Posterior segment manifestations of human immunodeficiency virus/ acquired immune deficiency syndrome

Ocular manifestations can occur in up to 50% of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients and posterior segment involvement is the most common presentation. The posterior segment manifestations of AIDS can be divided into four categories: retinal vasculopathy, opportunistic infections, unusual malignancies and neuro-ophthalmologic abnormalities. Retinal microvasculopathy and cytomegalovirus (CMV) retinitis are the most common manifestations, even in the era of highly active anti-retroviral therapy (HAART). Highly active anti-retroviral therapy has been shown to cause regression of CMV retinitis, reduce the incidence of CMV-related retinal detachments, and prolong patient survival. Immune recovery uveitis is a new cause of vision loss in patients on HAART. Diagnosis and treatment are guided by the particular conditions and immune status of the patient

Chronic NonInfectious Uveitis of the Posterior Segment: Current and Future Approaches to Individualize Management

Uveitis involving the posterior segment is a sight-threatening condition that can be associated with multiple underlying ocular and systemic diseases. Accurate diagnosis is the foundation for selecting treatment that can preserve vision and is guided by the findings of a thorough history, clinical examination, laboratory testing, and imaging. Evaluation and management of posterior uveitis varies globally, however, because of geographic/ethnic variation in its causes, differences in local practices, and varying access to diagnostic modalities and treatments. This case-based program captures the highlights of a roundtable discussion, in which an international panel of uveitis subspecialists provides their expert perspectives on the diagnosis and management of uveitis involving the posterior segment, including the role of emerging diagnostic techniques and new and emerging therapies. The cases are from the files of Sunil K. Srivastava, MD.This educational activity is intended for European, Asia/Pacific, and US ophthalmologists caring for patients with noninfectious uveitis of the posterior segmentThe New York Eye and Ear Infirmary of Mount Sinai designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity

Comparison of RetCam and Smartphone-Based Photography for Retinopathy of Prematurity Screening

This study aimed to compare the clinical performance between a smartphone-based fundus photography device and a contact imaging device for retinopathy of prematurity (ROP) screening. All patients were first examined with binocular indirect ophthalmoscopy (BIO), which served as the reference standard. The patients were then assessed by two devices. Imaging quality, ability to judge the zone and stage of ROP, agreement with the BIO results, vital signs, and pain scores were compared between these two devices. In total, 142 eyes of 71 infants were included. For the smartphone-based fundus photography, image quality was graded excellent or acceptable in 91.4% of examinations, although it was still significantly inferior to that of the contact imaging device (p < 0.001). The smartphone-based fundus photography images had moderate agreement with the BIO results regarding the presence or absence of plus disease (Cohen’s κ = 0.619), but evaluating the zone (p < 0.001) and stage (p < 0.001) of ROP was difficult. Systemic parameters, except for heart rate, were similar between the two imaging devices (all p > 0.05). In conclusion, although the smartphone-based fundus photography showed moderate agreement for determining the presence or absence of plus disease, it failed to identify the zone and stage of ROP

Role of Intravitreal Antivascular Endothelial Growth Factor Injections for Choroidal Neovascularization due to Choroidal Osteoma

We treated 26 eyes of 25 young patients having a mean age of 30 years with intravitreal vascular endothelial growth factor (VEGF) inhibitor for choroidal new vessel (CNV) formation overlying choroidal osteoma over a mean follow-up of 26 months. Mean number of injections was 2.4 at 6 months, 3.2 at 12 months, and 5.5 at 24 months. CNV was subfoveal in 14 eyes, juxtafoveal in 5, extrafoveal in 5, and peripapillary in 2. By paired comparison, mean decrease from baseline was 119.7 microns at 6 months (n = 15; P = 0.001), 105.3 microns at 1 year (n = 10; P = 0.03), and 157.6 microns at 2 years (n = 7; P = 0.08). BCVA improved by 3.3 lines at 6 months after therapy (n = 26; P < 0.001), 2.8 lines (n = 20; P = 0.01) at 1 year, and 3.1 lines (n = 13; P = 0.049) at 2 years. We conclude that intravitreal anti-VEGF injections improve vision in majority of eyes with CNV from choroidal osteoma

Resultados visuales a largo plazo del bevacizumab intravítreo en la neovascularización ocular inflamatoria

