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Purpose To evaluate the anatomical and functional findings in patients with vitreomacular traction (VMT) alone or in combination with epiretinal membrane (ERM). Methods In this retrospective, cross-sectional study, we studied 102 patients with VMT, either alone (n = 37) or combined with ERM (n = 65). All patients were examined with spectral-domain optical coherence tomography (SD-OCT). We recorded the vitreofoveal angle of VMT nasally and temporally, the horizontal diameter of VMT, macular thickness, the presence, type, and location of macular edema, the ellipsoid zone (ΕΖ)/external limiting membrane (ELM) status, and the visual acuity. Results Patients with VMT combined with ERM presented smaller vitreofoveal angle nasally and temporally, broader adhesion diameter, and a greater extent of EZ defect compared to patients with VMT alone, although there was no statistically significant difference in EZ and ELM condition regarding the number of affected cases. There is also no statistically significant difference between the 2 groups concerning the visual acuity. In the majority of patients with VMT alone, cystoid macular edema was present mainly at the foveal area. In cases where VMT coexisted with ERM, macular edema was mostly found to be diffuse, while cystoid or mixed type, extending to the whole macular area, was also present. Conclusions Patients with VMT in association with ERM have different characteristics in SD-OCT compared to those with VMT alone regarding the type and location of macular edema, the extent of EZ defect, as well as the vitreofoveal angle and the VMT diameter. Moreover, they presented worse visual acuity compared to those with VMT alone, although the difference did not reach statistical significance.

Purpose: To evaluate the external limiting membrane (ELM) by spectral domain optical coherence tomography (SDOCT) and its correlation with the inner segment/outer segment (IS/OS) line in patients with successful macular hole surgery. Procedures: Forty-five eyes were divided into 3 groups according to the interval between surgery and first examination. In the first group the interval was between 6 and 12 months, in group 2 it was >12 months and ≤24 months, and in group 3 it was >24 months. The IS/OS and ELM of participants’ eyes were postoperatively assessed using SDOCT in 2008 and 12 months later. Results: A statistically significant association between the integrity of the ELM and the IS/OS junction line was observed in postoperative examinations in all 3 groups. Eyes with a complete IS/OS junction line had an intact ELM. Between the first and the second examinations, a significant improvement in best-corrected visual acuity (BCVA) was noted only in group 1. A positive statistical association was also observed in group 1 between restoration of the IS/OS junction line and improvement in BCVA over follow-up. Conclusions: The restoration of the IS/OS junction line is directly related to the integrity of the ELM.

The authors describe a case with optic nerve head drusen and normal intraocular pressure that was followed up for 25 years. The patient had kinetic perimetry annually until 1997 and static automated perimetry thereafter. From 2002 on, optical coherence tomography scans were also performed but did not permit accurate nerve fiber layer thickness measurement due to peripapillary extension of the optic nerve head drusen. Comparison of visual fields over 25 years reveal a gradual deterioration and demonstrate the value of this diagnostic tool in the study of the disease, especially in cases where nerve fiber layer loss cannot be precisely assessed by optical coherence tomography.

OBJECTIVE Because many patients with diabetic macular edema (DME) do not respond to focal/grid laser photocoagulation, the only currently approved treatment, alternatives are needed. Based on encouraging preliminary findings, we aimed to assess efficacy and safety of the anti–tumor necrosis factor (TNF) monoclonal antibody infliximab in this condition. RESEARCH DESIGN AND METHODS This was a single-center, double-blind, randomized, placebo-controlled, crossover study. Eleven patients with sight-threatening DME persisting after two sessions of laser photocoagulation received infliximab (5 mg/kg) intravenously at weeks 0, 2, 6, and 14, followed by placebo at weeks 16, 18, 22, and 30, or vice versa. Blinding was maintained to week 32, when the final assessments were performed. Best corrected visual acuity evaluated by a mixed-models approach for imbalanced crossover design using the percentage difference as the outcome variable was the primary study end point. Data were analyzed on an intention-to-treat basis. RESULTS Early Treatment of Diabetic Retinopathy Study (ETDRS) scores dropped from 31.6 ± 5.1 (mean ± SD) letters read at baseline to 28.8 ± 11.6 letters read at week 16 in six placebo-treated eyes and improved to 35.4 ± 11.2 letters read after infliximab. In contrast, visual acuity improved from 23.5 ± 10.3 at baseline to 30.4 ± 13.4 letters read at week 16 in eight infliximab-treated eyes and was sustained at completion of placebo treatment (31.4 ± 12.1 letters read). The excess visual acuity in infliximab-treated eyes was greater by 24.3% compared with that in placebo-treated eyes (95% CI 4.8–43.7; P = 0.017). Infliximab treatment was well tolerated. CONCLUSIONS The positive results of this small phase III study suggest that larger and longer term trials should be conducted to assess the efficacy of systemic or intravitreal anti-TNF agent administration for primary treatment of DME.

