Results Of Fluorescein Angiography Research Articles

Clinical observation of the subthreshold micropulse laser combined with ranibizumab for treatment of diabetic macular edema

Objective: To evaluate the efficacy and safety of the subthreshold micropulse laser (SMPL) combined with ranibizumab in treating diabetic macular edema (DME). Methods: This was a prospective randomized controlled study. Patients diagnosed with DME in the Ophthalmology Department of Beijing Hospital were enrolled from January 2020 to December 2022. Patients were randomized in a ratio of 1∶1 using a table of random numbers into the ranibizumab monotherapy group and the SMPL combined with ranibizumab therapy group. We compared the changes of best-corrected visual acuity, central macular thickness measured by optical coherence tomography and optical coherence tomography angiography parameters, including the vessel density of the superficial and deep capillary plexus (DCP), foveal avascular zone size and peripapillary vessel density, at baseline, 6 and 12 months after the treatment. After 12 months of follow-up, fundus fluorescein angiography results, adverse events, and the number of injections or laser therapies were recorded. The Fisher's exact test and group t-test were used for statistical analysis. Results: Seventy-two patients (72 eyes) were enrolled, with a mean age of (61.1±8.2) years. Patients in the combination therapy group included 19 males and 17 females, while patients in the ranibizumab monotherapy group were 17 males and 19 females. There was no statistically significant difference in baseline characteristics between the two groups (P>0.05). A significant improvement in best-corrected visual acuity was shown in both groups at 6 and 12 months [(58.5±12.9) and (58.2±12.2) ETDRS letters in the combination therapy group, and (63.3±13.1) and (63.8±12.5) ETDRS letters in the ranibizumab monotherapy group]. A significant reduction in central macular thickness was shown in both groups at 6 and 12 months [(451.0±185.5) and (380.4±159.3)μm in the combination therapy group, and (387.5±135.5) and (372.8±146.1)μm in the ranibizumab monotherapy group]. However, there was no significant difference between groups at each timepoint (all P>0.05). At 12 months, the vessel density of the superficial capillary plexus showed no statistical difference compared to the baseline value in each group or between groups (42.6%±5.9% in the ranibizumab monotherapy group and 42.2%±5.5% in the combination therapy group, P>0.05). The vessel density of the DCP in the combination therapy group significantly increased to 47.5%±5.6% at 12 months, significantly different from that in the ranibizumab group (43.4%±5.1%; P<0.05). The foveal avascular zone size in the ranibizumab monotherapy group reduced to (0.32±0.13) mm2, significantly different from that in the combination therapy group [(0.34±0.16) mm2] at 12 months (P<0.05). Patients in the ranibizumab monotherapy group received (7.3±2.5) intravitreal injections, while patients in the combination therapy group received 3 injections. No unfavorable outcomes on fundus fluorescein angiography or systemic or topical severe adverse events were observed during the follow-up. Conclusions: The SMPL combined with intravitreal ranibizumab injections was effective and safe in treating DME patients. The combination treatment significantly reduced the number of injections and improved the vessel density of the DCP and macular ischemia, compared to the ranibizumab monotherapy.

A Multiple Evanescent White Dot Syndrome–like Reaction to Concurrent Retinal Insults

To describe a clinical picture resembling classic multiple evanescent white dot syndrome (MEWDS) potentially triggered by previous or concurrent, apparently unrelated, ocular events and to provide a literature review of similar presentations. Retrospective chart series and literature review. Consecutive patients diagnosed with MEWDS at the Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and the IRCCS San Raffaele Scientific Institute, Milan, Italy, between July 2019 and June2020. Charts of patients were reviewed. Ophthalmic history, best-corrected visual acuity, spectral-domain OCT results, OCT angiography results, fundus autofluorescence results, ultra-widefield fluorescein angiography results, and indocyanine green angiography results were collected. A PubMed-based search was carried out for similar presentations using the terms MEWDS and white spot syndromes. An ocular history positive for previous or concurrent ocular events in patients with MEWDS was sought in our cohort and the existing literature. Five eyes of 4 patients (2 females; age range, 16-81 years) were included. The first eye had a history of bilateral Best vitelliform dystrophy and unilateral choroidal neovascularization. The second eye had angioid streaks complicated by choroidal neovascularization and underwent prior thermal laser photocoagulation. The third eye had a history of high myopia and a scleral buckle procedure for retinal detachment. The fourth patient had bilateral idiopathic retinochoroiditis. We identified 16 case reports from 5 previous publications that support a MEWDS-like reaction to previous ocular insults. We suggest a MEWDS-like reaction may be elicited by ocular events in a subset of susceptible patients. We hypothesize that damage to the outer retina may play a role in triggering the local inflammatory response.

