sub-Tenon Corticosteroid Research Articles

Orbital abscess following sub-Tenon's corticosteroid injection: A rare but severe complication

Orbital abscess following sub-Tenon's corticosteroid injection: A rare but severe complication

Intraocular sarcoid-like reaction in patients with chronic lymphocytic leukemia

ObjectifVérifier la fréquence de survenue et les caractéristiques cliniques de la réaction sarcoïdosique (SLR, pour sarcoid-like reaction) intraoculaire paranéoplasique dans la leucémie lymphoïde chronique (LLC). MéthodesExamen rétrospectif des dossiers de patients présentant une LLC entre le 1er janvier 1980 et le 31 décembre 2020. On a procédé à la recherche d'examens oculaires à l'aide de 22 mots clés évoquant une SLR, et les dossiers ont été vérifiés manuellement. RésultatsSur les 4209 patients uniques qui présentaient une LLC, 1021 (24 %) avaient subi au moins 1 examen oculaire selon les notes consignées à leur dossier, et au moins 1 mot clé figurait dans la description des résultats de l'examen oculaire de 324 (8 %) patients. Après vérification manuelle des dossiers, une SLR a été évoquée chez 12 patients (< 1 %) : 7 patients présentaient une SLR probable à caractéristiques typiques et 1 patient, une SLR possible sans caractéristique classique; chez les 4 autres, la SLR était soupçonnée, mais moins probable. Tous les patients qui ont eu une SLR probable ou possible (n = 8) étaient de race blanche, et la moitié (n = 4) étaient de sexe masculin. La SLR intraoculaire a été diagnostiquée en moyenne 49,7 mois après le diagnostic de LLC (n = 7) ou 1 mois avant le diagnostic de LLC (n = 1). Il s'agissait d'une atteinte bilatérale chez 5 patients. On comptait en tout 13 yeux touchés, et l'acuité visuelle moyenne au moment de l'examen initial était de 20/50 sur l’échelle de Snellen. À l'examen initial, les caractéristiques suivantes ont été fréquemment observées : cellules vitreuses (n = 13), cellules de la chambre antérieure (n = 10), précipités kératiques (n = 9), synéchies postérieures (n = 6), lésions choriorétiniennes (n = 5) et flou du vitré (n = 5). Le traitement a reposé sur les corticostéroïdes topiques seuls (n = 5), avec l'administration sous-ténonienne de corticostéroïdes (n = 1) ou d'immunosuppresseurs d’épargne cortisonique (n = 1), ou sur les corticostéroïdes oraux seuls (n = 1). Après un suivi moyen de 19,8 mois, l'acuité visuelle finale moyenne était de 20/30. ConclusionLa SLR intraoculaire touche moins de 1 % des patients atteints de LLC et doit figurer sur la liste des diagnostics différentiels des troubles oculaires en présence de LLC. L'administration de corticostéroïdes permet une prise en charge efficace de la plupart des patients.

Outbreak of Rift Valley Fever Retinitis in Rwanda: Novel Imaging Findings and Response to Treatment with Corticosteroids

ABSTRACT Purpose To describe the clinical and epidemiological characteristics of the first epidemic of Rift Valley Fever retinitis in Rwanda and to report novel imaging findings and a possible role for corticosteroids. Methods Retrospective analysis of all patients who presented with presumed Rift Valley Fever retinitis at the Rwanda Charity Eye Hospital over a period of 4 months in 2022. Multimodal images are reviewed including optical coherence tomography, fluorescein angiography, color, infrared, red-free, and autofluorescence photography. Results The newly identified arciform hyporeflective pattern on infrared imaging was present in 100% of patients. Out of 9 patients treated with oral corticosteroids, 7 (78%) experienced a visual acuity increase of at least 0.2 during follow-up, in comparison to only 4 (28%) out of 14 of untreated patients. Out of four patients treated with a subtenon corticosteroid injection, only one (25%) reached this threshold. Post-hoc pairwise comparison with Bonferroni correction revealed a significant difference in average visual acuity improvement (p = 0.034) between patients receiving oral corticosteroids (0.35 ± 0.07) versus no treatment (0.11 ± 0.04). Conclusion The identified arciform hyporeflective pattern on infrared imaging appears to be characteristic of Rift Valley Fever retinitis and should be known to clinicians working in endemic regions. Compared to a historical cohort and to untreated patients in this non-randomized study, there appears to be a benefit of treatment with oral corticosteroids.

