Spontaneous Large Serous Retinal Pigment Epithelial Tear

Purpose

To report cases of spontaneous retinal pigment epithelial (RPE) tear complicating serous pigment epithelial detachment (PED).

Methods

The records of 3 Asian patients with spontaneous giant RPE tear were reviewed retrospectively by including clinical presentation, angiography, optical coherence tomography, fundus autofluorescence imaging, and visual outcome.

Results

Three patients (4 eyes) were included in this study, with a mean age of 48.3 (42–56) years, and a mean follow-up period of 7.75 (4–18) months. Fundus examination in all patients showed giant RPE tear associated with bullous PED. Two cases had a history of prior corticosteroid use, and 1 had no history of medication use. All 3 patients developed spontaneous resolution of subretinal fluid with no treatment. However, in patients who used corticosteroids, initial progression of the tear and subretinal fluid were observed despite ceasing medication. On subsequent follow-up, an incomplete RPE regeneration was demonstrated by fundus autofluorescence imaging, and choroidal neovascularization developed in 1 patient.

Conclusion

Large PED with RPE tear is a rare manifestation. When the fovea is spared, visual prognosis is favorable. No specific treatment is required, but careful choroidal neovascularization monitoring should be performed.Key Words: Retinal pigment epithelial tear, Pigment epithelial detachment, Retinal pigment epithelial rip     

The diagnostic value of intraocular fluid analysis by polymerase chain reaction in Thai patients with uveitis

Uveitis is a major cause of severe visual impairment throughout the world and can be initiated by various infectious and non-infectious causes. Early recognition of specific infections is important as the treatment with antimicrobial agents might stop the progression or even cure the eye disease. To determine the infectious causes of uveitis in Thailand, intraocular fluid samples of 100 HIV-negative patients and 47 HIV-positive patients with uveitis were examined using real-time PCR analysis for herpes simplex virus, varicella zoster virus, cytomegalovirus and Toxoplasma gondii. Positive PCR results were found in 33/100 (33%) HIV-negative patients and in 33/47 (70%) HIV-positive patients with uveitis. In Thailand, cytomegalovirus was identified as the most frequent cause of infectious uveitis in both HIV-negative and HIV-positive patients (49 and 91%, respectively). PCR analysis of intraocular samples in uveitis was a valuable diagnostic assay. The pattern of uveitis observed in the Far East differs from that found in the West.     

Predictive factors of open globe injury in patients requiring vitrectomy

Background

To determine the outcomes and predictive factors of patients with open globe injury requiring pars plana vitrectomy (PPV).

Methods

The medical records of 114 patients age 10 years or older who had undergone PPV due to ocular trauma, with at least 6 months follow up, were retrospectively reviewed.

Results

The mean age of the patients was 42 (SD14) years, with males accounting for 89% of the cases. Penetrating eye injury was the most common injury mechanism (43%) with most injuries occurring secondary to work related incidents (54%). After surgical interventions, 78% of the patients had visual improvement of one or more Snellen lines, while no light perception occurred in 10%. Anatomical attachment was achieved in 87% of eyes at the final follow up. Logistic regression analysis showed that the presence of a relative afferent pupillary defect (RAPD) was a significant predictive factor of visual outcome, while initial retinal detachment was a significant predictor of anatomical outcome.

Conclusions

Pupillary reaction is an important presenting ocular sign in estimating the post-vitrectomy poor visual outcome for open globe injury. Vision was restored and improved in more than half of the patients in this study; however, long-term sequelae should be monitored.     

