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We present a series of nine cases involving primary intraocular lens implantation in congenital cataracts. Because of the problems encountered with the technique used in the earlier cases, we developed a new surgical technique that may be described as primary epilenticular posterior chamber lens implantation followed by pars plana endocapsular lensectomy. This new technique ensures a clear pupillary area, minimizes postoperative complications, and ultimately prevents amblyopia, resulting in useful vision.

Since the number of cases for each of the conditions in our study was small, only preliminary conclusions can be made; in order to establish the fluorescein pattern of each of these peripheral retinal lesions, additional studies will be required. The following summarizes our preliminary observations. 1. Areas of retinal white-with-pressure or without and peripheral retinal cystoid degeneration did not reveal remarkable fluorescein angiographic findings. One exception was in an area of pigment epithelial disturbance characterized by atrophy and proliferation, which showed a "window and masking" effect of choroidal fluorescence. 2. Fluorescein angiography of areas of the fundus with lattice retinal degeneration showed little or no findings in early or mild cases. In severe or advanced cases, the affected retina revealed poor or absent perfusion caused by vascular occlusion. The retinal and choroidal circulation was devoid of fluorescein leakage. Advanced lesions displayed choroidal hypofluorescence in areas of pigment proliferation and hyperfluorescence in areas of pigment atrophy. 3. In advanced cases, occlusive vascular changes over areas of acquired retinoschisis were observed. There was intraretinal leakage of the dye from deep capillaries and pooling of the dye in cystic cavities near the margin of the retinoschisis. 4. There was no perfusion of the choroid and retina in the area of the hole and in the retina surrounding it. This finding suggests choroidal and retinal ischemia in the pathogenesis of a retinal hole. 5. Fluorescein angiography of retinal tears revealed fluorescein leakage along the edge of the tear and absent perfusion of the retinal flap. The retinal and choroidal circulation-around the tear was otherwise unremarkable. The choroidal fluorescein underlying the retinal flap was not visible, perhaps because it was masked by the retinal flap. 6. Our fluorescein angiographic findings in cases of rhegmatogenous retinal detachment confirmed those of others [7, 8, 10]. Transit of fluorescein through the retinal circulation was sluggish. The retinal capillaries were dilated. 7. In cases of rhegmatogenous retinal detachment which had become reattached surgically, areas treated with diathermy or cryoapplications showed absent or diminished choroidal and retinal perfusion. Leakage of the fluorescein from capillaries in the optic disc and retina in the posterior pole was sometimes persistent several months postoperatively.

One hundred twenty-eight consecutive aphakic glaucomatous eyes of 91 patients were examined by fluorescein angiography. Macular edema was present in 16 (28%) of 56 eyes currently being treated with epinephrine and 9 (13%) of 72 eyes not currently being treated with epinephrine. This difference is statistically significant at the 95% confidence level. Epinephrine therapy was discontinued in seven eyes with macular edema. A follow-up of these patients for six months to one year with serial anglograms showed resolution of edema in six of seven eyes. In one eye without macular edema, administration of epinephrine was associated with appearance of edema. Discontinuing epinephrine therapy was associated with resolution of edema. No significant correlation was found between use of other antiglaucomatous medications and macular edema. It is evident from this study that there is statistical support for the concept of an epinephrine-induced macular edema.

Peripapillary subretinal neovascularization progressively developed in both eyes of a 17-year-old black woman with bilateral chronic granulomatous uveitis. Despite intensive medical therapy, central vision was lost in the left eye due to disciform scarring that extended to the macula. When a similar process was discovered in the right eye, argon laser therapy was started and was successful in eliminating all areas of subretinal neovascularization in the right eye while maintaining good cental vision. Chronic uveitis is probably another cause of peripapillary subretinal neovascularization, which can be treated with photocoagulation in spite of the presence of inflammation.

A 30-year-old black woman with biopsy-proven sarcoidosis and sickle cell anemia had peripheral retinal neovascularization. Elevated fibrovascular proliferations and distal retinal ischemia with nonperfused ghost vessels passing through the area of neovascularization were found at the temporal periphery. No signs of intraocular inflammation were present. Both diseases occur in black patients and should always be considered in the presence of peripheral retinal neovascularization.

