Hyperviscosity Syndrome-related Retinopathy in a Patient with Waldenström Macroglobulinemia

Purpose@#We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved. @*Conclusions@#In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.

Two Cases of Tacrolimus-related Transplant-associated Thrombotic Microangiopathy Retinopathy after Allogenic Peripheral Blood Stem Cell Transplantation

Purpose@#We report two cases of tacrolimus-related transplant-associated thrombotic microangiopathy (TA-TMA) retinopathy in leukemia patients who had undergone allogenic peripheral blood stem cell transplantation (PBSCT).Case summary: (Case 1) A 58-year-old woman with a history of PBSCT due to acute myelocytic leukemia and taking tacrolimus was referred to the ophthalmology clinic with visual disturbance. Her visual acuity (VA) was 0.4 in the right eye and 0.5 in the left eye. Multiple cotton wool spots and retinal hemorrhages were found in both eyes on fundus examination. Multiple capillary non-perfusions were seen on fluorescein angiography (FA). Tacrolimus-related TA-TMA retinopathy was suspected. Tacrolimus was discontinued and plasmapheresis was performed. After 3 months, neovascular glaucoma developed and her VA became “counting fingers” at 20 cm in both eyes. (Case 2) A 20-year-old man with a history of PBSCT due to acute lymphocytic leukemia and taking tacrolimus was referred to our clinic because of decreased VA in both eyes. His VA was 0.05 in the right eye and 0.025 in the left eye. Fundus and FA findings were the same as in Case 1, and the patient was suspected to have tacrolimus-related TA-TMA retinopathy. Tacrolimus was discontinued and plasmapheresis was performed. His VA was 0.2 in the right eye and 0.4 in the left eye at 1 month after treatment. @*Conclusions@#It is necessary to consider TA-TMA retinopathy in leukemia patients taking calcineurin inhibitors, such as tacrolimus, who have decreased VA. Early diagnosis and treatment are important.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Changes in Iridocorneal Angle Configuration and Intraocular Pressure during Smartphone Use under Room Light

Purpose@#To investigate changes in intraocular pressure (IOP) and iridocorneal angle (ICA) configuration during smartphone use under room light. @*Methods@#We included healthy adults aged 19-35 years with no ophthalmological abnormalities. All read text on a smartphone for 6 minutes under room light. IOP was measured via rebound tonometry at baseline and at 2, 4, and 6 minutes. ICA images were obtained via anterior segment optical coherence tomography after each IOP measurement. After 6 minutes, participants stopped reading text and rested for 2 minutes. IOP was then measured again. @*Results@#The IOP significantly increased at 2, 4, and 6 minutes of reading compared to baseline (p < 0.001) but recovered to baseline after 2 minutes of rest (p = 1.000). The anterior chamber depth decreased significantly, and the anterior chamber angle width increased after 6 minutes of smartphone reading (both p < 0.05). @*Conclusions@#IOP increased when reading smartphone text under room light but the ICA did not change. Prolonged smartphone reading is inappropriate for a patient at risk of glaucoma or glaucoma progression. Such patients should be cautioned.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Changes in Iridocorneal Angle Configuration and Intraocular Pressure during Smartphone Use under Room Light

Purpose@#To investigate changes in intraocular pressure (IOP) and iridocorneal angle (ICA) configuration during smartphone use under room light. @*Methods@#We included healthy adults aged 19-35 years with no ophthalmological abnormalities. All read text on a smartphone for 6 minutes under room light. IOP was measured via rebound tonometry at baseline and at 2, 4, and 6 minutes. ICA images were obtained via anterior segment optical coherence tomography after each IOP measurement. After 6 minutes, participants stopped reading text and rested for 2 minutes. IOP was then measured again. @*Results@#The IOP significantly increased at 2, 4, and 6 minutes of reading compared to baseline (p < 0.001) but recovered to baseline after 2 minutes of rest (p = 1.000). The anterior chamber depth decreased significantly, and the anterior chamber angle width increased after 6 minutes of smartphone reading (both p < 0.05). @*Conclusions@#IOP increased when reading smartphone text under room light but the ICA did not change. Prolonged smartphone reading is inappropriate for a patient at risk of glaucoma or glaucoma progression. Such patients should be cautioned.

