Intravitreal Injection of Dexamethasone Implant during Cataract Surgery in Patients with Noninfectious Uveitis

PURPOSE: To investigate the efficacy and safety of intravitreal dexamethasone implant for controlling postoperative inflammation among uveitis patients undergoing cataract extraction. METHODS: Ten eyes with noninfectious uveitis underwent phacoemulsification with intraocular lens implantation followed by intravitreal injection of 0.7-mg dexamethasone implant (implant group) between February 2011 and January 2014. Twenty age- and gender-matched controls who received cataract surgery without implantation during the same period were recruited (non-implant group). Medical records of the subjects were retrospectively reviewed and 6-month postoperative clinical outcomes were compared between the 2 groups. RESULTS: The mean age was 42.30 +/- 15.81 years in the implant group and 45.65 +/- 13.63 years in the non-implant group. The 2 groups were similar in terms of age, gender, preoperative inflammatory status, and preoperative visual acuity (p = 0.552, 1.000, 0.133 and 0.767, respectively). After surgery, oral steroid was used in the non-implant group (8.8 +/- 1.5 mg/day on average) and the implant group (3.5 +/- 1.3 mg/day; p = 0.029). Visual acuity (log MAR) improved significantly in both groups (p = 0.789) with no significant difference between the 2 groups. Postoperative recurrence rates of uveitis were reduced more (40%) in the implant group than in the non-implant group (50%) but without significance (p = 0.709). Elevated intraocular pressure > or =25 mm Hg occurred in 3 eyes (30%) in the implant group and 4 eyes (20%) in the non-implant group (p = 0.657), of which 1 in each group required a filtering surgery. Otherwise, no significant complications developed in either group. CONCLUSIONS: Intravitreal dexamethasone implants help reduce conventional oral steroid dosage for controlling postoperative inflammation. Dexamethasone implants could be an effective and safe alternative to control the inflammation after cataract surgery in uveitis patients.

Comparison of Choroidal Hyperpermeability Change after Photodynamic Therapy and Ranibizumab for Chronic Central Serous Chorioretinopathy

PURPOSE: To compare changes in choroidal hyperpermeability after half-energy photodynamic therapy (PDT) and intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC). METHODS: Post-hoc analysis was performed in a randomized, controlled trial comparing half-energy PDT versus intravitreal ranibizumab for chronic CSC; during the experiments, the other treatment was available for salvage treatment if the original was unsuccessful at 3 months. A commercially available image analysis program (Adobe(R) Photoshop(R) CS6 [Adobe Systems, Inc., San Jose, CA]) was used for quantification of change in choriodal hyperpermeability on indocyanine green angiography after half-energy PDT or three consecutive intravitreal injections of ranibizumab. Post-treatment images were subtracted from pre-treatment images after adjustments were made to create images depicting the change in choroidal hyperpermeability with treatment. Integrated gray scale values per area in this image were used for analysis of change in choroidal hyperpermeability. RESULTS: The calculated change in choroidal hyperpermeability was significantly greater in the half-energy PDT group (17.36 +/- 8.74) than in the ranibizumab group (6.78 +/- 5.03) (p < 0.001). All eyes in the half-energy PDT group showed complete resolution of subretinal fluid, and no significant difference in change of choroidal hyperpermeability was found in eyes that received half-energy PDT as primary or salvage treatment. In the ranibizumab-treated group, subretinal fluid resolution was accomplished in 5 eyes, and these eyes showed a significantly larger decrease in choroidal hyperpermeability when compared with eyes showing poor response (10.31 +/- 4.00 vs. 2.74 +/- 2.16, p = 0.005). In the successfully treated eyes with ranibizumab, there was no significant difference in choroidal hypopermeability change when compared to half-energy PDT (p = 0.124). CONCLUSIONS: Using our novel method of analysis of change in choroidal hyperpermeability following treatment for chronic CSC, greater change was found in eyes with good response, and the superior outcome of half-energy PDT over ranibizumab may be attributed to greater influence on choroidal hyperpermeability.

Surgical Removal of Retained Subfoveal Perfluorocarbon Liquid through a Therapeutic Macular Hole with Intravitreal PFCL Injection and Gas Tamponade

We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40 in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.

