A case of severe hydroxychloroquine-induced retinal toxicity in a patient with recent onset of renal impairment: a review of the literature on the use of hydroxychloroquine in renal impairment.

We present a case of a 67-year-old female who presented with a twelve-month history of progressive blurred vision in both eyes. The patient was on hydroxychloroquine 200 mg twice a day for eight years for the treatment of scarring alopecia. Two years prior to presenting, the patient was found to have chronic kidney disease stage 3 secondary to hypertension.

Diabetic retinopathy in pregnancy.

Pregnancy in a diabetic woman brings about many changes that can lead to the development of diabetic retinopathy (DR) or worsening of pre-existing disease. In some patients this may develop into sight threatening disease which, if not treated adequately, can cause devastating visual impairment. There is a lack of established guidelines for screening these patients during pregnancy.

Neurotrophic keratopathy and diabetes mellitus.

Diabetes mellitus is frequently associated with microvascular complications such as retinopathy, nephropathy, and peripheral neuropathy. Neurotrophic keratopathy occurs in response to a neuropathy of the ophthalmic division of the trigeminal nerve. Rarely has diabetic neurotrophic keratopathy been described.

Plasma vascular endothelial growth factor, angiopoietin-2, and soluble angiopoietin receptor tie-2 in diabetic retinopathy: effects of laser photocoagulation and angiotensin receptor blockade.

Background: Proliferative diabetic retinopathy (PDR) may be a response to abnormal angiogenic growth factors such as vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2), and the soluble angiopoietin receptor tie-2. The authors hypothesised the following: (a) there are differences in plasma levels of these growth factors in different grades of diabetic retinopathy; and (b) that the effects of intervention with panretinal laser photocoagulation (PRP) for PDR, and angiotensin receptor blockade (using eprosartan) for patients with other grades of diabetic retinopathy will be to reduce levels of the growth factors.

Methods: Cross sectional and interventional study (using PRP and eprosartan) in diabetic patients.

Hypertension and the eye: changing perspectives.

Systemic hypertension is a common condition associated with significant morbidity and mortality. Hypertension confers cardiovascular risk by causing target-organ damage that includes retinopathy in addition to heart disease, stroke, renal insufficiency and peripheral vascular disease. The recognition of hypertensive retinopathy is important in cardiovascular risk stratification of hypertensive individuals.

Age-related macular degeneration is associated with increased vascular endothelial growth factor, hemorheology and endothelial dysfunction.

Objective: To investigate laboratory evidence of abnormal angiogenesis, hemorheologic factors, endothelial damage/dysfunction, and age-related macular degeneration (ARMD).

Design: Comparative cross-sectional study.

Participants: We studied 78 subjects (26 men and 52 women; mean age 74 years; standard deviation [SD] 9.

Idiopathic polypoidal choroidal vasculopathy: a disease with diverse clinical spectrum and systemic associations.

Purpose: To report the clinical findings, angiographic results, clinical course, response to laser photocoagulation and systemic-associations in a group of patients with idiopathic polypoidal choroidal vasculopathy (IPCV).

Methods: All patients with IPCV attending the macular clinic underwent a complete ocular examination, and fluorescein and indocyanine green angiography. In addition, a systemic examination including blood pressure, full blood count, plasma viscosity and coagulation status of patients was carried out.

Plasma VEGF and soluble VEGF receptor FLT-1 in proliferative retinopathy: relationship to endothelial dysfunction and laser treatment.

Purpose: To study plasma levels of vascular endothelial growth factor (VEGF, an index of angiogenesis), its soluble receptor (sFlt-1) and von Willebrand factor (vWf, an index of endothelial damage or dysfunction) in patients with proliferative retinopathy and corresponding changes in plasma levels after pan-retinal photocoagulation (PRP).

Methods: Eighteen patients (10 men; age, 57+/-16 years, mean +/- SD) with proliferative retinopathy secondary to diabetes (n = 13) and ischemic retinal vein occlusion (n = 5) with no previous PRP therapy were studied. Blood samples were obtained before and at 4 months after the last PRP session.

Polyarthropathy, orbital myositis and posterior scleritis: an unusual adverse reaction to influenza vaccine.

