Intravitreal Dexamethasone Implant in the Treatment of Non-Infectious Uveitic Macular Edema

Macular Edema (ME) is a common complication, leading to severe vision loss in patients with Non-Infectious Uveitis (NIU). The treatment of uveitic ME is still very challenging for many ophthalmologists. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combatting uveitic ME. However, there is not enough evidence to support the efficacy of any of these agents. Intravitreal Dexamethasone Implant (IDI) (Ozurdex; Allergan Inc, Irvine, CA) is a widely administered corticosteroid for the long-term management of uveitic ME in certain cases. Ophthalmic implant is made up of a biodegradable copolymer that contains glycolic acid and lactic acid. Recent studies have demonstrated that dexamethasone implant effectively improves uveitis-related ME. The authors suggest that this effect could be sustained for at least six months with close monitoring and re-treatment, as needed. The current study reviewed major clinical studies about IDI in eyes with NIU and briefly overviewed their results

Optical Coherence Tomography Angiography in Eyes with Non-infectious Posterior Uveitis; Some Practical Aspects

Optical coherence tomography angiography (OCTA) is an innovative imaging technology enabling clinicians to learn more about the pathophysiology of disease processes as it facilitates visualization of the retinal and choroidal circulation without injection of a dye. Also it provides ample qualitative and quantitative data on the vascular supply. OCTA has become an important tool nowadays in the diagnosis and follow-up of patients with age-related macular degeneration, inherited chorioretinal diseases, diabetic retinopathy, retinal vascular occlusive diseases and optic nerve disorders. However, its place is relatively less known in non-infectious posterior uveitis (NIPU). OCTA may help mainly in assessing macular and peripheric retinal perfusion status, detection of retinal and/or disc neovascularization, diagnose of inflammatory choroidal neovascularization and visualizing the uveitic white-dot lesions. This mini-review describes the use of OCTA in patients with NIPU and summarizes some practical points in several uveitic entities. Epub: October 1, 2019

Intravitreal Dexamethasone Implant in the Treatment of Non-Infectious Uveitic Macular Edema

Macular Edema (ME) is a common complication, leading to severe vision loss in patients with Non-Infectious Uveitis (NIU). The treatment of uveitic ME is still very challenging for many ophthalmologists. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combatting uveitic ME. However, there is not enough evidence to support the efficacy of any of these agents. Intravitreal Dexamethasone Implant (IDI) (Ozurdex; Allergan Inc, Irvine, CA) is a widely administered corticosteroid for the long-term management of uveitic ME in certain cases. Ophthalmic implant is made up of a biodegradable copolymer that contains glycolic acid and lactic acid. Recent studies have demonstrated that dexamethasone implant effectively improves uveitis-related ME. The authors suggest that this effect could be sustained for at least six months with close monitoring and re-treatment, as needed. The current study reviewed major clinical studies about IDI in eyes with NIU and briefly overviewed their results

An Overview of Rare and Unusual Clinical Features of Bietti’s Crystalline Dystrophy

Bietti’s crystalline dystrophy (BCD) is a rare disease presenting with the appearance of intraretinal crystalline deposits and varying degrees of chorioretinal atrophy commencing at the posterior pole. Within time, intraretinal crystals gradually disappear and chorioretinal atrophy extends beyond the macula even resulting in complete chorioretinal atrophy. Concomitant corneal crystals can be noted in 1/2 - 1/3 of the patients, and the presence of corneal crystals is not a must for establishing the diagnosis. For the past decade, genetic evaluations and newer imaging modalities expand our knowledge about the disease. CYP4V2 gene is found to be the gene responsible for the disease process and new mutations are still being described. Modern imaging modalities, such as a spectral domain optical coherence tomography (SD-OCT) shed light on the anatomic features of the disease. By this, we reiterate the rare and unusual clinical features of BCD

An Overview of Rare and Unusual Clinical Features of Bietti’s Crystalline Dystrophy

Bietti’s crystalline dystrophy (BCD) is a rare disease presenting with the appearance of intraretinal crystalline deposits and varying degrees of chorioretinal atrophy commencing at the posterior pole. Within time, intraretinal crystals gradually disappear and chorioretinal atrophy extends beyond the macula even resulting in complete chorioretinal atrophy. Concomitant corneal crystals can be noted in 1/2 - 1/3 of the patients, and the presence of corneal crystals is not a must for establishing the diagnosis. For the past decade, genetic evaluations and newer imaging modalities expand our knowledge about the disease. CYP4V2 gene is found to be the gene responsible for the disease process and new mutations are still being described. Modern imaging modalities, such as a spectral domain optical coherence tomography (SD-OCT) shed light on the anatomic features of the disease. By this, we reiterate the rare and unusual clinical features of BCD