Efficacy of subtenon 20-mg triamcinolone injection versus 0.1% dexamethasone eye drops for controlling inflammation after phacoemulsification: a randomized controlled trial

A prospective randomized control trial of 140 eyes from 140 patients, who underwent phacoemulsification, was conducted to compare the efficacy of subtenon corticosteroids injection with corticosteroids eye drops for controlling postoperative intraocular inflammation. Seventy patients received subtenon 20-mg triamcinolone injection (TA group), whereas the other 70 patients received 0.1% dexamethasone eye drops (Dexa group) after the uneventful surgeries. We examined and measured anterior chamber inflammation (ACI) score, laser flare-cell metering, conjunctival redness, pain, discomfort, visual acuity, intraocular pressure, and central foveal thickness on 1, 7, 14, 28 and 90 days postoperatively. At one month after the surgery, full recovery (zero ACI score) was found in 43 patients (63.20%) in the Dexa group versus 47 patients (68.10%) in the TA group (p = 0.55). There were no statistically significant differences in aqueous cells (p = 0.37) and flare (p = 0.86) between the two groups at one month. All participants experienced no serious adverse events. In conclusion, we found no statistically significant difference between subtenon 20-mg triamcinolone injection and 0.1% dexamethasone eye drop to control inflammation postoperatively. A single subtenon 20-mg triamcinolone injection could be an alternative anti-inflammatory treatment for an uneventful phacoemulsification.

Short-term results for brolucizumab in treatment-naïve neovascular age-related macular degeneration: a Japanese multicenter study.

To investigate short-term treatment outcomes of intravitreal brolucizumab (IVBr) for treatment-naïve neovascular age-related macular degeneration (AMD) in a Japanese multicenter study. Retrospective case control study METHODS: The subjects were 58 eyes of 57 patients with neovascular AMD (43 men and 14 women, mean age 74.6years) of whom 43 eyes of 42 patients completed initial loading of 3 monthly IVBr injections and were followed for more than 3 months. Best-corrected visual acuity (BCVA) changes, anatomical outcomes, and complications were investigated. Of the 43 eyes that completed loading doses, the AMD subtype was type 1 and type 2 macular neovascularization (MNV) in 51%, polypoidal choroidal vasculopathy (PCV) in 42%, and type 3 MNV in 7%. At 3months after initiating treatment, BCVA significantly improved (P = 0.002) and central retinal thickness significantly decreased (P < 0.0001). At 3months, complete retinal and subretinal fluid resolution was achieved in 91% of all eyes and complete regression of polypoidal lesions was achieved in 82% of PCV eyes. Iritis occurred in 8 eyes of 8 patients (14%), but resolved using topical or subtenon corticosteroid injection without visual loss in all cases. IVBr for treatment-naïve neovascular AMD was effective in the short-term, achieving significantly improved BCVA, good retinal fluid resolution, and a high rate of polypoidal lesion regression. However, iritis was noted in 14% of patients which may limit use of this drug.

Combined therapy with intravitreal aflibercept and subtenon corticosteroids in eyes with severe diabetic papillopathy: two case reports

BackgroundDiabetic papillopathy is a rare diagnosis of exclusion characterized by unilateral or bilateral optic disc edema with variable degrees of visual loss. Although the visual prognosis has been generally reported as favorable, the presence of severe disc edema associated with macular edema prompts the need for treatment. We present a specific and unreported therapeutic approach consisting of intravitreal aflibercept and subtenon triamcinolone acetonide injections in two patients with evidence of diabetic papillopathy and macular edema.Case presentationIn the first case, a 60-year-old Caucasian woman affected by type II diabetes mellitus presented with fundoscopic evidence of sequential bilateral optic disc edema associated with acute severe visual loss in both eyes. The second patient, a diabetic 57-year-old Caucasian male, presented with sudden painless visual loss in his left eye. Multimodal imaging and systemic findings correlated towards an infrequent diagnosis of diabetic papillopathy. In a period of 5–7 weeks after treatment, both patients experienced almost full visual and anatomical recovery. A steady situation was observed at 12 months of follow-up.ConclusionsBoth our cases displayed a severe grade of optic disc edema, which was optimally reversed with intravitreal aflibercept and subtenon triamcinolone acetonide leading to a relatively rapid and safe improvement in visual acuity.

