Diagnosing Polypoidal Choroidal Vasculopathy Using Color Fundus Photography, Optical Coherence Tomography, and Optical Coherence Tomography Angiography

Purpose@#To compare the diagnostic accuracy of differentiating polypoidal choroidal vasculopathy (PCV) from exudative age-related macular degeneration (AMD), using color fundus photography (CFP), optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA) without using indocyanine green angiography (ICGA). @*Methods@#Treatment-naive eyes with exudative AMD that underwent CFP, OCT, SS-OCTA, and ICGA imaging before treatment were identified. Images of each patient were categorized into two sets (set A, CFP + OCT; set B, CFP + SS-OCTA). In set B, both the en face and cross-sectional B scans were analyzed. Each set was reviewed by two graders, and it was determined whether the presumed diagnosis was PCV. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for the diagnosis of PCV were assessed for each set by comparing diagnoses that included ICGA. The number of polypoidal lesions in each set was calculated and compared to ICGA. @*Results@#A total of 94 eyes from 94 patients with AMD were included in the study, of which 66.0% were male, and the mean age was 71.8 ± 9.0 years. The PCV diagnosis rate using ICGA was 45.7%. The sensitivity was 0.88 for set A and 0.93 for set B, while the specificity was 0.94 for set A and 0.96 for set B. The AUC was 0.90 (95% confidence interval [CI], 0.83–0.97) for set A and 0.96 (95% CI, 0.90–1.00) for set B. Set A detected 1.28 ± 0.91 polypoidal lesions, while set B detected 1.47 ± 1.01; ICGA showed 1.51 ± 0.86. @*Conclusions@#This study highlights that, without using ICGA, both CFP combined with OCT and CFP combined with SS-OCTA demonstrate high sensitivity, specificity, and AUC in diagnosing PCV. It is evident that SS-OCTA contributes to enhancing sensitivity, specificity, and AUC for PCV diagnosis.

Correlation between Topographic Progression of Geographic Atrophy and Visual Acuity Changes

Purpose@#To analyze topographic progression of geographic atrophy with different concentric circles centered on the fovea in correlation with decrease of visual acuity. @*Methods@#We retrospectively analyzed 36 eyes of 26 patients diagnosed with geographic atrophy and followed at least 1 year. One millimeter circular area at the foveal center were defined as zone 1, and doughnut shape areas from between 1 and 2 mm to between 5 and 6 mm were defined as zone 2 to 6. Then, changes of geographic atrophy area in each zone were measured with semi-automatic software. Correlation analysis and regression analysis were performed to determine the relationship between changes in visual acuity and atrophic area in each zone. @*Results@#Mean age was 76.9 years and follow-up period were 3.38 years. The mean atrophic area increased from 8.09 to 16.34 mm2 and visual acuity decreased from 0.39 to 0.69 on logarithm of the minimal angle of resolution. Mean change of total geographic atrophy area was not significantly correlated with visual acuity decrease. While geographic atrophy progression within zone 1, 2, and 3 showed significant causal relationship with decrease of visual acuity (all, p < 0.05). @*Conclusions@#In contrast to the total geographic atrophy area, progression of geographic atrophy in parafoveal area was significantly correlated with decrease of visual acuity.

Effects of Blue Light on Eye of Zebra Fish and Protective Role of Polyphenolic Compounds

