The internal limiting membrane (ILM) is the structural interface between the vitreous and retina. As the basement membrane of retinal Müller cells, it serves as a protective barrier and provides biomechanical strength for the central retina.1-3 It also acts as a scaffold for cellular proliferation for myofibroblasts, fibrocytes, and retinal pigmented epithelial cells. ILM removal ensures separation of the posterior hyaloid from the macular surface, which can relieve macular traction4,5 and prevent postoperative epiretinal membrane formation.6,7 Thus, vitrectomy with ILM peeling has become an increasingly utilized and vital component in surgical intervention for various vitreoretinal disorders.
BACKGROUND AND OBJECTIVE: Retinopathy of prematurity presents differently in developing versus developed countries, which may be due to environmental as well as racial differences.PATIENTS AND METHODS: Retrospective chart review of infants screened for ROP at a single neonatal intensive care unit. Risk factors were reviewed. Main outcome measures were rates of plus disease or treatment-requiring ROP by race.RESULTS: The study included 497 infants screened for ROP in an urban neonatal intensive care unit. Gestational age, birth weight, and bronchopulmonary dysplasia were independent risk factors for both plus disease and treatment-requiring ROP with type 3 multivariate analysis. Self-identified white race was also a risk factor for plus disease and treatment-requiring ROP. Race was significantly associated with maternal age, multiple births, and blood transfusions.CONCLUSION: In the study population, white race was an independent risk factor for plus disease and ROP treatment.
Pre-retinal arterial loops are usually incidental findings during examinations in healthy individuals. They are rarely associated with arterial occlusion, with only nine previously reported cases in the literature. The authors report a case of a pre-retinal arterial loop associated with a branch retinal artery occlusion in a myopic young man. They also report the first documented optical coherence tomography scan through the loop causing the branch retinal artery occlusion.
BACKGROUND AND OBJECTIVE To evaluate anatomic and clinical outcomes of pneumatic retinopexy for treatment of primary retinal detachment. PATIENTS AND METHODS Noncomparative, single-center, consecutive, interventional case series evaluating all patients treated between 2000 and 2012. Patients with less than 1 month of follow-up or coexisting neovascular age-related macular degeneration, uveitis, endophthalmitis, or prior posterior segment surgery were excluded. RESULTS Sixty-three eyes of 63 patients with primary retinal detachment treated with pneumatic retinopexy were included. Median follow-up was 10.3 months. Single-operation success (SOS), defined as anatomic reattachment with pneumatic retinopexy alone, occurred in 40 eyes (63%). The retina was successfully reattached in 21 of the other 23 eyes (91%) with one additional surgery. There was no difference in visual acuity outcomes between SOS and additional surgical intervention (P = .85). New or missed breaks were identified in 19 of 63 eyes (30%). Postoperative subretinal fluid was observed in 22 of 63 eyes (35%) and persisted at last follow-up in two of 63 eyes (3%). At final follow-up, the retina was fully attached in 97% of eyes. CONCLUSION Pneumatic retinopexy remains a reasonably successful option in the management of primary retinal detachment. No difference in best corrected visual acuity outcomes in eyes achieving SOS versus those requiring additional surgery was demonstrated.
The authors describe the clinical management and spectral-domain optical coherence tomography (SD-OCT) findings of three unusual cases of neovascular age-related macular degeneration (AMD). Each patient presented with decreased vision and a diagnosis of neovascular AMD, with SD-OCT findings of marked macular fluid. Macular fluid was noted to be subretinal fluid, pigment epithelial detachment, or both. In each case, visual acuity improved and the fluid resolved rapidly with monthly anti-vascular endothelial growth factor therapy.
The authors report the use of an anti-VEGF agent in the resolution of subretinal fluid and hemorrhage with improvement in best corrected visual acuity (BCVA) in a patient with choroidal osteoma. The reported case involves a 20-year-old man who presented with a choroidal osteoma and chronic subretinal fluid associated with hemorrhage. He was treated with six intravitreal doses of bevacizumab over a 13-month period. The fluid resolved and his BCVA improved with these treatments. Intravitreal bevacizumab can be used to successfully treat subretinal fluid associated with choroidal osteomas and may lead to an improvement in BCVA.
