Photodynamic therapy of choroidal neovascularization with enlargement of the spot size to include the feeding complex

This is a case report of a 83-year-old man with choroidal neovascularization (CNV), due to age-related macular degeneration (AMD) in his right eye. Digital fluorescein (FA) and indocyanine green angiography (ICG) were performed, which disclosed predominantly classic subfoveal CNV and a dilated and tortuous feeding complex. The visual acuity was 20/800. Anti-vascular endothelial growth factor (anti-VEGF) treatment was suggested, however, the patient was not keen to receive an intraocular injection. Modified photodynamic therapy (PDT) with spot size enlarged, to include not only the CNV lesion but the feeding complex as well, was performed. Ten days after one session of PDT, ICG showed absence of leakage from the CNV and complete occlusion of the feeding complex. The visual acuity gradually improved to 20/100 and remained stable during the following 23 months. No evidence of CNV leakage was seen in the FA and ICG during the follow up period. Adjustment of the PDT spot size to include the detectable by ICG feeding complex might be an additional option in order to close the subfoveal CNV and might be considered as an alternative to intravitreal injection of anti-VEGF in selected cases where anti-VEGF treatment is not available

Quantitative determination of glycosaminoglycans in tears of diabetic patients

Marilita M Moschos1, Alexandros A Rouvas1, Spyridon Papadimitriou1, Athanasios Kotsolis1, Nikolaos Sitaras2, Michael Apostolopoulos11Department of Ophthalmology; 2Department of Pharmacology, University of Athens, GreecePurpose: To determine the amount of glycosaminoglycans (GAGs) in tears of patients with diabetic retinopathy (DR) and to compare it with normal subjects.Methods: 38 patients with DR and 24 normal volunteers were included. Thirty subjects suffered from background diabetic retinopathy (BDR) and 8 from proliferate diabetic retinopathy (PDR). For the GAGs assay, the uronic carbazole reaction was used.Results: The mean concentration of GAGs was significantly higher in patients with DR than in normal subjects. The GAGs concentration in patients with BDR or PDR was significantly higher than in normal subjects.Conclusion: The measurement of GAGs in tears of diabetic patients could be a tool in order to assess the stability or not of the disease.Keywords: glycosaminoglycans, tears, diabetic retinopath

Skin rash associated with intravitreal bevacizumab in a patient with macular choroidal neovascularization

Ioannis D Ladas, Marilita M Moschos, Thanos D Papakostas, Athanasios I Kotsolis, Ilias Georgalas, Michail ApostolopoulosDepartment of Ophthalmology, “G. Gennimatas” Hospital of Athens, University of Athens, Athens, GreecePurpose: The purpose of this observational case report is to describe a case of skin rash after intravitreal use of bevacizumab.Methods: A 50-year-old man with choroidal neovascularization in the right eye due to age-related macular degeneration was treated with three intravitreal injections of bevacizumab.Results: Twelve days after the first injection, the patient developed a maculopapular rash on his forehead and on both temporal regions around his eyes. The rash disappeared eight days after treatment with topical corticosteroids. A skin rash with the same distribution reappeared 14 days after the second and 10 days after the third injection. Similarly, it disappeared five and seven days after the use of the same treatment. The follow-up period was 15 months after the third injection. During the follow-up period the rash did not reappear.Conclusion: This case report may initiate further investigation of similar cases to support this observation, as there are a lack of reports of skin rash after intravitreal administration of bevacizumab.Keywords: skin rash, bevacizumab, age-related macular degeneratio

Peripheral capillary non-perfusion in asymptomatic Waldenström's macroglobulinemia

<p>Abstract</p> <p>Background</p> <p>To report the rare association of peripheral retinal ischemia in a patient with Waldenström's macroglobulinemia.</p> <p>Case Presentation</p> <p>A 39-year old man with a recent diagnosis of asymptomatic Waldenström's macroglobulinemia (WM) was referred from his physician for ocular evaluation. The fundus examination in his right eye (RE) revealed very mild central vein dilation, while retinal hemorrhages associated with microaneurismal alterations of the vascular plexus were detected at the temporal periphery. Fluoroscein angiography of his RE revealed an extended area of capillary dropout distal to the microaneurismal lesions. In our patient with WM an extensive area of capillary non-perfusion, in the absence of severe involvement of the posterior pole was documented; this association to the best of our knowledge has never been reported before.</p> <p>Conclusion</p> <p>Although the incidence of the disease is rare, meticulous examination of the retinal periphery should be performed in all patients with WM and vice versa the differential diagnosis of peripheral retinal ischemia of unknown origin should include an investigation to rule out asymptomatic Waldenström's macroglobulinemia.</p

Optical Coherence Tomography Angiography of Foveal Neovascularization in Diabetic Retinopathy

Purpose: To report a case of foveal neovascularization in a patient with proliferative diabetic retinopathy as seen on optical coherence tomography angiography (OCT-A). Methods: Multimodal imaging was used for diagnostic investigation. Patient: A 61-year-old male with a 16-year history of insulin-dependent diabetes mellitus was referred to our medical retina department for examination and management. Meticulous fundus examination and multimodal imaging revealed proliferative diabetic retinopathy lesions, including neovascularization located in the foveal area. Results: OCT-A allowed us to detect the neovascular lesion, confirm that it originated from perifoveal capillaries, estimate its retinal depth, and evaluate the vessel blood flow in multiple layers. Conclusion: To the best of our knowledge this is the first report of OCT-A imaging of foveal neovascularization in diabetic retinopathy. OCT-A is a very useful examination for the diagnostic investigation of patients with diabetic retinopathy

Fluorescein angiography and optical coherence tomography concordance for choroidal neovascularisation in multifocal choroidtis

Purpose To compare the utility of fluorescein angiography (FA) and optical coherence tomography (OCT) as diagnostic adjuncts in evaluating symptomatic patients with choroidal neovascularisation (CNV) due to multifocal choroiditis (MFC). Methods Patients with CNV due to MFC were retrospectively evaluated in a consecutive fashion. Fundus photography, FA, OCT and biomicroscopy were used to establish the diagnosis. Primary outcome measures included CNV classification (type 1 or occult and type 2 or classic) location and the associated FA and OCT findings. Results Twenty eyes from 17 patients were included in the study. In 19 eyes (95%) the FA revealed CNV type 2; in one eye (5%) the type of CNV was indeterminate due to a subretinal haemorrhage that covered the lesion. Thirteen eyes had OCT imaging and all revealed hyper-reflectance beneath the neurosensory retina. However, only 53.8% revealed subretinal fluid (SRF) or intraretinal cystic abnormalities. Conclusions The CNV in MFC is virtually always type 2, or so-called classic CNV, with vessels beneath the neurosensory retina. Except when blocked by subretinal blood, the neovascularisation is clearly demonstrated by FA. In contrast, only 53.8% of these eyes showed clear evidence of actively proliferating neovascularisation on OCT. Therefore, eyes suspected of having CNV in MFC should be evaluated with FA