An international collaborative evaluation of central serous chorioretinopathy: different therapeutic approaches and review of literature. The European Vitreoretinal Society central serous chorioretinopathy study

PURPOSE

To study and compare the efficacy of different therapeutic options for the treatment of central serous chorioretinopathy (CSCR).

METHODS

This is a nonrandomized, international multicentre study on 1719 patients (1861 eyes) diagnosed with CSCR, from 63 centres (24 countries). Reported data included different methods of treatment and both results of diagnostic examinations [fluorescein angiography and/or optical coherent tomography (OCT)] and best-corrected visual acuity (BCVA) before and after therapy. The duration of observation had a mean of 11 months but was extended in a minority of cases up to 7 years. The aim of this study is to evaluate the efficacy of the different therapeutic options of CSCR in terms of both visual (BCVA) and anatomic (OCT) improvement.

RESULTS

One thousand seven hundred nineteen patients (1861 eyes) diagnosed with CSCR were included. Treatments performed were nonsteroidal anti-inflammatory eye drops, laser photocoagulation, micropulse diode laser photocoagulation, photodynamic therapy (PDT; Standard PDT, Reduced-dose PDT, Reduced-fluence PDT), intravitreal (IVT) antivascular endothelial growth factor injection (VEGF), observation and other treatments. The list of the OTHERS included both combinations of the main proposed treatments or a variety of other treatments such as eplerenone, spironolactone, acetazolamide, beta-blockers, anti-anxiety drugs, aspirin, folic acid, methotrexate, statins, vitis vinifera extract medication and pars plana vitrectomy. The majority of the patients were men with a prevalence of 77%. The odds ratio (OR) showed a partial or complete resolution of fluid on OCT with any treatment as compared with observation. In univariate analysis, the anatomical result (improvement in subretinal fluid using OCT at 1 month) was favoured by age <60 years (p < 0.005), no previous observation (p < 0.0002), duration less than 3 months (p < 0.0001), absence of CSCR in the fellow eye (p = 0.04), leakage outside of the arcade (p = 0.05) and fluid height >500 μm (p = 0.03). The OR for obtaining partial or complete resolution showed that anti-VEGF and eyedrops were not statistically significant; whereas PDT (8.5), thermal laser (11.3) and micropulse laser (8.9) lead to better anatomical results with less variability. In univariate analysis, the functional result at 1 month was favoured by first episode (p = 0.04), height of subretinal fluid >500 μm (p < 0.0001) and short duration of observation (p = 0.02). Finally, there was no statistically significant difference among the treatments at 12 months.

CONCLUSION

Spontaneous resolution has been described in a high percentage of patients. Laser (micropulse and thermal) and PDT seem to lead to significant early anatomical improvement; however, there is little change beyond the first month of treatment. The real visual benefit needs further clarification.

Acquired perforating collagenosis associated with ranibizumab injection and succesfully switched to aflibercept

Objective: To report a case of acquired reactive perforating collagenosis (ARPC) triggered by an intravitreal ranibizumab injection that was successfully treated by switching to aflibercept (AFL).

Methods: A 73-year-old Caucasian man with an occult choroidal neovascular membrane in the right eye received three-monthly intravitreal ranibizumab injections. Two weeks after the second ranibizumab injection, he complained about a generalized, excessively pruriginous eruption that was further exacerbated by the third injection. On the basis of clinical and histological findings, he was diagnosed with ARPC and treated with narrow band ultraviolet-B (NBUVB) phototherapy.

Results: He was subsequently switched to intravitreal AFL injections administered according to a pro re nata regimen. Following NBUVB phototherapy, three additional AFL injections were required. Still, the reactive perforating collagenosis was in remission and the choroidal neovascular membrane was inactive.

Conclusions: Our case is the first report of ARPC after ranibizumab injections. Both the skin lesions and the choroidal neovascular membrane were successfully treated after switching to AFL.

The Efficacy and Safety of Intravitreal Dexamethasone Implant for the Treatment of Macular Edema Related to Retinal Vein Occlusion: Real-life Data and Prognostic Factors in a Turkish Population

Objectives:

To evaluate the efficacy and safety of dexamethasone (DEX) implants as mono or combination therapy for macular edema in retinal vein occlusion (RVO) with real-life conditions, and to detect factors that influence final visual acuity.