Coats disease in 351 eyes: Analysis of features and outcomes over 45 years (by decade) at a single center.

Purpose:To assess features and outcomes of Coats disease over 5-decades.Methods:Retrospective review of Coats disease patients at a single center. Features and outcomes were compared based on decade of presentation.Results:There were 351 patients with Coats disease. The presenting median age (6 years), male sex (84%), and unilaterality (100%) did not change per decade. Coats disease classification did not change per decade with Stage 1 (1%), Stage 2 (21%), Stage 3 (68%), Stage 4 (6%), and Stage 5 (1%). Clinical features that changed per decade (1970s vs. 1980s vs. 1990s vs. 2000s vs. 2010s) included 1980s features of more eyes with exudation in all 4 quadrants (22% vs. 58% vs. 44% vs. 33% vs. 27, P = 0.01) and total exudative retinal detachment (33% vs. 53% vs. 39% vs. 27% vs. 21%, P < 0.001). Imaging features that changed per decade included 2010s greater fluorescein angiographic extent of retinal non-perfusion in mean clock hours (4 vs. 4 vs. 3 vs. 5 vs. 6, P = 0.003), and 1980s greater mean height of retinal detachment ultrasonographically (5 vs. 12 vs. 5 vs. 5 vs. 4 mm, P < 0.001). Treatment features that changed per decade included 1980s greater primary enucleation (11% vs. 16% vs. 3% vs. 4% vs. 1%, P = 0.001), and 2010s greater use of laser photocoagulation (55% vs. 33% vs. 38% vs. 40% vs. 72%, P < 0.001), sub-Tenon corticosteroid (0% vs. 4% vs. 5% vs. 8% vs. 29%, P < 0.001), and intravitreal anti-VEGF) (0% vs. 4% vs. 2% vs. 13% vs. 18%, P = 0.003). Outcomes that changed per decade included 2010s findings of more complete resolution of subretinal fluid (64% vs. 59% vs. 38% vs. 58% vs. 72%, P = 0.01) and less need for primary/secondary enucleation (17% vs. 27% vs. 14% vs. 13% vs. 6%, P = 0.04).Conclusion:Eyes with Coats disease in the 1980s demonstrated more advanced findings, often requiring enucleation. Over the decades, greater use of laser photocoagulation and injections has led to improved disease resolution with greater globe salvage.

Медикаментозное сопровождение и особенности хирургии увеальной катаракты. Предварительные результаты

Purpose. To present the results of complicated uveal cataract surgery using medication treatment schemes and a minimally invasive surgery technique. Materials and methods. The study included 13 eyes of 12 patients with uveitis-associated cataract, who underwent phacoemulsification with implantation of hydrophobic acrylic intraocular lenses. All cases were categorized into two groups with different preoperative treatment. The patients of the group 1 received the intravitreal application of Ozurdex (main group) and in the group 2 subtenon corticosteroids injections in combination with systemic pulse-therapy (the control group). The etiology of the disease was established in 10 patients where relapse-free period was 7.3±2.5 months. Minimization of surgical trauma was provided by the use of vitreoretinal instruments 25-27G, an intraoperative local (step-by-step) pupil dilatation and a gentle posterior capsule peeling. The postoperative follow-up period was from 4 to 22 months. In addition to the standard ophthalmological examination, all patients underwent B-scanning, optical coherence tomography (OCT) on Carl Zeiss Cirrus 5000, and laser flare photometry. Results. The postoperative BCVA increased in all patients (0.47±0.17) and was significantly higher than the preoperative BCVA (0.11±0.1, p<0.05). Reactivation of the inflammation was observed in 3 patients (two – in the control group and one – in the main group); an additional use of Ozurdex implant allowed to stop inflammation and macular edema. Conclusion. The use of minimally invasive phacoemulsification technique and intravitreal administration of Ozurdex implant in uveitisassociated cataract patients provides an uncomplicated postoperative period.

