Francesco Prascina

Bevacizumab compared with macular laser grid photocoagulation for cystoid macular edema in branch retinal vein occlusion.

Introduction: To evaluate the outcome of cystoid macular edema treated with intravitreal injections of bevacizumab and macular grid laser photocoagulation (GLP), in patients with perfused branch retinal vein occlusion. Methods: Thirty eyes of 30 consecutive patients with cystoid macular edema secondary to nonischemic branch retinal vein occlusion were assigned to either GLP group or to intravitreal bevacizumab (IB) group. Complete ophthalmologic examinations were performed just before GLP and IB injection at 1, 3, 6, and 12 months after treatment. Changes in logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), central macular thickness (CMT) shown by optical coherence tomography-3 were evaluated. Results: Baseline BCVA (logMAR) and CMT were, respectively, 0.89 ± 0.13 and 650 ± 140 &mgr;m for the GLP group, 0.87 ± 0.16 and 690 ± 120 &mgr;m for the IB group. After the treatment, at 1, 3, 6, and 12 months in the GLP group, BCVA had improved by 0.19, 0.22, 0.21, and 0.20 logMAR, CMT had decreased by 40%, 41.3%, 40.5%, and 42%. In the IB group, BCVA had improved by 0.31, 0.32, 0.30, and 0.31 logMAR and CMT had decreased by 59.5%, 59%, 60%, and 60.3%. The group receiving bevacizumab had better BCVA and lower CMT values at all time points (P < 0.05). Conclusion: Intravitreal bevacizumab injection improves BCVA and reduces CMT more than GLP. Intravitreal bevacizumab injection was well tolerated and could be used as primary treatment in patients with cystoid macular edema secondary to perfused branch retinal vein occlusion.

Short-term safety and efficacy of intravitreal bevacizumab for pseudophakic cystoid macular edema.

Purpose: To determine the feasibility, safety, and clinical effect of intravitreal bevacizumab (Avastin) in patients with refractory cystoid macular edema after uncomplicated cataract surgery. Methods: Ten eyes of 10 patients affected by pseudophakic cystoid macular edema refractory to medical treatment treated with at least one intravitreal injection of 1.25 mg of bevacizumab were enrolled in the study. Follow-up visits included Early Treatment Diabetic Retinopathy Study visual acuity testing, optical coherence tomography imaging, and ophthalmoscopic examination. Results: The follow-up was 6 months. All eyes had improved best corrected visual acuity, and no eye had worse visual acuity (≥2 Early Treatment Diabetic Retinopathy Study lines). The mean baseline best corrected visual acuity was 20/80 and the mean final best corrected visual acuity 20/32, the difference was statistically significant (P < 0.0001). The mean central macular thickness at baseline (546.8 mm; range, 359–720 mm) decreased significantly (228.7 mm; range, 190–280 mm) by the end of follow-up (P < 0.0001). No ocular or systemic adverse events were observed. Conclusions: Short-term results suggest that intravitreal bevacizumab is safe and well tolerated in patients with pseudophakic cystoid macular edema. Treated eyes had a significant improvement in best corrected visual acuity and decrease in macular thickness by optical coherence tomography.

Combined surgical ablation and intravitreal triamcinolone acetonide for retinal angiomatous proliferation

Purpose Neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) has a poor natural history and the efficacy of any treatment has not yet been established. The authors describe a combined surgical treatment. Methods A 76-year-old woman presented with a best-corrected visual acuity (BCVA) of 20/600 in the right eye and macula with stage 3 RAP as identified by fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). After a standard three-port pars plana core vitrectomy (PPV), endodiathermy of the arteriolar and venous feeder vessels of each lesion was performed, intraretinal RAP feeder vessels were cut with manual vertical intraocular scissors, and 0.1 mL of triamcinolone acetonide (TAAC) was injected intravitreally At 1 and 4 weeks and at the sixth month, the patient underwent a complete eye examination, FA, ICGA, and OCT to assess outcomes and complications. Results Six months later, BCVA was stable at 20/300, intraocular pressure was 15 mmHg, anterior segment and vitreous cavity were clear without evidence of TAAC granules, and retina was attached. FA and ICGA showed a complete occlusion of the RAP and absence of leakage or ischemia and OCT demonstrated decreased macular thickness with resolution of both intraretinal edema and pigment epithelium detachment, and the restoration of the normal macular profile. At the end of follow-up, the authors did not observe any ocular or systemic complication. Conclusions Surgical approach to RAP stage 3 with intravitreal injection of 4 mg of TAAC was safe and anatomically effective.

Isolated foveal hypoplasia.

Purpose To describe a patient with isolated foveal hypoplasia. Methods A 55-year-old man with the clinical suspicion of foveal hypoplasia was given a complete ophthalmological examination, including optical coherence tomography (OCT), fluorescein angiography (FA) and fundus-related perimetry (FRP). Mutation screening for oculocutaneous albinism and aniridia was also performed, but the results were negative for both. Results Following a complete ophthalmological examination and genetic studies, we were able to confirm the clinical suspicion of isolated foveal hypoplasia in this otherwise healthy patient. Conclusions With this report we want to highlight the roles of OCT, FA and FRP in the diagnosis of such a singular condition as isolated foveal hypoplasia.

Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab

A 67-year-old woman developed refractory pseudophakic cystoid macular edema (CME) after uneventful phacoemulsification. Three months after an intravitreal injection of bevacizumab (1.25 mg), the CME was completely resolved, with resultant improvement in visual acuity.

Intravitreal pegaptanib sodium (Macugen®) for radiation retinopathy following episcleral plaque radiotherapy

than intravitreal injection because the need was to treat an anterior chamber neovascular membrane; furthermore, intracameral injection is simpler and more comfortable for the patient. There is one previous report to our knowledge (Grisanti et al. 2006) of intracameral use of bevacizumab for treatment of neovascular glaucoma. Three patients were given 0.04 ml intracameral bevacizumab with a dramatic reduction of leakage demonstrated by iris fluoroscein angiography, which was still evident 30 days after injection. In our case, a significantly lower intracameral dose of bevacizumab resulted in rapid iris neovascularization regression. Intraocular bevacizumab, by either intravitreal or intracameral injection, can prove useful as an adjunct to glaucoma drainage surgery.

Focal laser photocoagulation for polypoidal choroidal vasculopathy associated with choroidal nevus.

PURPOSE To describe a patient treated with focal laser photocoagulation for polypoidal choroidal vasculopathy (PCV) secondary to choroidal nevus. METHODS A 62-year-old woman presented with PCV secondary to choroidal nevus in the right eye and best-corrected visual acuity of 20/100. The polypoidal lesions were treated with focal laser photocoagulation and clinical and instrumental data were prospectively analyzed. RESULTS Three months after focal laser photocoagulation, fluorescein angiography showed no leakage from the polypoidal lesions, optical coherence tomography scans displayed absence of subretinal fluid, and visual acuity improved to 20/25 and remained stable throughout an 18-month follow-up. CONCLUSION Focal laser photocoagulation seems to be an effective and safe treatment for PCV secondary to choroidal nevus.

Intravitreal avastin for choroidal neovascularization associated with stargardt-like retinal abnormalities in pseudoxanthoma elasticum

The aim of the study was to describe a patient with pseudoxanthoma elasticum (PXE), showing Stargardt-like retinal abnormalities, who underwent treatment with intravitreal bevacizumab for subfoveal choroidal neovascularization (CNV) of the right eye (RE). A 57-year-old woman with diagnosis of angioid streaks, retinal flecks, and chorioretinal Stargardt-like atrophy due to PXE was referred to our department for sudden decreased vision in her RE (20/160). Upon a complete ophthalmologic examination, including fluorescein angiography (FA), and optical coherence tomography (OCT), the patient was diagnosed with subfoveal CNV of the RE. Owing to the subfoveal localization of the CNV, the patient was submitted to intravitreal bevacizumab injection. At the 1-month follow-up, visual acuity (VA) improved (20/40), and FA and OCT revealed the CNV closure. Twelve months after the treatment, the patient’s VA remained stable with no recurrence of active CNV. On the basis of our findings, a single intravitreal bevacizumab injection seems to induce total regression of CNV complicating PXE, in a patient showing Stargardt-like retinal abnormalities. Further investigations are required to confirm our results.

Combined central retinal vein and cilioretinal artery occlusion

We present a case of combined central retinal vein and cilioretinal artery occlusion which, due to the absence of the temporal branch retinal artery, was initially misdiagnosed as a combined central retinal vein occlusion and temporal branch retinal artery occlusion. Given that – in contrast to cases of combined central artery and central retinal vein occlusion – the prognosis for cilioretinal artery occlusion with central retinal vein occlusion is quite good, this case illustrates the importance of suspecting an unusual condition in the presence of a combined occlusion.

Morphologic and functional changes in solar retinopathy: a study by optical coherence tomography and fundus-related perimetry.

PURPOSE Solar retinopathy is caused by macular exposure to solar radiation and is mediated by photochemical and thermal mechanisms. Ultrastructural examination shows the retinal pigment epithelium (RPE) and the outer segments of the photoreceptors as the most susceptible to solar insult. The authors describe the optical coherence tomography (OCT-3 Stratus) and the fundus-related perimetry (MP-1 microperimeter) findings of the disease. METHODS The authors performed a complete ophthalmologic examination in three patients with solar retinopathy, including two new, highly sensitive diagnostic tools, the OCT-3 and the MP-1, soon after solar exposure and again up to 18 months after diagnosis. RESULTS Symptoms and macular changes were similar in these three patients despite different exposures to solar radiation. On initial visit, the OCT scans revealed in all three patients an irregular inner high-reflective layer (I-HRL) that appeared fragmented and interrupted. In addition, the OCT images showed a hyperreflective lesion, which, in one patient, involved the full foveal thickness, and in two patients was confined to the outer half of the foveal layers. In two patients there was an associated reduced reflectiveness of the outer high-reflective layer (O-HRL). These OCT signs disappeared as early as 1 month follow-up. Fundus-related perimetry demonstrated, at the first visit, a significant reduction of retinal sensitivity in all patients, which was no longer evident at 1-month follow-up. CONCLUSIONS OCT may be an effective tool in diagnosing the acute phase of solar retinopathy and in differentiating it from other maculopathies. Fundus-related perimetry would seem to be a useful adjunctive method to better characterize the functional aspect of the disease.