BACKGROUND AND OBJECTIVETo evaluate the effectiveness of Leksell Gamma Knife stereotactic radio-surgery (Elekta, Stockholm, Sweden) with respect to local tumor control, visual acuity, and radiation side effects for uveal melanoma.PATIENTS AND METHODSRetrospective, non-comparative case series of 23 patients with uveal melanoma treated with Gamma Knife stereotactic radiosurgery at Tufts Medical Center from 2000 to 2012. Patients received single-fraction stereotactic radiation therapy of 20-25 gray (Gy) (mean: 21.7 Gy), primarily at the 50% isodose line. Follow-up was 4 to 121 months (median: 41.5 months). Main outcome measures included local tumor control, metastasis, visual acuity, and complications of therapy.RESULTSIn 21 of 23 patients (91%), local control was achieved with a single session of Gamma Knife therapy. Both patients who did not have local control, as well as a third patient (three of 23, 13%) developed liver metastases. Visual acuity was 20/200 or better in eight of 23 patients (35%) at last follow-up. Radiation side effects severe enough to cause vision loss were present in 14 of 23 patients (61%).CONCLUSIONGamma Knife therapy may be an effective alternative to enucleation in patients with uveal melanoma who are deemed less satisfactory candidates for brachytherapy or wish to avoid surgery.
BACKGROUND AND OBJECTIVE To describe a novel technique using a guarded needle to drain suprachoroidal hemorrhage. PATIENTS AND METHODS A guarded needle is used to drain suprachoroidal hemorrhage under direct microscope visualization. A scleral buckling sleeve is used to create a guarded 26-gauge needle to avoid over-penetration of the needle beyond the suprachoroidal space. Active extrusion can be used to drain suprachoroidal blood. RESULTS The authors report two cases in which active aspiration using a guarded needle was successful in draining suprachoroidal hemorrhage without complications. In both cases, the vitreous cavity could be restored, allowing for subsequent pars plana vitrectomy. CONCLUSION The technique of active aspiration using a guarded needle optimizes surgeon control of suprachoroidal hemorrhage drainage and also has the added benefit of easy transition to secondary vitrectomy after drainage has been completed.
This is a report of a 5-year-old boy who presented with an exudative retinopathy consistent with Coats' disease. Optical coherence tomography confirmed the concurrent presence of retinoschisis in the same eye, adjacent to the areas of exudation and ischemia. Treatment with laser photocoagulation, corticosteroids, and anti-VEGF therapy led to the resolution of the schisis cavity 1 year later. This represents the second published account of retinoschisis in the setting of Coats' disease.
Intravitreal injection of a dexamethasone implant was used to treat a 24-year-old patient with retinitis pigmentosa (RP) who developed cystoid macular edema (CME) in both eyes that was refractory to oral acetazolamide and intravitreal bevacizumab treatment. After injection, best corrected visual acuity (BCVA) improved and central macular thickness decreased, but CME recurred in both eyes 6 months later. Although a second intravitreal dexamethasone implant injection resolved the CME and improved the BCVA, CME recurred in both eyes 6 months later. The intravitreal dexamethasone implant may be useful for CME in patients with RP, but its efficacy seems to be limited over time.
[ Ophthalmic Surg Lasers Imaging Retina . 2014;45:179–180.]
BACKGROUND AND OBJECTIVE:To report on the efficacy of macular and optic nerve spectral-domain optical coherence tomography (SD-OCT) in differentiating between long-standing central retinal artery occlusion (CRAO) and nonarteritic anterior ischemic optic neuropathy (NAION).PATIENTS AND METHODS:SD-OCT scans of the macula and optic nerve in 24 patients with unilateral optic atrophy secondary to CRAO (12 patients) and NAION (12 patients) were compared both qualitatively and quantitatively for differentiating features.RESULTS:In patients with long-standing CRAO, there was a significantly greater (P < .001) thinning of the macula relative to the fellow uninvolved eye (-59.7 ± 31.8 μm) compared to patients with longstanding NAION (-19.9 ± 8.4 μm) even though both conditions caused a similar (P = .726) degree of peripapillary retinal nerve fiber layer loss (-42.4 ± 18.5 μm and -44.1 ± 12.4 μm, respectively).CONCLUSION:SD-OCT macular scans can be used as an adjunctive tool for differentiating between longstanding CRAO and NAION.
