Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole

Purpose@#To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole. @*Methods@#The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months. @*Results@#Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade. @*Conclusions@#Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole

Purpose@#To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole. @*Methods@#The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months. @*Results@#Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade. @*Conclusions@#Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Novel Findings of Polypoidal Choroidal Vasculopathy via Optical Coherence Tomography Angiography

PURPOSE: To introduce novel findings of polypoidal choroidal vasculopathy (PCV) via optical coherence tomography angiography (OCTA) METHODS: This study is a retrospective chart review of 16 patients (16 eyes) with PCV. OCTA (Avanti RTVue XR) findings were evaluated and selected for analysis after agreement by two retina specialists . RESULTS: Twenty one polyps in 16 eyes (16 patients) with PCV were included in this study. The mean patient age was 67 years (13 men and three women). The shape of polypoidal lesions on OCTA at initial were halo (five polyps), rosette (seven polyps), and vascular network (nine polyps). Eight months after anti-vascular endothelial growth factor treatment, in a total of four eyes, seven polyps could be followed up completely, the two halo type polypoidal lesions changed to rosette and vascular network type. The lesions of three rosette and two vascular network type lesions did not change in shape. In addition, the size of the polypoidal lesions (one among two halo types, two among three rosette types, and two among two vascular network types) decreased, but one halo type did not change and one rosette type increased in size on OCTA. CONCLUSIONS: En-face OCTA enabled us to categorize novel types of PCV with polypoidal lesions.

Macular Edema after Gabapentin

No abstract available.

High Dose Intravitreal Bevacizumab for Refractory Pigment Epithelial Detachment in Age-related Macular Degeneration

PURPOSE: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) is the first choice of treatment for age-related macular degeneration. However, quite a few eyes treated using conventional dose anti-VEGF (CDAV) have persistent pigment epithelial detachment (PED) on optical coherence tomography. This study investigated the efficacy and safety of high dose anti-VEGF (HDAV) for refractory PED. METHODS: In this retrospective study, 31 eyes of neovascular age-related macular degeneration patients with persistent PED findings despite six or more intravitreal injections of CDAV (bevacizumab 1.25 mg or ranibizumab 2.5 mg) were analyzed. Changes in visual outcome, central foveal thickness, and PED height were compared before and after HDAV (bevacizumab 5.0 mg) for these refractory PED cases. RESULTS: The mean age of patients was 67.7 years. The number of CDAV injections was 12.1. The number of HDAV injections was 3.39. Best-corrected visual acuity in logarithm of the minimum angle of resolution before and after HDAV was 0.49 and 0.41 (p < 0.001), respectively. Central foveal thickness before and after HDAV was 330.06 and 311.10 µm (p = 0.125), respectively. PED height before and after HDAV was 230.28 and 204.07 µm (p = 0.014), respectively. There were no serious adverse reactions in all the eyes. CONCLUSIONS: Increasing the dose of bevacizumab in refractory PED may be a possible treatment option.

Management of Acute Submacular Hemorrhage with Intravitreal Injection of Tenecteplase, Anti-vascular Endothelial Growth Factor and Gas

PURPOSE: To evaluate the visual and anatomical outcomes for neovascular age-related macular degeneration with submacular hemorrhage after intravitreal injections of tenecteplase (TNK), anti-vascular endothelial growth factor (VEGF) and expansile gas. METHODS: This study was a retrospective clinical case series following 25 eyes of 25 patients. All patients received a triple injection using 0.05 mL TNK (50 µg), 0.05 mL anti-VEGF and 0.3 mL of perfluoropropane gas. Retreatment with anti-VEGF was performed as needed. Preoperative and postoperative best-corrected visual acuity and central retinal thickness were analyzed. RESULTS: The mean logarithm of the minimum angle of resolution of best-corrected visual acuity improved significantly from 1.09 ± 0.77 at baseline to 0.52 ± 0.60 at 12 months (p < 0.001). The mean central retinal thickness also improved significantly from 545 ± 156 at baseline to 266 ± 107 at 12 months (p < 0.001). A visual improvement of 0.3 logarithm of the minimum angle of resolution unit or more was achieved in 15 eyes (60%). During the 12 postoperative months, an average of 4.04 intravitreal anti-VEGF injections was applied. CONCLUSIONS: A triple injection of TNK, anti-VEGF, and a gas appears to be safe and effective for the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration.

