A 38-year-old man with longstanding low intraocular pressure (IOP) in his right aphakic eye presented with severe pain and high IOP (35 mm Hg). On examination, visual acuity was light perception. The central and peripheral portions of the iris were directly opposed to the posterior corneal surface and synechial closure of the pupil margin. B-scan ultrasonography showed posterior vitreous detachment. The patient was treated with topical cycloplegics, a topical beta-blocker, and a systemic hyperosmotic agent. After 1 week, the anterior chamber was deep centrally, with peripheral synechiae between the iris and the cornea. The IOP of the right eye was 4 mm Hg. This case is an unusual spontaneous malignant glaucoma occurring in a longstanding hypotonous eye.

Orbital infarction syndrome is a rare but devastating disorder resulting in sudden visual loss. A patient with orbital infarction syndrome due to orbital cellulitis after transcanalicular dacryocystorhinostomy with diode laser is described. A 55-year-old woman presented 3 days after transcanalicular dacryocystorhinostomy. Initial examination revealed significant eyelid swelling, marked proptosis, total ophthalmoplegia, and no light perception in the right eye. Fundus examination revealed ophthalmic artery occlusion. The clinical findings of the patient were consistent with orbital infarction syndrome. Clinical findings improved with antibiotic therapy, but visual acuity did not change.

This retrospective case series describes a novel technique that involves the creation of an arcuate retinotomy in the treatment of large macular holes after failed primary repair. Six eyes (six patients) with large macular holes, all of which had failed primary repair, underwent 25-gauge pars plana vitrectomy revision coupled with full-thickness arcuate retinotomy temporal to the macular hole and fluid-gas exchange. The main outcome measure was anatomic macular hole closure based on optical coherence tomography (OCT), with visual acuity and visual field evaluation as secondary outcome measures. Five of the six patients (83%) had successful hole closure, with three of the six patients (50%) exhibiting improvement in visual acuity. Arcuate retinotomy is a new approach that may aid in the repair of large macular holes not otherwise amenable to closure with traditional techniques.

The authors describe two cases of bilateral simultaneous stage 1 macular hole diagnosed via optical coherence tomography (OCT). Vitreomacular traction, foveal pseudo cysts, and outer retinal changes were present initially. Resolution of the foveal pseudo cysts and outer retinal changes occurred in cases where a complete posterior vitreous detachment was noted. The initial step in the pathogenesis of macular holes is "traction" from the detaching posterior hyaloid. However, there are missing links in the exact inciting events and in the progression of the disease. The development of bilateral stage 1 macular holes simultaneously is unique and interesting because an unknown common inciting factor might be at play in these cases.

The authors report a clinical and echographic correlation of a retinal vasoproliferative tumor that assumed a mushroom shape. A 64-year-old man with a history of retinal detachment repair presented with vitreous hemorrhage. A clinical examination including standardized ultrasound was performed, which revealed a mushroom-shaped tumor with high reflectivity. The patient underwent pars plana vitrectomy with fine needle aspiration biopsy. Histopathology of the biopsy specimen demonstrated vascular proliferation. The lesion was diagnosed to be a retinal vasoproliferative tumor. Clinicians should be aware that a mushroom-shaped configuration can be seen in such cases, although it is common for uveal melanoma.

BACKGROUND AND OBJECTIVE:

To compare duration and efficacy of the dexamethasone (DEX) intravitreal implant in vitrectomized (pars plana vitrectomy [PPV] group) and non-vitrectomized eyes (control group) with macular edema related to central retinal vein occlusion (CRVO).

PATIENTS AND METHODS:

Eyes that received the DEX implant for CRVO related to macular edema were included in a retrospective chart review. Outcomes measured were best-corrected visual acuity (BCVA) and central macular thickness (CMT)

RESULTS:

Fifteen eyes were included in the study. Eight of 15 eyes had prior vitrectomy. Mean BCVA was 20/160 in both groups. Baseline mean CMT was 550 microns (PPV group) and 556 microns (control group, P = .70), and improved to 307.5 microns (PPV group) and 316.3 microns (control group) (P = .90) after implant. The BCVA was 20/125 (PPV group) and 20/200 (control group) (P = .60). Time to next procedure was similar in both groups.

