Safety Evaluation of Bilateral Same-day Intravitreal Injections of Bevacizumab

Purpose@#To evaluate the short-term ophthalmic side effects of bilateral same-day intravitreal bevacizumab injections. @*Methods@#We retrospectively analyzed patients who underwent intravitreal bevacizumab injection in both eyes on the same day from January 2015 to June 2019. The patients were followed up at 1 day, 1 week, and 1 month after the injection. @*Results@#A total of 281 patients (153 males and 128 females) and 562 eyes were included in the study, and 950 bilateral same-day intravitreal bevacizumab injections were performed. The mean age of patients was 58.87 ± 13.44 years. The most common cause of bilateral injection was that of complications due to diabetic retinopathy, which accounted for 66.3%, followed by age-related macular degeneration at 22.2%, retinal vein occlusion at 5.1%, and central serious chorioretinopathy at 2.1%. There were 0 cases of endophthalmitis after 950 injections, 13 cases of subconjunctival hemorrhage, and 17 patients with a temporary elevation of intraocular pressure. There were 11 patients with acute intraocular inflammation after bilateral injection, but none in both eyes. Patients with acute intraocular inflammation were followed up at short-term intervals until they improved. All patients showed complete improvement within 2 weeks after injection. Comparing the patients’ condition before and after injection, visual acuity improved (p < 0.001). @*Conclusions@#In terms of the frequency of short-term ophthalmic adverse events, bilateral same-day intravitreal bevacizumab injection is a safe procedure with fewer side effects and is more convenient for both the patient and the doctor.

The Effect of Intraocular Pressure-lowering Eye Drops on Myopic RetinoschisisPatients

Purpose@#To investigate the influence of intraocular pressure (IOP)-lowering eye drops on myopic retinoschisis. @*Methods@#We investigated myopic retinoschisis patients with high myopia (defined as a myopic refractive error more than -8.0 dioptersor an axial length longer than 26.5 mm), who were suspected of having glaucomatous optic neuropathy, using IOP-loweringeye drops between April 2014 and December 2018. We retrospectively analyzed the changes in optical coherence tomographyfindings after 6 months using IOP-lowering eye drops. The progression of retinoschisis was assessed by analyzing retinalvolume changes. A decrease in the total retina volume and a decrease in volume more than 10% in one section out of five withoutmore than a 10% volume increase in any other section was defined as resolution of myopic retinoschisis. The opposite casewas defined as an aggravation. @*Results@#We analyzed 17 eyes of 15 patients with high myopia. Six of 17 eyes (35.3%) showed a resolution of myopic retinoschisisat 6 months after using IOP-lowering eye drops. Of the 17 eyes, two (11.8%) experienced progression of myopicretinoschisis. Seven out of 14 eyes (50.0%) who were followed-up over 1 year showed resolution of myopic retinoschisis, andtwo eyes (14.3%) experienced progression of myopic retinoschisis. There was no macular hole development or posterior vitreousdetachment during the follow-up period in the seven eyes, and there was no significant correlation between the absolute valueof the initial IOP, axial length, IOP change, and degree of improvement of myopic retinoschisis. @*Conclusions@#The use of IOP-lowering eye drops on highly myopic eyes with retinoschisis showed a significant improvement ofmyopic retinoschisis, when compared to previous studies. These findings suggest the possibility of IOP-lowering eye drops delayingor improving the natural course of myopic retinoschisis.