Sterile Inflammation after Intravitreal Injection of Aflibercept in a Korean Population

PURPOSE: To report the frequency and clinical features of sterile inflammation after intravitreal aflibercept injection in a Korean population. METHODS: A single-center, retrospective study was performed in patients who received intravitreal aflibercept from July 2013 through January 2015. RESULTS: A total of four cases of post-injection sterile inflammation were identified from 723 aflibercept injections in 233 patients. Patients presented 1 to 13 days after intravitreal aflibercept injection (mean, 5 days). The mean baseline visual acuity was 20 / 60, which decreased to 20 / 112 at diagnosis but ultimately recovered to 20 / 60. Three cases had inflammatory cells in the anterior chamber (mean, 2.25+; range, 0 to 4+), and all cases had vitritis (mean, 3+; range, 2+ to 4+). No patients had pain. Only one patient underwent anterior chamber sampling (culture negative) and injection of antibiotics. Three of four patients were treated with a topical steroid, and all experienced improvement in their symptoms and signs of inflammation. CONCLUSIONS: The overall incidence of sterile inflammation after intravitreal aflibercept injection in a Korean population was 4 of 723 injections (0.55%), or 4 of 233 patients (1.79%). Sterile inflammation after intravitreal aflibercept injection typically presents without pain, and the visual outcomes are generally favorable.

Aflibercept Treatment for Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy Refractory to Anti-vascular Endothelial Growth Factor

PURPOSE: To report the results of switching treatment to vascular endothelial growth factor (VEGF) Trap-Eye (aflibercept) in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) refractory to anti-VEGF (ranibizumab and bevacizumab). METHODS: This is a retrospective study involving 32 eyes from 29 patients; 18 were cases of neovascular AMD and 14 were cases of PCV. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of spectral-domain optical coherence tomography were evaluated. RESULTS: BCVA and CMT improved from 0.58 to 0.55 (p = 0.005) and from 404 to 321 microm (p < 0.001), respectively, after switching to aflibercept. The 14 eyes that received 6 or more aflibercept injections remained stable at 0.81 to 0.81 and 321 to 327 microm (p = 1.0, 0.29), respectively, after 3 aflibercept injections. The 10 eyes that received 3 or more bevacizumab injections after 3 or more aflibercept injections worsened, from 0.44 to 0.47 and from 332 to 346 microm (p = 0.06, 0.05), respectively. The results showed similar improvement of BCVA and CMT in neovascular AMD and PCV. CONCLUSIONS: Aflibercept seems to be effective for improvement and maintenance of BCVA and CMT for neovascular AMD and PCV refractory to anti-VEGF. Switching from aflibercept back to bevacizumab treatment may not be a proper strategy.

A Case of Ocular Toxocariasis Successfully Treated with Albendazole and Triamcinolon

We present a case of ocular toxocariasis treated successfully with oral albendazole in combination with steroids. A 26-year-old male visited the authors' clinic with the chief complaint of flying flies in his right eye. The fundus photograph showed a whitish epiretinal scar, and the fluorescein angiography revealed a hypofluorescein lesion of the scar and late leakage at the margin. An elevated retinal surface and posterior acoustic shadowing of the scar were observed in the optical coherence tomography, and Toxocara IgG was positive. The patient was diagnosed with toxocariasis, and the condition was treated with albendazole (400 mg twice a day) for a month and oral triamcinolone (16 mg for 2 weeks, once a day, and then 8 mg for 1 week, once a day) from day 13 of the albendazole treatment. The lesions decreased after the treatment. Based on this study, oral albendazole combined with steroids can be a simple and effective regimen for treating ocular toxocariasis.