Retinal Vasculitis and Intraocular Inflammation after Intravitreal Injection of Brolucizumab

To evaluate features and outcomes of eyes with retinal vasculitis and intraocular inflammation (IOI) after intravitreal injection (IVI) of brolucizumab 6 mg/0.05 ml for treatment of neovascular age-related macular degeneration. Retrospective case series. Fifteen eyes from 12 patients identified from 10 United States centers. Review of patient demographics, ophthalmologic examination results, and retinal imaging findings. Baseline and follow-up visual acuity (VA), prior anti-vascular endothelial growth factor (VEGF) injections, clinical presentation, retinal findings, fluorescein angiography results, and treatment strategies. The number of previous anti-VEGF IVIs ranged between 2 and 80 in the affected eye before switching to brolucizumab. Retinal vasculitis and IOI were diagnosed at a mean of 30 days after brolucizumab IVI. Mean VA before brolucizumab IVI was 0.426 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/53) and VA at diagnosis of retinal vasculitis was 0.981 logMAR (Snellen equivalent, 20/191; range, 20/25-20/1600; P= 0.008). All affected eyes showed IOI with variable combinations of focal or elongated segmental sheathing and discontinuity of small and large retinal arteries, sclerotic arteries, regions of vascular nonperfusion, cotton-wool spots, Kyrieleis plaques, irregular venous caliber with dilated and sclerotic segments, perivenular hemorrhages, and foci of phlebitis. Fluorescein angiography revealed delayed retinal arterial filling, retinal vascular nonperfusion, and variable dye leakage from affected vessels and the optic nerve. Systemic evaluation for embolic causes was unrevealing in 2 patients, and 3 patients showed negative laboratory assessment for uveitis. Treatment consisted of various combinations of corticosteroids (systemic, intravitreal, and topical), and 2 eyes underwent vitrectomy without improvement in vision. After a mean follow-up of 25 days, mean VA was 0.833 logMAR (Snellen equivalent, 20/136), which was reduced compared with baseline (P= 0.033). Retinal vasculitis and IOI after brolucizumab IVI are characterized by variable occlusion of large or small retinal arteries, or both, and perivenular abnormalities. It may span from peripheral vasculitis to occlusion of large retinal arteries around the optic nerve or macula with severe vision loss. A high index of suspicion is required because vitreous cells may obscure visualization of retinal details.

Coats-like Exudative Vitreoretinopathy in Retinitis Pigmentosa: Ocular Manifestations and Treatment Outcomes

To provide a comprehensive review of the ocular manifestations, outcomes, and genetic findings in patients with Coats-like retinitis pigmentosa (RP). Multicenter, retrospective, nonconsecutive case series. Patients with a diagnosis of RP demonstrating Coats-like exudative vitreoretinopathy between January 1, 2008, and October 1,2019. Evaluation of ocular findings at RP diagnosis and at time of presentation of Coats-like exudative vitreoretinopathy, pedigree analysis, genetic testing, retinal imaging, and anatomic outcomes after treatment. Visual acuity, ophthalmoscopy results, OCT results, fluorescein angiography results, and identification of genetic mutations. Nine patients diagnosed with RP and demonstrating Coats-like exudative vitreoretinopathy were included. Median age at time of RP diagnosis was 8 years (range, 1-22 years), and median age at presentation of Coats-like exudative vitreoretinopathy was 18 years (range, 1-41 years). Seven patients were female, and 2 were male. The genetic cause of disease was identified in 6 patients. Three patients demonstrated Coats-like fundus findings at the time of RP diagnosis. Exudative retinal detachment (ERD) localized to the infratemporal periphery was present in all patients, with bilateral disease observed in 7 patients. In all treated patients, focal laser photocoagulation was used to treat leaking telangiectasias and to limit further ERD expansion. Cystoid macular edema refractory to carbonic anhydrase inhibitor therapy and ultimately amenable to treatment with intravitreal anti-vascular endothelial growth factor injection was observed in 4 patients. Coats-like vitreoretinopathy is present in up to 5% of all RP patients. The term Coats-like RP is used colloquially to describe this disease state, which can present at the time of RP diagnosis or, more commonly, develops late during the clinical course of patients with longstanding RP. Coats-like RP is distinct from Coats disease in that exudative pathologic features occur exclusively in the setting of a coexisting RP diagnosis, is restricted to the infratemporal retina, can affect both eyes, and does not demonstrate a male gender bias. Given the risk of added vision loss posed by exudative vitreoretinopathy in patients with RP, a heightened awareness of this condition is critical in facilitating timely intervention.