Vitritis after Boston Keratoprosthesis Type 1 Implantation

To describe the incidence, presentation, and clinical course of vitritis occurring after Boston keratoprosthesis type 1 implantation. Retrospective chart review. Medical records of all patients undergoing type 1 Boston keratoprosthesis implantation over a 4-year period were reviewed. Cases of vitreous inflammation were classified as either postoperative (within 1 month after surgery without endophthalmitis), reactive (secondary to ocular surface inflammation), idiopathic, or infectious endophthalmitis. The presenting features and postoperative course of all patients were reviewed. Postoperative inflammation. A total of 110 eyes underwent type 1 Boston keratoprosthesis implantation with a median follow-up of 5.6 years. Overall, there were 21 episodes of vitritis occurring in 17 patients; 6 cases of vitritis were postoperative, whereas 5 were reactive, 7 were idiopathic, and 3 were infectious endophthalmitis. Patients with vitritis sought treatment a median of 10 months after surgery (range, 1 week-7 years). Compared with patients in whom vitritis did not develop, those with vitritis were younger (50.8 years of age vs. 62.2 years of age; P=0.01), but with a similar prevalence of autoimmune disease (P= 1.00). Eyes with postoperative vitritis had a benign and short course, and were all managed with topical medications. Reactive vitritis occurred in association with infectious keratitis (4 cases) or corneal melting (1 case). Patients with idiopathic vitritis and endophthalmitis demonstrated similar symptoms of pain and severe vision loss. The mean duration of inflammation in patients of idiopathic vitritis was 3.3 months; all patients later demonstrated retroprosthetic membrane, and 2 patients (29%) demonstrated retinal detachment. Three of 7 patients with idiopathic vitritis underwent a vitreous tap, which showed negative results in all cases. The 3 cases of infectious endophthalmitis had a prolonged and severe course, with only 1 eye retaining functional vision. Patients undergoing type 1 Boston keratoprosthesis implantation are at risk of postoperative vitreous inflammation, which may present in the immediate postoperative period or years later. Cases of idiopathic inflammation may present similarly to infectious endophthalmitis, and a low threshold should be taken for performing vitreous tap and injection of antimicrobials. Caution should be exercised using sub-Tenon corticosteroids, given the high prevalence of glaucoma and possibility of exacerbating fungal infections.

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine-Gass syndrome: a prospective case series.

PurposeTo determine the preliminary efficacy and safety of off-label dexamethasone implant for treatment of recurrent cystoid macular edema (CME) secondary to Irvine-Gass syndrome (IGS).Patients and methodsThis study was set in Raghudeep Eye Clinic, Ahmedabad and LV Prasad Eye Institute, Hyderabad (India). It is a Prospective Case Series. Prospective case series comprising of patients with uncomplicated pseudophakia and CME due to IGS who recurred after one course of topical steroids with NSAIDS and a sub-Tenon corticosteroid injection. A complete ocular and systemic exam, fluorescein angiography, and central subfield thickness (CST) on optical coherence tomography scans were performed. Follow-up visits were on days 1, 15, and 30 and then monthly for a year. Appropriate statistical analysis was done. The primary outcome measure was the change in CDVA at months 1, 6, and 12. Secondary outcome measures were recurrence of CME and complications if any as noted at months 1, 2, 6, and 12.ResultsAbout 27 patients (27 eyes) with 16 males were included. Median age: 63.24±5.62 years. At 1 month, the CDVA improved to 0.04±0.02 (20/25) logMAR from 0.52±0.12 logMAR (20/70) (P=0.001) with a reduction in CST from 454.2±45.3 to 218.32±38.15 microns(P=0.013). The CDVA was 0.04±0.03 logMAR(P<0.001) at month 6 and 0.05±0.02 logMAR(P<0.001) at month 12. The CST was 221±35.2 microns (P=0.013) at month 6 and 214±43.34 microns (P=0.0124) at month 12. All improvements were maintained for a year. Only one patient required a second injection. No complications were noted.ConclusionThe implant is safe and effective for the treatment of recurrent CME due to IGS.