Multimodal Imaging Characteristics of a Large Retinal Capillary Macroaneurysm in an Eye With Severe Diabetic Macular Edema: A Case Presentation and Literature Review

Though microaneurysms are the hallmark of diabetic retinopathy (DR), large aneurismal changes termed as ''macroaneurysms'' (MAs) may also occur in the course of chronic diabetic macular edema. MAs are usually accompanied by intraretinal hard exudates, fluid accumulation and retinal hemorrhages. Detection of MAs is clinically important as it implies that macular edema is usually chronic and therefore can be resistant to intravitreal anti-vascular endothelial growth factor injections. Multimodal imaging consisting of fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) or OCT-angiography (OCTA) can be performed to detect and understand the nature of MA and thereby select proper treatment modality. Herein, we report multimodal imaging features of a 64-year-old woman with insulin-dependent diabetes mellitus presented with treatment naïve severe macular edema and a macroaneurysm at the right temporal macula. In conclusion, FA, ICGA and OCT seem to be far superior to OCTA to detect these lesions due to probable slow flow inside the MA

Multimodal Imaging Characteristics of a Large Retinal Capillary Macroaneurysm in an Eye With Severe Diabetic Macular Edema: A Case Presentation and Literature Review

Though microaneurysms are the hallmark of diabetic retinopathy (DR), large aneurismal changes termed as ''macroaneurysms'' (MAs) may also occur in the course of chronic diabetic macular edema. MAs are usually accompanied by intraretinal hard exudates, fluid accumulation and retinal hemorrhages. Detection of MAs is clinically important as it implies that macular edema is usually chronic and therefore can be resistant to intravitreal anti-vascular endothelial growth factor injections. Multimodal imaging consisting of fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) or OCT-angiography (OCTA) can be performed to detect and understand the nature of MA and thereby select proper treatment modality. Herein, we report multimodal imaging features of a 64-year-old woman with insulin-dependent diabetes mellitus presented with treatment naïve severe macular edema and a macroaneurysm at the right temporal macula. In conclusion, FA, ICGA and OCT seem to be far superior to OCTA to detect these lesions due to probable slow flow inside the MA

Bilateral Choroidal Detachment Induced by Unilateral Application of a Fixed Combination of Topical Timolol Maleate and Brinzolamide

We describe a 66-year-old man who developed bilateral choroidal detachment that was induced by unilateral topical administration of a fixed combination of 1% brinzolamide and 0.5% timolol maleate the day after an uneventful phacoemulsification surgery and intraocular lens implantation involving his right eye. We believe that the reaction was an idiosyncratic reaction, most likely against brinzolamide. The condition improved rapidly after the cessation of the fixed combination of brinzolamide and timolol maleate and treatment with 1% topical prednisolone acetate every hour and 1% cyclopentolate twice a day bilaterally. Although there are several similar cases involving choroidal detachment after oral acetazolamide and topical dorzolamide treatment mentioned in the literature, the present case is the first case report involving bilateral choroidal detachment after topical treatment with brinzolamide.Â

Bilateral Choroidal Detachment Induced by Unilateral Application of a Fixed Combination of Topical Timolol Maleate and Brinzolamide

We describe a 66-year-old man who developed bilateral choroidal detachment that was induced by unilateral topical administration of a fixed combination of 1% brinzolamide and 0.5% timolol maleate the day after an uneventful phacoemulsification surgery and intraocular lens implantation involving his right eye. We believe that the reaction was an idiosyncratic reaction, most likely against brinzolamide. The condition improved rapidly after the cessation of the fixed combination of brinzolamide and timolol maleate and treatment with 1% topical prednisolone acetate every hour and 1% cyclopentolate twice a day bilaterally. Although there are several similar cases involving choroidal detachment after oral acetazolamide and topical dorzolamide treatment mentioned in the literature, the present case is the first case report involving bilateral choroidal detachment after topical treatment with brinzolamide.

Nodular Scleritis in Association with Panuveitis in Behçet’s Disease

This case report involves a 32-year-old man with Behçet’s disease who had simultaneous bilateral anterior uveitis, unilateral nodular scleritis, and occlusive vasculitis with retinal hemorrhages. Although scleritis is not a classical feature of Behçet’s disease, a diagnosis of Behçet’s disease should be considered in patients with scleritis