Mostafa Elgohary

Outcome of Phacoemulsification in Patients with Uveitis

are no current therapeutic options. The size and the scope of our article were limited by the nature of a retrospective chart review, which only allows analysis of followup that occurred within the defined time frame. Additional factors limiting the scope and length of the study included (1) the logistical and financial complexity involved in following up patients in two geographically separated states; (2) the differences in available equipment in the two institutions; and (3) the importance of sharing a potential new treatment with the ophthalmic community sooner rather than later. The retrospective chart review process was begun while the senior author was at the University of Florida, and because he moved from Florida to Massachusetts, the analysis was carried out in Massachusetts, and appropriate Institutional Review Board approval from the Massachusetts site was published in the article. The valproic acid treatment regimen analysed retrospectively in the charts of the seven patients is detailed in the article. Prospective follow-up was not carried out, nor is it allowed under the mandate of a retrospective chart review. To clarify, the treatment of patients with valproic acid has not been stopped for any of the patients who tolerated it well (most of the patients). Our retrospective chart review reported on in the BJO article captured a relatively short period for a slowly progressive condition such as RP, and we recognise that the most rigorous validation of a therapy will be a well-designed clinical trial. A prospective, multicentre, randomised, placebo-controlled clinical trial is in the final stages of preparation in the USA, and we will be registering this clinical trial very soon at the US clinical trials website, http://www.clinicaltrials.gov. On a separate note, as part of our current clinical practice in Massachusetts, several RP patients new to our practice have been treated with valproic acid; our clinical impressions of these new patients are similar to what was reported in our article. There is mounting evidence that valproic acid may have potent neuroprotective properties and have other beneficial effects, and we have an intensive programme of in vitro and in vivo experiments (including mice models of RP) under way. The results of our experiments in the context of retinal degenerative conditions have been reported at recent meetings. We are planning to submit these data as articles to peer-reviewed journals. Our work has been motivated by the spirit of translational research, with the goal of more quickly identifying a promising therapeutic approach and stimulating scientific interest and further research, based on preclinical data and unexpectedly positive vision function observed in a clinical setting. Repurposing drugs such as valproic acid, which have been shown to be safe, is an economical and time-efficient way to quickly bring new treatments to patients.

Repeat intravitreal triamcinolone acetonide injections in uveitic macular oedema

retreatment only after the sixth month. The design of this compassionate program study provided for retreatment from the fourth month on a PRN basis. Our results show that a sustained effect can be obtained for both functional and anatomical aspects. It is worth remarking that our patients displayed older CRVO forms, with longer ME duration in comparison with the GENEVA trial (13 versus 5 months, respectively), lower mean BCVA at baseline (20 ⁄ 320, versus 20 ⁄ 80, respectively) and higher CFT (620 versus 550 lm, respectively) (Haller et al. 2010). Although obvious limitations include small number of patients and absence of a control group, this study illustrates, with all due caution, the positive effect of dexamethasone implant for ME secondary to CRVO in a clinical setting, demonstrating a sustained effect if a PRN basis is followed. Further studies are needed to ascertain the best therapeutic approach and the most appropriate timing of the treatment.

Using spectral-domain optical coherence tomography imaging to identify the presence of retinal silicone oil emulsification after silicone oil tamponade.