Cytomegalovirus Retinitis after Intravitreal Bevacizumab Injection in an Immunocompetent Patient

We report a case of cytomegalovirus (CMV) retinitis after intravitreal bevacizumab injection. A 61-year-old woman with diabetic macular edema developed dense vitritis and necrotizing retinitis 3 weeks after intravitreal bevacizumab injection. A diagnostic vitrectomy was performed. The undiluted vitreous sample acquired by vitrectomy was analyzed by polymerase chain reaction and culture. Polymerase chain reaction of the vitreous was positive for CMV DNA. Other laboratory results did not show evidence of other infectious retinitis and systemic immune dysfunction. Human immunodeficiency virus antibodies were also negative. After systemic administration of ganciclovir, retinitis has resolved and there has been no recurrence of retinitis during the follow-up period of 12 months. Ophthalmologists should be aware of potential risk for CMV retinitis after intravitreal bevacizumab injection.

Clinical Outcomes of Cyclosporine Treatment for Noninfectious Uveitis

PURPOSE: To assess the clinical outcomes of cyclosporine treatment for noninfectious uveitis. METHODS: A retrospective review of medical records was completed for 182 noninfectious uveitis patients who were treated with cyclosporine between January 2001 and August 2010. Data was obtained relevant to demographic characteristics, anatomic classification, and laterality of uveitis, associated systemic disorder, dosage of cyclosporine and prednisolone, usage of other immunosuppressive drugs, visual acuity (VA), control of uveitic activity, and adverse effects during the cyclosporine use. RESULTS: Uveitic activity was controlled to a level of minimal inflammation in 89.0% and completely in 78.6% of patients by the median duration of 49 and 98 days, respectively. Prednisolone-sparing (dose < or =10 mg) control of inflammation equal to or less than the minimal activity was achieved in 75.3% of patients. VA was aggravated more than 0.2 logarithm of the minimum angle of resolution in 17.3% of eyes in spite of cyclosporine treatment for the mean follow-up of 698.4 days. Dose reduction and cessation of cyclosporine was required only in 3.3% and 9.3%, respectively, due to the intolerable toxicity, although 44.0% of patients experienced mild to moderate adverse effects. CONCLUSIONS: Cyclosporine combined with corticosteroids or other immunosuppressive drugs as needed is an effective treatment for noninfectious uveitis, thus minimizing the adverse effects of corticosteroids and other toxic drugs. However, careful monitoring for the toxicity of cyclosporine is needed, because a small group of patients cannot tolerate its toxicity.

Efficacy of Autologous Plasmin-Assisted Vitrectomy for Rhegmatogenous Retinal Detachment

PURPOSE: To evaluate the efficacy and complication of autologous plasmin (AP) injected before vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS: Intravitreal AP injection (0.2 ml) was performed on the eyes without posterior vitreous detachment (PVD) 20 minutes before the vitrectomy for RRD. The extent of PVD was evaluated intraoperatively. Surgical PVD induction was performed and the ease of the procedure was graded. The extent of PVD, ease of PVD induction, and complications (including incidence of iatrogenic retinal break) were compared to those of the control eyes. In order to evaluate complications and measure activated partial thromboplastin time, a microbial culture of injected AP was performed and the rate of postoperative intraocular hemorrhage was investigated. Change in visual acuity and the rate of retinal reattachment were compared in order to evaluate the long-term surgical outcome. RESULTS: The extent of PVD was greater in the AP group than in the control group, and vitreal separation was facilitated by intravitreal AP injection. However, ease of PVD induction and frequency of iatrogenic retinal break found were not significantly different between cases and controls. Neither postoperative intraocular hemorrhage nor systemic coagulation abnormality occurred. Postoperative endophthalmitis and positive microbial culture of the AP solution were also not reported. There was no significant difference in the change in visual acuity and the rate of retinal reattachment between the two groups. CONCLUSIONS: Intravitreal AP injection can facilitate vitrectomy for RRD and has no effect on the rate of retinal reattachment.

Photoreceptor Disruption Related to Persistent Submacular Fluid after Successful Scleral Buckle Surgery

PURPOSE: To investigate serial changes in photoreceptor status and associated visual outcome in patients with persistent submacular fluid after successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment. METHODS: This was a prospective observational case series including 76 consecutive patients who underwent successful scleral buckle surgery for macula-off rhegmatogenous retinal detachment with symptom duration < or =90 days at a single tertiary hospital. Optical coherence tomography (OCT) and visual acuity examination were performed at one month and three months postoperatively and at three-month intervals until the submacular fluid disappeared. Main outcome measures were postoperative photoreceptor status on OCT and visual acuity. RESULTS: Forty-two patients (55.3%) showed persistent submacular fluid at postoperative one month. Of 42 patients with persistent submacular fluid, three (7.1%) showed photoreceptor disruption on OCT. None of the 34 patients without persistent submacular fluid showed photoreceptor disruption. Two patients (4.8%) had progressive photoreceptor disruption, and one patient (2.4%) had early photoreceptor disruption. All three patients showed photoreceptor reappearance and limited visual restoration after absorption of submacular fluid. Final visual acuities were significantly worse in these three patients (20 / 1000, 20 / 133, and 20 / 133) compared to those of the other patients (mean, 20 / 30) with persistent submacular fluid and intact photoreceptors. CONCLUSIONS: Even after successful scleral buckle surgery for rhegmatogenous retinal detachment, photoreceptor disruption can occur related to persistent submacular fluid and may be a cause of poor visual outcome.

