Faculty Bibliography

BACKGROUND AND OBJECTIVE: To evaluate choroidal involvement in acute posterior multifocal placoid pigment epitheliopathy (APMPPE). PATIENTS AND METHODS: Retrospective study in five eyes of three patients evaluated through multimodal imaging, including enhanced-depth imaging optical coherence tomography (OCT), ultra-wide field color photography, fundus autofluorescence, and fluorescein angiography (FA). Choroidal thickness and structure were evaluated on OCT. RESULTS: During the acute phase, choroidal OCT showed choroidal thickening and a lucency at the level of the inner choroid. Subclinical lesions detected in the retinal periphery using wide-field retinal imaging were isoautofluorescent and corresponded to choriocapillaris filling-defects on FA. At final follow-up, all patients showed resolution of choroidal thickening and the inner choroidal lucency, as well as the disappearance of subclinical lesions. CONCLUSION: These results suggest a transient ischemic choroiditis in APMPPE that may lead to secondary permanent retinal pigment epithelium damage in the posterior pole but not in the retinal periphery. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:20-26.].

PURPOSE: To report a case of presumed gemcitabine-induced retinopathy and nephropathy. METHODS: Case Report. Retrospective chart review. RESULTS: A 64-year-old woman with a recent diagnosis of metastatic cholangiocarcinoma presented with progressive visual loss and renal failure shortly after the initiation of a chemotherapy regimen which included gemcitabine. Clinical examination and fluorescein angiography showed findings of severe retinal ischemia. CONCLUSION: Although gemcitabine chemotherapy has been reported to cause a Purtscher-like retinopathy, we propose in our patient a gemcitabine-induced vasculopathy that lead to significant retinal and renal ischemia.

The aim of this study is to determine the incidence of cystoid macular edema (CME) following repositioning and McCannel iris-suturing of dislocated intraocular lenses. This study is conducted in an urban private practice. A retrospective chart review was performed on consecutive patients who presented with posteriorly dislocated IOLs and underwent iris-sutured posterior chamber (PC) intraocular lens (IOL) placement using the McCannel suture technique by a single surgeon for IOL repositioning from December 2008 to August 2012. All charts were reviewed for etiology of dislocation, time elapsed from cataract surgery, best-corrected visual acuity (BCVA), slit-lamp examination, tonometry, and dilated fundus examination. Presence of CME was determined by spectral domain optical coherence tomography (Cirrus HD OCT; Carl Zeiss Meditec, Dublin, California, USA). Of the 58 cases reviewed, lens dislocation resulted from trauma in 21 %, zonular incompetence in 17 %, recent intraocular surgery in 12 %, and unknown in 50 %. Mean best-corrected logMAR visual acuity improved from 1.07 preoperatively to 0.52 postoperatively (P < 0.001). The mean follow-up time was 7.8 months. Two cases (3.4 %) of CME occurred postoperatively at a mean follow-up time of 4.5 months. Of these two patients, one had concurrent fragmetome lensectomy at the time of initial surgery. Iris-sutured PC IOL placement in this case series resulted in an improvement in BCVA with a low incidence of CME.

The purpose of this paper is to report a series of macular holes that developed after demarcation laser photocoagulation for subclinical retinal detachments. This observational case series consists of three eyes from three patients seen between 2005 and 2012. Delayed idiopathic macular hole formation occurred following demarcation laser photocoagulation for subclinical retinal detachment. Demarcation laser photocoagulation of subclinical retinal detachments may predispose to macular hole formation.

PURPOSE: To report a case of late failure of a posterior segment placed Ahmed valve in a uveitic eye with a corneal graft and a minimally invasive, ab interno approach in restoring valve function, pressure control, and preservation of vision. DESIGN: Case report. METHODS: A 25 gauge trans-conjunctival 3-port pars plana vitrectomy was performed to inspect and clean the ostium of the Ahmed valve of any vitreous debris. The Ahmed valve was not disturbed externally and conjunctival dissection was not performed. A 27-gauge blunt cannula was introduced through the vitrector site and used to cannulate the tube and flush it with balanced salt solution. A bleb was immediately re-established and all instruments were removed requiring no sutures. RESULTS: Intraocular pressure returned to target levels and a filtration bleb was re-established. Corneal graft clarity was restored with resolution of preoperative microcystic edema. Postoperative inflammation was minimal and vision was restored. CONCLUSIONS: A nonfunctioning tube shunt residing in the vitreous cavity may be revised ab interno without disturbing the shunt placement or the conjunctiva under which it resides to re-establish filtration.

BACKGROUND AND OBJECTIVE: To evaluate the correlation between macular hole (MH) surgery outcomes and preoperative factors believed to affect surgical success rates. PATIENTS AND METHODS: A retrospective, consecutive case series was designed to evaluate the correlation between anatomic success and preoperative factors: MH duration prior to surgery, visual acuity (VA), and MH diameter measured by optical coherence tomography (OCT) at the base and the narrowest midpoint. RESULTS: A total of 153 eyes were enrolled. There was no significant difference in mean duration prior to surgery for MH success and failure (P = .13). Mean preoperative VA was significantly better for MH success than failure (P = .03). Mean mid-hole diameter (P < .001) and mean base-hole diameter (P < .001) were significantly less for MH success than failure. Failure rate was 0% among eyes with mid-hole diameter less than 500 microns and 14.9% with mid-hole 500 microns or greater (P < .001). Failure rate was 0% among eyes with base-hole diameter less than 500 microns, 1.4% with base-hole 500 to 999 microns, and 19.1% with base-hole of 1,000 microns or greater (P = .001). CONCLUSION: Preoperative VA, mid-hole diameter, and base-hole diameter are correlated with anatomic success in MH surgery. An excellent surgical prognosis exists for MHs with mid-hole diameter less than 500 microns and base-hole less than 1,000 microns.