Severe epithelial ingrowth after pars plana vitrectomy ten years after LASIK relifting

Epithelial ingrowth is one of the most significant complications of Laser in Situ Keratomileusis (LASIK) refractive surgery. We present the case of a 72-year-old male with a history of myopic LASIK (1999), who underwent cataract surgery and a second thin LASIK sub-Bowman flap to correct refractive error. Then, three months after pars plana vitrectomy for an epiretinal membrane, the patient complained of progressive vision loss. A diffuse haze of the corneal stroma that did not exist before surgery was observed. As the main suspicion was epithelial ingrowth, the flap was lifted and meticulous de-epithelialization of the stromal bed was performed. Mitomycin C 0.02% was applied, the flap was sutured with 10-0 Nylon, and a bandage contact lens was placed. The epithelialization of the interface after vitrectomy in a patient with LASIK could occur even when it is a rare complication and without obvious flap traumatism.

Corneal endothelial validation in the eye bank: differences in automated methods and repeatability

PURPOSE

To evaluate reproducibility of endothelial cell density (ECD) measurements using the Konan Cell Check D in donor corneas by two different ophthalmologists and to compare the two automated cell count methods (center and flex-center) available in the software of this specular microscope.

METHODS

ECD values were quantified in 54 donor corneas by two independent investigators using the Cell Check D (Konan Medical USA Inc) with both automated cell count methods. In the center method, at least 30 contiguous cells are marked. For the flex-center method, an area is delineated and only the cells within the designated area are counted.

RESULTS

The mean ECD was 2473.81±378.22 cells/mm2. Good ECD intergrader reproducibility for the center (ICC=0.821) and the flex-center method (ICC=0.784) were noted. Poor reliability was observed for coefficient of variation and hexagonality (ICC≤0.265). When both methods for ECD analysis were compared, a moderate correlation for the two independent graders using the two manual (center and flex-center) methods was detected (correlation coefficient of 0.678 and 0.745 for each of the investigators). Comparison between methods yielded significantly higher ECD with the flex-center method (P=0.013). When corneas were divided by ECD, those under 2200 cells/mm2 and those between 2200 and 2700 cells/mm2 also had significantly higher ECD with the flex-center method (P<0.022).

CONCLUSIONS

ECD values are reproducible with both methods, although the flex-center method ECDs tend to be higher, particularly in cases of low ECD. Eye banks and surgeons should exercise caution in making decisions based only on small differences in ECD.

Evaluation of the perception of physical and emotional health of ophthalmologists in Spain and the influence of the COVID-19 pandemic

Objective

The main objective was to study the perception of physical and emotional health of Spanish ophthalmologists and their health habits, as well as the possible influence of the COVID-19 pandemic.

Methods

An observational, cross-sectional, non-randomized and uncontrolled study was carried out among at Spanish ophthalmologists through an online survey of 47 questions on eating habits, tobacco, alcohol, physical exercise, workload, and perception of physical and emotional state.

Results

Of a total of 2,179 ophthalmologists, 260 (11.9%) of whom 55% were men responded to the survey, with a mean age of 52.9 ± 11.4 years. 5.8% were smokers. In total, 51.5% reported good physical health, with a mean Body Mass Index of 24.4 kg/m². Overall, 53.5% reported depression, 66.9% tiredness, 34.6% difficulty sleeping, and 57.3% considered their work hard. Up to 28.5% of those surveyed had thought about leaving their job and 60.8% about reorganizing their workload. In total, 91.9% would continue to choose Ophthalmology as a specialty. In total, 36.2% reported an increase in workload, 42.3% worsening of physical state and 63.8% worsening of emotional state as a consequence of the COVID-19 pandemic.

Conclusions

Spanish ophthalmologists have a positive perception of their physical and emotional health, despite having life habits that are not always healthy and feeling mostly down. The COVID-19 pandemic has had a negative influence on the physical and emotional health of ophthalmologists.

POS1355 TO COMBINE OR NOT TO COMBINE: INFLUENCE OF IMMUNOSUPPRESSIVE DRUG COMBINATION IN THE INDUCTION OF THERAPEUTIC RESPONSE IN NON-INFECTIOUS UVEITIS

Background

Non-infectious uveitides (NIUs) include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational studies showed that the use of ISDs in combination could be more effective than their use in monotherapy. However, a direct comparison between these two treatment strategies has not been carried out yet.

