Optical coherence tomography characteristics of group 2A idiopathic parafoveal telangiectasis.

PURPOSE: To describe the optical coherence tomography (OCT) characteristics of patients with group 2A idiopathic parafoveal telangiectasis (IPFT) and to correlate them with biomicroscopic and fluorescein angiographic (FA) findings based on Gass and Blodi staging classification for group 2A IPFT. METHODS: Fifty-two eyes of 26 consecutive patients with IPFT underwent biomicroscopic fundus examination, color fundus photography, FA, and OCT. Main outcome measures were OCT characteristics and their correlation with biomicroscopy and FA. RESULTS: The most common OCT findings that help differentiate between stages in group 2A IPFT are 1) highly reflective dots in the inner retina that correspond with microvessels seen by FA in Stage 1 (5 eyes [62.5%]); 2) the presence of hyporeflective intraretinal spaces in the absence of retinal thickening and highly reflective dots in the retina in Stage 2 (9 [81.8%] and 10 eyes [90.9%], respectively); 3) in Stage 3, both outer and inner retina exhibit areas of similar high reflectivity. In addition, the retinal pigment epithelium (RPE)/choriocapillaris complex is thickened or disrupted as evidenced by an area of high reflectivity (13 eyes [81.2%]); 4) a highly reflective area nasal or temporal to the fovea in the inner or outer retinal layers in Stage 4 suggesting RPE proliferation and migration (13 eyes [100%]); and 5) a fusiform thickening and duplication of the highly reflective RPE/choriocapillaris complex corresponding to choroidal neovascularization in Stage 5 (4 eyes [100%]). Our OCT characteristics correlated well with biomicroscopic and FA findings for Stages 4 and 5. However, the hyporeflective spaces that are evident on OCT could not be seen clinically at the slit lamp or on FA. In addition, our OCT findings on eyes with group 2A IPFT Stage 3 have not, to our knowledge, been previously described. CONCLUSIONS: Optical coherence tomography findings in group 2A IPFT were characteristic for each stage and may be helpful in making the diagnosis as well as defining the anatomical staging proposed by Gass and Blodi. Optical coherence tomography complements biomicroscopic and FA findings in the evaluation of group 2A IPFT.

Indocyanine green-mediated photothrombosis with and without intravitreal triamcinolone acetonide for subfoveal choroidal neovascularization in age-related macular degeneration: a pilot study.

PURPOSE: To determine the feasibility, safety, and clinical effect of treating patients with subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) with indocyanine green (ICG)-mediated photothrombosis (IMP) with and without intravitreal triamcinolone acetonide (TA). METHODS: Fifteen patients (19 eyes) participated in the study. Nine eyes of seven patients were treated with IMP immediately followed by an intravitreal injection of 4 mg of TA (Group A), and 10 eyes of 8 patients were treated with IMP only (Group B). Patients had a mean follow-up of 6.9 months (range: 3 to 12 months). Patients underwent single or two sessions of IMP. RESULTS: In Group A, visual acuity (VA) showed stability in 6 eyes (66.7%), improvement of VA in 2 eyes (22.2%), and worsening of VA in 1 eye (11.1%). Group B presented VA stability in 9 eyes (90%), and improvement in 1 eye (10%). In total, of the 15 patients (19 eyes) with IMP with or without intravitreal TA, 3 eyes (15.8%) showed improvement, 15 eyes (78.9%) stability, and 1 eye (5.3%) showed worsening of VA. A significant regression of the CNV and diminishing of subretinal fluid was demonstrated with fluorescein angiography and optical coherence tomography in both groups. No patient in Group A required retreatment. Four of 10 eyes (40%) in Group B required one retreatment during the study period. CONCLUSIONS: ICG-mediated photothrombosis with and without intravitreal TA may provide stability or improvement in visual acuity and fundus findings in subfoveal CNV in AMD. Further evaluation in a multicenter, randomized, placebo-controlled clinical trial with longer follow-up is needed to accurately assess the safety and efficacy of this new treatment modality.

Full-thickness macular hole after LASIK for the correction of myopia.