Endophthalmitis Caused by an Intraocular Cilium

PURPOSE: To report a case of intraocular cilium revealed by diagnostic vitrectomy in a case of stubborn uveitis that was unresponsive to steroid therapy. CASE SUMMARY: A 39-year-old man was referred to our hospital due to decreased vision in his right eye that started two months prior to presentation. He had previously been treated for a diagnosis of iridocyclitis. The patient's history revealed a blunt trauma to the right eye while wearing glasses after which he developed a microhyphema and was treated for traumatic iritis at another clinic 3 months ago. He was treated with topical and oral steroids after being diagnosed with iridocyclitis and had recently been prescribed additional oral cyclosporine because his condition had not improved. Ocular examination revealed inflammatory cells in the anterior chamber and vitreous cavity with hand motion vision. Ultrasonography revealed a hazy vitreous cavity but the retina was flat. Diagnostic vitrectomy with intravitreal antibiotic injection was performed and an intraocular foreign body presumed as a cilium was detected without an entrance wound on the exterior or interior surface of the eye. After removal of the foreign body, the patient's vision was completely recovered. CONCLUSIONS: In cases of chronic uveitis that do not respond to immunosuppressive treatment without a clearly definable cause, diagnostic vitrectomy should be considered, keeping in mind the possibility of intraocular foreign body.

Hereditary and Clinical Features of Retinitis Pigmentosa in Koreans

There has been no report about hereditary and clinical features of retinitis pigmentosa (RP) in Koreans. To evaluate these, data were collected from 365 RP patients including age, gender, visual acuity (VA), spherical equivalent (SE) of refractive errors, funduscopic findings, color vision test, visual field score (VFS) obtained from Goldmann perimetry, and the inheritance patterns from pedigrees. Simplex RP was the most common inheritance pattern (61.9%); followed by autosomal recessive RP (17.3%), autosomal dominant RP (12.1%) and X-linked recessive RP (8.8%). Myopia was the most common refractive errors (77.5%) including 16.1% of high myopia. The most common cataract type was posterior subcapsular cataract (25.8%). Observed retinal findings included changes of retinal pigment epithelium (88.8%), bony spicule-like pigmentation (79.7%), attenuation of retinal vessel (76.2%), waxy disc pallor (12.6%), golden ring around optic disc (2.2%), epiretinal membrane (0.8%) and cystoid macular edema (0.5%). Corrected VA and refractive errors did not show any significant difference between the inheritance patterns. VFS was significantly worse in autosomal recessive RP than in autosomal dominant RP. Color vision defect was noted in 66.1% on Hardy-Rand-Rittlers color vision test. In conclusion, Korean RP patients have the indigenous hereditary and clinical features as well as the ordinary ones.

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.

Short-term Clinical Outcome of Patterned Scanning Laser Photocoagulation With Short Exposure Time in Diabetic Retinopathy

PURPOSE: To investigate the clinical effect and complications of patterned scanning laser photocoagulation with short exposure time in diabetic retinopathy. METHODS: A prospective study was performed on patients with diabetic retinopathy who required panretinal photocoagulation (PRP). Twenty-nine eyes of twenty five consecutive patients underwent patterned scanning laser photocoagulation with exposure time of 0.02 sec over the entire retina. Pain score at treatment, best-corrected visual acuity, the development of macular edema, regression of neovascularization in fluorescein angiography, and related complications were monitored during a three-month follow-up. RESULTS: Treatment time for PRP was much reduced to 6.1 min on the entire retina. Pain during the photocoagulation was moderate, and enabled patients to finish PRP with ease. During a three-month follow-up, visual acuity was well preserved. Foveal minimum thickness increased at 1 month after treatment and maintained in a study period of three months. Macular volume showed significant increase (3.6%) at 1 month after treatment, maximum increase (9.8%) at 2 months, and persistent increase (4.9%) at 3 months. In every patient with very severe nonproliferative diabetic retinopathy, retina was maintained, and in 10 of 18 eyes with proliferative diabetic retinopathy, neovascularization regressed during follow-up period. No significant complication occurred except a transient vitreous hemorrhage in one eye. CONCLUSIONS: Patterned scanning laser photocoagulation with short exposure time may induce transient macular edema, but the visual acuity was preserved without any other significant complication. It is considered to be a safe and efficient treatment method in diabetic retinopathy.

