Anti-Vascular Endothelial Growth Factor Therapy for Choroidal Neovascularization Secondary to Optic Nerve Head Drusen

PURPOSE@#To describe a patient with optic nerve head drusen who showed improved retinal hemorrhage and visual acuity following intravitreal anti-vascular endothelial growth factor (bevacizumab) injection.CASE SUMMARY: A 53-year-old woman with no underlying disease presented with sudden vision loss in her left eye. Her best-corrected visual acuity was 1.0 in the right eye and 0.8 in the left eye; the intraocular pressure was 15 mmHg in both eyes. Anterior segment examination revealed no abnormal findings. Fundus examination showed subretinal hemorrhage and serous retinal detachment in the left eye. Fluorescein angiography and indocyanine green fundus examination revealed hyperfluorescence near the optic disc. The patient was diagnosed with choroidal neovascularization of the left eye secondary to optic nerve head drusen; intravitreal bevacizumab injection was then performed. Three weeks later, the patient showed improved retinal hemorrhage.@*CONCLUSIONS@#Intravitreal anti-vascular endothelial growth factor injection may be an effective treatment for choroidal neovascularization associated with optic nerve head drusen.

Retinal Nerve Fiber Layer Thickness Measurement Using Swept Source Optical Coherence Tomography in Healthy Korean

PURPOSE: To investigate retinal nerve fiber layer (RNFL) thickness using swept source (SS)-optical coherence tomography (OCT) in healthy Koreans and to evaluate the effects of age on the distributional variability of thickness. METHODS: We performed a retrospective review of 309 normal eyes presenting for examination of peripapillary nerve fiber layer thickness measured by SS-OCT (DRI OCT-1, Atlantis SS-OCT, Topcon, Tokyo, Japan) from July 2014 to February 2016. The patients were between the ages of 20 and 79 without systemic or ocular disease. The patients were divided into 3 age groups of 20 to 39 years (85 eyes), 40 to 59 years (140 eyes), and 60 to 79 years (84 eyes). The groups were matched based on average RNFL thickness and quadrant and 12 o'clock position RNFL thickness. RESULTS: The average RNFL thickness of the inferior quadrant was the thickest of the layers and revealed a bimodal distribution. In the three groups, the thicknesses of the average RNFL, quadrant, and 12 o'clock RNFL decreased with age. There was significant difference in the measurements (p < 0.05) of quadrant RNFL thickness except that in the nasal quadrant (p = 0.068). CONCLUSIONS: The thickness of the circumpapillary retinal nerve fiber layer measured by SS-OCT differs according to age and analysis of normal values by age can be useful in the diagnosis of disease.

Retinal Nerve Fiber Layer Thickness Measurement Using Swept Source Optical Coherence Tomography in Healthy Korean

PURPOSE: To investigate retinal nerve fiber layer (RNFL) thickness using swept source (SS)-optical coherence tomography (OCT) in healthy Koreans and to evaluate the effects of age on the distributional variability of thickness. METHODS: We performed a retrospective review of 309 normal eyes presenting for examination of peripapillary nerve fiber layer thickness measured by SS-OCT (DRI OCT-1, Atlantis SS-OCT, Topcon, Tokyo, Japan) from July 2014 to February 2016. The patients were between the ages of 20 and 79 without systemic or ocular disease. The patients were divided into 3 age groups of 20 to 39 years (85 eyes), 40 to 59 years (140 eyes), and 60 to 79 years (84 eyes). The groups were matched based on average RNFL thickness and quadrant and 12 o'clock position RNFL thickness. RESULTS: The average RNFL thickness of the inferior quadrant was the thickest of the layers and revealed a bimodal distribution. In the three groups, the thicknesses of the average RNFL, quadrant, and 12 o'clock RNFL decreased with age. There was significant difference in the measurements (p < 0.05) of quadrant RNFL thickness except that in the nasal quadrant (p = 0.068). CONCLUSIONS: The thickness of the circumpapillary retinal nerve fiber layer measured by SS-OCT differs according to age and analysis of normal values by age can be useful in the diagnosis of disease.

Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V

PURPOSE: To investigate the relationships between estimated cerebrospinal fluid pressure (CSFP) and trans-lamina cribrosa pressure difference (TLCPD) in open-angle glaucoma (OAG) in Korean population. METHODS: A total of 10,801 eyes were included from the Korean National Health and Nutrition Examination Survey V. All participants (aged 19 years or older) were classified as non-glaucomatous group, OAG suspect group and OAG group. CSFP was calculated as CSFP (mm Hg) = 0.44 body mass index (kg/m²) + 0.16 diastolic blood pressure (mm Hg) - 0.18 age (years) - 1.91. TLCPD was calculated by subtracting CSFP from intraocular pressure. RESULTS: The mean estimated CSFP was (8.7 ± 3.3 mm Hg vs. 11.6 ± 3.7 mm Hg, 11.2 ± 3.8 mm Hg vs. 11.6 ± 3.7 mm Hg) was lower, and the mean TLCPD (5.7 ± 4.4 mm Hg vs. 2.2 ± 4.4 mm Hg, 3 ± 4.7 mm Hg vs. 2.2 ± 4.4 mm Hg) was higher in the OAG group and in the OAG suspect group than in the non-glaucomatous control group, respectively (p < 0.001). After adjusting relating factor with CSFP and TLCPD using simple linear regression and multivariate analyses, the mean estimated CSFP was distributed lower (p < 0.001; beta: -0.12; B: -2.306; 95% confidence interval [CI]: -2.717, -1.895) in OAG group than in non-glaucomatous group and the mean TLCPD was distributed higher (p < 0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72; p < 0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289) in OAG suspect group and in OAG group than in non-glaucomatous group, respectively. CONCLUSIONS: Estimated CSFP and calculated TLCPD showed essential association with OAG presence. It supports the potential role of low CSFP in the pathogenesis of OAG.

Diagnostic Ability of Macular Ganglion Cell Layer Measurements in Glaucoma Using Swept Source Optical Coherence Tomography

PURPOSE: To evaluate diagnostic ability of macular ganglion cell complex (mGCC), macular ganglion cell inner plexiform layer (mGCIPL) measurements in glaucoma using swept source deep range imaging optical coherence tomography (DRI OCT-1, Topcon Co., Tokyo, Japan). METHODS: From August of 2014 to July of 2015, 109 eyes of 109 subjects were assessed for the average thickness and sectional thickness of both mGCC and mGCIPL to determine whether there exists any significant difference among advanced stage glaucoma group, early stage glaucoma group and normal group in Swept source OCT. Comparisons were also made between the above measurements and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements in their diagnostic accuracy, sensitivity, and specificity. RESULTS: The diagnostic ability of mGCC based-mean thickness value (area under the curve [AUC] = 0.78/0.99) in detecting early stage glaucoma group as well as advanced stage group was not significantly different from that of cpRNFL thickness measurement. However, there was a significant difference in thickness between mGCIPL (AUC = 0.70) and cpRNFL in early stage glaucoma groups (p = 0.018). The sensitivities and specificities of mGCC were 0.95/0.97, and those of mGCIPL were 0.92/0.97, respectively. CONCLUSIONS: The two swept source OCT based methods measuring retinal ganglion cell layer thickness appeared to have a good diagnostic accuracy, high sensitivity and specificity in detecting glaucomatous eyes. Nevertheless, of the two methods, mGCC thickness measurement was more efficient in detecting early glaucomatous changes.

