Photodynamic Therapy in the Treatment of Choroidal Neovascularization Complicating Central Serous Chorioretinopathy

We report the favorable anatomic and functional outcome of photodynamic therapy with verteporfin in a case of chronic central serous chorioretinopathy complicated with choroidal neovascularization (CNV). This 37-year-old Chinese male with bilateral chronic central serous chorioretinopathy presented with central scotoma, reduced vision and metamorphopsia in his right eye. Fluorescein angiography (FA) disclosed macular hemorrhage, exudate and subfoveal classic CNV. Photodynamic therapy (PDT) with verteporfin was applied to the CNV according to standard protocol with 2.2-mm spot size. Best-corrected visual acuity (BCVA) improved from 6/20 to 6/10 1 month after PDT. BCVA recovered to 6/7.5 without leakage on FA 3 months after PDT. Neither recurrent CNV lesion nor new hemorrhage was noted over 12 months of follow-up. Short-term results suggest that PDT with verteporfin for CNV secondary to central serous chorioretinopathy is a safe and effective treatment modality

Management of Anaphylactic Shock During Intravenous Fluorescein Angiography at an Outpatient Clinic

We report the proper management of a severe adverse reaction of anaphylactic shock during intravenous fluorescein angiography at an outpatient clinic. A 72-year-old male developed the severe, life-threatening complication after intravenous injection of sodium fluorescein dye for retinal angiography. Three minutes after receiving an intravenous injection of fluorescein, the patient developed syncope, apnea and circulatory shock. Fortunately, he recovered without any neurologic sequelae after immediate intensive resuscitation with fluid and inotropic support. We highlight the occurrence of anaphylactic shock as a potentially fatal complication during intravenous fluorescein angiography. Thus, one should be alert to the possibility of this adverse event and be prepared to deal with it when fluorescein angiography is performed. When it happens, immediate intensive medical resuscitation is essential to minimize morbidity and to avoid mortality

Systolic blood pressure, choroidal thickness, and axial length in patients with myopic maculopathy

Background: In the population-based Shihpai Eye Study, patients aged >65 years with myopic maculopathy were found to have higher systolic blood pressure. This finding deserved further exploration because this is the only correctable factor for preventing maculopathy in patients with high myopia. Therefore, we investigated the association between myopic maculopathy and systolic blood pressure, as well as other ocular parameters in this study. Methods: A clinic-based, retrospective cross-sectional study at a medical center was conducted between February 2011 and October 2012. Patients with high myopia were included and medical charts were reviewed. High myopia was defined as axial length ≥26.5 mm in at least one eye. Myopic maculopathy was defined as the presence of lacquer cracks, focal areas of deep choroidal atrophy, diffuse chorioretinal atrophy, and macular choroidal neovascularization or geographic atrophy in the presence of high myopia. Systolic blood pressure measurements were collected, and fundus photography and optical coherence tomography were performed. Subfoveal choroidal thickness (SFCT) shown on optical coherence tomography was measured and recorded. Results: The medical records of 187 high-myopic patients (87 without and 100 with maculopathy) were reviewed. Patients with maculopathy were older (56.96 years vs. 42.95 years, p < 0.01), had longer axial length (29.96 mm vs. 27.31 mm, p < 0.01), thinner SFCT (49.71 μm vs. 155.77 μm, p < 0.01), higher systolic blood pressure (132.28 mmHg vs. 125.31 mmHg, p < 0.05), greater prevalence of hypertension (31% vs. 16%, p < 0.05), and longer history of hypertension (2.34 years vs. 0.59 years, p < 0.01) compared to patients without maculopathy. After multivariate adjustment, SFCT and axial length were the only significant factors for maculopathy. Conclusion: Thinner SFCT and longer axial length are significant risk factors for myopic maculopathy. Unlike previous epidemiological surveys, results of this clinic-based study suggested that systolic blood pressure is not a significant factor for maculopathy

Idiopathic Polypoidal Choroidal Vasculopathy

Idiopathic polypoidal choroidal vasculopathy (IPCV) has been recognized as a peculiar form of choroidal neovascularization. The clinical features of recurrent serous retinal leakage and retinal hemorrhage may vary from single lesion to mul-tifocal, from self-limited to recurrent. Caucasian and Japanese patients with IPCV have been reported in the literature. However, research and case reports about IPCV in Chinese patients are relatively rare. We present 2 Chinese patients with IPCV in Taiwan with 2 different clinical pictures and visual outcomes during long-term follow-up. Further study for the etiology, clinical courses and treatments of the different subtypes of IPCV in Chinese is necessary

Combination photodynamic therapy and intravitreal bevacizumab used to treat circumscribed choroidal hemangioma

