Shreyas Temkar

Modified Approach in Management of Submacular Hemorrhage Secondary to Wet Age-Related Macular Degeneration.

PurposeThe aim of this study was to evaluate the surgical outcomes of a modified approach in the management of thick submacular hemorrhage in patients with wet age-related macular degeneration. DesignThis was a retrospective study. MethodsA retrospective chart review was performed on 10 eyes of 10 patients with submacular hemorrhage secondary to wet age-related macular degeneration treated with 23-gauge pars plana vitrectomy, followed by submacular injection of recombinant tissue plasminogen activator (12.5 &mgr;g/0.1 mL), bevacizumab (2.5 mg/0.1 mL), and air (0.3 mL). Gas tamponade was given with 20% SF6 and postoperative propped-up positioning. Patients were evaluated for displacement of hemorrhage, preoperative and postoperative best-corrected visual acuity, occurrence of intraoperative and postoperative complications, and recurrence of hemorrhage. All patients were followed up for 6 months. ResultsDisplacement of the submacular bleed was achieved in all cases. Improvement of best-corrected visual acuity was seen in 8 of 10 patients. Rebleed was seen in 2 eyes that were retreated with intravitreal injection of recombinant tissue plasminogen activator, bevacizumab, and 20% SF6 gas. ConclusionsThis modified technique aids in the effective displacement of thick submacular hemorrhage with simultaneous treatment of the underlying choroidal neovascular membrane, which halts the disease progression resulting in significant improvement of visual acuity.

Predictors of successful laser capsulotomy for significant posterior capsule opacification after phacoemulsification

Purpose: This study aimed to determine the reasons behind the failure of laser capsulotomy (LC) performed for significant posterior capsular opacification (PCO). Methods: Eighty-eight eyes of 88 patients referred for LC at a tertiary care center were retrospectively analyzed. The data recorded included the cause of cataract, visual acuity, duration of PCO, location of PCO, intraocular lens (IOL) position, IOL type, and lens capsule status. These data were later analyzed for determining the requirement of high pulse energy during LC and the success rate of primary LC. Results: The mean age of the participants was 55.77 ± 18.60 years with 58 (65.9%) male patients. The mean duration between cataract and LC surgeries was 45.58 ± 37.33 months. Senile (n=58), uveitic (n=12), post-pars plana vitrectomy (PPV) (n=12), and traumatic (n=6) cataracts were the common causes. Late-presenting PCO, trauma, uveitis, sulcus placement of IOLs, irregular capsulorhexis shape, and polymethyl methacrylate (PMMA) IOLs were significantly associated with unsuccessful LC and/or higher pulse energy settings during LC. Conclusion: Significant PCO is often associated with cataract caused by uveitis or trauma, and after PPV. PCO associated with trauma, sulcus placement of IOLs, and PMMA IOLs may need multiple LCs.

Familial Exudative Vitreoretinopathy and Glaucoma: Observations, Insights and Management Strategies

We report two cases of bilateral severe familial exudative vitreoretinopathy (FEVR) presenting with bilateral angle closure glaucoma, with evidence of neovascularization in one eye of each case. Both cases displayed bilateral disc dragging with evidence of avascular retinae on fundus fluorescein angiography. Retinal laser photocoagulation and antivascular endothelial growth factor injections provided satisfactory regression of the neovascularization. Medical management of glaucoma was administered to both patients. Lens aspiration with posterior chamber intraocular lens implantation was performed for one eye of each patient. It helped in clearing media as well as in increasing anterior chamber depth, helping in indirect control of intraocular pressure. Although the primary pathology of FEVR lies in the retina, a comprehensive glaucoma screening is essential. We conclude that neovascular glaucoma albeit uncommon in FEVR, may be the presenting feature in advanced unlasered cases, and should be specifically looked for.