Purpose@#To investigate the oxidative damage and changes of retinas by blue light through zebrafish and to confirm the protective effect of polyphenol on retina cells using grape seed-derived polyphenols. @*Methods@#To induce oxidative damage and changes of the retina by blue light, blue light LED (10,000 Lux, 480 nm) was added to the zebrafish grown in the dark room after pretreating polyphenols derived from grape seed at various concentrations (0, 0.1, 1, 10 μg/mL, respectively) for 4 days. Changes in retinal thickness and numbers of outer nuclear layer nuclei through hematoxylin & eosin staining were evaluated. @*Results@#Photoreceptor layer thickness of blue light exposed group was significantly thinner than the group without blue light (108.1 ± 27.7 μm vs 41.1 ± 17.0 μm). As pretreated polyphenol concentration increased, photoreceptor layer thickness was increased (41.1 ± 17.0, 56.3 ± 18.6, 90.7 ± 23.7, 99.1 ± 23.1 μm, p < 0.05), and damage to outer nuclear layer nuclei was also decreased. @*Conclusions@#Exposure to blue light is an important factor for increasing oxidative stress in the retina. Grape seed-derived polyphenols have been shown to protect photoreceptor cells and retinal pigment epithelial cells from oxidative stress. This suggests that the antioxidant effect of polyphenol compounds may help suppress the progression of retinal diseases associated with oxidative stress such as age-related macular degeneration.

Comparison of Focal and Conventional Verteporfin Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).METHODS: This study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.RESULTS: The mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).CONCLUSIONS: Focal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.

Long-term Results of Taking Anti-oxidant Nutritional Supplement in Intermediate Age-related Macular Degeneration

PURPOSE: We prospectively investigated clinical changes and long-term outcomes after administration of the drugs recommended by the Age-Related Eye Disease Study-2 to patients with intermediate age-related macular degeneration (AMD). METHODS: This prospective multicenter study enrolled 79 eyes of 55 patients taking lutein and zeaxanthin. The primary endpoint was contrast sensitivity; this was checked every 12 months for a total of 36 months after treatment commenced. The secondary endpoints were visual acuity, central macular thickness, and drusen volume; the latter two parameters were assessed using spectral domain optical coherence tomography. RESULTS: The mean patient age was 72.46 ± 7.16 years. Contrast sensitivity gradually improved at both three and six cycles per degree. The corrected visual acuity was 0.13 ± 0.14 logMAR and did not change significantly over the 36 months. Neither the central macular thickness nor drusen volume changed significantly. CONCLUSIONS: Contrast sensitivity markedly improved after treatment, improving vision and patient satisfaction. Visual acuity, central retinal thickness, and drusen volume did not deteriorate. Therefore, progression of AMD and visual function deterioration were halted.

Comparison of Ranibizumab and Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

PURPOSE: To assess the effectiveness and safety of intravitreal ranibizumab compared with bevacizumab for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: This was a retrospective study of 80 eyes with macular edema associated with BRVO. Patients received either 0.5 mg of ranibizumab (n = 24) or 1.25 mg of bevacizumab (n = 56) intravitreally. Both groups received three initial monthly injections followed by as-needed injections. The best-corrected visual acuity, central subfield thickness, mean number of injections, and retreatment rate were evaluated monthly for 6 months after the initial injection. RESULTS: The best-corrected visual acuity significantly improved from logarithm of the minimal angle of resolution (logMAR) 0.55 ± 0.26 at baseline to 0.24 ± 0.26 at 6 months in the ranibizumab group (p < 0.001) and from logMAR 0.58 ± 0.21 at baseline to 0.29 ± 0.25 at 6 months in the bevacizumab group (p < 0.001), which is not a statistically significant difference (p = 0.770). The mean reduction in central subfield thickness at 6 months was 236 ± 164 µm in the ranibizumab group (p < 0.001) and 219 ± 161 µm in the bevacizumab group (p < 0.001), which is not also a statistically significant difference (p = 0.698). The mean numbers of ranibizumab and bevacizumab injections were 3.25 ± 0.53 and 3.30 ± 0.53, respectively (p = 0.602). In addition, after the three initial monthly injections, the retreatment rates for ranibizumab and bevacizumab injections were 20.8% and 26.7%, respectively (p = 0.573). CONCLUSIONS: Both ranibizumab and bevacizumab were effective for the treatment of BRVO and produced similar visual and anatomic outcomes. In addition, the mean number of injections and the retreatment rates were not significantly different between the groups.