Objectives

To analyze the effect of ISDs combination therapy (CT) on the response rate in patients with NIUs.

Methods

Patients attending a Uveitis Outpatient Clinic from a tertiary care center in Madrid, Spain, and prescribed with ISDs from 1991 to 2018 were included. Patients were assigned as controls or cases based on whether they were prescribed with ISDs in monotherapy (MT) or CT. ISD treatment changes during the observation period were also considered. The primary outcome was good therapeutic response (GTR), defined as the complete resolution of the eye inflammatory manifestations and oral corticosteroid dosage ≤10 mg of prednisone equivalent a day. Furthermore, this situation had to be maintained in at least two consecutive visits spanned at least 28 days. Several propensity score based and non-based weighting techniques for data balancing, followed by Cox regressions, were performed to estimate the effect of CT on the response rate. Random forest (RF) models and clinical appraisal were used to select the variables to be balanced.

Results

100 episodes of ISD prescription belonging to 73 patients were included in this analysis. In 32 episodes, patients were prescribed with CT (in 3 episodes CT was the initial therapeutic strategy; in 29, combination was the result to adding a second or third ISD). The most frequent drug used in MT was cyclosporine A (CYA; n=39), and the most frequent CT was synthetic + biological ISD (n=21). After RF, the number of previously used ISDs, the prescription of CYA, the dosage of oral corticosteroids at prescription, a previous ISD withdrawal due to inefficacy, and duration of disease were selected for balancing. In addition, after clinical appraisal, uveitis diagnosis, prescription with azathioprine, prescription with methotrexate, and eye activity features at prescription (presence of cells in anterior chamber, vitreous haze, macular edema, active chorioretinal lesions) were also balanced. The Energy balancing method showed the best balance for GTR. After Cox-regression, CT prescription did not show a statistically significant effect in the hazard of response (p=0.43; Table 1).

Table 1.

Cox models showing the effect of combination therapy in the hazard of good therapeutic response after balancing covariates using the Energy method.

VariableHR (95% CI)p valueSchoenfeltest p valueCombination Therapy0.66 (0.24-1.83)0.430.82Cyclosporine A prescription3.36 (1.22-9.27)0.0190.96Methotrexate Prescription2.20 (0.72-6.71)0.160.95Presence of cell in anterior chamber1.75 (0.83-3.72)0.140.89

Conclusion

The use of CT in our study was not associated with a better therapeutic response in NIU patients compared with the prescription of MT. Considering that most CT episodes were the result of the addition of a new ISD in a patient already treated and still active, the effectiveness of CT as the initial therapeutic strategy remains unanswered.

Disclosure of Interests

None declared

POS1354 ANALYSIS OF FACTORS ASSOCIATED WITH GOOD THERAPEUTIC RESPONSE TO IMMUNOSUPPRESSIVE DRUGS IN PATIENTS WITH NON-INFECTIOUS UVEITIS: A SURVIVAL ANALYSIS

Background

Non-infectious uveitides (NIUs) encompass a varied group of inflammatory diseases affecting the uvea and adjacent tissues, with evidence suggesting an immune-mediated cause. A correct management of these conditions is essential to prevent substantial and sometimes permanent visual loss and the development of ocular complications. Although immunosuppressive drugs (ISDs) have shown effectiveness in achieving a sustained control of the inflammatory process, not all patients achieve a satisfactory response.

Objectives

To identify factors affecting the response rate to ISDs in subjects with NIUs.

Methods

Longitudinal retrospective study, with patients collected from the Hospital Clinico San Carlos Uveitis Clinic, included from 1991 until December 2018, and followed-up until December 2019. Patients entered the study at ISD prescription and were followed-up until a) the achievement of a good therapeutic response (GTR), b) ISD treatment change (withdrawal of the prescribed ISD and/or addition of a new ISD), c) 12 months of follow-up, or d) loss of follow-up or end of the study (December 31th, 2019). GTR was defined as the complete resolution of the eye inflammatory manifestations and oral corticosteroid ≤10 mg of prednisone equivalent a day. Furthermore, this situation had to be maintained in at least two consecutive visits spanned at least 28 days. Kaplan-Meier (KM) curves were set to account for GTR. Associated demographic, clinical and treatment-related factors were analyzed using bivariate and multivariate Cox robust regression models. Different models were compared using the Akaike Information Criteria, to select the fittest model to the data. Proportional hazard assumption was tested using Schoenfeld residuals and the scaled Schoenfeld residuals. In case a variable or certain category of a categorical variable were non-proportional, they were included in the Cox models with a time-varying effect, in case the interaction with time was significant (p<0.05).