Purpose To assess the long-term role of bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) in inflammatory ocular neovascularization. Design Retrospective multicenter consecutive case series of inflammatory ocular neovascularization. Methods settings: Multicenter institutional and private practices. study population: Patients with inflammatory ocular neovascularization in one or both eyes of varying etiologies who failed standard therapy. intervention: Intravitreal injection of bevacizumab. main outcome measures: Improvement of best-corrected visual acuity (BCVA) expressed as logarithm of minimal angle of resolution (logMAR), and decrease in central foveal thickness as measured by optical coherence tomography at 6, 12, 18, and 24 months of follow-up. Results Mean logMAR BCVA (central foveal thickness) following intravitreal bevacizumab was as follows: baseline, 0.65 (6/27 or 20/90) (338 ?m; 99 eyes of 96 patients); 6 months, 0.42 (6/16 or 20/53) (239 ?m; 2.0 injections; 81 eyes); 12 months, 0.39 (6/15 or 20/49) (241 ?m; 2.3 injections; 95 eyes); 18 months, 0.40 (6/15 or 20/50) (261 ?m; 3.0 injections; 46 eyes); and 24 months, 0.34 (6/13 or 20/44) (265 ?m; 3.6 injections; 27 eyes). Paired comparisons revealed significant visual improvement at 6 months of 2.4 lines (P = .000), at 12 months of 2.5 lines (P = .000), at 18 months of 2.5 lines (P = .001), and at 24 months of 2.2 lines (P = .013). Paired comparisons revealed significant central foveal flattening at 6 months of 78 ?m (P = .000), at 12 months of 85 ?m (P = .000), at 18 months of 90 ?m (P = .003), and at 24 months of 77 ?m (P = .022). Three eyes developed submacular fibrosis and 1 eye submacular hemorrhage. Conclusion Intravitreal bevacizumab led in the long-term to significant mean visual improvement of ?2.2 lines and significant foveal flattening in a wide variety of inflammatory ocular diseases without major complications. Choroidal neovascularization (CNV) and neovascularization of the disc or elsewhere (NVD/E) in the retina can be an occasionally late sequela of inflammatory chorioretinal diseases,1 and rarely an early manifestation.2 Our group has previously reported the 3-month results of intravitreal bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) in inflammatory ocular neovascularization in 84 eyes. Intravitreal bevacizumab led to short-term significant visual improvement and regression of inflammatory ocular neovascularization in a wide variety of inflammatory ocular diseases.3 The long-term safety profile of bevacizumab, and visual prognosis in inflammatory ocular neovascularization, may be jeopardized by submacular fibrosis,4, 5 cystoid macular edema (CME),6, 7, 8 or spread of chorioretinal atrophy. The objective of this report is to assess the long-term safety and efficacy of intravitreal bevacizumab in a retrospective collaborative case series study of inflammatory ocular neovascularization. Methods Consecutive cases of inflammatory ocular neovascularization resistant to corticosteroid with or without antimicrobial therapy and/or immunosuppression treated with intravitreal bevacizumab and followed for more than 6 months were included in the present analysis. The cases were contributed by members of the American Society of Retina Specialists and the American Uveitis Society as detailed elsewhere.3 Intravitreal bevacizumab was injected using a 30-gauge needle in a sterile manner after topical anesthesia and povidone instillation in the lower cul-de-sac. Bevacizumab aliquots were prepared in the hospital pharmacies of the corresponding institution. A standardized spreadsheet was used to collect the clinical data. Cases with prior CME, diabetes mellitus, or age-related macular degeneration were excluded. Most of the patients had initially been treated in a stepwise fashion with high-doses of oral corticosteroid, with or without intraocular or sub-Tenon corticosteroid or immunosuppressive therapy (as monitored by a rheumatologist). All patients signed an informed consent after detailed information about the limited experience, potential side effects, and the off-label usage of the drug. Best-corrected visual acuity (BCVA) was assessed using either Early Treatment Diabetic Retinopathy Study (ETDRS) or Snellen charts (half-and-half) and listed as logarithm of minimal angle of resolution (logMAR) equivalents. Retreatment was done when there was recurrent activity evaluated by funduscopy, fluorescein angiography (leakage, growth of CNV), or optical coherence tomography examination. Differences between final and initial BCVA or central foveal thickness (CFT) were tested using paired Student t test. For small sample size comparisons, nonparametric tests were used. Further associations were performed using one-way analysis of variance (ANOVA) or ?2 test for continuous and categorical variables, respectively. All analysis was conducted using SPSS 13.0 statistical package (SPSS Inc, Chicago, Illinois, USA), and a P value less than .05 was considered significant. Results Ninety-nine consecutive eyes of 96 patients, 33 male and 63 female (78 White, 9 Asian, 8 Hispanic, and 1 Black) with a mean age of 39 years, were examined at baseline and followed up between 6 months and 24 months (TABLE 1, TABLE 2). The right eye was involved in 55 subjects and the left in 44 subjects (3 patients having bilateral disease). Uveitis was active in 26 eyes at the time of ocular neovascularization. Forty-one patients (44 eyes) were taking oral, periocular, or intraocular corticosteroids or other immunosuppressive agents. Thirty-three eyes received 0.1 ml (2.5 mg) of intravitreal bevacizumab and 66 eyes received 0.05 ml (1.25 mg). The diagnosis was punctate inner choroidopathy (23), multifocal choroiditis with panuveitis (19), ocular histoplasmosis (13), idiopathic (12), serpiginous choroiditis (9), Vogt-Koyanagi-Harada disease (6), ocular toxoplasmosis (5), Eales disease (4), sarcoidosis (2), sympathetic ophthalmia (2), tuberculosis (2), acute placoid pigment epitheliopathy (1), and birdshot choroiditis (1)

