J. Niklas Ulrich

Peripheral retinal nonperfusion in fellow eyes in coats disease.

Purpose: To measure peripheral nonperfusion and describe bilateral vascular abnormalities in patients with Coats disease, emphasizing subtle findings in the contralateral eyes of patients diagnosed with unilateral disease. Methods: Clinical records, including retina drawings and fluorescein angiography images obtained under anesthesia, were retrospectively reviewed from consecutive pediatric patients with Coats disease. The main outcome measure was disk diameters of peripheral nonperfusion and proportion of Coats disease patients with bilateral findings. Results: Twenty-two of 32 patients with Coats disease had bilateral abnormal peripheral vasculature. In Group 1 (classic Coats disease: presumed unilateral, ocular only disease), 15 of 24 patients had peripheral nonperfusion >2 disk diameters in their contralateral eyes, 5 with telangiectasis and/or microaneurysms. Seven of 8 patients in Group 2 (Coats-like disease: systemic and/or clinically bilateral disease) had bilateral vascular anomalies. Conclusion: Bilateral vascular abnormalities are more common in Coats disease than previously reported. This observation supports a systemic and/or genetic association with Coats disease. Patients with Coats disease should have careful evaluation of the periphery of the less affected eye, preferably with fluorescein angiography, to identify vascular changes not visible clinically. Both eyes warrant surveillance over the lifetime of the patient for potential progression to exudative disease that would warrant treatment.

Determination of retinal and vitreous temperature in vitrectomy.

Purpose/Background: To maximize recovery after neurologic injury, physicians use therapeutic hypothermia of 90°F to 93°F (32.2–33.9°C). Temperatures below this are avoided because of increased side effects. The extent to which the retina is cooled during routine vitreous surgery is unknown. This study seeks to describe the temperature changes of the vitreous and retinal surface during vitreous surgery. Methods: In this prospective study of 6 patients undergoing vitrectomy, a 23-gauge thermoprobe was used to measure intraocular temperatures before, during, and after vitrectomy. Results: Before vitrectomy, the mean midvitreous temperature was 93.1°F (33.9°C) and retinal temperature was 94.7°F to 95.4°F (34.8–35.2°C). During vitrectomy, the mean midvitreous cavity temperature was 76.9°F (24.9°C) and retinal temperature was 83.2°F to 85.1°F (28.4–29.5°C). After completion of vitrectomy and with a closed infusion line, the mean midvitreous cavity temperature was 87.0°F (30.6°C) and retinal temperature was 90.1°F to 90.9°F (32.3–32.7°C). These changes in temperature before, during, and after vitrectomy were found to be statistically significant. Conclusion: During routine vitreous surgery, the vitreous cavity and retina are cooled to much lower temperatures than those used in therapeutic hypothermia. Rapid rewarming occurs within the eye once the infusion line is closed.

Topical nepafenac after intravitreal injection: a prospective double-masked randomized controlled trial.

Purpose: To evaluate if a single drop of nepafenac can reduce the ocular discomfort after intravitreal injections compared with placebo. Methods: One hundred and twenty patients undergoing intravitreal injections of bevacizumab or ranibizumab received a drop of nepafenac or placebo (Systane Ultra) after the injection in a prospective, double-masked, randomized controlled design. Patients rated their pain levels from 0 to 3 (no pain, mild pain, moderate pain, severe pain) at 1 hour, 6 hours, and 24 hours after the procedure. Results: Statistically significant reduction of postinjection pain with nepafenac was noted 6 hours after the injection when compared with placebo (0.8 ± 0.6 [standard deviation] vs. 1.3 ± 0.8, P < 0.001) with similar trends at 1 hour (1.1 ± 0.7 vs. 1.3 ± 0.7, P = 0.12) and 24 hours (0.3 ± 0.5 vs. 0.5 ± 0.6, P = 0.15). Conclusion: A single drop of nepafenac is effective in reducing discomfort after intravitreal injections.

The Characteristics and Short-term Refractive Error Outcomes of Cystoid Macular Edema in Premature Neonates as Detected by Spectral-Domain Optical Coherence Tomography

BACKGROUND AND OBJECTIVE To explore characteristics associated with cystoid macular edema (CME) in neonates screened for retinopathy of prematurity (ROP). PATIENTS AND METHODS In this institutional review board-approved, prospective, observational study, premature neonates underwent imaging with handheld spectral-domain optical coherence tomography. RESULTS Of 73 included infants (median gestational age [GA]: 28 weeks, range 23-33 weeks; birth weight: 966 g, range 506 g-1695 g), 28 (38%) had CME and 17/28 (61%) had ROP. CME was associated with ROP (P=.03) and younger GA (P=.04), but not associated with sex, race, birth weight, postmenstrual age at imaging, ROP severity, or myopia at median 6 months corrected age. CME resolved in three cases after bevacizumab treatment for type 1 ROP and in five cases without treatment. CME appeared in two cases several weeks following injections. CONCLUSION CME was associated with ROP and younger GA, but not with myopia. Intravitreal bevacizumab for type 1 ROP has inconclusive effects on CME.