Retinal shortening: Ultrasonic evaluation of proliferative vitreoretinopathy

Purpose: To evaluate the effect of extraretinal proliferative vitreoretinopathy (PVR) on retinal shortening in eyes with rhegmatogenous retinal detachment (RD) using ultrasound (USG) and objectively prove the presence of intraretinal PVR (iPVR). Methods: This is a double-masked pilot prospective controlled case series. Patients with total RD planned for vitreoretinal surgery were included in the study. USG was used to determine retinal-to-choroidal length ratios (RCRs) in all the quadrants. Group 1 included 10 patients with preoperative PVR more than Grade B while Group 2 had 14 with PVR of Grades A or B. Severe retinal shortening was defined as RCR < 0.8. Primary outcome measures were severe retinal shortening and an early unexplained recurrence of RD within 15 days of surgery. Results: Mean RCRs were significantly low in all the four quadrants of Group 1 upon comparison with Group 2. The mean RCR had a good negative correlation with number of quadrants of PVR (R = −0.66, P ≤ 0.001). Overall, severe quadrantic retinal shortening was detected in nine patients. In these 9 patients, 11 of the 36 retinal quadrants had severe retinal shortening in the absence of extraretinal PVR (ePVR). Six patients developed early unexplained RD, and all of these belonged to Group 1. Severe quadrantic retinal shortening had the highest odds ratio of developing early unexplained RD (odds ratio = 58, P = 0.01). Conclusion: Retinal shortening occurs both due to ePVR and iPVR, and iPVR occurs independently at least in some cases. Severe quadrantic retinal shortening indicates poor primary anatomical prognoses.

Tamoxifen maculopathy in a male patient

### Case descriptionnnA 28-year-old male patient presented with the history of blurring of vision in both the eyes for the past 5u2009months. Thexa0patient was a diagnosed case of desmoidxa0fibromatosis of the right axilla 8u2009years back. The tumour was initially debulked followed by four cycles of systemic chemotherapy, after which patient was symptom-free for 3u2009years. Thexa0patient noticed an increment in the tumour size, for which he consulted another oncologist. A repeat biopsy was done, whichxa0proved the same findings. The patient was started on a combination of tamoxifen 80u2009mg/day and celecoxib 200u2009mg/day. He had received tamoxifen at a cumulative dose of 116u2009g over 4 years. Examination in our clinic revealed visual acuity of 20/20 in both eyes with unremarkable anterior chamber findings. Intraocular pressurexa0was 14 and 16u2009mmxa0Hg in right and left eye, respectively. Fundus showed bilateral crystalline refractile deposits in …

Outcomes in Autoimmune Retinopathy Patients Treated With Rituximab

WE READ THE ARTICLE ‘‘OUTCOMES IN AUTOIMMUNE RETInopathy patients treated with rituximab’’ by Davoudi and associates with great interest. In a rare compilation of 16 patients with autoimmune retinopathy (AIR), the authors have compared visual acuity (VA), electroretinography (ERG) (full-field and multifocal), optical coherence tomography (OCT), and adaptive optics scanning laser ophthalmoscope (AO-SLO) before and after initiation of rituximab therapy. We write this letter to express our query regarding possibility of presence of patients of autoimmune-related nephropathy and optic neuropathy (ARRON) in this study cohort. The authors have reported statistically significant improvement/stabilization of VA in a few patients while the ERG, OCT, and AO-SLO largely remained stable during the study period. Hence one is left to ponder about the pathogenesis behind visual gain in those selected patients in whom visual acuity was seen to improve. The investigations mentioned above essentially rule out improvement in retinal structure, receptor structure, and function of the neural pathway within the retina up until the secondorder neurons. Therefore, third-order neurons (ganglion cell–retinal nerve fiber layer) or the optic nerve as such may have been the actual site responsible for visual improvement. If possible, analyzing the visual evoked potentials (VEP) may help in answering the query. As ‘‘nonsignificant’’ improvement in investigations has been mentioned in 4 eyes in Table 2 of the article, and the same number of eyes had significant visual gain (Table 2), it should be seen if these eyes belong to the same patients. In this regard, the criteria suggested for diagnosis of ARRON by Oyama and associates describes requirement