CONCLUSIONS:

This retrospective study shows similar CMT reductions with DEX implant treatment for CRVO-related macular edema in vitrectomized and non-vitrectomized eyes.

The management of evisceration and enucleation has changed over time. The authors assessed the practice patterns regarding eye removal among oculoplastic surgeons.Internet-based surveys were sent to American Society of Ophthalmic Plastic and Reconstructive Surgeons members regarding preferences in evisceration and/or enucleation, including indications, surgical techniques, preoperative evaluation modalities, implant types used, and postoperative complications experienced.Surgeons who recently completed fellowship training are more likely to perform eviscerations than their senior counterparts. The variety of viable implant types and the use of enucleation or evisceration for certain indications were not always in concordance with historical guiding principles. However, changing trends are in line with the current literature.Current practice patterns reflect recent literature and historical trends.

Retained Descemet's membrane (DM) following penetrating keratoplasty (PKP) is a rare finding that may reduce visual acuity following opacification or endanger the graft endothelium. The association between Nd:YAG laser membranotomy and corneal graft failure is reported. Five of 1,350 patients (0.37%) undergoing PKP for pseudophakic bullous keratopathy or graft failure between 1986 and 2008 presented with inadvertent retained DM located close to the graft endothelium. The membrane opacified within 3 to 4 months, reducing the patients' vision. Nd:YAG laser membranotomy was performed using low energy and few pulses. Patients' visual acuity improved from 6/40 to 6/90 before treatment to 6/15(-) to 6/20 at 2 weeks following membranotomy. However, the corneal graft decompensated within 6 to 8 weeks following this procedure, necessitating repeat PKP, with removal of the retained DM. Nd:YAG laser membranotomy may lead to corneal graft failure due to shockwave damage created by the laser pulses, focused near the endothelial surface.

BACKGROUND AND OBJECTIVE:

To evaluate the clinical outcome and complications of intravitreal injections of triamcinolone acetonide as adjuvant to reduce postoperative macular edema in patients undergoing pars plana vitrectomy for epiretinal membranes.

PATIENTS AND METHODS:

This retrospective comparative study included 22 patients (22 eyes) who underwent pars plana vitrectomy with membrane peeling for the treatment of idiopathic epiretinal membrane. Fifteen eyes (15 patients) received an intravitreal injection of 4 mg (0.1 cc) of triamcinolone acetonide at the end of surgery, and no injection was performed for 7 eyes (7 patients). Main outcome measures were visual acuity and intraocular pressure. Minimum follow-up was 3 months.

RESULTS:

Twenty-two eyes of 22 patients were included in the study. The follow-up ranged from 3 to 12 months. Visual acuity improved in both groups at 3 months; logarithm of the minimum angle of resolution -0.26 ± 0.19 in the triamcinolone acetonide group (P = .001) and -0.26 ± 0.13 in the control group (P = .002). However, there was no statistically significant difference in visual acuity improvement 1, 3, and 12 months postoperatively in the triamcinolone acetonide group compared with the control group (P = .79, = .94, and = .21, respectively). No significant difference in rate of intraocular pressure or intraocular pressure change between the two groups during the follow-up period (P > .05).

CONCLUSION:

The current pilot study suggests that postoperative intravitreal injection of triamcinolone acetonide does not lead to better visual outcomes in patients undergoing pars plana vitrectomy for the treatment of idiopathic epiretinal membranes.

A 62-year-old man with lung cancer presented with a 2-week history of decreased vision and clinical features of cytomegalovirus retinitis. The patient was empirically treated for viral retinitis, but microbiological testing of the vitreous fluid was negative. Based on the suspicion for retinal metastasis, the patient underwent pars plana vitrectomy with retinal biopsy. Surgical techniques included the use of a chandelier illumination to enable bimanual manipulation of the retinal tissue, creation a focal retinal detachment with a 41-gauge subretinal cannula, diathermy demarcation of the biopsy site, localized retinectomy with vertical scissors, endolaser, and long-acting gas tamponade. Histopathologic examination revealed sheets of tumor cells with pleomorphic nuclei and positive staining for cytokeratins consistent with metastatic adenocarcinoma. The patient subsequently underwent external beam radiation and was alive 10 months after presentation. This surgical technique may be valuable in select patients with retinal metastasis for diagnostic, therapeutic, and counseling purposes.