Robert Beardsley

Reactivation West Nile Virus Infection-related Chorioretinitis

West Nile Virus is a relatively uncommon infection that can involve retinal and choroidal inflammation leading to photopsias, photophobia, and orbital pain. The diagnosis is made by clinical history, serology, and characteristic funduscopic exam and fluorescein angiography findings. Treatment involves primarily supportive care as there are no known effective anti-viral agents. Visual recovery is usually full. Here we present a case of West Nile Virus Infection Related chorioretinitis that demonstrated active linear chorioretinal lesions approximately one year after the initial infection was diagnosed and treated. The patient noted new onset blurry vision and floaters for two weeks prior to presentation. Antibody titers to West Nile Virus increased from baseline levels indicating active infection. This represents the first case of reactivation West Nile Virus Infection Related chorioretinitis that has been documented.

Recurrent leakage after Visudyne photodynamic therapy for the treatment of circumscribed choroidal hemangioma.

BACKGROUND To report on the recurrence of serous retinal detachment following verteporfin photodynamic therapy for circumscribed choroidal hemangioma. PATIENTS AND METHODS A single-center chart review was performed for patients with circumscribed choroidal hemangioma (CCH) treated with Visudyne (verteporfin injection; QLT Ophthalmics, Menlo Park, CA) photodynamic therapy (PDT). Initial and post-treatment visual acuity, ultrasound and ocular coherence tomography were evaluated. RESULTS Four patients who were treated with PDT for symptomatic serous retinal detachment secondary to CCH were managed for recurrent leakage and followed for an average of 47.5 months. Two patients required three re-treatments and two required four re-treatments for recurrent detachment. Average time to re-treatment was 23.4 months, with successive re-treatment intervals decreasing to 13 months, then 9.5 months, and finally 3.5 months. CONCLUSION Visudyne PDT is a successful initial treatment modality for CCH with serous retinal detachment; however, those patients who require multiple re-treatments may experience recurrent leakage at more frequent intervals.

Visual Acuity, Contrast Sensitivity and Color Vision Three Years After Iodine-125 Brachytherapy for Choroidal and Ciliary Body Melanoma

Purpose : To report visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after iodine-125 brachytherapy for choroidal and ciliary body melanoma (CCM). Design : Prospective interventional case series. Participants : Thirty-seven patients (37 eyes) with CCM. Methods : Patients had best-corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, Pelli-Robson contrast sensitivity and Hardy-Rand-Rittler color vision measurement; comprehensive ophthalmology examination; optical coherence tomography; and ultrasonography at baseline prior to, 1 year after, 2 years after and 3 years after I-125 brachytherapy. Main Outcome Measures : Visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after brachytherapy. Results : Nineteen (19) men and 18 women with mean age of 58 years (SD 13, range 30-78) prior to, 1 year after, 2 years after and 3 years after brachytherapy had mean best-corrected visual acuity of 77 letters (20/32), 65 letters (20/50), 56 letters (20/80) and 47 letters (20/125); contrast sensitivity of 30, 26, 22 and 19 letters; color vision of 26, 20, 17 and 14 test figures, respectively. Decrease in visual acuity, contrast sensitivity and color vision was statistically significant from baseline at 1 year, 2 years, and 3 years after brachytherapy. Decreased acuity at 3 years was associated with mid-choroid and macula melanoma location, ≥ 4.1 mm melanoma height, radiation maculopathy and radiation optic neuropathy. Conclusion : 1, 2 and 3 years after brachytherapy, eyes with CCM had significantly decreased visual acuity, contrast sensitivity and color vision.

