Correlations between Macular Microvascular Alterations and Peripheral Ischemia in Patients with Branch Retinal Vein Occlusion

Purpose@#We used optical coherence tomography angiography (OCTA) to investigate the correlation between retinal microvascular alteration and peripheral retinal ischemia (evaluated with the aid of ultra-widefield fluorescein angiography [UWFA]) in patients with branch retinal vein occlusion (BRVO). @*Methods@#We retrospectively analyzed 23 eyes of 23 patients with BRVO. Vessel density (VD) and the foveal avascular zone area were measured using OCTA; UWFA was employed to measure the peripheral ischemic area and the ischemic indices (ISIs) of the entire retina and concentric retinal zones. We derived correlations between these factors. Receiver operating characteristic curves were used to predict ISI employing OCTA parameters. @*Results@#The VDs of the superficial capillary plexus (SCP) correlated with the ischemic areas of all retinal zones, and the ISIs of all zones except the far-peripheral area (FPA). The VD of the deep capillary plexus (DCP) correlated significantly with the ischemic areas and ISIs of all retinal zones except those of the FPA. On multivariate linear regression analysis, the VD was significantly correlated with the ISI; when the VDs of the SCP and DCP decreased to 24.7 and 26.1% respectively, this raised a suspicion of severe ischemic conditions with ISI > 10%. @*Conclusions@#A decrease in the BRVO VD was associated with the severity of peripheral ischemia. Our findings may aid identification of high-risk patients who require invasive fluorescein angiography.

Effect of Topical Bromfenac as a Treatment of Cystoid Macular Edema Following Pars Plana Vitrectomy

Purpose@#To investigate the functional and anatomical effectiveness of bromfenac sodium hydrate ophthalmic solution for the treatment of cystoid macular edema (CME) after pars plana vitrectomy (PPV). @*Methods@#A retrospective chart review of 53 patients was performed. Thirty-seven eyes received topical 0.1% bromfenac sodium hydrate ophthalmic solution (nonsteroidal anti-inflammatory drug [NSAID] group), and 16 eyes were treated with subtenon triamcinolone acetonide injection (injection group). Of the NSAID group, 27 eyes underwent PPV with cataract surgery, and 10 eyes underwent PPV without cataract surgery. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured at baseline and monthly after treatment initiation over a 6-month period. @*Results@#No significant difference in mean BCVA from baseline was found for either group over the 6-month follow-up. The injection group showed significantly greater improvement in CMT than the NSAID group at 4 months; however, there was no significant difference between the two groups at the 5-month follow-up visit. IOP was significantly higher in the injection group (p = 0.035 at 2 months), but not in the NSAID group. In the NSAID group, neither PPV group, with and without cataract surgery, showed any significant difference in mean BCVA from baseline over the 6 months of follow-up. The baseline CMT was significantly greater in the PPV with cataract surgery group than in the PPV without cataract surgery group (p = 0.023). However, at the 1-month follow-up, no significant difference in mean CMT from baseline values was observed in either group over the remaining follow-up examinations, up to 6 months. @*Conclusions@#Topical bromfenac resulted in an improvement in the BCVA and a reduction in the CMT, with a less adverse effect in the treatment of CME after PPV, regardless of whether cataract surgery was performed at the same time.

Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab

PURPOSE: To compare the efficacy of intravitreal dexamethasone implants according to previous response to bevacizumab treatment in patients with diabetic macular edema (DME).METHODS: Forty-nine eyes of 49 patients who received intravitreal dexamethasone implants for DME were reviewed retrospectively. Of these patients, 13 were treatment-naïve and 36 had previously received intravitreal injections of bevacizumab. Of the 36 previously treated patients, 24 comprised a refractory group showing no response to previous injections, and 12 comprised a responder group showing a response to previous treatments. The best-corrected visual acuity, central macular thickness (CMT), and retreatment percentages were assessed monthly for 6 months.RESULTS: After the intravitreal dexamethasone implants, visual acuity improved significantly over 6 months in the treatment-naïve group, while in the responder group, a significant improvement in visual acuity was seen at the 2-month follow-up. In the refractory group, there was no significant improvement in visual acuity during the follow-up period. The CMT showed a significant decrease in all three groups, and there was no significant difference in the CMT among the three groups at any time point. Five patients in the treatment-naive group (38.5%), 19 patients in the refractory group (79.2%), and nine patients in the responder group (75.0%) needed retreatment for recurrent macular edema, and there was a significant difference among the three groups in the rate of recurrence (p = 0.034).CONCLUSIONS: In DME patients, intravitreal dexamethasone implants were associated with a significant anatomical improvement irrespective of previous bevacizumab treatment response. However, the treatment-naïve and responder groups showed improvements in visual acuity, whereas the refractory group showed limited improvement.