Resultados visuales a largo plazo del bevacizumab intravítreo en la neovascularización ocular inflamatoria

Purpose To assess the long-term role of bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) in inflammatory ocular neovascularization. Design Retrospective multicenter consecutive case series of inflammatory ocular neovascularization. Methods settings: Multicenter institutional and private practices. study population: Patients with inflammatory ocular neovascularization in one or both eyes of varying etiologies who failed standard therapy. intervention: Intravitreal injection of bevacizumab. main outcome measures: Improvement of best-corrected visual acuity (BCVA) expressed as logarithm of minimal angle of resolution (logMAR), and decrease in central foveal thickness as measured by optical coherence tomography at 6, 12, 18, and 24 months of follow-up. Results Mean logMAR BCVA (central foveal thickness) following intravitreal bevacizumab was as follows: baseline, 0.65 (6/27 or 20/90) (338 ?m; 99 eyes of 96 patients); 6 months, 0.42 (6/16 or 20/53) (239 ?m; 2.0 injections; 81 eyes); 12 months, 0.39 (6/15 or 20/49) (241 ?m; 2.3 injections; 95 eyes); 18 months, 0.40 (6/15 or 20/50) (261 ?m; 3.0 injections; 46 eyes); and 24 months, 0.34 (6/13 or 20/44) (265 ?m; 3.6 injections; 27 eyes). Paired comparisons revealed significant visual improvement at 6 months of 2.4 lines (P = .000), at 12 months of 2.5 lines (P = .000), at 18 months of 2.5 lines (P = .001), and at 24 months of 2.2 lines (P = .013). Paired comparisons revealed significant central foveal flattening at 6 months of 78 ?m (P = .000), at 12 months of 85 ?m (P = .000), at 18 months of 90 ?m (P = .003), and at 24 months of 77 ?m (P = .022). Three eyes developed submacular fibrosis and 1 eye submacular hemorrhage. Conclusion Intravitreal bevacizumab led in the long-term to significant mean visual improvement of ?2.2 lines and significant foveal flattening in a wide variety of inflammatory ocular diseases without major complications. Choroidal neovascularization (CNV) and neovascularization of the disc or elsewhere (NVD/E) in the retina can be an occasionally late sequela of inflammatory chorioretinal diseases,1 and rarely an early manifestation.2 Our group has previously reported the 3-month results of intravitreal bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) in inflammatory ocular neovascularization in 84 eyes. Intravitreal bevacizumab led to short-term significant visual improvement and regression of inflammatory ocular neovascularization in a wide variety of inflammatory ocular diseases.3 The long-term safety profile of bevacizumab, and visual prognosis in inflammatory ocular neovascularization, may be jeopardized by submacular fibrosis,4, 5 cystoid macular edema (CME),6, 7, 8 or spread of chorioretinal atrophy. The objective of this report is to assess the long-term safety and efficacy of intravitreal bevacizumab in a retrospective collaborative case series study of inflammatory ocular neovascularization. Methods Consecutive cases of inflammatory ocular neovascularization resistant to corticosteroid with or without antimicrobial therapy and/or immunosuppression treated with intravitreal bevacizumab and followed for more than 6 months were included in the present analysis. The cases were contributed by members of the American Society of Retina Specialists and the American Uveitis Society as detailed elsewhere.3 Intravitreal bevacizumab was injected using a 30-gauge needle in a sterile manner after topical anesthesia and povidone instillation in the lower cul-de-sac. Bevacizumab aliquots were prepared in the hospital pharmacies of the corresponding institution. A standardized spreadsheet was used to collect the clinical data. Cases with prior CME, diabetes mellitus, or age-related macular degeneration were excluded. Most of the patients had initially been treated in a stepwise fashion with high-doses of oral corticosteroid, with or without intraocular or sub-Tenon corticosteroid or immunosuppressive therapy (as monitored by a rheumatologist). All patients signed an informed consent after detailed information about the limited experience, potential side effects, and the off-label usage of the drug. Best-corrected visual acuity (BCVA) was assessed using either Early Treatment Diabetic Retinopathy Study (ETDRS) or Snellen charts (half-and-half) and listed as logarithm of minimal angle of resolution (logMAR) equivalents. Retreatment was done when there was recurrent activity evaluated by funduscopy, fluorescein angiography (leakage, growth of CNV), or optical coherence tomography examination. Differences between final and initial BCVA or central foveal thickness (CFT) were tested using paired Student t test. For small sample size comparisons, nonparametric tests were used. Further associations were performed using one-way analysis of variance (ANOVA) or ?2 test for continuous and categorical variables, respectively. All analysis was conducted using SPSS 13.0 statistical package (SPSS Inc, Chicago, Illinois, USA), and a P value less than .05 was considered significant. Results Ninety-nine consecutive eyes of 96 patients, 33 male and 63 female (78 White, 9 Asian, 8 Hispanic, and 1 Black) with a mean age of 39 years, were examined at baseline and followed up between 6 months and 24 months (TABLE 1, TABLE 2). The right eye was involved in 55 subjects and the left in 44 subjects (3 patients having bilateral disease). Uveitis was active in 26 eyes at the time of ocular neovascularization. Forty-one patients (44 eyes) were taking oral, periocular, or intraocular corticosteroids or other immunosuppressive agents. Thirty-three eyes received 0.1 ml (2.5 mg) of intravitreal bevacizumab and 66 eyes received 0.05 ml (1.25 mg). The diagnosis was punctate inner choroidopathy (23), multifocal choroiditis with panuveitis (19), ocular histoplasmosis (13), idiopathic (12), serpiginous choroiditis (9), Vogt-Koyanagi-Harada disease (6), ocular toxoplasmosis (5), Eales disease (4), sarcoidosis (2), sympathetic ophthalmia (2), tuberculosis (2), acute placoid pigment epitheliopathy (1), and birdshot choroiditis (1)