Results

73 patients (100 episodes of ISD prescription) were analyzed. In 44 episodes, a GTR was achieved (incidence rate 102.0 [95% Confidence Interval (CI): 75.9 to 137.1] per 100 patient-years). Figure 1 shows the KM curve for GTR. In the bivariate analysis, several variables showed a significant association with GTR, including gender, diagnosis of Behçet Disease, prescription of Cyclosporine A (CYA), number of previously prescribed ISDs, previous use of the same ISD, previous discontinuation of a ISD due to inefficacy, higher systemic corticosteroid use in the previous year before ISD prescription, presence of macular edema (ME), and longer intermediate and posterior activity before ISD prescription. Table 1 shows the results of the multivariate analysis. Prescription of CYA was associated with a higher hazard of GTR, compared with the use of other ISDs (methotrexate, azathioprine or biologic drugs). In addition, the higher dosage of oral corticosteroids used in the previous year before ISD prescription, the lower the hazard of achieving a GTR. Finally, presence of ME at prescription was associated with lower hazard of GTR, although this risk diminished with time.

Table 1.

Multivariate Cox robust regression to analyze variables independently associated with the achievement of good therapeutic response.

VariableHR (95% CI)p valueSchoenfel test p valueCYA prescription2.04 (1.14-3.67)0.0170.56Number of previous ISDs0Reference--112.61 (2.07-76.73)5.9x10-30.001≥23.54 (1.55-8.05)2.6x10-30.561 previous ISD X Time0.01 (0.001-1.00)0.005Higher oral corticosteroids dosage (mg) in the previous year0.98 (0.97-0.99)0.0130.83Macular edema0.14 (0.04-0.45)9.3x10-30.001Macular edema X Time14.20 (1.55-103.10)0.019Figure 1.

Kaplan-Meier failure curves representing good therapeutic response after immunosuppressive drug prescription for non-infectious uveitis.

Conclusion

We have identified several variables associated with therapeutic response to ISDs in NIUs patients.

Disclosure of Interests

None declared

Poor re-epithelialization following corneal collagen crosslinking with riboflavin-uva for advanced bullous keratopathy: Case series

OBJECTIVE

To assess safety and efficacy of corneal collagen crosslinking (CXL) for advanced bullous keratopathy (BK).

MATERIAL AND METHODS

Eight eyes of eight patients subjected to Dresden CXL protocol.

INCLUSION CRITERIA

BK history of at least one year, severe pain and no indication for keratoplasty due to poor visual prognosis.

VARIABLES

best corrected visual acuity (BCVA), pain (decimal visual scale), central corneal thickness (CCT) by tomography (Pentacam®, Oculus Inc, Germany), corneal bullae and complications.

RESULTS

Seven women and one man of median age 77.00 (range 58-79) years. The median follow-up was 7 (range 5-7) months. BCVA remained unchanged through follow-up. A significant decrease in pain was observed at the end of the follow-up period (median 6, range 5-6 vs. median 0, range 0-4, P=0.05). Corneal tomography could only be performed in three cases, due to poor vision or image quality. A reduction in mean CCT was observed in the first post procedural month (from 708.33±140.48 to 627±136.89μm). In all eight cases, the absence of corneal bullae only persisted for two months after CXL. In six patients, corneal re-epithelialization after CXL was poor; in four of these eyes, the problem was resolved with topical treatment, but in the remaining two eyes, amniotic membrane transplant and mechanical debridement were required.

CONCLUSIONS

In this uncontrolled small case series, CXL treatment improved pain in patients with advanced BK. However, the high rate of poor re-epithelialization requiring surgical treatment observed in one third of cases makes this treatment controversial.

Biometry data and prevalence of corneal astigmatism in caucasian spanish candidates for cataract surgery

PURPOSE

To describe ocular biometric parameters and the prevalence of corneal astigmatism as well as age and gender correlations in a population of cataract surgery candidates and to estimate the number of eyes that would be candidates for a toric intraocular lens (IOL).