To report a case of full-thickness macular hole (FTMH) after intravitreal injection of ranibizumab in a patient with retinal pigment epithelium detachment (PED) and tear.A 67-year-old woman with PED and retinal pigment epithelium (RPE) tear due to age-related macular degeneration was studied by biomicroscopy, fluorescein and indocyanine green angiography, and optical coherence tomography and was treated with intravitreal ranibizumab.The patient developed a FTMH that was observed 1 month after the ranibizumab injection.Intravitreal ranibizumab may create focal sites of tractional forces on the retinal surface while contraction of the choroidal neovascular membrane may also place forces on the RPE and outer retina. Both actions may have as a result contraction and tearing of the retina leading to the formation of a FTMH.

PURPOSE To study the evolution of idiopathic epiretinal membrane (IERM) as examined by optical coherence tomography (OCT) in the 1-mm-diameter circle centered on the fovea. METHODS In a case series study 71 subjects (71 eyes) with idiopathic epiretinal membrane and macular thickness greater than 220-/+10 micro m were evaluated by OCT. The fellow healthy eye of 52 patients was used as the control group. The mean follow-up was 36 months. Measurements of macular thickness at baseline and at the final examination were performed. Best-corrected visual acuity was expressed as the number of letters read on the Early Treatment Diabetic Retinopathy Study chart. RESULTS Within the inner macular central circle of 1 mm diameter the thickness of the fovea increased by an average of 12.29% (p

To study the natural course of lamellar macular hole (LMH) as examined by optical coherence tomography (OCT) in a noncomparative observational case series. Forty-one eyes of 41 patients with LMH were included in this analysis. Baseline and final OCT findings related to LMH diameter, foveal thickness and visual acuity (VA) were collected and compared. Mean follow-up was 37.1 months. Main outcome measures were best-corrected visual acuity (BCVA), diameter of the LMH opening, foveal thickness, epiretinal membrane (ERM), posterior vitreous detachment (PVD) and vitreoretinal traction. The diameter of the LMH increased by an average of 13.7%. A statistically significant association was found between the LMH diameter increase and the presence of ERM. The mean foveal thickness depicted a statistically significant decrease between the initial and the final examination. The decrease of the foveal thickness showed to correlate with visual acuity deterioration. BCVA was stable in 30 (78%) and deteriorated in 11 (22%) cases. In eight of the 11 cases, the visual acuity deterioration ranged from 2 to 15 letters. We identified an increase of LMH diameter related to the presence of ERM and a decrease of the foveal thickness within a period of observation which ranged from 24 to 54 months (mean 37.1 months).

To evaluate macular thickness (MT) changes, using spectral domain optical coherence tomography (SD-OCT) in patients with optic disc pit (ODP) maculopathy after pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling.Our retrospective study included nine patients with ODP maculopathy, treated with either PPV (n = 5) or PPV with ILM peeling (n = 4). All participants, who had a mean long-term follow-up of 33.4 ± 7.0 months, underwent a complete ophthalmological examination and SD-OCT. Due to the preoperative macular elevation, the postoperative MT in the operated patients was compared with that of fellow eyes and with normative data.A significant reduction in MT was noticed in all macular sectors of the operated cases at the last examination. The reduction was more evident in the group of PPV with ILM peeling. At the last examination of the follow-up, there was a statistically significant improvement regarding BCVA in both groups in comparison with baseline, while the two groups did not differ significantly in between (p = 0.245).In the long-term follow-up period, our study demonstrated a significant reduction in MT in patients with ODP maculopathy treated with PPV, which was more profound in those cases where PPV included ILM peeling. .

A case of bilateral "drusenoid" pigment epithelial detachment that was studied with fundus fluorescein angiography and optical coherence tomography is described. Fundus fluorescein angiography depicted staining of the drusen without any sign of pooling of the dye, whereas optical coherence tomography displayed detachment of the retinal pigment epithelium. These findings remained unchanged during a 10month period. [Ophthalmic Surg Lasers Imaging 2005;36:147-150.]