Comparison of Outcomes between Endoscopic and Transcleral Cyclophotocoagulation

Importance: Traditionally cyclophotocoagulation has been reserved as a treatment of last resort for eyes with advanced stage glaucoma, but increasingly it is offered to eyes with less severe disease. Endoscopic approaches in particular are utilized in increasing numbers of patients despite only a small number of publications on its results. Objective: The purpose of this study was to compare the efficacy and safety of endoscopic and transcleral cyclophotocoagulation (ECP and TCP) procedures in eyes with refractory glaucomas. Design, Setting, and Participants: A chart review was performed on consecutive patients who underwent ECP and TCP at a tertiary ophthalmology care center between January 2000 and December 2010. Cases with fewer than 3 months of follow-up or that had concurrent pressure reducing procedures were excluded. The main outcome measures examined were intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), additional glaucoma procedure required, and complications. Main Outcomes and Measures: Forty-two eyes (42 patients) that underwent ECP and forty-four eyes (44 patients) that underwent TCP were identified. The TCP group had a statistically higher mean age (71.2 ± 16.7 vs. 58.1 ± 22.9 years, respectively), larger proportion of neovascular glaucoma (40.9% vs. 16.7%), worse initial BCVA (logMAR 2.86 vs. 1.81), and higher preoperative IOP (45.3 vs. 26.6 mmHg) than the ECP group. At 12 months follow-up, the mean IOP difference between groups was not statistically significant, although the change in IOP from baseline to 12 months was greater for the TCP group (p = 0.006). The rates of progression to no light perception (NLP) and phthisis bulbi were significantly higher amongst TCP eyes than ECP eyes (27.2% vs. 4.8%, p = 0.017, and 20.5% vs. 0%, p = 0.003, respectively). Of these eyes that progressed, a majority had neovascular glaucoma (NVG). Corneal decompensation was the most frequent complication following ECP (11.9%). Conclusions and Relevance: In patients with preoperative BCVA of 20/400 or better, overall complication rates (cystoid macular edema, exudative retinal detachment, inflammation, cornea decompensation) were higher after ECP than with TCP. In refractory glaucomas in a real world setting (not a trial), TCP was more frequently used in ischemic eyes. TCP was associated with a higher rate of progression to phthisis bulbi and loss of light perception than ECP. However, ECP was associated with a clinically significant rate of corneal decompensation. These outcomes likely were related to the severity of underlying ocular diseases found in these eyes.

RTVue Optical Coherence Tomography as an Imaging Modality for Scleral Thickness

Purpose: To examine RTVue (Optovue, Inc) optical coherence tomography (OCT) as a method for measuring scleral thickness. Methods: A prospective, single-center study of eyes with a variety of ocular diseases (no scleral diseases) was performed to image scleral thickness utilizing the RTVue OCT. Repeated measurements of scleral thickness were performed using a line scan 3 mm from the limbus in the inferior nasal and inferior temporal quadrants of each eye. Obtained values were analyzed statistically. Results: A total of 25 eyes in 14 subjects were measured. An average of 3 measurements per location per eye were taken. The mean scleral thickness 3 mm from the limbus was 654.22 μm. The average standard deviation of the measurements from each location was 30.88 μm. The Original Research Article Cramer et al.; OR, 3(4): 95-99, 2015; Article no.OR.2015.016 96 boundary of the conjunctiva and sclera was easily distinguishable. Conclusion: The results of this study suggest that RTVue high-resolution OCT is a user-friendly modality for measuring scleral thickness.

Optical coherence tomography findings in ocular argyrosis.

A 68-year-old Caucasian man with a remote history of daily colloidal silver ingestion presented for ophthalmic examination in which he was noted to have a distinct slate gray skin discoloration. Funduscopy revealed confluent perimacular drusenoid deposits bilaterally, most of which localized at the level of or anterior to the inner segment ellipsoid band by optical coherence tomography (OCT) imaging. Enhanced depth imaging OCT demonstrated marked choroidal thinning. Fluorescein angiogram displayed a dark or silent choroid. Confirmatory serum silver levels were found to be markedly elevated. This report describes a unique geographic maculopathy with large drusenoid deposits anterior to the ellipsoid layer and severe choroidal thinning in association with ocular argyrosis.A 68-year-old Caucasian man with a remote history of daily colloidal silver ingestion presented for ophthalmic examination in which he was noted to have a distinct slate gray skin discoloration. Funduscopy revealed confluent perimacular drusenoid deposits bilaterally, most of which localized at the level of or anterior to the inner segment ellipsoid band by optical coherence tomography (OCT) imaging. Enhanced depth imaging OCT demonstrated marked choroidal thinning. Fluorescein angiogram displayed a dark or silent choroid. Confirmatory serum silver levels were found to be markedly elevated. This report describes a unique geographic maculopathy with large drusenoid deposits anterior to the ellipsoid layer and severe choroidal thinning in association with ocular argyrosis.

Microsurgical Techniques in Ophthalmology - Current Procedures and Future Directions

A thorough understanding of normal ocular anatomy is critical to define pathologic anatomic conditions, to delineate surgical goals, and to develop and utilize surgical tools to optimize patient outcomes. The anatomy of the eye and orbit can be broadly categorized as extraocular structures (including the eyelids, lacrimal gland, canalicular system, conjunctiva, and extraocular muscles) and intraocular structures, located within the globe of the eye. Intraocular structures are further grouped based on their location in the anterior or posterior segments of the eye (figure 1). The anterior segment consists of (from anterior to posterior): the cornea, anterior chamber, iris, and crystalline lens. The crystalline lens is suspended in place by hundreds of zonular fibers, which extend from the ciliary body to a thin capsule surrounding the lens. Contraction of the ciliary body changes the tension of the zonular fibers on the lens, allowing the lens to change its shape and focusing power. The cornea and lens are of particular importance as a majority of ophthalmic surgical interventions are performed on these structures, such as corneal transplantation, refractive corneal surgery, and cataract extraction.