The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

The Efficacy of Intravitreal Triamcinolone Acetonide Injection for Macular Edema in Central Retinal Vein Occlusion

PURPOSE: To investigate the effect of intravitreal injection of triamcinolone acetonide (IVTA) for the treatment of macular edema in central retinal vein occlusion (CRVO). METHODS: Seventy patients with CRVO and persistent macular edema were included in this retrospective study. Thirty-six eyes of 36 patients received an intravitreal injection of 4 mg (0.1 cc) triamcinolone and 34 eyes of 34 control patients didnot receive an injection. Any differences in visual acuity and foveal thickness were measured and compared between the two groups. The correlation between the change in foveal thickness and visual acuity was also evaluated. RESULTS: In ischemic CRVO group, the mean difference of visual acuity between the injection and the control groups was not statistically significant (p<0.05) at the initial measurement and at one week, one, three, and six months after the injection. However, in the non-ischemic CRVO group it was not clinically significant (p<0.05) at the initial time, one week or six months after the injection. But it was clinically significant at one months and three months after receiving the injection (p=0.004 and 0.001). The mean difference in foveal thickness was clinically significant (p<0.001). The visual acuity and foveal thickness were correlated in non-ischemic group but not in the ischemic group. CONCLUSIONS: The IVTA appears to be an effective treatment in patients with macular edema associated with CRVO. The visual acuity of patients with non-ischemic CRVO improved temporally after the IVTA injection, but there was no significant improvement in ischemic CRVO group.

The Efficacy of Intravitreal Triamcinolone Acetonide Injection for Macular Edema in Central Retinal Vein Occlusion

PURPOSE: To investigate the effect of intravitreal injection of triamcinolone acetonide (IVTA) for the treatment of macular edema in central retinal vein occlusion (CRVO). METHODS: Seventy patients with CRVO and persistent macular edema were included in this retrospective study. Thirty-six eyes of 36 patients received an intravitreal injection of 4 mg (0.1 cc) triamcinolone and 34 eyes of 34 control patients didnot receive an injection. Any differences in visual acuity and foveal thickness were measured and compared between the two groups. The correlation between the change in foveal thickness and visual acuity was also evaluated. RESULTS: In ischemic CRVO group, the mean difference of visual acuity between the injection and the control groups was not statistically significant (p<0.05) at the initial measurement and at one week, one, three, and six months after the injection. However, in the non-ischemic CRVO group it was not clinically significant (p<0.05) at the initial time, one week or six months after the injection. But it was clinically significant at one months and three months after receiving the injection (p=0.004 and 0.001). The mean difference in foveal thickness was clinically significant (p<0.001). The visual acuity and foveal thickness were correlated in non-ischemic group but not in the ischemic group. CONCLUSIONS: The IVTA appears to be an effective treatment in patients with macular edema associated with CRVO. The visual acuity of patients with non-ischemic CRVO improved temporally after the IVTA injection, but there was no significant improvement in ischemic CRVO group.

The Outcomes After Indocyanine Green-assisted Peeling of the Internal Limiting Membrane in Macular Hole Surgery

PURPOSE: To investigate whether indocyanine green (ICG) staining of the internal limiting membrane (ILM) improves surgical and visual outcomes in macular hole surgery. METHODS: Three consecutive groups of patients with stage 3 and stage 4 macular hole underwent standard vitrectomy. Group I (45 eyes) underwent an adjunctive peeling of ILM stained with intravitreal application of 0.1 ml of 0.5% ICG dye, group II (23 eyes) an adjunctive ILM peeling without use of ICG dye, and group III (23 eyes) no adjunctive technique. Postoperative anatomic closure rates of the hole and the logarithm of the minimal angle of resolution (logMAR) visual acuity improvement were compared among the groups. RESULTS: The mean age was 61 years, and the mean follow-up period was 11 months. The rate of macular hole closure, as determined by optical coherence topography was 70% in group I, 61% in group II, and 61% in group III, and the difference were not statistically significant (p=0.726). The differences between preoperative and postoperative logMAR visual acuities among the three groups were not statistically significant (p=0.898). CONCLUSIONS: Intravitreal ICG-assisted ILM peeling did not improve anatomic outcomes in macular hole surgery. (Ed-confirm, something appears to be missing here)

