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To describe the occurrence of cystoid macular edema (CME) in the setting of central foveal thickness (CFT) under 250 μm as measured by optical coherence tomography (OCT) in patients with retinitis pigmentosa (RP).Stratus OCT was used to measure CFT in a total of 90 eyes from 46 patients with RP. Cross-sectional OCT images were also evaluated for CME, which was defined as cystoid changes in the macula seen on at least two linear scans.CME was identified in 13 of the 46 patients or in 22 of 90 eyes by OCT. In eyes with macular edema, CFT ranged from 224 to 718 μm (mean = 339 ± 137 μm). In eyes without macular edema, CFT ranged from 99 to 273 μm (mean = 184 ± 40 μm). Bilateral CME occurred in 9 of 13 patients (69%). CFT was considered "normal" in 7 of the 22 eyes (32%) with CME. Two patients had bilateral CME with normal CFTs, under 250 μm.We demonstrate the occurrence of CME in RP patients without associated thickening, which has not been described. This concept likely is applicable to other diseases with retinal thinning.

Purpose: To report on a novel treatment strategy in an eye with a retinal angioma and macular edemaMethods: Wide-angle angiography was used to characterize the lesion and response to theraphy, while the treatment combined laser photocoagulation with the indirect laser delivery system, and intravitreal injections of pegaptanib and bevacizumab. Treatment was rendered over 21 months’ time.Results: The treatment resulted in graduate resolution of marked macular edema and exudation, with a gain in visual acuity.Conclusion: A combination of laser photocoagulation and anti-VEGF theraphy can be effective in the treatment of macular exudation and edema from a retinal angioma.

An insulin-dependent diabetic woman of 42 years received a combined pancreas and kidney transplant five years prior to referral to our clinic for ophthalmic consultation. Her systemic immunosupression included oral steroids and she subsequently developed huge bilateral central serous retinal detachments affecting both posterior poles and the temporal midperiphery of the left eye. Her vision was reduced to count fingers (CF) in both eyes. Fluorescein angiography (FA) revealed diffuse mild retinal pigment epithelium (RPE) staining in both eyes. As an empiric treatment grid laser photocoagulation with an 810 nm diode laser (Iridex Corp., Mountain View, California) was performed with complete resorption of subretinal fluid in both eyes and visual improvement to 20/70 in the right eye and 20/200 in the left eye at 18 months post-treatment. In patients diagnosed with atypical central serous retinal detachment whose fluorescein angiogram displays widespread RPE damage and in whom systemic steroids are medically necessary, diode grid laser photocoagulation may be a reasonable treatment option.

Four patients (age range 54-82, 1F 3M) diagnosed with non-arteritic ischemic optic neuropathy experienced acute worsening of visual function after instillation of phenylephrine for dilated funduscopic examination. They experienced decreased visual function immediately or shortly after administration of topical mydriatic drops given in preparation for funduscopy. In all cases one drop each of 2.5% phenylephrine and 0.5-1% tropicamide was used. Three patients had classical risk factors such as hypertension, diabetes, and had a contralateral "disc-at-risk". The female and youngest patient had ischemic optic neuropathy presumed secondary to lupus erythematosus. The time from acute visual loss to presentation to neuro-ophthalmic care ranged from 1-6 days. The time of onset of the decline in visual function varied from 45 minutes (patient with lupus) to 12 hours after instillation of mydriatic drops. Visual acuity at diagnosis ranged from 20/40-20/400. Phenylephrine is a mydriatic with vasoconstrictive properties, which may be absorbed through the cornea, thus yielding non-negligible intraocular concentrations. Vasoconstriction of the watershed posterior ciliary capillary beds may result in further precipitating infarction of already compromised circulatory territories in edematous optic nerves. Because phenylephrine is a known vasoconstrictor in vivo and in vitro, it is more likely to cause deleterious vasoconstriction and an acute decline in visual function in patients with acute ischemic optic neuropathy than tropicamide. The routine practice of using phenylephrine to prepare patients for funduscopic assessment should be re-examined, particularly in patients with ischemic optic neuropathy.

Purpose: To report an atypical presentation of ocular toxoplasmosis and to demonstrate the utility of wide-field angiography in delineating peripheral retinal pathology.Methods: Case Report.Results: A 17-year-old male presented with acute unilateral papillitis and retinochoroiditis. Laboratory testing supported reactivation of congenitally acquired Toxoplasma gondii infection. Wide-field fluorescein angiography showed extensive retinal vasculitis. The patient was treated with sulfamethoxazole/trimethoprim. Ocular inflammation resolved over a two-week period. There was no documented visual loss.Conclusion: Wide-field fluorescein angiography details ocular pathology otherwise unnoticed on traditional posterior pole fluorescein angiography. Documentation of extensive vasculitis associated with ocular toxoplasmosis can assist with management decisions.

Drusen are deposits located deep in the sensory retina that are seen characteristically in eyes with macular degeneration (AMD). As multiple large drusen are a risk factor for the development of visual loss from AMD, laser strategies to cause drusen to resorb have been devised. Two large, randomized controlled trials using laser photocoagulation prophylactically for the treatment of AMD are underway to determine the efficacy of such treatment.

INCE THE 1950s, scleral buckling has been S the standard of care for the repair of retinal detachments. In the quest for the perfect retinal detachment procedure, alternate techniques have been developed over the past decade. The Lincoff balloon was designed with the idea that not all retinal breaks require the permanent support afforded by a buckle.' Although the Lincoff balloon has been used successfully to treat retinal detachments, it requires a conjunctival incision, and is associated with some of the same adverse consequences as scleral b~ckling."~ Obviating the need for hospitalization, pneumatic retinopexy, or the outpatient injection of a gas bubble into the vitreous cavity to tamponade the retinal breaks, offers potential advantages over more conventional approaches. HISTORY OF PNEUMATIC RETINOPEXY