Michael P. Teske

Retinal arterial macroaneurysms

Retinal arterial macroaneurysms represent a distinct clinical entity. Macroaneurysms are seen in the elderly with a marked female predominance and a strong association with hypertension and arteriosclerotic vascular changes. The classic appearance provides an easy diagnosis; however, variable presentations, such as subretinal hemorrhage, macular exudate, and epiretinal membranes can make the diagnosis difficult. The differential diagnosis of retinal arterial macroaneurysms include retinal telangiectasia, angiomatosis retinae, venous macroaneurysms, background diabetic retinopathy, and cavernous hemangioma. The clinical characteristics of the reported cases are summarized, and our series of 60 patients is presented. The natural history of most macroaneurysms is spontaneous involution without loss of vision. However, visual loss may occur secondary to macular edema, exudate, hemorrhage and neurosensory retinal detachment, and photocoagulation may expedite visual recovery. Photocoagulation treatment may be applied directly to the macroaneurysm, indirectly by surrounding the macroaneurysm, or as a combination of these two methods.

Phacoemulsification combined with pars plana vitrectomy

Phacoemulsification combined with pars plana vitrectomy was performed on seven patients with both cataracts and vitreoretinal disease. Six of the seven had a posterior chamber intraocular lens (PC-IOL) placed in the capsular bag following cataract extraction. Visual acuities ranging from light perception to hand movement preoperatively, postoperatively ranged from hand movement to 20/25. There were no perioperative complications. During an average follow-up of more than 6 months, neovascular glaucoma developed in one patient, and a conjunctival cyst in another. The PC-IOLs were well tolerated. The small limbal incision used in phacoemulsification allows better control during the vitrectomy procedure and ensures a water-tight wound. In addition, with the limbal approach, the posterior lens capsule is maintained, with all the attendant advantages.

Corneal-scleral melt in association with cataract surgery and intraocular lenses: A report of four cases

ABSTRACT Four patients with rheumatoid arthritis had cataract extraction with implantation of an intraocular lens (IOL). Postoperatively three patients developed progressive scleromalacia perforans. All three cases required patch grafting of the sclera and two of them developed progressive melting of the sclera and graft. The fourth case involved progressive corneal melting with extrusion of the IOL despite treatment with penetrating keratoplasties. All four cases developed retinal detachments with loss of vision and three of the eyes were subsequently enucleated. We describe each case and discuss the clinicopathologic correlations of this condition. The need for careful evaluation of rheumatoid arthritis patients with cataract surgery and IOL implantation is emphasized.

Intravitreal injection of triamcinolone acetonide for macular EDEMA due to retinitis pigmentosa and other retinal diseases

Macular edema is a swelling of the macula that can result in decreased visual acuity. Because the macula is extensively surrounded by blood vessels, any resulting leakage can lead to macular edema and subsequent visual loss. Such leakage can be secondary to retinitis pigmentosa, and other retinal diseases including diabetic retinopathy, retinal vein occlusion, inflammatory processes such as uveitis, or can be a result of ocular surgery, referred to as Irvine-Gass Syndrome.

Intravitreal versus subretinal tissue plasminogen activator injection for submacular hemorrhage

BACKGROUND AND OBJECTIVE The objective of this study was to compare visual acuity outcomes between the following procedures used to treat submacular hemorrhages: pneumatic displacement followed by intravitreal tissue plasminogen activator (tPA) if needed (pneumatic ± tPA) and pars plana vitrectomy (PPV) with subretinal tPA (PPV + tPA). PATIENTS AND METHODS This is a retrospective chart review of submacular hemorrhages treated with either pneumatic ± tPA or PPV + tPA. RESULTS Eighteen patients had pneumatic ± tPA, and 14 patients had PPV + tPA. The percentage of patients achieving three lines or greater of vision improvement 1 year postoperatively was 46% and 18% in these groups, respectively (P = .194). CONCLUSION The difference in visual acuity was not statistically significant; however, the lack of a statistical difference is important as pneumatic ± tPA is a less-invasive, less costly procedure that can be done in a clinical setting. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:26-32.].

Effect of Oral Valproic Acid vs Placebo for Vision Loss in Patients With Autosomal Dominant Retinitis Pigmentosa: A Randomized Phase 2 Multicenter Placebo-Controlled Clinical Trial

Importance There are no approved drug treatments for autosomal dominant retinitis pigmentosa, a relentlessly progressive cause of adult and childhood blindness. Objectives To evaluate the potential efficacy and assess the safety of orally administered valproic acid (VPA) in the treatment of autosomal dominant retinitis pigmentosa. Design, Setting, and Participants Multicenter, phase 2, prospective, interventional, placebo-controlled, double-masked randomized clinical trial. The study took place in 6 US academic retinal degeneration centers. Individuals with genetically characterized autosomal dominant retinitis pigmentosa were randomly assigned to receive treatment or placebo for 12 months. Analyses were intention-to-treat. Interventions Oral VPA 500 mg to 1000 mg daily for 12 months or placebo. Main Outcomes and Measures The primary outcome measure was determined prior to study initiation as the change in visual field area (assessed by the III4e isopter, semiautomated kinetic perimetry) between baseline and month 12. Results The mean (SD) age of the 90 participants was 50.4 (11.6) years. Forty-four (48.9%) were women, 87 (96.7%) were white, and 79 (87.8%) were non-Hispanic. Seventy-nine participants (87.8%) completed the study (42 [95.5%] received placebo and 37 [80.4%] received VPA). Forty-two (46.7%) had a rhodopsin mutation. Most adverse events were mild, although 7 serious adverse events unrelated to VPA were reported. The difference between the VPA and placebo arms for mean change in the primary outcome was −150.43 degree2 (95% CI, −290.5 to −10.03; P = .035). Conclusions and Relevance This negative value indicates that the VPA arm had worse outcomes than the placebo group. This study brings to light the key methodological considerations that should be applied to the rigorous evaluation of treatments for these conditions. This study does not provide support for the use of VPA in the treatment of autosomal dominant retinitis pigmentosa. Trial Registration ClinicalTrials.gov Identifier: NCT01233609