Faculty Bibliography

PURPOSE: To determine if oral hydration decreases the incidence of verteporfin infusion-associated pain and to find out if other factors play a role in predisposing to this undesired complication. METHODS: Nonrandomized clinical trial. We prospectively examined 250 consecutive patients who have been diagnosed with subfoveal choroidal neovascularization secondary to age-related macular degeneration and received photodynamic therapy using verteporfin. One hundred twenty-five patients were assigned to receive 500 ml of water orally administered 30 minutes before beginning the verteporfin infusion, and the remaining 125 consecutive patients were used as controls. Historical and clinical factors in these patients were evaluated for their association with the presence of verteporfin infusion-associated pain. RESULTS: Out of 125 patients receiving water before treatment 12 (9.6%) experienced verteporfin infusion-associated pain. Among the 125 patients who did not get hydration before therapy 12(9.6%) experienced verteporfin infusion-associated pain. There was no statistical difference between the incidence of pain in the two groups (P = 1.0). No statistically significant association was evidenced between the presence of pain and participant's baseline characteristics, except for pain on previous administration of verteporfin (P < .001). Out of 250 total patients 24 (9.6%) developed verteporfin infusion-associated pain. Back pain was the most common and occurred in 21 (8.4%) patients, but other sites included leg, groin, chest, buttock, arm, and shoulder pain concurrently or independently. All patients had resolution of their pain, including chest pain, on cessation of the infusion. CONCLUSIONS: Verteporfin infusion-associated pain may be more common than has been previously reported and is not limited to the back area. It appears to be an idiosyncratic reaction to the drug. It does not seem to be prevented by oral hydration before infusion of verteporfin, and no baseline characteristics, other than a history of pain on previous infusion, seem to be predictive of verteporfin infusion-associated pain

PURPOSE: To report the foveal anatomy in patients with perifoveal posterior vitreous detachments (PPVD) using optical coherence tomography. DESIGN: Retrospective observational case series. METHODS: A retrospective study of fellow eyes of patients of patients with macular holes and those with early macular hole states were examined with optical coherence tomography, biomicroscopy, and contact b-scan ultrasonography. Twenty-three eyes of 23 patients were discovered to have PPVD, which was defined as persistent attachment of the vitreous to the central macula with a limited detachment of the posterior vitreous in the perifoveal region. RESULTS: The mean diameter of persistent vitreous attachment in eyes with no foveal deformation was 1829 microm, flattening of the foveal depression 840 microm, and with foveal cavitation 281 microm (P < .001, Spearman rank correlation). The difference in the mean diameters was significant (P = .001, Kruskal-Wallis test, all pairwise comparisons showing significant difference using the Mann-Whitney test). CONCLUSIONS: This study found that the diameter of the vitreous attachment in eyes with PPVD correlated with induced changes in foveal anatomy. The diameters of vitreous attachment were consistent with known regions of robust attachment of the vitreous determined histologically. Although the actual force loading on the central macula cannot be determined in patients with perifoveal posterior vitreous detachments, the stress, which is force / unit area may well increase with smaller areas of attachment leading to mechanical failure of the macula

The authors sought to evaluate the effect of linoleic acid hydroperoxide (18:2/LHP) in promoting choroidal neovascularization (CNV). Albino male rabbits received a subretinal injection of various amounts of LHP (ranging from 5 to 200 microg) dissolved in 50 microl of sodium borate buffer. Control eyes received the buffer only. Eyes were examined up to 4 weeks later with indirect ophthalmoscopy, fundus photography and fluorescein angiography. Animals were killed on days 3, 7, 14 or 28, and eyes examined by light and transmission electron microscopy. In eyes injected with LHP of 150-200 microg, exposed areas turned white as observed ophthalmoscopically and showed both severe retinal and choroidal atrophy histologically. Neither fluorescein leakage nor CNV was found in these eyes or in controls. In 33 eyes injected with LHP of 100 microg or less, prominent fluorescein leakage was seen in three (9%) and less prominent focal leakage in five (15%). In 11 (46%) of the 24 eyes injected with 12.5-50 microg LHP, CNV was found histologically. Subretinal injection of LHP is capable of inducing CNV