Fluorescein angiography as a primary guide for reduced-fluence photodynamic therapy for the treatment of chronic central serous chorioretinopathy.

The aim of this study is to investigate the results of fluorescein angiography (FA)-guided reduced-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSCR), with the hypothesis that indocyanine green angiography (ICGA) guidance is avoidable in some cases. This retrospective study includes a consecutive nonrandomized series of chronic CSCR cases. All eyes were examined with FA and the ones that had discrete active leakage areas or points had undergone reduced-fluence PDT. The study included 45 eyes of 41 patients with a mean age of 48.8 ± 10.7. The main duration of last chronic CSCR episode was 13.0 ± 11.9months. Thirty-nine (86.7%) out of 45 consecutive eyes had active leakage area(s) on FA, which enabled them to be treated with PDT. Remaining six eyes had undergone ICGA examination and had received an ICGA-guided PDT. In FA-guided eyes, the mean BCVA improved from 0.44 ± 0.25 Snellen lines to 0.63 ± 0.32 lines in the last control visit (p < 0.001). Both central macular thickness and subfoveal choroidal thickness decreased significantly in treated eyes. Thirty-eight eyes (97.4%) in FA-guided group and six eyes (100.0%) in ICGA-guided group had total resorption of subretinal fluid. This study provides basis to support the hypothesis that FA-guided half-fluence PDT may be justified as an alternative method of treatment in appropriate cases of chronic CSCR without compromising the therapeutic success.

Ocular Manifestations of Cutis Marmorata Telangiectatica Congenita

To describe the range of ocular manifestations in cutis marmorata telangectatica congenita (CMTC). Multicenter, retrospective, nonconsecutive case series. Patients with a diagnosis of CMTC referred for ophthalmologic evaluation between January 1, 2015, and December 31,2018. Evaluation of ocular findings at presentation, systemic manifestations suggestive of a diagnosis of CMTC, genetic testing, and visual outcomes after treatment. Visual acuity, findings on ophthalmoscopy, and results of fluorescein angiography. Nine patients with CMTC diagnosed clinically based on stereotypical cutaneous vascular malformations were included. The median age at presentation was 8 weeks (range, 2 weeks-4 years). Six patients were female and 3 were male. Avascular retina was identified on dilated fundus examination, fluorescein angiography, or both in 11 eyes of 6 patients. Retinal neovascularization was present bilaterally in 2 patients at presentation. One patient demonstrated retinal venous tortuosity, and another patient showed mild straightening of nasal retinal vessels in both eyes. Two patients (2 eyes) demonstrated retinal detachment (RD). Both were managed surgically. One infant demonstrated RD, whereas the other child showed extensive neovascularization and later progressed to combined tractional-rhegmatogenous detachment. A unique constellation of lacy peripheral capillary anomalies with prominent terminal vascular bulbs was noted in 3 patients. Granular pigment abnormalities were noted in the macula in 5 patients. Two patients demonstrated glaucoma, 1 requiring surgical intervention. Two patients demonstrated features of Adams-Oliver syndrome, with genetic testing identifying a Notch1 mutation in 1 patient. Retinal vascular abnormalities in CMTC may occur more frequently than recognized previously. Given the variability of ocular involvement and the potential for rapidly progressive retinal vascular abnormalities and development of RD, complete ophthalmologic evaluation including measurement of intraocular pressure, gonioscopy, dilated fundus examination, and fluorescein angiography is recommended in infants with suspected CMTC shortly after birth. The distinct pattern of lacy capillary anomalies with prominent terminal bulbs seen in CMTC has not been described in other syndromes of vascular dysgenesis. Therefore, ophthalmic examination may be a valuable method to distinguish CMTC from other disorders demonstrating similar dermatologic and systemic manifestations.