Lattice degeneration (LD), routinely diagnosed with indirect ophthalmoscopy, is one of the most common and clinically significant peripheral retinal findings. In this review, we have summarized the data on currently available imaging techniques which help to improve diagnosis and our understanding of LD pathogenesis. Ultra-wide field imaging provides reliable color fundus capturing for the primary diagnosis of LD and may also be used as a screening tool. Wide-field imaging can be used for targeted documentation of LD lesions using true colors and with minimal optical distortions. Information on the status of the vitreoretinal interface, including detection of retinal holes, detachments, and vitreous tractions, can be obtained with peripheral structural optical coherence tomography (OCT) or scanning laser ophthalmoscopy in retro-mode. These techniques clarify the associated risks of rhegmatogenous retinal detachment. Fundus autofluorescence can provide details on atrophic changes. However, the risk of retinal detachment by means of this technique requires further investigation. OCT angiography may be successfully performed for some lesions. Taken together, OCT and OCT angiography demonstrate thinning of the choroid, alteration of local choroidal microcirculation, and, in severe lesions, involvement of the sclera. OCT angiography confirms loss of retinal microcirculation within LD lesion, which was previously shown with fluorescein angiography. In conclusion, despite relatively simple primary diagnosis, imaging of LD lesions remains challenging due to their peripheral localization. However, several new strategies, including ultra-wide field imaging, peripheral OCT, and scanning laser ophthalmoscopy, make LD imaging possible on a routine basis, improving diagnosis and understanding of LD pathogenesis. [ABSTRACT FROM AUTHOR]

Purpose: To present two cases of concomitant retinal neovascularization (RNV) in acquired peripheral retinoschisis and analyze its characteristics on optical coherence tomography angiography and based on a literature review., Methods: This was an observational, retrospective case study., Results: Case 1 presented with bullous retinoschisis and RNV near the schisis cavity. Optical coherence tomography angiography revealed no angioflow into the retinal arterioles of the cavity. An arterial filling delay to the retinoschisis with extensive leakage from the RNV was noted on fluorescein angiography. Case 2 involved the superficial retinoschisis and telangiectatic vessels inside the schisis cavity. Optical coherence tomography angiography revealed damage to the superficial capillary plexus of the cavity, absence of angioflow to the inner schisis layer, and increased angioflow to the RNV. Fluorescein angiography showed focal leakage from the RNV and diffuse leakage from telangiectasia. No vision-threatening complications were identified in either patient up to the last follow-up, subsequent to laser photocoagulation., Conclusion: Acquired peripheral retinoschisis is associated with RNV. Inner retinal ischemia caused by hemodynamic resistance or a damaged superficial capillary plexus can interrupt angioflow to the inner schisis retinal layer on optical coherence tomography angiographic findings and develop RNV inside or outside the retinoschisis.