A Case of Repeated Dexamethasone Implantation in a Suspected Patient with IRVAN Syndrome

PURPOSE: In the present study, a case of repeated intravitreal dexamethasone implantation for a suspected idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome associated with recurrent exudative retinal detachment and macular edema is reported. CASE SUMMARY: A 39-year-old female who underwent steroid pulse therapy due to Vogt-Koyanagi-Harada disease in the left eye was referred for exudative retinal detachment and macular edema. Best corrected visual acuity (BCVA) was 1.0 in the right eye and 0.5 in the left eye. Cystoid macular edema combined with serous retinal detachment was observed on spectral-domain optical coherence tomography. Fluorescein angiography revealed neovascularization and multiple macroaneurysms with fluorescein leakage in the left peripapillary area. Severe peripheral capillary non-perfusion and fluorescein leakage were also observed in both eyes. Intravitreal dexamethasone implantation was performed in the left eye and macular edema showed wax-and-wane pattern. No edema was observed after 4 additional dexamethasone implantations, however, preretinal hemorrhage occurred in the peripapillary area during treatment. Seventeen months after initiation of treatment, BCVA was 0.6 in the left eye and dry macula was maintained. CONCLUSIONS: Repeated intravitreal dexamethasone implantation was effective for recurrent macular edema in a patient suspected with IRVAN syndrome.

Long-term Outcomes of Diabetic Macular Edema Following Initial Intravitreal Ranibizumab Injection Based on Morphologic Pattern

PURPOSE: To evaluate the 3-year visual and morphological outcomes of diabetic macular edema (DME) based on the morphological pattern observed on optical coherence tomography (OCT) after intravitreal ranibizumab injections. METHODS: Thirty-two eyes of 32 patients with DME were classified according to the following OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All patients received 3 consecutive monthly intravitreal injections of 0.5 mg ranibizumab. After 3 injections, patients received ranibizumab or dexamethasone implantation as needed. The primary outcome was the number of treatments received based on the DME type over 36 months. Best-corrected visual acuity (BCVA), central subfoveal thickness, and macular volume changes were also evaluated. RESULTS: The eyes were classified as DRT (n = 16), CME (6), or SRD (10). The mean number of injections over 3 years was significantly different among the groups: DRT (4.25), CME (7.5), SRD (7.6; p = 0.048). The number of patients who did not need additional treatment after the initial 3 injections was 13 with DRT (81.3%), 2 with CME (33.3%), and 5 with SRD (50%; p = 0.045). BCVA at 36 months significantly improved from baseline in the DRT group (p = 0.003). The CME group showed the worst BCVA among the groups (p = 0.023). Six patients who received intravitreal dexamethasone implantation showed no significant improvement of BCVA but significant decrease in macular volume from 12 to 36 months. CONCLUSIONS: Clinical courses varied according to the morphological pattern of DME after intravitreal ranibizumab injection, and patients with DRT maintained visual and anatomical improvement with fewer injections over 36 months. Additional dexamethasone implantation showed limited effect in reducing macular edema with persistent macular cystic change, but no significant improvement in visual acuity.

Imported Intraocular Gnathostomiasis with Subretinal Tracks Confirmed by Western Blot Assay

We report a case of intraocular gnathostomiasis diagnosed by western blot assay in a patient with subretinal tracks. A 15-year-old male patient complained of blurred vision in the right eye, lasting for 2 weeks. Eight months earlier, he had traveled to Vietnam for 1 week and ate raw wild boar meat and lobster. His best-corrected visual acuity was 20/20 in both eyes and anterior chamber examination revealed no abnormalities. Fundus examination showed subretinal tracks in the right eye. Fluorescein angiography and indocyanine green angiography showed linear hyperfluorescence of the subretinal lesion observed on fundus in the right eye. Ultrasound examination revealed no abnormalities. Blood tests indicated mild eosinophilia (7.5%), and there was no abnormality found by systemic examinations. Two years later, the patient visited our department again for ophthalmologic evaluation. Visual acuity remained 20/20 in both eyes and the subretinal tracks in the right eye had not changed since the previous examination. Serologic examination was performed to provide a more accurate diagnosis, and the patient's serum reacted strongly to the Gnathostoma nipponicum antigen by western blot assay, which led to a diagnosis of intraocular gnathostomiasis. This is the first reported case of intraocular gnathostomiasis with subretinal tracks confirmed serologically using western blot in Korea.