Evaluation of the tear film function in diabetic patients using the Keratograph 5M

Objective: To evaluate the tear film function of diabetic patients using the Keratograph 5M and to analyze its related factors. Methods: Case-control study. A total of 89 inpatients (174 eyes) diagnosed with diabetes in the Department of Endocrinology at our hospital were recruited. According to the fundus fluorescein angiography results, subjects were divided into two groups, diabetic retinopathy (DR) group and none-DR group. All subjects were examined for duration of diabetes, glycosylated hemoglobin, creatinine, 24-hour urinary protein, and 24-hour urinary microalbumin/urinary creatinine, and by electromyography. The Keratograph 5M was used to obtain the first and average tear film break-up time (BUTf and BUTav), tear meniscus height, the upper and lower meibomian gland loss scores. The data were analyzed by SPSS. Results: Compared to the non-DR group, the BUTf and the BUTav in the DR group were shorter [(8.42±4.71) s vs. (10.24±5.32) s, (11.20±5.25) s vs. (12.67±5.52) s; P=0.000]. There was no significant difference in the tear meniscus height between the three groups (P=0.067). The tear meniscus height were negatively related with glycosylated hemoglobin, and not related with duration of diabetes, 24-hour urinary microalbumin/urinary creatinine, creatinine, 24-h urinary protein, and electromyography results. As the duration of diabetic longer, the upper and lower meibomian gland loss scores added(Z=19.514, 15.342, P<0.05). Patients with EMG abnormal, the lower meibomian gland loss scores added(Z=-2.312, P<0.05). Conclusions: The Keratograph 5M can directly evaluate the tear film condition of diabetic patients.Diabetic patients with retinopathy and higher glycosylated hemoglobin tend to suffer tear film dysfunction. (Chin J Ophthalmol, 2018, 54:762-766).

Vitrectomy technique in aggressive posterior retinopathy of prematurity

to develop the methodology of early primary vitrectomy for aggressive posterior retinopathy of prematurity. The study included 10 preterm infants (20 eyes; gestational term - 26-30 weeks, post-conceptual age - 34-39 weeks) with severe forms of aggressive posterior retinopathy of prematurity (AP-ROP). All patients underwent a complex ophthalmic examination. Their results were compared with retrospective data of earlier treated AP-ROP patients (10 preterm infants, 20 eyes), in whom laser photocoagulation (LC) was done first (gestational period at the time of LC ranged from 26 to 30 weeks, post-conceptual age - from 34 to 39 weeks). In all cases, the disease progressed despite LC, thus, second-stage vitrectomy was required. Taking into account the similarity between clinical and morphometric data of the study group and retrospective patients, laser treatment was voted inexpedient as predictably inefficient and, therefore, a decision was made to perform vitreoretinal surgery. For that, an original technique of vitrectomy without preliminary LC was designed. Follow-up periods were up to 6 months. In all cases, AP-ROP regression to inactive stage was diagnosed 1 month after vitrectomy. According to digital retinoscopy findings, initial sings of blood vessel growth into the previously avascular retina appeared on day 20-26 after surgery. This was confirmed by the results of fluorescein angiography. In general, complete retinal reattachment was obtained in 16 eyes (80%), partial - in 3 eyes (15%). In 1 case, the retina failed to reattach (5%). The proposed method of primary vitrectomy enables optimization of the treatment approach to severe AP-ROP and can be regarded as promising.

Three-Year Results of Fluorescein Angiography–Guided Standard Photodynamic Therapy with Multiple Spots for Central Serous Chorioretinopathy