BACKGROUND AND OBJECTIVE To measure the subfoveal choroidal thickness in patients with age-related macular degeneration (AMD) over 6 months. PATIENTS AND METHODS A retrospective, observational study of patients with AMD followed up for 6 months at the New England Eye Center. Baseline and 6-month follow-up subfoveal choroidal thickness was measured using spectral-domain OCT and compared. RESULTS For the entire cohort, there was statistically significant thinning of the subfoveal choroidal thickness at 6 months compared to baseline that was driven by the cohort of patients with neovascular AMD (181.2 ± 75 μm to 173.4 ± 63 μm; P = .049). CONCLUSION There was a statistically significant decrease in subfoveal choroidal thickness observed in this cohort of patients with AMD over 6 months, but it was driven by the subgroup of patients with neovascular age-related macular degeneration.
Macula-threatening degenerative retinoschisis is a rare clinical problem. In the current report, imaging of three patients with asymptomatic and nonprogressive retinoschisis is presented. The visual and anatomic findings have remained stable during follow-up.
BACKGROUND AND OBJECTIVE To evaluate B-scan and computed tomographic appearance of a wooden intraocular foreign body within the posterior segment. MATERIALS AND METHODS The authors report a case of a patient with an occult retained foreign body. To identify why the object was elusive, an in vitro study was conducted using computed tomography (CT) and B-scan on five human cadaveric eyes with known foreign bodies implanted into the vitreous cavity. RESULTS Posterior segment metal and glass produced comet tail artifacts on B-scan, whereas stone, wood, and plastic produced shadowing artifacts. There was difficulty in identifying wood within the posterior chamber via CT. However, stone and plastic were easily detectable but difficult to identify without Hounsfield units. CONCLUSION CT provides quick imaging of suspected posterior segment foreign bodies; however, B-scan ultrasonography may prove more useful than CT in detecting wooden foreign bodies.
The authors report the in vivo visualization through multimodal imaging of silicone oil in the vitreous cavity, optic nerve, and retina of a patient 11 years after surgical removal of the main tamponade. Contact B-scan ultrasonography revealed countless small echogenic particles in the vitreous cavity and a hyperreflective structure within the optic nerve head. Swept-source optical coherence tomography showed multiple round hyporeflective spaces within the substance of the prelaminar optic nerve head. Adaptive optics imaging revealed numerous particles in the optic nerve head and within the retina in the same plane as the photoreceptors, with similar size and shape to the silicone oil droplets in the vitreous cavity. The authors hypothesize that in this case, the silicone oil droplets in the retina and optic nerve head may be associated with the patient's otherwise unexplained progressive visual loss.
BACKGROUND AND OBJECTIVETo report five cases of iritis after intravitreal injection of bevacizumab.PATIENTS AND METHODSThe clinical charts of patients who received intravitreal injections of bevacizumab or ranibizumab from January 2009 to September 2011 by one physician were retrospectively reviewed.RESULTSA total of 1,097 injections of bevacizumab and 571 of ranibizumab were administered. Five patients developed acute anterior uveitis and presented with severe pain, photophobia, conjunctival injection, and anterior chamber reaction 2 to 24 hours after intravitreal injection of bevacizumab. All five patients were treated with topical corticosteroids with rapid resolution of the inflammation.CONCLUSIONAlthough uncommon, acute iritis is a complication of intravitreal injection of bevacizumab.
BACKGROUND AND OBJECTIVE: To present a case series to elucidate a novel technique that involves the creation of an arcuate retinotomy in the treatment of large macular holes after failed primary repair. PATIENTS AND METHODS: retrospective chart review. Six eyes (six patients) with large macular holes, all of which had failed primary repair, underwent 25 gauge pars plana vitrectomy revision coupled with full thickness arcuate retinotomy temporal to the macular hole and fluid-gas exchange. The main outcome measure was anatomic macular hole closure based on optical coherence tomography (OCT), with visual acuity and visual field evaluation as secondary outcome measures. RESULTS: Five of the six patients (83%) had successful hole closure with three of the six patients (50%) exhibiting improvement in visual acuity. CONCLUSION: Arcuate retinotomy is a new approach that may aide in the repair of large macular holes not otherwise amenable to closure with traditional techniques.