Short-term Changes in Ocular Surface pH after 23-gauge Microincision Vitrectomy Surgery

Purpose@#This study aimed to investigate changes in ocular surface pH after 23-gauge microincision vitrectomy surgery. @*Methods@#This retrospective study included 42 patients who underwent 23-gauge microincision vitrectomy. Best-corrected visual acuity and intraocular pressure were measured. Fundus examination, color fundus photography, and spectral-domain optical coherence tomography were performed. Chemosis was evaluated once a day after surgery, and the ocular surface pH was measured using a microelectrode on the day before surgery and every day up to day 5 after surgery. @*Results@#A total of 42 eyes in 42 patients were examined. The average age was 63.7 years. The indications for surgery included epiretinal membrane in 14 eyes (33.3%), vitreous hemorrhage in 11 eyes (26.2%), macular hole in 11 eyes (26.2%), and rhegmatogenous retinal detachment in six eyes (14.3%). Although the mean ocular surface pH increased from 7.12 ± 0.04 to 7.55 ± 0.04 on the first day after surgery (p < 0.001), it gradually decreased to 7.41 ± 0.03 from the second day postoperatively (p < 0.001). It was subsequently measured as 7.33 ± 0.04 on the third day (p < 0.001) and 7.23 ± 0.03 on the fourth day (p < 0.001) postoperatively. On the fifth postoperative day, the ocular surface pH further decreased to 7.15 ± 0.03 (p = 0.152) and recovered to the preoperative state. A statistically significant correlation was found between the change in ocular surface pH and the chemosis grade (p = 0.001). @*Conclusions@#After 23-gauge microincision vitrectomy surgery, the ocular surface pH shifted temporarily in the alkaline direction within a physiological range correlated with chemosis and intravitreal tamponade usage.

Characteristics of Ocular Manifestations of Patients with Coronavirus Disease 2019 in Daegu Province, Korea

Background@#The coronavirus disease 2019 (COVID-19) has reportedly affected almost 23 million people, with more than 800 thousand deaths globally. There have been a few reports on the ocular manifestations of COVID-19 patients in China but no reports in Korea. The present study aimed to examine ocular manifestations of COVID-19 patients in Korea. @*Methods@#COVID-19 patients admitted from March 2020 to April 2020 at Keimyung University Dongsan Hospital and Keimyung University Daegu Dongsan Hospital were reviewed retrospectively for ocular manifestations. During the period of hospitalization, ocular symptoms as well as blood test results were noted and analyzed. Patients were then divided into the first-episode and relapsed group and ocular symptoms were analyzed in the groups. @*Results@#A total of 103 patients were included in this study. Among them, 71patients were in the first-episode group and 32 patients in the relapsed group. No significant differences were determined in terms of positivity of ocular symptoms between the first-episode group (12 patients, 16.9%) and the relapsed group (10 patients, 31.3%, p > 0.05). Symptoms of positive upper respiratory infection and lower creatine phosphokinase were determined to be related to positive ocular symptoms. Conjunctival congestion was noted in seven patients. In the subgroup analysis, the conjunctival congestion-positive patients exhibited higher positivity of upper respiratory infection symptoms (100%) as compared with those in the negative group (40%, p = 0.017). @*Conclusion@#Positive upper respiratory infection symptoms and lower creatine phosphokinase were determined to be related to ocular symptoms in COVID-19 patients.Among these patients, positive upper respiratory infection symptoms were associated with conjunctival congestion.

Choroidal Neovascularization in a Patient with Best Disease

PURPOSE: To report a case of choroidal neovascularization in a Best disease patient treated with intravitreal bevacizumab injection and followed up with optical coherence tomography angiography (OCTA). CASE SUMMARY: A 20-year-old female visited our clinic with decreased visual acuity of the left eye for 6 months. On optical coherence tomography (OCT), subretinal fluid and hyperreflective subretinal clumps were observed in the macula of the right eye. Subretinal hemorrhage and subretinal fluid were observed in the left eye. Choroidal neovascularization in the left eye was observed using OCTA, fluorescein angiography, and indocyanine green angiography. A full-field electroretinogram was normal in both eyes, but an electrooculogram revealed that the Arden ratio was 1.564 in the right eye and 1.081 in the left eye. Intravitreal bevacizumab injection was performed in the left eye. At 6 months after the intravitreal injection, the best-corrected visual acuity of the left eye had recovered to 20/20. OCT revealed that subretinal fluid reduced and choroidal neovascularization was stable. After 12 months, visual acuity of the left eye was maintained at 20/20, but OCTA revealed that choroidal neovascularization had increased. CONCLUSIONS: Choroidal neovascularization associated with Best disease can improve by intravitreal bevacizumab injection, and the changes in choroidal neovascularization can be followed using OCTA.

