Nazimul Hussain

Eales’ disease: diagnosis and management

Eales’ disease is an idiopathic inflammatory venous occlusive disease. It primarily affects young adults and is often bilateral. It is characterized by three overlapping stages of venous inflammation (vasculitis), occlusion, and retinal neovascularization. Diagnosis is mostly clinical and requires exclusion of other systemic or ocular conditions that could present with similar retinal features. Recurrent vitreous haemorrhage is the hall mark of Eales’ disease. Treatment is usually corticosteroids in the inflammation stage and photocoagulation in the proliferative stage of the disease. Visual prognosis is good if treated early in the course of the disease.

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

PURPOSE To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. MATERIALS AND METHODS We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. RESULTS Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. CONCLUSION PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.

Optical coherence tomographic pattern of fluorescein angiographic leakage site in acute central serous chorioretinopathy

Purpose:  To study the optical coherence tomography (OCT) pattern of the fluorescein angiographic leakage in acute central serous chorioretinopathy (CSCR).

Comparison of mean macular thickness using optical coherence tomography and visual acuity in diabetic retinopathy

Background:  The purpose of the present study was to quantitatively assess the mean macular thickness in diabetic patients using optical coherence tomography and its correlation with visual acuity.

The future implications and indications of anti-vascular endothelial growth factor therapy in ophthalmic practice.

In the last few years anti-vascular endothelial growth factor (VEGF) therapy has changed the paradigm in the treatment of neovascular age-related macular degeneration (ARMD). Besides, its potential use in the treatment of diabetic retinopathy and other possible proliferative vascular disorders has also shown promise. Clinical trial results have shown tremendous beneficial effect of ranibizumab in ARMD. Off-label use of bevacizumab has also shown similar benefit but long-term and clinical trial results do not exist. Some of the potential questions in the use of anti-VEGF are recurring cost, possible long-term effect on physiological function of VEGF and determination of endpoint of treatment. Overall, the use of anti-VEGF therapy in ocular angiogenesis has proven to be beneficial at least now.

Two years follow-up outcome of verteporfin therapy for subfoveal choroidal neovascularization in pathologic myopia in Indian eyes.

Context: In India, refractive errors are a major cause of treatable blindness. Population surveys in southern India have shown prevalence of high myopia to be 4.32-4.54%. Photodynamic therapy (PDT) for choroidal neovascularization (CNV) caused by pathologic myopia is beneficial. Aims: To report the 24 months outcome of PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes Settings and Design: Prospective case series Materials and Methods: Review of prospectively collected data of Indian patients with pathologic myopia and subfoveal CNV treated with verteporfin therapy between 2001 and 2005 using standard regimen for PDT. Statistical Analysis Used: Wilcoxon signed rank test was used to see the difference in the mean letter acuity at intervals compared to baseline. Kaplan Meier Survival analysis was done to estimate the success rate of verteporfin therapy for CNV caused by pathologic myopia. Results: Fifteen patients (15 eyes) treated with standard fluence PDT and who had completed 24 months follow-up were analyzed. The mean spherical equivalent was -13.36 ± 5.88 diopter. Five out of 15 eyes in six months, three out of 15 eyes at 12 months and four eyes out of 15 at 24 months had improved vision by > 10 letters. The mean number of treatment session was 2.2 in two years. Conclusions: PDT with verteporfin for subfoveal CNV caused by pathologic myopia in Indian eyes is effective.