Purpose: To describe small hyperreflective areas using spectral-domain optical coherence tomography (SD-OCT) imaging in eyes that have had silicone oil tamponade. Methods: Retrospective case series of 11 eyes of 11 patients. The authors retrospectively identified patients who underwent vitrectomy and silicone oil tamponade secondary to a rhegmatogenous retinal detachment (nine patients), panuveitis with retinal necrosis (one patient), or recurrent full-thickness macular hole surgery (one patient) who had manifestations of silicone oil emulsion on SD-OCT imaging. Patients were monitored during the postoperative period by clinical examination and using SD-OCT. A model eye in which emulsified silicone oil had been injected in the anterior chamber was used to obtain anterior segment SD-OCT images for comparison. Results: The mean age of our patients was 50 years (range, 39–76 years). In eight eyes, the SD-OCT examination was carried out after silicone oil removal, and in three eyes, the SD-OCT examination was carried out with the oil in situ. Of the nine eyes treated for rhegmatogenous retinal detachment, five had a relieving retinectomy for advanced anterior proliferative vitreoretinopathy or for traumatic retinal incarceration (one eye). The eye treated for full-thickness macular hole had a vitrectomy, internal limiting membrane peel, and silicone oil injection for recurrent macular hole. Ten eyes showed hyperreflective, spherical, tiny droplets using SD-OCT imaging. These were thought to represent silicone oil droplets intraretinally or underneath epiretinal membranes, and one eye showed hyperreflective areas subretinally (retina detached). One additional patient was found to have tiny intravitreal silicone oil droplets after silicone oil removal. Similarly, the silicone oil appeared as multiple hyperreflective spherical droplets as detected by SD-OCT. Anterior segment studies of silicone oil emulsification in the experimental model revealed a similar appearance to that seen with in vivo SD-OCT imaging. Conclusion: The authors have found small hyperreflective areas intraretinally, subretinally, and underneath epiretinal membranes on SD-OCT in eyes that have had silicone oil tamponade for a variety of indications. The authors have seen a similar appearance when silicone oil emulsification is examined in vivo. The authors conclude that the hyperreflective areas are likely (but not certain) to be very small bubbles of emulsified silicone. Further studies are required to determine the incidence, clinicopathologic, and functional significance of probable silicone oil emulsification and deposition within the retinal layers.

Incidence and risk factors of Nd:YAG capsulotomy after phacoemulsification in non‐diabetic and diabetic patients

Purpose:  To estimate the cumulative incidence and identify the risk factors of posterior capsule opacification (PCO) that required Nd:YAG capsulotomy in non‐diabetic and diabetic patients.

Simple technique to abort pupillary block glaucoma secondary to anterior chamber crystalline lens dislocation in Marfan's syndrome.

logical findings, and the follow-up evaluation demonstrated that nimesulide powder had been the triggering agent of our patient FDE. Few cases of FDE elicited by nimesulide ingestion have been reported to date, with a spectrum of different skin manifestations. Nevertheless, the eyelid involvement is quite rare in FDE spectrum of manifestations. To our knowledge, this is the first case of nimesulide-induced FDE presenting with both ocular and cutaneous involvement. In particular, it is not common that ocular sings develop before skin rash spreading. Hence, this report stresses the importance of collaboration between dermatologists and ophthalmologists for a more rapid diagnosis and an appropriate management.

RESCUE PNEUMATIC RETINOPEXY IN PATIENTS WITH FAILED PRIMARY RETINAL DETACHMENT SURGERY.

Purpose: To describe the outcome of a series of patients who underwent pneumatic retinopexy (PR) for recurrent retinal detachment after scleral buckling and vitrectomy. Methods: This is a retrospective review of 42 consecutive cases who underwent secondary PR after either scleral buckling (n = 22) or vitrectomy (n = 20) between 1995 and 2011. Fishers exact and nonparametric tests were used for comparison. Results: Hundred percent of patients in the scleral buckle group and 90% of the vitrectomy group were repaired with 1 PR procedure (P = 0.67). The two patients in the vitrectomy group failed because of presumed new breaks and proliferative vitreoretinopathy. The median time between the primary procedure and PR was 8.5 days for the scleral buckle group (interquartile range, 5–55 days) and 31.5 days for the vitrectomy group (interquartile range, 21–52 days) (P = 0.003). Postoperative median visual acuity improved by more than 2 logMAR lines in both the scleral buckle group (P = 0.0008) and the vitrectomy group (P = 0.007), with no difference between groups (P = 0.19). The overall complication rate in our patients was 16%, including transient intraocular pressure rise and development of tears requiring further indirect laser retinopexy within 3 months. None of the patients had vitreous hemorrhage, subretinal gas, or endophthalmitis. Conclusion: Rescue PR seems to be a safe and effective method of treating recurrent retinal detachment after both unsuccessful scleral buckling and vitrectomy.