Table of Contents - WOC 2012

PO-RET-04
Examining Recalcitrant Diabetic Macular Edema with Optos Wide-
Field Fluorescein Angiography
Patel Ravi D. (1) , Hariprasad Seenu M. (1) , Messner Leonard V. (2) , Teitelbaum
Bruce (2)
1. University of Chicago Dept of Surgery, Section of Ophthalmology & Visual
Science
2. Illinois College of Optometry, Illinois Eye Institute
Objective: To Examine Recalcitrant Diabetic Macular Edema With Optos Wide-
Field Fluorescein Angiography (WFFA).
Methods: A retrospective observational Case Series Of approximately 50 Eyes
Of 25 Patients Who Have Been Diagnosed With DME For At Least 2 Years.
Protocols were Approved By The Institutional Review Board. A Retrospective
Review Of All Optos WFFA And Spectral Domain OCT (SD-OCT) Was
Performed At Baseline (1 Clinic Visit). Three Study Cohorts Were Enrolled.
Cohort 1 (Control) Subjects Were Diagnosed With NPDR Without DME.
Cohort 2 Subjects Were Diagnosed With NPDR And Recalcitrant DME. Cohort
3 Subjects Diagnosed With PDR And Recalcitrant DME With Or Without
Previous Pan Retinal Photocoagulation (PRP).
Results: Our Data Demonstrates An Increased Incidence Of Peripheral
Nonperfusion On Optos WFFA With Recalcitrant DME (On SD-OCT) In All
Non-Control Cohorts. The Diagnostic Value Of The WFFA Was Demonstrated
By Detecting Subtle Peripheral Neovascularization That Was Not Found On
Clinical Exam.
Conclusion: WFFA Is An Excellent Diagnostic Instrument That Provides A
Reproducible Method To Detect Subtle Peripheral Neovascularization In
Diabetic Retinopathy. Areas Of Untreated Retinal Nonperfusion May Generate
Biochemical Mediators That Promote Ischemia And Recalcitrant DME. Targeted
Retinal Photocoagulation To Ischemic Retina Will Likely Show Improvement Of
Recalcitrant DME.
PO-RET-05
Solitary circumscribed Retinal Astrocytic Proliferation (SCRAP).
Shields Jerry (1) , Bianciotto Carlos (1) , Kivela Tero (1) , Shields Carol (1)
1. Wills Eye Institute
Purpose: To report clinical features and differential diagnosis of an unusual
entity provisionally termed solitary circumscribed retinal astrocytic proliferation
(SCRAP).
Methods: Retrospective review of medical records.
Results: All patients with SCRAP were asymptomatic and the lesion was found
on routine examination. There were 5 men and 2 women with median age of
60 years. No patient had a history or clinical findings of tuberous sclerosis
complex (TSC). Ophthalmoscopically, the lesion occupied the inner retina, was
circumscribed, abruptly elevated, opaque white to yellow-white, obscured the
underlying retinal vessels, and had no associated subretinal fluid, hemorrhage,
calcification, or traction. Fluorescein angiography disclosed fine intrinsic
vascularity in the venous phase and moderate late staining. Autofluorescence
showed mild hyperautofluorescence of the lesion. Ultrasonography showed
no calcification. Optical coherence tomography revealed an abruptly elevated
inner retinal mass. All lesions were stable after a median follow up of 6
years, except for one lesion that gradually disappeared. The pathology and
pathogenesis of are not yet established.
Conclusions: SCRAP appears to be a unique retinal lesion of adulthood that
resembles astrocytic hamartoma or retinoblastoma but displays distinct
ophthalmoscopic features.
WOC2012 Abstract Book
PO-RET-06
Exudative macular detachment post laser photogoaglation
Elgendy Hussein (1)
1. Magrabi Eye and Ear hospital
Objectives: case presentation to show that laser photocoagulation might
induce massive retinal exudation
Methods: 21 years young male diabetic with renal impairment suffering from
diabetic macular edema ,Proliferative Diabetic Retinopathy with iris
neovascularization, Visual Acuity of 20/200 improved to 20/40 after an
intravitreal injecton of avastin. 72 hours post injecton augmentation of
his previous photo coagulation was done resulting in a massive retinal
exudation,more in the macular region with drop of vision to counting fingers.
topical steroid and carbonic anhydrase inhibitors were started
Results: complete resolution within a week with iprovement of vision
Conclusion: laser photocoagulation might induce massive exudation in a
physically ill patients
PO-RET-07
Macular hole formation after intravitreal ranibizumab in patients with
age related macular degeneration : a case series
Mitra Arijit (1) , Mukherjee Chandoshi (1) , Kumar Najith (1) , Elsherbiny Samer (1) ,
Gibson Jonathan (1)
1. Birmingham and Midland Eye Centre
Purpose: To report 3 cases of macular hole formation after intravitreal injection
of ranibizumab in patients with wet age related macular degeneration (ARMD).
Methods: In this retrospective interventional case series, 3 patients with occult
choroidal neovascular membranes (CNVM) secondary to ARMD were treated
with intravitreal ranibizumab. All patients had pigment epithelium detachments.
In addition, one patient had vitreomacular adhesion, which was confirmed with
optical coherence tomography (OCT).
Results: All cases developed full thickness macular holes (FTMH) 1-2 months
following treatment with ranibizumab. One patient was treated successfully
with surgery for the macular hole, and the vision improved from 2/60 to 6/36.
Conclusion: Several possible mechanisms may lead to the development of
FTMH: 1) Intravitreal ranibizumab may have induced vitreous incarceration
causing vitreoretinal traction. 2) Contraction of the CNVM may impose forces on
the retinal pigment epithelium as well as the retinal surface resulting in macular
hole formation. 3) Ranibizumab may modify the structure of the vitreous gel and
cause vitreous syneresis, thereby inducing an incomplete vitreous detachment
leading to traction and macular hole formation. Clinicians need to be aware
of the possibility of visual acuity decrease following ranibizumab injection in
patients with ARMD, due to FTMH formation.
PO-RET-08
Atypical ocular toxoplasmosis
Al-Hajri Rayah (1) , Al-Harthy Nailah (1)
1. Oman Medical Speciality Board
Objective: 1- To report a case of a 19 years old girl immunocompetent with
optic disc Swelling. 2- To discuss the possibility that she is a case of atypical
toxoplasmosis Method and
Result : 19 year old female was referred to ophthalmology department with h/o
sudden unilateral decrease of vision . She was found to have a feature
suggestive of optic neuritis . Systemic steroid was initiated and lead to
reactivation of chorioretinal lesions on the other eye and vitritis in both eyes
which lead us the diagnosis of the ocular toxoplasmosis. Systemic steroid
was stopped and showed a good response to systemic azithromycine .A
typical ocular toxoplasmosis presenting as optic nerve changes can presents
as juxtapupillary retinochoroiditis , pure papillitis ,swellen optic disc in the
presence of a distant active lesion , neuroretinitis or mixed lesion . Our patient
presentation was pure papillitis.
Conclusion : Ocular toxoplasmosis is the most common cause of posterior
uvities and can present as typical or atypical presentation . It should be
consider in any patient presenting with optic nerve swelling .
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