METHODS

In consecutive patients requiring cataract surgery over a one-year period (June 2016 to June 2017), the following optical biometry measurements were performed on an IOLMaster 700 or Lenstar 900: axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (K), flat keratometry (K1), steep keratometry (K2), corneal astigmatism (Cyl) and white-to-white diameter (WTW). Descriptive statistics for the demographic and biometric data were analyzed.

RESULTS

The study sample included 6111 eyes of 3332 patients (59.3% women), with a mean age of 74.78±9.7years. The means of the compiled data are as follows: AL 23.58±1.55mm, ACD 3.08±0.41mm, LT 4.55±0.52mm,K 44.15±1.54 diopters (D), K1 43.64±1.57 D, K2 44.69±1.61 D, Cyl 1.0±0.81. D and WTW 11.88±0.46mm. The male patients had significantly larger eyes (higher AL, ACD and WTW) and flatter corneas (lower flat and steep K). Older patients had significantly lower AL, ACD and WTW, while their LT values were higher. Corneas became significantly steeper with age. 60.5% of eyes had less than 1 D of corneal astigmatism, while 3.1% had ≥3.0 D.

CONCLUSIONS

Less than 1 D of corneal astigmatism was present in the majority of cataract surgery candidates. 3.1% of eyes were candidates for a toric IOL. This study provides useful information on inventory requirements for planning hospital resources.

Corneal densitometry and topography in patients with primary congenital glaucoma

OBJECTIVE

To compare corneal densitometry and topography variables in patients with primary congenital glaucoma (PCG) and healthy subjects.

MATERIAL AND METHODS

Cross sectional study, consecutive recruitment with gender- and age-matched control group. Forty eyes of 40 patients in each group were studied with Pentacam corneal topography. The variables compared between the two groups were: intraocular pressure (IOP), visual acuity (VA) and Pentacam (Oculus, Wetzlar, Germany) corneal topography measurements: mean and maximum keratometry (Km, Kmax), cylinder (Cyl), anterior elevation apex (AEA), central anterior elevation (CAE), maximum anterior elevation (MAE), posterior elevation apex (PEA), central posterior elevation (CPE), maximum posterior elevation (MPE), pachymetry and anterior, mid-stromal and posterior corneal densitometry in the 0-2mm, 2-6mm, 6-10mm zones.

RESULTS

Significant differences between patients and healthy controls were detected in the topographic variables MAE (P=0.002) and MPE (P<0.001), and in all the densitometry variables (anterior, mid-stromal, posterior for the 0-2mm, 2-6mm and 6-10mm zones) (P<0.001 each). In the PCG group, negative correlation was observed between VA and total densitometry (r=-0.49; P=0.004).

CONCLUSION

Patients with PCG and healthy subjects display differences in corneal densitometry and topographic measurements. PCG patients show greater corneal density with an inverse relationship between visual acuity and higher elevation (anterior and posterior values).

Assessment of ocular redness measurements obtained with keratograph 5M and correlation with subjective grading scales

OBJECTIVE

To examine correlations between ocular redness scores provided by the Keratograph 5M and those determined using two image-based grading scales.

METHODS

Observational prospective cross-sectional study. Two hundred and twenty six eyes of two hundred and twenty six participants (175 patients using anti-glaucoma eye drops and 51 subjects untreated). All subjects were scored automatically using the keratograph 5M. These redness scores (RS) were then correlated with the gradings provided by the Efron and McMonnies/Chapman-Davies scale (MC-D) scales (two observers).

RESULTS

Excellent reproducibility was observed for both the Efron (weighted K=0.897, 95% CI 0.823-0.904) and MC-D (weighted K=0.783, 95% CI 0.752-0.795) scales. Keratograph RS and the scores obtained with both Efron (Spearman's Rho=0.43, P<0.001) and MC-D (Spearman's Rho=0.48, P<0.001) scales were significantly correlated. RS for the bulbar and limbal - nasal and temporal quadrants also correlated moderately with the two subjective scales. Through Bland Altman analysis, poor agreement was detected between the objective and subjective methods: agreement values for the Efron scale or MC-D scale (matching scorers between observers) versus overall RS showed high biases (-15.58 and -22.05 respectively) and wide limits of agreement (LOA) (-46.169 to 15.005 and -52.534 to 8.19 respectively). Lowest bias was observed between temporal limbal RS and Observer 2 Efron score (-0.04).

CONCLUSIONS

Although it emerged as a reliable objective method, the keratograph 5M overestimated the scores compared with the subjective grading scales when used to grade the degree of ocular redness. Therefore, they should not be interchangeable methods.

