letters in the higher-dose group and 1 letter in the lowerdose group. At the visit 10 ± 2 weeks after stopping the levodopa treatment, the mean change in visual acuity in the amblyopic eye from baseline was ϩ5 (±4) letters in the lowerdose group and ϩ4 (±5) letters in the higher-dose group. Levodopa-carbidopa was not discontinued by any subject during the 9-week dosing regimen. Adverse events were reported for 8 of 16 subjects (29 events) in the lowerdose group and 11 of 17 subjects (26 events) in the higherdose group (eTable 2). No adverse events were considered serious. Headaches were reported by 6 subjects; a cold, upper respiratory tract infection, and cough were reported by 6; rash was reported by 4; and nausea and vomiting were reported by 3. Comment. We enrolled a small cohort to gain experience with the drug, define the treatment dose for a future trial, and develop study procedures. The results suggested that levodopa-carbidopa therapy for residual amblyopia in older children and teenagers is well tolerated and may improve visual acuity. There was a suggestion of partial regression of the improvement in visual acuity after treatment was discontinued. No serious adverse effects were noted. Headache and nausea were infrequent. Without a patching-only control group, no conclusions about the efficacy, safety, or frequency of adverse effects associated with this treatment can be made. A placebo-controlled trial is necessary to determine whether levodopa can successfully augment occlusion therapy in the treatment of amblyopia.

Because the pearl necklace configuration can be found adjacent to hard exudates in the outer plexiform layer, the authors speculate that the hyperreflective material is composed of lipoproteins or lipid-laden macrophages. This novel spectral domain optical coherence tomography sign gives further insight into the development and progression of hard lipoprotein exudates in exudative maculopathy.

Purpose To describe the treatment of macular oedema secondary to branch retinal vein occlusion (BRVO) with concomitant pars plana vitrectomy/arteriovenous sheathotomy and intraoperative intravitreal triamcinolone acetonide. Methods Retrospective case series. Results Four eyes of four patients were identified. Patients improved from a mean best-corrected visual acuity of 20/124 at baseline to 20/122 at month 1, 20/83 at month 3, 20/74 at month 6, 20/59 at month 9 and 20/44 at month 12 (p¼0.01). All patients demonstrated improvement in visual acuity and macular oedema on fluorescein angiography and/or optical coherence tomography (OCT). Conclusion For patients with persistent macular oedema due to BRVO refractory to pharmacotherapy and/or laser photocoagulation, concomitant pars plana vitrectomy with arteriovenous sheathotomy and intravitreal triamcinolone may improve best-corrected acuity and reduce macular oedema on fluorescein angiography and OCT.Branch retinal vein occlusion (BRVO) is the second most prevalent retinovascular disease following diabetic retinopathy, and typically affects patients 50 years of age and older.1 BRVO usually has a favourable natural history, as approximately 60% of patients retain 20/40 vision or better.2 However, in many cases there is significant and sustained vision loss due to disease sequelae that include macular oedema, macular ischaemia, vitreous haemorrhage, secondary neovascularisation, serous retinal detachment, traction retinal detachment, traction-rhegmatogenous retinal detachment and capillary non-perfusion.3 A variety of treatment modalities have been explored, including laser photocoagulation, intraocular corticosteroid injections, limited arteriovenous-crossing manipulation without pars plana vitrectomy, pars plana vitrectomy alone, intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs and arteriovenous sheathotomy with or without pars plana vitrectomy.1e5 This report describes four patients who underwent vitrectomy and arteriovenous sheathotomy combined with intraoperative intravitreal triamcinolone acetonide for the treatment of persistent macular oedema due to BRVO. MATERIALS AND METHODSThe study adhered to the tenets of the Declaration of Helsinki and received approval by the institutional review board of New York Presbyterian Hospital (New York). Medical records of patients who underwent concomitant pars plana vitrectomy with arteriovenous sheathotomy and intraoperative intravitreal triamcinolone acetonide for the treatment of macular oedema due to BRVO from December 2002 to December 2008 at Columbia University Medical Center's Edward S Harkness Eye Institute were reviewed retrospectively in compliance with the Health Insurance Portability and Accountability Act. Data abstracted included patient demographics, ocular history and Snellen bestcorrected visual acuity (BCVA) immediately before surgery and at postoperative months 1, 3, 6, 9 and 12. Optical coherence tomography (OCT) and fluorescein angiography images were reviewed in an...

Patients with cone dystrophy can accumulate intraretinal edema in the macula, which may respond to carbonic anhydrase therapy.