To report the long-term results of fluorescein angiography (FA)-guided standard photodynamic therapy (PDT) for central serous chorioretinopathy (CSCR) and its adverse effects. Prospective, noncomparative, interventional study. Consecutive patients (N= 63 eyes) with acute (39 eyes) or chronic (24 eyes) CSCR. All eyes underwent FA-guided conventional PDT, using multiple spots in 1 session if appropriate, and were assessed before PDT, as well as at months 3, 6, and 12 after PDT, and every 6 months thereafter until the end of the 3-year follow-up time. Primary outcome measures were the resolution of subretinal fluid (SRF) and the improvement of the Snellen best-corrected visual acuity (BCVA) to better than 20/100 at the end of the study. Secondary outcomes were the changes in mean BCVA and central foveal thickness (CFT) during the follow-up time. All 63 eyes with acute or chronic CSCR demonstrated complete resolution of SRF at the end of the study. Of the studied eyes, 51 (80.95%) underwent a single PDT application. The mean CFT improved significantly at all time points in the acute CSCR group (P < 0.001) from 515.13±110.5 μm to 297.75±22.3 μm at 3 years and in the chronic CSCR group from 484.12±62.49 μm to 293.81±16.89 μm. At 3 years, a gain of more than 20/100 in Snellen BCVA was seen in 28 acute and 16 chronic CSCR PDT-treated eyes (71.8% vs. 66.67%; P= 0.779). The mean logarithm of the minimum angle of resolution BCVA improved from 0.349±0.18 at baseline to 0.060±0.06 at the end of the study (P < 0.001) for eyes with acute CSCR and from 0.502±0.28 to 0.198±0.11 correspondingly for the eyes with chronic CSCR (P < 0.001). None of the study eyes demonstrated any serious systemic or ophthalmologic complication related to the use of the standard PDT with verteporfin. Fluorescein angiography-guided conventional PDT achieved outcomes for acute and chronic CSCR comparable with those reported with modified PDT techniques. We did not identify new safety concerns.

Posterior Polar Central Choroidal Dystrophy: A Case Report.

A 52-year-old male presented with a 25-year history of decreasing vision. Best corrected visual acuity was 0.3 in his right and 0.2 in his left eye. Fundoscopic examination showed bilateral symmetric atrophy of the retinal pigment epithelium and choriocapillaris in the posterior polar areas between vascular arcades and surrounding the optic disc. On fluorescein angiography, the large choroidal vessels beneath these affected regions were easily seen. Fundus autofluorescence imaging showed clearly defined hypoautofluorescent areas that corresponded to the aforementioned lesions. Atrophy of the choriocapillaris and outer retinal layer were detected in optical coherence tomography. Photopic and scotopic responses were subnormal in flash electroretinogram (ERG), and responses were also minimal in pattern ERG and multifocal ERG. The patient was diagnosed with posterior polar central choroidal dystrophy. We aimed to present the results of fluorescein angiography, fundus autofluorescence imaging, optical coherence tomography, and electrophysiological tests in this rare case of posterior polar central choroidal dystrophy.

RESOLUTION OF NONINFECTIOUS UVEITIC CYSTOID MACULAR EDEMA WITH TOPICAL DIFLUPREDNATE.

To evaluate the short-term safety and efficacy of topical difluprednate (0.05%) for the treatment of noninfectious uveitic cystoid macular edema. Twenty-seven patients (35 eyes) undergoing treatment with difluprednate 4 times daily for 3 weeks for noninfectious uveitic cystoid macular edema were reviewed for visual acuity, intraocular pressure, optical coherence tomography, and fluorescein angiography results. A mixed model analysis was fit with each measure as the outcome, visit as the primary predictor, and patient and eye as random effects. Mean central foveal thickness decreased by 117 μm (P < 0.001) at 30 ± 15 days, 124 μm (P < 0.001) at 60 ± 15 days, and 152 μm (P < 0.001) at 180 ± 30 days. Complete resolution of intraretinal fluid was observed in 15 of 34 (44%) eyes at 30 ± 15 days, 11 of 21 (52%) eyes at 60 ± 15 days, and 9 of 12 (75%) eyes at 180 ± 30 days. Improvement in fluorescein leakage was noted in 7 of 8 eyes (88%). Visual acuity improved by a mean of 5 letters (P = 0.001) at 30 ± 15 days, 5.5 letters (P = 0.007) at 60 ± 15 days, and 7 letters (P = 0.032) at 180 ± 30 days. Mean increase in intraocular pressure was 1.48 mmHg at 30 ± 15 days (P = 0.080), 1.92 mmHg at 60 ± 15 days (P = 0.110), and 6.18 mmHg (P = 0.001) at 180 ± 30 days. Topical difluprednate is a well-tolerated and effective treatment for noninfectious uveitic cystoid macular edema with decreased central foveal thickness, mild improvement in visual acuity, and elevation of intraocular pressure observed in a few patients.

