Background: Peripheral cryotherapy appears to be efficacious in the treatment of neovascularization of the vitreous base in patients with pars planitis, although it may be associated with the development of rhegmatogenous retinal detachments. Objective: To evaluate the safety and efficacy of peripheral scatter photocoagulation for treatment of neovascularization of the vitreous base when used alone or combined with pars plana vitrectomy. Methods: Six patients (10 eyes) presented with vitritis, cystoid macular edema, and neovascularization of the vitreous base, unresponsive to corticosteroid therapy. Three patients (five eyes) received scatter diode or argon photocoagulation treatment alone. The other three patients (five eyes) underwent pars plana vitrectomy coupled with argon or diode photocoagulation, placed in three rows, posterior to the area of inferior neovascularization of the vitreous base. Results: Pretreatment visual acuity ranged from 20/20 to 20/200. All patients were followed up for a minimum of 6 months. After placement of photocoagulation (with or without concurrent pars plana vitrectomy), the neovascularization regressed, inflammation was stabilized, and cystoid macular edema improved in all eyes. There were no retinal detachments or other complications of treatment. Posttreatment visual acuity ranged from 20/20 to 20/100. When final visual acuity was 20/40 or less, cataract formation was generally responsible. Conclusions: Peripheral scatter photocoagulation is efficacious and appears at least equal to peripheral cryotherapy in causing regression of neovascularization of the vitreous base in patients with pars planitis.

2Peripheral Scatter Photocoagulation for Neovascularization Associated With Pars Planitis

Different types of imaging modalities are used in the diagnosis of ocular cancer. Selection of an imaging modality is based on the features of a tumor as well as the inherent characteristics of the imaging technique. It is vital to select an appropriate imaging modality in diagnosis of ocular tumor with confidence. This review focuses on five most commonly used imaging modalities, i.e., positron emission tomography-computed tomography (PET/CT), single photon emission computed tomography (SPECT), optical coherence tomography (OCT), ultrasound (US), and magnetic resonance imaging (MRI). The principal of imaging modalities is briefly explained, along with their role in the diagnosis and management of the most common ocular tumors such as retinoblastoma and uveal melanoma. Further, the diagnostic features of ocular tumors corresponding to each imaging modality and possibilities of utilizing imaging techniques in the process of ocular drug development are included in this review.

Imaging Techniques in the Diagnosis and Management of Ocular Tumors: Prospects and Challenges

Objective To compare the reattachment rate and visual acuity results among patients with rhegmatogenous retinal detachment who underwent scleral buckle surgery with retinopexy by intraoperative cryotherapy (cryopexy) vs postoperative (1 month later) laser photocoagulation (laserpexy). Methods Eighty-six patients with rhegmatogenous retinal detachment scheduled for scleral buckle surgery were randomly assigned to the cryopexy or laserpexy group. Main Outcome Measures The primary outcome was the 1-week reattachment rate. Other outcome measures included later reattachment rate (1 month and 6 months), best-corrected visual acuity, rate of subsequent operations, and postoperative complications. Results The 1-week, 1-month, and 6-month anatomical success rates were similar in the 2 groups: 93% (40 patients), 100%, and 100% in the cryopexy group and 95% (41 patients), 100%, and 100% in the laserpexy group, respectively. Three patients in the cryopexy group and 2 in the laserpexy group underwent 1 additional rhegmatogenous retinal detachment surgery (pars plan vitrectomy) after primary failure at 1-week follow-up. The types of postoperative complications were similar in both groups, except for eyelid edema. Visual recovery was slower in the cryotherapy group, but the difference in visual acuity after 6 months was not significant. Conclusions In patients with uncomplicated retinal detachment, both techniques of retinopexy have shown satisfactory anatomical and functional success. Laserpexy offers faster visual acuity recuperation with fewer postoperative complications but requires a second intervention and costs more than cryotherapy. Application to Clinical Practice Laserpexy is a successful alternative to cryopexy in creating chorioretinal adhesion for scleral buckle surgery. Trial Registration clinicaltrials.gov Identifier:NCT01068379

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=OPHTH&articleId=426641&pdfFileName=ect05010_1519_1522.pdf

Cryotherapy vs Laser Photocoagulation in Scleral Buckle Surgery: A Randomized Clinical Trial

PURPOSE: To determine the effect of peripheral retinal laser photocoagulation (PLP) on visual acuity, intraocular inflammation, and other ocular findings, including retinal neovascularization in eyes with pars planitis. METHODS: A retrospective chart review of eyes with pars planitis that had undergone PLP. RESULTS: Twenty-two eyes in 17 patients with pars planitis had undergone treatment with PLP at 2 centers. The mean age at the time of treatment was 19.3 years. Following treatment, mean follow-up was 16.3 months (range, 6 to 37 months). Mean visual acuity was 20/60 preoperatively and 20/50 postoperatively. This level of improvement was not statistically significant (P > .10), but there was a statistically significant decrease in the use of corticosteroids between the preoperative examination and the last postoperative examination (86% versus 27%, P < .05). There was also a statistically significant decrease in vitritis at the last follow-up (P = .0008) and a decrease in neovascularization of the vitreous base (P = .03) and in clinically apparent cystoid macular edema (P = .02). Epiretinal membranes were noted in 23% of eyes preoperatively and in 45% of eyes postoperatively. Only one of these epiretinal membranes was considered to be visually significant. One eye developed a tonic dilated pupil, which slowly improved. CONCLUSIONS: Although the long-term natural history of clinical findings in pars planitis is not well documented, PLP appears to decrease the need for corticosteroids while stabilizing visual acuity. It also appears to decrease vitreous inflammation. PLP has few complications and should be considered in patients with pars planitis who are unresponsive or have adverse reactions to corticosteroids.

Results of peripheral laser photocoagulation in pars planitis.

Trans-scleral diode laser photocoagulation in proliferative sickle cell retinopathy

Objective: To compare the effects of contact transscleral diode laser treatment and retinal cryotherapy on blood-retinal barrier integrity with the use of high-resolution magnetic resonance imaging techniques with constant infusion of gadolinium—diethylenetriaminepentaacetic acid (Gd-DTPA). Methods: Transscleral diode laser photocoagulation and retinal cryotherapy were used to treat equivalent areas of the inferior retinal periphery of pigmented rabbits. Magnetic resonance imaging time-course studies with measurement of signal enhancements due to Gd-DTPA leak-age were conducted 2 and 15 days following treatment. Results: Two days following treatment, cryotherapytreated eyes exhibited a mean (±SD) effective Gd-DTPA permeability coefficient of 4.6±0.8×10 −6 cm/s; in comparison, diode laser—treated eyes exhibited 1.6×1.4×10 −6 cm/s effective permeability. Significant decreases in the effective permeability were also noted 15 days after treatment in both groups. Conclusions: Transscleral contact probe diode laser photocoagulation induces less disruption of the blood-retinal barrier than does conventional cryotherapy. In addition, the continuous infusion method of Gd-DTPA delivery is a reliable and easily interpretable alternative to the commonly used bolus injection approach.

High-Resolution Magnetic Resonance Imaging Evaluation of Blood-Retinal Barrier Integrity Following Transscleral Diode Laser Treatment

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High-Resolution Magnetic Resonance Imaging Evaluation of Blood-Retinal Barrier Integrity Following Transscleral Diode Laser Treatment