Wilson Heriot

Management of submacular hemorrhage with intravitreal injection of tissue plasminogen activator and expansile gas.

Purpose: To evaluate the clinical outcome of intravitreal tissue plasminogen activator (tPA) and expansile gas injection as a minimally invasive treatment for submacular hemorrhage (SMH). Methods: This study was a retrospective clinical case series examining 104 eyes that received an intravitreal injection of 30–100 mcg of tPA and expansile gas (SF6 or C3F8) for SMH. The main outcomes evaluated were visual acuities (VA), anatomic displacement of submacular blood, and surgical complications. Results: A total of 85, 77, and 81 eyes were available at 1 week, 3 months, and 12 months follow up, respectively. Postoperatively, ≥2 Snellen lines improvement were achieved in 43/85 eyes (51%) at 1 week, 49/77 eyes (63%) at 3 months, and 52/81 eyes (64%) at 12 months. Postoperative VA improvement was significantly associated with preoperative VA, submacular blood displacement, and the underlying cause of SMH. Diagnostic postoperative angiogram and clinical examination were possible at 8.2 ± 7.4 weeks and 9.5 ± 7.4 weeks, respectively. The observed complications included breakthrough vitreous hemorrhage in 8 eyes (8%) and retinal detachment in 3 eyes (3%). Conclusions: In this retrospective series, intravitreal injection of tPA and expansile gas was shown to be a safe and effective technique that can improve VA in most eyes with SMH and assist in the diagnosis of the underlying cause.

Development of a surgical procedure for implantation of a prototype suprachoroidal retinal prosthesis

Current surgical techniques for retinal prosthetic implantation require long and complicated surgery, which can increase the risk of complications and adverse outcomes.

Needle drainage of subretinal fluid. A randomized clinical trial.

Abstract: Needle drainage of subretinal fluid with simultaneous observation using the indirect ophthalmoscope has been reported to have a very low complication rate. The technique was evaluated by a prospective clinical trial. The study group consisted of 100 patients undergoing scleral buckling for rhegmatogenous retinal detachment who were randomly assigned to groups treated with needle drainage or conventional two-stage drainage. At 1 month, the retina was anatomically flat in 88% of all cases. Subretinal hemorrhage occurred in 10 of 45 patients (22.2%) after needle drainage and in 7 of 55 patients (12.7%) after conventional drainage. The difference was not statistically significant. Retinal puncture occurred during conventional drainage in one case and in no cases during needle drainage. There were no cases of retinal incarceration. The results showed that subretinal hemorrhage was more common after needle drainage, but a larger study would be required to show whether this difference was statistically significant. The fear that the retina would be damaged by placement of a needle in the subretinal space throughout the drainage procedure was unfounded.

Phototoxic maculopathy associated with arc welding: clinical findings and associated functional vision impairment

luxation was noted 7 weeks following the fourth laser treatment (8 months after the initial DLCC application). To our knowledge, however, this is the first reported case of late-onset crystalline lens subluxation occurring 5 years after DLCC. There was no clinical evidence of collagen disorders, pseudoexfoliation syndrome or other diseases that can potentially predispose to lens instability. The patient denied any history of ocular trauma including the 5-year follow-up period following DLCC. We believe that the diode laser-induced destruction of ciliary processes and the disruption of the zonules is a progressive process and can lead to delayed zonular dehiscence and lenticular subluxation/dislocation. We recommend that patients should be informed about this rare complication especially when repeated treatments are necessary. With the increasing use of DLCC in sighted eyes, cataract surgeons should be aware of the potential zonular weakness in this group of patients. In conclusion, dislocation of the crystalline lens may occur as a rare complication after DLCC, especially when repeated treatments are needed.

Ocular involvement in a patient with Legionella longbeachae 1 infection

endophthalmitis has a poor visual prognosis. Over the last few years, a few cases of Alternaria keratitis treated with a combination of topical and intrastromal/intracameral antifungals have been reported. Voricanozole was first reported for the management of Alternaria keratitis by Ozbek et al. with resolution of the infection within 10 days of beginning therapy. Tu reported three cases of Alternaria keratitis that responded rapidly to either topical fluconazole 0.02% or a combination of intrastromal voriconazole and topical caspofungin 0.5%. Neoh et al. reported a case of Alternaria keratitis in a patient with a corneal graft that was successfully managed with intrastromal and topical caspofungin in combination with intrastromal, topical, and oral voriconazole. However, once the infection was under control, the patient underwent penetrating keratoplasty. Konidaris et al. reported a case of Alternaria keratitis in a patient that had underwent corneal transplantation for pseudophakic bullous keratopathy. They treated the patient with topical and systemic antifungals, and the patient had to undergo a second keratoplasty as there was significant corneal melting. This case is unique because by using a combination of intensive topical, intracorneal and subconjunctival antifungal therapy, we were able to successfully manage Alternaria fungal keratitis with endophthalmitis in a patient with a corneal graft, without the need for a repeat penetrating keratoplasty or vitrectomy, while preserving 20/20 bestcorrected visual acuity. Neoh et al. reported a similar case on a patient with a graft but without the presence of endophthalmitis. However, in their case the patient required a penetrating keratoplasty for corneal scarring once the infection was under control. While Neoh’s case highlights the potential benefits of intracorneal injection of antifungal medication in medically recalcitrant fungal keratitis complicated with endophthalmitis, our patient also received intracameral and intravitreal reservoirs of antifungals for a concurrent endophthalmitis. This case highlights the importance of intensive medical management employing various modes of drug delivery (topical, subconjuctival and intrastromal) in a case of a severe fungal keratitis.