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To describe a patient with a choroidal osteoma treated with photodynamic therapy to prevent tumor growth in whom choroidal neovascularization (CNV) developed after being treated with photodynamic therapy.Case report.A 5-year-old Hispanic woman presented with an asymptomatic choroidal osteoma, temporal to the macula of her right eye. According to the patient's mother, her medical, surgical, and family history was unremarkable. At examination, best-corrected visual acuity was 20/30 in both eyes. After 11 months of follow-up, signs of tumor growth toward the fovea without any signs of CNV was noted. Photodynamic therapy was performed to prevent invasion of the foveola. Two months thereafter, the patient developed CNV in the macula region in the right eye, decreasing visual acuity to 20/200. The patient was treated with four total intravitreal injections of 1.25 mg of bevacizumab over 24 weeks, which resulted in inactivation of the CNV and improved visual acuity to 20/20. Choroidal neovascularization had been never reported in her past history and her follow-up visits over 7 years. In addition, no evidence of recurrent neovascular activity or tumor growth was reported.Choroidal osteoma is a benign tumor that can result in vision-threatening complications, caused by tumor growth and tumor decalcification. Photodynamic therapy is an effective modality in inducing choroidal osteoma decalcification and stabilization; however, CNV due to reperfusion following photodynamic therapy can be seen in the retina.

PURPOSE To describe four cases of varix of the vortex vein ampulla imaged with dynamic echography. METHODS Observational case series of four patients with varix of the vortex vein ampulla diagnosed with ocular examination maneuvers such as digital pressure or Valsalva. Dynamic echography was used to confirm the diagnosis. RESULTS Dynamic echography can quickly and noninvasively show the varix of the vortex vein ampulla disappear with external pressure, or engorge with a Valsalva maneuver or altered gaze directions. CONCLUSION Dynamic echography is very helpful in the establishment of the diagnosis of varix of the vortex vein ampulla and differentiating this benign condition from other retinal or choroidal abnormalities.

Background/purpose To describe the use of topical mitomycin-C in sclerostomy revision for recalcitrant idiopathic uveal effusion syndrome. Methods A 50-year-old healthy man presented with painless, gradual vision loss in the right eye. He underwent multimodal retinal imaging with wide-field fundus photography, spectral domain optical coherence tomography, and B-scan and A-scan ultrasonography. He was found to have idiopathic (non-nanophthalmic) uveal effusion syndrome with choroidal and serous retinal detachments in the right eye and a peripheral choroidal detachment in the left eye. Central vision became threatened in the right eye. Medical treatment with oral corticosteroids and surgical treatment with choroidal drainage through sclerostomies and sclerostomy revision were administered. Results Initial treatment with systemic corticosteroids was ineffective. Subsequent choroidal drainage through sclerostomies only partially resolved the effusion. Later sclerostomy revision with application of topical mitomycin-C led to complete resolution with anatomical stability maintained after at least 42 months of follow-up. Conclusion Successful use of topical mitomycin-C in sclerostomy revision has not previously been reported in idiopathic (non-nanophthalmic) uveal effusion syndrome. We propose that topical mitomycin-C may be considered as a potential therapeutic adjunct in the treatment of refractory idiopathic uveal effusion syndrome before further sclerostomy procedures are attempted in additional quadrants of the eye.

The proposed doses of chloroquine (CQ) and hydroxychloroquine (HCQ) for treatment of COVID-19 (1000 mg/day for 10 days, CQ; 800 mg first day then 400 mg/day for 5 days, HCQ) in many guidelines worldwide, are considerably higher than the maximum recommended daily safe doses of both agents (≤2.3 mg/kg/day, CQ; ≤5.0 mg/kg/day, HCQ) for development of retinal toxicity. Irreversible retinal damage can occur if the exposure to the safe doses is >5 years. It is not known whether exposure to high doses over a short period of time can also cause the damage. We recommend that before prescribing CQ or HCQ, history of ocular disease should be obtained to avoid the prescription if appropriate. If either agent is to be used, routine baseline ocular examination is not absolutely necessary. Patients who do not have ocular disease should also be informed about the potential risk of retinal toxicity. Both agents, however, have not yet been proven to be beneficial to COVID-19.