Purpose: To document and study the spontaneous closure of lamellar macular holes (LMH) by optical coherence tomography (OCT). Methods: Two women with LMH, 62 and 71 years old, respectively, were followed up with fundoscopy, fundus photography and OCT. Results: In both patients spontaneous closure of LMH was observed 11 and 21 months after baseline examination, respectively. The foveal thickness in case 1 increased from 84 μm at baseline to 162 μm at the final examination. The foveal thickness in case 2 increased from 48 μm at baseline to 148 μm at the final examination. The foveal contour was also restored in both eyes. The foveal morphology was preserved in both eyes during the follow-up period. Conclusion: In both patients the spontaneous closure of LMH could be attributed to the shrinkage of the hole or the release of the tension on the retinal surface, which followed the complete posterior vitreous detachment and separation of epiretinal membrane from the retina.

Purpose: To describe a patient who developed cystoid macular oedema (CMO) within 24 h after a single application of Latanoprost. Methods: Observational case report. Results: A 77-year-old man who had a previous cataract operation with vitreous loss in his left eye developed CMO 8 h after instillation of one drop of latanoprost. Five days after discontinuation of latanoprost the CMO resolved almost completely. Both the CMO and its resolution were documented with fluorescein angiography (FA) and optical coherence tomography (OCT). Conclusions: Latanoprost can lead to CMO even after a single application, as demonstrated in our case by FA and, in particular, by OCT. Caution is advised when administering the drug in high–risk eyes.

Purpose: To describe the evolution of a full-thickness macular hole in myopic foveoschisis. Methods: A 62-year-old woman with myopic foveoschisis developed a full-thickness maculare hole after 36 months. The evolution of the macular hole was observed by optical coherence tomography (Stratus OCT3). Results: During the first stages of macular hole formation, a small triangular foveolar retinal detachment, with corresponding elevation of inner segment/outer segment junction line, was observed. The retinal detachment later enlarged. A concrete intraretinal columnar structure, extending between the inner fovea’s layer and the roof of foveal detachment, was observed. Conclusion: The so-called columnar structure, detected in our case, possibly transmitted the vitreomacular traction contributing to the opening of the RD roof, the outer lamellar macular hole formation, and finally in the creation of a full-thickness macular hole.

To evaluate the natural course of idiopathic vitreomacular traction (VMT) with spectral-domain optical coherence tomography (SDOCT) from the vitreomacular adhesion (VMA) stage to the spontaneous resolution of VMT.Prospective observational case series.We studied the natural course of idiopathic VMT in 46 eyes (46 patients), divided into those that proceeded to spontaneous VMT resolution (12 cases) and those that remained at the VMT stage (34 cases). All patients were examined with SDOCT at regular 3-month intervals. We recorded the vitreomacular angle of VMA nasally and temporally, the horizontal diameter of VMA, macular thickness, visual acuity, photoreceptor layer, and external limiting membrane.In the 12 eyes that proceeded to spontaneous resolution, the vitreous adhesion angle had a mean increase of 38 degrees at VMT, compared to the angle at the VMA stage. In the 34 eyes that remained at the VMT stage, the mean angle of traction increased by only 1 degree throughout follow-up. In all 46 patients, the angle at the VMT stage was significantly associated with traction resolution (nasally P = .001, temporally P.001). The likelihood of resolution was more than 99% lower for patients with a VMT diameter400 μm compared with that of eyes with a VMT diameter400 μm. Patients with broad-type VMT remained at the same stage, whereas patients with V-type VMT had 80% probability of resolution.Spontaneous VMT resolution is negatively associated with the horizontal adhesion diameter. The strength of the traction exerted by the vitreous on the fovea seems to be positively related to the size of the vitreomacular angle.

Purpose: The aim was to report the evolution of a case of von Hippel–Lindau (VHL) juxtapapillary retinal capillary haemangioblastoma (RCH) by optical coherence tomography (OCT3). Case report: The progress of a 24-year-old man suffering from VHL disease with a juxtapapillary haemangioblastoma and a small peripheral lesion was followed for 26.4 months with fundus photographs and OCT of the optic nerve head using the optic nerve head rim volume, ranging from 1.106 to 1.895 mm3. Visual acuity remained 6/6 throughout. Conclusions: OCT can be a useful tool in the follow up and decision-making of patients with small retinal capillary haemangioblastoma of the optic nerve.

