Andres Emanuelli

Efficacy and safety of intraoperative mitomycin C as adjunct therapy for pterygium surgery.

Purposes: The primary objective of this study was to determine if intraoperative application of mitomycin C (MMC) is safe as an adjunct for pterygium surgery. The secondary objectives of the study were to determine if MMC reduces pterygium recurrence rate and to evaluate the effect of MMC on intraocular pressure. Methods: We conducted a nonconcurrent prospective study of 68 patients with primary or recurrent pterygium. Patients underwent a comprehensive eye examination preoperatively and postoperatively to evaluate for possible complications associated with the use of MMC. The recurrence rate of pterygia was also included in the data. Results: We examined a total of 68 patients (68 eyes). The follow-up time ranged from 12 to 98 months (mean = 27.7 ± 28.8 months). Only 2 postoperative complications were reported: a scleral dellen and a conjunctival cyst. Eight patients (12.0%) with primary pterygium had a recurrence of pterygia after surgery. However, no recurrences occurred in patients with previous recurrent pterygia. Conclusions: Findings in our study suggest that MMC is efficacious in preventing recurrences and a safe adjunct therapy during pterygium surgery. Findings in our study suggest that intraoperative MMC application leads to few complications while providing a significant reduction in the recurrence rate.

Foveal thickness and macular volume in patients with oculocutaneous albinism.

Purpose: To measure foveal thickness and macular volume in patients with oculocutaneous albinism (OCA) using optical coherence tomography (OCT) technology and to evaluate the possible association between albinism type and OCT retinal findings. Methodology: The authors measured retinal structures such as foveal thickness and macular volume of patients and obligate carriers of the various types of OCA using OCT technology. Results: Participants with OCA (all types included) have thicker foveas (P = 0.0009) and less macular volume (P = 0.0022) than the general population. Carriers of mutations leading to OCA (all types included) have normal foveal thicknesses and higher macular volumes (P = 0.0009) than the general population. Participants with Hermansky–Pudlak syndrome (HPS)-Type 1 have thicker foveas but less macular volume (P = 0.0468) than the general population. Conclusions: Results of this study suggest that patients with OCA (all types included) and patients with HPS-1 have thicker foveas than the general population. This may be due to the absence of foveal pit as part of foveal hypoplasia associated with OCA. Conversely, participants have lower macular volumes than the general population. This finding is compatible with loss of retinal nuclear layers in patients with OCA.

Low-dose methotrexate for the treatment of chronic central serous chorioretinopathy: a retrospective analysis.

Purpose: To evaluate the utility of oral methotrexate (MTX) for the treatment of chronic central serous chorioretinopathy (CSCR). Methods: Retrospective review of all eyes of patients on oral MTX as treatment for chronic CSCR in three different centers. Visual acuity as well as optical coherence tomography central macular thickness and total volume parameters were analyzed. Complete blood count and serum chemistry results were monitored. Results: Nine eyes of 9 patients treated with MTX for chronic CSCR met the criteria for analysis. Mean duration of CSCR was 28 months (range, 3–94 months). Mean starting dose of oral MTX was 7.04 mg (range, 5–10 mg), and mean final dose was 7.27 mg (range, 5–10 mg). The mean duration of treatment was 89 days. Mean visual acuity improved from 20/67 at baseline to 20/35 at 8 weeks (P < 0.01, paired t-test). Mean central macular thickness improved from 309 &mgr;m to 213 &mgr;m at 8 weeks (P < 0.01, paired t-test). Mean total macular volume improved from 8.14 to 7.21 at 8 weeks (P ⩽ 0.02, paired t-test). Eighty-three percent of the patients achieved total resolution of subretinal fluid. No MTX-associated toxicity was evident. Conclusion: Methotrexate may have a role in the treatment of chronic CSCR as evidenced by these results. A randomized controlled clinical trial is warranted to better understand the effects of MTX in these patients.

Endophthalmitis caused by Achromobacter xylosoxidans after cataract surgery.

Purpose: To report Achromobacter xylosoxidans as a cause of both acute-onset and delayed-onset postoperative endophthalmitis after cataract surgery. Methods: A noncomparative consecutive case series of patients with culture-proven A. xylosoxidans endophthalmitis between 1970 and 2012. Cataract surgery and intraocular lens placement were performed in all patients before endophthalmitis. Positive cultures were obtained from the vitreous, capsular bag, and/or the removed intraocular lens. Results: The clinical diagnosis was confirmed in four patients with positive cultures. Two patients with endophthalmitis had a preliminary culture report of Pseudomonas species. In addition to receiving intravitreal antibiotics, all patients underwent capsulectomy and intraocular lens removal at the time of pars plana vitrectomy. Visual acuity at last follow-up was 20/40 or better in 2 (50%) of the 4 patients, but the remaining 2 patients were 20/200 or worse. Conclusion: A. xylosoxidans may be a cause of acute, recurrent, and delayed-onset postoperative endophthalmitis after cataract surgery. Complete capsulectomy and intraocular lens removal can be considered in recurrent and recalcitrant patients.

