Patients with aphakic lens status, anterior chamber intraocular lens with a disrupted posterior capsule, posterior chamber intraocular lens and a ruptured capsule, prior vitrectomy, and large peripheral iridectomies may be susceptible to migration of dexamethasone intravitreal implants into the anterior chamber.
Hydroxychloroquine (HCQ), an antimalarial drug in use since 1955, is still used with great success in the treatment of systemic lupus erythematosis and other rheumatological diseases. HCQ is generally well tolerated and its side effect profile confers many advantages over many other immunosuppressive agents. However, HCQ is known to induce retinopathy. Unfortunately, HCQ-induced retinopathy can present insidiously with subtle color vision changes and paracentral scotoma, which makes early detection difficult. Moreover, cessation of HCQ does not typically result in resolution of the visual loss, and vision loss may actually continue to progress even after HCQ is stopped. Therefore, identifying those patients most at risk for development of retinopathy is of the utmost importance, and adequate screening of patients taking HCQ is recommended. A brief case presentation of a patient who has developed retinal toxicity from hydroxychloroquine is provided along with a discussion regarding the characteristic retinopathy and review of current screening recommendations.
BACKGROUND AND OBJECTIVE:
The management of premacular hemorrhage secondary to non-accidental trauma (NAT) is unclear. The authors describe the outcomes of NAT infants referred for surgical evaluation of premacular hemorrhage.
PATIENTS AND METHODS:
Retrospective institutional review board-approved case series between 2000 and 2019 of vision-threatening premacular hemorrhage (sub-hyaloid or sub-internal limiting membrane hemorrhage without vitreous hemorrhage) in NAT infants. Time to hemorrhage resolution, vision, and comorbidities were collected.
RESULTS:
Thirty-six patients (62 eyes) with mean age of 5.4 months (range: 2–10 months) were included. Nine eyes (14.5%) underwent vitrectomy. Median time to hemorrhage resolution by observation was 75 days (interquartile range [IQR]: 60–120 days), and time to vitrectomy was 54.5 days (IQR: 47.8–58.5 days). Eight eyes (12.9%) had amblyopia, which was not significantly different between groups. Despite hemorrhage clearance, a higher proportion of eyes in the vitrectomy group had pigmentary changes (
P
= .04) and strabismus (
P
= .002) at follow-up.
CONCLUSIONS:
Most cases of NAT-related premacular hemorrhage resolve within 3 months without surgical intervention. Comorbidities may limit visual prognosis.
[
Ophthalmic Surg Lasers Imaging Retina.
2020;51:715–722.]
To demonstrate a surgical technique for visualization and removal of visually significant posterior capsule opacification (PCO) in a patient with a telescope prosthesis for end-stage age-related macular degeneration, in what is to our knowledge the first reported case of visually significant PCO associated with the use of this device. Methods: A pars plana capsulotomy using a 25-gauge vitrector was performed to remove PCO. Results: Pars plana capsulotomy was performed and visual acuity improved to pre-PCO levels. Challenges associated with the management of this condition are discussed. Conclusions: The development of visually significant PCO in patients with a telescope prosthesis is a rare occurrence that poses a unique treatment dilemma. Given the risks of damaging the device with Nd:YAG laser, a method for pars plana capsulotomy using a 25-gauge vitrectomy instrument was determined and successfully performed to remove PCO in a telescope-implanted eye.
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