Prognostic Factors in Vitrectomy for Macular Epiretinal Membrane

PURPOSE: To identify prognostic factors associated with a favorable outcome after vitrectomy for patients with macular epiretinal membrane (ERM). METHODS: The authors retrospectively reviewed the records of 63 patients (64 eyes) with macular ERM, who were treated by vitrectomy between 2003 and 2008, and followed for more than 6 months. RESULTS: The mean follow-up period was 13.21 +/- 9.11 months and the mean best corrected visual acuity after vitrectomy was log MAR 0.32 +/- 0.34. Univariate analysis revealed the patients in the group with a postoperative log MAR of 0.3 or better had better preoperative visual acuity and shorter symptom duration; multivariate analysis revealed the same results. In 24 eyes, intraretinal structures which contained pseudoholes, intraretinal cysts, retinal folds and vitreoretinal traction were analyzed with Cirrus HD-OCT, however, there was no correlation with visual acuity after vitrectomy. CONCLUSIONS: The present study demonstrated vitrectomy for macular ERM resulted in favorable visual improvement. The preoperative visual acuity and symptom duration were a significant prognostic factor.

The Effects of Intravitreal Bevacizumab Injection According to the Type of Diabetic Macular Edema

PURPOSE: To investigate the effects of intravitreal bevacizumab injection on diabetic macular edema (DME) of different types classified using Optical Coherence Tomography (OCT). METHODS: A total of 82 eyes with refractory DME were enrolled. The DME was classified into diffuse, cystoid, or serous type based on the OCT findings. All cases had received an intravitreal injection of 1.25 mg bevacizumab each month for three months. Foveal thickness, macular volume, and best corrected visual acuity (BCVA) were measured before and one month after the injection, and the interval changes in these parameters were compared. RESULTS: The types of DME were classified as follows: diffuse macular edema 50%, cystoid macular edema 31.7%, and serous macular detachment 18.3%. Foveal thickness and total macular volume after intravitreal bevacizumab injection decreased in all types, and the cystoid and serous types showed better response than did the diffuse type with regard to foveal thickness. However, there were no significant differences in the extent of the change in total macular volume or BCVA among the three types of DME. CONCLUSIONS: There were differences in the therapeutic effects of intravitreal bevacizumab injection among the different types of DME classified using OCT. These differences may be associated with the stabilizing effect of the bevacizumab. This effect was stronger with regard to vascular permeability, the primary factor in the pathogenesis of the cystic and serous types, than with regard to leakage from the microaneurysm, the primary factor in the pathogenesis of the diffuse type. Practical application of bevacizumab to eyes with different DME types will help in further evaluating intravitreal bevacizumab injection as a treatment option for DME.

One Sister and Brother with Mirror Image Myopic Anisometropia

We report a case of one sister and brother with mirror image myopic anisometropia. One sister and brother complained visual disturbance. The sister was 10 years 11 months old, and brother was 8 years 4 months old. Full ophthalmic examinations were performed, including slit lamp examination, intraocular pressure, keratometry, anterior chamber depth, axial length, fundus examination and the cycloplegic refraction. The cycloplegic refractive power was -15.50 dpt cyl.+4.50 dpt Ax 85degrees (right eye), -1.00 dpt cyl.+0.50 dpt Ax 90degrees (left eye) in the sister; -1.75 dpt cyl.+2.25 dpt Ax 90degrees (right eye), -9.50 dpt cyl.+4.00 dpt Ax 80degrees (left eye) in the brother. The co-occurrence of severe myopic anisometropia in a sister and brother is extremely rare. The present case suggests that severe myopic anisometropia may be related by genetic inheritance.