Outpatient Distribution for Glaucoma Evaluation

PURPOSE: To analyze the reasons for glaucoma evaluation and distribution of new patients visiting the glaucoma department. METHODS: In a retrospective study, 330 new patients underwent ocular examination using Goldmann applanation tonometry, gonioscopy, optic disc analysis, optical coherence tomography, and Humphrey perimeter under suspicion of glaucoma for the first time in the Glaucoma Department from January 2013 to December 2013. We analyzed the reasons and their diagnostic outcomes. RESULTS: The reasons for glaucoma evaluation were health screening (103 patients, 32.49%), other symptoms (102 patients, 31.55%), known glaucoma (56 patients, 17.67%), pre-refractive surgery evaluation (31 patients, 9.78%), family history (19 patients, 5.99%), and high myopia (6 patients, 1.89%). The diagnostic outcomes were as follows: glaucoma (139 patients, 43.85%), glaucoma suspect (60 patients, 18.93%), ocular hypertension (9 patients, 2.84%), neither glaucoma nor ocular hypertension (79 patients, 24.92%), normal (30 patients, 9.46%). The percentages of confirmed glaucoma according to the reasons for glaucoma evaluation were as follows: health screening, 26.21%; other symptoms, 40.20%; known glaucoma, 85.71%; pre-refractive surgery evaluation, 58.06%; family history, 15.79% and high myopia, 33.33%. CONCLUSIONS: The reasons for glaucoma evaluation were diverse. Glaucoma was confirmed in 43.85% of the patients and the predicted value of positive test for glaucoma including glaucoma suspect and ocular hypertension was 65.62%.

Combined Operation Assosciated with Ahmed Glaucoma Valve Implantation

PURPOSE: To evaluate surgical results after combined operation associated with Ahmed glaucoma valve (AGV) implantation. METHODS: A retrospective review was performed for 71 eyes of 67 patients who underwent combined operation associated with AGV implantation from June 2003 to August 2012. RESULTS: Pars plana vitrectomy or phacoemulsification combined with AGV implantation were performed for 16 eyes and AGV implantation alone was performed in 55 eyes. Mean IOP (mm Hg) and the number of antigluacoma agents for both the combined and single groups showed a statistically significant decrease (combined/single; p = 0.008/0.000, 0.002/ 0.000). Visual acuity (log MAR) was improved, but these differences were not statistically significant (combined/single; p = 0.309/0.052). CONCLUSIONS: Combined vitrectomy or phacoemulsification and AGV implantation for intractable glaucoma with vitreoretinal disease or cataract is considered to be the primary procedure because of its equivalent efficacy in lowering IOP, improving visual acuity and decreasing the number of glaucoma agents.

Clinical Features According to the Occlusion Site in Patients with Branch Retinal Vein Occlusion

PURPOSE: To evaluate clinical patterns according to the occlusion site in patients with branch retinal vein occlusion. METHODS: Ninety-one branch retinal vein occlusion patients were divided into 4 groups according to the occlusion site based on the description by Duke-Elder and Wybar: Papillary retinal vein occlusion group (group A), main retinal vein occlusion group (group B), minor retinal vein occlusion group (group C), and retinal venule occlusion group (group D). The following factors were analyzed retrospectively: baseline/final visual acuity, visual improvement, macular thickness, and macular circulatory states. RESULTS: The macular thickness (microm) was 575.33 +/- 178.44 in group A, 511.92 +/- 218.02 in group B, 397.21 +/- 144.51 in group C, and 336.68 +/- 120.55 in group D. The retinal ischemic area (DD) was 22.00 +/- 13.28 in group A, 18.26 +/- 10.12 in group B, 12.52 +/- 10.52 in group C, and 12.36 +/- 11.92 in group D, which was found to be significantly greater in the group with the higher branch occlusion site (p < 0.05). However, visual acuity, macular circulatory states and other clinical characteristics were not significantly different. CONCLUSIONS: Occlusion site is a relating factor for retinal ischemic area and macular thickness in patients with Branch retinal vein occlussion, but which is not a prognostic factor for final visual acuity.

Surgical Results of Modified Harada-Ito Operation for Excyclotorsion

PURPOSE: We evaluated the efficacy of the modified Harada-Ito operation for excyclotorsion in acquired superior oblique palsy patients after trauma. METHODS: This study represents a retrospective review of 10 eyes in 9 patients who were surgically treated for excyclotorsion. Cyclotorsion was measured with the double maddox-rod test and fundus photographies preoperatively and postoperatively. RESULTS: The median measured change in excyclotorsion before and after the surgery in the primary gaze was reduced from 15.67 +/- 6.00 to 4.78 +/- 3.42 according to fundus photographies and from 12.30 +/- 6.27 to 2.45 +/- 3.73 according to the double maddox-rod test. Subjective and objective changes in excyclotorsion werer not significantly different. CONCLUSIONS: The Modified Harada-Ito operation is an effective treatment for correcting excyclotorsion. Although not statistically significant, the amount of excyclotorsion on fundus photography is exaggerated. This point should be considered to achieve effective surgery.