PurposeTo report bilateral hemorrhagic retinopathy in an adult female subject after lumbar spinal surgery and seizure.Case ReportA 38-year-old woman presented with bilateral blurry vision and spots in the visual field. The patient had lumbar spondylosis surgery that was complicated by a dura

Purpose To report outer retinal disruption and uveal effusion after gemcitabine and docetaxel combination therapy. Case report A 78-year-old woman presented with blurry vision after two cycles of gemcitabine and docetaxel combination chemotherapy for stage IV sarcoma. At presentation, visual acuity was finger counting and 20/25 in the right and left eyes, respectively. Slit-lamp examination and B-scan ultrasonography revealed severe uveal effusion in the right eye and choroidal folds in the left eye. Spectral domain optical coherence tomography showed disruption of photoreceptor inner segment ellipsoid band in the right eye. The patient was monitored weekly with ophthalmic examination and B-scan ultrasonography, while continuing with gemcitabine monotherapy. At 8 weeks follow-up, uveal effusion improved considerably and visual acuity was 20/40 and 20/20 in the right and left eyes, respectively. Conclusions Uveal effusion and outer retinal disruption were reported after gemcitabine and docetaxel chemotherapy. Early detection and close ophthalmic monitoring may allow concurrent cancer treatment and prevention of possible chemotherapy-induced ocular side effects.

Update on controversies in the surgical management of rhegmatogenous retinal detachment.There are multiple new reports regarding the development and management of retinal detachment. Current use of oral fluoroquinolones may be associated with onset of retinal detachment, although the clinical relevance of this correlation is uncertain at this time and the finding has not been replicated in subsequent studies. Pars plana vitrectomy (PPV) continues to demonstrate efficacy as a primary treatment for retinal detachment, especially in pseudophakic patients. In many patients with macula-on retinal detachment, scheduling surgery after a short time delay is not necessarily deleterious and may actually be beneficial. Novel surgical tools, including bioerodible scleral buckling materials and artificial vitreous substitutes, are being investigated.Retinal detachment remains an important cause of visual loss. Although current surgical techniques demonstrate high rates of anatomic and visual success, further advances will probably benefit patients with retinal detachment.

PURPOSE To report two cases of central macular sparing of subhyaloid hemorrhages secondary to vitreomacular adhesion documented by spectral-domain ocular coherence tomography findings. METHODS Review of two patients with subhyaloid hemorrhage secondary to proliferative diabetic retinopathy and a macroaneurysm were performed. Treatment was not performed in either patient for management of the hemorrhage, but the patient with proliferative diabetic retinopathy was treated with panretinal photocoagulation for peripheral neovascularization. Foveal sparing of the hemorrhage was documented clinically and on spectral-domain ocular coherence tomography. RESULTS In Case 1, the proliferative diabetic retinopathy was stabilized with 2 rounds of panretinal photocoagulation treatment, and the visual acuity improved to 20/20 in the affected left eye after 8 months of observation. In Case 2, the visual acuity returned to baseline at 20/60 after 4 months of observation. CONCLUSION Macular involvement of subhyaloid hemorrhages may cause visual impairment, but vitreomacular adhesion may block the hemorrhage from obstructing the fovea.

To determine the cumulative incidence and annual incidence of intraocular hemorrhage (subretinal hemorrhage or vitreous hemorrhage) in patients with neovascular age-related macular degeneration (AMD) and association with daily antiplatelet or anticoagulant (AP/AC) medication usage (aspirin, clopidogrel, and warfarin), age, gender, hypertension, diabetes mellitus, or bilateral neovascular AMD.Retrospective cross-sectional study in a tertiary university setting. Data on 195 eyes of 195 patients without previous intraocular hemorrhage examined over 73 months were reviewed.Ninety-six of 195 patients (49.2%) were taking daily AP/ACs. Of patients taking daily AP/AC agents, 63.5% had hemorrhage compared with 29.2% of patients not taking (odds ratio = 4.21; 95% confidence interval = 1.42-8.46; P0.001). The overall annual incidence of intraocular hemorrhage was 0.14% per year. Among patients taking daily AP/AC, the cumulative incidence (61 of 96, 63.5%) and annual incidence (0.10%) of concurrent intraocular hemorrhage were significantly greater compared with patients not taking them (29 of 99, 29.2% and 0.04%, respectively; P0.0001). Fourteen of 18 patients (77%) taking more than 1 daily AP/AC had occurrence of intraocular hemorrhage. Antiplatelet or anticoagulant usage was an independent risk factor for the development of intraocular hemorrhage. The use of any agent resulted in a significantly increased risk of developing intraocular hemorrhage. Additionally, presence of bilateral neovascular AMD was a significant association in those taking daily AP/ACs, whereas age was a significant association in those not taking daily AP/AC agents.All three daily AP/AC types were significantly associated with an increased risk of the development intraocular hemorrhage in patients with neovascular AMD, whereas gender, hypertension, and diabetes were not. Age was not significantly associated with hemorrhage in patients taking daily AP/AC agents, whereas the presence of bilateral neovascular AMD was significantly associated with hemorrhage. These findings indicate that the AP/AC use may predispose patients with neovascular AMD to intraocular hemorrhage more so than age and duration of disease alone. While the risk that discontinuing these medicines would pose to the patients' health may be too great to justify, ensuring that an appropriate medication dosage is maintained should be a priority within this patient population.