Concenteric Chorioretinal Atrophy after Photodynamic Therapy

PURPOSE: To report a case of chorioretinal atrophy after photodynamic therapy to subfoveal choroidal neovascular membrane. METHODS: We followed up the photodynamic treatment to a 57-year-old woman who complained of the falling of vision in her right eye for 2 months and was diagnosed with subfoveal choroidal neovascular membrane at our institution. Since the size of neovascular membrane increased 3 month after the first photodynamic treatment, the patient underwent retreatment. Concentric chorioretinal atrophy developed around the laser applied site 3 months after retreatment, and enlargement of the atrophy area occurred 2 years later. In multifocal electroretinography, the retinal function of the chorioretinal atrophic eye was not decreased compared with the other eye. RESULTS: The choroids collateral circulation damage or direct drug photochemical effect was thought to be the cause of the chorioretinal atrophy after photodynamic treatment at the laser applied site but there is no functional decline of the atrophic retina.

The Efficacy of Intravitreal Triamcinolone Acetonide for Macular Edema in Branched Retinal Vein Occlusion

PURPOSE: To investigate the administration of an intravitreal injection of triamcinolone acetonide (IVTA) for the treatment of macular edema in branch retinal vein occlusion (BRVO). METHODS: Forty-four patients with BRVO were enrolled in this study. At the first and third month after the injection of triamcinolone acetonide (4 mg/0.1 cc), the best corrected visual acuity (BCVA) was measured by Snellen chart and the thickness of macula by OCT. RESULTS: BCVA and the macular thickness were not correlated in BRVO. Average BCVA was 0.99 (log MAR), and the mean macular thickness was 498 micrometer before injection. At the third month after injection, the results were 0.7 (log MAR) and 258 micrometer, respectively. Although 3 eyes experienced a transient increase of intraocular pressure, there were no serious complications affecting visual acuity. CONCLUSIONS: Macular edema and various other factors are considered as the causes of decreased visual acuity in BRVO. IVTA is effective in treating macular edema but not in improving visual acuity.

Postoperative Refractive Error after Vitrectomy In Macular Hole Patients

PURPOSE: To evaluate the postoperative refractive error after vitrectomy and gas tamponade in macular hole patients. METHODS: Thirty patients with full-thickness macular hole were enrolled in this study. Thirty eyes had vitrectomy, internal limiting membrane peeling, and gas tamponade. Preoperative and postoperative refractive errors were compared. Five eyes also had cataract extraction and implantation of an IOL and actual and expected refractive errors were compared. RESULTS: The refraction after vitrectomy and gas tamponade shifted toward myopia by 0.71 diopter compared with preoperative refraction. The actual refractive errors in cataract surgery group shifted toward myopia by 0.65 diopter. CONCLUSIONS: . Use of a gas tamponade in macular hole patients is thought to have induced the myopic change by pressing the crystalline lens forward.

Non-invasive Diagnosis of Melanocytoma and 1 Case Report

PURPOSE: To report one case of juxtapapillary choroidal melanocytoma diagnosed noninvasive methods. METHODS: A 27 year-old female patient was referred to our hospital due to her rapid growing peripapillary mass which had been detected by routine examinations for LASIK operation for the past 2 years. On fundus exam, a markedly pigmented brown-black colored mass located nasal to the margin of the optic nerve head was observed. Its margin was feathery and its surface showed pigmented granular appearance. On fluorescein angiography, the tumor was hypofluorescent and surrounded by bright stained rim, which seemed to be like `semicircular well-defined comet-tail'. Optical coherence tomography demonstrated that lesion had a high reflectance signal anteriorly and optical shadowing behind. The high signal was continuous with the retinal nerve fiber layer, which was consistent with growth patterns of melanocytoma. CONCLUSIONS: From the experience of a case of peripapillary melanocytoma, we suggest noninvasive diagnostic methods of melanocytoma such as optical coherence tomography and fluorescein angiography may be very useful in differentiating melanocytoma from choroidal melanocytic lesions. Periodic follow-up to use it clinically is also suggested.