Characterization of idiopathic macular telangiectasia type 2 by fundus fluorescein angiography in Indian population

Purpose To characterize the variations in fundus fluorescein angiography (FFA) features in idiopathic macular telangiectasia (IMT) type 2. Methods Retrospective observational study. The authors included all the patients with IMT type 2 who underwent FFA during the period from January 2004 to December 2005. The main outcome measures were subretinal neovascularization and number and distance of telangiectasia from the center of the foveal avascular zone. Results The mean age of 21 patients included in the study was 53.0±7.7 years. There were 11 women and 10 men. Six of the 21 patients had a history of diabetes mellitus. Subretinal neovascularization (SRN) was observed in 10 (23.8%) eyes. Subretinal plaque of pigment hyperplasia in the macula was found in 7 (21.9%) eyes, and crystalline yellowish deposits on the retinal surface were seen in 19 (59.4%) eyes. Only one eye had visible retinal telangiectasia. Most had more than 10 telangiectatic lesions in the macular area and the temporal macula was most commonly involved. The mean distance from the center of the foveal avascular zone (FAZ) up to which telangiectasia could be observed was 1340±400 μm. The maximum distance from the FAZ at which telangiectasia was identified was 2530 μm. Conclusions In IMT type 2, telangiectasia may be seen farther from the parafoveal area.

Combination therapy of intravitreal triamcinolone and photodynamic therapy with verteporfin for subfoveal choroidal neovascularization

AIM To evaluate the six months follow-up outcome of combined intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) for subfoveal choroidal neovascularization compared to PDT alone. STUDY DESIGN Prospective interventional pilot study. MATERIALS AND METHODS Patients with six months follow-up of IVTA following PDT (Group I, eight eyes) and PDT alone (Group II, eight eyes) were included. Four mg/ 0.1 ml of IVTA was injected 7-10 days following PDT. The patients were reevaluated every month for the first two months and every three months thereafter in both the groups. RESULTS Group I: The mean age was 65.8+/-11.8 years (range: 47-79 years). Five patients were male. The total treatment sessions in six months were 11 (mean: 1.36). At six months, one eye had >or= 10 letters gain and three eyes had > 10 letters loss. Four eyes had stable vision. Two eyes (25%) developed increased intraocular pressure (>40 mmHg) during follow-up. Group II: The mean age was 58.7+/-11.7 years (range: 46-76 years). Five patients were male. The total treatment sessions in six months were 17 (mean: 2.13). At six months, six eyes had >or= 10 letters gain and none had > 10 letters loss. Two eyes had stable vision. CONCLUSION The mean number of treatment sessions following combination therapy of IVTA (4 mg) and PDT appears relatively less (1.36 at six months) compared to PDT alone (mean: 2.13). (P =0.02).

Persistent Choroidal Thickening Despite Photodynamic Therapy for Circumscribed Choroidal Hemangioma

A 19-year-old man presented with blurred vision in the right eye, which was diagnosed as a circumscribed choroidal hemangioma. The choroidal thickening on B-scan ultrasonography persisted after receiving repeat photodynamic therapy with verteporfin, although there was regression of the tumor.

Verteporfin therapy for neovascular age-related macular degeneration in Indian eyes.

PurposeTo determine visual outcome after a 12-month follow-up period of verteporfin therapy for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) in Indian patients.MethodsTwenty-five patients (26 eyes) who completed a 12-month follow-up after photodynamic therapy for subfoveal CNV secondary to AMD were included in the study. The follow-up schedule was every month for 2 months and then every 3 months thereafter until 12 months. Improvement in visual acuity was defined as a ≥10-letter gain, and deterioration as a ≥10-letter loss in the Early Treatment Diabetic Retinopathy Study chart at 4 m.ResultsThe mean age of the 25 patients was 62.3 ± 9 years. There were 17 male patients (68%). The mean initial letter acuity was 28. 4 ± 14.1, and the final letter acuity was 25.5 ± 18.4 at 12 months. Initial visual acuity was ≥20/40 in seven eyes, 20/50–20/80 in nine eyes, and 20/100–20/200 in ten eyes; seven eyes had a ≥10-letter gain, and three eyes had a ≥10-letter loss. At the end of 12 months, six eyes had a ≥10-letter gain and ten eyes had a ≥10-letter loss.ConclusionPhotodynamic therapy appears to preserve the vision in subfoveal CNV secondary to AMD in the eyes of Indian patients.