Solmaz Abdolrahimzadeh

Long-term results of intravitreal bevacizumab for choroidal neovascularisation in pathological myopia

Aim To evaluate the long-term results and prognostic factors of intravitreal bevacizumab (IVB) for myopic choroidal neovascularisation (mCNV). Methods Thirty-two eyes of 30 patients with mCNV were included in a prospective case series. Treatment consisted of three monthly 1.25 mg IVB injections. Best corrected visual acuity (BCVA) and CNV area were compared before and after treatment. Prognostic factors included in the regression analyses were age, axial length, baseline BCVA, pretreatment CNV area, CNV location and peripapillary atrophy area. Results Results were evaluated at 2 years for 32 eyes and at 3 years for 27 eyes. Mean (±SD) baseline BCVA had improved significantly from 30.1 (±15.6) letters to 45.4 (±13.0) letters at 3 years (p<0.0001), with a better outcome in eyes with juxtafoveal CNV (40.4 ± 13.5 vs. 54.0 ± 5.8, p=0.001). Baseline BCVA correlated positively with final BCVA (β= 0.560, p=0.001), while age showed a negative correlation (β= −0.399, p=0.01). CNV area decreased from 0.63 (±0.71) mm2 at baseline to 0.40 (±0.57) mm2 at 3 years (p<0.0001). Peripapillary atrophy area was the only significant contributing determinant for re-treatment (OR 1.20, 95% CI 1.01 to 1.42, p=0.04). Conclusions A regimen of three monthly IVB injections yielded effective and sustained results in the treatment of mCNV at 3 years of follow-up. Initial BCVA and age were the factors that correlated independently with BCVA outcome.

Intravitreal anti-vascular endothelial growth factor for retinal angiomatous proliferation in treatment-naive eyes: long-term functional and anatomical results using a modified PrONTO-style regimen.

Purpose: To evaluate long-term outcome of intravitreal anti–vascular endothelial growth factor monotherapy in retinal angiomatous proliferation. Methods: Twenty-one treatment-naive eyes were included in this prospective, interventional case series. Treatment was three monthly injections of bevacizumab and/or ranibizumab with a modified PrONTO-style regimen. Best-corrected visual acuity (BCVA) was evaluated. The influence of baseline BCVA and pretreatment pigment epithelial detachment on BCVA outcome or retreatment were assessed by Pearson correlation analysis. Results: Results were evaluated at 2 years and 3 years for 21 and 13 eyes, respectively. Mean baseline BCVA improved significantly from 44.5 (±11.0) (20/32) to 51.1 (±9.7) (20/24) and 50.8 (±10.4) letters (20/24) at 2 and 3 years, respectively (P = 0.02 and P = 0.049). Pigment epithelial detachment correlated negatively with BCVA outcome (r = −0.65, P = 0.002 and r = −0.67, P = 0.01 at 2 years and 3 years, respectively) and was significantly associated with retreatment (r = 0.62, P = 0.003 and r = 0.87, P < 0.0001 at 2 years and 3 years, respectively). Complete occlusion of the lesion was obtained in 71% and 69% of eyes at 2 years and 3 years, respectively, with a mean of 9.4 injections at 3 years. Conclusion: Intravitreal anti–vascular endothelial growth factor monotherapy was a valid option for retinal angiomatous proliferation. Stable or improved visual acuity was obtained in 95% and 100% of eyes at 2 years and 3 years, respectively.

A new method of biofeedback in the management of low vision

Twenty-eight patients with low vision were enrolled into the study. A preliminary study was carried out on 18 eyes of 13 patients with low vision who underwent visual rehabilitation with a new instrument for biofeedback (BF) applied to vision; improved biofeedback integrated system (Ibis). Successively, eight patients (16 eyes) with bilateral low vision were subjected to biofeedback in one eye. The experimental and control eye were evaluated separately. Then a placebo training was developed on seven patients (12 eyes). Visual acuity, colour vision, automated perimetry, contrast sensitivity and flash VEP were evaluated. A brief review of the literature and the possible mechanisms behind the results are discussed.