PURPOSE: To describe 19 patients (20 eyes) who developed a macular hole (MH) after undergoing bilateral LASIK for the correction of myopia. DESIGN: Noncomparative, interventional, retrospective, multicenter case series. PARTICIPANTS: Nineteen patients (20 eyes) who developed an MH after bilateral LASIK for the correction of myopia at 10 institutions in Venezuela, Colombia, Puerto Rico, Spain, and the United States. METHODS: Chart review. MAIN OUTCOME MEASURE: Macular hole development. RESULTS: The MH formed between 1 to 83 months after LASIK (mean, 12.1). In 60% of cases, the MH developed < or =6 months after LASIK, and in 30% of cases it developed > or =1 year after LASIK. Eighteen of 19 (94.7%) patients were female. Mean age was 46 years (range, 25-65). All eyes were myopic (range, -0.50 to -19.75 diopters [mean, -8.9]). Posterior vitreous detachment was not present before and was documented after LASIK in 55% of eyes. A vitrectomy closed the MH on the 14 eyes that underwent surgical management, with an improvement of final best-corrected visual acuity in 13 of 14 (92.8%) patients. Our 20 eyes with a full-thickness MH after LASIK reflect an incidence of approximately 0.02% (20/83938). CONCLUSION: An MH may infrequently develop after LASIK for the correction of myopia. Our study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with an MH after LASIK. Vitreoretinal interface changes may play a role in MH formation after LASIK for the correction of myopia.

Indocyanine green-mediated photothrombosis with intravitreal triamcinolone acetonide for subfoveal choroidal neovascularization in age-related macular degeneration.

BACKGROUND: There is a need for alternative treatments for the management of exudative age-related macular degeneration (AMD). The purpose of this paper is to determine the feasibility, safety, and clinical effect of indocyanine green (ICG)-mediated photothrombosis (IMP) combined with intravitreal triamcinolone acetonide (TA) in patients with subfoveal choroidal neovascularization (CNV) in AMD. METHODS: Thirty-one eyes of 26 patients who were treated with IMP immediately followed by an intravitreal injection of 4 mg of TA were investigated in the study. The patients had a mean follow-up of 9 months (range 3 months to 26 months). Patients underwent one to four sessions of IMP combined with intravitreal TA. RESULTS: Visual acuity showed stability in 19 eyes (61.3%), improvement of visual acuity (VA) in seven eyes (22.6%), and worsening of VA in five eyes (16.1%). A significant regression of the CNV, and diminishing of subretinal fluid, was demonstrated with fluorescein angiography and optical coherence tomography. We found no complications associated with the intravitreal injection procedure or IMP. Five (16.1%) eyes developed an increase in intraocular pressure related to the presence of TA in the vitreous cavity. However, it was medically controlled with topical anti-glaucoma medications. Nineteen of 31 eyes (61.2%) required at least one re-treatment (mean 1.7; range 1-4) during the study period. CONCLUSIONS: Combined IMP and intravitreal TA may provide stability or improvement in visual acuity and fundus findings in choroidal neovascularization. Further evaluation in a multicenter, randomized, placebo-controlled clinical trial with longer follow-up is needed to accurately assess the safety and efficacy of this new treatment modality.

Maculopatías luego de queratomileusis in situ asistida por láser (LASIK) para la corrección de miopía / Maculopathy then of keratomileusis for laser (LASIK) in situ the correction of myopia

Reportar nuestra experiencia con el uso de propósito: describir veinte y ocho ojos (26 pacientes) que desarrollaron agujeros maculares (AM) unilaterales de espersor total (16 ojos de 15 pacientes) o membranas neovasculares o coroideas subfoveales (CNV)(12 ojos de 11 pacientes) luego de procedimiento de LASIK bilateral para la correción de miopía. Serie de casos. Los AM se formaron ente una 30 meses luego de LASIK (promedio: 7.5 meses), 93.7 por ciento de los pacientes fueron género femenino. La media edad fue de 43.9 años (25-58). Todos los ojos fueron miopes (rango: -0.50 a -15.25 dioptrias [D]; promedio: -7.94 D). El despremdimiento del Vítreo posterior estuvo no presente antes del LASIK y se documentó posterior al procedimiento en 56.2 por ciento de los ojos. La Viterctomía cerró los agujeros maculares en 11 ojos que fueron a manejo quirúrgico mejorandose la agudeza visual final corregida en todos los pacientes. La incidencia de nuestros quince pacientes (ojos) con AM de espesor cpmpleto post LASIK reflejaron un valor de 0.03 por ciento (16/46,486). Adicionalmente, la CNV ocurrió en una media de 25.2 meses (rango: 1 a 60 meses) luego del LASIK. La miopia en este grupo de pacientes presentó un promedio de -15.12D (rengo:-13:00D a-25.50D). Nuve de nuestros casos se beneficiearon de la Terapia fotdinámica (PDT) con mejoría o estabilidad de la agudeza visual en 77.7 por ciento de los casos. Nuestros doce pacientes con CNV luego del LASIK representan una incidencia del 0.02 por ciento (12/46,486).El LASIK parece ser un procedimiento seguro con una baja incidencia de complicaciones vitero-retinales, sin embargo la CNV y el agujero macular pueden desarrollarse luego del LASIK

Photodynamic therapy with verteporfin for subfoveal choroidal neovascular membranes in highly myopic eyes after laser in situ keratomileusis.