Long-Term Results of Intravitreal Bevacizumab Injection for Macular Edema: Retinal Vein Obstruction and Diabetic Retinopathy

PURPOSE: To evaluate the long-term results of intravitreal bevacizumab injection for macular edema (ME) due to retinal vein obstruction (RVO) and diabetic retinopathy (DR). METHODS: The objects of study were patients with decreased visual acuity due to ME with RVO and DR for whom intravitreal injections of 1.25 mg (0.05 ml) bevacizumab were repeated three times with an interval of six weeks and who were available for a follow-up period of more than 12 months. The patients underwent additional bevacizumab injections if ME increased as assessed by optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and follow-up visits. RESULTS: There were 16 patients with RVO and 18 patients with DR. In the RVO group, the mean length of follow-up was 12.4+/-1.1 months, the mean baseline BCVA was 0.75+/-0.32 and the final BCVA was 0.42+/-0.25, a difference that was statistically significant (p0.05). The mean CMT at baseline was 462.0+/-195.0 microm and decreased to a mean of 282.2+/-177.3 microm at the end of the follow-up period (p<0.05). CONCLUSIONS: In RVO and DR, three injections of intravitreal bevacizumab with an interval of six weeks and additional injections as indicated were effective in reducing ME and showed especially good results in improvement of visual acuity for ME due to RVO.

Early and Late Intravitreal Bevacizumab Injection in Macular Edema Due to Branch Retinal Vein Occlusion

PURPOSE: To compare the effects of early and late intravitreal injection of bevacizumab in patients with macular edema (ME) due to branch retinal vein occlusion (BRVO). METHODS: The study sample included 56 eyes of 56 patients who received intravitreal bevacizumab injection for ME due to BRVO and were followed up with at least six months of observation. We retrospectively divided eyes into two classes that included 36 eyes with a disease duration of 3 months (late treatment group). We assessed the effects of injection on the best corrected visual acuity (BCVA), central retinal thickness and IOP at one, three, and six months after treatment. RESULTS: There was no statistically significant differences in terms of sex, age, number of injections, ischemia, pre-injection visual acuity and central retinal thickness between the two treatment groups. Improvements in central retinal thickness were observed in both groups but were not significantly different between the groups. Visual acuity improved in both groups after treatment; the improvement was significantly better in the early treatment group observed three and six months after treatment. IOP did not change after treatment in either group. CONCLUSIONS: In cases of ME due to BRVO, early intravitreal bevacizumab injection is more effective than late injection for maintaining and improving visual acuity.

Comparison of Vitreolytic Effect in Rabbit Eyes: Plasmin, Hyaluronidase, and Their Mixtures

PURPOSE: The aim of the present study was to quantify and compare the vitreolytic effect of plasmin, hyaluronidase, and a combination of the two. METHODS: Thirty-six rabbits were randomized into 3 groups: (A) twelve rabbits had an intravitreal injection of plasmin 1 U with hyaluronidase 10 U/0.1 mL into the right eye, (B) twelve rabbits had an injection of plasmin alone (1 U/0.1 mL), and (C) twelve rabbits had an injection of hyaluronidase alone (10 U/0.1 mL). The left eye of each rabbit was used as control, which was injected with 0.1 mL phosphate buffered saline (PBS). The eyes were enucleated 1 hour and 24 hours after injection. The volume of fluid-type vitreous and gel-type vitreous was measured with a micropipette using the melting point as the difference. Statistical analysis was performed and light microscopy was used to assess potential damage to the retinal tissue. RESULTS: The volume of remaining gel-type vitreous was measured as 52.5%, 60.3%, 59.2%, and 76.5% after 1 hour enucleation and as 44.6%, 56.7%, 56.1%, and 74.7%, after 24 hours enucleation in group A, B, C, and control group, respectively. Group A, B, and C showed statistically significant differences against the control group. Group A (plasmin with hyaluronidase) showed less remaining gel-type vitreous volume than a single injection of plasmin or hyaluronidase alone. CONCLUSIONS: Intravitreal injection of plasmin with hyaluronidase showed more vitreolytic effect than a single injection of plasmin or hyaluronidase alone. The enzyme may be useful in liquefying the vitreous, and may be a useful biochemical adjunct to vitrectomy.

