Photodynamic therapy of choroidal neovascularization with enlargement of the spot size to include the feeding complex

This is a case report of a 83-year-old man with choroidal neovascularization (CNV), due to age-related macular degeneration (AMD) in his right eye. Digital fluorescein (FA) and indocyanine green angiography (ICG) were performed, which disclosed predominantly classic subfoveal CNV and a dilated and tortuous feeding complex. The visual acuity was 20/800. Anti-vascular endothelial growth factor (anti-VEGF) treatment was suggested, however, the patient was not keen to receive an intraocular injection. Modified photodynamic therapy (PDT) with spot size enlarged, to include not only the CNV lesion but the feeding complex as well, was performed. Ten days after one session of PDT, ICG showed absence of leakage from the CNV and complete occlusion of the feeding complex. The visual acuity gradually improved to 20/100 and remained stable during the following 23 months. No evidence of CNV leakage was seen in the FA and ICG during the follow up period. Adjustment of the PDT spot size to include the detectable by ICG feeding complex might be an additional option in order to close the subfoveal CNV and might be considered as an alternative to intravitreal injection of anti-VEGF in selected cases where anti-VEGF treatment is not available

Quantitative determination of glycosaminoglycans in tears of diabetic patients

Marilita M Moschos1, Alexandros A Rouvas1, Spyridon Papadimitriou1, Athanasios Kotsolis1, Nikolaos Sitaras2, Michael Apostolopoulos11Department of Ophthalmology; 2Department of Pharmacology, University of Athens, GreecePurpose: To determine the amount of glycosaminoglycans (GAGs) in tears of patients with diabetic retinopathy (DR) and to compare it with normal subjects.Methods: 38 patients with DR and 24 normal volunteers were included. Thirty subjects suffered from background diabetic retinopathy (BDR) and 8 from proliferate diabetic retinopathy (PDR). For the GAGs assay, the uronic carbazole reaction was used.Results: The mean concentration of GAGs was significantly higher in patients with DR than in normal subjects. The GAGs concentration in patients with BDR or PDR was significantly higher than in normal subjects.Conclusion: The measurement of GAGs in tears of diabetic patients could be a tool in order to assess the stability or not of the disease.Keywords: glycosaminoglycans, tears, diabetic retinopath

Eccentric Macular Hole after Pars Plana Vitrectomy for Idiopathic Macular Hole: A Case Report

Introduction: Postoperative eccentric macular hole (MH) formation is an uncommon complication after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for epiretinal membrane or MH treatment. Herein, we present a case of eccentric MH formation after PPV with ILM peeling for MH. Case Description: A 72-year-old female patient underwent 23-gauge PPV with ILM peeling for idiopathic MH in her right eye. The visual acuity was 6/24 in the right eye. One week postoperatively the retina was attached and the MH seemed to be closed, while visual acuity was 6/12. One month after PPV, there was a single eccentric retinal hole below the macula, which was detected at the fundoscopy and was confirmed by OCT. The visual acuity was 6/9 and the patient referred no symptoms. No further intervention was attempted, and at the 6-month follow-up the visual acuity and the size of the eccentric MH remained stable. Conclusions: Eccentric MHs can develop after PPV and are usually managed conservatively by observation

Retinal Arterial Occlusive Diseasein a Young Patient with Cat Scratch Disease

Purpose: To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. Methods: A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyanine angiography did not reveal choroidal involvement. Laboratory analysis showed rising IgG titers for Bartonellahenselae. Results: Cat scratch disease was diagnosed, and a 4-week course of doxycycline was initiated. The patient responded well to the antibiotics. Both retinitis and arterial occlusion were resolved, the visual field was regained and the patient reported elimination of her symptoms. Conclusions: Cat scratch disease should be considered in the differential diagnosis in young patients with retinal occlusive disease

Enlargement of the hypofluorescent post photodynamic therapy treatment spot after a combination of photodynamic therapy with an intravitreal injection of bevacizumab for retinal angiomatous proliferation

Background To report a case of enlargement of the post photodynamic therapy treatment (PDT) spot in a patient with retinal angiomatous proliferation (RAP) that was treated with PDT combined with an intravitreal injection of bevacizumab. Methods 74-year-old woman with RAP due to age-related macular degeneration was treated with one verteporfin PDT session, sequenced by a single intravitreal injection of bevacizumab (1.25 mg) after 30 minutes. Results The patient’s visual acuity (VA) at baseline was 20/200 and is now at the 10-month follow-up visit 20/400, while the RAP has disappeared according to the indocyanine angiography (ICG) findings. The post PDT hypofluorescent treatment spot has enlarged from 1,450 mu m at the day of the treatment, to 5,360 mu m at the 6-week visit. The patient is now at the 10-month follow-up visit and the hypofluorescence is still persisting. Conclusions The simultaneous combination of PDT with bevacizumab in patients with RAP may enhance the photochemical stress in normal choroid with prolonged and magnified hypofluorescence in ICG, due to ischemia in normal choriocapillaries

SAFETY OF REPEAT INTRAVITREAL INJECTIONS OF BEVACIZUMAB VERSUS RANIBIZUMAB Our Experience After 2,000 Injections

Purpose: To compare the safety of repeat intravitreal injections of bevacizumab versus ranibizumab performed on a large series of patients during the past 2 years period of time. Methods: Four hundred fifty patients receiving 2,000 injections (1,275 bevacizumab and 725 ranibizumab) were studied retrospectively. Injections performed in a usual examination room under the standard sterile conditions. Follow-up varied from 3 to 24 months. Results: Serious ocular adverse events were uncommon. Only one patient developed retinal detachment (0.05%). Most common procedure-related ocular adverse event was injection-site redness (64.75%). Postoperative subconjuctival hemorrhage occurred after 200 (10%) injections. Patients receiving aspirin treatment were more prone to have subconjuctival hemorrhage (P = 0.0002). Most common drug-related ocular adverse event was uveitis (1.90%), which was treated successfully and lasted no > 12 days. There was no statistically significant difference between the patients treated with bevacizumab or ranibizumab regarding the noted adverse events (P > 0.5%). Conclusion: Multiple intravitreal injections of bevacizumab or ranibizumab were both well tolerated and safe. Performing injections on a usual examination room proved safe. Injection-site redness, subconjuctival hemorrhage, and uveitis were the most common ocular adverse events. Aspirin treatment was a risk factor for the development of subconjuctival hemorrhage