Use of intravitreal triamcinolone for the treatment of optic nerve edema in a patient with acute retinal necrosis: case report.

PURPOSE: To report the use of combined intravitreal triamcinolone and foscarnet therapy in a patient with active acute retinal necrosis. METHODS: Retrospective case report. A 40-year-old white woman with a history of ulcerative proctitis, intolerant to oral steroids, developed an aggressive case of acute retinal necrosis complicated by severe optic nerve edema resulting in 20/200 vision. RESULTS: Intravitreal foscarnet provided an initial improvement of the vitritis and retinitis; however, optic nerve edema and 20/200 vision persisted. After 2 weeks, intravitreal triamcinolone was combined with the foscarnet dose. Four days later, the optic nerve edema had resolved, the vision returned to 20/40, and the herpetic infection remained controlled. Eight months later, the patient had not experienced a retinal detachment, and acuity was 20/20. Oral steroids are an accepted adjunct to antiviral therapy in acute retinal necrosis; however, combined intravitreal steroid and antiviral therapy has not been previously reported. After combined intravitreal therapy was attempted, the patient experienced a rapid resolution of symptoms without exacerbating her retinitis. CONCLUSION: In select patients, combined intravitreal triamcinolone and foscarnet may be effective in treating acute retinal necrosis and its inflammatory sequelae.

Refractive surgery policy and its effect on visual acuity qualification rates for the 2004 and 2011 Army ROTC flight applicant pools.

OBJECTIVES: The goal of this study was to ascertain the effect of recent U.S. Army Aviation corneal refractive surgery (CRS) policy changes on the size of flight school applicant pools by comparing statistics from the 2004 and 2011 Warrior Forge Army Reserve Officers' Training Corps training camps. METHODS: A retrospective chart review was performed using the United States Army Aeromedical Activity's Aeromedical Electronic Resource Online database. RESULTS: Of the 607 applicants from 2004, 100 (16%) were disqualified for decreased visual acuity and had refractive errors correctable by CRS. Thirty-four cadets (6%) had prior CRS, and 21 qualified for flight school in 2004. Of the 625 applicants from 2011, 105 (17%) were disqualified for decreased visual acuity and had correctable refractive errors. Sixty-four applicants (10%) had prior CRS, and 54 subsequently qualified in 2011. CONCLUSIONS: Changes to Army Aviation CRS policy over the last decade have been associated with an increased number of initial flight applicants who now meet visual acuity standards. However, only a small percentage is using this resource. Army Aviation has the potential to significantly widen its applicant pool if more candidates are made aware of accepted CRS techniques that can help them to meet rigorous vision standards.