Long-term Outcomes of and Recurrence Risk Factors Associated withPhotodynamic Therapy to Treat Central Serous Chorioretinopathy

Purpose@#We sought risk factors for the development of persistent or recurrent central serous chorioretinopathy (CSC) in patientsunder long-term follow-up (>1 year) after photodynamic therapy (PDT). @*Methods@#We retrospectively reviewed the medical records of patients who received PDT to treat CSC from January 2005 toFebruary 2016. CSC was considered persistent if subretinal fluid (SRF) was evident for longer than 3 months or if additionaltreatment was required before 3 months. Also, CSC was regarded as recurrent when SRF re-appeared after initial completeresorption. @*Results@#We enrolled 73 patients (77 eyes). The mean follow-up period was 48.9 ± 31.3 months (12 to 144 months). The persistentgroup consisted of 10 eyes (13%) and the recurrent group 17 eyes (22%). The mean time to recurrence was 39.8 ± 23.3months, ranging from 3 to 91 months. Fifty patients (52 eyes) were enrolled in the treatment-naive group. The persistent groupconsisted of four eyes (8%) and the recurrent group 10 eyes (19%). The mean time to recurrence was 48.4 ± 30.0 months. Onchi-squared analysis of recurrence risk factors in all patients, the odds ratio for eyes with a history of both focal laser and anti-vascular endothelial growth factor treatments prior to PDT was 2.94 (p = 0.031). @*Conclusions@#CSC patients with histories of other treatment are likely to exhibit persistent or recurrent disease after PDT.

Safety Evaluation of Bilateral Same-day Intravitreal Injections of Bevacizumab

Purpose@#To evaluate the short-term ophthalmic side effects of bilateral same-day intravitreal bevacizumab injections. @*Methods@#We retrospectively analyzed patients who underwent intravitreal bevacizumab injection in both eyes on the same day from January 2015 to June 2019. The patients were followed up at 1 day, 1 week, and 1 month after the injection. @*Results@#A total of 281 patients (153 males and 128 females) and 562 eyes were included in the study, and 950 bilateral same-day intravitreal bevacizumab injections were performed. The mean age of patients was 58.87 ± 13.44 years. The most common cause of bilateral injection was that of complications due to diabetic retinopathy, which accounted for 66.3%, followed by age-related macular degeneration at 22.2%, retinal vein occlusion at 5.1%, and central serious chorioretinopathy at 2.1%. There were 0 cases of endophthalmitis after 950 injections, 13 cases of subconjunctival hemorrhage, and 17 patients with a temporary elevation of intraocular pressure. There were 11 patients with acute intraocular inflammation after bilateral injection, but none in both eyes. Patients with acute intraocular inflammation were followed up at short-term intervals until they improved. All patients showed complete improvement within 2 weeks after injection. Comparing the patients’ condition before and after injection, visual acuity improved (p < 0.001). @*Conclusions@#In terms of the frequency of short-term ophthalmic adverse events, bilateral same-day intravitreal bevacizumab injection is a safe procedure with fewer side effects and is more convenient for both the patient and the doctor.

A Case of Ocular Perforation by an Acupuncture Needle Directly Through the Bulbar Conjunctiva

PURPOSE: To report a case of ocular perforation by an acupuncture needle directly through the bulbar conjunctiva. CASE SUMMARY: A 62-year-old male visited our clinic with acute ocular pain and decreased vision in his left eye. He had received intraocular acupuncture therapy one day earlier. A slit-lamp examination revealed conjunctival hyperemia and vitreous prolapse at the superonasal quadrant of the bulbar conjunctiva. Grade one of anterior chamber cells was found in the left eye. Dilated fundoscopy revealed three retinal hemorrhages at the superonasal quadrant of the retina; vitreous hemorrhage and opacity were also observed. Thus, vitrectomy and injections of intravitreal antibiotics were performed. Intraoperatively, we identified the entry site, located in the superonasal retinal quadrant, immediately behind the ora serratia. At the three-month postoperative follow-up, the patient's visual acuity was 0.9 in the left eye and the retina remained flat with no postoperative complications. CONCLUSIONS: We observed a case of ocular perforation and endophthalmitis following ocular acupuncture treatment. This case illustrates the dangers of intraocular acupuncture therapy.

