A 49-year-old, white man presented with a 2-week history of painless loss of vision in his left eye and dull, pressure-like frontal headache. His blood pressure (BP) was 190 ⁄ 100. He had been on atenolol 50 mg daily for the previous 2 weeks for initial BP of 210 ⁄ 140, but his BP was still not well controlled. He smoked 15 cigarettes per day. A low glomerular filtration rate assessed by creatinine clearance indicated renal impairment. Diabetes mellitus and glucose intolerance were excluded. Duplex ultrasound, a combination of conventional and Doppler ultrasound, demonstrated the structure of his carotid arteries and the blood flow through them to be normal. Neurological examination was unremarkable.Corrected visual acuities (VA) were 1.0 in the right eye (RE) and 0.1 in the left (LE), with no relative afferent pupillary defect. Fundal examination revealed deep grey)yellow spots in both eyes, as well as hyperpigmented spots surrounded by a hypopigmented halo (Elschnig's spots). In the LE, small pigment epithelial detachments (PEDs) and an exudative retinal detachment (RD) extending through the fovea were seen clinically and captured by optical coherence tomography (OCT). Retinal arteriolar narrowing, vascular tortuosity and arteriolovenous nicking were also identified. Fundus fluorescein angiography (FA) showed decreased perfusion of the choroid at the left macula, accompanied by patchy secondary pigment changes and small PEDs in both eyes. (Fig. 1). Diagnosis⁄Therapy in Ophthalmology

Aim To report on visual acuity (VA) and angiographic outcomes in patients presenting with subfoveal choroidal neovascular membranes (CNV) secondary to punctate inner choroidopathy (PIC), treated with photodynamic therapy (PDT) with verteporfin combined with systemic corticosteroids. Methods A prospective case series of patients with subfoveal CNV secondary to PIC was analysed. All patients were treated with PDT combined with oral prednisolone (1 mg/kg body weight/day) which was started 5 days before PDT. Fluorescein angiography was performed at baseline and every 3 months post-treatment to establish the size, position, and activity of the CNV. Visual acuity was measured using the ETDRS scale. Further PDT treatment was carried out at follow-up visits if there was angiographic evidence of ongoing CNV activity. Results Five female patients with a mean age of 30.4 years (range 25-43 years) were treated over a 12-month period. The mean greatest linear diameter (GLD) of the CNV was 1.66 mm (range 0.46-3.28 mm). A mean improvement in vision of nine ETDRS letters (range À15-20 letters) after treatment was found, which was maintained at final followup. The mean follow-up time was 12 months (range 10-14 months). The mean number of PDT treatments was two (range 1-3). Conclusions: The vaso-occlusive effect of PDT combined with the vasostatic and antiinflammatory effect of systemic oral prednisolone appears to be a safe and effective option in the primary treatment of subfoveal CNV in patients with PIC.

No abstract

A low nutrient culture medium was used to identify the pathogens in four cases of persisting ocular infection. Bacto R2A agar was used in addition to conventional liquidand solid-phase media to culture pathogenic bacteria from one case of recurrent keratitis, one case of suture-related keratitis with endophthalmitis and two eyes (two patients) with post-operative endophthalmitis. In each case, a pathogen was identified solely with R2A agar after culture for 6 days. Species isolated were Pseudomonas aeruginosa (one), Propionibacterium acnes (two) and Staphylococcus aureus (one). Antibiotic therapy was tailored to conform to the sensitivity of the cultured organism in each case. The use of Bacto R2A low nutrient agar should be considered in culture negative eyes not showing clinical improvement, or for chronic cases where bacteria may have become adapted to more stringent ocular environments.