Pregnancy is often associated with ocular changes, most often transient in nature, though occasionally permanent. It can be associated with development of new conditions, or can exacerbate pre-existing conditions. The ocular effects of pregnancy may be divided into physiologic changes, pathologic conditions or modifications of pre-existing conditions. Pathologic conditions include entities such as pre-eclampsia and eclampsia, along with conditions that are seen with increased frequency during pregnancy such as central serous retinopathy. The most significant modified pre-existing condition is diabetes mellitus. The various effects of pregnancy on the eye will be reviewed in this article.

To study the results of modern vitrectomy in traction and combined traction-rhegmatogenous retinal detachment involving the macula in cases of ocular toxocariasis.This was a cohort study of patients seen in different institutions in the United States. Ten eyes of 10 patients were studied. Vitrectomy was performed in all eyes, combined with membrane removal, scleral buckle, fluid-gas exchange, silicone oil, or lensectomy in certain cases. The anatomic and visual results of surgery were reviewed.Ten eyes from 10 patients ranging in age from 2 to 33 years (median, 6 years) were reviewed. Follow-up ranged from 3 months to 8 years (median, 2 years). All eyes achieved macular attachment following surgery; vision improved in 5 (50%) eyes, and was unchanged in 5 (50%). Histologic specimens from six eyes were reviewed, and revealed combinations of fibrous tissue, eosinophils, plasma cells, lymphocytes, and giant cells. One specimen revealed an encysted Toxocara canis organism.Inflammation created in response to Toxocara larvae may lead to traction retinal detachment of the macula. Vitreoretinal surgery has a good chance of reattaching the macula and improving vision.

PURPOSE To report the outcome of repeated photodynamic therapy (PDT) for a patient with choroidal neovascularization complicating Stargardt disease. METHODS Interventional case report. RESULTS A 41-year-old patient with Stargardt disease developed unilateral choroidal neovascularization treated multiple times with PDT over 2.5 years. At that time, she developed choroidal neovascularization in the fellow eye also treated with PDT. Despite poor interim vision, after >4 years of follow-up, final visual outcome was excellent. CONCLUSION Our case provides further evidence that repeated PDT may be used for the treatment of choroidal neovascular membrane complicating Stargardt disease without deleterious effects up to 4 years after treatment.

Golf-related ocular injuries have been reported since the early 1900s. Although this type of ocular injury is fortunately a relatively rare occurrence, the effects are usually devastating. The purpose of this article is to review the mechanism of golf injuries, the prognosis for different types of golf-related injuries, and how such injuries might be prevented.

BACKGROUND Visual recovery after submacular surgery for age-related macular degeneration (AMD) has been very limited. METHODS A patient with an extrafoveal fibrotic choroidal neovascular membrane from AMD had an overlying serous foveal detachment with the fibrotic tissue elevating the foveal retina. Photocoagulation of the neovascular membrane was not recommended because of its nonpigmented, fibrotic nature. The membrane was surgically excised. RESULTS Preoperative and postoperative visual acuity and central 30 degrees visual fields were followed. Visual acuity improved from 20/200 to 20/25, and a preoperative central scotoma resolved completely 18 months after surgical excision of the extrafoveal fibrotic neovascular membrane. There were no intraoperative or postoperative complications. CONCLUSION This type of patient may represent a distinct subset of patients with AMD amenable to subretinal surgery who could potentially have good recovery of vision.

The cases of 4 patients with clinical signs of intraocular large cell lymphoma are described. Initial cytopathologic examination of vitrectomy specimens failed to establish the malignant character of the vitreous infiltrates. Three of the four patients eventually developed solid central nervous system tumors, intracranial biopsy samples of which revealed large cell lymphoma, 13 months to 42 months after initial examination. In one patient, transscleral retinochoroidal biopsy confirmed the diagnosis at the same time as negative vitreous cytologic examination. Results of cytopathologic examination alone of vitreous biopsy specimens may not be sufficient to make a diagnosis in certain cases of large cell lymphoma that are subsequently documented by CNS biopsy. Careful attention should be paid to the handling, processing, and interpretation of vitrectomy specimens from patients suspected of having intraocular large cell lymphoma. Consideration should be given to immunocytologic staining and interpretation by centers that are highly experienced in vitreous cytopathology.