Circumscribed choroidal hemagioma (CCH) is an ocular tumor that can result in decreased vision or blindness. Numerous treatment methods have been reported without satisfying results. In recent years, photodynamic therapy (PDT) with verteporfin has been used to treat choroidal hemagioma and resolve the associated exudative retinal detachment, and the results have been inspiring. Here, we report the case of a 36-year-old man with longstanding CCH who suffered from blurred vision for 3 years. He underwent PDT with intravenous infusions of verteporfin, which was a treatment method based on a modified version of the standard macular degeneration PDT protocol, in addition to subsequent intravitreal administrations of bevacizumab as adjuvant therapy for macular edema. Twelve months after treatment, the CCH tumor remained noticeably shrunken, with the complete absorption of the subretinal fluid and the absence of macular edema. In terms of treating subretinal fluid retention, this combination treatment is a safe, effective, and long-lasting therapy for treating established CCH tumors. However, even though the patient’s visual field defects improved, the patient’s visual acuity remained stable at 6/60 without further improvement. Long-term CCH with prolonged macular edema might have affected the visual prognosis. Patients with CCH still require long-term follow-up examinations after receiving PDT treatments

Intravitreal Injection of Bevacizumab for the Treatment of Choroidal Neovascularization in a Patient with Angioid Streaks

We report the favorable outcome of intravitreal injection of bevacizumab (Avastin) to treat choroidal neovascularization (CNV) secondary to angioid streaks in an 82-year-old Chinese man. Within 2 weeks of bevacizumab injection, visual acuity improved from 20/40 to 20/25 and optical coherence tomography revealed complete resolution of CNV and retinal edema. The juxtafoveal hemorrhage nearly disappeared, and the size of CNV markedly regressed from 1,200 mm to unre- markable on fluorescein angiography. These improvements were maintained after 2 additional doses of intravitreal bevacizumab administered at 4-week intervals. No ocular or systemic side effects were observed. Neither recurrent CNV lesion nor new hemorrhage was noted during 18 months of follow-up. The short-term results suggest that intravitreal injection of bevacizumab for the treatment of CNV in patients with angioid streak is well tolerated and highly effective. It may be a promising pharmacologic treatment option since limited therapies are available for this disease with a rather aggressive course

Persistent exudative retinal detachment after photodynamic therapy and intravitreal bevacizumab injection for multiple retinal capillary hemangiomas in a patient with von Hippel–Lindau disease

Photodynamic therapy (PDT) has been used in treating peripheral retinal capillary hemangioma (RCH) with satisfactory results. We report a rare case of von Hippel-Lindau (VHL) disease with three large peripheral RCHs, treated with PDT and intravitreal bevacizumab injection (IVB), who developed persistent bullous exudative retinal detachment (RD) despite significant tumor regression. The patient is a sporadic case of VHL disease, with a de novo nonsense mutation in codon 161 with C → T transition at nucleotide position 694 of the VHL gene. Multiple RCHs were noted in both eyes. Four small RCHs were found in the left eye and were treated with laser photocoagulation. Three large RCHs in the peripheral retina of the right eye were complicated with cystoid macular edema and subretinal fluid accumulation. The RCHs were treated with PDT combined with IVB, and bullous exudative RD developed on the second day after treatment. Three months after PDT, the tumors had regressed significantly, but exudative RD persisted, despite multiple IVB and intravitreal triamcinolone acetonide injection (IVTA). External drainage with sclera buckling, IVB, and IVTA were performed, and the retina attached after surgical intervention. The application of PDT in the treatment of RCHs and its possible complications are discussed

Management and clinical outcomes of intraocular foreign bodies with the aid of orbital computed tomography

Background: Computed tomography (CT) is known to be the first-line imaging method for patients with or suspect to have intraocular foreign bodies (IOFBs). The purpose of this study is to evaluate clinical outcomes in the management of IOFBs with the aid of CT. Methods: Retrospective chart review of patients who received orbital CT prior to the removal of an IOFB between January 2000 and December 2010 was carried out. Patients with an IOFB who did not receive an operation or those without a preoperation CT examination were excluded. Twenty patients with a mean age of 37 years were selected. The duration between injury and surgery ranged from hours to 4 months. Detailed information and ophthalmologic examination results including patient history, visual acuity (VA), slit-lamp examination, fundoscopic examination, operation notes and bacterial culture results were recorded for all patients. The orbital CT images were performed with multidetector CT scanners with a 2–3.75 mm slice thickness. Results: This study found 18 patients (90%) with only one IOFB on CT image, in which only nine IOFBs were discovered on clinical assessment. The CT image failed to discover the IOFB in two patients who had tiny iron dust fragments located in the cornea stroma or embedded in the lens. Preoperative determination of the IOFB size and location was helpful in the decision-making of the route of extraction. Further, there was a correlation between clinical presentation about vitreous hemorrhage and the development of postoperative retinal detachment (Fisher's exact test, p = 0.029). The presence of positive bacterial cultures was also found to be associated with decreased VA (Fisher's exact test, p = 0.047). The injured eyes were anatomically preserved in all patients. However, two patients had loss of light perception. Eleven patients (55%) had improved VA of more than two lines on Snellen's chart, seven patients worsened, and two patients retained the same initial VA. Conclusion: Multidetector CT plays an important role in the detection, localization, size measurement, and surgical approach towards the extraction of the IOFB. The presence of vitreous hemorrhage is a predictive factor for postoperative retinal detachment, and positive bacterial cultures result in poorer visual outcomes