Rapid and Sustained Resolution of Serous Retinal Detachment in Sturge-Weber Syndrome after Single Injection of Intravitreal Bevacizumab

Purpose: To report the effect of a single intravitreal bevacizumab injection on serous retinal detachment (SRD) in Sturge-Weber syndrome (SWS). Design: Interventional case report.

Methods: A 15-year-old boy with history of SWS was referred with a complaint of sudden visual loss 2 days before, having choroidal hemangioma accompanied with SRD. Visual acuity was 20/160.

Results: He was treated with 1.25?mg of bevacizumab injected intravitreally. One week later, the retina was completely attached and visual acuity was 20/20. After 20 months, without repeating the injection, the retina remained attached and vision was stable.

Conclusions: An early single dose of intravitreal bevacizumab is effective in the treatment of serous retinal detachment in SWS with good long-term results.     

Retinal detachment with macular hole following combined photodynamic therapy and intravitreal bevacizumab injection

PURPOSE: To report a case of retinal detachment with a macular hole following photodynamic therapy (PDT) using verteporfin and intravitreal bevacizumab injection in the treatment of myopic choroidal neovascularization (CNV). METHODS: A 58 -year-old woman was diagnosed with myopic CNV and treated with a combination of PDT with verteporfin and intravitreal bevacizumab injection that same day. She received the second injection of intravitreal bevacizumab four weeks after the initial treatment. RESULTS: The patient developed a sudden decline in vision one week after the second injection; and was subsequently diagnosed with retinal detachment associated with a macular hole. She underwent standard three-port pars plana vitrectomy with internal limiting membrane peeling, fluid-air exchange and silicone oil injection. The retina was still firmly attached at the patient's final follow-up visit. CONCLUSIONS: PDT and intravitreal bevacizumab injection used for the treatment of myopic CNV can be associated with retinal detachment with a macular hole. Patients need to be informed about this potential complication, and a higher index of suspicion may be warranted in patients who report sudden vision loss after the treatment.     

玻璃体腔注入空气治疗视网膜脱离

采用玻璃体腔注入空气联合其他复位手术治疗３９例各种类型视网膜脱离，取得满意疗效，随访治愈率为８９．７％。消毒空气较易得到，空气在玻璃体腔停留的数日内。有助于裂孔封闭，视网膜下液的排除、吸收、脱离的视网膜复位。介绍了球内注气的方法、检查事基、对注入空气的临床应用、适应症及并发症进行了讨论。     

Bilateral Serous Retinal Detachment as a Presenting Sign of Acute Lymphoblastic Leukemia

We present a case of bilateral serous retinal detachment (SRD) as a presenting sign of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ ALL). A 45-year-old woman presented with decreased vision and was found to have bilateral serous retinal detachment. Peripheral blood smears revealed leukocytosis of 53.9×10³/µL with 64.6% lymphoblasts. A bone marrow aspirate revealed the presence of lymphoblasts. Cytogenetic and molecular genetic analysis detected a reciprocal translocation between chromosome 9 and 22, t(9;22) (q34;q11). A diagnosis of Ph⁺ ALL was made. Following systemic chemotherapy, the bilateral SRD resolved completely with full recovery of vision. The sudden appearance of SRD should raise suspicion for leukemia. Prompt recognition of this disease is important for early systemic treatment and restoration of visual function.     

Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion

We report three cases of neovascular glaucoma secondary to central retinal artery occlusion (CRAO) which were effectively managed with intravitreal bevacizumab (IVB) followed by panretinal photocoagulation (PRP). Neovascular glaucoma without peripheral anterior synechiae developed between one and five weeks following CRAO onset. All patients received 0.75 mg (0.03 ml) IVB. In all patients, complete regression of the iris and anterior chamber angle neovascularization was confirmed within one week. PRP was applied two weeks after the injection. The follow-up period was four to seven months (average, five months). Intraocular pressure was controlled in all patients using topical antiglaucoma medications alone. However, one patient experienced a recurrence of neovascularization three months after the initial combination treatment. This patient received another IVB injection and additional PRP, and the recurrent neovascularization resolved. There were no local or systemic adverse events in any patients. Therefore, intravitreal bevacizumab may be an effective adjunct in the treatment of neovascular glaucoma associated with CRAO.     

视网膜脱离伴脉络膜脱离的临床分析

伴脉络膜脱离的视网膜脱离发病占同期视网膜脱离的４．１５％。分析住院手术１３５眼，总痊愈率为６５．９３％与同期不含脉络脱离的视网膜脱离成功率相比，复位率低且明显差异（Ｐ〈０．０１），将１３５例脉络膜脱离分为花边，半月，球形三型，花边型组手术成功率较高，放视网膜下液有很高的意外率，封闭了裂孔，可以完成环扎术，不放水更有利。对注气要慎重，术前术后要早用、用足激素，同足激素，同时尽早手术以提高成功率。     

Photodynamic therapy following intravitreal bevacizumab in multifocal choroiditis

