Clinical Outcomes after Switching from As-needed to Proactive Injections in the Neovascular Age-related Macular Degeneration

Purpose@#To evaluate long-term clinical outcomes in patients with neovascular age-related macular degeneration (AMD) who were treated with an as-needed regimen but were switched to a proactive regimen during the course of treatment. @*Methods@#This retrospective study included 23 eyes with neovascular AMD which were initially treated with an as-needed regimen, but switched to a proactive regimen during the course of treatment. The duration of the as-needed phase was compared to that of the proactive phase. In addition, the number of injections per year and the degree of visual deterioration per year were compared between the two phases. @*Results@#The duration of the as-needed and proactive phases were 17.9 ± 8.3 months and 31.3 ± 13.2 months, respectively. The duration of the proactive phase was significantly longer (p < 0.001). The number of injections per year during the proactive phase (4.4 ± 1.0) was significantly more than that during the as-needed phase (2.8 ± 1.0) (p < 0.001). The degree of visual deterioration per year during the as-needed phase (0.08 ± 0.14) was slightly greater than that during the proactive phase (0.04 ± 0.08). However, the difference was not statistically significant (p = 0.229). @*Conclusions@#The number of injections was higher after switching to the proactive regimen. However, the degree of visual deterioration was slightly lower than that noted during the as-needed phase. Further studies with a more controlled design are needed to determine more clearly the impact of switching treatment regimens on long-term clinical outcomes.

Usefulness of Measuring Airway Length with Cephalometry in Pediatric Subjects with Obstructive Sleep Apnea

Concurrent Mucosal Melanoma and Angiofibroma of the Nose

Malignant melanoma rarely develops in the paranasal sinuses, and generally has a poor prognosis. However, mucosal melanoma can masquerade both clinically and histopathologically as a benign lesion, rendering accurate early diagnosis difficult. On the other hand, angiofibroma, a benign tumor, is more easily diagnosed than a mucosal melanoma, because the former exhibits specific histopathological features. No cases of concurrent angiofibroma and mucosal melanoma have been reported to date. We describe such a case below.

Phacoemulsification and Intraocular Lens Implantation after Unexpected Intralenticular Injection of a Dexamethasone Implant

PURPOSE: To report two cases of phacoemulsification and intraocular lens implantation after inadvertent intralenticular injection of a dexamethasone implant. CASE SUMMARY: (Case 1) A 73-year-old male was referred to our hospital after an accidental intralenticular injection of a dexamethasone implant in a local clinic for treatment of branch retinal vein occlusion in his right eye. During the follow-up period, posterior capsular opacity progressed and phacoemulsification and intraocular lens implantation were performed 10 days later. During the surgery, the dexamethasone implant shattered and could not be repositioned into the vitreous cavity. The remnants of that implant were removed and a second dexamethasone implant was successfully injected into the vitreous cavity. (Case 2) A 69-year-old female was being treated for branch retinal vein occlusion in her left eye in our hospital. A dexamethasone implant was accidentally injected into her lens, thus phacoemulsification and intraocular lens implantation were performed the following day. During the procedure, we were able to successfully reposition the dexamethasone implant into the vitreous cavity. CONCLUSIONS: Cataract formation after intralenticular injection of a dexamethasone implant can be easily managed with phacoemulsification. However, the dexamethasone implant shattered 10 days after the injection and could not be repositioned. The implant kept its hardness for at least one day and we were able to reposition it into the vitreous cavity without extending the rupture site of the posterior capsule.

Clinical Outcomes of Nd-YAG Laser Membranotomy in Retained Host Corneal Membrane after Keratoplasty

PURPOSE: To evaluate the clinical efficacy and shortcomings of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser membranotomy in inadvertently retained host membrane. METHODS: Among 742 patients who underwent penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgery at Seoul St. Mary's Hospital between January 2007 and May 2013 by a single surgeon, 10 patients had a thin, opaque membrane in the anterior chamber observed under slit lamp examination and both a subjective decrease in visual acuity and decrease i best corrected visual acuity. A single surgeon performed membranotomy using the Nd-YAG laser at 4.9 months after graft surgery. In this study we compared the differences in visual acuity, endothelial cell count and correlations between distance from donor endothelium and retained host membrane and endothelial loss before and after the graft surgery. RESULTS: Patients who had Nd-YAG laser membranotomy performed on the retained host membrane showed significant improvements in visual acuity (p = 0.039). Donor endothelial cell count was significantly reduced 1 month after Nd-YAG laser. The average distance between donor endothelium and retained host membrane was 712.0 +/- 217.5 microm. The distance and the decreased donor endothelial cell count were not statistically correlated (R2 = 0.39, p = 0.072). There were no significant complications after the laser membranotomy. CONCLUSIONS: Inadvertently retained host membrane forms close to the donor endothelium as identified on optical coherence tomography (OCT) images. Nd-YAG laser membranotomy significantly affected clear vision but endothelial cell count loss was also observed.