Confocal biomicroscopy in four patients with polychromatic corneal dystrophy

INTRODUCTION

Polychromatic corneal dystrophy is an unusual pre-descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy.

CLINICAL CASES

Four women, between 36 and 72 year-old, with the diagnosis of polychromatic corneal dystrophy in routine reviews. None reported visual symptoms or ocular history of interest. Anterior biomicroscopy showed multiple and small multicoloured brilliant opacities in the posterior area of the corneal stroma, with normal epithelium and anterior stroma. The opacities were bilateral and distributed throughout the entire cornea. Direct family members were examined, but none of them showed opacities. In the specular biomicroscopy, a normal endothelium, with pre-descemet hypereflective particles, was observed. With confocal microscopy, there were no abnormalities in epithelium, Bowman layer, or sub-basal nervous plexus. In two cases, the anterior stroma showed hyper-reflective keratocytes and with small hypereflective particles among them. In the middle stroma, hyper-reflective keratocytes were seen in the four cases, two of them showed tiny hypereflective particles, and in the other two there were abnormal keratocytes with prominent cytoplasmic processes. Posterior stroma in the four cases showed a lot of hypereflective keratocytes and hypereflective particles of different sizes. These particles prevented examining the endothelium.

CONCLUSIONS

Polychromatic corneal dystrophy has typical signs that allow it to be diagnosed and characterised. Although the biomicroscopy image only seems to show alterations in the posterior stroma, confocal microscopy shows that the dystrophy affects the entire corneal stroma.

Fibrin glue conjunctival autograft for primary pterygium: Overall outcomes and outcomes in expert versus trainee ophthalmologists

INTRODUCTION

To determine outcomes of conjunctival autograft attached with fibrin glue (FG) for primary pterygium, and compare these outcomes in expert versus closely supervised trainee ophthalmologists.

METHODS

This was a retrospective, comparative, non-randomized, interventional study. Patients were recruited among those with primary nasal pterygium undergoing FG conjunctival autograft. Surgery was performed by expert (136 eyes) or closely supervised trainee (128 eyes) ophthalmologists. Mean follow-up was 7.82±8.23months. Main outcome measures were recurrence rate, reoperation rate and complications.

RESULTS

The study sample comprised 264 eyes of 225 patients. Participants were of mean age 47.09±12.89years; 46.7% were male, 28.4% Caucasian and 70.5% Hispanic. Recurrence was recorded in 6.4%: 5.9% in the expert group and 7% in the trainee group (P=0.704) and reoperation in 1.9%: 0.7% and 3.1% (P=0.202), respectively. Both groups showed similar rates of complications such as transient graft edema, graft dehiscence, hematoma or ocular hypertension. Reoperation was slightly more frequent in patients younger than 40years (P=0.064).

CONCLUSIONS

Good outcomes were observed for FG conjunctival autografting in primary pterygium surgery, with no differences recorded between supervised trainee and expert surgeons. Our findings suggest the need to supervise pterygium surgeries during training.

Agreement and clinical comparison between a new swept-source optical coherence tomography-based optical biometer and an optical low-coherence reflectometry biometer

PurposeTo compare measurements taken using a swept-source optical coherence tomography-based optical biometer (IOLmaster 700) and an optical low-coherence reflectometry biometer (Lenstar 900), and to determine the clinical impacts of differences in their measurements on intraocular lens (IOL) power predictions.MethodsEighty eyes of 80 patients scheduled to undergo cataract surgery were examined with both biometers. The measurements made using each device were axial length (AL), central corneal thickness (CCT), aqueous depth (AQD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW), and pupil diameter (PD). Holladay 2 and SRK/T formulas were used to calculate IOL power. Differences in measurement between the two biometers were determined using the paired t-test. Agreement was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots.ResultsMean patient age was 76.3±6.8 years (range 59-89). Using the Lenstar, AL and PD could not be measured in 12.5 and 5.25% of eyes, respectively, while IOLMaster 700 took all measurements in all eyes. The variables CCT, AQD, LT, and MK varied significantly between the two biometers. According to ICCs, correlation between measurements made with both devices was excellent except for WTW and PD. Using the SRK/T formula, IOL power prediction based on the data from the two devices were statistically different, but differences were not clinically significant.ConclusionsNo clinically relevant differences were detected between the biometers in terms of their measurements and IOL power predictions. Using the IOLMaster 700, it was easier to obtain biometric measurements in eyes with less transparent ocular media or longer AL.