Anterior Uveitis Caused by Listeria Monocytogenes Infection

PURPOSE: To report a case of anterior uveitis secondary to Listeria monocytogenes infection. CASE SUMMARY: A 57-year-old male presented to our clinic with ocular pain and decreased vision in the right eye for 2 days. The patient had a history of liver transplantation 2 years prior and used immunosuppressive agents. Listeria monocytogenes was identified in blood cultures 1 month before his visit. At presentation, best-corrected visual acuity (BCVA) of the right eye was counting fingers at 20 cm and the intraocular pressure (IOP) was 50 mmHg. Conjunctival hyperemia, corneal edema, keratic precipitates, and cells in the anterior chamber were observed in the right eye. The patient was diagnosed as anterior uveitis in the right eye. Conventional uveitis treatment was initiated but clinical features did not improve and black hypopyon appeared. The possibility of anterior uveitis caused by Listeria monocytogenes infection was considered. An anterior chamber tap and culture were conducted to identify pathogens. Anterior chamber antibiotic injections and systemic antibiotic injections were performed. One week after injection, the BCVA of the right eye improved to 0.4 and the IOP decreased to 14 mmHg. One month after injection, the BCVA of the right eye improved to 1.0 and the IOP decreased to 16 mmHg. No inflammation of the anterior chamber was observed. CONCLUSIONS: When nonspecific uveitis occurs in immunosuppressed patients, cultures and appropriate antibiotics should be considered because of the possibility of infection.

A Case of Polypoidal Choroidal Vasculopathy and Serous Retinal Detachment in a Bilateral Dome-shaped Macula

PURPOSE: To report a case of polypoidal choroidal vasculopathy in the right eye which improved after intravitreal injection of anti-vascular endothelial growth factor, and serous retinal detachment (SRD) in the left eye which improved spontaneously in a patient with a bilateral dome-shaped macula (DSM) with a tilted optic disc and inferonasal posterior staphyloma. CASE SUMMARY: A 50-year-old female visited our clinic with visual disturbance of the right eye for 5 days. A tilted optic disc with inferonasal posterior staphyloma and DSM were observed in both eyes by fundus examination and spectral domain optical coherence tomography (SD-OCT), and there was no specific finding in the left eye, but pigment epithelial detachment (PED) with subretinal hemorrhage was observed in the right eye. Polyps and branching vascular networks were found using indocyanine green angiography. We performed intravitreal C3F8 gas and aflibercept injection. After 3 months, SD-OCT of the right eye showed no subretinal hemorrhage and diminished PED. SD-OCT of the left eye showed SRD but the SRD disappeared after 1 month. SD-OCT of the left eye showed no recurrence of the SRD. CONCLUSIONS: In a patient with a tilted optic disc and dome-shaped macula, polypoidal choroidal vasculopathy and SRD may occur, so appropriate treatment will be necessary.

Roth Spots and Panuveitis in a Patient with Infectious Mononucleosis

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.

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.

Short-term Analysis of the Residual Volume of an Eye Drop Following 23-Gauge Microincision Vitrectomy Surgery

