Bilateral leukocoria in infant with afibrinogenemia

M Necati Demir1, Mehmet Akif Acar1, Yusuf Ziya Aral2, Nurten Ünlü11Ankara Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey; 2Aydin Menderes University, Faculty of Medicine, Department of Pediatric Hematology, Aydin, TurkeyPurpose: To report a bilateral leukocoria case in a patient suffering from afibrinogenemia.Methods: An observational case where congenital afibrinogenemia was presented with bilateral retinal and vitreous hemorrhages that proceeded to vitreoretinal surgery was presented. In addition, complete ophthalmic and radiological examinations and vitreoretinal surgery were performed.Results: Right eye had a complete recovery while the left eye showed serious proliferative vitreoretinopathy and shortened retina. Three years after the surgery clinical examination showed that the right eye was aphacic with an attached retina and clear ocular media while the left eye was phtysic.Conclusion: We recommend broad clotting profile for infants suffering from vitreous or retinal hemorrhages with no obvious physical abuse. Our present case furthermore implies that afibrinogenemia can lie beneath the pathogenesis of bilateral leukocoria and should alert physician for the presence of an afibrinogenemia among several types of bleeding predispositions.Keywords: afibrinogenemia, retinal hemorrhage, vitreous hemorrhage, vitrectom

Corticosteroid Treatment in Diabetic Macular Edema

Diabetic macular edema is the most common cause of visual impairment in patients with diabetes mellitus. The pathogenesis of macular edema is complex and multifactorial. For many years, laser photocoagulation has been considered the standard therapy for the treatment of diabetic macular edema; however, few patients achieve significant improvements in visual acuity. Today the intravitreal administration of anti-inflammatory or anti-angiogenic agents together with the use of laser photocoagulation represents the standard of care for the treatment of this complication. The intravitreal route of administration minimizes the systemic side effects of corticosteroids. Steroid-related ocular side effects are elevated intraocular pressure and cataract, while injection-related complications include endophthalmitis, vitreous hemorrhage, and retinal detachment. In order to reduce the risks and complications, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated injections for the management of diabetic macular edema. In this review, the efficacy, safety, and therapeutic potential of intravitreal corticosteroids in diabetic macular edema are discussed with a review of recent literature

Incomplete treatment response, treatment resistance, pharmaceutical changes and combined treatments in branch retinal vein occlusion and macular edema

Retinal ven dal tıkanıklığı (RVDT) diyabetik retinopatiden sonra en sık görülen retina damar hastalığıdır. Görme kaybı etkilenen venin bulunduğu bölgeye göre değişkendir. RVDT’nda görme kaybının başlıca nedenleri maküla ödemi ve maküler iskemidir. Anti-VEGF ajanlar, RVDT’na bağlı makula ödeminde görme keskinliğinde artış sağlaması nedeniyle tedavide öncelikli tercih edilmektedir. Anti-VEGF tedavi ile erken yanıt alınsa da bazı olgularda maküla ödemi tedaviye dirençlidir. Bu derlemede RVDT ve maküla ödeminde tedaviye yanıtsızlık, tedaviye direnç, ilaç değişimleri ve kombine tedaviler gözden geçirilecektir.Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disease after diabetic retinopathy. Vision loss varies depending on the affected area. The main causes of vision loss in BRVO are macular edema and macular ischemia. Anti- VEGF agents are preferred in the treatment of macular edema due to BRVO because of the increase in visual acuity. Although anti-VEGF therapy provides early response, in some cases macular edema is resistant to the treatment. In this review, incomplete treatment response, treatment resistance, pharmaceutical changes and combined treatment are mentioned in cases with BRVO and macular edema

Outcomes of Phacoemulsification with Anterior Chamber Maintainer in Vitrectomized Eyes

Pur po se: To evaluate the outcomes of phacoemulsification with anterior chamber maintainer in vitrectomized eyes with complicated cataract. Ma te ri al and Met hod: Twenty eyes of 20 patients who developed complicated cataract after pars plana vitrectomy (PPV) were included in the study. Phacoemulsification with clear corneal incision and foldable intraocular lens implantation was performed. In group 1, anterior chamber maintainer (ACM) was used during phacoemusification and in group 2, ACM was not used. Pre- and postoperative visual acuities as well as per- and postoperative complications were reviewed retrospectively. Re sults: Anterior chamber maintainer was used during the surgery in 12 (60%) cases and was not used in 8 (40%) cases. Phacoemulsification was performed 16.5±9.2 (4-40) months after PPV. Best-corrected visual acuities were between hand motions and 0.4 preoperatively and between counting fingers from 1 meter and 1.0 postoperatively in group 1. Best-corrected visual acuities were between hand motions and 0.1 preoperatively and between counting fingers from 1 meter and 0.8 postoperatively in group 2. Posterior capsule was ruptured in 1 eye peroperatively in group 1. In group 2, phacoemulsification was more difficult due to deep anterior chamber in 8 eyes and intraoperative complications were iris sphincter rupture in 1 eye and posterior capsule rupture in 1 eye. Mild corneal edema in 7 (58.3%) eyes, fibrin reaction in 2 (16.6%), intraocular lens decentralization in 1 (8.3%) and posterior capsule opacification in 4 (33.3%) eyes were the postoperative complications in group 1. Mild corneal edema in 5 (62.5%) eyes, fibrin reaction in 1 (12.5%) and posterior capsule opacification in 2 (25%) eyes were the postoperative complications in group 2. Dis cus si on: Complicated cataracts which may develop after PPV can be treated safely with phacoemulsification. Continuous irrigation during the surgery may provide a stable anterior chamber and prevents surgical complications. (Turk J Ophthalmol 2012; 42: 253-6