Vito Primavera

Incidence and treatment of diplopia after three-wall orbital decompression in Graves' ophthalmopathy.

PURPOSE To describe our experience treating diplopia after orbital decompression in patients with thyroid orbitopathy. PATIENTS AND METHODS From May 1997 to July 2001, we performed orbital decompression on 102 patients (34 men and 68 women) with severe proptosis. In 10 (9.8%) of these patients who had no diplopia preoperatively, diplopia in primary gaze occurred after decompression. In 19 (18.6%) of the patients with diplopia in primary gaze before surgery, there was no modification of diplopia after decompression. In 24 (23.5%) of the patients with diplopia in primary gaze before surgery, a more severe imbalance occurred after decompression. Forty-four (83%) of these 53 patients underwent adjustable extraocular muscle surgery with the use of viscoelastic substances to gain single vision in primary position. In 9 (17%) of the patients, diplopia was resolved with the use of prismatic lenses. RESULTS In 31 (70.4%) of 44 patients, we obtained a stable resolution of diplopia in primary position (minimum follow-up, 6 months). In 10 (22.7%) of these patients, a second surgery on the oblique muscles was necessary 6 months after the first surgery to resolve torsional diplopia. In 3 (6.8%) of the patients, diplopia has been resolved with prismatic lenses. CONCLUSION Orbital decompression reduces proptosis, but may cause diplopia or worsen it.

Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab

A 67-year-old woman developed refractory pseudophakic cystoid macular edema (CME) after uneventful phacoemulsification. Three months after an intravitreal injection of bevacizumab (1.25 mg), the CME was completely resolved, with resultant improvement in visual acuity.

Pilot Evaluation of a New Surgical Technique for Persistent or Recurrent Large Macular Holes

BACKGROUND AND OBJECTIVE To describe a new surgical technique for persistent or recurrent large macular holes (MHs). PATIENTS AND METHODS Patients with recurrent or persistent large MHs following vitrectomy with internal limiting membrane (ILM) peeling were recruited between October and September 2017 in this pilot study. All patients underwent preoperative and postoperative best-corrected visual acuity (BCVA), slit-lamp ophthalmoscopy, and spectral-domain optical coherence tomography (SD-OCT). This new technique consisted in autologous ILM patch transplantation on top of MH under perfluorocarbon liquid (PFCL) bubble, using SF6 as tamponade. The patients maintained a prone position for 3 days. RESULTS Five eyes of five consecutive patients (two males, three females; mean age: 67.4 years) with recurrent (one patient) or persistent (four patients) MHs were successfully treated. At 1-month follow-up, mean BCVA increased from approximately 20/400 to approximately 20/63, and MHs were closed in all cases. Mean follow-up was 5 months ± 2.2 months (6 months for four out of five included eyes). Positive outcomes were consistent at last follow-up. CONCLUSION This new technique consisting of autologous ILM patch transplantation on top of MH under PFCL bubble using SF6 as tamponade may represent a validated surgical option for persistent or recurrent large MHs. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:266-268.].

Residual bubble of oxane hd: a study by optical coherence tomography and fundus-related perimetry.

PURPOSE Oxane HD is a mixture of silicone oil and a mixed fluorinated and hydrocarbonated olefin. The authors report a complication of Oxane HD as internal tamponade after removal of all visible heavy silicone oil. METHODS A 71-year-old man who underwent vitrectomy with Oxane HD presented with adherence of a residual bubble of Oxane HD in the macula after removal of all visible heavy silicone oil. In this patient OCT displayed an optical artifact due to the residual bubble, and fundus-related perimetry revealed a predominantly eccentric and relatively unstable fixation and very low macular sensitivity. RESULTS After surgical removal of the residual bubble, metamorphopsia resolved, sensitivity improved as revealed by fundus-related perimetry, and fixation became predominantly central and more stable. CONCLUSION The authors suggest a way to manage this rare complication of Oxane HD as internal tamponade after removal of all visible heavy silicone oil.

361 L’OCT et la périmétrie reliée au FO dans la fermeture spontanée d’un trou maculaire traumatique : à propos d’un cas

Introduction Traumatic macular hole (TMH) closure after ocular trauma is not uncommon, especially in young people. We report a case of TMH prospectively followed using OCT (OCT-3) and fundus-related perimetry (MP-1 microperimetry). Material and Methods A 36 years-old man was diagnosed with TMH a few hours after a traumatism of his left eye (soccer ball). We analyzed the spontaneous evolution of the TMH performing OCT-3 and MP-1, up to 18 months after the initial observation. Results At initial examination, visual acuity was light perception and fundoscopy revealed a macular hole with associated commotio retinae of the posterior pole. OCT-3 showed the presence of a full-thickness macular hole with cuff of subretinal fluid and minimal parafoveal edema. MP-1 showed unstable and eccentric fixation and diffuse reduction of sensitivity. As early as one-week follow-up, the macular hole closed spontaneously and visual acuity improved. At the 18-month follow-up, best corrected visual acuity (BCVA) was 20/40, OCT scans showed complete closure of the macular hole with some atrophic changes, and MP-1 revealed a localized reduction of sensitivity (superior aspect of the posterior pole) and a new eccentric and stable fixation (preferred-retinal-locus, PRL). Discussion In our case, OCT and fundus-related perimetry were respectively able to show the spontaneous closure of TMH and the development of the new PRL. Conclusion OCT-3 and MP-1 are useful tools to predict the evolution of TMH.