Photoreceptor Progenitor mRNA Analysis Reveals Exon Skipping Resulting from the ABCA4 c.5461-10T→C Mutation in Stargardt Disease

To elucidate the functional effect of the ABCA4 variant c.5461-10T→C, one of the most frequent variants associated with Stargardt disease (STGD1). Case series. Seventeen persons with STGD1 carrying ABCA4 variants and 1 control participant. Haplotype analysis of 4 homozygotes and 11 heterozygotes for c.5461-10T→C and sequence analysis of the ABCA4 gene for a homozygous proband. Fibroblasts were reprogrammed from 3 persons with STGD1 into induced pluripotent stem cells, which were differentiated into photoreceptor progenitor cells (PPCs). The effect of the c.5461-10T→C variant on RNA splicing by reverse-transcription polymerase chain reaction was analyzed using PPC mRNA. Invitro assays were performed with minigene constructs containing ABCA4 exon 39. We analyzed the natural history and ophthalmologic characteristics of 4 persons homozygous for c.5461-10T→C. Haplotype and rare variant data for ABCA4, RNA splice defects, age at diagnosis, visual acuity, fundus appearance, visual field, electroretinography (ERG) results, fluorescein angiography results, and fundus autofluorescence findings. The frequent ABCA4 variant c.5461-10T→C has a subtle effect on splicing based on prediction programs. A founder haplotype containing c.5461-10T→C was found to span approximately 96 kb of ABCA4 and did not contain other rare sequence variants. Patient-derived PPCs showed skipping of exon 39 or exons 39 and 40 in the mRNA. HEK293T cell transduction with minigenes carrying exon 39 showed that the splice defects were the result of the c.5461-10T→C variant. All 4 subjects carrying the c.5461-10T→C variant in a homozygous state showed a young age of STGD1 onset, with low visual acuity at presentation and abnormal cone ERG results. All 4 demonstrated severe cone-rod dystrophy before 20 years of age and were legally blind by 25 years of age. The ABCA4 variant c.5461-10T→C is located on a founder haplotype lacking other disease-causing rare sequence variants. Invitro studies revealed that it leads to mRNA exon skipping and ABCA4 protein truncation. Given the severe phenotype in persons homozygous for this variant, we conclude that this variant results in the absence of ABCA4 activity.

Multifocal Electroretinogram and Fundus Autofluorescence Findings in Acute Zonal Occult Outer Retinopathy during a Three- Year Follow-Up

Acute zonal occult outer retinopathy is a disease difficult to diagnose. Within this pathology, many clinical and para-clinical tests appear normal regardless the great advances in technology. However, the findings we discovered with electrophysiology when paired with a thorough clinical anamnesis are the more reliable parameters for giving the right diagnosis.We present a clinical case of a 26 year old patient with diagnosis of acute zonal occult outer retinopathy whose optical coherence tomography and fluorescein angiography results were normal while the results of the wide field electroretinogram and multifocal electroretinogram showed alterations in the outermost layers of the retina which correlated with inferior arcuate defect in the visual field and peri-macular areas of hyperautofluorescence in the auotofluorescence. The evolution of the case is shown during 3 years appreciating the disappearance of the autofluorescence as well as progressive improvement in the visual field.