Late Opacification of Hydrophilic Acrylic Intraocular Lenses

PURPOSE: To report clinical, pathological, histochemical, ultrastructural, and spectrographic analysis of explanted hydrophilic acrylic intraocular lenses (IOLs). By IOL extraction and new IOL implantation, patients resulted in increased visual acuity. METHODS: Four hydrophilic acrylic IOLs (ACRL-C160,Opthalmed(R),California,USA)were explanted from the 3 patients who had developed decreased visual acuity after about 5months from uneventful phacoemulsification and IOL implantation. Four IOLs were examined by gross and light microscopy. Staining of IOLs was performed with 1% alizarin red and von Kossa method (both stains for calcium). Some were submitted for scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), Infrared spectral analysis (IR), X-ray diffraction (XRD) and energy dispersive X-ray spectroscopy (EDS). RESULTS: Microscopic analysis showed opaque materials on explanted IOL surface. The deposits were stained positive with Alizarin red and the von Kossa method for the detection of calcium. SEM revealed IOL surface covered by calcium crystals and collagen fibers. Many studies such as XPS, IR, EDS showed that the causes of opacification of IOLs were calcium phosphate hydroxide (hydroxyapatite). We suspect silicone promoted this reaction as catalyst. CONCLUSIONS: This is the rarest cases and clinical, pathological and spectroscopic report of opacified hydrophilic acrylic IOLs (ACRL-C160,Opthalmed(R),California,USA). We found out materials causing opacification by many special studies. Additional studies should be done to determine possible mechanisms and biocompatibility of the IOLs materials containing UV absorbable coating materials, packaging system and foldable systems in the intraocular conditions

A Case of Retinal Hemorrhage after Climbing the Himalaya Mountains

High altitude exposure may produce multiple symptoms of mountain sickness. A 27-year-old man presented with metamorphopsia in his left eye which occurred following climbing the Himalaya Mountains. His best corrected visual acuity was right eye, 0.9 and left eye, 0.3. Ophthalmoscopy disclosed retinal hemorrhages in both eyes and a subfoveal hemorrhage in left eye. Fluorescein angiography showed blockage of fluorescence caused by retinal hemorrhages. Indocyanin green angiography showed no hot spot. One month later, best corrected visual acuity of his left eye was 0.4 and the degree of metamorphopsia decreased. Thus we report the case of mountain sickness who showed retinal hemorrhage and subfoveal hemorrhage with a review of available literatures.

TGF-betas Synthesized by RPE Cells Have Autocrine Activity on Mesenchymal Transformation and Cell Proliferation

The present study investigated the effects of transforming growth factor (TGF)-beta on retinal pigment epithelial (RPE) transformation in a simplified model and also whether or not TGF-beta exhibits similar proliferation effects on transformed RPE cells that it has on primary RPE cells. Furthermore, we examined the cell proliferation effects of RPE-conditioned medium (CM). A vertical wound measuring 2 mm in diameter was made on primary RPE monolayers. The expression of alpha- smooth muscle actin (SMA) by the cells located at the wound edges was observed using a confocal microscope under immunofluorescent staining. Cell proliferation was measured by incorporating 3H-thymidine into DNA. The presence of alpha- SMA was observed in the cells within the wound after treatment with TGF-beta2, while negative expression was observed in control cells. TGF-betas inhibited the proliferation of the primary cultures of RPE cells in a dose-dependent manner, but the spindle-shaped late-passaged RPE cells were not inhibited by these growth factors. The medium conditioned by RPE cells stimulated the proliferation of subconjunctival fibroblasts and inhibited the proliferation of primary RPE cells, in a manner similar to TGF-beta. These findings demonstrate that TGF-beta-stimulated RPE cells may evoke proliferative vitreoretinopathy through mesenchymal transformation and cell proliferation.