The Comparison of Macular Thickness Measurements and Repeatabilities Between Time Domain and Spectral Domain OCT

PURPOSE: To compare macular thickness measurements obtained from time domain optical coherence tomography (TD-OCT) and 2 spectral domain (SD) OCTs and to evaluate their repeatability and agreement in normal subjects and diabetic macular edema patients. METHODS: Fifty-four healthy, normal subjects and 26 diabetic macular edema patients were participated in this study. In a randomly selected eye from each subject, two serial macular measurements were obtained from TD-OCT (Stratus OCT) and SD-OCTs (Cirrus HD-OCT, Spectralis HRA+OCT) by an experienced technician in random order. Nine areas of macular thickness map and repeatabilities obtained by the 3 OCTs were compared. RESULTS: In relative repeatability, SD-OCT showed better results overall compared to TD-OCT. Macular thickness was greatest in the Spectralis HRA+OCT in both normal subjects and diabetic macular edema patients, followed by Cirrus HD-OCT and Stratus OCT. In normal subjects, regardless of the type of comparison between the machines there was a statistically significant difference in all 9 areas. CONCLUSIONS: While the TD-OCT and the 2 SD-OCTs are reliable for macular thickness measurement, SD-OCT has better measurement repeatability compared with TD-OCT. Because macular measurements obtained from the 3 OCT systems cannot be interchanged, an effort should be made to standardize the measurement of each system.

Clinical Evaluation of Patients with Nonproliferative Diabetic Retinopathy Following Medication of Anthocyanoside: Multicenter Study

PURPOSE: To prospectively investigate the change of clinical manifestations after 1 year of administration of anthocyanoside (Tagen-F(R)) to patients with NPDR-associated macular edema. METHODS: One hundred seventy-five eyes in 88 patients were enrolled in this study, at 5 centers, from March, 2005 to October, 2005. Patients took 3 capsules of Vaccinium myrtillus extract (170 mg/capsule, Tagen-F(R), Kukje pharmaceutical) per day. The primary endpoints were corrected visual acuity and contrast sensitivity which were checked at 2 months following the beginning of treatment [East 1]. The secondary endpoints were the number of hard exudates, microaneurysms, leaking points and the changes of foveal thickness. These were examined at the beginning of, 6 months after, and 12 months after treatment. RESULTS: Corrected visual acuity showed no significant changes during 12 months. Contrast sensitivity improved gradually, especially in 12, 16 cycles per degree [East 2]. There was no statistically significant changes in the numbers of hard exudates, microaneurysms, and leaking points. Foveal thickness measured by OCT was maintained and there was no aggravation of macular edema. CONCLUSIONS: There was marked improvement of contrast sensitivity in patients with NPDR after 1 year of administration of anthocyanoside (Tagen-F(R)), and it might contribute to the quality of vision and the satisfaction of patients. Visual acuity and macular edema were maintained without aggravation.

Comparison of Silicone Oil Removal Using 23-Gauge and 20-Gauge System for Pars Plana Vitrectomy