Materials and Methods:

Twenty-five eyes with macular edema secondary to RVO underwent assessments for central macular thickness (CMT), best-corrected visual acuity (BCVA), adverse events, and also morphologic changes in optical coherence tomography at an interval of 4-8 weeks after at least one DEX implant.

Results:

Seventeen eyes with branch RVO and 8 eyes with central RVO were eligible for the study. The mean follow-up duration was 17 months (range, 12-26 months). Both mean BCVA (p=0.009) and CMT (p=0.006) improved significantly, and visual gains of ≥3 lines were achieved in 32% and ≥2 lines in 52% at the end of the follow-up period. The most powerful individual predictor of final visual acuity was baseline BCVA (r2=0.611, p<0.001, stepwise multiple regression), but the most efficient model was the combination of the ellipsoid zone (EZ) integrity and baseline BCVA (r2=0.766, p<0.001, stepwise multiple regression). Complication rates were very low after repeated DEX implants.

Conclusion:

DEX implant seems to be an effective and safe treatment for macular edema in RVO despite negative real-life factors, and visual outcomes are associated with baseline visual acuity and EZ integrity.

External ophthalmomyiasis seen in a patient from Istanbul, Turkey

Ophthalmomyiasis externa, results from infestation of the conjunctiva by the larval form of Oestrus ovis. It is usually seen in rural areas. We report a case with ophthalmomyiasis externa in a young man living in an urban area (Istanbul, Turkey) who had no known history of traveling to the rural area. Even in patients living in urban areas ophthalmomyiasis externa should be taken into consideration in differential diagnosis of red eye.

Screening for retinopathy of prematurity in a tertiary hospital in Istanbul: incidence and risk factors

PURPOSE

To study the incidence and risk factors of retinopathy of prematurity (ROP) in premature infants examined in a tertiary hospital in Istanbul.

METHODS

Data of infants screened for ROP from April 2007 to September 2009 were retrospectively reviewed. Possible risk factors and eye examinations were recorded and analyzed using the chi-square test and univariate and multivariate regressions.

RESULTS

ROP was detected in 177 (34.3%) of the 517 infants enrolled in the study; 64 had mild ROP (77.4%) and 38 had severe ROP (22.6%). The mean gestational age and birth weight of patients who were treated for ROP were 28.6 ± 2.3 and 1,143.5 ± 337.4, respectively. Two of these infants had a gestational age of 32 g or greater and three had a birth weight of 1,500 g or greater. The multivariate regression analyses showed gestational age, birth weight, sepsis, respiratory distress syndrome, and length of oxygen therapy as independent predictors of ROP.

CONCLUSION

The incidence of ROP observed in this study was higher than that in developed countries and relatively more mature infants were affected. Criteria including gestational age of less than 34 weeks or birth weight of less than 2,000 g would have identified all infants who were at risk.

A cluster of acute-onset postoperative endophthalmitis over a 1-month period: investigation of an outbreak caused by uncommon species

AIM

To report the clinical course, treatment response and prognosis of eight cases which developed acute-onset postoperative endophthalmitis over a 1-month period.

METHODS

8 patients who were operated on over a period of 1 month and developed acute postoperative endophthalmitis were evaluated. Five of the patients had cataract surgery, one had cataract surgery combined with silicone extraction, and two patients had pars plana vitrectomy (PPV). Clinical patterns were observed, intraocular cultures were obtained, and the source of the organisms causing the epidemic was investigated. All patients had intravitreal antibiotic injections, three had PPV, and in two patients anterior chamber irrigation was performed.

RESULTS

Vitreous cultures showed Cellulosimicrobium cellulans in three cases and Stenotrophomonas maltophilia in one case. Four of the cases were culture negative. Stenotrophomonas maltophilia were also isolated from unused bottles of irrigating solutions. The final visual acuity of the patients ranged between HM and 7/10. All three patients with Cellulosimicrobium cellulans had a final visual acuity of ≥ 5/10. The available irrigating solutions were changed, and the endophthalmitis did not recur.

CONCLUSIONS

The authors are unaware of any previous reports of postoperative endophthalmitis associated with Cellulosimicrobium cellulans. Prompt management with microbiological support, intravitreal antibiotics and PPV when needed were the key to good visual outcomes in this endophthalmitis outbreak.