Role of Intravitreal Antivascular Endothelial Growth Factor Injections for Choroidal Neovascularization due to Choroidal Osteoma

We treated 26 eyes of 25 young patients having a mean age of 30 years with intravitreal vascular endothelial growth factor (VEGF) inhibitor for choroidal new vessel (CNV) formation overlying choroidal osteoma over a mean follow-up of 26 months. Mean number of injections was 2.4 at 6 months, 3.2 at 12 months, and 5.5 at 24 months. CNV was subfoveal in 14 eyes, juxtafoveal in 5, extrafoveal in 5, and peripapillary in 2. By paired comparison, mean decrease from baseline was 119.7 microns at 6 months (n = 15; P = 0.001), 105.3 microns at 1 year (n = 10; P = 0.03), and 157.6 microns at 2 years (n = 7; P = 0.08). BCVA improved by 3.3 lines at 6 months after therapy (n = 26; P < 0.001), 2.8 lines (n = 20; P = 0.01) at 1 year, and 3.1 lines (n = 13; P = 0.049) at 2 years. We conclude that intravitreal anti-VEGF injections improve vision in majority of eyes with CNV from choroidal osteoma

Gender variation in central serous chorioretinopathy

Background: Comparison of presentation and outcomes of central serous chorioretinopathy (CSC) between male and female subjects in different ethnic populations. Methods: Retrospective comparison between male and female subjects with CSC was completed. Demographic details, clinical presentations, imaging features and treatment outcomes were compared at baseline and at last follow-up. Results: This study included 155 male and 155 female subjects with a mean (CSD) age of 43.8 ± 10.3 and 57.0 ± 12.1 years, respectively, and a mean duration of follow-up of 8.49 ± 12.6 months. At presentation, there was no difference in visual acuity; however, visual acuity was significantly higher for female subjects at last follow-up (p = 0.02). Optical coherence tomography (OCT) analysis showed that subretinal deposits (p < 0.001), hyperreflective foci (p = 0.001), retinal pigment epithelial detachment (p = 0.01) and retinal pigment epithelium (RPE) irregularities (p = 0.03) were higher in male subjects at presentation. Angiographic analysis showed that diffuse leakage and RPE tracts were common in males (p = 0.01 and p = 0.02). No significant differences in choroidal dilatation or diffuse choroidal leakages were noted. Conclusions: Female subjects with CSC appear to have better outcomes, with less chances of diffuse RPE damage and other OCT features compared to males