An alternative treatment to repeat vitrectomy in postvitrectomy diabetic vitreous hemorrhage (PDVH) is outpatient fluid-air exchange, but the long-term visual results of this procedure are not known. Between January 1986 and April 1989, a pars plana air-pump technique was used to perform outpatient fluid-air exchange in 20 eyes of 17 patients (17 phakic eyes) within 8 weeks of onset of PDVH. A mean follow-up interval of 78 weeks was obtained. Preoperative vitreous hemorrhage was severe enough to obscure all fundus detail (17 eyes) or produce erythroclastic glaucoma (three eyes). Initial visual acuity was hand motions or light perception in 19 eyes and improved to a median visual acuity of 20/300 soon after resolution of the intraocular air bubble. Early complications included postoperative fibrin formation (one eye) and early postoperative intraocular pressure elevation (two eyes). Recurrent vitreous hemorrhage required repeated fluid-air exchanges in seven eyes. Long-term complications included worsening of posterior subcapsular cataract (10 of 17 phakic eyes, 59%), for which cataract extraction was required in five eyes (29%). Fluid-air exchange appeared to exacerbate cataract formation, justifying a period of observation for PDVH. However, it appeared to be a low-risk alternative to repeat vitrectomy, allowing rapid visual recovery from severe PDVH.

The authors examined 104 patients with penetrating ocular injuries and retained intraocular foreign bodies. Nineteen patients (18%), with 20 injured eyes, were aged 18 years or younger. Fifty percent of eyes in the young people (10/20) achieved a final visual acuity of 20/30 or better and 65% (13/20) achieved 20/100 or better. Young people were significantly more likely than adults to be injured as a result of a projectile weapon or explosion (P less than 0.001). They also had a greater incidence of an initial visual acuity worse than 5/200 (P less than 0.001), which was statistically associated with a greater incidence of hyphema (P = 0.002), retinal detachment (P = 0.022), and uveal prolapse (P = 0.082). Although the distribution of final visual acuity was not significantly different between young people and adults, the latter tended to have poorer visual outcome after adjusting for initial visual acuity (P = 0.01). Language: en

The authors report a patient who was observed to have a localized retinal detachment with combined central retinal artery and vein occlusion after cataract surgery performed with retrobulbar anesthesia. The authors propose that this condition resulted from injection of the anesthetic mixture into the optic nerve. No acute neurologic symptoms occurred, but visual loss was severe and permanent. This case adds to the previously reported spectrum of complications from retrobulbar anesthesia.

Repair of retinal detachments in high myopia may be associated with numerous intraoperative complications. Included are complications involved with the drainage of subretinal fluid as well as those arising from thin sclera. Highly myopic eyes tend to be more prone to these complications than less myopic or nonmyopic eyes. A retrospective study of 51 consecutive highly myopic eyes (six diopters (D) or greater) undergoing primary scleral buckling procedures was performed. Intraoperative complications occurred in a total of six eyes (12%). The complications were related to drainage of subretinal fluid in four eyes (8%) and associated with thin sclera in two eyes (4%). Despite the above-noted complications, there was no adverse effect on the final level of visual acuity or on the anatomic status of the retina. In the comparison of the incidence of drainage-related complications with previously published studies not preselected according to refractive status, there appears to be no added risk of complications based on the degree of myopia.

PURPOSE: To describe the clinical characteristics and management of retinal injuries caused by soccer ball impact as well as the mechanism of injury, prognostic features, risk factors, and possible prevention strategies. METHODS: Thirteen cases of soccer ball injuries from retina referral practices were retrospectively reviewed, with attention to the mechanism of associated ocular complications and the anatomic and visual outcomes. RESULTS: Soccer ball injuries occurred in both male and female patients (9 male, 4 female) with ages ranging from 8 to 21 years (median 14 years). These patients were observed from 0 to 64 months (median follow-up, 8 months). Four patients had traumatic macular holes, two eyes had retinal detachment associated with retinal dialysis, two had retinal tears associated with hemorrhage, one had a choroidal rupture, and one had only vitreous hemorrhage and Berlin's edema. Although six eyes had some degree of traumatic retinal pigment epitheliopathy, it was the primary diagnosis in only three. Visual acuity at presentation ranged from 20/20 to count fingers, with 7/13 (54%) having 20/200 or worse vision. Seven eyes underwent surgical procedures; the remainder were observed. Final visions ranged from 20/20 to count fingers, with 3/13 (23%) having 20/200 or worse vision. Six eyes (46%) improved by two or more lines by the last follow-up. CONCLUSION: Soccer ball-related ocular injuries disproportionately affect young players, are more frequent in females than previously reported, and have more severe visual consequences than previously recognized. Injury prevention strategies to minimize contact between the eye and the soccer ball may reduce the incidence and severity of eye injuries. Language: en

A 67-year-old white woman had a lesion that clinically, echographically, and angiographically appeared to be consistent with choroidal melanoma. At follow-up examination 2 months later, the lesion had clinically completely resolved. A limited choroidal hemorrhage simulating a choroidal melanoma is postulated.