Twelve-Month Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Retinal Angiomatous Proliferation

PURPOSE: To evaluate the 12-month outcomes of anti-vascular endothelial growth factor (VEGF) treatment for patients with retinal angiomatous proliferation (RAP). METHODS: Retrospective review of medical records was performed for 33 patients (33 eyes) who were diagnosed with RAP. All patients were initially treated with three consecutive intravitreal anti-VEGF injections after diagnosis. Additional treatment was performed when the recurrence of exudation was noted. The best-corrected visual acuity (BCVA) was measured before the first injection and at 3, 6, and 12 months after the first injection. The value measured before the treatment was compared with those measured after treatment. RESULTS: The patients received an average of 4.2 +/- 1.7 intravitreal anti-VEGF injections during the 12-month follow-up period. The logarithm of minimal angle of resolution (log MAR) values of BCVA before the first injection and at 3, 6, and 12 months after the first injections were 0.76 +/- 0.49, 0.55 +/- 0.35, 0.67 +/- 0.41, and 0.70 +/- 0.50, respectively. BCVA was significantly improved at 3 and 6 months (p or =2 log MAR lines of improvement) BCVA. CONCLUSIONS: Anti-VEGF therapy was found to be beneficial in both normalizing macular thickness and in improving or maintaining visual acuity in the majority of patients with RAP.

Development of bioadhesive transdermal bupivacaine gels for enhanced local anesthetic action

Topical drug dosage forms such as ointments and creams can be easily removed through wetting, movement and contact. The new bioadhesive formulations with enhanced local anesthetic effects are needed for topical administration. The adhesive capacity of hydroxypropyl methylcellulose [HPMC] was determined by measuring the maximum detachment force and the adhesion work with an auto peeling tester. The release of drug from a HPMC gel was studied according to the drug concentration. Permeation study through the rat skin was performed at 37°C using phosphate buffer solution [pH = 7.4] as a receptor medium. To increase the skin permeation of bupivacaine from the HPMC gels, penetration enhancer such as the saturated and unsaturated fatty acids, the pyrrolidones, the propylene glycol derivatives, the glycerides, and the non-ionic surfactants were incorporated in the bupivacaine-HPMC gels. The local anesthetic effect of the formulated gel preparation was examined using a tail-flick analgesimeter. As the concentration of HPMC increased, the bioadhesive force and viscosity were increased. The rate of drug release was increased with increasing the drug concentration. Among the enhancers used, polyoxyethylene 2-oleyl ether showed the most enhancing effects on drug permeation through the skin. In the rat tail flick test, the area under the efficacy curve of bupivacaine gel containing polyoxyethylene 2-oleyl ether and tetrahydrozoline showed a 2.36-fold increase in anesthetic activity compared to control gel without any additives. The bupivacaine gels containing both penetration enhancer and vasoconstrictor showed enhancement and prolonged efficacy compared to the control gel. To enhance the local anesthetic effects of bupivacaine, the transdermal bupivacaine gel formulation containing penetration enhancer and vasoconstrictor could be developed

Regression of Choroidal Neovascularization in a Choroideremia Patient after Intravitreal Bevacizumab Injection: A Case Report

PURPOSE: To report the first domestic case of choroidal neovascularization in a choroideremia patient treated with intravitreal bevacizumab injection. CASE SUMMARY: A 29-year-old male presented with a sudden decline in vision in the left eye. Fundus examination revealed areas of choriocapillaries and retinal pigment epithelium atrophy with macular hemorrhage. Fluorescein angiogram revealed vascular hyperfluorescence in the juxtafoveal area. Neurosensory detachment around the macula and increased central macular thickness was also observed using optical coherence tomography. Upon the diagnosis of choroideremia with choroidal neovascularization, the patient was treated with 1.25 mg intravitreal bevacizumab. Visual acuity improved after four injections of intravitreal Bevacizumab with improvement in both detachment and fluorescein leakage. CONCLUSIONS: In patients with choroideremia presenting sudden decline in vision, ophthalmologists should detect for possible choroidal neovascularization. The results from the present study show that judicious use of intravitreal Bevacizumab may be effective in such cases. Further studies with a large sample size and sufficiently long follow-up periods are required.

A Case of Macular Hole after Exposure to Tattoo Removal by Q-Switched Neodymium:YAG Laser

PURPOSE: To report a case of a macular hole resulting from accidental exposure to tattoo removal by the Q-Switched Nd:YAG laser, which was treated successfully by vitrectomy and silicone oil infusion. CASE SUMMARY: A 33-year-old man presented with decreased visual acuity after accidental exposure to a Q-Switched Nd:YAG laser. According to fundus examination, vitreous hemorrhage and macular edema were observed. After 21 days, a macular hole had developed which was treated by standard pars plana vitrectomy and gas tamponade. Unfortunately, closure was not obtained on the first attempt. Therefore, a second attempt using silicone oil infusion was performed. Four months after the initial visit, BCVA had increased to 20/50, and anatomical occlusion was achieved. CONCLUSIONS: The authors of the present study experienced an unusual case of macular hole developed from the Q-Switched Nd:YAG laser used to remove a tattoo. A satisfactory visual acuity was achieved after silicone oil infusion despite failure in the first surgery.

A Case of Flavobacterium Indologenes Keratitis

PURPOSE: Flavobacterium indologenes is known to cause keratitis very rarely. Authors have experienced 1 case of keratitis from Flavobacterium indologenes with history of diabetes mellitus, thereby reporting it. METHODS: History taking, slit lamp examination, staining and culture, sensitivity test about antibiotics were performed on 1 case of keratitis. RESULTS: Flavobacterium indologenes was detected in staining and culture that was performed on the first visit. Piperacillin was used based on the sensitivity test about antibiotics. Improvement of corneal lesion and symptom was observed with the use of piperacillin. CONCLUSIONS: Flavobacterium indologenes can be considered as a casual pathogen in keratitis with condition susceptible to opportunistic infection such as systemic illness or abnormal ocular immunity.

The Effect of Vitrectomy on the Complication of Branch Retinal Vein Occlusion

PURPOSE: This study was designed to evaluate the effect of vitrectomy on the recovery of impaired visual acuity from complication of branch retinal vein occlusion (BRVO). METHODS: The medical records were obtained from all patients who underwent vitreoretinal surgery for complication of BRVO and were followed up at least for 6 months postoperatively. RESULTS: The Surgical indications included vitreous hemorrhage (29 patients), epiretinal membrane (7), and retinal detachment (4). Mean follow-up was 13 months. Preoperatively, best corrected visual acuity was greater than or equal to 0.1 in 14 eyes (35.0%). Six months postoperatively, best corrected visual acuity was greater than or equal to 0.1 in 36 eyes (90.0%). Clinical features associated with better visual outcome included better preoperative visual acuity (P<0.01) and absence of preoperative macular edema (P<0.02). CONCLUSIONS: Vitrectomy is a good procedure for the recovery on the visual impairment due to BRVO complication.