Background/Aims: To evaluate changes in macular thickness measured by optical coherence tomography (OCT) during a hemodialysis (HD) session in diabetic patients with end-stage renal disease. Methods: 72 eyes of 36 diabetic patients with and without macular edema were evaluated before and immediately after an HD session. Average and maximum macular thicknesses in the central disk (6 mm in diameter) and total macular volume were measured. Results: In the eyes with diabetic macular edema, maximum macular thickness within the central disk of 6 mm, and mainly in its peripheral parts, was significantly reduced by 31.18 ± 4.18 µm after HD (p < 0.001). Average macular thickness and total macular volume were also significantly reduced (p = 0.003 and 0.015, respectively). In diabetic eyes without edema, maximum macular thickness decreased significantly by 11.21 ± 1.98 µm after HD (p < 0.001), while average macular thickness and total macular volume decreased slightly (p = 0.034, p = 0.043). Best-corrected visual acuity failed to change. We found a significant association of macular thickness changes with osmolality reduction and the presence of macular edema. Conclusion: HD decreases macular thickness in diabetic patients with macular edema, while there exists a less-pronounced effect in diabetic eyes without edema.

A patient with cone-rod dystrophy, who was examined thoroughly with biomicroscopy, fluorescein angiography, optical coherence tomography, and electrophysiology, is presented. Although fluorescein angiography depicted only window-defect type of hyperfluorescence, optical coherence tomography disclosed detachment of the neurosensory retina, focal absence of the outer parts of the photoreceptors’ layer in the fovea, and cystoid edema in the macula. To the authors’ knowledge, these findings have not been described in cone-rod dystrophy so far.

To study the prognostic factors that influence best-corrected visual acuity (BCVA) outcome in patients with secondary epiretinal membrane (ERM) after retinal detachment surgery.Retrospective case series.Forty-two patients with ERM were divided into macula-on and macula-off groups based on the macular status before retinal detachment surgery and were studied using the same spectral-domain optical coherence tomography device. Several variables, including the integrity of the external limiting membrane (ELM), the status of the photoreceptor inner segment/outer segment (IS/OS) junction line, and central foveal thickness were evaluated in 17 treated and 25 untreated patients. Linear regression analysis was used to determine the best combination of all variables affecting BCVA.Final BCVA was significantly better in macula-on and macula-off eyes with intact ELMs and IS/OS junction lines (0.35 ± 0.18 logarithm of the minimal angle of resolution [logMAR] and 0.51 ± 0.17 logMAR, respectively) than in macula-off eyes with disrupted or absent ELMs and IS/OS junction lines (0.83 ± 0.17 logMAR and 1.04 ± 0.05 logMAR, respectively; P.001, analysis of variance). Final BCVA also was better in the treated group than in the controls (0.55 ± 0.31 logMAR and 0.73 ± 0.26 logMAR, respectively; P = .05, t test). ELM and IS/OS junction line integrity were the main variables significantly affecting the final BCVA outcome (β = 0.42; P = .006, linear regression analysis). Disruption of the ELM and IS/OS junction line was observed in 21 of the 42 cases studied.ERM secondary to retinal detachment surgery is accompanied by a high incidence (50%) of IS/OS junction line and ELM disruption. Among the variables studied, the condition of the IS/OS junction layer and the ELM are the main factors that predict final BCVA after ERM peeling.

Background: To evaluate the correlation between the extent of the inner/outer segment (IS/OS) defect preoperatively and improvement in postoperative best-corrected visual acuity (BCVA) associated with IS/OS line restoration. Methods: Forty-six eyes (46 patients) with successfully operated idiopathic full-thickness macular holes were studied using Stratus OCT3 with a mean follow-up of 34.7 months (range 24–60 months). The preoperative extent of the IS/OS junction defect, macular hole base diameter (MHBD) and BCVA were studied before surgery. The degree of IS/OS line restoration, macular thickness and BCVA were measured after treatment. Results: The mean preoperative MHBD and IS/OS defect size were 783 and 1,973 µm, respectively. Postoperative continuity of the IS/OS junction was observed in 11 of 46 cases 12 months after treatment. In the remaining 35 patients, the IS/OS line was interrupted at 12 months of follow-up. The size of the preoperative IS/OS defect line was negatively correlated with the size of the postoperative IS/OS line and BCVA at 6 months and 12 months only (p < 0.0001). In all 46 eyes, the mean BCVA before and 12 months after treatment was 10 and 36.7 letters, respectively. BCVA remained almost unchanged after the first postoperative year of observation. Conclusions: The degree of reorganization of the photoreceptor layer after successful macular hole closure varies and is mostly related to the preoperative extent of the IS/OS defect line and the MHBD. A small-sized IS/OS preoperative defect favors improvement and restoration of the IS/OS line after treatment. The IS/OS junction line and BCVA are mostly restored during the first 12 months after treatment.