Copyright of Current Retina Journal / Güncel Retina Dergisi is the property of Anadolu Kitabevi Basim Yayim Medikal Turizm Kirtasiye Tic. Ltd. Sti. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To explore the effectiveness and safety of vitrectomy for congenital cataract surgery. Methods: We searched PubMed, Science Direct, The Cochrane Library, China National Knowledge Infrastructure and the Wanfang Database. Two researchers extracted data and assessed paper quality independently. Posterior capsule opacification (PCO) or visual axis opacification (VAO), reoperation rate, visual acuity, intraocular lenses (IOL) deposit, synechias, uveitis, secondary glaucoma, low‐contrast sensitivity and IOL decentration were compared. Results: We included 11 randomized controlled trials (RCTs) with 634 congenital cataract eyes. Cases of posterior capsule opacification in vitrectomy group were significantly less than that of control group, with risk ratio (RR) of 0.15 [95% confidence interval (CI): 0.09, 0.26], and there was no heterogeneity (I2 = 0%, p = 0.94). Reoperation rate in vitrectomy group was lower than that of control group either (RR = 0.40, 95%CI: 0.17, 0.94), and there was no heterogeneity (I2 = 0%, p = 0.85). Best‐corrected visual acuity (BCVA) measured in LogMAR unit of vitrectomy group was smaller, with a mean difference (MD) of −0.17 (95%CI: −0.28, −0.05), and I2 was only 22%, indicating of a small heterogeneity. No statistical difference was found between two groups on IOL deposit (RR = 1.23, 95%CI: 0.70, 2.17), and the heterogeneity was small (I2 = 16%, p = 0.31). No statistical difference was found between two groups on synechias (RR = 1.08, 95%CI: 0.60, 1.94), with a quite small heterogeneity (I2 = 3%, p = 0.38). No statistical difference was found between two groups on uveitis (RR = 0.55, 95%CI: 0.15, 2.01), and there was no heterogeneity (I2 = 0%, p = 0.94). There was no statistical difference on IOP either, with a MD of 0.25 (95%CI: −1.56, 2.07), and there was no heterogeneity (I2 = 0%). Egger's test showed that there was no publication bias for all assessed outcomes. Low‐contrast sensitivity was better in the vitrectomy group. And no evidence indicated vitrectomy could lead to a higher risk on secondary glaucoma or IOL decentration. Conclusion: Vitrectomy helps lower the PCO risk and reoperation risk after congenital cataract surgery, and also, vitrectomy helps patients gain a better BCVA and achieve a better low‐contrast sensitivity, with no trade‐off on IOP control, IOL deposit, synechias, uveitis and secondary glaucoma. We recommend performing vitrectomy during congenital cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To describe the epidemiology of macular edema (ME) in patients with uveitis.Methods: Review of articles listed on PubMed pertaining to uveitic ME.Results: Reported rates of uveitic ME ranging from 20% to 70%, depending on the ancillary tests used (fundus examination, fluorescein angiography, optical coherence tomography). Macular edema might develop due to uveitis itself, or occur as an adverse effect of drugs taken for different diseases. It is more frequently observed in adults than in children, in chronic uveitis, and in intermediate uveitis. Males with ankylosing spondylitis are more prone to develop ME than females. Three patterns of uveitic ME are observed, either isolated or in combination: cystoid ME, the most frequently encountered pattern seen in up to 80% of cases, diffuse ME and serous retinal detachment.Conclusion: Older age, chronicity of uveitis and intermediate uveitis are risk factors for the development of ME in patients with uveitis. [ABSTRACT FROM AUTHOR]

Purpose: Retrospective, pilot study to determine whether nepafenac treatment pre- and postcataract surgery in glaucoma patients using topical hypotensive agents minimized cystoid macular edema by comparing pre- and postsurgical foveal characteristics, as in some cases these agents cannot be withdrawn and, hypothetically, their inflammatory effect on the fovea could be neutralized by the addition of nepafenac. Methods: Patients were divided into two subgroups depending on whether or not topical nepafenac was added to the surgical protocol (NEP = nepafenac group and nNEP = non nepafenac group). All had undergone phacoemulsification and data on pre- and postoperative macular status were recorded. Results: In the nNEP group, there was a significant increase in foveal thickness (FT) in the first month postoperative visit with respect to the preoperative status ( p = 0.006), and this situation did not change at the third postoperative month ( p = 0.9411). In the NEP group, the increase in FT was not significant at the first month after surgery ( p = 0.056) nor at the final visit ( p = 0.268), in contrast to the nNEP group. Conclusion: This study of the possible prophylactic effect of nepafenac on postoperative macular edema supports the results of other studies that confirm subclinical edema post phacoemulsification, and found a significantly lower gradient in the increase in FT in patients treated pre- and postoperatively with nepafenac. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in the corneal endothelial cell parameters and macular thickness after intraocular application of epinephrine [Formula: see text] and epinephrine[Formula: see text]., Methods: In this study, 210 eyes from 210 patients with age-related cataracts who underwent uncomplicated surgery were included. For all patients, specular microscopy of the corneal endothelium and macular OCT were performed before surgery and 3 months after the surgery. Patients were divided randomly into three groups: without drug (control group), epinephrine [Formula: see text], and epinephrine[Formula: see text]. Three months after the surgery, specular microscopy of the cornea and macular OCT measurements were performed. Measurements were compared between the three groups. Postoperative measurements were also compared with those measurements obtained before surgery., Results: All the three groups showed a statistically significant decrease in the endothelial cell density after surgery; the reduction in endothelial cell density in the epinephrine [Formula: see text] group was significantly more than those of the other two groups (P value < 0.001). Hexagonality of endothelial cells was significantly reduced in the three groups after the surgery, the epinephrine [Formula: see text] group had more reduction compared with both other groups (P values < 0.001). All the three groups showed a statistically significant increase in the macular thickness after the surgery (P values < 0.001). The mean increase in the macular thickness in the epinephrine [Formula: see text] group was significantly more than those of the other two groups (P values < 0.05)., Conclusion: Toxicity of the drug to many endothelial cell parameters and macula was reduced with decreasing concentration of epinephrine to [Formula: see text].

