Stuart N. Green

Pneumatic retinopexy : a two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling

The authors report 2-year follow-up information on 179 of 198 eyes (90%) enrolled in a previously published multicenter, randomized, controlled clinical trial comparing pneumatic retinopexy (PR) with scleral buckling (SB) for the management of selected retinal detachments. Scleral buckling was compared with PR with regard to redetachment after the initial 6-month follow-up period (1% versus 1%), overall attachment (98% versus 99%), subsequent cataract surgery (18% versus 4%; P less than 0.05), preoperative visual acuity (no significant difference), and final visual acuity of 20/50 or better in eyes with macular detachment for a period of 14 days or less (67% versus 89%; P less than or equal to 0.05). Reoperations after a failed PR attempt did not adversely affect visual outcome. After 2 years, PR continues to compare favorably with SB.

The Development of Lacquer Cracks in Pathologic Myopia

We examined three patients with pathologic myopia who had mild visual symptoms and subretinal hemorrhages. None had subretinal neovascularization. In all three patients, lacquer crack lesions of the choroid appeared shortly after clearing of the subretinal hemorrhages. The lacquer cracks were always more extensive than the preceding hemorrhages. These findings support the theory that mechanical stretching and rupture of the Bruchs membrane-pigment epithelium-choriocapillaris complex is the cause of these lesions. Fluorescein angiography helped differentiate these subretinal hemorrhages from those caused by subretinal neovascularization.

ACUTE TEAR OF THE RETINAL PIGMENT EPITHELIUM

Tears of the retinal pigment epithelium are a recently recognized complication of senile macular degeneration. A retinal pigment epithelial tear associated with an extramacular pigment epithelial detachment is described in which the patient recovered excellent vision. The clinical features of this condition are discussed, and evidence is presented which localizes the cleavage plane in retinal pigment epithelial detachments to be between retinal pigment epithelial basement membrane and the remainder of Bruchs membrane.

Short-term complications of intravitreal injection of triamcinolone acetonide

Purpose: To describe the short-term complications associated with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of posterior segment disorders. Methods: The medical records of 784 patients (929 consecutive eyes) were retrospectively reviewed at a single institution. One or more IVTA injections for treatment of a variety of steroid-responsive posterior segment disorders (predominantly diabetic macular edema, choroidal neovascularization, and retinal venous occlusions) were administered. Adverse events occurring within 3 months of the initial injection were identified. Results: The most common adverse event occurring within 3 months after the initial injection was steroid-related ocular hypertension, with intraocular pressure spikes of >21 mm Hg in 21% of eyes and >25 mm Hg in 11% of eyes. Ocular inflammation occurred in six eyes (0.6%): four eyes with sterile hypopyon and two eyes without hypopyon. Three eyes (0.3%) had corneal epithelial defects thought to be related to pretreatment with povidone–iodine solution. No eyes had culture-positive infectious endophthalmitis. Cataract progression was not assessed in this analysis. Conclusion: IVTA injection for the treatment of steroid-responsive disorders of the posterior segment, when administered under sterile conditions, is associated with a low incidence of serious vision-threatening adverse events within the first 3 months after injection.

Micropulsed laser photocoagulation and intravitreal triamcinolone acetonide injection for the treatment of retinal angiomatous proliferation.

Purpose: To investigate visual acuity and fluorescein angiographic outcomes, as well as adverse events, associated with treatment of retinal angiomatous proliferation (RAP) with micropulsed laser photocoagulation and intravitreal triamcinolone acetonide injection. Methods: In this retrospective, noncomparative, interventional, consecutive case series, the medical records of all patients treated for RAP with micropulsed laser photocoagulation (yellow or green dye; duration, 0.02–0.05 second; power adjusted to achieve a white burn of moderate intensity at the level of the RAP lesion in the retina) and intravitreal triamcinolone acetonide (4 mg/0.1 mL) injection between January 2003 and November 2004 were reviewed by one of four retina specialists at a single retina practice. Main outcome measures were visual acuity, leakage shown by fluorescein angiography, and adverse events. Results: The study included 14 eyes of 13 patients (8 women and 5 men; median age, 83 years [range, 70–90 years]). Triamcinolone acetonide injection preceded laser treatment by a median duration of 7 days (range, 5–16 days) in 8 eyes, was performed on the same day as laser treatment in 2 eyes, and followed laser treatment by a median duration of 7 days (range, 7–28 days) in 4 eyes. Eyes were followed a median of 18 months (range, 12–27 months) after treatment with both laser and intravitreal triamcinolone injection. Compared with pretreatment visual acuity, vision at 12 months and the last follow-up examination was stable in 5 eyes (36%), improved by ≥2 lines in 6 eyes (43%), and worsened by ≥2 lines in 3 eyes (21%). The median visual acuity before treatment was 20/200 compared with 20/80 at 3 months after treatment (P = 0.02), 20/100 at 6 months after treatment (P = 0.16), 20/200 at 12 months after treatment (P = 0.73), and 20/100 (P = 0.63) at the last follow-up examination. For 13 eyes (93%), fluorescein angiography performed 6 months after administration of both laser and intravitreal triamcinolone injection demonstrated resolution of all leakage; one eye was treated with photodynamic therapy with verteporfin 6 months after treatment for persistent low-grade leakage. Elevated intraocular pressure (>25 mm Hg) occurred in 2 eyes at 2.5 months and 2 months after intravitreal triamcinolone acetonide injection; both eyes were treated with transient use of antiglaucoma eyedrops. Seven (78%) of 9 phakic eyes had cataract progression, and 5 of these 7 eyes underwent cataract extraction during the follow-up period. No other adverse events occurred. Conclusions: Micropulsed laser photocoagulation and intravitreal triamcinolone acetonide injection may be effective and safe treatment for RAP lesions.

Acute exudative polymorphous vitelliform maculopathy in a young man: a case report.

PURPOSE To describe ocular findings consistent with acute exudative polymorphous vitelliform maculopathy in a healthy 34-year-old man. METHODS Observational case report of a patient presenting with blurred vision in the left eye greater than the right eye. RESULTS Funduscopic examination and fluorescein angiography were consistent with acute exudative vitelliform maculopathy, a rare exudative macular disorder. Five months after presentation, the patient was diagnosed with metastatic melanoma. CONCLUSION A case is reported in a young man with no diagnosis of primary neoplasm at the time of presentation, and no other symptoms overall, who was later diagnosed with a metastatic malignancy.

Tumor-associated retinal pigment epithelial proliferation simulating retinal pigment epithelial tear.

A lesion with both the clinical and fluorescein angiographic appearance of the classical retinal pigment epithelial (RPE) tear was discovered over the dome of an actively growing metastatic choroidal tumor in a patient with a previous history of breast carcinoma. However, our patient exhibited no evidence of pigment epithelial detachment or age-related macular degeneration, the underlying cause of the RPE tear. Although we cannot be sure that a true RPE tear did not exist over our patients tumor, more likely, we are observing a tumor induced zone of RPE dehiscence accompanied by RPE proliferation at its border, giving a very similar fundus appearance. Possible pathogenic mechanisms for the finding in our patient, and a comparison to those mechanisms responsible for the classical RPE tear, are discussed.