Chetan K. Patel

Intravitreal triamcinolone acetonide for ischaemic macular oedema caused by branch retinal vein occlusion

No proved treatment exists for ischaemic macular oedema associated with branch retinal vein occlusion (BRVO) despite the potential for significant visual loss in affected eyes.nnWe report a patient with an ischaemic BRVO with associated macular oedema treated with intravitreal triamcinolone acetonide.nnA 38 year old man was referred to our department with a 6 week history of acute visual loss in his right eye (RE). On examination, visual acuity was 6/60 RE and 6/6 LE. A right relative afferent pupillary defect was present. Intraocular pressures were 9 and 10 mm Hg, respectively. Anterior segment examination showed no evidence of neovascularisation. There was no vitreous inflammation. Dilated fundus examination revealed a right inferotemporal BRVO with macular oedema. Collateral disc vessels were present. Systemic and haematological examinations, including full blood count, erythrocyte sedimentation rate, C-reactive protein, clotting screen, serum angiotensin converting enzyme, serum cholesterol and triglycerides, clotting screen, chest x ray, and ECG, were negative for systemic …

Outpatient Ultra wide-field intravenous fundus fluorescein angiography in infants using the Optos P200MA scanning laser ophthalmoscope.

Purpose To determine the feasibility of Ultra wide-field intravenous fundus fluorescein angiography (UWF-IV-FFA) in infants. Methods A retrospective review of infants who underwent UWF-IV-FFA with the Optos P200MA was performed. The ability to capture different phases of the angiogram, the total image acquisition time and the presence of image artefacts were analysed. Results Twelve infants with a variety of proliferative retinopathies underwent UWF-IV-FFA over a 7-month period. The mean age was 3.4u2005months (range 2–6u2005months) and the mean image acquisition time was 4u2005min (range 3–5). Pseudocolour fundus images and the venous, recirculation and late phases of UWF-IV-FFA were captured successfully in all infants (100%). Choroidal and arterial phases were captured in one (8.3%) and 10 (83.3%) infants, respectively. Image artefacts due to eyelashes and corneal desiccation occurred in nine (75%) and six (50%) infants, respectively. No adverse medical problems were noted. Conclusions We have shown that UWF-IV-FFA can be successfully and safely performed in infants using the Optos P200MA system. It is a feasible new alternative to RetCam for obtaining an IV-FFA in the outpatients setting.

Heidelberg Spectralis Ultra-Widefield Fundus Fluorescein Angiography in Infants

PURPOSEnTo describe the intraoperative use of the Heidelberg Spectralis for ultra-widefield fundus fluorescein angiography in infants.nnnDESIGNnRetrospective observational case series.nnnMETHODSnA modified Heidelberg Spectralis was used to perform ultra-widefield fundus fluorescein angiography in infants undergoing an examination under general anesthesia for a range of retinal vasculopathies. Peripheral angiographic findings, angiographic image acquisition time, and any complications were reviewed.nnnRESULTSnA total of 22 eyes of 11 infants underwent intraoperative ultra-widefield fundus fluorescein angiography using the modified Heidelberg Spectralis. Ultra-widefield fundus fluorescein angiography was successfully performed in all infants and permitted capture of the posterior pole as well as the peripheral retina in a single shot centered on the macula. Peripheral retinal pathologies captured include neovascularization, capillary nonperfusion, and skip areas from previous laser treatment. Capturing of angiographic images took a mean time of 7.09 minutes. Image artifact from condensation of the ultra-widefield lens was noted during imaging of 1 infant.nnnCONCLUSIONSnThe modified Heidelberg Spectralis is an effective and reliable imaging tool for performing ultra-widefield fundus fluorescein angiography in infants. It is capable of capturing wide-angle images of high quality. The technique has advantages as an alternative to RetCam fluorescein angiography in infants undergoing an examination under general anesthesia.

Revesz syndrome masquerading as bilateral cicatricial retinopathy of prematurity

Dyskeratosis congenita is a group of rare genetic bone marrow failure syndromes. Reveszxa0syndrome, a variant disorder, is characterized by retinopathy, aplastic anemia, nail dystrophy, and cerebellar hypoplasia. We report the case of an 11-month-old boy with bilateralxa0cicatricial retinal detachments associated with fibrovascular proliferation. Genetic testing ultimately confirmed a diagnosis of Revesz syndrome, which can mimic cicatricial retinopathy of prematurity. Prompt referral to a hematologist expedites diagnosis and treatment.

National survey of progressive symptomatic retinal detachment complicating retinoschisis in the United Kingdom

National survey of progressive symptomatic retinal detachment complicating retinoschisis in the United Kingdom

Incidence, mechanism and outcomes of schisis retinal detachments revealed through a prospective population-based study

Aim To determine the incidence, presentation and outcomes of progressive sight-threatening retinal detachment (RD) complicating degenerative retinoschisis. Methods We conducted the first prospective population-based epidemiological study of progressive schisis detachment over a 1-year period (2014–2015) in the UK. Case ascertainment was via monthly British Ophthalmological Surveillance Unit reporting cards sent to all ophthalmologists in the UK. For each reported case, data were collected using incident and 6u2005months follow-up questionnaires gathering information including demographic, presenting symptoms, retinal findings, primary management, primary outcome, secondary management and secondary outcome. Results Fifty-five cases of progressive schisis RD were identified with similar age distribution to conventional rhegmatogenous RD (mean age 64.0u2005years, range 20–88), and male-to-female ratio of 2.3:1. The locations of schisis detachments were predominantly supratemporal (46.7%) and infratemporal (35.6%). At least 70% of schisis RD were associated with posterior vitreous detachment (PVD) at presentation and 21% with grade B-C proliferative vitreoretinopathy. Primary management consisted of pars plana vitrectomy (82%), scleral buckle (9%), observation (4%), laser (2%) and combined vitrectomy-buckle (2%). Primary reattachment rate was 70%. Final reattachment rate was 87% with mean best-corrected visual acuity of 0.49 Decimal (SD 0.34) for fovea-on and 0.42 Decimal (SD 0.29) for fovea-off schisis detachments at mean follow-up of 8.7u2005months (SE 1.0). Conclusions The estimated annual incidence of progressive schisis RD was 0.85 per million population (95% CI 0.64 to 1.11), equivalent to around 0.66% of all rhegmatogenous RD. PVD may play a key pathogenic role in the development of progressive schisis detachments. Surgical outcomes are inferior to those of conventional rhegmatogenous RD.