We report a patient who developed an acute symmetrical polyarthropathy, orbital myositis and posterior scleritis following inoculation with the 1993 Fluvirin (inactivated influenza vaccine: surface antigen) vaccine. We believe that this represents a hypersensitivity reaction to the vaccine as extensive investigations revealed no underlying infective, inflammatory or systemic cause. We review the current indications for vaccination against the influenza virus and the known adverse reactions to the vaccine.

Long-term follow-up of a single continuous adjustable suture in penetrating keratoplasty.

Penetrating keratoplasty was performed on 30 patients using a single adjustable continuous 10/0 nylon suture. Seventeen patients had astigmatism of 4.00 dioptre cylinders (DC) or more and were adjusted.

Digital indocyanine-green videoangiography of occult choroidal neovascularization.

Background: Occult choroidal neovascularization (CNV) secondary to age-related macular degeneration occurs in the majority of patients with exudative maculopathy. Since occult CNV cannot be imaged clearly by fluorescein angiography, this condition is untreatable. The authors performed digital indocyanine-green videoangiography (ICG-V) on 657 consecutive eyes with occult CNV by fluorescein angiography to determine if this technique could be useful in enhancing the imaging of the neovascularization, and thus increasing treatment eligibility.

Adverse reactions due to indocyanine green.

Background: Although adverse reactions to indocyanine green (ICG) are known to occur, the dye has been used for more than 30 years in tests of cardiac and hepatic function, with a high level of safety. Improved digital video technology has renewed interest in the use of intravenous ICG in ophthalmic imaging. This report describes the authors' experience regarding the safety of ICG for digital angiography and their recommendations for its use in the ophthalmic setting.

Dye enhanced laser photocoagulation in the treatment of a peripapillary subretinal neovascular membrane.

A 45-year-old female with an elevated peripapillary subretinal neovascular membrane was treated with dye enhanced laser photocoagulation, using indocyanine green and the diode laser. Following treatment the membrane regressed, with flattening of the lesion. No side effects occurred and excellent visual acuity was maintained over a 12 month follow-up period.

Detection of varicella-zoster virus DNA in ocular samples from patients with uveitis but no cutaneous eruption.

Herpes zoster ophthalmicus is a well-recognised cause of intraocular inflammation, which may become recurrent or chronic after the acute phase has elapsed. Although it commonly presents with the typical rash, cases of ocular zoster with no cutaneous eruption have been well documented. We present two patients with unilateral anterior uveitis complicated by cataract, in whom molecular techniques based on the polymerase chain reaction detected varicella-zoster virus DNA in intraocular material obtained during cataract surgery.

Oral tetracycline in the treatment of recurrent corneal erosions.

We report the results of a prospective, randomised controlled, 24 week trial to assess the efficacy of oral tetracycline and oral tetracycline with topical prednisolone in the treatment of recalcitrant recurrent corneal erosions, i.e. those which fail to respond to standard therapy.

Recurrent corneal erosion: clinical features.

The clinical features of a group of 30 patients with recalcitrant recurrent corneal erosions (i.e. those who failed to respond to conventional therapy) were evaluated.

Analysis of vascularized pigment epithelial detachments using indocyanine green videoangiography.

Background: Occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) is known to occur with and without an associated serous pigment epithelial detachment (PED). Digital indocyanine green (ICG) videoangiography has been reported to provide enhanced definition of occult CNV.

Methods: A total of 244 of 657 (37%) consecutive patients with AMD, with occult CNV and an associated serous PED evident on fluorescein angiographic examination, were further studied with ICG videoangiography.

Ultrastructural findings in solar retinopathy.

This study documents the ultrastructural findings in a case of solar retinopathy, 6 days after sungazing. A malignant melanoma of the choroid was diagnosed in a 65-year-old man. On fundoscopy, the macula was normal.

The management of post-keratoplasty astigmatism by post-operative adjustment of a single continuous suture.

Penetrating keratoplasty was performed in 39 consecutive patients. A 16 bite 10-0 nylon continuous suture was used. Post-operatively, the suture was adjusted to reduce astigmatism, as determined by refraction, keratoscopy and keratometry.