Elias C. Mavrofrides

One-year Safety And Efficacy Of Intravitreal Triamcinolone Acetonide For The Management Of Macular Edema Secondary To Central Retinal Vein Occlusion

Purpose: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) as treatment for macular edema associated with central retinal vein occlusion (CRVO). Methods: A retrospective review was performed of data for 40 consecutive patients (40 eyes) with CRVO and macular edema treated with IVTA at the Bascom Palmer Eye Institute (Miami, FL). Results: Median duration of symptoms before the first injection was 3 months (range, 1 day to 8 years). Median Snellen visual acuity was 20/400 at baseline (range, 20/60 to light perception; n = 40), 20/300 at 1 month (P = 0.010; n = 37), 20/300 at 3 months (P = 0.007; n = 33), 20/400 at 6 months (P = 0.726; n = 28), and 8/200 at 1 year (P = 0.569; n = 17). Vision improved by ≥3 lines in 21% of eyes at 1 month, 27% at 3 months, 14% at 6 months, and 12% at 1 year. Visual acuity was unchanged from baseline in 71% of eyes at 6 months and 1 year. By 1 year, 50% of eyes received more than one injection (mean = 1.6 injections; range 1–4 injections). Overall, intraocular pressure increased by ≥10 mmHg in 24% of eyes at 1 year. Trabeculectomy was performed on 2 of 12 eyes with preexisting open-angle glaucoma. Conclusion: IVTA can substantially improve vision in some patients, but most patients have stable visual acuity compared with baseline at 1 year despite repeated injections.

Indocyanine green-assisted internal limiting membrane peeling for macular holes: toxicity?

Background: Indocyanine green (ICG) staining facilitates definitive internal limiting membrane (ILM) peeling during macular hole surgery (MHS), but might cause toxicity. Purpose: To determine if ICG to assist in ILM peeling has an effect on anatomic or visual results in MHS with ILM peeling. Methods: Retrospective, comparative review including primary analysis of 173 cases undergoing MHS. Visual acuity ≥20/50, ≤20/200, three-line visual acuity improvement, and anatomic success rates were analyzed as endpoints. Results: The single operation hole closure rate was 87% with ICG versus 83% without ICG (P = 0.52). Postoperative median best-corrected visual acuity was 20/70 and 20/80 in the ICG and no ICG groups with median follow-up intervals of 8 and 9 months. The use of ICG was associated with a higher rate of ≤20/200, but ILM peeling and ICG use was not associated with better anatomic success, visual improvement, or ≥20/50 visual acuity. Conclusions: ICG usage during macular hole surgery was not associated with worse visual outcomes, suggesting possible toxic effects reported are not clinically significant. If the ILM cannot be peeled effectively, ICG should be considered a safe option.

Anterior segment ischemia following laser therapy for threshold retinopathy of prematurity

Purpose: To report on the clinical characteristics and outcomes of premature infants developing signs of anterior segment ischemia after laser therapy for threshold retinopathy of prematurity treated or referred to a university institution. Methods: A retrospective review of the medical records of premature infants with a primary diagnosis of retinopathy of prematurity undergoing laser therapy for threshold disease from January 1, 2001, to June 1, 2006. Results: A total of 10 eyes in six patients were identified that developed signs of anterior segment ischemia for which a 1-year follow-up was available. The mean gestational age of patients developing anterior segment ischemia was 26.1 weeks. The mean weight was 855 g. The mean gestational age when laser photoablation was initiated was 36.3 weeks. All infants developing ischemia were treated with intermittent dense laser pattern using the diode laser. No infants treated thus far with confluent laser pattern have developed anterior segment ischemia. Conclusion: Confluent laser pattern in our experience does not predispose to anterior segment ischemia. Anterior segment ischemia primarily affects premature infants less than 28 weeks gestational age with low birthweights, less than 1,075 g. Intravitreal steroids at the time of pars plana vitrectomy and lensectomy may be beneficial in selected patients.

Development of multiple subretinal hemorrhages during diode laser supplementation for retinopathy of prematurity.

A premature infant had subretinal hemorrhages in one eye after laser ablation for threshold retinopathy of prematurity. We postulate that subretinal hemorrhages occur from trauma to the microvasculature secondary to globe manipulation during scleral depression at the time of laser treatment.

Extended Endotamponade with Perfluoro-n-Octane in Pediatric Retinal Detachment.

The use of perfluoro-n-octane (PFnO) for extended endotamponade in an infant with X-linked retinoschisis and complex tractional retinal detachments associated with proliferative vitreoretinopathy (PVR) was reported. The patient had undergone multiple vitrectomy surgeries with silicone oil tamponade. After extensive retinectomy, slippage of the retina produced folds that were flattened under extended PFnO tamponade. The retinas of both eyes remained anatomically reattached 11 months after exchange of PFnO for silicone oil.

Fluorescein Angiography of a Closing Funnel Retinal Detachment in Familial Exudative Vitreoretinopathy

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