In Brief Purpose: To report the visual outcomes and ocular complications of intravitreal triamcinolone acetonide (IVTA) in the treatment of the nonproliferative stage of type II idiopathic parafoveal telangiectasia (IPT). Methods: Retrospective, multicenter, uncontrolled interventional case series of 19 eyes of 14 consecutive patients with the nonproliferative stage of IPT that had undergone at least one intravitreal injection of 4 mg of triamcinolone acetonide. Demographic, medical, and ocular data were obtained through chart review. The main outcome measures included best-corrected visual acuity at several timepoints of follow up and ocular complications. Results: At baseline the mean logMAR visual acuity was 0.83 ± 0.41 (Snellen 20/135, range 0.3–2). After an average follow-up of 21.2 months (range 6–44 months), the mean logMAR visual acuity remained essentially unchanged from baseline. At 3 months, the logMAR visual acuity was 0.86 ± 0.44 (Snellen 20/145, P = 0.8378), at 6 months 0.86 ± 0.42 (Snellen 20/145, P = 0.8149), at 12 months 0.87 ± 0.46 (Snellen 20/148, P > 0.9999), at 18 months 0.84 ± 0.35 (Snellen 20/138, P = 0.8385), and at the last follow-up 0.82 ± 0.44 (Snellen 20/132, P = 0.9301). Seven eyes were reinjected once. Ten of 19 eyes (53%) developed cataract (3 eyes underwent phacoemulsification and intraocular lens implantation) and 7 of 19 eyes (37%) had an elevated intraocular pressure, none of which required surgical treatment. Conclusion: IVTA does not seem to improve visual acuity in most eyes with the nonproliferative stage of IPT. The "macular edema" seen in the nonproliferative stage of type II idiopathic perifoveal telangiectasia (IPT) is probably not a true edema as seen in other retinal vascular disorders. Intravitreal triamcinolone does not seem to improve visual acuity in most eyes with the nonproliferative stage of IPT.
To evaluate the visual acuity results of monthly ranibizumab injections compared with a variable-dosing schedule for the treatment of neovascular age-related macular degeneration.A retrospective study that compared two cohorts of consecutive patients. All patients were treatment naive, with baseline visual acuity of 20/400 or better, and completed 12 months of therapy. In the first group all patients received monthly injections. In the other group, after 3 monthly loading doses, a variable-dosing schedule was used, based on a monthly clinical assessment and optical coherence tomography.Fifty-six consecutive patients (60 eyes) were included. At 12 months the median number of injections were 12 and 8, respectively, and the mean change in Snellen visual acuity was an improvement of 0.27 logarithm of the minimum angle of resolution in the monthly treated group versus 0.21 logarithm of the minimum angle of resolution improvement in the variable-dosing group (P = 0.53). In the monthly treated group 96.8% of eyes lost <0.3 logarithm of the minimum angle of resolution versus 96.6% of eyes in the variable-dosing group (P = 1.0).We were able to show that in our clinical setting patients achieved similar visual acuity results with either monthly injections or with a variable-dosing protocol. There was a trend toward better results with monthly treatment.
To report two cases of acute syphilitic posterior placoid chorioretinitis (ASPPC) with choriocapillaris flow voids that partially resolved with systemic antibiotic treatment.Observational case report with multimodal imaging.Two young healthy men suffered an acute monocular loss of vision. Spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCT-A) revealed outer retinitis with loss of the ellipsoid layer and choriocapillaris flow voids. Systemic work-up revealed syphilis. Upon systemic treatment with antibiotics, the patients recovered their vision and the OCT and OCT-A abnormalities partially resolved.Transient choriocapillaris flow voids characterize ASPPC and may be responsible for the visual loss seen in these patients.
In Brief Purpose: To report the 6-month anatomical and visual outcomes after injecting two different doses of intravitreal bevacizumab in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: An interventional, retrospective multicenter study of 45 eyes that were treated with at least one intravitreal injection (24 eyes, 1.25 mg; 21 eyes, 2.5 mg) of bevacizumab is reported. The main outcome measures were the central 1-mm macular thickness (CMT) and the change in ETDRS lines of best-corrected visual acuity (BCVA) at 6 months. Results: Forty-five eyes were injected on average 26.1 months (range, 3–86 months) after the diagnosis. The average follow-up was 35.2 weeks (range, 24–52 weeks). All patients completed at least 6 months of follow-up. In the 1.25-mg dose group, at 1 month, there was an average gain of 4.5 lines of BCVA; at 3 months, 5.1 lines of BCVA; and at 6 months, 5.1 lines of BCVA (P < 0.005). In the 2.5-mg dose group, at 1 month, there was an average gain of 2.3 lines of BCVA; at 3 months, 3.8 lines of BCVA; and at 6 months, 4.8 lines of BCVA (P = 0.05). In the 1.25-mg dose group, the mean CMT ± SD decreased from 461 ± 211 μm at baseline to 321 ± 152 μm at 1 month, 273 ± 99 μm at 3 months, and 277 ± 114 μm at 6 months (P = 0.0002). In the 2.5-mg group, the mean CMT ± SD decreased from 385 ± 168 μm at baseline to 279 ± 111 μm at 1 month, 249 ± 97 μm at 3 months, and 240 ± 93 μm at 6 months (P = 0.011). Conclusion: There were no statistically significant differences between the two dose groups with regard to the number of injections and anatomical and functional outcomes. Intravitreal injection of bevacizumab at doses up to 2.5 mg appears to be effective in improving BCVA and reducing CMT in BRVO in the short term. Multiple injections are needed in a large number of eyes for continued control of macular edema and preservation of visual acuity in the short term. Longer studies are needed to determine what role if any intravitreal injection of bevacizumab may play in the long-term treatment of this condition. Intravitreal injection of bevacizumab at doses of 1.25 mg or 2.5 mg appears to be effective in reducing macular edema and improving visual acuity in eyes with branch retinal vein occlusion. However, reinjections are necessary in a large number of eyes to maintain a beneficial effect during the short term.