OBJECTIVE: To describe clinical and angiographic features of patients with central serous chorioretinopathy (CSC) who had yellowish subretinal deposits forming a reticulated leopard-spot pattern during fluorescein angiography. METHODS: We conducted case studies using the clinical and photographic records of 5 patients. RESULTS: All 5 patients were older men between the ages of 68 and 81 years who had been treated with corticosteroids and had bilateral CSC. Nine eyes of the 5 patients developed yellowish deposits in a reticulated pattern in the macular region under the chronic detached neurosensory retina. The pattern of leopard-spot deposits was well demonstrated on the fluorescein angiogram, with hypofluorescence in most of the deposits and hyperfluorescence from atrophy of the retinal pigment epithelium. Later phases of the fluorescein angiographic study showed leaks from the retinal pigment epithelium. During the indocyanine green angiography evaluation of 4 patients, all had bilateral multifocal patches of hyperfluorescence in the midphase, findings typical of CSC. CONCLUSIONS: Yellowish deposits forming a reticulated leopard-spot pattern may occur under the neurosensory retina and are associated with chronic neurosensory detachment caused by CSC. All patients were older men being treated with corticosteroids. This report described a newly recognized finding: the subretinal deposition of a yellowish material in a leopard-spot pattern in eyes with CSC

PURPOSE: To describe a patient with Wegener's granulomatosis presenting with bilateral retinal and choroidal arterial occlusion. METHODS: A 64-year-old male with Wegener's granulomatosis was examined using ophthalmoscopy and indocyanine green angiography. RESULTS: The patient had central retinal arterial occlusion in the right eye and branch retinal arterial occlusion in the left eye associated with bilateral choroidal infarcts. Early phase wide-angle ICG angiography of left eye revealed widespread choroidal perfusion problems, presumably from the confluence of multiple segmental arterial occlusions. Indocyanine green angiography of the right eye showed similar widespread choroidal arterial occlusions. CONCLUSIONS: This patient developed loss of vision from multiple arterial occlusions of the retina and choroid. Retinal and choroidal ischemia of this patient may have been caused by vasculitis leading to occlusion of retinal arteries and multiple short posterior ciliary arteries

As a whole, the complication rate of retrobulbar and peribulbar injections is low, especially if done correctly (see appendix I). Side effects, however, can be extremely serious, and alternative methods such as topical or sub-Tenon's anesthesia should be considered (see appendix II), particularly when evaluating monocular patients with high-risk characteristics

PURPOSE: To report three patients who developed central serous chorioretinopathy after epidural corticosteroid injection for treatment of back pain. DESIGN: Interventional case series. METHODS: Three men, aged 73, 52, and 73 years, presented with bilateral central serous chorioretinopathy after corticosteroid injection in the epidural space for treatment of back pain. In all three cases, we did not initially elicit the history of corticosteroid use. RESULTS: Two of the three patients, aged 52 and 73 years, had diffuse retinal pigment epitheliopathy and one, aged 73 years, had classic central serous chorioretinopathy. Two patients had a spontaneous resolution of the subretinal fluid in both eyes. One patient had laser photocoagulation in both eyes but continued to have diffuse leakage in one eye. CONCLUSIONS: A careful history to determine corticosteroid use, including possible intrajoint and epidural injection, should be performed in older people with serous detachment of the macula, particularly when bilateral

PURPOSE: To report the optical coherence tomographic characteristics of persistent bleb-like subretinal lesions after retinal reattachment surgery, including scleral buckling and cryopexy. METHODS: Case reports. RESULTS: In two eyes of two patients yellow to yellowish-orange bleb-like lesions were found in the posterior pole after retinal reattachment surgery. The common aspects of the surgery were scleral buckling procedures and cryopexy. There were subretinal precipitates in some of the lesions. The lesions showed no associated leakage during fluorescein or indocyanine green angiography. Optical coherence tomography demonstrated that the bleb-like lesions were tiny retinal detachments. CONCLUSION: Optical coherence tomography examination of bleb-like subretinal lesions showed that they were actually retinal detachments. Our patients and previously reported patients developed these lesions after scleral buckling and cryopexy. These lesions may represent persistent retinal detachment because of the presence of protein in the subretinal fluid

PURPOSE: To report a patient who had concomitant combined hamartoma of the retinal pigment epithelium and retina and juvenile nasopharyngeal angiofibroma. METHOD: Case report. RESULTS: An 18-year-old man presented with a juvenile nasopharyngeal angiofibroma and a combined hamartoma of the retina and retinal pigment epithelium in the ipsilateral eye. The diagnosis of juvenile nasopharyngeal angiofibroma was confirmed by histopathology, and the diagnosis of combined hamartoma was established by typical ophthalmoscopic and fluorescein angiographic findings. CONCLUSION: Juvenile nasopharyngeal angiofibroma may be associated with combined hamartoma of the retina and retinal pigment epithelium