Purpose: We examined the relation between ocular sarcoidosis and severe cardiac sarcoidosis necessitating pacemaker implantation. Methods: In this retrospective, observational, cross-sectional study, we reviewed the clinical records of 108 patients diagnosed with ocular sarcoidosis based on new diagnostic criteria established in Japan. We examined and compared the relationship between fundus findings of ocular sarcoidosis and severe cardiac sarcoidosis necessitating pacemaker implantation. Results: Of 108 patients with ocular sarcoidosis, seven patients (6.5 %) with median age of 61 years (interquartile range 59-63 years) also had severe heart disease leading to implantation of a pacemaker. Median duration of ocular symptoms was 4.5 years (interquartile range 3.6-7.8 years). Of seven patients with severe cardiac involvement, six had multiple peripheral chorioretinal atrophic lesions (MPCAL), two had nodules in the angle and tent-like peripheral anterior synechia, and two had snowball vitreous opacity. The prevalence of atrophic MPCAL lesions was significantly higher than that of other ocular findings ( P < 0.05). Conclusions: In patients with concurrent ocular sarcoidosis and severe cardiac sarcoidosis, MPCAL atrophic lesions were observed significantly more frequently, suggesting that severe cardiac involvement may be predicted by specific fundus lesions. [ABSTRACT FROM AUTHOR]

Macular edema constitutes a serious pathologic entity of ophthalmology resulting in vision loss with a remarkable impact on the quality of life of patients. It is the final common pathway of various systemic diseases and underlying intraocular conditions, with diabetes mellitus being the most frequent cause. Other causes include venous occlusive disease, intraocular surgery, and inflammatory conditions of the posterior segment of the eye. Macular edema is a recognized side effect of various systemic and local medications and requires special consideration among ophthalmologists and other clinicians. Recently, antidiabetic thiazolidinediones have been implicated in the development of macular edema, and a review of the English literature revealed that other systemically administered drugs like fingolimod, recently approved for relapsing forms of multiple sclerosis, the anticancer agents tamoxifen and the taxanes, as well as niacin and interferons have been reported to cause macular edema. Ophthalmologic pharmaceutical agents, like prostaglandin analogs, epinephrine, timolol, and ophthalmic preparation preservatives have also been reported to cause macular edema as an adverse event. The purpose of this article is to provide a short, balanced overview of the available evidence in this regard. The available data and the possible pathophysiologic mechanisms leading to the development of macular edema are discussed. Possible therapeutic strategies for drug-induced macular edema are also proposed. [ABSTRACT FROM AUTHOR]