Uveitic macular edema.

Macular edema (ME) may complicate anterior, intermediate, and posterior uveitis, which may be because of various infectious, neoplastic or autoimmune etiologies. BRB breakdown is involved in the pathogenesis of Uveitic ME (UME). Optical coherence tomography has become a standard tool to confirm the diagnosis of macular thickening, due to its non-invasive, reproducible, and sensitive features. Retinal fluorescein and indocyanine green angiography is helpful to study the macula and screen for associated vasculitis, detect ischemic areas and preretinal, prepapillary or choroidal neovascular complications, and it may provide information about the etiology and be needed to assess the therapeutic response. UME due to an infection or neoplastic infiltration may require a specific treatment. If it remains persistent or occurs in other etiologies, immunomodulatory treatments may be needed. Intravitreal, subconjunctival, or subtenon corticosteroids are widely used. Their local use is contraindicated in glaucoma patients and limited by their short-lasting action. In case of bilateral sight-threatening chronic posterior uveitis, systemic treatments are usually needed, and corticosteroids are used as the standard first-line therapy. In order to reduce the daily steroid dose, immunosuppressive or immunomodulatory agents may be added, some of them being now available intravitreally. Ongoing prospective studies are assessing biotherapies and immunomodulators to determine their safety and efficacy in this indication.

Treatment of Coats' Disease With Combination Therapy of Intravitreal Bevacizumab, Laser Photocoagulation, and Sub-Tenon Corticosteroids.

The authors investigate the efficacy of combination treatment with laser photocoagulation, intravitreal bevacizumab (IVB) (Avastin; Genentech, South San Francisco, CA), and sub-Tenon corticosteroids in Coats' disease. Patient records at the Bascom Palmer Eye Institute were reviewed from August 2002 to January 2014. Primary outcome measures were anatomic success, globe salvage, and final visual acuity. Of the 26 patients (26 eyes) reviewed, 20 patients had stage 3A2, four patients had stage 3A1, and two patients had stage 2A. Mean follow-up time was 2.26 years. The median number of applications was five and three for laser and IVB, respectively. Five patients received sub-Tenon triamcinolone injections. Global salvage was achieved in all patients. Final visual acuity outcomes were reasonable: 20/20 to 20/50 in five patients, 20/60 to 20/100 in five patients, and 20/200 or less in 16 patients. Intravitreal injections of bevacizumab used in combination with repetitive laser photocoagulation therapy yielded anatomic success, global salvage, and reasonable visual acuity outcomes. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:443-449.].

Dexamethasone intravitreal implant for treatment of persistent macular oedema in Birdshot retinochoroidopathy

Clinical caseThe case is reported of a 32 year-old man with a bilateral cystoid macular oedema and serous macular detachment due to Birdshot retinochoroidopathy. An intravitreal implant of 0.7mg dexamethasone (Ozurdex®, Allergan) was performed on both eyes, after a partial response of the macular oedema to oral and subtenon corticosteroids. Anatomical and visual improvements were observed and maintained after six months of follow up. DiscussionIntravitreal dexamethasone implant may be a good therapeutic option in patients with macular oedema due to Birdshot retinochoroidopathy, and who were refractory or had intolerance to previous therapies.

Implante intravítreo de dexametasona como terapéutica del edema macular persistente en la retinocoroidopatía de Birdshot

Clinical caseThe case is reported of a 32 year-old man with a bilateral cystoid macular oedema and serous macular detachment due to birdshot retinochoroidopathy. An intravitreal implant of 0.7mg dexamethasone (Ozurdex®, Allergan) was performed on both eyes, after a partial response of the macular oedema to oral and subtenon corticosteroids. Anatomical and visual improvements were observed and maintained after six months of follow up. DiscussionIntravitreal dexamethasone implant may be a good therapeutic option in patients with macular oedema due to Birdshot retinochoroidopathy, and who were refractory or had intolerance to previous therapies.

