Severe hypotony and filtering bleb leak after intravitreal injection of ranibizumab

We report a case of a patient with age-related macular degeneration, who had undergone trabeculectomy nine years earlier, and developed severe hypotony and bleb leak after treatment with intravitreal injections of ranibizumab. Although the incident is rare, in patients with longstanding filtering blebs, who need treatment with antivascular endothelial growth factors, close follow-up may be advocated, since the occurrence of bleb rupture could lead to permanent vision loss

Comparative studies of RNFL thickness measured by OCT with global index of visual fields in patients with ocular hypertension and early open angle glaucoma

Sergios Taliantzis, Dimitris Papaconstantinou, Chrysanthi Koutsandrea, Michalis Moschos, Michalis Apostolopoulos, Gerasimos GeorgopoulosAthens University Medical School, Department of Ophthalmology, Athens, GreecePurpose: To compare the functional changes in visual fields with optical coherence tomography (OCT) findings in patients with ocular hypertension, open angle glaucoma, and suspected glaucoma. In addition, our purpose is to evaluate the correlation of global indices with the structural glaucomatous defect, to assess their statistical importance in all the groups of our study, and to estimate their validity to the clinical practice.Methods: One hundred sixty nine eyes (140 patients) were enrolled. The patients were classified in three groups. Group 1 consisted of 54 eyes with ocular hypertension, group 2 of 42 eyes with preperimetric glaucoma, and group 3 of 73 eyes with chronic open angle glaucoma. All of them underwent ophthalmic examination according to a prefixed protocol, OCT exam (Stratus 3000) for retinal nerve fiber layer (RNFL) thickness measurement with fast RNFL thickness protocol and visual fields (VF) examination with Octopus perimeter (G2 program, central 30–2 threshold strategy). Pearson correlation was calculated between RNFL thickness and global index of VF.Results: A moderate correlation between RNFL thickness and indices mean sensitivity (MS), mean defect (MD) and loss variance (LV) of VF (0.547, -0.582, -0.527, respectively; P < 0.001) was observed for all patients. Correlations of the ocular hypertension and preperimetric groups are weak. Correlation of RNFL thickness with global indices becomes stronger as the structural alterations become deeper in OCT exam. Correlation of RNFL thickness with the global index of VF, in respective segments around optic disk was also calculated and was found significant in the nasal, inferior, superior, and temporal segments.Conclusion: RNFL average thickness is not a reliable index for early diagnosis of glaucoma and for the follow-up of patients with ocular hypertension. Segmental RNFL thickness seems to be a more reliable index. Deep structural alterations with OCT examination constitute an important indication of early functional changes, even if they are not still detected with achromatic perimetry. The MD index of VF seems to be more sensitive for the follow-up of patients with ocular hypertension.Keywords: glaucoma, ocular hypertension, OCT, visual fields, RNFL thicknes

The Association between TGF-β1 G915C (Arg25Pro) Polymorphism and the Development of Primary Open Angle Glaucoma: A Case-Control Study

The purpose of the current study was to identify the potential association between Single Nucleotide Polymorphism (SNP) TGFβ1 +915 (C or G) in codon 25 and Primary Open Angle Glaucoma (POAG). Overall, 88 cases with POAG and a control group of 52 healthy individuals were recruited from the First Ophthalmology Department of Athens University. DNA was isolated from whole blood samples and genotype frequencies for the polymorphism rs1800471 (G915C, Arg25Pro) of the TGF-β1 gene were assessed. Genotype distribution frequencies for the polymorphism rs1800471 (G915C, Arg25Pro) of the TGF-β1 gene were not statistically different between patients with POAG and control subjects. The present study failed to determine any significant genotypic association with POAG, despite the fact that the presence of the C allele was scarcely increased in the POAG when compared with the control group

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

Radial peripapillary capillary density as a predictive factor for glaucoma in eyes with ocular hypertension. An observational, comparative, single-centred study [version 1; peer review: 1 approved, 2 approved with reservations]

Background: Ocular hypertension (OH) is a condition characterized by elevated intraocular pressure (IOP) exceeding the normal range, without any evident damage to the optic nerve or visual field defects characteristic of glaucoma. It constitutes a significant precursor to the development of glaucoma, a leading cause of irreversible vision loss worldwide. Emerging evidence has shown that microcirculation alterations in eyes with OH could serve as predicting factors to identify eyes at high risk for progression to glaucoma. In view of the above, the purpose of our study is to investigate microcirculation alterations of the radial peripapillary capillary plexus using optical coherence tomography angiography (OCT-A) in patients with ocular hypertension (OH). Methods: A total of 192 eyes were included in this observational, comparative, single-centre study and were divided in two groups: OH eyes and healthy controls. OCT-A was performed to analyze microcirculation characteristics at the peripapillary area. Radial peripapillary capillary density was measured at the total area of the optic disc and at each separate region (superior, inferior, inside). The parameters of age, medical treatment for ocular hypertension, sex and retinal fiber layer thickness were evaluated.  Results: Total radial peripapillary capillary density was significantly lower in patients with OH than in healthy controls Concerning the microcirculation characteristics at each separate region of the peripapillary area, the results were as follows: inferior radial peripapillary capillary density was significantly decreased in individuals with OH than in controls, while measurements in the superior peripapillary area and internal optic disc were similar in both groups.   Conclusions: Our study indicates decreased radial peripapillary capillary density in eyes with OH. Microcirculation alterations in the inferior peripapillary area could potentially comprise biomarkers for OH progression to glaucoma