Intravitreal bevacizumab in the treatment of peripapillary choroidal neovascular membrane secondary to idiopathic intracranial hypertension.

A 14 year-old Caucasian boy with idiopathic intracranial hypertension (IIH) presented with blurred vision in his left eye. Visual acuity was 20/20, right eye, and 20/80, left eye, and funduscopy revealed bilateral papilledema. In addition, there was peripapillary choroidal neovascular membrane (PPCNVM) in the left eye. Oral acetazolamide improved the symptoms and signs of IIH, but seven weeks later, acuity remained 20/80, left eye, with an increase in subretinal hemorrhage. Two weeks following an intravitreal injection of bevacizumab, visual acuity on the left had improved to 20/30 with resolution of subretinal hemorrhage and fibrosis of PPCNVM. After an additional 2 weeks, visual acuity improved to 20/20, and there has been no sign of recurrence over 3.5 years of follow-up.

Wedge resection and lamellar dissection for pellucid marginal degeneration.

PURPOSE: To describe the use of crescentic corneal lamellar wedge resection and autolamellar dissection for the correction of pellucid marginal degeneration (PMD), and to assess its effectiveness in improving uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), astigmatism, corneal topography, and contact lens or spectacle tolerability. METHODS: The setting was a specialist referral corneal surgery center, United Kingdom. A retrospective review was performed of all patients who underwent a corneal wedge resection for PMD at our institutions. All patients had progressive deterioration of BCVA, increased astigmatism, and intolerance to contact lens wear. The irregular corneal shape with ectasia was detected clinically and confirmed by Orbscan tomography. A crescentic wedge of ectatic corneal tissue was excised in each case, the extent of which was judged both clinically and by Orbscan. Complete host deep lamellar dissection (limbus to limbus) was performed in 3 cases and partial host lamellar dissection in 3 cases to enable closure by mobilizing the host anterior lamellar cornea. Mersilene 10-0 (Ethicon, Somerville, NJ) sutures were used and adjusted to achieve a 90-degree shift in the axis of astigmatism. RESULTS: Seven eyes of 6 patients had wedge resections performed by 1 surgeon (S.M.D.). The patients were followed for a mean of 10.7 months (SD, 9.2; range, 1-25 months). The eyes of patients with >1 month of follow-up had improved UCVA and BCVA. Four of 5 eyes of patients with >2 months of follow-up had a BCVA of 6/12 or better. Four patients were able to manage with improved visual acuity in spectacles, and 1 patient chose to wear contact lenses to achieve 6/7.5. One patient with only 6 months of follow-up had a UCVA of 6/7.5. The average reduction in keratometric cylinder for cases with >2 months of follow-up was 9.1 diopters (SD, 5.3; range, 3.1-16.3 diopters). CONCLUSIONS: Corneal wedge resection with and without lamellar dissection is an effective surgical intervention for corneal ectasia in PMD and avoids allogeneic transplantation by way of a large penetrating or lamellar keratoplasty. The technique has a low intraoperative complication rate and gives improved UCVA, BCVA, keratometric cylinder, and spectacle or contact lens tolerance.

Ocular adnexal Langerhans cell histiocytosis clinical features and management.

PURPOSE: To review the clinical features, investigations, management, and outcomes of Langerhans cell histiocytosis (LCH) with ocular adnexal involvement. MATERIALS AND METHODS: Retrospective, non-comparative, chart review of 30 patients with LCH involving the ocular adnexa treated at 6 major Australian hospitals. Clinical features, imaging findings, treatment, local and distant recurrence and outcome were evaluated. RESULTS: Twenty-four patients (80%) were male with a mean age of presentation of 9.5 years. Females presented at an earlier age (mean age 4.1 years) with more severe involvement. Eighty percent of the cases presented with periorbital swelling. Computed tomography usually showed destructive osteolytic lesions centred on the frontal bone. Twenty-four patients (80%) had unifocal, unisystem disease. From this group, none of 13 treated with excision alone had recurrence whereas 2 of 6 treated with excision followed by chemotherapy recurred. CONCLUSIONS: Unifocal, unisystem LCH often presents to the ophthalmologist and can usually be diagnosed on clinical and imaging grounds. Computed tomography and magnetic resonance imaging are complementary imaging studies. Biopsy is essential to confirm diagnosis. Unifocal, unisystem disease can be treated with local excision and curettage. Incomplete excision, recurrent disease or multifocal disease may require systemic chemotherapy.

Orbital cellulitis, panophthalmitis, and ecthyma gangrenosum in an immunocompromised host with pseudomonas septicemia.

PURPOSE: To describe a case of Pseudomonas aeruginosa septicemia complicated by orbital cellulitis, panophthalmitis, and ecthyma gangrenosum. DESIGN: Observational case report. METHODS: An immunosuppressed 62-year-old man developed an unusual skin rash and a painful, swollen right eye with decreased vision. He had myelodysplastic syndrome and P. aeruginosa septicemia. The skin rash manifested as ecthyma gangrenosum. Metastatic orbital cellulitis and panophthalmitis was diagnosed. RESULTS: Despite intravitreal and topical gentamicin, the patient eventually required enucleation. CONCLUSIONS: This case represents a rare combination of events: an immunocompromised man developed pneumonia, P. aeruginosa septicemia, and endogenous seeding of the Pseudomonas to the skin, orbit, and eye. Early recognition of endogenous ophthalmic disease is imperative. The prognosis of combined orbital cellulitis and panophthalmitis is poor.