Paraproteinemic Maculopathy

Paraproteinemia relates to monoclonal gammopathy-producing pathologic antibodies with serous macular detachment being an uncommon ocular manifestation. We ascertained the clinical course of maculopathy in paraproteinemia and investigated the effect of various therapeutic methods on the resolution of subretinal deposits. Multicenter, retrospective, observational case series. The records of patients with paraproteinemia with optical coherence tomography (OCT) documentation of serous macular detachment were reviewed. Data collection included coexisting morbidity, rheology data (immunoglobulin level, hematocrit, and blood viscosity), clinical examination results, and OCT findings. Best-corrected visual acuity (BCVA), height and basal area of the serous macular detachment, and systemic versus local therapies. A total of 33 cases were collected: 10 new and 23 previously reported in the literature. Diabetes was present in 7 patients, systemic hypertension in 9 patients, and anemia in 18. Mean initial immunoglobulin level was 6497 mg/dl, and mean serum viscosity was 5.5 centipoise (cP). Mean logarithm of the minimum angle of resolution initial vs. final BCVA was 0.55 (Snellen equivalent, 20/71) vs. 0.45 (20/56) in the right eye and 0.38 (20/48) vs. 0.50 (20/63) in the left eye. After mean follow-up of 7 months (range, 0-51 months). Systemic therapies included plasmapheresis (18), chemotherapy (30), blood transfusions (2), transplantation of progenitor hematopoietic cells (2), and oral rituximab (10). Immunoglobulin levels normalized in 8 patients and were unchanged in 1 after plasmapheresis, chemotherapy, or both. Ocular therapy in 8 patients included vitrectomy (1), laser photocoagulation (4), intravitreal bevacizumab (5), intravitreal triamcinolone (2), intravitreal dexamethasone implant (1), intravitreal rituximab (1), and sub-Tenon corticosteroid (1). The maculopathy resolved partially or completely in 17 patients and worsened or remained unchanged in 14 patients over median follow-up of 7 months. Maculopathy was unilateral in 9 cases and occurred at a lower initial immunoglobulin level in diabetics. There was a positive correlation between area of the detachment and serum viscosity. Paraproteinemic maculopathy can be unilateral. Decreasing the blood immunoglobulin level is the primary goal of therapy for paraproteinemic maculopathy, and this can be achieved by a systemic route. Coexisting diabetes facilitates leakage of immunoglobulins at lower levels than in nondiabetics.

Rare case of exogenous Candida dubliniensis endophthalmitis: a case report and brief review of the literature.

BackgroundCandida dubliniensis is a recently described opportunistic fungal pathogen that rarely infects the eye. Reported cases of C. dubliniensis endophthalmitis have been of endogenous etiology and demonstrated recovery of visual acuity with timely treatment. We herein report an unusual case of severe C. dubliniensis endophthalmitis requiring enucleation.FindingsThis is a retrospective, descriptive case report with a brief literature review. A 41-year-old Caucasian man, with a history of blunt trauma 8 months prior, presented to the emergency department with left eye pain and loss of vision 2 days after complicated cataract surgery. He was first evaluated by an outside ophthalmologist 3 months after trauma for left eye pain and progressive vision loss. He was found to have light perception vision with non-granulomatous anterior uveitis but no sign of ruptured globe. A dense cataract developed while he was treated with topical and subtenon's corticosteroids for which he underwent cataract surgery. Our examination revealed no light perception vision with a relative afferent pupillary defect, elevated intraocular pressure, moderate anterior chamber reaction, pupillary membrane, vitritis, and choroidal thickening on B-scan ultrasonography. Diagnostic vitrectomy revealed purulent vitreal debris, retinal detachment with severe retinal necrosis, and choroidal infiltrates. Operative fungal cultures grew C. dubliniensis. Despite intravitreal and systemic anti-fungal treatment, vision and pain did not improve, resulting in subsequent enucleation.ConclusionC. dubliniensis endophthalmitis is uncommonly encountered and typically has reasonable visual outcomes. This is the first reported case of C. dubliniensis, likely exogenous endophthalmitis, resulting in enucleation, illustrating the potential virulence of this newly described organism.

