Muna Bhende

Ultrasound biomicroscopy of sclerotomy sites after pars plana vitrectomy for diabetic vitreous hemorrhage.

OBJECTIVE This study was aimed at assessing changes at the sclerotomy site using the ultrasound biomicroscope (UBM) in eyes that underwent primary pars plana vitrectomy for complications of proliferative diabetic retinopathy. DESIGN Prospective, observational case series. PARTICIPANTS Eighty-six eyes of 84 patients with vitreous hemorrhage caused by proliferative diabetic retinopathy. INTERVENTION Three-port pars plana vitrectomy followed by UBM evaluation of all sclerotomy sites between 6 and 8 weeks after surgery. Correlation with intraoperative findings done in case of reoperations. Forty-one eyes had repeat UBM at 6 months. MAIN OUTCOME MEASURES The changes at the sclerotomy site were classified into six groups: well healed, gape, plaque, vitreous incarceration, fibrovascular proliferation, and anterior hyaloidal fibrovascular proliferation (AHFVP). The UBM characteristics of each of the groups were defined. The findings at 6 months were compared with those at 6 to 8 weeks. RESULTS At 6 to 8 weeks after surgery, most sclerotomies were well healed or had either moderate to high reflective plaques bridging the site. Wound gape was seen in 22.1% of active ports, 32.6% of light ports, and 25.6% of infusion ports. Vitreous incarceration was seen most often at the infusion port (18. 6% of eyes). Fibrovascular proliferation was seen in 9.3% of active ports, 12.8% of light ports, and 15.1% of infusion ports. Thirteen eyes had recurrent vitreous hemorrhage 6 to 8 weeks after surgery. Cases with rebleeding and no fibrovascular proliferation at the sclerotomy on UBM did well with outpatient fluid-air exchange (two eyes) or observation only (three eyes). Those with fibrovascular proliferation on UBM (eight eyes) required more extensive surgery. CONCLUSIONS UBM is helpful in detecting complications at the sclerotomy sites after pars plana vitrectomy and is an invaluable tool in the assessment of the patient before reoperation.

Intraocular cysticercosis: clinical characteristics and visual outcome after vitreoretinal surgery

PURPOSE To report the clinical characteristics of, discuss the surgical options for, and analyze the factors affecting the anatomic and visual outcome of intraocular cysticercosis. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Forty-five eyes of 44 Indian patients with posterior segment intraocular cysticercosis. METHODS The charts of 45 eyes, in which intraocular cysticercosis was removed by vitreoretinal surgery (either transscleral or transvitreal), were reviewed. MAIN OUTCOME MEASURES These included the postoperative retinal status and the best-corrected Snellen visual acuity. RESULTS Intraocular cysticercosis was present in the vitreous cavity of 27 eyes (60%) and in the subretinal space of 18 eyes (40%). Anterior segment inflammation was seen in 13 eyes (28.8%) and vitreous inflammation in 38 eyes (84.4%). Retinal detachment was observed in 22 eyes (48.8%), with proliferative vitreoretinopathy in 13 eyes (59.09%). Subretinal cysts anterior to the equator (4 eyes) were removed transsclerally, whereas subretinal cysts posterior to the equator and intravitreal cysts (41 eyes) were removed transvitreally. The mean follow-up was 10.5 months. At the last follow-up, the retina was attached in 39 eyes (86.6%); visual acuity of >/=5/200 was achieved in 67.5%. CONCLUSIONS Current vitreoretinal surgical techniques enable removal of intraocular cysticercosis in all cases, with reattachment of the retina in 86.6% and recovery of ambulatory vision in approximately 67% of cases.

Subretinal fibrosis and nonrhegmatogenous retinal detachment associated with multifocal central serous chorioretinopathy.

Purpose: To report the rare occurrence of subretinal fibrosis in patients with multifocal central serous chorioretinopathy and evaluate the role of systemic corticosteroids and the effects of laser photocoagulation on multifocal leaks. Methods: A total of 29 patients (mean age, 37.7 years; 89.7% male) treated for subretinal fibrosis and multifocal central serous chorioretinopathy from 1983–1995 were reviewed retrospectively. Mean follow up was 26 months (range, 6.8–81 months). Results: Retinal detachment involved the macula in 72.4% cases. Fluorescein angiography showed a mean of 6.7 (range, 2–22) central serous chorioretinopathy leaks and a mean of 1.8 (range, 1–5) retinal pigment epithelial detachments. The fundus pictures of 23 patients who were taking systemic corticosteroids showed no improvement. Following laser treatment, however, retinal reattachment was obtained in all eyes, and improvement in visual acuity of > 2 Snellen lines was noted in 68.9% of patients. Conclusions: The presence of subretinal fibrosis with secondary retinal detachment in otherwise healthy young patients, particularly in men, should alert the physician to look for multifocal central serous retinopathy leaks. Systemic cortiosteroids did not prove effective in treating these patients, although laser treatment is recommended for each leak identified on an angiogram.

A Multivariate Analysis of Anatomic Success of Recurrent Retinal Detachment Treated with Pneumatic Retinopexy

PURPOSE The purpose of the study is to determine the success rate of pneumatic retinopexy (PR) after failed scleral buckling and to elucidate the predictors for anatomic failure by multiple logistic regression analysis. METHODS Thirty-six eyes with recurrent retinal detachment after failed scleral buckling underwent PR. Intraocular tamponade was attained with SF6 (20 eyes), C3F8 (13 eyes), and air (3 eyes). Median follow-up was 14 months. RESULTS Retinal reattachment was obtained in 69.4%. Multivariate analysis identified two risk factors for failure: location of retinal break either on the posterior slope or posterior to buckle (P = 0.01) and extent of retinal detachment greater than two quadrants (P = 0.02). CONCLUSIONS Pneumatic retinopexy is an effective alternative to revision surgical operations if the leaking retinal break is located on the buckle.