Rétinopathie pigmentaire associée à un pseudocoats

To provide a comprehensive review of the ocular manifestations, outcomes, and genetic findings in patients with Coats-like retinitis pigmentosa (RP).Multicenter, retrospective, nonconsecutive case series.Patients with a diagnosis of RP demonstrating Coats-like exudative vitreoretinopathy between January 1, 2008, and October 1, 2019.Evaluation of ocular findings at RP diagnosis and at time of presentation of Coats-like exudative vitreoretinopathy, pedigree analysis, genetic testing, retinal imaging, and anatomic outcomes after treatment.Visual acuity, ophthalmoscopy results, OCT results, fluorescein angiography results, and identification of genetic mutations.Nine patients diagnosed with RP and demonstrating Coats-like exudative vitreoretinopathy were included. Median age at time of RP diagnosis was 8 years (range, 1–22 years), and median age at presentation of Coats-like exudative vitreoretinopathy was 18 years (range, 1–41 years). Seven patients were female, and 2 were male. The genetic cause of disease was identified in 6 patients. Three patients demonstrated Coats-like fundus findings at the time of RP diagnosis. Exudative retinal detachment (ERD) localized to the infratemporal periphery was present in all patients, with bilateral disease observed in 7 patients. In all treated patients, focal laser photocoagulation was used to treat leaking telangiectasias and to limit further ERD expansion. Cystoid macular edema refractory to carbonic anhydrase inhibitor therapy and ultimately amenable to treatment with intravitreal anti–vascular endothelial growth factor injection was observed in 4 patients.Coats-like vitreoretinopathy is present in up to 5% of all RP patients. The term Coats-like RP is used colloquially to describe this disease state, which can present at the time of RP diagnosis or, more commonly, develops late during the clinical course of patients with longstanding RP. Coats-like RP is distinct from Coats disease in that exudative pathologic features occur exclusively in the setting of a coexisting RP diagnosis, is restricted to the infratemporal retina, can affect both eyes, and does not demonstrate a male gender bias. Given the risk of added vision loss posed by exudative vitreoretinopathy in patients with RP, a heightened awareness of this condition is critical in facilitating timely intervention.

Comparison of the effects of intravitreal bevacizumab and triamcinolone acetonide in the treatment of macular edema secondary to central retinal vein occlusion

Aim:To compare the effects of intravitrealbevacizumab (IVB) and intravitreal triamcinolone acetonide (IVT) in the treatment of macular edema (ME) secondary to central retinal vein occlusion (CRVO).Materials and Methods:There were 20 patients treated with IVB (1.25 mg/0.05 mL) and 16 treated with IVT (4 mg/0.1 mL). The two groups were compared with regard to best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT), slit-lamp biomicroscopy and fundus fluorescein angiography results, intraocular pressure (IOP), numbers of injections, and adverse events.Results:The mean follow-up times in the IVB and IVT groups were 17.45±8.1 months (range: 8–33 months) and 19.94±10.59 months (range: 6–40 months), respectively (P = 0.431). Visual acuity increased and CMT decreased significantly within both groups, but no differences were observed between the groups (P = 0.718). The percentages of patients with increased IOP and iatrogenic cataracts were significantly higher in the IVT group than in the IVB group.Conclusions:Treatment with IVB and IVT both resulted in significant improvement in visual acuity and a decrease in CMT in patients with ME secondary to non-ischemic CRVO, with no difference between the two treatments. The incidence of adverse events, however, was significantly greater in the IVT group than in the IVB group. IVB may be preferred over IVT for the treatment of ME in patients with non-ischemic CRVO.

C-Reactive Protein and Complement Components in Patients with Pathological Myopia

To investigate the association between pathological myopia (PM) and immunological/inflammatory markers and to identify the possible risk factors for the formation of myopic choroidal neovascularization (mCNV). One hundred fourteen unrelated subjects were recruited: 63 PM patients (PM group) with spherical equivalent of at least -8.00 diopters (range, -8.00 to -25.00) and axial length exceeding 26.5 mm, accompanied by characteristic pathologic changes, and 51 emmetropic age- and sex-matched individuals (control group) with spherical equivalent within ±1.0 diopter in both eyes. In the PM group, patients were assigned to two subgroups, mCNV group and no CNV group, according to the results of fluorescein angiography. Serum high-sensitivity C-reactive protein (hs-CRP) and complement profile (C3, C4, and CH50) were assayed. Statistical analysis was performed between the two groups. Binary logistic regression analysis was used to analyze the relative risk factors that were associated with the development of mCNV in the PM group patients. The range of axial length was 26.50 to 37.08 mm in the PM group and 22.32 to 24.56 mm in the control group. There were 24 patients in the mCNV group and 39 patients in the no CNV group. The PM group patients had significantly higher serum hs-CRP (p = 0.033), C3 (p = 0.004), and CH50 (p < 0.001) compared with the control group patients. There were no significant differences between the two groups for C4 level (p = 0.071). Binary logistic regression analysis, which included hs-CRP, C3, C4, CH50, age, and sex as covariates, showed that C3 (p = 0.03) and age (p = 0.01) were risk factors for mCNV, whereas serum hs-CRP, C4, CH50, and sex were not statistically significant predictors of mCNV in the PM group patients (p > 0.05). Our data support the hypothesis that immunological/inflammatory markers, namely hs-CRP, C3, and CH50 may play an important role in the development of PM, and that C3 level may be a predictive risk factor for mCNV formation.

