Internal drainage for chronic macula-involving serous retinal detachment in idiopathic central serous chorioretinopathy

Conventional treatment of idiopathic central serous chorioretinopathy (ICSC) consists of argon laser, photodynamic therapy, or observation. However, in cases of atypical bullous ICSC with exudative detachment preventing any laser therapy, a surgical approach with external drainage of fluid has been performed. We present a case of ICSC with persistent macula involving exudative retinal detachment without evidence of uveitis that responded favorably to internal drainage by vitrectomy along with a scleral buckle placement. Our case, treated with internal drainage, also demonstrated successful long-term reattachment of the serous retinal detachment without any additional complications from the surgery

Accidental Nd:YAG Laser–Induced Macular Hole in a Pediatric Patient

After being exposed to an industrial Nd:YAG laser, an 11-year-old boy developed a full-thickness macular hole in the right eye with resultant visual acuity of 20/100. Five months after the initial injury, the vision was stable and the hole was still present. The patient underwent pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade with prone positioning. Three months postoperatively, visual acuity improved to 20/25 with closure of the macular hole; however, there was a focal photoreceptor deficit. A review of the English-language literature identified 15 eyes with similar macular hole injuries after Nd:YAG exposure. Three eyes were surgically managed. While all holes were successfully closed, only two experienced visual improvement

Bilateral exudative retinal detachments due to thrombotic microangiopathy associated with intravenous abuse of Opana ER

Purpose: To report the only known case, to our knowledge, of bilateral exudative retinal detachments in the setting of thrombotic microangiopathy associated with intravenous abuse of extended-release oxymorphone (Opana ER). Observations: A 35-year-old male presented with headaches and acute, painless vision loss in the context of daily IV abuse of crushed oral Opana ER. The patient was found to have microangiopathic hemolytic anemia (MAHA), acute kidney injury in conjunction with hypertensive crisis and bilateral exudative retinal detachments. Conclusions and importance: Bilateral exudative retinal detachments are rare ophthalmic complications that have been reported with thrombotic thrombocytopenic purpura (TTP). Non-TTP thrombotic microangiopathy, initially described as a “TTP-like illness” consisting of MAHA and thrombocytopenia, has been associated with the IV abuse of Opana ER. We report a case of bilateral exudative retinal detachments due to thrombotic microangiopathy in the setting of IV abuse of Opana ER. Keywords: Bilateral exudative retinal detachment, Opioid drug abuse, Opana ER, Drug-induced thrombotic microangiopath

Retinopathy of Prematurity Versus Familial Exudative Vitreoretinopathy: Report on Clinical and Angiographic Findings

Retinopathy of prematurity (ROP) and familial exudative vitreoretinopathy (FEVR) are classified as distinct diseases; however, emerging genetic research and fluoresce-in angiographic evidence suggest a margin of overlap between the two. PATIENTS AND METHODS This was an institutional review board-approved, retrospective case series. A literature review was performed, and medical records of all pediatric patients who underwent examination under anesthesia and laser for FEVR at the Bascom Palmer Eye Institute Pediatric Retina Service by one of the authors (AMB) from Jan. 1, 2006, to June 30, 2013, were analyzed retrospectively. Nine infants born prematurely had fluorescein angiograms and a clinical course most consistent with FEVR. Angiographic findings included irregular sprouts of vascularization at the vascular/ avascular junction, distinct pruning of vessels, pinpoint areas of hyperfluorescence, and segmental areas of vascular leakage. The authors propose a classification of ROPER (ROP vs. FEVR) to more accurately stratify these patients. Identification of this subset of patients will allow for sustained surveillance of infants with ROPER who demonstrate a continuing risk of disease activity

Retained subretinal date palm tree thorn in a child

A 3-year-old boy presented with severe eye pain and nausea after colliding with a date palm tree branch. Examination under anesthesia revealed a self-sealed corneal laceration and traumatic cataract in his left eye. Cultures were taken and the patient received prophylactic subconjunctival, intravitreal, and systemic antibiotics because of the high risk of endophthalmitis. A thorn from the same tree grew Bacillus cereus. Examination after 2 weeks of the injury revealed a subretinal foreign body (a palm tree thorn), although there were no signs of endophthalmitis or retinal detachment. The patient underwent cataract extraction and laser demarcation of the subretinal foreign body, which was not removed. He was fitted for an aphakic contact lens. With alternate patching, his best-corrected visual acuity improved to 20/30