Results of pterygium excision adjunct with conjunctival autograft transplantation for primary pterygium by ophthalmology trainees

To evaluate the results of pterygium excision with conjunctival autograft transplantation for primary pterygium performed by trainee ophthalmologists. Design Prospective interventional case series. Setting A tertiary eye care center in northern Thailand. Participants Patients with primary pterygium recruited from July 2011 to August 2012. Intervention In all cases, the affected eye underwent pterygium excision followed by a superior conjunctival autograft carried out by trainee ophthalmologists. Main outcome measure The recurrence of pterygium and other post-operative complications. Results Sixty-two eyes from 54 patients were studied. There were 36 females (66.7 %) and 18 males (33.3 %). The mean age of the patients was 54.5 (±9.8) years with the mean corneal invasion measured at 3.3(±0.8) mm. Pterygium morphologies of Grade 1, Grade 2, and Grade 3 were 33.9, 48.4, and 17.7 %, respectively, with the mean follow-up time of 17.3 (±7.9) months. Pterygium recurred in the cornea of six eyes (9.7 %). All recurrences occurred within 6-month post-operation. Other post-operative complications included conjunctival recurrence (4.8 %), graft retraction (3.2 %), conjunctival cyst (3.2 %), and increased intraocular pressure (1.6 %). The recurrence of pterygium was not associated with the patient age (p = 0.72), occupation (p = 0.23), sun exposure time (p = 0.18), pterygium duration (p = 0.22), pterygium size (p = 0.67), or pterygium morphology (p = 0.85). Conclusion The recurrence rate and post-operative complications of pterygium excision with conjunctival autograft performed by trainee ophthalmologists were within acceptable limits. All recurrence occurred within 6 months after surgery.     

Spectral-domain optical coherence tomography of macula in myopia

The aim of this study is to determine the associations between regional macular thickness and gender, age, axial length, and degree of myopia in young and middle-aged healthy myopic eyes. One hundred and seventy-one subjects with ?0.5 diopters of myopia or worse underwent prospective macular thickness measurement by Spectralis spectral-domain optical coherence tomography. Subjects’ mean age was 32.40 ± 8.25 years (range 18 to 49 years), with 45 % being male. The mean degree of myopia was ?4.57 ± 3.52 diopters, with a mean axial length of 25.09 ± 1.67 mm. Multivariate regression analysis demonstrated significantly thicker central (mean 9.13 µm thicker) and inner subfields (mean 8.55 µm thicker) in males (P values were <0.001 and 0.002, respectively). In addition, in both genders, for each millimeter of increased axial length, the central subfield thickness increased by 2.11 µm, the inner subfield decreased by 2.25 µm, and the outer subfield decreased by 3.62 µm (P values were 0.010, <0.001, and <0.001, respectively). Factors including gender and axial length affect baseline regional macular thickness in young and middle-age myopic subjects. The central subfield and inner subfield were affected by both gender and axial length, while the outer subfield was affected only by axial length. The macular thickness of myopic subjects with macular disease should be interpreted in light of these factors.     

Risk Factors for Development of Rhegmatogenous Retinal Detachment in Patients with Uveitis

Purpose: To describe risk factors for development of rhegmatogenous retinal detachment (RRD) in patients with uveitis.

Methods: We performed a retrospective review of 411 consecutive human immunodeficiency virus-negative patients with uveitis (571 affected eyes) and report on prevalence, risk factors and visual outcomes of patients with RRD.

Results: Prevalence of RRD was 7% of all patients with uveitis. Multivariate analysis revealed that posterior uveitis and panuveitis were associated with RRD (P = 0.001). Strong association between RRD development and infectious uveitis was also observed (P = 0.009). Acute retinal necrosis (ARN) was firmly associated with RRD development (P = 0.016). Although anatomical success was obtained, functional outcome was poor. Poor visual outcomes at 6-month and 1-year follow-up were associated with initial VA < counting fingers (P = 0.05, P = 0.044).

Conclusions: Prevalence of RRD in uveitis was 7% and development of RRD was encountered in posterior and panuveitis. Infectious uveitis (specifically ARN) formed a high risk for RRD.     

Psychometric utility of the international HIV dementia scale and Montreal Cognitive Assessment in HIV-associated asymptomatic neurocognitive impairment

Journal of NeuroVirology - There is a growing need for brief screening measures for HIV Associated Neurocognitive Disorders (HAND). We compared two commonly used measures (the Montreal Cognitive...