Intravitreal Bevacizumab versus Intravitreal Bevacizumab Combined with Posterior Subtenon Triamcinolone Acetonide for Diabetic Macular Edema

PURPOSE: To investigate the outcome of intravitreal bevacizumab (IVB) combined with posterior subtenon triamcinolone acetonide injections compared to IVB injection alone in patients with diabetic macular edema (DME). METHODS: IVB injection (IVB group) and combination therapy injection (combination group) were administered to 35 eyes and 31 eyes, respectively, diagnosed with proliferative diabetic retinopathy combined with DME. Changes in best corrected visual acuity (BCVA), central macular thickness (CMT), total macular volume (TMV), amount of hard exudates and intraocular pressure (IOP) were compared retrospectively between groups prior to injection and 1, 2 and 3 months after injection. RESULTS: BCVA changes in both groups were only statistically significant at 4 weeks after injection. Reduction of CMT and TMV was maintained for 1 month after treatment in all groups, but CMT and TMV deteriorated 2 months after treatment. No significant differences in BCVA, CMT or TMV were detected between the IVB and combination groups. The amount of hard exudates were only significantly decreased at month 3 in the combination group whereas the amount of hard exudates was not significantly different at 3 months in the IVB group (at baseline 2,899 ± 2,314 pixels vs. at 3 months 2,536 ± 1,981 pixels, p-value = 0.041). IOP showed no significant difference between the groups. Elevated IOP or endophthalmitis were not observed. CONCLUSIONS: In terms of BCVA improvement, subtenon triamcinolone provided no additional benefit on CMT and TMV reduction. However, combination therapy was effective in reducing the amount of hard exudates at 3 months.

Clinical Outcomes of Minimal Exposure to Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane

PURPOSE: To evaluate the clinical outcomes of epiretinal membrane (ERM) surgery with minimal exposure to indocyanine green (ICG) dye-assisted internal limiting membrane (ILM) peeling compared with no ICG dye. METHODS: We divided 33 eyes with ERM treated by vitrectomy into 2 groups. ICG dye was used in the first group of 18 eyes (ICG group) but not in the second group of 15 eyes (no dye [ND] group). In the ICG group, 0.25% diluted ICG dye was injected into the fluid-filled eye and removed with a back-flushing needle after 3-5 seconds to peel ILM. Value changes in several parameters including visual acuity, central macular thickness, Humphrey automated kinetic perimetric analysis, and peripapillary retinal nerve fiber layer (RNFL) thickness were followed up and compared according to ICG dye use. RESULTS: No differences were found between the 2 groups in terms of visual acuity, central macular thickness, and peripapillary RNFL thickness preoperatively and at 6 months postoperatively (p = 0.125 for visual acuity, p = 0.734 for central macular thickness, p = 0.615 for RNFL thickness). Six months after surgery, no significant increase was found in any region of visual field in the ICG group (p = 0.392). The visual field was significantly increased in the superior region in the ND group (p = 0.042). The RNFL thickness in the temporal quadrant was significantly reduced at 6 months postoperatively compared to baseline values in both groups (p = 0.011 for ICG group, p = 0.042 for ND group). CONCLUSIONS: ICG dye-assisted ILM peeling does not aggravate clinical outcomes of ERM surgery in terms of visual acuity, central macular thickness, visual fields, or RNFL thickness and can be safely utilized with proper techniques.

Risk Factors for Neovascular Glaucoma after Vitrectomy in Patients with Proliferative Diabetic Retinopathy

