Foveal neovascularization in a patient with Type 2 diabetes mellitus.

Retinal neovascularization in Diabetes mellitus (DM) is commonly seen at the optic disc and mid-periphery. It is rare at the fovea as the fovea is an avascular zone and there are very few case reports of foveal neovascularization in Type 1 DM. We report a case of unilateral foveal neovascularization in Type 2 DM.

Cabbage Leaf Inverted Flap ILM Peeling for Macular Hole: A Novel Technique.

Large macular holes have poor surgical outcomes with conventional vitrectomy and internal limiting membrane (ILM) peeling surgery, but improved anatomical closure rates have been seen with an inverted ILM flap technique. Many studies have been reported with modifications in the original inverted ILM technique that help in better retention of the flap over the macular hole. The authors describe a new technique of inverted ILM flap in a case of chronic, large, full-thickness macular holes, in which multiple ILM flaps were inverted over each other and the hole-like cabbage leaves. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:830-832.].

Comparison of Transcorneal and Pars Plana Routes in Pediatric Cataract Surgery in Infants Using a 25-Gauge Vitrectomy System.

PURPOSE: To demonstrate and compare the performance of the 25-gauge transconjunctival sutureless vitrectomy system via anterior (transcorneal) and posterior (pars plana) routes in congenital cataracts in infants. METHODS: In this prospective interventional study, 12 pediatric patients younger than 1 year with bilateral congenital cataract were included to undergo cataract surgery with posterior vitreorhexis and limited anterior vitrectomy using a 25-gauge vitrectomy system. One eye of each patient was operated on by the anterior (transcorneal) route and the other by the posterior (pars plana) route. All eyes were left aphakic. Intraoperative and postoperative (12 months after surgery) results were compared between the two routes, including visual axis opacification and astigmatism. All eyes were rehabilitated with contact lenses or spectacles. RESULTS: The 25-gauge vitrectomy system allowed excellent intraoperative control in both groups. Postoperatively, there was minimal conjunctival congestion, corneal edema, and inflammatory reaction. No intra-operative or postoperative complications were noted in any eye. All eyes had a clear visual axis 12 months after surgery. Mean spherical equivalent was 15.50 ± 2.28 diopters (D) and mean astigmatism was 0.25 ± 0.45 D in the transcorneal group, whereas in the pars plana group it was 15.46 ± 2.45 D and 0.16 ± 0.39 D, respectively, at 12 months, the difference being statistically insignificant (P > .05). CONCLUSIONS: The 25-gauge vitrectomy system allows sutureless surgery with excellent intraoperative control and minimal postoperative inflammation and astigmatism with clear visual axis by both the transcorneal and pars plana routes.

Peripheral retinal ischemia in a young Indian woman with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF-1) is an autosomal dominantly inherited disease characterized by café-au-lait spots, neurofibromas, axillary freckling, Lisch nodules of iris, gliomas and various systemic vascular ischemic manifestations mainly in the aorta, brain and kidney. Retinal vascular manifestations in patients with NF-1 are usually representative of retinal capillary hemangiomatosis. Few cases of NF-1 with retinal vascular occlusive disease have been described. We describe a young Indian woman with NF-1 with unilateral peripheral retinal ischemia but no vascular abnormality at the posterior pole.

Intravitreal Diclofenac in the Treatment of Macular Edema Due to Branch Retinal Vein Occlusion.

BACKGROUND AND OBJECTIVE: To evaluate the effect of a single dose of intravitreal diclofenac on macular edema (ME) due to branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: In this prospective, interventional case series, 15 eyes with BRVO and ME with central macular thickness (CMT) greater than 250 µm on spectral-domain optical coherence tomography (SD-OCT) were enrolled. All patients were given 0.05 mg/0.1 mL of intravitreal diclofenac under aseptic conditions and followed up for 3 months with respect to best-corrected visual acuity (BCVA), intraocular pressure (IOP), fundus fluorescein angiography, and CMT measured on OCT. RESULTS: The mean visual acuity improved from 0.115 ± 0.03 preoperatively to 0.356 ± 0.29 at 3 months (P = .002). Mean line improvement was 2.2 ± 1.6. Mean preoperative CMT decreased from 453.2 µm ± 55.3 µm to 340.47 µm ± 101 µm at 3 months postoperatively (P = .001). The mean preoperative IOP was 16.4 mm Hg ± 1.59 mm Hg, whereas the mean postoperative IOP was 16.6 mm Hg ± 1.58 mm Hg (P = .08). None of the 12 phakic eyes showed evidence of cataract progression. CONCLUSION: Intravitreal diclofenac is safe and effective in improving BCVA and decreasing CMT in patients with BRVO and ME.