Macular thickness changes evaluated with spectral domain optical coherence tomography after uncomplicated phacoemulsification.

PurposeTo determine macular thickness changes after uncomplicated cataract surgery using spectral domain optical coherence tomography (OCT).MethodsThis was a prospective non-randomized, clinical study. Data were analysed for 40 healthy patients undergoing uneventful phacoemulsification. OCT measurements were performed before surgery and postoperatively at day 1, week 1 and 2, and month 1, 2, 3, and 6. The retinal map was divided into central point thickness (CPT), central 1-mm subfield (CSF), and two peripheral ring areas with diameters of 3 and 6 mm. Fellow eyes were used as controls. Retinal thickness change between the operated and fellow eyes were compared using unpaired t-test. Correlations were analysed using the Spearman or the Pearson analysis.ResultsThere was a progressive significant increase in retinal thickness of the operated eyes compared with the fellow eyes, with a peak at 1 month (P<0.0001) for the 3- and 6-mm areas and a peak at 2 months for CPT and CSF (P=0.01 and P<0.0001, respectively). At 6 months, retinal thickness was still significantly increased only in the peripheral areas (P<0.0001). There was no significant correlation between macular thickness changes and preoperative factors (age, axial length, anterior chamber depth, posterior vitreous detachment, best-corrected visual acuity), intraoperative factors (length of surgery, effective phaco time, phaco energy) or BCVA change.ConclusionsThe present study demonstrated a significant increase in macular thickness up to 6 months after uncomplicated cataract surgery. The most important finding was the regional pattern of retinal thickening with an early involvement of the parafoveal area.

Ultrasound biomicroscopy of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts

AIM To evaluate the ciliary body and peripheral retina in degenerative retinoschisis associated with pars plana cysts using ultrasound biomicroscopy (UBM). METHODS 18 eyes of 12 patients with degenerative retinoschisis associated with pars plana cysts were selected through binocular indirect ophthalmoscopy and Goldmann three mirror lens examination, both with scleral depression. These patients were studied in detail with UBM. RESULTS Study of the ciliary body with UBM showed pars plana cysts of different size and uneven shape. In cross sections the morphology of pars plana cysts in detail and the close relation of the cysts with the oral region and the peripheral retina, where areas of cystoid degeneration and retinoschisis were present, were observed. In transverse sections three main morphological aspects of pars plana cysts could be differentiated (“isolated,” “confluent,” and “clustered” cysts). Furthermore, ultrabiomicroscopy allowed differential diagnosis between retinoschisis and associated retinal detachment in six eyes. CONCLUSIONS The study of peripheral degenerative retinoschisis and pars plana cysts is possible in vivo by means of UBM, showing the detailed morphology of the lesions (not otherwise evident through ophthalmoscopic examination) and the close relation between pars plana cysts, cystoid degeneration, and peripheral retinoschisis.

Ocular alterations in alopecia areata

Purpose To determine the ocular alterations occurring in alopecia areata with regard to the lens and fundus.Methods Seventy-five patients with alopecia areata were examined. Seventy healthy control patients unaffected by skin, ocular or systemic disorders were also studied.Results Symptomless punctate lens opacities were found in 38 (51%) patients, whereas only 2 (3%) control patients had similar lens changes. Fundus alterations were found in 31 (41%) cases of alopecia areata and in only 16 (23%) controls.Conclusions These ocular alterations and their prevalence are reported and some theories regarding the possible aetiopathogenetic mechanisms are discussed.

Ophthalmic Alterations in the Sturge-Weber Syndrome, Klippel-Trenaunay Syndrome, and the Phakomatosis Pigmentovascularis: An Independent Group of Conditions?

