[Photodynamic therapy of AMD for the first (better sight) and the second (worse sight) eyes]

BACKGROUND

Photodynamic therapy (PDT) is the standard treatment procedure for many forms of exudative and/or neovascular AMD. Despite therapy, visual acuity often drops to low vision levels. The cost efficiency of treating the eye in which vision is worse is therefore the subject of some controversy.

PATIENTS AND METHODS

A retrospective case-control study was conducted in all patients who were treated with PDT at the Universitätsspital Zürich between September 1999 and November 2004. Each patient's first (with worse vision) and second (with better vision) eyes were compared for situation on presentation and course during treatment.

RESULTS

In 117/228 cases (51.3%) visual acuity of the treated eye was better than (or identical to) that of the fellow eye at presentation. Visual acuity before therapy was an average of 0.58+/-0.27 logMAR [Snellen: 0.26 (0.14-0.49)] in the eyes with better visual acuity and 0.69+/-0.4 logMAR [Snellen 0.20 (0.08-0.51)] in the fellow eyes (p=0.015). After therapy there was no significant difference between the patient groups in visual acuity or in the magnitude of any change in visual acuity, or in lesion size or change in lesion size.

CONCLUSION

The outcome of PDT of a second eye (with better visual acuity) is not significantly better than the result obtained in the first eye (the one with worse visual acuity initially).

Pseudo-endophthalmitis after intravitreal injection of triamcinolone

AIMS

To describe an unusual endophthalmitis-like reaction after an intravitreal injection of triamcinolone acetonide in four patients.

METHODS

Retrospective case series.

RESULTS

Four patients are reported with an endophthalmitis-like reaction following an intravitreal injection of triamcinolone acetonide. There was a dense vitreous haze with severe reduction of fundus view in all cases. One case was treated as an infectious endophthalmitis but the vitreous tap showed no evidence of an endophthalmitis and no bacterial or fungal growth in culture. In all four cases, the vitreous haze cleared without specific treatment. The anterior chamber remained quiet in all cases but one, which was examined 30 minutes after the injection, and there was no periorbital inflammation or pain.

CONCLUSION

Pseudo-endophthalmitis after an intravitreal injection of triamcinolone acetonide seems to be a distinct clinical entity that may resolve without specific treatment.

Heroin and strabismus

QUESTIONS UNDER STUDY

We report on a series of patients with acute strabismus related to heroin and methadone intake or withdrawal, discuss possible mechanisms involved in this clinical picture and make recommendations for work-up and referral.

METHODS

Retrospective study.

RESULTS

Five patients presented with acute esotropia within days of heroin withdrawal, and two patients developed exotropia related to heroin or methadone intake. Neurological work-up and neuroimaging was non-contributory in all four patients who were examined.

CONCLUSION

Acute esotropia with double vision is a disturbing side effect of heroin withdrawal, and, similarly, acute exotropia may be related to heroin intake. In the absence of focal neurological signs, further work-up is not mandatory. Referral to a specialised orthoptic service is beneficial in offering the patient symptomatic treatment and reassurance, thus supporting successful withdrawal therapy.

Heroin and strabismus

QUESTIONS UNDER STUDY

We report on a series of patients with acute strabismus related to heroin and methadone intake or withdrawal, discuss possible mechanisms involved in this clinical picture and make recommendations for work-up and referral.

METHODS

Retrospective study.

RESULTS

Five patients presented with acute esotropia within days of heroin withdrawal, and two patients developed exotropia related to heroin or methadone intake. Neurological work-up and neuroimaging was non-contributory in all four patients who were examined.

CONCLUSION

Acute esotropia with double vision is a disturbing side effect of heroin withdrawal, and, similarly, acute exotropia may be related to heroin intake. In the absence of focal neurological signs, further work-up is not mandatory. Referral to a specialised orthoptic service is beneficial in offering the patient symptomatic treatment and reassurance, thus supporting successful withdrawal therapy.