COMPARATIVE EVALUATION OF SEQUENTIAL INTRAOPERATIVE USE OF WHOLE BLOOD FOLLOWED BY BRILLIANT BLUE VERSUS CONVENTIONAL BRILLIANT BLUE STAINING OF INTERNAL LIMITING MEMBRANE IN MACULAR HOLE SURGERY.

PURPOSE: To compare the structural and functional outcome of use of autologous heparinized whole blood before staining internal limiting membrane with brilliant blue (BB) versus conventional BB-assisted macular hole surgery. METHODS: Sixty eyes of 60 patients were randomly divided equally in Group A (BB staining using whole blood) and Group B (conventional BB staining). Clinical assessment and spectral domain optical coherence tomography was done at baseline and 3 weeks, 6 weeks, 16 weeks, and 6 months postoperatively. RESULTS: Group A eyes had a significantly higher best-corrected visual acuity as compared with Group B postoperatively (P < 0.001, <0.001, 0.004, 0.04 at 3, 6, 16 weeks, and 6 months). Inner segment/outer segment junction continuity was noted in greater number of eyes in Group A compared with Group B (P = 0.02, 0.002, 0.003, and 0.03 at 3, 6, 16 weeks, and 6 months). Eyes in Group A had significantly higher outer foveal thickness at 3 weeks (P = 0.001) and 6 weeks (P < 0.001) compared with Group B. CONCLUSION: Use of whole blood before staining internal limiting membrane with BB causes earlier and better visual rehabilitation postoperatively, which could be attributed to earlier photoreceptor regeneration as evidenced by inner segment/outer segment junction continuity and increase in outer foveal thickness.

Intravitreal bevacizumab in congenital retinal macrovessel with retinal arteriolar macroaneurysm.

Congenital retinal macrovessel (CRM) refers to an aberrant vessel, usually a vein, which traverses the macula and supplies both sides of the horizontal raphe. It is a rare condition, mostly asymptomatic and discovered on routine examination. We describe a case of both arterial and venous CRM with a macroaneurysm along the arterial CRM that presented with decreased vision due to prominent lipid exudation at the macula. Treatment with intravitreal bevacizumab resulted in a favourable anatomical as well as functional outcome. To the best of our knowledge, this is the first report of this unusual presentation of CRM, and its successful management with intravitreal bevacizumab.

Bilateral optic disc pit with maculopathy in a patient with cleft lip and cleft palate.

Optic disc pit (ODP) is small, gray-white, oval depression found at the optic nerve head. It is a congenital defect that occurs due to imperfect closure of superior edge of the embryonic fissure. Cleft lip and palate are also congenital midline abnormalities occurring due to defect in the fusion of frontonasal prominence, maxillary prominence and mandibular prominence. There is only one case report describing the occurrence of ODP in a young patient with cleft lip and palate who also had basal encephalocele. We describe a 52-year-old patient with congenital cleft lip and palate with bilateral ODP with maculopathy but without any other midline abnormality.

The Optical Performance of Spherical and Aspheric Intraocular Lenses in Pediatric Eyes: A Comparative Study.

PURPOSE: To compare the optical performance of aspheric intraocular lenses (IOLs) designed to correct the corneal spherical aberration versus spherical IOLs in pediatric eyes after cataract surgery. METHODS: In this prospective study, 40 eyes of patients 6 to 16 years old with developmental cataract were randomly assigned to receive a spherical IOL or an aspheric IOL after pediatric cataract surgery. At 3 months postoperatively, the outcomes compared between the two groups were best-corrected visual acuity, contrast sensitivity, and wavefront aberrometry. RESULTS: The mean best-corrected visual acuity was 0.32 ± 0.19 logMAR in the spherical IOL group and 0.28 ± 0.16 logMAR in the aspheric IOL group (P = .179). The aspheric IOL group showed better contrast sensitivity at 1.5, 3, and 6 cycles per degree than the spherical IOL group (P < .05). Total ocular aberrations, higher-order aberrations, and spherical aberrations were significantly lower in the aspheric IOL group (P < .05). CONCLUSIONS: The results suggest that aspheric IOLs compensate for the spherical aberration of pediatric eyes. In comparison to spherical IOLs, eyes with aspheric IOLs had decreased ocular aberrations, particularly spherical aberration, which contributed to better contrast sensitivity in these eyes. Further studies are required to evaluate the role of aspheric IOLs in children.

Full-thickness macular hole in Bartonella henselae neuroretinitis in an 11-year-old girl.