648 Modifications anatomiques et fonctionnelles dans la rétinopathie solaire

Introduction Solar retinopathy, due to macular exposure to solar radiation, is mediated by photochemical and thermal mechanisms. We describe the optical coherence tomography and the fundus-related perimetry findings of the disease. Aim and Methods We performed a complete ophthalmological examination in 3 patients affected by solar retinopathy, including optical coherence tomography (OCT 3) and the fundus-related perimetry (FRP) after solar exposure, up to 18 months after diagnosis. Results On initial visit, the optical coherence tomography scans revealed an irregular inner high-reflective layer that appeared fragmented in 2 patients and interrupted in 1 patient. In addition, OCT3 showed a hyperreflective lesion, which, in 1 patient, involved the full foveal thickness, and in 2 patients was confined to the outer half of the foveal layers. In 2 patients there was an associated reduced reflectivity of the outer high-reflective layer. These OCT3 signs disappeared as early as one month follow-up. Fundus-related perimetry (FRP) demonstrated, at the first visit, a significant reduction of retinal sensitivity in all patients, which was no longer evident at one-month follow-up. Discussion OCT3 was very successful in detecting the alteration of inner high-reflective layer, corresponding to the yellowish-white spot seen on ophthalmoscopy. FRP demonstrated the recovery of retinal sensitivity at one-month follow-up. Conclusion OCT3 is an effective tool in diagnosing solar retinopathy and in differentiating it from other maculopathies. FRP seems to be a useful adjunctive method to better characterize the functional aspect of the disease.

408 Périmétrie reliée au FO dans la DMLA

Introduction Patients with age-related macular degeneration (AMD) usually present fixation and sensitivity abnormalities. We tried to find a relationship between fundus lesions and functional abnormalities, using the fundus-related perimetry (MP-1 microperimeter). Materials and Methods A complete ophthalmologic examination, including best corrected visual acuity (BCVA) and MP1 fundus-related perimetry was performed in 80 eyes of 80 consecutive patients (43 F and 37 M) with AMD and in 20 matched healthy control subjects (11 F e 9 M). Results The age ranged from 55 to 85 years and BCVA ranged from 20/20 to 20/400. Fixation and retinal sensitivity analysis, in patients with either early and late AMD, were as follows: in patients with early AMD, fixation was foveal and stable, with presence of a relative scotomata in correspondence of the abnormal retinal areas; in patients with dry AMD we have noticed an absolute scotomata in correspondence of the atrophic retinal areas, with a stable fixation in presence of a central fixation, and, vice versa, an unstable fixation in presence of an eccentric fixation; in patients with neovascular AMD we have noticed an absolute scotomata in correspondence of the neovascular areas, again, with a stable fixation in presence of a central fixation, and, vice versa, an unstable fixation in presence of an eccentric fixation. Discussion MP1 microperimeter may be an useful tool in the diagnosis and the progression of AMD. Conclusion MP1 microperimeter is a non-invasive instrument that provides new useful information to better characterize AMD.

663 Métastase choroïdienne d’un adénocancer de la prostate : iconographie d’un cas rare

Introduction Choroidal metastases are often the revealing feature of malignant diseases. We report a rare case of prostatic adenocarcinoma with metastasis in the choroid. Materials and Methods A 54-year-old man was referred to our department for decreased vision in his left eye, lasting for 1 month. Best corrected visual acuity (BCVA) was 20/20 in his right eye and 20/63 in his left eye. Fundoscopic examination revealed 2 amelanotic choroidal masses in both his right and left eyes. Ultrasonografic A-scan and B-scan examination showed 4 dome-shaped lesions of medium-high reflectivity surrounded by secondary retinal detachment. OCT-3 scans showed the deep sub-retinal dome shaped lesions and the surrounding secondary retinal detachment. Both FA and ICGA showed early mottled hyperfluorescence with late increase in fluorescence in all masses but one, which, conversely, showed choroidal blockage until late phase. The systemic work-up revealed elevated serum prostate-specific antigen (PSA) and alkaline phosphatase, extensive abnormalities of axial skeleton, and nodular pulmonary shadows; thus, prostatic adenocarcinoma was suspected. Needle biopsies confirmed adenocarcinoma of the prostate, with metastatic disease. We decided to submit the patient to intermittent total androgen blockade alone. Results The patient perfectly responded to intermittent total androgen blockade with oral bicalutamide and triptoreline injection alone. Within 2 months, ultrasonografic examination showed regression in thickness and in secondary retinal detachment. OCT-3 scans showed atrophic chorio-retinal lesions instead of sub-retinal dome shaped choroidal masses, and the resorption of surrounding secondary retinal detachment. Both FA and ICGA showed initial choroidal blockage, followed by mottled hyperfluorescence and pinpoint leaks with no late increase in fluorescence. Discussion The prostatic carcinoma should be considered in any male patient with a choroidal mass suspected to be a metastasis. In our patient, FA, ICGA and OCT were well able to document the complete regression of choroidal metastasis with the treatment of the prostatic carcinoma. Conclusion Fluorescein angiography, indocyanine-green angiography and optical coherence tomography are useful tools in the diagnosis and follow-up of prostatic adenocarcinoma metastatic to the choroid.