Purpose To report the use of intravitreal bevacizumab (avastin) followed by photodynamic therapy (PDT) in a case of choroidal neovascular membrane (CNVM) due to multifocal choroiditis. Design Interventional case report. Methods In the setting of institutional practice, a 40-year male patient with previously diagnosed multifocal choroiditis presented with reduced vision in his left eye. A CNVM was revealed through hazy vitreous in the left eye. Due to a prior episode of increased intraocular pressure with use of periocular steroid (triamcinolone), and marked vitreous haze precluding precise assessment of the neovascular membrane, intravitreal injection of bevacizumab was tried followed by PDT. Results There was clearing of the vitreous haze and reduction of leakage one week after intravitreal injection. PDT one month after injection resulted in stable vision at three-month follow-up without angiographic leakage. Conclusion Intravitreal bevacizumab may be tried in cases of CNVM due to multifocal choroiditis. Timing of the injection may vary with the clinical scenario.     

Prospective Comparison of Low-Fluence Photodynamic Therapy Combined with Intravitreal Bevacizumab versus Bevacizumab Monotherapy for Choroidal Neovascularization in Age-Related Macular Degeneration

Abstract

Purpose: To evaluate combination treatment with reduced-fluence photodynamic therapy (RDPDT) with Verteporfin and intravitreal bevacizumab, compared to bevacizumab alone, for choroidal neovascularization (CNV) in age-related macular degeneration. Methods: This was a prospective, randomized comparative study comprising 95 patients with CNV. 49 patients received RDPDT (25?J/cm²) followed by intravitreal bevacizumab 1.25?mg one hour later, while 46 received intravitreal bevacizumab alone. Patients were followed for 12 months at four-week intervals with visual acuity (VA) assessment and Optical Coherence Tomography (OCT) of the macula. Bevacizumab re-injections were performed as needed. Results: On average, patients were re-injected 4.45 times in the combination group and 6.96 times in the bavacizumab group (p?<?0.001). At 12 months, VA improved by 8.64 letters in the bevacizumab group and by 8.37 letters in the combination group (p?=?0.922). Conclusion: Adding a reduced-fluence PDT arm in combination with bevacizumab offers similar results to those of intravitreal bevacizumab alone with significantly reduced number of injection repetitions.     

Combined Intravitreal Bevacizumab and Triamcinolone Acetonide Injection for Idiopathic Neuroretinitis

Purpose: To present a case with idiopathic neuroretinitis that was treated with combined intravitreal bevacizumab and triamcinolone. Design: Case report. Methods: Interventional case report. Results: A 31-year-old man presented with a visual acuity of 3/10 and afferent pupillary defect in the right eye. Ophthalmologic examination disclosed papillitis and macular edema. Neurology consultation with cranial computerized tomography scan revealed no abnormality. The patient was injected with bevacizumab and triamcinolone intravitreally. One week later, the vision increased to 10/10, macular edema disappeared. One month later, optic disc edema disappeared. Conclusions: Intravitreal injection of bevacizumab and triamcinolone effectively treated idiopathic neuroretinitis.     

Severe Corneal Changes following Intravitreal Injection of Bevacizumab

Purpose: To report a series of severe corneal changes following intravitreal injection of bevacizumab (Avastin) for age-related macular degeneration.

Design: Retrospective noncomparative case series.

Methods: The authors retrospectively reviewed the corneal changes that developed after the procedure in 1200 (460 patients) intravitreal injections of bevacizumab.

Results: Five significant corneal changes (1.1%) occurred in these patients within the 1st postinjection week. The severe corneal changes included corneal infiltrative keratitis (n?=?2) and corneal stromal edema and descemet folds (n?=?3). The findings depended on clinical examination and biomicroscopic and confocal evaluation. In terms of causality assessment, no rechallenge was possible. The appropriate treatment was applied and recovery was achieved in all patients during the follow-up period.

Conclusions: Intravitreal injection of bevacizumab may cause corneal changes. The safety and effects of bevacizumab on the cornea should be evaluated in detail.     

Serous Macular Detachment Associated with Retinal Arterial Macroaneurysm

Purpose

To report optical coherence tomography (OCT) findings of macular edema secondary to retinal arterial macroaneurysms.

Methods

Six eyes with retinal arterial macroaneurysms were retrospectively examined by OCT. All eyes had macular edema without massive macular hemorrhage. Fluorescein angiography was performed in six eyes, and indocyanine green angiography was done in four eyes. Five eyes underwent direct laser photocoagulation to the retinal arterial macroaneurysms. The foveal thickness, height of the serous macular detachment, and visual acuity (VA) were evaluated from the initial examination until the macular edema resolved.

Results

In all six eyes, the macular edema secondary to retinal arterial macroaneurysms comprised a serous macular detachment with retinal swelling. No cystoid macular edema was observed in any eyes. Dye leakage occurred only from the macroaneurysms in all eyes. OCT showed complete resolution of the serous macular detachment and retinal swelling 1 to 4 months after the initial examination. Macular hard exudates developed during absorption of the serous macular detachment in all eyes. VA improved more than two lines in all eyes after the macular edema resolved.