PURPOSE: To evaluate the change of residual volume of eye drop after instillation in patients with 23-gauge microincision vitrectomy surgery (MIVS). METHODS: Patient who were treated 23-gauge MIVS from November 2014 to July 2015 were included. The residual volume was defined as the amount of remnant eye drop in patient's eyes after instillation, calculated as the difference between instillation volume and spilled volume of eye drop. Calculation of residual volume of eye drop was performed one day before surgery, and daily from postoperative day 1 to day 5. RESULTS: Forty consecutive patients were included. The residual volume of eye drop decreased from 30.3 ± 1.4 µL at baseline to 13.0 ± 1.5 µL at day 1, 18.3 ± 1.6 µL at day 2, 24.7 ± 1.5 µL at day 3, and 27.9 ± 1.4 µL in day 4, postoperatively (p < 0.001, respectively). The volume at postoperative day 5 was 29.4 ± 1.3 µL, but it was not different from the volume at baseline (p = 0.105). The change of residual volume was significantly correlated with postoperative chemosis (r = 0.672, p < 0.001) and effected by the number of quadrant with postoperative chemosis (p < 0.05). CONCLUSIONS: This study shows that postoperative residual volume of eye drop after instillation decreased until postoperative day 4, and postoperative chemosis affects the change of residual volume. Thus, checking proper use of eye drops and teaching about instillation technique by physician is necessary for patients with 23-gauge MIVS.

Retinoic Acid Syndrome and Pseudotumor Cerebri in Patients with Acute Promyelocytic Leukemia

PURPOSE: To report cases of a retinal, preretinal and vitreous hemorrhage due to retinoic acid syndrome and a papilledema caused by increased intracranial pressure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA). CASE SUMMARY: (Case 1) A 48-year-old female visited our clinic with headache, dyspnea, and visual disturbance during ATRA medications for acute promyelocytic leukemia. Her visual acuity of both eyes was hand motion, and fundus examination revealed extensive retinal, preretinal, and vitreous hemorrhage. The laboratory test showed leukocytosis and computed tomography of brain and chest revealed subarachnoid hemorrhage and pulmonary alveolar hemorrhage. She was diagnosed with retinoic acid syndrome and was treated with vitrectomy in both eyes. (Case 2) A 17-year-old male, who had been treated with ATRA for acute promyelocytic leukemia, had headache and visual disturbance. His best-corrected visual acuity was 1.0 in both eyes, but the fundus examination showed papilledema and retinal hemorrhage in both eyes. Goldmann visual field examination revealed an enlarged blind spot in both eyes. He was diagnosed with papilledema caused by ATRA induced increased intracranial pressure, and was observed. CONCLUSIONS: Patients with acute promyelocytic leukemia treated with ATRA may have retinoic acid syndrome and increased intracranial pressure that could result in retinal hemorrhage, vitreous hemorrhage, and papilledema.

Epiretinal Membrane: Prevalence and Risk Factors from the Korea National Health and Nutrition Examination Survey, 2008 through 2012

PURPOSE: To investigate the prevalence and risk factors for an epiretinal membrane (ERM) in Korean population. METHODS: Using the database of the Korea National Health and Nutrition Examination Survey from 2008 through 2012, 14,772 participants 40 years of age or older with gradable fundus photographs were included. The presence of ERM was determined by using fundus photographs. The prevalence of ERM was estimated and possible risk factors including systemic factors, nutritional status, and blood tests were analyzed via multiple logistic regression analyses. RESULTS: The prevalence of ERM was 2.9% (95% confidence interval [CI], 2.6% to 3.3%). On multiple logistic regression analysis, the prevalence of ERM was affected by age. The odds ratios (ORs) against the forties were 2.70, 5.48, and 5.69 in the fifties, sixties, and seventies, respectively. ERM was also significantly affected by cataract surgery (OR, 2.82; 95% CI, 2.08 to 3.81) and by the increase in intake of 100-mg calcium (OR, 1.05; 95% CI, 1.00 to 1.11). ERM had negative associations with red blood cell count (OR, 0.66; 95% CI, 0.45 to 0.95). CONCLUSIONS: The estimated nation-wide prevalence of ERM in Korea is 2.9%. The presence of ERM in the general population is associated with age, cataract surgery, increased dietary calcium, and a low red blood cell count.

Central Retinal Artery Occlusion by Left Atrial Myxoma

No abstract available.