PURPOSE: The purpose of this study was to compare the clinical results of silicone oil removal using a 23-gauge transconjunctival sutureless pars plana vitrectomy (TSVS) and the 20-gauge pars plana vitrectomy (PPV) system and to evaluate the clinical value of 23-guage PPV system in silicone oil removal. METHODS: Eight eyes of 8 patients who received removal of silicone oil using the 23-gauge TSVS and 6 eyes of 6 patients using the 20-gauge PPV system were included in this study. The total operation time, silicone oil removal time, intraoperative and postoperative advantages, shortcomings, and complications were compared. RESULTS: The operation time and silicone oil removal time were 44.6+/-14.1 minutes, 42.7+/-10.5 minutes and 2.0+/-0.9 min/cc, 1.4+/-0.6 min/cc when silicone oil removal was performed using 23-gauge TSVS and 20-gauge PPV system, respectively. They were not significantly different (p=0.80, 0.22). Attention for the complete removal of the oil is necessary because of the intraocular trocar length when the 23-gauge TSVS is used. There were no complications except transient hypotonies (2 eyes), transient hypertonies (2 eyes) in the 23-gauge system and transient hypertonies (2 eyes) in the 20-gauge system. CONCLUSIONS: The operation time for silicone oil removal using the 23-gauge TSVS was not different than that of the 20-gauge PPV system and can be performed safely without any particular complications. Care and precautionary measures are needed in order to remove silicone oil completely.

Long-term Effect of Intravitreal Bevacizumab for CNV Secondary to Age-Related Macular Degeneration

PURPOSE: To investigate the long-term therapeutic effect and safety of repeated intravitreal bevacizumab injections for managing choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: Clinical data of 14 eyes of 14 patients who were treated with repeated (3 times or more) intravitreal bevacizumab injections for secondary to AMD and followed up for 12 months were collected. Patients were treated with 1.25 mg of intravitreal bevacizumab. Bevacizumab was injected at 6-week intervals. Reinjection was performed with the same method according to the physician's decision. RESULTS: Mean visual acuity change increased by 4.0 lines from 1.13+/-0.47 to 0.73+/-0.44 (LogMAR). Mean central retinal thickness change decreased by 114.8 micrometer from 240.3+/-123.8 micrometer to 125.5+/-39.4 micrometer. Visual acuity improved statistically significantly at 12 weeks after first intravitreal bevacizumab injections and was maintained for 12 months. Central retinal thickness decreased statistically significantly at 6 weeks after the first intravitreal bevacizumab injection and was maintained for 12 months. During the 12 months of 4 intravitreal bevacizumab injections, mean visual acuity change increased by 4.0 lines at 12 months and 4.4 lines at 7 months. CONCLUSIONS: Intravitreal bevacizumab injection causes a significant decrease in central retinal thickness and improvement in visual acuity in eyes with CNV due to AMD for 12 months.

Evaluation of the Prophylactic Use of Mitomycin to Inhibit Haze Formation after LASEK

PURPOSE: To evaluate the effects of the prophylactic use of mitomycin C in low concentration and short duration (0.01%, 60 sec) in inhibiting haze formation after laser epithelial keratomileusis (LASEK). METHODS: Forty-two eyes of 71 patients with refractive error from -5.0 D to -8.50 D were enrolled in this study. The eyes were divided into 2 groups according to the use of mitomycin C. All eyes were examined for refraction, UCVA, BCVA, and the incidence and degree of corneal haze before surgery and at 1, 3, 6 months after operation. RESULTS: Fifty-one eyes were operated by LASEK with intraoperative application of 0.01% mitomycin C for 60 seconds and 20 eyes were operated by LASEK without mitomycin C. There was no statistical difference in UCVA, BCVA, and spherical equivalent between 2 groups. In the study group, the degree of corneal haze was 0.54+/-0.39. 0.38+/-0.48, 0.30+/-0.50 at 1, 3, 6 months after operation and in the control group, 0.92+/-0.58, 0.79+/-0.66, 0.50+/-0.60 at 1, 3, 6 months after operation respectively. The difference in the postoperative corneal haze between 2 groups was statistically significant at 1, 3 months after operation, but at 6 months the difference was not statistically significant. CONCLUSIONS: In this study, intraoperative single use of mitomycin C in lower concentration and short duration could reduce the formation of corneal haze effectively in early postoperative period after LASEK. A more longterm period of follow up will be required to assess the continuous effect of mitomycin C on inhibiting corneal haze after LASEK.