Cat scratch disease is a febrile illness caused by Bartonella henselae and is associated with rash at the site of cat bite or scratch and regional lymphadenopathy. Various ocular manifestations of cat scratch disease have been described, mainly retinochoroiditis, optic disc swelling, neuroretinitis, vascular occlusive events, serous retinal detachment, vitreous hemorrhage, intermediate uveitis, inflammatory lesions of the optic nerve head and rarely full thickness macular hole. We describe a case of an 11-year-old girl who presented 2 weeks after the onset of symptoms, with B. Henselae neuroretinitis with full thickness macular hole at presentation.

Ocular findings in a case of periorbital giant congenital melanocytic nevus.

Giant congenital melanocytic nevus (GCMN) is a large melanocytic nevus that rarely occurs in the periorbital region. Various systemic, as well as ophthalmic associations, have been reported with GCMN. However, there is only one case report describing ophthalmic findings in periorbital GCMN. We describe the ocular findings in a case of periorbital GCMN.

Branch retinal artery occlusion associated with congenital retinal macrovessel.

A congenital retinal macrovessel (CRM) is a large retinal vessel, usually a vein, which traverses through the central macula and has large tributaries extending on both sides of the horizontal raphe. In the majority of cases, CRM have no effect on visual acuity, although in rare cases, macular hemorrhage, foveolar cysts, serous macular detachment, and the presence of the anomalous vessel in the foveola can affect vision. We describe a case of CRM with decreased vision secondary to a branch retinal artery occlusion (BRAO). To the best of our knowledge, this association has not been reported previously.

Parry-Romberg syndrome studied by spectral-domain optical coherence tomography.

Parry-Romberg syndrome is a rare disorder characterized by progressive hemifacial atrophy. Ophthalmic findings are characterized by enophthalmos, strabismus, nerve palsies, anisometropia, glaucoma, and angle abnormalities. Vision loss has also been reported due to retinal changes such as venous dilatation, disc edema, retinal edema, and retinal folds. The authors describe a case of Parry-Romberg syndrome with retinal alterations but a normal macula on spectral-domain optical coherence tomography.

Spectral-domain optical coherence tomography following Nd:YAG laser membranotomy in valsalva retinopathy.

BACKGROUND AND OBJECTIVE: To describe spectral-domain optical coherence tomography (SD-OCT) findings following Nd:YAG laser membranotomy in premacular hemorrhage due to Valsalva retinopathy. PATIENTS AND METHODS: Interventional case series of 7 eyes with premacular hemorrhage due to Valsalva retinopathy. Best-corrected Snellen visual acuity (BCVA) and color fundus photography were obtained before and after the laser treatment. SD-OCT scans were obtained at 1, 3, and 6 months following treatment. RESULTS: SD-OCT revealed a convex dome-shaped cavity lined by a hyperreflective layer in all cases, which persisted until the end of follow-up. Two patients complained of metamorphopsia, although BCVA improved dramatically in all cases. The site of laser puncture was visible in 2 patients. No abnormality was detected in the underlying retinal layers. CONCLUSION: SD-OCT reveals formation of a premacular cavity following laser puncture for premacular hemorrhage in Valsalva retinopathy, which may persist despite successful drainage of blood. This may later result in metamorphopsia in certain patients.

Role of intravitreal bevacizumab in adult onset Coats' disease.

To evaluate the role of intravitreal bevacizumab in the treatment of Coats' disease diagnosed in adulthood. Prospective, interventional case series. Three patients with Coats' disease diagnosed in adulthood were managed with a single intravitreal injection of bevacizumab (1.25 mg) with peripheral laser photocoagulation 3 weeks later. All three patients had exudation at the macula (Stage 2B) along with peripheral retinal telangiectasia and aneurysms. They were followed up for 9 months. An appreciable reduction in the exudation at the macula and macular edema was observed in all cases following intravitreal bevacizumab therapy. In all patients, the visual acuity improved, and no signs of recurrence were observed at the final follow-up at 9 months. Intravitreal bevacizumab injections may be effective as an adjunctive treatment for adult-onset Coats' disease with foveal exudation along with laser photocoagulation to the peripheral retinal vascular abnormalities. Intravitreal bevacizumab was well tolerated by our patients, and no adverse effects were observed.

Proliferative retinopathy in a child with congenital cyanotic heart disease.

In congenital cyanotic heart disease, oxygenated and deoxygenated blood mixes, and oxygen saturation of the arterial blood is not maintained. As a result, an ischemic environment prevails in the entire body. While various ocular findings have been described in patients with cyanotic heart disease, proliferative retinopathy has not been previously noted. We report a child with congenital cyanotic heart disease and multiple fibrovascular fronds over the fundus consistent with proliferative retinopathy.