Search

PURPOSE To present a unique case of optic disk pseudo-duplication with proliferative diabetic retinopathy. METHODS Case report. RESULTS A 63-year-old white diabetic man presented with an apparent duplicated optic disk in the superonasal midperiphery of his left eye. A large flat frond of neovascularization fanned out from this structure. Optical coherence tomography scanning showed a noncolobomatous scar with a large plume of blood vessels sprouting from the choroid, thru the retina and branching out into the vitreous. Magnetic resonance imaging scanning revealed a normal left globe and orbit with a single optic nerve. The neovascularization regressed after panretinal photocoagulation and anti-vascular endothelial growth factor therapy. CONCLUSION We describe a unique case of proliferative diabetic retinopathy associated with pseudo-duplication of the optic disk. This case is unique in the peripheral location of the pseudo-duplication, the presence of spontaneous choroidovitreal neovascularization in proliferative diabetic retinopathy, and the appearance of neovascularization elsewhere mimicking neovascularization of the duplicated disk.

Purpose To present a case of atypical solar maculopathy. Methods Case report. Results A 7-year-old boy who viewed an eclipse 17 months earlier had macular findings blending features of solar and laser pointer maculopathies. The right macula clinically had a central 1,000-μm, slightly irregular round area of pigmentary changes and a tiny outer macular optical coherence tomography defect. In addition, the superior fovea had a hyperreflective mound-like retinal pigment epithelial detachment extending into the outer retina. The left macula contained several, more typical solar maculopathy lesions. Conclusion We describe a unique case of solar maculopathy displaying typical optical coherence tomography findings in both eyes along with a unilateral laser pointer-like hyperreflective retinal pigment epithelial detachment.

PURPOSE To evaluate the optical coherence tomography (OCT) imaging findings in recent onset neurosensory retinal detachments induced by central serous chorioretinopathy and to attempt to corroborate these findings with proposed anatomical correlates. METHODS Retinal detachments due to central serous chorioretinopathy of less than 3 months' duration and the surrounding area were scanned with OCT. The imaging of the outer retinal bands was evaluated according to proposals by Cuenca et al and the IN•OCT Consensus classification. RESULTS Optical coherence tomography findings in 11 eyes (11 patients) with CSC showed that all hyperreflective bands above Band 4 were variably continuous within the outer portion of the serous detachment. We then attempted to reconcile inconsistencies in current explanations for the outer retinal bands to propose changes to the outer retinal OCT nomenclature. CONCLUSION Our patients' OCT findings support the current standard that Band 3 is an outer retinal structure and that Band 4 represents the retinal pigment epithelium/Bruch complex. Confusion exists regarding whether the interdigitation zone extends halfway up or for the full length of the outer segments, and the hyporeflective band between Bands 3 and 4 has yet to receive an appropriate term. We therefore propose a modification to the IN•OCT Consensus classification by renaming the trilaminar hyporeflective, hyperreflective, and hyporeflective bands between Bands 2 and 4 as the outer segment-interdigitation zone complex consisting of the inner, middle, and outer segment-interdigitation zone, respectively.

Purpose To report a previously undescribed spectral-domain optical coherence tomography finding, the outer Bruch membrane layer. Methods Prospective case descriptions. Results Patients with variable macular abnormalities were examined with spectral-domain optical coherence tomography scanning. All had areas of either retinal pigment epithelial elevation or atrophy with an underlying hyperreflective band that we interpret as the outer Bruch membrane layer. Conclusion The outer Bruch membrane is a consistent optical coherence tomography finding in areas of absent, atrophic, or elevated retinal pigment epithelium.

Purpose: The authors determine if specific features of the clinical presentation of acute postoperative endophthalmitis correlate with the microbiologic culture results. Methods: A total of 420 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation were evaluated as part of a randomized clinical trial. Results of cultures performed on aqueous and vitreous specimens obtained at presentation were categorized as follows: gram-positive coagulase-negative micrococci, "other" gram-positive, gram-negative, and equivocal/no growth. Results: Eleven features of the initial clinical presentation were associated with significant differences in the microbiologic spectrum ( P Conclusions: The presenting characteristics of acute endophthalmitis after cataract surgery may be helpful in predicting the most likely culture results. Such predictions do not appear sufficiently strong to guide the initial empiric choice of intravitreal antibiotics.

