Christina Canakis

Intravitreal triamcinolone acetonide for refractory chronic pseudophakic cystoid macular edema.

Purpose: To determine the safety and efficacy of intravitreal triamcinolone acetonide (TAAC) injections in patients with refractory cystoid macular edema (CME) after cataract extraction. Setting: LSU Eye Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. Methods: In this nonrandomized retrospective case review, 8 eyes of 8 patients with a history of pseudophakic CME recalcitrant to current standard treatment modalities were enrolled. The mean duration of the CME was 20 months. The patients received intravitreal injections of 1 mg of TAAC and were followed for a mean of 8 months. The main outcome measures included visual acuity, the presence of CME on biomicroscopic examination, angiographic evidence of perifoveal leakage, intraocular pressure (IOP), and complications related to treatment. Results: The visual acuity increased in all patients. The magnitude of improvement was mainly restricted by underlying macular pathology and correlated well with the level of visual acuity at entry into the study. Angiographic improvement occurred in all patients. Temporary increases in IOP were easily controlled with topical medications. No other adverse effects could be attributed to this technique. Repeated injections were required. Conclusions: Intravitreal administration of TAAC was safe and effective in recalcitrant cases of pseudophakic CME with a beneficial effect on the macular edema and visual acuity. A prospective randomized study is needed to determine with accuracy the efficacy, safety, and exact timing of this technique and possibly to recognize subtypes with a more favorable response. Repeated injections were required in all eyes. The development of a sustained‐release intravitreal drug‐delivery system would be beneficial.

Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy

OBJECTIVE To report two cases of recurrent anterior uveitis with sectoral iris atrophy and ocular hypertension during attacks caused by cytomegalovirus (CMV). DESIGN Two observational case reports. PARTICIPANTS Two immunocompetent patients with a history of recurrent unilateral hypertensive anterior uveitis with sectoral iris atrophy were referred to us with the presumptive diagnosis of herpetic uveitis. MAIN OUTCOME MEASURES Comprehensive ophthalmic examination, aqueous humor polymerase chain reaction (PCR), and peripheral blood serologic studies were performed on both patients. RESULTS Examination of aqueous humor by PCR was positive for CMV and negative for herpesvirus. Serum IgG/IgM titers disclosed past CMV infection. Both patients responded well to antiviral therapy with ganciclovir. The final visual acuity level was 20/20 in both eyes of both patients. CONCLUSIONS CMV infection can produce recurrent attacks of anterior uveitis with clinical characteristics indistinguishable from those previously considered highly suggestive or even pathognomonic for herpetic infection. This observation has implications for the therapeutic management of such patients.

The effect of internal limiting membrane peeling on chronic recalcitrant pseudophakic cystoid macular edema: a report of two cases.

PURPOSE To describe the effect of internal limiting membrane peeling in chronic recalcitrant pseudophakic cystoid macular edema. DESIGN Two interventional case reports. METHODS Two consecutive patients with chronic pseudophakic cystoid macular edema of 11-22 months duration, after uncomplicated cataract surgery, unresponsive to previous treatment, were enrolled. The surgical technique consisted of pars plana vitrectomy and internal limiting membrane peeling. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and perifoveal leakage on fluorescein angiography. Optical coherence tomography scans were performed postoperatively. RESULTS Pars plana vitrectomy with internal limiting membrane peeling resulted in anatomical, angiographic, and functional improvement in both patients, for total follow-up periods of 8 and 11 months, respectively. CONCLUSION To our knowledge, this is the first report of chronic pseudophakic cystoid macular edema that favorably responded to pars plana vitrectomy with internal limiting membrane peeling, as concluded after a MEDLINE search.

Small-size pediatric vitrectomy wide-angle contact lens

PURPOSE We describe a new wide-field vitrectomy contact lens specifically designed to facilitate pediatric vitreoretinal surgery. DESIGN Experimental study, instrument description. METHODS A wide-field contact two-piece glass vitrectomy lens was designed with the largest diameter of 13.6 mm and a contact diameter of 7.00 mm, sacrificing only the more tilt-sensitive parts of the optics in order to reduce its physical size. RESULTS Laboratory measurements in a model eye demonstrated a 61-degree binocular field of view, a 94-degree static field of view, and a maximum 129-degree field of view. Image magnification was 0.50 x. No complications were linked to the use of this instrument, and the need to exchange for another lens was never encountered in 10 cases. The two-piece glass construction enabled this lens to be sterilized in an autoclave or sterilized by any other instrument sterilization technique. CONCLUSION The instrument successfully fulfilled the purpose of its design, providing at the same time an excellent wide field of view and ample space for the surgeon, performing well in 10 pediatric vitreoretinal cases (8 cases of retinopathy of prematurity; 2 cases of traumatic eye injury). Its loose two-piece design rendered it suitable for all sterilization techniques.

A new high-speed pneumatic vitrectomy cutter

PURPOSE To describe a new high-speed pneumatic vitrectomy instrument capable of 2000 cuts/minute. DESIGN Observational report. METHODS A high-speed guillotine vitrector, developed to perform vitrectomy, with the ability to adjust from 1 to 2000 cuts/minute, was used in 80 consecutive vitreoretinal cases with a variety of diagnoses in a hospital setting. RESULTS The performance was almost vibration-free. The instrument performed efficiently up to 1500 cuts/minute during vitrectomy, maintaining a constant flow rate. Higher cutting rates were used successfully for special indications. No complications were linked to the use of the instrument. CONCLUSION The instrument was used successfully in 80 consecutive vitrectomies for a variety of diagnoses, performing efficiently up to 1500 cuts/minute, with a constant flow rate without complications. Higher cutting rates (2000 cuts/minute) were used successfully for special indications.

An adjustable-tip brush for the induction of posterior hyaloid separation and epiretinal membrane peeling.

PURPOSE To report a new adjustable-tip brush for induction of posterior hyaloid separation and epiretinal membrane peeling. DESIGN Observational report. METHODS The adjustable-tip brush made of 10-0 nylon was used during vitrectomy for a variety of vitreoretinal disorders to induce posterior vitreous detachment and to peel internal limiting membrane or epiretinal membranes. RESULTS The instrument was especially effective in inducing posterior vitreous detachment in eyes with chronic pseudophakic macular edema and diabetic macular edema. It was used successfully to strip thin, immature epiretinal membranes and to unfold rolled edges of giant retinal tears. No complications were associated with the use of the adjustable-tip brush. CONCLUSION The adjustable-tip brush was useful for posterior hyaloid separation and epiretinal membrane peeling during vitrectomy for a variety of vitreoretinal procedures.