BACKGROUND AND OBJECTIVE: To study the morphological features of the macula of patients with retinitis pigmentosa and visual acuities of 20/200 or less as examined by optical coherence tomography. PATIENTS AND METHODS: In an observational case series study, 42 eyes (21 patients) with retinitis pigmentosa and visual acuities of 20/200 or less were evaluated by optical coherence tomography. RESULTS: Thirty-four (81%) eyes had atrophic retina (group 1) and 8 (19%) eyes had cystoid macular edema (group 2). The mean visual acuity was 20/1000 in group 1 and 20/300 in group 2. Epiretinal membrane was identified in 27 (64.3%) eyes. CONCLUSION: Optical coherence tomography is a more sensitive method in detecting macular pathology and can help in selecting cases where treatment may be applied. [Ophthalmic Surg Lasers Imaging 2010;41:35–39.]

Background and Objective:To compare the performance of the newest generation optical coherence topography (OCT) and scanning laser polarimetry with variable corneal compensation (SLP-VCC) in eyes with glaucoma, ocular hypertension, and suspected glaucoma.Patients and Methods:One eye each of 84 patients (30 with glaucoma, 26 with suspected glaucoma, and 28 with ocular hypertension) was included in the study. Retinal nerve fiber layer (RNFL) thickness was measured with both technologies and thickness parameters were compared in the three groups of eyes. The correspondence of RNFL thickness measurements with visual field function was also studied.Results:Average OCT-RNFL thickness was found to have a statistically significant difference between patients with glaucoma and either suspected glaucoma or ocular hypertension. A statistically significant correlation between the average RNFL thicknesses measured by the two different technologies was shown only in the glaucoma group. A significant correlation with visual field mean deviation was found for superior average RNFL thickness as measured by SLP and for nerve fiber indicator and average and inferior average RNFL thickness as measured by OCT in glaucomatous eyes. Regression analysis indicated nerve fiber indicator to be the most valuable factor in predicting mean deviation.Conclusion:RNFL thickness measurements obtained with OCT and SLP-VCC correlate well only in eyes with more advanced glaucomatous damage. The nerve fiber indicator parameter derived by SLP correlated best with mean deviation.

A case of Parry–Romberg syndrome that was studied by fluorescein angiography and optical coherence tomography (OCT) is described. OCT revealed the existence of retinal nerve fiber layer edema and abnormalities of the vitreoretinal interface. The presence of diffused retinal edema throughout the papillomacular area and the formation of thick retinal folds with intra-retinal diffuse macular edema were also evident. Fluorescein angiography demonstrated optic disc swelling, engorgement of the retinal vessels, and mottling of the pigment epithelium. The retinal nerve fiber layer edema and the hyperreflectivity of the retinal surface indicate abnormalities and thickening of the vitreoretinal interface, as shown on OCT, and may further contribute to the retinal involvement in Parry–Romberg syndrome.

PURPOSE. To report in a single case the effectiveness of bevacizumab in the treatment of feeder vessels (FVs) of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS. One patient received intravitreal bevacizumab (Avastin) (1.25 mg) which was repeated 4 weeks after the first intravitreal injection. Fluorescein angiography and optical coherence tomography (OCT) were performed. Visual acuity (VA) was also checked. RESULTS. Occlusion of the FVs was observed 4 weeks after starting treatment. During the follow-up period and in the final examination 13 months after the first injection, the FVs remained occluded. Complete resolution of macular edema and improvement of the VA were noticed after the second bevacizumab intravitreal injection. CONCLUSIONS. This report documents the successful occlusion of FVs of subfoveal neovascularization after two intravitreal bevacizumab injections in a patient who was followed up for 1 year after the occlusion. Further long-term investigation is warranted given the promising 12-month results. (Eur J Ophthalmol 2007; 17: 853-6) K EY WORDS. Age-related macular degeneration, Bevacizumab, Feeder vessel, Fluorescein angiography, Optical coherence tomography, Subfoveal neovascularization