A Case of Acute Angle-closure Glaucoma Secondary to Spontaneous Suprachoroidal Hemorrhage

PURPOSE: To report a case of acute angle-closure glaucoma secondary to spontaneous suprachoroidal hemorrhage in a hemodialysis patient. CASE SUMMARY: A 71-year-old man visited our clinic after 3 days of vision loss and ocular pain in the right eye. He had been treated with hemodialysis using heparin due to diabetic nephropathy. Visual acuity (VA) was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure (IOP) was 58 mmHg in the right eye and 15 mmHg in the left eye. Gonioscopic examination revealed a closed angle in the right eye. Fundus examination of the right eye showed a massive hemorrhagic retinal detachment and ultrasound sonography revealed a dome-shaped retinal detachment with suprachoroidal hemorrhage in the right eye. The patient was treated with topical aqueous suppressants and cycloplegics. After two weeks of medical treatment, VA in the right eye was still hand motion and IOP was 8 mmHg. Gonioscopic examination showed a wide-open angle in the right eye. During the two-month observation period, VA in the right eye did not recover, however there was no sign of IOP elevation or symptoms of ocular pain. CONCLUSIONS: Spontaneous suprachoroidal hemorrhage can occur in patients who receive hemodialysis with heparin. This spontaneous suprachoroidal hemorrhage can be subsequently accompanied by acute angle-closure glaucoma. Spontaneous decrease of suprachoroidal hemorrhage, loss of angle-closure, and decline of IOP can be expected by treating with topical aqueous suppressants and cycloplegics.

Fundus Autofluorescence, Fluorescein Angiography and Spectral Domain Optical Coherence Tomography Findings of Retinal Astrocytic Hamartomas in Tuberous Sclerosis

PURPOSE: To analyze the structural and morphological characteristics of retinal astrocytic hamartomas in tuberous sclerosis patients using fundus autofluorescence, fluorescein angiography and spectral-domain optical coherence tomography. CASE SUMMARY: Fundus examination, fundus autofluorescence, fluorescein angiography and spectral-domain optical coherence tomography were performed in three patients with tuberous sclerosis and the morphological and structural characteristics of retinal astrocytic hamartomas were analyzed. In the fundus autofluorescence, type 1 retinal astrocytic hamartoma showed hypofluorescence and type 3 showed central hyperfluorescence and surrounding hypofluorescence. Spectral domain optical coherence tomography showed dome-shaped hyper-reflectivity within the nerve fiber layer and focal adhesion of the vitreous cortex in the type 1 retinal astrocytic hamartoma. No abnormalities were observed in the outer retinal layer and retinal pigment epithelium. In the type 3 retinal astrocytic hamartoma, optical coherence tomography showed disorganization of retinal tissue and posterior shadowing. Intratumoral cavitation and moth-eaten appearance caused by intratumoral calcification were observed and the vitreous cortex adhered to the top of the tumor and showed traction. Retinal arterial sheathing was observed in all cases and hyper- reflectivity of the arterial wall was noted on optical coherence tomography. CONCLUSIONS: Fundus autofluorescence, fluorescein angiography and spectral-domain optical coherence tomography are helpful for the classification and diagnosis of retinal astrocytic hamartomas found in tuberous sclerosis patients as well as for differentiation from other lesions.

Preferences and Trends in the Treatment of Diabetic Retinopathy in Korea and Japan

PURPOSE: To evaluate preferences and trends in the management of diabetic retinopathy in Korea and Japan. METHODS: An Internet survey comprised of 49 questions was sent to the members of Korean Retina Society (KRS) and Japanese Society of Ophthalmic Diabetology (JSOD). The survey was conducted during the period between June 2012 and July 2012. RESULTS: Ninety-one of 210 members of the KRS (43%) and 120 of 754 members of the JSOD (16%) participated in the survey. For diffuse diabetic macular edema, 'intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) followed by focal laser treatment' was the most preferred treatment in Korea (48%), while 'sub-tenon steroid injection followed by focal laser treatment' was the most common procedure in Japan (33%). Vitrectomy was the second most common procedure in Japan (18%). In contrast, none of the KRS members preferred vitrectomy in this situation. For refractory diabetic macular edema, however, vitrectomy with or without the use of anti-VEGF was chosen in 75% of the KRS members. In Japan, vitrectomy without the use of intravitreal injection of anti-VEGF or steroid was relatively more preferred. Small-gauge (G) vitrectomy using either a 23 G or 25 G needle was popular in both countries (90% in Korea, 64% in Japan). CONCLUSIONS: Although the trends in diagnostic and surgical environments were similar in Korea and Japan, the preferred treatment approaches for diabetic macular edema were different. Sub-tenon steroid injection and vitrectomy were preferred in Japan, while anti-VEGF injection was most commonly employed in Korea.