PurposeTo compare the functional outcome of epilenticular intraocular lens (IOL) implantation vsthe technique of anterior continuous curvilinear capsulorhexis (ACCC), posterior continuous curvilinear capsulorhexis (PCCC) with vitrectomy and in-the-bag IOL implantation in paediatric cataract surgery.MethodsForty eyes of 33 children with developmental or traumatic cataract, whose mean age was 2–12 years, were randomly divided into two groups A and B. Group A patients underwent epilenticular IOL implantation while in group B patients, ACCC, PCCC with anterior vitrectomy with in-the-bag IOL implantation was performed. Equal number of eyes (10 each) with developmental cataracts (subgroups A1 and B1) and traumatic cataracts (subgroups A2 and B2) were allotted to both the groups. Postoperative visual acuity, opacification of the visual axis, and possible complications were observed and analysed.ResultsFour eyes in subgroup B2 had fibrous or ruptured capsules, and were managed by epilenticular IOL implantation technique. One eye in subgroup B2 developed central posterior capsular opacification and hence required a secondary capsulotomy. All cases in group A maintained a clear visual axis at the last follow-up. Minimal postoperative inflammation was noticed in all groups, which subsided with anti-inflammatory medication. At the last follow-up, all eyes in group A gained visual acuity ≥6/18. Whereas in group B, visual acuity ≥6/18 was obtained in 85.7% cases with the epilenticular IOL implantation technique and in 83.3% cases with ACCC and PCCC with anterior vitrectomy technique.ConclusionEpilenticular IOL implantation offers a safe and effective alternative for management of paediatric cataract. In selected cases of traumatic cataract, it is the preferred treatment modality.Eye (2007) 21, 1367–1374; doi:10.1038/sj.eye.6702451; published online 9 June 2006 [ABSTRACT FROM AUTHOR]

Purpose This study was carried out to evaluate the postoperative visual results and complications following epilenticular intraocular lens implantation in paediatric traumatic cataracts.Materials and methods A total of 30 patients undergoing epilenticular intraocular lens implantation for traumatic pediatric cataract were evaluated prospectively for visual results and complications. After-cataract formation was the prime area of interest. Follow-up of patients ranged from 2 to 8 years (mean 5 years). In all, 90% of eyes had a visual acuity of 6/60 or worse at the time of presentation.Results In total, 80% of our patients achieved a visual acuity of 6/12 or better postoperatively after a mean follow-up of 5 years. None of our patients had after-cataract formation and the visual axis remained clear until the last follow-up in all the patients.Conclusion Epilenticular intraocular lens implantation in paediatric traumatic cataracts is associated with favourable anatomic and visual results.Eye (2004) 18, 126-130. doi:10.1038/sj.eye.6700605 [ABSTRACT FROM AUTHOR]

Decrease of visual acuity in birdshot retinochoroidopathy is due either to optic atrophy or to 3 types of macular involvement: cystoid macular oedema, geographic atrophy, or macular serous detachment. We describe 3 cases of juxtapapillary subretinal neovascularisation occurring in long-standing birdshot retinochoroidopathy. The mechanism of the formation of the new vessels is discussed. [ABSTRACT FROM PUBLISHER]

Nine eyes in nine patients with rhegmatogenous retinal detachments of 1-18 years, duration showed clinical evidence of significant retinal neovascularization in the equatorial region. The retinal new vessels showed a sea-fan configuration. Their extent in the periphery of the fundus ranged from 10° to 180°. All retinal detachments were associated with round atrophic retinal holes in the equatorial region. Retinal reattachment was achieved in all eyes with scleral buckling. The retinal new vessels totally regressed within 15 days to 3 months after retinal reattachment. It is believed that the peripheral retinal new vessels were secondary to retinal hypoxia resulting from decreased retinal blood flow in the detached retina. [ABSTRACT FROM AUTHOR]

Copyright of Albrecht von Graefes Archiv für Klinische und Experimentelle Ophthalmologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Presents a letter to the editor in response to the article "Posterior Continuous Curvilinear Capsulorhexis With and Without Optic Capture of the Posterior Chamber Intraocular Lens in the Absence of Vitrectomy," by Usha K. Raina.

Presents a response by Usha K. Raina and colleagues to a letter to the editor about the article "Posterior Continuous Curvilinear Capsulorhexis With and Without Optic Capture of the Posterior Chamber Intraocular Lens in the Absence of Vitrectomy."