The phakomatoses have been traditionally defined as a group of hereditary diseases with variable expressivity characterized by multisystem tumors with possible malignant transformation. The Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and the phakomatosis pigmentovascularis have the facial port-wine stain in common. Numerous pathophysiogenetic mechanisms have been suggested such as venous dysplasia of the emissary veins in the intracranial circulation, neural crest alterations leading to alterations of autonomic perivascular nerves, mutation of the GNAO gene in the Sturge-Weber syndrome, PIK3CA mutation in malformative/overgrowth syndromes such as the Klippel-Trenaunay syndrome, and the twin-spotting phenomenon in phakomatosis pigmentovascularis. Other features linked to the port-wine stain and typical to all of the three conditions are glaucoma and choroidal alterations. Glaucoma can be due to malformations of the anterior chamber or high episcleral venous pressure and in phakomatosis pigmentovascularis it can also be associated with angle hyperpigmentation. The choroid can be thickened in all diseases. Furthermore, choroidal melanocytosis in the phakomatosis pigmentovascularis can lead to malignant transformation. Although the multiple pathophysiological mechanisms still require clarification, similarities in ophthalmic manifestations make it reasonable to classify these diseases in an independent group.

Sturge-Weber syndrome associated with naevus of Ota.

The association of Sturge-Weber syndrome with naevus of Ota is an infrequently reported phenomenon and there are only four previously described cases in the literature. In this paper we briefly review the literature regarding the coexistence of vascular and pigmentary naevi and present an additional patient with the association of the Sturge-Weber syndrome and naevus of Ota.

Morphologic and vasculature features of the choroid and associated choroid–retinal thickness alterations in neurofibromatosis type 1

Background/aims A normal structural and functional choroid is essential in supplying blood flow to the retina. Neurofibromatosis type 1 (NF1) is a neurocristopathy where the choroid is altered due to the presence of nodules. The present transversal study was conducted to examine choroidal nodules and their effect on choroidal and retinal thickness in NF1 patients. Methods Near-infrared reflectance and optical coherence tomography with enhanced depth imaging were used to evaluate choroidal morphology and vasculature in 19 patients with NF1 and 19 healthy, age-matched control subjects. Choroidal thickness, neuroepithelium thickness, photoreceptors together with retinal pigment epithelium (RPE) thickness and outer nuclear layer (ONL) thickness were measured at the fovea and 1000 μm nasal, temporal, superior and inferior to the fovea in NF1 patients and control subjects. Choroidal and neuroepithelium thickness were assessed overlying and adjacent to nodules in NF1 patients. Results Choroidal nodules were classified as ‘dome-shaped’ or ‘placcoid’ subtypes in 17 patients. Small and medium calibre choroidal vessels were observed above dome-shaped nodules where choroidal thickness was significantly reduced. There was a statistically significant reduction in mean choroidal thickness (p=0.013) in NF1 patients with respect to control subjects. The neuroepithelium, photoreceptors together with RPE and ONL had a statistically significant reduction in mean thickness in NF1 patients (p<0.001, p<0.001, p=0.012, respectively). Conclusions In NF1, there are dome-shaped and placcoid choroidal nodules which alter choroidal morphology and thickness. There is reduction in mean choroid thickness with generalised thinning of the neuroepithelium, photoreceptors together with RPE and ONL in NF1 patients.

Fox's modified technique using the Mersilene mesh sling in the management of blepharoptosis.

BACKGROUND AND OBJECTIVE Frontalis suspension is the best surgical procedure for severe ptosis with poor or absent levator muscle function. In addition to autologous fascia lata, a variety of materials are available for suspension. The authors describe the use of Mersilene mesh slings developed to overcome the problems of failure, slippage, and extrusion commonly associated with various suspensory materials. PATIENTS AND METHODS Brow suspension was performed in 20 ptotic eyelids of 14 patients. All patients had severe ptosis with levator function of 4 mm or less. The surgical technique used was a modified version of the method originally described by Fox using the Mersilene mesh sling. RESULTS The improvement in lid height was evaluated by preoperative and postoperative vertical aperture measurements and ranged from 2 to 5 mm (average 3.5 mm). The results were maintained in all cases during a follow-up period of 18 months. CONCLUSION The good functional and cosmetic results suggest that Foxs modified technique using the Mersilene mesh sling has a definite place in ptosis management.