Short-Term Visual Outcomes According to Patterns of Macular Edema in Retinal Vein Occlusion Patients

PURPOSE: To study the short-term visual outcomes affected by the patterns of macular edema in retinal vein occlusion patients. METHODS: In a retrospective study, 33 eyes of 33 consecutive patients with macular edema from retinal vein occlusion received an intravitreal injection of bevacizumab. Macular edema was classified according to OCT patterns and the effect on visual outcome evaluated: Diffuse macular edema (DME) vs. focal macular edema (FME), and macular edema with serous retinal detachment (SRD) vs. macular edema without serous retinal detachment (non-SRD). RESULTS: Nine patients had CRVO, 24 patients had BRVO and the follow-up period was 3.6 months. In the FME group, the mean baseline BCVA was 0.61 +/- 0.34 and the final BCVA was 0.26 +/- 0.29, a difference that was statistically significant (p < 0.01). In the DME group, the mean baseline BCVA was 0.85 +/- 0.44 and the final BCVA was 0.73 +/- 0.37, a difference that was not statistically significant (p = 0.07). In the non-SRD group, the mean baseline BCVA was 0.76 +/- 0.43 and the final BCVA was 0.38 +/- 0.36, a difference that was statistically significant (p < 0.01). In the SRD group, the mean baseline BCVA was 0.73 +/- 0.40 and the final BCVA was 0.64 +/- 0.42, a difference that was not statistically significant (p = 0.07). CONCLUSIONS: Visual outcome was significantly better in the FME and non-SRD groups. The patterns of macular edema measured according to OCT were a prognostic factor for visual outcome.

ON and OFF Responses of the Electroretinogram in Patients with Glaucoma

PURPOSE: To investigate whether there is a difference in ON- and OFF-responses of the photopic electroretinogram (ERG) in glaucomatous eyes. METHODS: Photopic ERG and optical coherence tomography were performed in 15 normal, 13 glaucoma suspect, and 22 glaucoma subjects. Amplitudes and implicit times for a, b, d, i, photopic negative response (PhNR), and retinal nerve fiber layer thickness were compared among the three groups. RESULTS: The PhNROFF amplitude (microV) was 19.05 +/- 11.41 in the glaucoma group, 14.24 +/- 10.37 in the glaucoma suspect group, and 2.69 +/- 12.16 in the normal group, demonstrating a significant difference among the three groups (p < 0.01). The PhNRON amplitude (microV) was 20.15 +/- 13.99 in the glaucoma group, 31.49 +/- 17.09 in the glaucoma suspect group, and 37.59 +/- 9.53 in the normal group, a significant difference (p < 0.01). However, there was no significant difference between the three groups. The ON-OFF response PhNR amplitude was correlated with retinal nerve fiber thickness (r = 0.481, r = -0.480, respectively), and areas under the receiver operating characteristic curve were 0.782, and 0.718, respectively. CONCLUSIONS: There is a potential role for the ON-OFF response PhNR in early detection of glaucomatous damage.

Preserved Fascia Lata Transplantation for Implant Plate Exposure after Ahmed Glaucoma Valve Implant Surgery: One Case

We report one case of implant plate exposure after Ahmed valve implantation, treated with preserved fascia lata transplantation. Exposure of implant occurred in 47-year-old patient with Ahmed glaucoma valve implantation. She was treated with preserved fascia lata graft and amniotic membrane transplantation. No recurrent implant plate exposure has been found since then. Intraocular pressure has been maintained well for 3 months of follow-up. In cases of implant plate exposure, additional preserved fascia lata graft and amniotic membrane transplantation can improve surgical success.