To assess vitreous findings in optic disc pit maculopathy using Optical Coherence Tomography (OCT). Thirty-eight eyes of 38 patients (14–51 years of age) with macular detachment associated with optic disc pit maculopathy were included in the study. The patients were divided into two groups. In group 1, 16 eyes were studied by OCT at presentation and after surgical treatment. In group 2, 22 eyes were examined by OCT only after treatment. In both groups thorough vitreous examination was performed over the macula and the optic disc. All patients were operated by the macular buckling procedure. Vitreous abnormalities were found in 28 out of 38 eyes (74%) of both groups. In group 1, 10 of the 16 eyes had vitreous traction on the macula at presentation. The traction started from the optic disc and terminated to the macula. The posterior hyaloid that exerted the traction between the points of adhesion at the optic disc and the macula had a course parallel to the retinal surface in 9 of the 10 cases. Postoperatively, vitreous traction on the macula was not found. Of the remaining 6 eyes 4 had complete or partial posterior vitreous detachment. In group 2, 8 eyes had vitreous strands over the optic disc and 5 eyes posterior vitreous detachment. In the remaining 9 cases no vitreous involvement was noticed. OCT was able to detect vitreous abnormalities such as vitreomacular traction, vitreous strands over the optic disc and complete or partial posterior vitreous detachment associated with optic disc pit maculopathy. Our observations support the view that the abnormal vitreous over the macula and optic disc is likely to play a role in the development of macular elevation in cases with optic disc pit. Prospective OCT studies could further assist to better understand the role of vitreous in this disease.

This study was undertaken to relate the anatomic and functional results of patients who underwent retinectomy for complex retinal detachment (RD) to preoperative prognostic variables. Three hundred and four eyes of 302 patients whose surgery involved retinectomy were included in the analysis. All eyes had established proliferative vitreoretinopathy (PVR grade C). The main outcome measures were (1) postoperative visual acuity of 6/24 or better, (2) status of the retina at the end of follow-up, and (3) incidence of hypotony whilst under review. PVR was secondary to rhegmatogenous RD in 237 eyes (78%), posterior trauma in 51 eyes (16.8%), tractional RD in vasoproliferative vasculitides in 12 eyes (4%), acute retinal necrosis in 2 eyes and endophthalmitis in 2 eyes. Complete reattachment rate after one operation was 51%, with final complete reattachment success rate of 72%. The visual acuity improved in 138 eyes (45%), remained the same in 73 eyes (24%) and became worse in 89 cases (29%). Postoperative visual acuity of 6/24 or better was significantly associated with preoperative vision, the duration of silicone oil tamponade, silicone oil removal and retinectomy size. There was also some evidence of association between visual outcome and the number of clock hours of retinal detachment. Final retinal attachment was significantly associated with silicone oil removal and preoperative vision, and final hypotony was significantly associated with silicone oil removal. The incidence of sympathetic ophthalmia in our study was 0.09% (one case). Good functional outcome is possible following retinectomy surgery despite advanced pathology and often multiple surgical procedures. Retinal redetachment as a result of reproliferation and hypotony appear to be the main reasons for anatomical and functional failure. The clinical features we have identified as good indicators for improved final visual acuity such as shorter tamponade duration, removal of silicone oil, smaller retinectomy size, fewer previous operations and better preoperative vision are surrogate markers of less advanced PVR and should prompt retinal surgeons to consider retinectomy at an earlier stage in the process of PVR development. Clinicians should be aware of the small risk of sympathetic ophthalmia from complex retinal surgery.

PURPOSE. To report a case of pigment epithelium detachment (PED) which appeared after photodynamic therapy (PDT) and was followed up for 50 months. METHODS. Case report. RESULTS. A 71-year-old woman with occult choroidal neovascular membrane due to age-related macular degeneration (ARMD) developed PED 48 hours after PDT. The patient was studied with fluorescein angiography (FA) and optical coherence tomography (OCT). Fluorescein angiographic evidence of PED remained essentially unchanged during the follow-up period of 50 months. Although OCT initially gave clear evidence of PED, in the last 12 months of follow-up the PED appears to have resolved. CONCLUSIONS. Photodynamic treatment could be involved in the occurrence of PED in occult choroidal neovascular membrane due to ARMD. In this particular case OCT could be considered since it offers useful information in the pretreatment and the post-treatment follow-up period.