The Relationship of Vogt-Koyanagi-Harada Syndrome to Ocular Hypertension and Glaucoma.

ABSTRACT Purpose: Vogt–Koyanagi–Harada (VKH) syndrome is a systemic inflammatory autoimmune disease with associated ophthalmic pathology. Glaucoma has been reported in patients with VKH. The purpose of this report is to examine the frequency and types of glaucoma associated with VKH. Methods: This was a retrospective case series. Electronic medical records of patients with VKH were reviewed from two medical centers: Duke University and the University of North Carolina. Results: Of 45 eyes with VKH, 28 (62%) developed ocular hypertension (OHT) or glaucoma. In the patients with VKH and OHT/glaucoma, 18/28 (64%) had posterior synechiae and/or peripheral anterior synechiae. Conclusions: We have shown a high prevalence of OHT and glaucoma in eyes with VKH. Furthermore, in addition to secondary open angle from corticosteroid treatment and uveitis, secondary angle closure resulting from posterior synechiae, frequently associated with iris bombé configuration, is an important cause of glaucoma in VKH eyes.

First Experience with Teleophthalmology in Rural Nepal

Access to subspecialty eye care is a challenge in Nepal, given the lack of subspecialists in rural areas, the mountainous terrain, and lack of infrastructure. The use of telemedicine was tested at two different sites in rural Nepal in 2008. Photos of fundus pathology were taken, uploaded to an Internet server, and evaluated by subspecialists in Kathmandu and the USA. Even though telemedicine seems to be a good fit for rural Nepal, major obstacles including power supply, Internet connection, and technical support have to be overcome before telemedicine could be implemented for routine use.

Evaluation of retinopathy of prematurity incidence with telemedicine confirmation in Gansu, China: a pilot study

ABSTRACT Purpose: To determine the incidence of retinopathy of prematurity (ROP) in Gansu, China by combining bedside examinations with remote RetCam (Clarity Medical Systems, Pleasanton, CA, USA) diagnosis. Methods: ROP screening via indirect ophthalmoscopy followed by RetCam imaging was performed from 2014 to 2015. Three ROP-experienced ophthalmologists interpreted images remotely. Incidence of ROP was determined by combining bedside and telemedicine diagnoses. Results: Of 139 examined infants and 137 complete records, 20 (14.6%) patients developed ROP, with 11 (8.0%) stage 1, six (4.4%) stage 2, and three (2.2%) stage 3 based on combined diagnoses. Perinatal asphyxia was significantly associated with ROP incidence (p = 0.01). ROP incidence by combined diagnosis (20/137 or 14.6%) versus clinician diagnosis alone (21/137 or 15.3%, p = 0.50) was similar. Telemedicine changed diagnoses in 4/21 (19.0%) ROP cases. Conclusions: Telemedicine may be helpful in confirming ROP incidence and may serve as a training and support model for less experienced and professionally isolated ROP examiners.

Intraocular and extraocular hemorrhage associated with ligature release of non-valved glaucoma drainage implant

Purpose To report a rare complication of non-valved glaucoma drainage device surgery. Observations An 85-year-old pseudophakic white male presented with painless vision loss and bloody tears. He was 5 weeks removed from uncomplicated non-valved glaucoma drainage device (Baerveldt 101-350, [AMO, Santa Clara, CA]). There was serosanguinous discharge without apparent source and a 25% layering hyphema in the anterior chamber. The tube was unobstructed in the anterior chamber and not abutting the iris. There was no presence of neovascularization or other abnormal vessels in the angle. After clearing of the hyphema, the patient had persistent vitreous hemorrhage necessitating pars plana vitrectomy. No source of hemorrhage was identified. Conclusions and importance This is the first report of a rare occurrence of intraocular and extraocular hemorrhage associated following spontaneous release of ligature of a non-valved glaucoma drainage implant. The presumed mechanism was sudden shallowing of the anterior chamber resulting in the tube irritating uveal vasculature. We do not have an explanation for the extraocular blood.

Enhanced depth imaging spectral domain optical coherence tomography in syphilitic chorioretinitis.

PURPOSE To describe the enhanced depth imaging optical coherence tomography features in syphilitic chorioretinitis. METHODS This is a case report. RESULTS A 69-year-old man was diagnosed with syphilitic chorioretinitis after presenting with a 3-week history of blurred vision in his right eye. Fundus examination revealed vitritis and retinal whitening along the inferotemporal arcade. Enhanced depth imaging optical coherence tomography showed choroidal thickening and increased reflectivity of the overlying retina. Intravenous penicillin G was started and clinical improvement followed with corresponding reduction in choroidal thickness and decreased reflectivity of the overlying retina. CONCLUSION Enhanced depth imaging optical coherence tomography can be used in conjunction with clinical examination to localize tissue involvement in syphilitic chorioretinitis and monitor treatment response.