Abstract: Four challenging and unusual retinal cases: (I) 11-year follow-up for retinal hemangioblastoma with von Hippel-Lindau (VHL) disease; (II) treatment for central serous chorioretinopathy (CSC)—observation, half does photodynamic therapy (PDT) or micropulse laser photocoagulation; (III) diagnosis and treatment for a child with optic nerve defect; (IV) the optional treatment for retinal detachment (RD) with iridolenticular choroidal coloboma, were presented and discussed by three international retinal specialists at a retinal clinical round in Fundus Diseases Center of Zhongshan Ophthalmic Center (ZOC). The discussion helps us a better understanding of the pathogenesis and managements of these four retinal diseases and their association with systemic conditions.
Abstract: Primary vitreoretinal lymphoma (PVRL), as a subset of primary central nervous system lymphoma (PCNSL), is a rare and fatal ocular malignancy. Most PVRL masquerades as chronic posterior uveitis, which makes the clinical diagnosis challenging. Vitreous cells, subretinal lesions and imaging techniques are essential for clinical diagnosis. Importantly, cytopathology/histopathology identification of malignant cells is the gold standard for the diagnosis of PVRL. In addition, molecular detection of immunoglobulin heavy chain (IgH) or T cell receptor (TCR) gene rearrangements, immunophenotyping for cell markers, and cytokine analysis of interleukine-10 elevation are often used as adjunct procedures. Current management of PVRL involves local radiation, intravitreal chemotherapy (methotrexate and rituximab), with or without systemic chemotherapy depending on the involvement of non-ocular tissues. In cases with concomitant PCNSL, systemic high-dose methotrexate/rituximab based therapy in conjunction with local therapy, whole brain radiotherapy and/or autologous stem cell transplantation is considered. Although PVRL normally responds well to initial treatment, high rates of relapse and CNS involvement usually lead to poor prognosis and limited survival. A professional team of medical experts in ophthalmologists, ocular pathologists, neuro-oncologists and hemato-oncologists is essential for optimizing patient management.
Background: To report a new simplified surgical technique to manage small iris coloboma or traumatic iris defect.
Methods: A new surgical technique in which simplified pupilloplasty technique through only a clear corneal paracentesis to manage the iris coloboma or traumatic iris defect within the 120° range was designed. A retrospective revision of the medical records of patients treated with this technique between the years 2013 and 2016 was made. Six eyes of six patients with iris coloboma or traumatic iris defect treated with this new technique were included.
Results: All the operated eyes quickly recovered with central round pupil, negligible complications, inessential symptoms of photophobia and glare, and mild inflammation after a median follow-up time of 22 months (range: 6–34 months).
Conclusions: The simplified pupilloplasty technique presented here could be a good alternative for the management of small iris coloboma or traumatic iris defect.
Background: To evaluate efficacy and safety of combined pars plana vitrectomy (PPV) and scleral fixated intraocular lens (SFIOL) surgery as a single procedure.
Methods: Retrospective interventional case series done at a tertiary eye care center in Northern India. Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.
Results: Mean age of the patients was 43.36±15.12 years (range, 22–64 years). Eight were male. Mean baseline best corrected visual acuity (BCVA) was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units, the visual gain being statistically significant (P=0.021). None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units. Choroidal detachment (CD) was the only notable complication, seen in three patients. Other complications included two cases of intraoperative retinal breaks, a case each of reversible corneal edema, ocular hypertension and cystoid macular edema.
Conclusions: Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery. There may be short-term reversible complications with no impact on final visual gain.
Abstract: Myopia and astigmatism, two common refractive errors frequently co-exist, are degrading vision at all working distances in populations worldwide. Eyeballs having high degrees of myopia and astigmatism are known to exhibit abnormal eye shape at the anterior and posterior eye segments, but whether the outer coats of these abnormal eyeballs, cornea anteriorly and sclera posteriorly, are regulated by region-specific molecular mechanism remains unclear. Here we presented the changes in eye shape and mRNA expression levels of three genes (MMP2, TIMP2, and TGFB2), all known to participate in extracellular matrix organization, at five regions of the cornea and sclera in chickens developing high myopia and astigmatism induced by form deprivation. Our results showed that, compared to normal chicks, the highly myopic-astigmatic chicks had significantly astigmatic cornea, deeper anterior chamber, longer axial length, and higher expressions of all three genes in the superior sclera. These results imply that local molecular mechanism may manipulate the eye’s structural remodeling across the globe during refractive eye growth.
Abstract: Angle closure glaucoma (ACG) is one of the major causes of blindness. Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris, which results in increased intraocular pressure (IOP) through impaired aqueous flow. Considering pupillary block by crystalline lens is the most frequent mechanism, lens extraction is regarded as an effective therapy. Recently, to validate the effect of lens extraction, the EAGLE study was reported. In this study, subjects were 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure (PAC) with intraocular pressure 30 mmHg or greater or primary angle-closure glaucoma (PACG), and were divided into clear-lens extraction group and standard care group (laser peripheral iridotomy and topical glaucoma medication). This study suggested that clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy. Initial clear lens extraction showed better clinical course and patient-reported outcomes. This study provided evidence to support clear lens extraction as the first line treatment for PAC with high IOP or PACG patients.