Tacrolimus-Associated Ischemic Optic Neuropathy and Posterior Reversible Encephalopathy Syndrome After Small Bowel Transplantation

Tacrolimus-Associated Ischemic Optic Neuropathy and Posterior Reversible Encephalopathy Syndrome After Small Bowel Transplantation

Preclinical Safety Evaluation of AAV2-sFLT01— A Gene Therapy for Age-related Macular Degeneration

AAV2-sFLT01 is a vector that expresses a modified soluble Flt1 receptor designed to neutralize the proangiogenic activities of vascular endothelial growth factor (VEGF) for treatment of age-related macular degeneration (AMD) via an intravitreal injection. Owing to minimal data available for the intravitreal route of administration for adeno-associated virus (AAV), we initiated a 12-month safety study of AAV2-sFLT01 administered intravitreally at doses of 2.4 × 10(9) vector genomes (vg) and 2.4 × 10(10) vg to cynomolgus monkeys. Expression of sFlt01 protein peaked at ~1-month postadministration and remained relatively constant for the remainder of the study. Electroretinograms, fluorescein angiograms, and tonometry were assessed every 3 months, with no test article-related findings observed in any group. Indirect ophthalmoscopy and slit lamp exams performed monthly revealed a mild to moderate but self-resolving vitreal inflammation in the high-dose group only, which follow-up studies suggest was directed against the AAV2 capsid. Histological evaluation revealed no structural changes in any part of the eye and occasional inflammatory cells in the trabecular meshwork, vitreous and retina in the high-dose group. Biodistribution analysis in rats and monkeys found only trace amounts of vector outside the injected eye. In summary, these studies found AAV2-sFLT01 to be well-tolerated, localized, and capable of long-term expression.

Half-fluence photodynamic therapy to treat chronic central serous chorioretinopathy: A case series

Objective:To evaluate the efficacy and safety of half-fluence photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC) in Omani population.Materials and Methods:A Retrospective chart review of all patients with chronic CSC treated with half-fluence PDT from November 2009 to December 2010 was carried out. Recorded parameters included best-corrected visual acuity, findings of clinical examination, results of fluorescein angiography and optical coherence tomography at baseline and during follow-up visits after treatment.Results:Six eyes (of five Omani patients) with chronic CSC, of at least 9 months duration, were treated with half-fluence PDT. All eyes showed a complete resolution of CSC within 1 month following treatment. Four eyes showed visual improvement and two had unchanged stable vision. No complications from the treatment were noticed during the follow-up visits.Conclusion:Half-fluence PDT to treat chronic CSC in Omani population is a promising treatment that results in both structural and functional improvement.

Intravitreal Ranibizumab for Choroidal Neovascularization in Angioid Streaks

To analyze retrospectively the efficacy of intravitreal ranibizumab injections for the management of choroidal neovascularization (CNV) in patients with angioid streaks. Nonrandomized, double-center, retrospective, interventional case series. A consecutive series of patients affected with CNV associated with angioid streaks were treated with intravitreal ranibizumab injections (0.5 mg/0.05 mL). Best-corrected visual acuity, fundus photography results, optical coherence tomography (OCT) results, and fluorescein angiography results were examined before and after treatment. The primary end point was the percentage of eyes with stable or improved visual acuity at the end of follow-up. Secondary end points were the percentage of eyes with stable or decreased macular thickness on optical coherence tomography and the percentage of eyes with persistent leakage on fluorescein angiography at the last follow-up examination. Thirty-five eyes of 27 patients were treated with repeated intravitreal ranibizumab injections (mean, 5.7 injections; range, 2 to 14 injections) for a mean of 24.1 months (range, 6 to 37 months). At the end of follow-up, visual acuity was stabilized or improved in 30 (85.7%) of 35 eyes. Macular thickness had stabilized or decreased in 18 (51.5%) of 35 eyes. At the last follow-up examination, on fluorescein angiography, no further leakage was observed in 23 (65.7%) of 35 eyes. In this large series of angioid streaks-associated CNV, ranibizumab injections allowed stabilization of visual acuity. Ranibizumab seems to be a safe therapeutic option in CNV associated with angioid streaks.