PURPOSE: The use of pre- and intraoperative vitreous bevacizumab injection and combined lens extraction with vitrectomy in patients with proliferative diabetic retinopathy (PDR) is increasing. In this study we analyzed the incidence and risk factors of neovascular glaucoma (NVG) after vitrectomy for PDR. METHODS: Patients who underwent vitrectomy for PDR from January 2004 to June 2011 were retrospectively reviewed. The minimum follow-up was 12 months. The cumulative incidence of NVG was calculated using the Kaplan-Meier survival analysis. The patients were divided into 4 groups according to lens status (preoperative pseudophakic group, simultaneous cataract surgery group, sequential cataract surgery group, non-cataract surgery group). The differences in incidence between the groups were determined by the Chi-square test. Finally, to analyze the risk factors associated with the occurrence of NVG, the Cox's regression model was used. RESULTS: Of the 614 eyes (402 patients), 284 were males and 330 were females. The mean age was 55.8 +/- 10.46 years (range 30-81 years) and the mean follow-up period was 36.6 months (range 1-93 months). Thirty-four of 614 patients (5.5%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 0.7% and 2.5%, respectively. The incidence between the 4 groups did not show a statistically significant difference. The risk factors for postoperative NVG were male gender (RR = 3.01 p = 0.004), preoperative intravitreal bevacizumab injection (RR = 7.20, p < 0.001), and reoperation (RR = 3.18, p = 0.0037). CONCLUSIONS: The frequency of NVG after vitrectomy in patients with PDR was 5.5%. Lens status was not associated with NVG occurrence. The risk factors related to NVG were male gender, preoperative intravitreal bevacizumab injection, and reoperation.

Diurnal Variation of Subjective Visual Symptoms of Diabetic Patients

PURPOSE: To investigate the diurnal variation of subjective visual symptoms of diabetic patients and to evaluate its correlation with visual acuity, blood pressure, blood glucose and OCT-measured macular thickness. METHODS: Fifty-five diabetic patients (56 eyes) who were hospitalized for the operation of the fellow eye were enrolled in the study. They underwent optical coherence tomography (OCT) measurements of macular thickness with retinal mapping protocol of OTI/SLO OCT at 5PM, 8PM on operation day, and at 7AM, 10AM on following day. Visual acuity (log MAR), refraction, intraocular pressure, blood glucose and blood pressure were also measured at each time. We surveyed the patients' symptomatic visual variation and its pattern if there is any change over a day. RESULTS: Thirteen patients (25%) had reported changes in their subjective visual symptom over a day according to their blood glucose level. Among twenty-four cases with changes in their subjective visual acuity throughout the exam, only ten showed their real visual acuity change in accordance with their symptoms. CONCLUSIONS: One fourth of our diabetic patients stated fluctuation in their vision according to their blood glucose level, but there were no correlations between visual acuity, blood glucose level and macular thickness.

Comparison of Intraocular Pressure Between Sutureless and Sutured 23-gauge Vitrectomy

PURPOSE: To compare 23-gauge transconjunctival sutureless vitrectomy (TSV) and sutured vitrectomy in the aspect of intraocular pressure (IOP) changes and complications. METHODS: Through a retrospective chart review, 45 sutureless patients (48 eyes) and 48 sutured patients (52 eyes) who had undergone 23-gauge transconjunctival vitrectomy by one surgeon (J.H. Sohn) were compared. IOP was measured routinely pre-operativley, at 1 day, 1 week, and 1 month post-operatively. Postoperative IOP, hypotony (IOP<7 mmHg) rates and complications associated with hypotony were assessed respectively. In addition, the cases involving intraocular air or gas tamponade or cataract extraction were compared. RESULTS: One day after the surgery, 3 eyes of the sutureless group developed hypotony,which persisted in 2 eyes through postoperative 1 week. Two eyes of the sutureless group developed hypotony 1 week after the surgery. Most of the hypotony cases were transient, but choroidal detachment occurred in 2 cases, and retinal detachment occurred in 1 case. In contrast, none of the sutured group developed hypotony. Intraocular air or gas tamponade significantly raised IOP 1 day after the surgery. When the operation was combined with cataract extraction, IOP was reduced postoperative 1 week and 1 month. CONCLUSIONS: The well-known risk factor of 23-gauge sutureless vitrectomy is postoperative hypotony. The present study showed postoperative hypotony can result in retinal detachment as a complication in contrast to previous studies. The authors conclude that suturing the wound for the prevention of hypotony is better, especially in cases with high risk of hypotony or definite wound leakage.