Effect of pharmacological pupil dilation on measurements and iol power calculation made using the new swept-source optical coherence tomography-based optical biometer

PURPOSE

To determine whether pupil dilation affects biometric measurements and intraocular lens (IOL) power calculation made using the new swept-source optical coherence tomography-based optical biometer (IOLMaster 700^©; Carl Zeiss Meditec, Jena, Germany).

PROCEDURES

Eighty-one eyes of 81 patients evaluated for cataract surgery were prospectively examined using the IOLMaster 700^© before and after pupil dilation with tropicamide 1%. The measurements made were: axial length (AL), central corneal thickness (CCT), aqueous chamber depth (ACD), lens thickness (LT), mean keratometry (MK), white-to-white distance (WTW) and pupil diameter (PD). Holladay II and SRK/T formulas were used to calculate IOL power. Agreement between measurement modes (with and without dilation) was assessed through intraclass correlation coefficients (ICC) and Bland-Altman plots.

RESULTS

Mean patient age was 75.17±7.54 years (range: 57-92). Of the variables determined, CCT, ACD, LT and WTW varied significantly according to pupil dilation. Excellent intraobserver correlation was observed between measurements made before and after pupil dilation. Mean IOL power calculation using the Holladay 2 and SRK/T formulas were unmodified by pupil dilation.

CONCLUSIONS

The use of pupil dilation produces statistical yet not clinically significant differences in some IOLMaster 700^© measurements. However, it does not affect mean IOL power calculation.

Acute glaucoma in a patient with an Artisan® due to trabecular blockage after combined intravitreal treatment for macular oedema

CASE REPORT

We present a 71-year-old patient with an Artisan(®) implant and macular oedema associated with unsatisfactory response to repeated intravitreal corticosteroids. An intravitreal Trigon(®) and Avastin(®) combined injection was given, and acute glaucoma developed. Anterior chamber washout was performed to resolve the rise in intraocular pressure. In spite of an excellent macular response, this was only temporary, and the corneal endothelium, which had remained competent so far, suffered irreversible damage.

DISCUSSION

The combination of both treatments, along with the particular anatomic features in these patients, may have been precipitating factors in this unfortunate outcome.

[Charles Bonnet syndrome precipitated by brimonidine]

CASE REPORT

An 81-year-old woman with age-related macular degeneration and pseudoexfoliative glaucoma developed visual hallucinations (faces, flowers and frames) shortly after beginning brimonidine drops. Neurologic and psychiatric examination was normal. Visual hallucinations disappeared within 10 days after discontinuing the drug.

DISCUSSION

The Charles Bonnet syndrome (CBS) is characterised by complex visual hallucinations in elderly patients in the setting of significant visual impairment without any psychiatric symptoms. Awareness of CBS among ophthalmologist is essential. Clinicians should treat visual impairment and be aware of possible visual hallucinations in patients treated with brimonidine.

[Pupillary block acute glaucoma due to acrylic intraocular lens posterior dislocation after Nd:YAG capsulotomy]

CASE REPORT

We present the clinical case of a 68 year-old woman who developed a pupillary block acute glaucoma due to vitreous hernia into anterior chamber following posterior dislocation of the intraocular lens one month after an Nd:YAG capsulotomy.

DISCUSSION

We should consider these symptoms in the differential diagnosis of pseudophakic acute glaucoma, especially when visualisation of the anterior chamber is difficult due to corneal oedema and Nd:YAG capsulotomy was done.

[Choroidal metastasis from a breast carcinoma. Diagnosis and follow-up with optical coherence tomography and fluorescein angiography and autofluorescence with HRA-II (Heidelberg Retina Angiograph)]

CLINICAL CASE

A 69-year-old woman developed choroidal metastasis from a breast carcinoma 2 years after the initial diagnosis, surgery and chemotherapy. After treatment with palliative chemotherapy and external radiotherapy, we used fluorescein angiography (FA) and optical coherence tomography (OCT) to evaluate the resolution of the serous retinal detachment, as well as a later relapse in the optic nerve.

DISCUSSION

OCT is useful in the follow-up of choroidal metastasis after treatment. However, OCT imaging is limited by the initial choroidal location of metastasis. The autofluorescence can detect exudative tumoral activity even without obvious changes in OCT or FA.