Subconjunctival Mycetoma After Sub-Tenon's Corticosteroid Injection

To describe a case of a subconjunctival mycetoma that developed after a patient received a sub-Tenon's injection of triamcinolone acetonide. Case report. A 76-year-old white male presented with a subconjunctival mass in the area of a previous posterior sub-Tenon's corticosteroid injection for wet age-related macular degeneration. Microbiologic and pathologic analysis of the mass revealed the causative organism to be the pigmented fungus Exophiala jeanselmei. This is the first published case of an Exophiala-associated subconjunctival mycetoma.

BEVACIZUMAB (AVASTIN) AND RANIBIZUMAB (LUCENTIS) FOR CHOROIDAL NEOVASCULARIZATION IN MULTIFOCAL CHOROIDITIS

Multifocal choroiditis (MFC) is an inflammatory condition, occasionally associated with choroidal neovascularization (CNV). Bevacizumab (Avastin) and ranibizumab (Lucentis) are therapies that target vascular endothelial growth factor. Bevacizumab and ranibizumab have been used successfully to treat CNV in age-related and myopic macular degeneration. : To describe the treatment of MFC-associated CNV with intravitreal bevacizumab and/or ranibizumab. Retrospective interventional case series. Six eyes of five patients with MFC-associated CNV were treated with intravitreal bevacizumab and/or ranibizumab. Visual acuity at 1, 3, and 6 months after the initial injection. Previous therapies (number of eyes treated) included sub-Tenon's corticosteroids (2), intravitreal corticosteroids (1), photodynamic therapy (1), and thermal laser (1). The mean number (range) of antivascular endothelial growth factor injections per eye was 2.3 (1-6). The mean duration (range) of follow-up per patient was 41.5 (25-69) weeks. Five of six eyes improved to 20/30 acuity or better at 6 months. One eye suffered a subfoveal rip of the retinal pigment epithelium with 20/400 acuity. There was a qualitative decrease in clinical and angiographic evidence of CNV. Bevacizumab and ranibizumab were effective at improving visual acuity over 6 months in a small series of patients with MFC-associated CNV. Tears of the retinal pigment epithelium may occur after intravitreal antivascular endothelial growth factor therapy in MFC-associated CNV.

Management of ocular complications of Vogt-Koyanagi-Harada syndrome

Vogt-Koyanagi-Harada syndrome (VKH) is a multisystem disorder, characterized by the T-cell-mediated autoimmune process directed against melanocytic antigens in the ocular, nervous, auditory and integumentary systems. The ocular hallmarks of the disease involve severe bilateral panuveitis associated with exudative retinal detachment. We report a pediatric case of probable VKH Syndrome with isolated ocular findings, in which bilateral vitritis, papillitis and serous retinal detachments involving the macula with intra-retinal edema and choroideal thickening were detected. Subtenon triamcinolone acetonide injection was performed in addition to systemic corticosteroid and cyclosporine treatments. Evolution Prompt improvement was seen in the ocular manifestations of VKH syndrome, which persisted for at least 4 months. Subtenon corticosteroid injection, together with systemic corticosteroid and cytotoxic treatment, prevented the ocular complications of invasive intraocular treatment modalities, and at the same time reduced the systemic corticosteroid dosage. We recommend use of ocular invasive treatment modalities in Vogt-Koyanagi-Harada Syndrome only if the disease progression cannot be controlled. If systemic medications fail to stop the progression of the disease activity, subtenon injections may be considered before intraocular treatment modalities.

Cystoid macular edema following photorefractive keratectomy complicated by presumptive infectious keratitis

A 71-year-old man developed cystoid macular edema (CME) following photorefractive keratectomy (PRK). He had a history of CME following cataract surgery in both eyes, which had responded well to topical steroid and nonsteroidal antiinflammatory drops. The cataract surgery in the left eye had resulted in a hyperopic surprise, with secondary anisometropia and visual discomfort. For this reason, the patient elected to have PRK. Three weeks after the procedure, he returned, complaining of visual loss. Optical coherence tomography and fluorescein angiography confirmed the presence of CME. This responded well to topical and sub-Tenon's corticosteroids and nonsteroidal antiinflammatory drops.