Intravitreal Bevacizumab Injection in Adult Coats' Disease

PURPOSE: To report the efficacy of intravitreal bevacizumab injection in adult patients with Coats' disease. CASE SUMMARY: Vascular telangiectasia, microaneurysms, circinate hard exudates, and macular edema were shown in the macula of two patients. Vascular abnormality was limited to < or =6 clock hours in both cases. In case 1, the temporal retina demonstrates filigree-like vessels and capillary nonperfusion. In case 2, the nasal retina demonstrates aneurysmal dilatation and multiple microaneurysms. Intravitreal bevacizumab injection was administered in both cases. After 1 month, macular edema decreased. Laser photocoagulation was performed for vascular telangiectasia, microaneurysms, and capillary nonperfusion area. Then an additional decrease of macular edema was observed. Fluorescein leakage decreased, as well. After 1 month (case 1) and 2 months (case 2), macular edema increased. The second and third intravitreal reinjections were administered to each patient. Macular edema decreased. CONCLUSIONS: We report two rare cases of Coats' disease in adult patients. Intravitreal bevacizumab injection in patients with Coats' disease can result in a rapid decrease of macular edema, which will then lead to rapid visual recovery and an opportunity for effective laser photocoagulation. We recommend that intraviteal bevacizumab injection be used in combination with laser photocoagulation for the treatment of Coats' disease.

Photodynamic Therapy for Chronic Central Serous Chorioretinopathy: Multicenter Study of 65 Cases

PURPOSE: To determine the effect of photodynamic therapy (PDT) on patients with chronic central serous chorioretinopahty (CSC). METHODS: This was a retrospective multicenter study. We collected demographic and ophthalmic data for patients with chronic CSC who were treated with PDT from 16 institutions in Korea. The best corrected visual acuity (BCVA), ophthalmoscopic finding and optical coherence tomography at baseline and follow-up visits were compared longitudinally. RESULTS: Sixty-five eyes of 65 patients were recruited. Males (51 patients, 78.5%) outnumbered females (14 patients, 21.5%). The mean age was 46.4+/-10.0 years of age (28~69). By 1 month, mean BCVA improved from 0.47 to 0.37 (logarithm of the minimum angle of resolution) (P <0.01). This BCVA increased throughout 6 months. Subretinal fluid resolved partially or completely in 89.1% of the patients. Central macular thickness (CMT) decreased from 303.4 to 168.7 micrometer. The amount of change in CMT after PDT was correlated to the female sex and prePDT CMT. At 3 months after PDT, the amount of change in BCVA was significantly related to that of change of CMT (p <0.05). Adverse events were reported in 4 cases, however, most were mild. CONCLUSIONS: PDT was effective and safe for treating chronic CSC.

The Effect of Intravitreal Bevacizumab Injection in Eales' Disease

PURPOSE: To report on 2 cases of Eales' disease that were successfully regressed with laser photocoagulation and intravitreal bevacizumab (Avastin; Genetech, Inc, San Francisco, California, USA) injection. CASE SUMMARY: Two male patients (30 years and, 40 years of age,) with a history of recurrent vitreous hemorrhage were diagnosed with Eales' disease. The 2 patients had peripheral retina neovascularization and active phlebitis in fundus fluorescein angiography. No other findings were observed in their eyes in the general examination. Scatter laser photocoagulation and intravitreal bevacizumab injection were performed. After 1 month follow-up, neovascularization completely regressed. There was no complication or recurrent vitreous hemorrhage at the 1 year follow up. CONCLUSIONS: Intravitreal bevacizumab injection, as combination treatment of laser photocoagulation, may be helpful in the regression of neovascularization due to Eales' disease.

