Alcoholic liver disease and bilateral multifocal central serous retinopathy:a case report

INTRODUCTION: We present a unique case of a patient with bilateral, multifocal central serous retinopathy in a patient with alcoholic liver disease. CASE PRESENTATION: A 58-year-old Caucasian man with alcoholic liver disease, liver cirrhosis and ascites presented to the eye clinic. The ophthalmoscopic examination of both eyes revealed a symmetrical pattern of variably sized, slightly yellowish, translucent, raised lesions throughout the fundi which were confirmed to be caused by multifocal central serous retinopathy after optical coherence tomography and autofluoresence tests. CONCLUSION: This case highlights the possible link between central serous retinopathy and end-stage liver disease, with potential implications for the pathogenesis of central serous retinopathy in these patients

Early foveal recovery after macular hole surgery

AIMS: To evaluate morphological and functional recovery after macular hole surgery using pars plana vitrectomy (PPV), inner limiting membrane (ILM) peeling, air-tamponade and short-time limited face-down positioning. DESIGN: Retrospective, interventional, non-comparative consecutive case series. PATIENTS: Thirty eyes in 30 patients (30 eyes) with unilateral full-thickness macular hole (stage II-IV). INTERVENTION: All eyes underwent PPV, ILM peeling and fluid-air exchange followed by postoperative face-down positioning for 2 days. MAIN OUTCOME MEASURES: Best corrected visual acuity, optical coherence tomography (OCT) assessment of macular integrity, and biomicroscopy at days 3 and 7, and months 1, 3, 6 and 12. RESULTS: On postoperative day 3, OCT demonstrated macular hole closure in 28 eyes (93%). One eye required vitrectomy 7 weeks after initial surgery due to retinal detachment. CONCLUSIONS: In the present case series, PPV with Trypan Blue-assisted ILM peeling, short-acting internal tamponade and thus shorter face-down positioning was associated with a 93% macular hole closure rate

Intraindividual comparison of color perception and contrast sensitivity with and without a blue light-filtering intraocular lens

PURPOSE. To investigate color perception and contrast sensitivity with and without additional glare in pseudophakic patients with a conventional intraocular lens (IOL) in one eye and a blue light-filtering IOL in the fellow eye. METHODS. Twenty-three bilaterally pseudophakic patients with a conventional IOL (AcrySof SA60AT) and a blue light-filtering IOL (AcrySof Natural SN60AT) were tested for intraindividual comparison of visual acuity (ETDRS chart), color perception (Farnsworth-Munsell 100-Hue test), and contrast sensitivity with and without glare (Contrast Sensitivity Pattern Generator). Information about subjective perception was gathered through a questionnaire. RESULTS. Four patients (17.4%) observed some difference in monocular color perception. Color testing did not show significantly different results for the two IOL types expressed as total error score and segmental error subscores for protan, deutan, and tritan ranges. Regarding contrast sensitivity, 5 patients (21.7%) indicated noticeable difference between the two eyes. Contrast sensitivity testing, however, showed similar curves for the two IOL types with and without additional glare. CONCLUSIONS. Despite some subjective difference in color and contrast perception in a minority of patients, the study did not show significantly different results for the two IOL types

Considerations for management of patients with diabetic macular edema: optimizing treatment outcomes and minimizing safety concerns through interdisciplinary collaboration

Diabetes is a growing worldwide epidemic and a leading cause of blindness in working-age people around the world. Diabetic retinopathy (DR) and diabetic macular edema (DME) are common causes of visual impairment in people with diabetes and often indicate the presence of diabetes-associated preclinical micro- and macrovascular complications. As such, patients with DR and DME often display complex, highly comorbid profiles. Several treatments are currently available for the treatment of DME, including anti-vascular endothelial growth factor (VEGF) agents, which are administered via intravitreal injection. While the safety profiles of approved ocular anti-VEGF therapies have been reassuring, the high-risk nature of the DME patient population means that treatment must be carefully considered and a holistic approach to disease management should be taken. This requires multidisciplinary, collaborative care involving all relevant specialties to ensure that patients not only receive prompt treatment for DME but also appropriate consideration is taken of any systemic comorbidities to evaluate and minimize potentially serious safety issues.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

Early postoperative recovery of idiopathic macular hole in a young adult

BACKGROUND: Idiopathic macular holes usually develop in the elderly. We report the case of a spontaneous macular hole in a 23-year-old man. HISTORY AND SIGNS: The patient noticed decreased central vision in his left eye since 5 days without any history of trauma or intraocular inflammation. On examination the best corrected visual acuity was 20/20 in the right eye and 20/50 in the left. Fundus biomicroscopy and OCT showed a full-thickness macular hole. Microperimetry demonstrated a scotoma within the macular hole. THERAPY AND OUTCOME: 2 months later the patient underwent pars plana vitrectomy, ILM-peeling with trypan blue staining and fluid-air exchange followed by face down positioning for 12 h a day for 2 days. On the 4th post-surgical day visual acuity was 20/32 and OCT showed a complete closure of the macular hole. During the further follow-up visual acuity in the left eye improved to 20/20. OCT examination showed a restored foveal depression, and microperimetry demonstrated an increased foveal sensitivity in the area of the previous scotoma. CONCLUSIONS: The aetiology of the macular hole in this patient is unclear. It is most likely an idiopathic macular hole in a young person. Post-surgical follow-up OCTs and microperimetry disclosed an early recovery of the foveal anatomy and function

Characteristics of severe intraocular inflammation following intravitreal injection of bevacizumab (Avastin)

BACKGROUND/AIMS: To report a series of severe intraocular inflammatory events following intravitreal injections of bevacizumab (Avastin). This procedure is performed on a rapidly increasing number worldwide, and rare complications such as intraocular inflammation, endophthalmitis or intraocular haemorrhage are gaining in importance in clinical routine. METHODS: This is a single-centre retrospective interventional case series of eight patients with severe intraocular inflammation after intravitreal injection of bevacizumab at one referral centre consecutively seen out of approximately a total of 2500 injections performed in that time period. Patients who developed severe intraocular inflammation after intravitreal injection were evaluated clinically, including slit-lamp examination, best-corrected Snellen visual acuity (VA), slit-lamp photography, optical coherence tomography and fluorescein angiography prior to the event and during follow-up. RESULTS: Patients noticed a painless drop in VA up to 2 days following the injection. All patients had a marked anterior chamber reaction with increased flare and cells, but no hypopyon. Typical posterior segment findings included vitreous cellular infiltrates of pseudogranulomatous aspect. Due to their initial clinical aspect suspicious of an endophthalmitis, three cases were treated with systemic antibiotics, but the final diagnosis was uveitis. Five cases showed a characteristic pseudogranulomatous vitreous infiltration as seen in vitritis and were treated only topically. CONCLUSIONS: Characteristic features of an inflammation induced by bevacizumab injection include an early onset with painless loss in VA mostly without conjunctival or ciliary injection. Patients respond to systemic or topical cortisone treatment with slow recovery but without permanent damage. Vitreous haemorrhage and infectious endophthalmitis might be differentiated by time course and symptoms