1/4. A case of Chandler's syndrome revealed by ultrastructural studies of the trabecular meshwork.PURPOSE: To investigate ultrastructural changes in the aqueous outflow route and discuss the mechanisms associated with intraocular pressure (IOP) elevation in a patient with presumably early stage Chandler's syndrome. methods: A 47-year-old man underwent trabeculectomy because of elevated IOP. A specimen obtained during surgery was studied by transmission electron microscopy. RESULTS: Electron microscopy showed the presence of a monolayer composed of corneal endothelium-like cells and thick basement membrane-like material. Neovascularization was also observed in the corneoscleral trabeculum. CONCLUSIONS: Our results indicate that several mechanisms, including the formation of basement membrane-like tissue, infiltration of inflammatory cells and neovascularization, might contribute to the elevation of IOP in Chandler's syndrome. These may occur even when there is no history of conspicuous inflammatory reaction in the anterior ocular segments.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
2/4. Complications of intravitreal steroid injections.BACKGROUND: Intravitreal corticosteroid injections are a new therapeutic procedure used to treat various retinal edematous and neovascular conditions. They have been used in the treatment of diabetic macular edema, exudative macular degeneration, pseudophakic cystoid macular edema, macular edema associated with retinal vein occlusion, and chronic uveitis as well as other conditions. Because the use of this therapeutic technique is becoming increasingly more common, adverse effects are now being seen. The most common adverse effects associated with intravitreal steroid injection are elevation of intraocular pressure and progression of cataract. endophthalmitis, pseudoendophthalmitis, and retinal detachment have also been reported. case reports: This report describes 2 patients who were followed up at the VA connecticut Healthcare System Newington Campus optometry Clinic for steroid-induced elevation of intraocular pressure after intravitreal corticosteroid injection. One patient exhibited elevation of intraocular pressure after his first intravitreal steroid injection for treatment of clinically significant macular edema secondary to diabetes. The second patient did not exhibit a steroid response to the first intravitreal steroid injection utilized as treatment for choroidal neovascularization from age-related macular degeneration. However, he did show a rise in intraocular pressure after a second intravitreal corticosteroid injection. Intraocular pressures, treatment, and frequency of follow-up in both patients pre- and postinjection are discussed. CONCLUSION: Elevation of intraocular pressure after intravitreal steroid injection can commonly be controlled with topical glaucoma medications. cataract progression is common in patients after intravitreal injection of corticosteroid; however, findings show these patients are at no additional risk for cataract surgery complications. Therefore, these do not appear to be major contraindications. However, because 30% to 50% of patients experience intraocular pressure rise up to a few months postinjection, and patients are at higher risk for complications such as endophthalmitis, optometrists should be aware of appropriate management after this increasingly utilized therapeutic procedure.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |
3/4. Needle bleb revision of encapsulated filtering bleb with bevacizumab.The utility of needle bleb revision with bevacizumab in a patient with a failing bleb following trabeculectomy is explored. The patient had previously failed needle bleb revision with mitomycin C. After needling and injection of 1 mg of bevacizumab, the bleb was noted to be more diffuse with a decrease in surface neovascularization. Bevacizumab may be an effective medication for rescuing failing filtering blebs that exhibit neovascularization.- - - - - - - - - - ranking = 2keywords = neovascularization (Clic here for more details about this article) |
4/4. Solitary silent venous papillary loops and ocular hypertension.A series of 24 eyes in 23 patients is described showing solitary silent venous papillary loops. These loops are usually associated with a considerable degree of ocular hypertension, presenting when this hypertension is being investigated. They are silent, usually with no previous ocular history, single with a large diameter, affecting veins at the optic disc and not extending into the vitreous. The optic disc is cupped, but usually not more than 0.6 disc diameter, there is good central vision and either a full visual field or only early field loss. fluorescein angiography shows the loops to be competent with no evidence of any other retinal vascular abnormality. Rarely loss of central vision may occur due to progression to advanced glaucoma. The condition is distinct from prepapillary vascular arterial papillary loops, neovascularization at the optic disc and optociliary shunt vessels. It is also distinct from the venous collateral vessels which develop at the optic disc after acute central or branch retinal vein occlusion. These collaterals are usually multiple, the accompanying ocular hypertension is of lesser degree, cupping of the disc and field loss are usually much more advanced and, while visual acuity may be normal, it is often grossly reduced. On fluorescein angiography all these cases of venous collaterals after retinal vein occlusion showed evidence of other retinal vascular dysfunction. Solitary silent venous papillary loops appear to develop from venules on the optic disc as a bypass to a low grade venous occlusion which is seldom clinically manifest. They form a distinct entity with a good prognosis if the accompanying ocular hypertension is carefully controlled.- - - - - - - - - - ranking = 1keywords = neovascularization (Clic here for more details about this article) |