Evaluation of the Efficacy of Vitrectomy for Persistent Diabetic Macular Edema and Associated Factors Predicting Outcome

PURPOSE: To evaluate the efficacy of vitrectomy for persistent diabetic macular edema after laser photocoagulation or intravitreal triamcinolone injections and to determine the demographic and ocular factors that influence functional and anatomical outcomes. METHODS: We retrospectively evaluated 55 eyes (51 patients) that had persistent diffuse macular edema after laser photocoagulation or intravitreal triamcinolone injections. We compared preoperative and postoperative best corrected visual acuity and macular thickness by Optical Coherence Tomography and investigated factors including patient's age, presence of vitreomacular traction, grade of diabetic retinopathy, and intraoperative internal limiting membrane removal that may influence the surgical results. RESULTS: The mean preoperative BCVA (log MAR) was 0.91+/-0.40 (0.8-1.2). The BCVA improved to 0.72+/-0.39 (0.3-1.2). The mean preoperative macular thickness was 440+/-130 (202-805) micrometer and the mean macular thickness decreased to 306+/-97 (136-580) micrometer postoperatively. The eyes showed statistically significant improvement in BCVA and central macular thickness (p<0.001). Preoperative better BCVA was associated with an improved postoperative visual acuity. (p=0.04). No other covariates were found to be statistically significant factors for prognosis of postoperative BCVA. CONCLUSIONS: In eyes with persistent diabetic macular edema after laser or IVTA injections, vitrectomy was effective for decreasing macular thickness and improvement of vision. The visual improvement after vitrectomy was associated with the preoperative better BCVA.

Arteriovenous Sheathotomy for Persistent Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. METHODS: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. RESULTS: The mean preoperative BCVA (log MAR) were 0.79+/-0.29 and postoperative BCVA (log MAR) at 3 months was 0.57+/-0.33. And improvement of visual acuity > or =2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22+/-76.83 micrometer (510-737 micrometer) and postoperative fovea thickness was 217.60+/-47.33 micrometer (164-285 micrometer). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.

Case Report: Endogenous Nocardial Endophthalmitis in a Renal Transplant Recipient

PURPOSE: To report a case of endogenous Nocardia endophthalmitis developed in an immunocompromized patient. METHODS: Case report. RESULTS: A 25 year-old man with terminal stage renal disease who was treated with renal transplantation and immunosuppressive medications, presented with reduced vision in his right eye. Ocular examination showed inflammation of anterior chamber, vitreous opacity and subretinal abscess. Prior to ocular symptom, he had been diagnosed to have Nocarida abscess in the lung, brain and soft tissue. He was treated with systemic antibiotics (Imipenam, TMP/SMX). Retinal lesion was improved to achieve 20/200 vision. CONCLUSIONS: We experienced a case of endogenous endophthalmitis due to systemic Nocardia infection in an immunocompromised patient. To our knowledge, this case was the first report of endogenous Nocardia endophthalmitis in Korea.

Retinopathy and Keratopathy Associated with Chronic Tamoxifen Medication

PURPOSE: Tamoxifen retinopathy is one of the uncommon side effects together with keratopathy, crystalline retinopathy and cystoid macula edema when tamoxifen is administered with high dose to breast cancer patients. We report here a case of retinopathy patient with five years of tamoxifen application. METHOD: A 46 year old female breast cancer patient complained about decreased visual acuity in both eyes after taking total amount of 37.28 g tamoxifen (20 mg/day) for 5 years. Whorl-like superficial corneal opacity was detected and yellowish white macular crystalline deposits were seen in both eyes. Moreover, decreased b wave amplitude of ERG was detected in electroretinography and RPE atrophy was found in FAG. RESULT: The patient stopped taking tamoxifen immediately after diagnosed with tamoxifen retinopathy. Two months later, it showed decreased corneal opacity and improved visual acuity in the left eye but also showed increased macular crystalline deposits in the left eye.

