Intravitreal anti-vascular endothelial growth factor agents as an adjunct in the management of Coats' disease in children.

We describe the role of intravitreal anti-vascular endothelial growth factor (VEGF) agents in Coats' disease in children. In a prospective, interventional, non-randomized case series, three patients (three eyes) aged 16, seven and two years were diagnosed to have Coats' disease. In Case 1 (16 yr/ male) with macular edema, previous laser photocoagulation being unsuccessful, intravitreal pegaptanib sodium (Macugen) was tried. Case 2 (seven yr/ male) and Case 3 (two yr/ female) were diagnosed to have Stage 4 Coats' and underwent external needle drainage, laser photocoagulation, SF6 gas injection and intravitreal injection of bevacizumab (Avastin). Reduction of exudation and attached posterior pole (Cases 2 and 3) was seen at a follow-up of six months and two months respectively. Intravitreal anti-VEGF agents may be successfully used as adjunct treatment in select cases of Coats' disease in childhood.

Evaluation of central, steady, maintained fixation grading for predicting inter-eye visual acuity difference to diagnose and treat amblyopia in strabismic patients.

BACKGROUND: Diagnosis of amblyopia in preverbal strabismic patients is frequently made by binocular fixation preference (BFP) testing. The reports on reliability of BFP are equivocal. This study evaluated the reliability of BFP testing in patients with horizontal strabismus. MATERIALS AND METHODS: This prospective observational study included patients with manifest, horizontal, comitant deviation> 10 prism diopter (PD). Inter-eye acuity difference (IEAD) was calculated by converting Snellen visual acuity to logMAR and was compared with BFP testing. The fixation behavior of the non-preferred eye was evaluated by a single investigator as central or uncentral, steady or unsteady and maintained or unmaintained. Amblyopia was defined as the IEAD of> 0.2 logMAR. RESULTS: Of total 61 patients 36 were females and 36 had convergent squint, mean age 9.8 years. The correlation of BFP testing with IEAD was good for esotropia and exotropia. The sensitivity, specificity, positive and negative predictive value of central, steady, maintained (CSM) grading was 93%, 78%, 79%, and 93% respectively. Sensitivity and negative predictive values were higher in children aged four to nine years and anisometropia> 1 diopter. The correlation between IEAD and lower grades of BFP testing was poor. CONCLUSIONS: CSM grading for BFP testing is useful for the detection of strabismic amblyopia but not useful to differentiate the depth of the amblyopia.

Paralysis of the near-vision triad in a child.

The near-vision triad, or complex, consists of convergence, miosis, and accommodation. Neuronal pathways that control each of these components are distinct but interrelated. Abnormalities affecting 1 or more components of the complex may present as eye pain, headache, blurred vision, or diplopia at near fixation. Although isolated abnormalities in any one of the components are common, a severe and concurrent defect in all three is rare.(1,2) We describe an 11-year-old child who presented with complete paralysis of the near triad without identifiable neurological defect. The child benefited from prism and plus lenses. To our knowledge, only three previous reports have described patients with idiopathic paralysis of convergence and accommodation in healthy children.(2-4) The methods we used to objectively confirm defects in the near-vision complex and rule out a psychogenic etiology may be instructive to other clinicians.

Photodynamic therapy following intravitreal bevacizumab in multifocal choroiditis.

PURPOSE: To report the use of intravitreal bevacizumab (avastin) followed by photodynamic therapy (PDT) in a case of choroidal neovascular membrane (CNVM) due to multifocal choroiditis. DESIGN: Interventional case report. METHODS: In the setting of institutional practice, a 40-year male patient with previously diagnosed multifocal choroiditis presented with reduced vision in his left eye. A CNVM was revealed through hazy vitreous in the left eye. Due to a prior episode of increased intraocular pressure with use of periocular steroid (triamcinolone), and marked vitreous haze precluding precise assessment of the neovascular membrane, intravitreal injection of bevacizumab was tried followed by PDT. RESULTS: There was clearing of the vitreous haze and reduction of leakage one week after intravitreal injection. PDT one month after injection resulted in stable vision at three-month follow-up without angiographic leakage. CONCLUSION: Intravitreal bevacizumab may be tried in cases of CNVM due to multifocal choroiditis. Timing of the injection may vary with the clinical scenario.