Conclusion

Retinal arterial macroaneurysms may leak extravasated fluid into the subretinal space, which may result in a serous macular detachment.?Jpn J Ophthalmol 2006;50:460–464 © Japanese Ophthalmological Society 2006     

Foveal Serous Retinal Detachment in Juvenile Idiopathic Arthritis-associated Uveitis

Purpose: In juvenile idiopathic arthritis (JIA)-associated uveitis complicated by foveal serous retinal detachment (FSRD), we documented the relationship between best corrected visual acuity (BCVA), level of anterior chamber flare and OCT features.

Methods: Nine children (15 eyes) with FSRD were identified among 38 children with JIA-associated maculopathy. Outcome measures included BCVA, ocular inflammatory activity quantified by laser flare photometry and the macular profile analyzed by OCT.

Results: The diagnosis of FSRD led to intensification of the treatment using subtenon’s injection of triamcinolone or systemic immunomodulatory therapy. The improvement of BCVA at presentation (0.46 logMAR) was significant at 36 months follow-up (0.15 logMAR). The resolution of FSRD along with visual improvement (p?=?0.0032) correlated with improvement in anterior chamber flare (p?=?0.01).

Conclusion: FSRD is a complication of chronic JIA-associated uveitis that responds well to intensification of immunomodulation. Visual improvement is correlated with FSRD resolution and with flare photometry values.     

Retinal Detachment Following the Acute Retinal Necrosis Syndrome

Twenty-six patients with the acute retinal necrosis involving 32 eyes have been followed at the Bascom Palmer Eye Institute. Sixteen eyes developed retinal detachment and surgical repair was attempted in thirteen. Ten eyes were successfully reattached. Vitreous surgery was necessary in ten eyes and was performed in eight of the ten successful eyes. The clinical characteristics of the retinal detachments as well as the surgical procedures and results are presented.     

Intravitreal bevacizumab for exudative age-related macular degeneration after multiple treatments

Background Photodynamic therapy with verteporfin (PDT) significantly reduces the risk of vision loss in patients with exudative age-related macular degeneration (AMD). Indocyanine green-mediated photothrombosis (IMP) and transpupillary thermotherapy (TTT) may also be beneficial for selective cases of exudative AMD. However, a substantial subset of patients responds poorly to these treatments. Intravitreal bevacizumab (IVB) has been recently used in the treatment of exudative AMD, showing both visual and anatomic improvement in the majority of cases. Methods This interventional retrospective case series reports the effects of IVB in 17 eyes with subfoveal neovascular AMD that had undergone repeated PDT (combined or not with triamcinolone acetonide) or PDT followed by either IMP or TTT with poor results. The main outcome measures were visual acuity and tomographic signs of intra/subretinal fluid, as well as central retinal thickness. Results Most patients received a single IVB injection. The mean follow-up was 4.47 months. The mean logMAR visual acuity changed from 1.17±0.40 to 1.06±0.44 (P=0.17). The mean central retinal thickness decreased from 404.05±245.26 to 280.23±143.14 μm (P=0.032). At the end of the study, lack of tomographic signs of intra/subretinal fluid was noted in four (23.5%) eyes. No ocular or systemic side effects were identified. Conclusions Short-term results with IVB for the treatment of exudative AMD have been promising. However, the chronic retinal and pigment epithelium changes frequently present in eyes that underwent multiple previous treatments may limit complete visual recovery. To our knowledge, this is the first report on the use of IVB for this particular group of AMD patients.     

Effects of Intravitreal Triamcinolone Injection on Macular Edema and Visual Prognosis in Central Retinal Vein Occlusion

Aim To determine the effect of intravitreal triamcinolone injection on macular edema and the visual prognosis in cases with CRVO. Methods Eyes with CRVO were classified as ischemic or nonischemic according to extend of retinal capillary nonperfusion. The patients received intravitreal triamcinolone acetonide injection (4 mg/0.1 ml). A complete ophthalmologic evaluation together with flourescein angiography (FA) and optical coherence tomography (OCT) were performed for each patient at presentation and at follow-up visits. The functional and anatomical results of both groups were assessed separately. Results A total of 22 eyes (11 ischemic, 11 nonischemic) were included in the study. Mean duration of symptoms before steroid injection was 4.9±5.5 months. Mean follow-up time was 11.5±2.4. All the eyes completed at least 9 months of examination. At least 3 lines of visual acuity increase using snellen visual acuity chart was observed in 81.8% of the eyes in nonischemic group, while only in 18.2% of the eyes in the ischemic group. In ischemic group, the mean foveal thickness was 766±320.7 μm at presentation, which significantly decreased to 441.7±166.9 μm at 9th month. In nonischemic group, the mean foveal thickness was 667±223 μm at presentation, which significantly decreased to 320±175.5 at 9th month. Significant IOP elevation was observed in 8 (36.4%) of the eyes, 75% of which could be controlled with medical treatment. Conclusion Intravitreal triamcinolone injection may be a promising and effective method for the treatment of macular edema associated with CRVO. Although anatomical results are similar in both groups, functional results are better in non-ischemic CRVO cases.