The authors describe the management of subfoveal choroidal neovascular membranes in highly myopic eyes after laser in situ keratomileusis with photodynamic therapy. Five cases of choroidal neovascular membrane after laser in situ keratomileusis for the correction of myopia (mean, 13.3 diopters; range, -8.00 to -16.25 diopters) treated with single or multiple sessions of photodynamic therapy with verteporfin are presented. Two cases had improved visual acuity (2 to 5 lines) after photodynamic therapy, two cases remained the same, and one case lost 4 lines of visual acuity. Photodynamic therapy with verteporfin seems to increase the chance of stabilizing or improving vision in patients with subfoveal choroidal neovascular membrane after laser in situ keratomileusis in highly myopic eyes.

Immune recovery uveitis in AIDS patients with cytomegalovirus retinitis treated with highly active antiretroviral therapy in Venezuela.

PURPOSE: To determine the characteristics of immune recovery uveitis (IRU) in acquired immunodeficiency syndrome (AIDS) patients with inactive cytomegalovirus (CMV) retinitis who responded to highly active antiretroviral therapy (HAART) in a Venezuelan population. METHODS: We examined 34 patients (50 eyes) with AIDS (HAART responders) and healed CMV retinitis. Patients were observed for a median of 19.3 months following an increase in the CD4 cell count. Ten eyes were treated with sub-Tenon space corticosteroid injections. An age-matched control group of patients with healed CMV retinitis who did not have IRU (30 eyes of 20 patients) was included to compare CMV surface area and complications. RESULTS: We found that 12 (37.5%) of 32 HAART responders developed IRU (18 eyes). The clinical findings of these 18 eyes with IRU are presented. The clinical spectrum of inflammation included vitritis, macular edema, epiretinal membranes, anterior uveitis, macular hole, retinal detachment with proliferative vitreoretinopathy, and cataract. Eyes with IRU had a mean CMV surface area of 31.7%. However, eyes without IRU (control group) had a mean CMV surface area of 35% (P = 0.41). Periocular treatment resulted in vision improvement (in 90% of eyes) without reactivation of retinitis. CONCLUSIONS: Symptomatic IRU developed in a significant number of patients with CMV retinitis following successful HAART in a Venezuelan population. CMV surface area does not seem to be a risk factor for the development of IRU. Eyes with IRU respond favorably to antiinflammatory therapy without reactivation of retinitis.

Ganciclovir intravítreo a altas dosis para el manejo de la retinitis por citomegalovirus / High dosis of intravitreal ganciclovir for the management of renitis by cytomegalovirus

Describir el uso de altas dosis de ganciclovir intravítreo para el tratamiento de la retinitis por citomegalovirus (CMV) en pacientes con el virus de inmunodeficiencia humana (HIV) que reciben la terapia antiretroviral de alta actividad (HAART). Catorce pacientes (19 ojos) infectados con HIV y con retinitis por CMV activa participaron en este estudio prospectivo no aleatorizado. Los pacientes con retinitis activa por CMV (84,2 por ciento en la zona 1 y 36,8 por ciento por ciento resistentes) recibieron ganciclovir intravítreo (5,0 mg/0,1 ml) una vez por semana hasta que ha retinitis cicatrizó, conjuntamente con terapia HAART. El seguimiento promedio fue de 10,9 meses. Se obtuvo regresión completa de la retinitis en 84,2 por ciento de los ojos (3 pacientes murieron antes de la conclusión del estudio) con una media de 4,8 semanas. La agudeza visual mejoró 2 o más líneas en 52,6 por ciento de los ojos. No se identificó toxicidad retiniana por el ganciclovir. La cantidad media de linfocitos T CD4 + aumentó desde 80,5 a 255,2 células/µL (aumento promedio de: 169,1 celulas/µL). Tres ojos presentaron reactivación de la retinitis por CMV en una media de 25,6 días después de su última inyección. Las complicaciones (4 por ciento) incluyeron uveítis por recuperación inmune (2 ojos), desprendimiento de retina (1 ojo) y endoftalmitis (1 ojo). El ganciclovir intravítreo a altas dosis (5,0 mg) conjuntamente con terapia HAART es bien tolerado y se administra hasta que la retinitis por CMV ha cicatrizado