Central areolar choroidal dystrophy

Inheritance is autosomal dominant

Presentation is in the 20's to 30's with gradual impairment of central vision.

Signs in chronological order:
1) Non-specific foveal granularity.
2) Circumscribed RPE atrophy and loss of the choriocapillaris at the macula.
3) Slowly expanding geographic atrophy with prominence of large choroidal vessels .

Prognosis is poor with severe visual loss occurring by the 50's to 60's. So if you see a younger patient with macular pigment changes orgeographic atrophy, consider this diagnosis.

PKP, HSV, & ACYCLOVIR

Cornea - Abstract: Volume 26(8) September 2007 p 930-934 Effect of Prophylactic Oral Acyclovir After Penetrating Keratoplasty for Herpes Simplex Keratitis.

This paper concludes:

Prophylactic oral acyclovir use after PK for HSV keratitis is associated with decreased episodes of rejection and improved graft survival.

AVASTIN FOR NVG

Journal of Glaucoma - Abstract: Volume 16(5) August 2007 p 437-439 Intravitreal Bevacizumab (Avastin) Injection for Neovascular Glaucoma.

This paper investigated the use of Avastin in 2 patients with nonvascular glaucoma. It concludes:

Both patients demonstrated dramatic short-term response in terms of intraocular pressure reduction and regression of neovascularization.

POST-DE IOP & GLAUCOMA PROGRESSION

The amount of intraocular pressure rise during pharmacological pupillary dilatation is an indicator of the likelihood of future progression of glaucoma -- Siam et al. 91 (9): 1170 -- British Journal of Ophthalmology

This study concludes:

In patients with open-angle glaucoma, the amount of increase in IOP caused by pharmacological pupillary dilatation is related to the likelihood of future progression of glaucoma.

Fabry's disease

http://revoptom.com/index.asp?page=2_12883.htm

The most common and first ocular sign of Fabry’s disease: bilateral corneal diffuse yellow epithelial haziness that gradually becomes concentrated into dense rays that radiate from the center of the cornea into dense bronze to cream-colored streaks arranged in a vortex or star-shaped pattern (whorl-like or verticillata).8,9 These opacities appear to be in the subepithelial or Bowman’s layer of the cornea.8 Corneal involvement occurs in over 90% of these patients,

CANALOPLASTY

Review of Ophthalmology

From this article, canalsplasty appears to be a safe & effective alternative to trabeculectomy. Results if one study shows lowering of IOP from around 24mm Hg to around 16 mm Hg. This article concludes:

Dr. Tetz says he believes canaloplasty is a good choice as a replacement for trabeculectomy. “Overall, the pressure results of viscocanalostomy are comparable to those of trabeculectomy without mitomycin,” says Dr. Tetz, “but with a much lower risk of postoperative complications and much less intense care required immediately postop. So far, the results of canaloplasty are even better.”

J Cataract Refract Surg 2007;33:7:1217-1226.

AVASTIN FOR UVEITIC CME

ScienceDirect - Ophthalmology : Intravitreal Bevacizumab for Treatment of Uveitic Macular Edema

This study concludes:

These results suggest that a single intravitreal injection of bevacizumab is well tolerated and is associated with short-term improvement in VA and decreased OCT retinal thickness in a considerable proportion of patients with uveitic CME resistant to conventional therapy. Further evaluation of intravitreal bevacizumab for uveitic CME in controlled randomized studies is warranted.