Purpose: To select the best surgical technique and predict the surgical success in cases of progressive symptomatic retinal detachment complicating retinoschisis (PSRDCR). Methods: Cases were divided into three groups: group I, those with outer layer breaks (OLBs) positioned anterior to the equator and no proliferative vitreoretinopathy (PVR); group II, those with OLB(s) at or posterior to the equator and no PVR at presentation; and group III, PVR greater than grade B at presentation. A retrospective study of 30 such eyes presenting to the authors and a review of the 47 previously reported cases to which the three-group anatomical classification might be applied were performed. Results: In group I, the overall primary and final success rates were 85% (17/20) and 95% (19/20), respectively. In group II, the corresponding data were 67% (34/51) and 94% (48/51), respectively. Group III eyes fared badly with primary and final success rates of 0 (0/6) and 17% (1/6), respectively. Conclusion: The overall 66% primary anatomical success rate was lower than those reported in most series of rhegmatogenous retinal detachment uncomplicated by retinoschisis. In group I, the surgical technique used had no detectable influence on outcome. Vitrectomy appears to have been the procedure of choice in group II, but a significant P value could not be demonstrated to support it (Yates corrected χ2 test, P = 0.84). This study, however, had very low power with which to investigate for such effects. PVR greater than grade B at presentation was not previously been recognized in cases of PSRDCR and when present was associated with very poor primary and final reattachment rates.

A 35-year-old man was observed during a 21 -year period with fundus color photography, fluorescein angiography, and B-scan ultrasonography for a presumed retinoma detected in his left eye during routine ophthalmoscopy in 1982. The patient was a carrier of the 13ql4 retinoblastoma gene. His retinal lesion remained stable during the follow-up period without signs of malignant transformation. Retinomas are most commonly observed in patients with retinoblastoma and their relatives. In this case, none of the patient's parents, siblings, or children had evidence of a retinal tumor. Photographic documentation of the nonprogressive nature of this presumed retinoma is provided and demonstrates the absence of growth. [Ophthalmic Surg Lasers Imaging 2005;36:155-157.]

Diabetic retinopathy and diabetic macular edema (DME) are leading causes of blindness in an increasing number of patients with diabetes (1). Reduction of visual aquity in DME results from accumulation of fluid produced from a rupture of the blood-retinal barrier into the inner nuclear layer of the retina (1,2). Although the etiology of DME is unclear, an altered local expression of the pleiotropic cytokine tumor necrosis factor (TNF) may play an important pathogenetic role (2–5). Standard treatment of clinically significant DME consisting of laser photocoagulation reduces the risk of vision loss in 60% of cases, but recurrences are common, even among those patients who achieve an initial response (1). Various pharmacological therapies are currently under study, including intavitreal triamcinolone injections (6) or high doses of nonsteroidal anti-inflammatory agents that lower retinal expression of TNF (7). The monoclonal anti-TNF antibody Infliximab neutralizes TNF actions and has been used for inflammatory arthritic conditions and Crohn’s disease since 1998 with a favorable safety profile (8). Because of the limitations of current treatments for DME, and based on our recent findings indicating that Infliximab is an effective therapy for cystoid macular edema associated with uveitis (9–11), we decided to give Infliximab for sight-threatening refractory DME. Four women, aged 52–76 years, with type 2 …

To describe the macular findings by optical coherence tomography in both eyes of a patient with tilted optic disk and visual decrease.A 35-year-old woman with bilateral tilted optic disk and serous macular detachment was examined by slit-lamp biomicroscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography (OCT).Fluorescein angiography demonstrated staining of the temporal rim of the staphyloma adjacent to the optic disk and hyperfluorescence of the diffuse pigmentary changes in the papillomacular area. Leakage points and serous macular detachment were not observed. The existing neurosensory detachment at the fovea became evident only by OCT.The existence of subretinal fluid, which became evident only by OCT, supports the view that OCT could further contribute to the study of the asymptomatic pigmentary lesions of the macula that are present in 11% of eyes with tilted optic disk. The reason for the localized macular detachment remains unclear. Dysfunction of the retinal pigment epithelium (RPE) or leakage of the optic disk staphyloma rim could possibly explain the cause of fluid accumulation in the macula.