Leiomyoma of the ciliary body extending to the anterior chamber : Clinicopathologic and ultrasound biomicroscopic correlation

Leiomyoma of the ciliary body is a rare tumor that often causes a diagnostic dilemma. Sclerouvectomy has been found to be beneficial in the management of iris and ciliary body leiomyoma. We treated a case of leiomyoma of the ciliary body presenting as a fleshy mass in the anterior chamber, removed by partial lamellar sclerouvectomy. Ultrasound biomicroscopic and histopathologic features, including light microscopic, immunohistochemistry, and transmission electron microscopic features, were studied and the literature was reviewed.

Vitrectomy For Accidental Intraocular Steroid Injection

Background: Accidental perforation of the globe and intraocular injection of steroid is a potential complication of periocular injections. Final outcomes in eyes in which this complication has occurred have been reported to be unsatisfactory in the past. However, the advent of vitrectomy has altered their prognosis significantly. Methods: A retrospective analysis was done of five cases of accidental intraocular steroid injection, treated by vitrectomy. Additional procedures involved treatment of retinal breaks (where required) with endolaser or transscleral cryopexy. Scleral buckling was done in one case. Results: Barring one case in which retinal detachment developed, there were no postoperative complications. At last follow up all patients had satisfactory recovery of visual acuity; had attached retina; and quiet anterior chamber and vitreous cavities. Conclusion: Vitrectomy is associated with satisfactory results in cases of accidental intra-ocular steroid injection. Delay up to a few days does not seem to materially influence the outcome.

A case of bilateral Chikungunya neuroretinitis

A 65-year old Asian–Indian presented with a month-old history of sudden, painless diminution of vision in both eyes (OD—20/200, OS—20/400). A nondiabetic, he had no history of hypertension or tuberculosis. He gave a history of fever and malaise associated with joint pain 1 week prior to onset of ocular symptoms. Left eye showed 2+ cells in the anterior chamber, while the right eye was quiet. No afferent pupillary defect was noted. Dilated fundus examination revealed neuroretinitis, cotton wool spots, hemorrhages, and a grade 2 vitreous haze in both eyes (a). Investigations for antinuclear antibodies, C-reactive protein, HIV, hepatitis B and C, Widal, Mantoux and QuantiFERON TB Gold were negative. The total leukocyte count and ESR were raised. Serum angiotensin-converting enzyme levels as well as platelet count were within normal limits. Reverse transcription polymerase chain reaction assay for Chikungunya performed on the patients serum revealed 358 copies of RNA/μl (b). A diagnosis of Chikungunya neuroretinitis was made, and the patient was treated with oral steroids and oral acyclovir 800 mg five times a day for 3 weeks, after which partial resolution was noted (c).

Scleral buckling: implant versus explant.

Purpose To compare the implant and explant techniques of scleral buckling. Methods This prospective, randomized clinical study compared the two techniques of scleral buckling. Variables such as size and extent of the buckle, duration of the surgery, complications, and anatomical and visual outcome were studied. The height of the buckle as measured by ultrasonography was also studied. Results No significant difference was found between the two groups for total duration of the surgery, complications, anatomical results, visual outcome, and buckle height. For the 1- to 2-quadrant buckles, duration of the surgery up to initiation of subretinal fluid drainage was found to be significantly shorter for the explant group. Serial ultrasonography showed significant reduction in buckle height over 6 months in both groups to an equal degree. Conclusions Scleral buckling seems to be equally effective whether performed as an implant or explant.

Photodynamic monotherapy or combination treatment with intravitreal triamcinolone acetonide, bevacizumab or ranibizumab for choroidal neovascularization associated with pathological myopia.

This retrospective, interventional case series analyses treatment outcomes in eyes with choroidal neovascularization (CNV) secondary to pathological myopia, managed with photodynamic therapy, (PDT), (Group 1, N = 11), PDT and intravitreal triamcinolone acetonide (4 mg/0.1ml) (Group 2, N = 3), PDT and intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab 1.25 mg/0.05 ml, ranibizumab 0.5 mg/0.05 ml and reduced-fluence PDT and intravitreal ranibizumab 0.5 mg/0.05 ml (Group 3, N=12). All the patients underwent PDT. Intravitreal injections were repeated as required. SPSS 14 software was used to evaluate the data. Wilcoxon signed ranks test was used to evaluate pre- and post-treatment vision. The Kruskal-Wallis test was used for comparison between the groups. All the groups were statistically comparable. All the eyes showed complete regression of CNV, with a minimum follow-up of six months. All groups had visual improvement; significantly in Group 3 (P = 0.003). Combination PDT with anti-VEGF agents appeared to be efficacious in eyes with myopic CNV. However, a larger study with a longer follow-up is required to validate these results.

Ultrasound biomicroscopy in the diagnosis and management of pars planitis caused by caterpillar hairs

PURPOSE To report the use of ultrasound biomicroscopy in the detection of caterpillar hairs in the pars plana in a patient with unilateral pars planitis. METHOD Ultrasound biomicroscopic imaging of the anterior segment of the eye. RESULTS Ultrasound biomicroscopy located a hair in the posterior chamber at the first visit and five more in the pars plana 1 month later. This finding was confirmed intraoperatively. CONCLUSION Ultrasound biomicroscopy is useful in the diagnosis and management of unilateral pars planitis of uncertain cause.