A Case of Vogt-Koyanagi-Harada Disease in a Patient With Graves Disease

A case of Vogt-Koyanagi-Harada disease (VKH) that developed in a 36-year-old woman with Graves' disease was described. The patient was treated with Lugol's solution and presented with bilateral serous retinal detachment. She had also suffered from methimazole-induced hypersensitivity and steroid-induced myopathy. Fluorescein angiography showed multiple leakage points and a lumbar puncture revealed pleocytosis, which was compatible with VKH. High dose steroid pulse therapy was successful. Altered immune regulation associated with drug-induced hypersensitivity may contribute to the development of VKH in patients with Graves' disease.

The Result of Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

PURPOSE: To determine the efficacy and complication of photodynamic therapy (PDT) with verteporfin in chronic central serous chorioretinopathy (chronic CSC). METHODS: The authors retrospectively examined 27 eyes of 26 patients who were diagnosed with chronic CSC and treated with PDT between February 2005 and February 2008, to determine visual acuity improvement, resolution of serous retinal detachment and occurrence of complications or recurrences. RESULTS: One month after PDT, neurosensory detachment had disappeared in all patients. In addition, visual acuity had improved in 9 eyes by two lines or more on the Snellen chart, remained unchanged in 14 eyes, and decreased in 4 eyes by two lines or more on the Snellen chart. Final visual acuity had improved in 18 eyes, and remained unchanged in 9 eyes. Choroidal neovascularization (CNV) had occurred in two patients, 9 days and 6 months after PDT. Intravitreal injection of Bevacizumab was performed and closure of CNV was obtained. One eye showed choroidal ischemia 1 month after PDT, although visual acuity was not decreased. CONCLUSIONS: PDT appears to be an effective treatment for chronic CSC, and the recurrence rate after PDT is low. However, CNV may occur after PDT. Further studies are necessary to verify treatment safety and modulate the parameters of PDT to reduce complications such as CNV.

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.

Analysis of Intraocular Chemokine and Chemokine Receptor in Patients with HLA-B27-associated Anterior Uveitis

PURPOSE: To evaluate the expression of chemokine and chemokine receptors in the aqueous humor (AH) of patients with recurrent anterior uveitis (AU) in terms of HLA-B-27-association. METHODS: Patients with endogenous uveitis were recruited from the uveitis clinic at Seoul National University Hospital. AH and peripheral blood (PB) were obtained from each patient. The expression of chemokine receptors in T-cells from AH and PB was measured using flow cytometric analysis. Interleukin (IL)-8, interferon-gammainducible protein (IP)-10, and regulated-on-expression, normal T-cell expressed and secreted (RANTES) levels of PB and AH were measured. The expression of chemokine receptor and chemokine levels in PB and AH were compared between HLA-B27-associated AU and idiopathic AU patients. RESULTS: Seventeen patients with HLA-B27-associated AU, 14 patients with idiopathic AU and 5 healthy controls were included in this study. IL-8 and IP-10 levels of AH were shown to be increased more than in PB, and intraocular concentrations of IL-8 and IP-10 were higher in patients with HLA-B27-associated AU than in idiopathic AU patients. RANTES levels in AH were significantly lower than in PB for all groups. In all groups, the expression of chemokine receptor in AH increased more than in PB. CONCLUSIONS: The results from this study show chemokine may play an important role in inflammation in patients with AU. This implies that the chemokine environment may be different in terms of HLA-B-27-association.

Clinical Features in Korean Patients with Sarcoid Uveitis

PURPOSE: To investigate the clinical features of Korean patients with sarcoid uveitis. METHODS: The medical records of patients with endogenous uveitis who were recruited from the uveitis clinic at Seoul National University Hospital were reviewed. Sex, age at presentation, ocular symptoms and signs, treatment, complications, and the rate of recurrence were analyzed. RESULTS: Of 440 patients with endogenous uveitis, 31 (7.1%) with sarcoidosis were included. The mean age at onset was 54.5 years. Sarcoidosis patients with uveitis tended to be older than those without uveitis (44.1 years). Uveitis was the primary manifestation of sarcoidosis in 16 of 31 patients (51.6%). Anterior uveitis was the most common in terms of the anatomic location of inflammation (54.8%), and posterior involvement (38.7%) was not rare. Systemic corticosteroid therapy was administered to 28 patients (90.3%). Five patients (16.1%) received corticosteroids combined with immunosuppressive agents. CONCLUSIONS: Sarcoid uveitis is not a rare etiology of endogenous uveitis. Topical or systemic corticosteroids could control inflammation in most cases, but immunosuppressive agents are needed in a small percentage of patients. Steroids combined with immunosuppressive agents can prevent severe visual losses in such patients.