Systemic Risk Factors for Postoperative Vitreous Hemorrhage Following Diabetic Vitrectomy

PURPOSE: To determine the incidence of and the systemic risk factors for postoperative vitreous hemor-rhage(PVH). METHOD: The records of 503 consecutive diabetic vitrectomy cases were reviewed. RESULT: Eighty-seven eyes(17.3%) had at least one episode of PVH. Sixty-five eyes(12.9%) had PVH within 3 months after vitrectomy, and the mean onset time of the first episode of PVH was about 13 weeks after vitrectomy. The mean follow-up period was 17.2 months in non-hemorrhage group, and 21.9 months in hemorrhage group. While 34 eyes(29.6%) had spontaneous absorption of blood, 42 eyes(36.5%) required air(or gas)-fluid exchange and 39 eyes(33.9%) vitreous cavity lavage. Using univariate analysis, the factors associated with increased incidence of PVH include type 1 diabetes mellitus(p=0.01), method of glycemia control(p=0.02), anemia(p=0.04), and hypercholesterolemia(p=0.005). Multivariate analysis revealed diabetic nephropathy(p=0.02) and hypercholesterolemia(p=0.01) were the risk factors. Five eyes(1.0%) lost light perception, 7 eyes(1.4%) had rhegmatogenous retinal detachment, and 11 eyes(2.2%) had neovascular glaucoma. CONCLUSION: Vitreous hemorrhage after diabetic vitrectomy occurred in the 17.3%, three quarters of them within 3 months. About one third had spontaneous clearing, and two-thirds required reoperation. Diabetic nephropathy and hypercholesterolemia were the systemic risk factors of vitreous hemorrhage after diabetic vitrectomy.

Nocardiosis Following Renal Transplantation / 대한이식학회지

PURPOSE: Infection with Nocardia species is an uncommon yet important cause of morbidity and mortality in renal transplant recipients. METHODS: We experienced 6 cases of nocardiosis among 239 renal transplant recipients maintained on tacrolimus- or cyclosporine-based immunosuppression from May 1999 to February 2001. RESULTS: All the six patients had pulmonary nocardiosis from 36 to 220 (mean 82) days after renal transplantation. Due to a multiplicity of infection sites, cerebral abscess was detected in 2 patients, soft tissue abscess in 2, allograft abscess in 1 and subretinal abscess in 1. Comparing the routine trimethoprim/ sulfamethoxazole (TMP/SMX) prophylaxis after transplantation, 5 out of 6 patients took TMP/SMX for a mean of 1.8 months due to an increased AST/ALT. All the cases required invasive diagnostic procedures such as percutaneous needle aspiration (PC NA) or stereotactic aspiration. In the antimicrobial susceptibility test, isolates were sensitive to TMP/SMX, amikacin and imipenem. In the early stage of infection, we used triple chemotherapy (TMP/SMX, amikacin, imipenem) for cerebral nocardiosis and dual therapy (TMP/SMX, amikacin) for localized pulmonary infection. There were no mortality and all the graft maintained stable function. CONCLUSION: After organ transplantation, pneumonia accompanied with satellite soft tissue infection should be considered as a nocardiosis. Pro- phylactic use of TMP/SMX is crucial for effective prevention of nocardiosis.

Postnatal Risk Factors of Retinopathy of Prematurity

In order to investigate the risk factors of retinopathy of prematurity[ROP], we retropspectively reviewed the medical records of 425 premature babies who had been admitted in our neonate intensive care unit between January 1994 and December 1998.After excluding 33 babies who had serious congenital anomalies, 83 out of 392 babies[20.7%]developed various stages of ROP.Gestational age and birthweight were the most significant risk factors. Among postnatal factors use of ventilator for 48 hours orlonger, apnea, and use of surfactant were independently increasing the progression of ROP in a linear logistic regression analysis.Other factors such as history of transfusion and sepsis had a tendency to worsen the retinopathy.On the other hand, fluctuation in blood gas, low apgar score or anemia did not seem to effect the progression of retinopathy. In conclusion, careful monitoring would be warrented when the premature babies had additional risk factors as listed above.