Acute Retinal Necrosis Secondary to Herpes Simplex Virus Type 2 in Neonates

Acute retinal necrosis (ARN) should be in the differential diagnosis of a neonate who presents with vitritis. This report includes three cases of neonatal ARN at the Bascom Palmer Eye Institute from 2004 to 2009. Medical treatment with acyclovir helped reduce sequelae of herpes simplex virus (HSV) 2 infection. Patients with ARN are at risk for retinal detachment and blindness. Although mothers are screened during pregnancy, they are at risk of reactivation or primary contraction of HSV. A neonate presenting with vitritis should raise suspicion of ARN.

Posterior subhyaloid precipitates in cytomegalovirus retinitis

PurposeThis study aims to report a novel finding of posterior subhyaloid precipitates (PSPs) in two patients with cytomegalovirus (CMV) retinitis.MethodsA small case series was conducted.ResultsClinical findings, treatment, and follow-up of two patients with CMV and PSPs are presented.ConclusionsInflammatory precipitates may collect in the posterior subhyaloid space in acute CMV retinitis and resolve with treatment.

Unilateral Choroidal Neovascular Membrane as a Herald Lesion for Crohn’s Disease

Crohns disease is a diffuse inflammatory disease primarily affecting the gastrointestinal tract but with associated ophthalmologic complications that often appear after the initial diagnosis. The authors report a case in which the appearance of a choroidal neovascular membrane prior to the final diagnosis of Crohns disease suggests its role as an advance lesion heralding an inflammatory state. A 13-year-old boy was referred for evaluation of a clinically isolated, unilateral choroidal neovascular membrane, which stabilized after treatment with intravitreal bevacizumab. Two years later, the patient was diagnosed with Crohns disease. Choroidal neovascular membranes, reported previously as a complication of Crohns disease following diagnosis, may be a precursor lesion.

Management of 2 Intraocular Lenses in the Same Eye

OBJECTIVE To present options for managing a patient with a dislocated intraocular lens (IOL) in the presence of a second, nondislocated IOL. METHODS A review of 3 consecutive cases and the surgical maneuvers used in managing them. RESULTS The anterior chamber IOL was removed after scleral fixating the dislocated posterior chamber IOL in 1 case with corneal disease. The foldable, dislocated, original posterior chamber IOL was manipulated around an existing posterior chamber IOL and then removed at the limbus in 2 other cases. The visual acuity and retained IOL were stable in all 3 eyes. CONCLUSIONS Existing techniques with minimal modifications can be applied to managing an eye with a dislocated IOL and a coexisting nondislocated IOL with satisfactory results, but treatment needs to be customized to the specific situation.

Minimal Refractive Change Induced by Sutureless 23- and 25-Gauge Pars Plana Vitrectomy

BACKGROUND AND OBJECTIVE This study reports the induced refractive error after 23- and 25-gauge (G) pars plana vitrectomy (PPV). PATIENTS AND METHODS In this non-randomized retrospective case series, refractive status was assessed with an autokeratorefractometer 1 week or more before and 6 months after surgery. Patients who had suture placement to close the sclerotomies were excluded from the study. RESULTS Among the 50 patients (50 eyes), the mean age was 63 years (range: 42 to 76 years) and 57% were female. Thirty eyes underwent 23-G PPV and 20 eyes underwent 25-G PPV. The mean refractive change was +0.50 diopters (D) sphere, +0.25 D cylinders and the mean axis of cylinder change was 6° for the 23-G group; the mean refractive change was +0.12 D sphere, +0.12 D cylinders and the mean axis of cylinder change was 17° for the 25-G group. CONCLUSION Following sutureless small-gauge vitrectomy, there were mild and minimally significant refractive changes in the 23-G and 25-G groups from baseline.

Spontaneous Closure Of A Full-thickness Macular Hole Secondary To Irvine-gass Syndrome

Purpose: To report a case of spontaneous closure of a full-thickness macular hole after a posterior subtenon injection of triamcinolone in a patient with Irvine-Gass syndrome. Methods: Case report and literature review. Results: A 70-year-old man presented to the retina clinic with visual disturbance in his right eye after an uneventful cataract surgery. Patient was found to have macular edema associated with a full-thickness macular hole, treated with a posterior subtenon injection of triamcinolone with subsequent spontaneous closure of the hole and excellent visual acuity. Conclusion: This case demonstrates possible resolution of a condition which traditionally requires surgical intervention, with a nonsurgical approach.