The Safety and Efficacy of Transconjunctival Sutureless 23-gauge Vitrectomy

PURPOSE: To evaluate the efficacy and safety of vitreoretinal surgery using a 23-gauge transconjunctival sutureless vitrectomy (TSV) system for various vitreoretinal diseases. METHODS: A retrospective, consecutive, interventional case series was performed for 40 eyes of 40 patients. The patients underwent vitreoretinal procedures using the 23-gauge TSV system, including idiopathic epiretinal membrane (n=7), vitreous hemorrhage (n=11), diabetic macular edema (n=10), macular hole (n=5), vitreomacular traction syndrome (n=5), diabetic tractional retinal detachment (n=1), and rhegmatogenous retinal detachment (n=1). Best corrected visual acuity (BCVA), intraocular pressure (IOP), and intra- and post-operative complications were evaluated. RESULTS: Intraoperative suture placement was necessary in 3 eyes (7.5%). The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001). In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day. No serous postoperative complications were observed during a mean follow-up of 8.4+/-3.4 months (range 3-13 months) CONCLUSIONS: The 23-gauge TSV system shows promise as an effective and safe technique for a variety of vitreoretinal procedures. It appears to be a less traumatic, more convenient alternative to 20-gauge vitrectomy in some indications.

Early versus Late Intravitreal Triamcinolone Acetonide for Macular Edema associated with Branch Retinal Vein Occlusion

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of 3 months, were treated using a single intravitreal triamcinolone injection (4 mg/0.1 ml). Best-corrected visual acuity and foveal thickness by optical coherence tomography were measured 1, 3, and 6 months post-injection. RESULTS: In patients that received treatment after a disease duration of 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.

Serous Retinal Detachment in Patients with Choroidal Neovascularization Following Photodynamic Therapy

PURPOSE: To quantify the development and resolution of serous retinal detachment in patients with choroidal neovascularization (CNV) following photodynamic therapy (PDT). METHODS: Six eyes of five patients who developed serous retinal detachment two days after PDT were included in this study. Retinal thickness was measured by optical coherence tomography (OCT) before PDT, and at two days, seven days, and three weeks after PDT. The number of PDT and the greatest linear dimension (GLD) of the CNV lesion were recorded. RESULTS: Serous retinal detachment was demonstrated on OCT at two days after PDT. Retinal elevation increased significantly from 313.2 micrometer before PDT to 640.7 micrometer two days after PDT (P<0.01); elevation and decreased to 303.2 micrometer seven days after PDT, and decreased to 223.4 micrometer three weeks after PDT. The mean number of PDT treatments 2.0 (range: 1~3), and the mean GLD before PDT was 3122.8+/-1275.9 micrometer. CONCLUSIONS: This study suggest that serous retinal detachment in patients with CNV may develop following PDT but may also resolve spontaneously seven days after PDT.

Photodynamic Therapy for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

PURPOSE: To investigate the effects of repeated photodynamic therapy (PDT) for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD) in Korean patients. METHODS: Clinical data of patients who were treated with repeated (3 times or more) PDT for subfoveal choroidal neovascularization secondary to AMD and followed up for more than 6 months were collected from 17 hospitals around the country. Visual outcomes at 12 and 24 months, follow-up were compared between subtypes of choroidal neovascularization. The factors related to final visual prognosis and PDT-related adverse effects were evaluated. RESULTS: 244 patients (244 eyes) were recruited (male: 60%, age: 67.7+/-9.1 years). The portion of patients with predominantly classic, minimally classic, and occult without classic choroidal neovascularization was 57%, 13%, and 24%, respectively and that of patients with visual improvements or less than moderate visual loss at 24 months follow-up were 28%, 38%, 30% and 47%, 56%, and 65%, respectively. Baseline visual acuity and age were significantly related to the final visual prognosis (p<0.05). PDT-related adverse events developed in 15 (6.1%) patients, but most were mild and transient. CONCLUSIONS: Repeated PDT for subfoveal choroidal neovascularization secondary to AMD has effects comparable to those of previous prospective, controlled trials without any significant safety concerns in Korea.