Purpose To compare aqueous levels of fluocinolone acetonide (FAc) after administration of FAc inserts or FAc implants (Retisert; Bausch & Lomb, Rochester, NY). Design Comparison of pharmacokinetics from 2 prospective, interventional, clinical trials. Participants Thirty-seven patients with diabetic macular edema (DME) (Fluocinolone Acetonide in Human Aqueous [FAMOUS] Study, C-01-06-002) and 7 patients with uveitis (NA-00019318). Methods Aqueous FAc was measured after administration of FAc implants or 0.2 μg/day (low dose, ILUVIEN; Alimera Sciences Inc., Alpharetta, GA) or 0.5 μg/day (high dose) FAc inserts. Main Outcome Measures The primary end point was aqueous levels of FAc. Results At 1 month after administration for subjects who received 1 treatment, mean aqueous FAc levels were 2.17 (low dose) and 3.03 ng/ml (high dose) for FAc inserts and 6.12 ng/ml for FAc implants with maximum levels of 3.83, 6.66, and 13.50 ng/ml, respectively. At 3 months, mean FAc levels were 1.76, 2.15, and 6.12 ng/ml, respectively. Between 6 and 36 months after low-dose inserts, aqueous levels of FAc were remarkably stable, ranging from 1.18 to 0.45 ng/ml. After high-dose inserts, mean FAc levels were stable between 6 and 24 months, ranging from 1.50 to 0.84 ng/ml and then decreasing to 0.35 ng/ml at 30 months and 0.15 ng/ml at 36 months. In implant-containing eyes, mean FAc levels remained >6 ng/ml through 15 months, the last time point with measurements from at least 6 eyes. Conclusions Low- and high-dose FAc inserts both provide stable long-term release of FAc with comparable peak levels in the aqueous: slightly >2 ng/ml for approximately 3 months followed by steady-state levels between 1.0 and 0.5 ng/ml through 36 months for low-dose inserts versus levels between 1.5 and 1.1 ng/ml through 24 months for high-dose inserts. Steady-state aqueous levels after FAc implants were >6 ng/ml. These results provide new insights that aid in the interpretation of efficacy trials and indicate that there is a dose effect for steroid-induced ocular hypertension. In susceptible patients, prolonged aqueous levels of FAc >1 ng/ml moderately increased the risk of glaucoma and levels >6 ng/ml posed a markedly increase risk. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.

Retinal astrocytomas are rare, usually asymptomatic, hamartomatous retinal tumors that are most commonly seen in patients with tuberous sclerosis. Serous detachment of the macula is a rare complication of retinal astrocytomas. The first successful treatment with laser photocoagulation of two eyes (two patients) with decreased vision due to a serous detachment of the macula from a retinal astrocytoma is described. Laser photocoagulation should be considered for retinal astrocytomas causing persistent or increasing exudation that is threatening the macula or causing visual loss.

The posterior dislocation of an intraocular lens is a serious complication of extracapsular cataract extraction with implantation of a posterior chamber intraocular lens. We describe a method of repositioning and suturing such a lens, using pars plana techniques. The method we recommend has several advantages over previously described methods, including the use of radially oriented scleral fixation sutures.

Bimanual vitrectomy has become the method of choice for performing closed vitrectomy. In certain situations, visualization is improved by using indirect ophthalmoscopy to see the vitrectomy instrument. A simple method using a +20.00-diopter condensing lens is described as a means of practicing the initially difficult unimanual technique, which requires working in an inverted operative field.

Background Transconjunctival cryotherapy or laser photocoagulation with simultaneous Eisner funnel scleral depression has been used to treat selected cases of rhegmatogenous retinal detachment. There are no studies to date reporting the use of the laser indirect ophthalmoscope coupled with scleral depression for treating retinal detachment. Methods 16 consecutive patients (18 retinal detachments in 17 eyes) were enrolled in a prospective, uncontrolled clinical trial using the laser indirect ophthalmoscope with scleral depression as the sole treatment for retinal detachment. The region immediately surrounding the break where subretinal fluid was present was directly treated rather than demarcated. All patients were treated with local anesthesia in an outpatient setting. Results Complete retinal reattachment was initially achieved in 14 (78%) of 18 eyes after scleral depression and laser alone. Significant postoperative complications of scleral depression with laser indirect ophthalmoscope photocoagulation included macular pucker (2 eyes), late recurrent rhegmatogenous retinal detachment without proliferative vitreoretinopathy (1 eye), and late recurrent rhegmatogenous retinal detachment with proliferative vitreoretinopathy (2 eyes). Failure of initial treatment to flatten the retina, late recurrent retinal detachment, macular pucker, or proliferative vitreoretinopathy led to scleral buckling and/or vitrectomy in 6 (86%) of the 7 eyes with clinical detachment and 3 (30%) of the 10 eyes with localized detachment. Final retinal reattachment at the last follow-up examination was achieved in all 17 eyes with subsequent surgical procedures. Conclusion Although scleral depression with laser indirect ophthalmoscope photocoagulation is a noninvasive outpatient surgical procedure that is capable of flattening selected retinal detachments, its use cannot be recommended because of the relatively high rate of postoperative complications requiring further surgical procedures.

The Macular Photocoagulation Study (MPS) recently documented the benefit of laser photocoagulation for selected patients with age-related macular degeneration and subfoveal choroidal neovascularization. 1-3 All MPS centers used either Zeiss (Carl Zeiss Inc, Thornwood, NJ) or Topcon (Topcon America Corporation, Paramus, NJ) cameras to produce standard 30° stereo fundus photographs and fluorescein angiograms. Both cameras, according to their manufacturers, produce images that are magnified by a factor of 2.5. Lesion size and location, as measured from these standard 30° photographs and fluorescein angiograms, were critical factors in determining which eyes benefited from treatment. The MPS published a replica of their disc area template to aid clinicians in deciding which eyes should be treated. 3 Using Canvas (Deneba Software, Miami, Fla), a precision drawing program for the Macintosh personal computer, I created a similar template for my own use. I created circles of 2.0, 3.5, 4.0, and 6.0 disc areas, assuming

Thermal papillitis is a previously unrecognized complication of photocoagulation for peripapillary choroidal neovascularization. This report describes a patient in whom transient thermal papillitis, choroidal ischemia, and two small branch retinal arteriolar occlusions developed after dye red photocoagulation of an idiopathic peripapillary choroidal neovascular membrane.