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Objective: To study the concentration of vascular endothelial growth factor in the aqueous humor before and after intravitreal injection of bevacizumab in eyes with proliferative diabetic retinopathy., Methods: In this prospective, interventional case series, 1.25 mg of bevacizumab was injected into the vitreous cavity as preoperative adjunctive therapy 1 week before pars plana vitrectomy to treat proliferative diabetic retinopathy in 18 eyes in 18 patients. Aqueous humor samples were obtained just before intravitreal injection of bevacizumab and just before vitrectomy 1 week after the injection. Aqueous humor samples also were obtained in patients with cataract without diabetes mellitus (control group). The vascular endothelial growth factor concentration in the aqueous humor was measured using an enzyme-linked immunosorbent assay., Results: Vascular endothelial growth factor concentration in the aqueous humor ranged from 146 to 676 pg/mL (mean +/- SD, 326 +/- 125 pg/mL) before intravitreal injection of bevacizumab and decreased to less than 31 pg/mL (P < .001) in all eyes 1 week after injection. Intravitreal bevacizumab therapy caused no adverse events. The concentrations in the control group ranged from 80 to 218 pg/mL (mean +/- SD, 146 +/- 40 pg/mL)., Conclusion: Intravitreal injections of bevacizumab resulted in a substantial decrease in vascular endothelial growth factor in the aqueous humor.

Foveal translocation surgery with 360 degrees retinotomy involves several surgical procedures, including creation of a total retinal detachment, rotation of the retina, and complete reattachment of the retina. Some of these procedures, which are time-consuming and difficult to perform, may damage the retina when conventional surgical instruments are used. To make these procedures safer and easier, we have developed 3 soft instruments: an atraumatic forceps, a modified Chang double-barrel cannula with a silicone tip, and a light pipe with a silicone tip. The atraumatic forceps allows the surgeon to grasp and peel off the retina with less damage during the creation of retinal detachment. A bimanual technique using the other 2 instruments allows surgeons to rotate and reattach the detached retina easily and safely. We believe that these soft-tipped instruments make foveal translocation a less complicated surgery.

Background: Most patients attain better visual acuity with the elimination of metamorphopsia after successful closure of a macular hole (MH) by vitrectomy., Objective: To determine the presurgical visual function of eyes with an MH., Methods: We examined 54 eyes of 51 patients with an idiopathic MH using the Amsler chart. We evaluated the types of subjective metamorphopsia and compared them with the clinical factors associated with MHs. In a prospective study, we performed a montage test on a separate group of 16 patients with unilateral idiopathic MHs. The patients were asked to choose, while viewing with their better eye, the computer-modified picture that best matched the unmodified image seen by the eye with the MH., Results: From the results of the Amsler chart test, we divided the subjective changes into 2 types of metamorphopsia; of the 54 eyes, pincushion distortion (bowed toward the center) was found in 33 (61%), and unpatterned distortion (no specific pattern) was found in 21 (39%). Pincushion distortion was significantly associated with an MH of shorter duration (< or =6 months) (P = .03) and an early stage (stage 2) of MH formation (P = .02). A scotoma was hard to detect, and patients had difficulty describing their scotomata and distortions. In the montage test, patients with early MHs chose portraits modified with a pincushion type of distortion., Conclusions: We found concentric pincushion metamorphopsia without subjective scotomata, which we suggest arises from an eccentric displacement of the photoreceptors. This accounts for the main characteristic of the visual performance of patients with idiopathic MHs.

Objective: To assess the efficacy and complications of intravitreal injection of perfluoropropane gas for displacement of subretinal hemorrhage (SRH), without the use of tissue plasminogen activator., Patients and Methods: Pure perfluoropropane gas (0.4-0.5 mL) was injected into the vitreous cavity in 5 patients with SRH involving the fovea because of age-related macular degeneration (4 eyes) or ruptured retinal arterial macroaneurysm (1 eye). The patients were instructed to maintain a prone position., Results: Visual acuity ranged from 20/300 to 20/2000 before gas injection. On the day after gas injection, SRH was dramatically displaced in 3 eyes and slightly displaced with a reduction in the thickness of subfoveal hemorrhage in the remaining 2 eyes. Final visual acuity improved in all cases, ranging from 20/15 to 20/220. Three eyes had a final visual acuity of 20/50 or better. Vitreous hemorrhage caused by migration of SRH into the vitreous cavity and retinal detachment each occurred in 1 eye, and both complications were successfully treated by vitrectomy., Conclusions: Gas injected into the vitreous cavity can displace SRH without the use of tissue plasminogen activator in some cases. Visual acuity after gas injection may be improved, making this treatment an alternative to evacuation of SRH with vitrectomy.

Intraoperative examination of the anterior chamber angle is necessary during several glaucoma procedures, including goniosynechialysis and goniotomy. Many of the available lenses for this purpose are difficult to use because they require oblique illumination and their size interferes with surgical manipulations at the limbus. We have developed a double-mirror gonioscopic lens that uses direct illumination; provides an upright image of angle structures; and has a small diameter, allowing simultaneous access to the entire limbal region. We compared our lens with the Posner goniomirror (Ocular Instruments, Bellvue, Wash) and found that it provides an equal view of angle structures. The double-mirror gonioscopic lens facilitates the intraoperative visualization of the anterior chamber angle and should allow surgeons who treat glaucoma to more accurately and safely perform angle-related procedures.

Many surgeons use prism lenses to see the periphery of the fundus during vitrectomy; however, chromatic aberrations in higher-power prismatic lenses cause blurring of the peripheral image. For better visualization of the periphery of the fundus, we developed a new contact lens, the double-mirror peripheral vitrectomy lens. The new lens is a quartz cylinder with two mirrors, and it provides a crisp, clear, upright image of much more of the peripheral fundus than is visible through conventional prism lenses. The new lens also provides a wider area of view than conventional prism lenses.

Iatrogenic retinal tears may complicate procedures to treat proliferative vitreoretinal diseases. To decrease the risk of this complication, we developed a new instrument, the membrane delamination wedge, that allows the surgeon to separate the proliferative membranes from the retina effectively and safely.

Two male patients had corneal endotheliopathy of unknown origin. In both patients it was characterized by continuously progressing bullous keratopathy preceded by a line of keratic precipitates resembling a rejection line. The disease was progressive and did not respond to intensive corticosteroid therapy. No virus could be isolated from the aqueous humor, and the aqueous-antibody titers to herpes simplex, varicella zoster, and measles viruses were below detection level.

Abnormality of the conjunctival epithelium was evaluated in ten patients with severe thermal and chemical injuries at the scarred stage, eight patients with Stevens-Johnson syndrome, five with cicatricial ocular pemphigoid, and 13 normal subjects, based on goblet cell densities obtained using impression cytologic examination. The average and SDs of goblet cell densities were 197.4 +/- 264.4/mm2 in thermal and chemical injuries, 3.0 +/- 5.6/mm2 in Stevens-Johnson syndrome, 0.6 +/- 0.8/mm2 in cicatricial ocular pemphigoid, and 38.7 +/- 25.8/mm2 in normal subjects. There were statistically significant differences in goblet cell densities between thermal and chemical injuries and both Stevens-Johnson syndrome and cicatricial ocular pemphigoid. Moreover, conjunctival specimens from both eyes in six unilateral cases of thermal and chemical injuries revealed higher goblet cell densities in the injured than in the normal fellow eyes in all cases. These findings imply that ocular surface diseases with similar clinical manifestations may have different cell-biologic abnormalities in the conjunctival epithelium.