Effect of Topical Bromfenac as a Treatment of Cystoid Macular Edema Following Pars Plana Vitrectomy

Purpose@#To investigate the functional and anatomical effectiveness of bromfenac sodium hydrate ophthalmic solution for the treatment of cystoid macular edema (CME) after pars plana vitrectomy (PPV). @*Methods@#A retrospective chart review of 53 patients was performed. Thirty-seven eyes received topical 0.1% bromfenac sodium hydrate ophthalmic solution (nonsteroidal anti-inflammatory drug [NSAID] group), and 16 eyes were treated with subtenon triamcinolone acetonide injection (injection group). Of the NSAID group, 27 eyes underwent PPV with cataract surgery, and 10 eyes underwent PPV without cataract surgery. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured at baseline and monthly after treatment initiation over a 6-month period. @*Results@#No significant difference in mean BCVA from baseline was found for either group over the 6-month follow-up. The injection group showed significantly greater improvement in CMT than the NSAID group at 4 months; however, there was no significant difference between the two groups at the 5-month follow-up visit. IOP was significantly higher in the injection group (p = 0.035 at 2 months), but not in the NSAID group. In the NSAID group, neither PPV group, with and without cataract surgery, showed any significant difference in mean BCVA from baseline over the 6 months of follow-up. The baseline CMT was significantly greater in the PPV with cataract surgery group than in the PPV without cataract surgery group (p = 0.023). However, at the 1-month follow-up, no significant difference in mean CMT from baseline values was observed in either group over the remaining follow-up examinations, up to 6 months. @*Conclusions@#Topical bromfenac resulted in an improvement in the BCVA and a reduction in the CMT, with a less adverse effect in the treatment of CME after PPV, regardless of whether cataract surgery was performed at the same time.

Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation

PURPOSE: To report a case of fulminant toxoplasmic chorioretinitis following intravitreal dexamethasone implantation monotherapy in a stabilized toxoplasmic chorioretinitis patient with initial treatment. CASE SUMMARY: A 60-year-old healthy female presented with decreased visual acuity in the left eye. On fundus examination, focal chorioretinitis and yellow-white infiltration were observed. Laboratory work-up, including blood chemistry, complete blood count, and serum serology, was negative; however, toxoplasmic chorioretinitis could not be ruled out. The primary lesion improved with antibiotics and prednisolone treatment. However, the patient did not come in for her follow-up visit, as she had already received an intravitreal dexamethasone implant for recurrent vitreous inflammation elsewhere. On her return, she presented with necrotic retinitis with extensive infiltration. She underwent diagnostic vitrectomy and implant removal. A diagnosis of toxoplasma antigen was confirmed by polymerase chain reaction analysis; the lesions stabilized after anti-toxoplasmic therapy. CONCLUSIONS: Intravitreal dexamethasone implant monotherapy with stabilized toxoplasmic chorioretinitis without systemic antibiotics can lead to fulminant toxoplasmic chorioretinitis and should be used with caution.

Comparison between 20 and 25 Prism Diopters in Bilateral Rectus Muscle Recession for Intermittent Exotropia

PURPOSE: To compare the outcomes of bilateral lateral rectus recession between 20 and 25 prism diopters (PD) for intermittent exotropia. METHODS: A retrospective study was performed with a total of 584 patients who underwent surgery for intermittent exotropia and were followed up for more than 12 months. The patients were classified into either the 20 PD group (5 mm bilateral rectus muscle recession [BLR]) or the 25 PD group (6 mm BLR). Successful postoperative motor alignment was defined as within 10 PD of exotropia and 4 PD of esotropia. RESULTS: Cumulative probabilities of surgical success rates for 24 months were 77.9% in the 20 PD group and 54.8% in the 25 PD group, respectively (p < 0.001). Postoperative deviations in recurrence patients were 13.41 +/- 3.64 PD and 14.66 +/- 3.87 PD (p = 0.062) at postoperative 12 months. CONCLUSIONS: All patients with relatively small angle of exodeviation such as 20 PD had a higher success rate and small postoperative exodaviation at 12 months. Therefore, surgery could be considered when the eye is exodeviated with a relatively small angle. However, in the group with the exotropic drift, approximately 2/3 of the preoperative angle of deviation is measured with similar outcomes between preoperative and postoperative angles of deviation.

The Effect of Unilateral Medial Rectus Resection for Recurrent Intermittent Exotropia

PURPOSE: The purpose of this study is to investigate the effect of unilateral medial rectus muscle resection (UMR) for the treatment of recurrent intermittent exotropia after bilateral lateral rectus muscle recession (BLR). METHODS: Medical records of 121 subjects who underwent UMR for the treatment of recurrent intermittent exotropia after BLR with more than six months of follow-up were reviewed. Patients were classified into two groups, the 4-mm group who underwent 4-mm UMR and the 5-mm group who underwent 5-mm UMR. Successful postoperative motor alignment was defined as within 10 prism diopters (PD) of exotropia and four PD of esotropia. RESULTS: The mean time interval between the primary surgery and recurrence was 13.55 +/- 20.78 months (1-120 months). Average follow-up period after secondary surgery was 27.42 +/- 15.98 months (6-48 months). Cumulative success rate at six months after UMR was 87.1% in the 4-mm group and 88.2% in the 5-mm group, respectively, and that at 24 months was 72.7% in the 4-mm group and 50.0% in the 5-mm group (p = 0.132). The average effect of resection was 4.87 +/- 0.91 PD/mm in the 4-mm group and 4.73 +/- 0.84 PD/mm in the 5-mm group (p = 0.374). CONCLUSIONS: Because of recurrent intermittent exotropia, less time is required for surgery in UMR after BLR, and patients and parents are more likely to accept a secondary surgery because of single muscle surgery. Therefore, UMR may be an effective surgical method for patients with 16-30 PD of recurrent intermittent exotropia.