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.

The Characteristics of Non-Retinal Lesions in the Ultra-Wide Field Scanning Laser Ophthalmoscope Image

PURPOSE: To evaluate various types and; characteristics of non-retinal lesions associated with ultra-wide field scanning laser ophthalmoscope images. METHODS: This retrospective study included 139 eyes of 139 patients with non-retinal lesions observed on color images obtained using Optomap 200Tx (Optos PLC, Dunfermline, Scotland, UK). The non-retinal lesion is a hyperreflective or hyporeflective shadow due to anterior segment of the eye or vitreous except the retina. Types and characteristics of red laser separation, green laser separation and autofluorescence images of non-retinal lesions were evaluated. RESULTS: All non-retinal lesions in images were categorized into 2 groups according to the location of non-retinal lesions. The anterior non-retinal lesions group included corneal opacity, cataract and posterior capsular opacity. The posterior non-retinal lesions group included asteroid hyalosis, posterior vitreous detachment, vitreous opacity and vitreous hemorrhage. Anterior non-retinal lesions were more often hyporeflective in red and green laser separation images (p < 0.001). Posterior non-retinal lesions were more often hyperreflective in green laser separation images and hyporeflective in red laser separation images (p < 0.001). CONCLUSIONS: Ultra-wide field scanning laser ophthalmoscope images can frequently have various shadows from anterior or posterior lesions of the eye. These shadows show a difference in reflectivity depending on their origins. To understand the difference helps in the interpretation of the fundus images.

The Ocular Fatigue of Watching Three-Dimensional (3D) Images

PURPOSE: To compare ocular fatigue, non-ocular symptoms, and ocular surface changes, such as tear break-up time (BUT) and ocular surface temperature, after watching 2-dimensional (2D) and 3-dimensional (3D) images. METHODS: Fourteen volunteers were enrolled in the present study. Subjects watched 2D as well as 3D images and answered questions regarding ocular fatigue and general symptoms such as headache. Before and after watching images, the spherical equivalent, degree of conjunctival injection, tear BUT, and ocular surface temperature were measured and the amount of change was analyzed. While watching images, subjects answered questions regarding ocular fatigue and the time when they began to feel definitive symptoms. RESULTS: Watching 3D images induced a greater degree of ocular fatigue, headache, and decreasing concentration than watching 2D images (p = 0.038, 0.003, and 0.045, respectively). While watching images, 3D images induced a greater degree of ocular fatigue than 2D images and caused subjects to feel earlier ocular fatigue (3D: 54.86 min, 2D: 78.57 min, p = 0.002). Spherical equivalents became more myopic after watching 3D images. CONCLUSIONS: After watching 3D images, a greater degree of ocular fatigue, headache, and decreasing concentration was induced and a shorter time to feel definitive ocular fatigue was observed than after watching 2D images. In addition, spherical equivalents changed myopically after watching 3D images.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

The Objective Methods to Evaluate Ocular Fatigue Associated With Computer Work

PURPOSE: To develop methods for the objective measurement of ocular fatigue. METHODS: Fifteen patients were enrolled in the present study. Subjects performed visual tasks on a computer for one hour. A survey of ocular fatigue was conducted with a questionnaire. Tear break-up time, blinking rate, ocular protection index, conjunctival injection, maximal blinking interval, temperature of the ocular surface, and visual evoked potential were evaluated before and immediately after the task. Surface electromyography of the orbicularis oculi muscle was performed before and during the task. RESULTS: The survey showed increases in subjective ocular fatigue in all subjects. Tear break-up time, ocular protection index and maximal blinking interval decreased, while temperature of the ocular surface increased after the task. Conjunctival injection showed a tendency to increase. Electromyography, and visual evoked potential did not change significantly. CONCLUSIONS: In the present study, tear break-up time, ocular protection index, maximal blinking interval, and temperature of the ocular surface changed as ocular fatigue increased. Therefore, these measures can be objectively used for the evaluation of ocular fatigue.

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.

Photodynamic Therapy With Verteporfin using Half Fluence for Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate the clinical results of half-fluence photodynamic therapy (PDT) using verteporfin in patients with chronic central serous chorioretinopathy (CSC). METHODS: The author reviewed the charts of 20 patients (22 eyes) who underwent PDT for chronic central serous chorioretinopathy. All 22 eyes were treated using an irradiance of 300 mW over 83 second (25 J/cm2). Postoperative evaluation included improvements in visual acuity, complications, changes in central macular thickness with the optical coherence tomogram (OCT), and recurrence. RESULTS: The best-corrected visual acuity improved significantly from 0.50+/-0.32 to 0.12+/-0.19 logMAR at 3 months (p<0.01), and the mean central macular thickness decreased from 377.7+/-86.3 micrometer to 166.2+/-29.3 micrometer at 3 months (p<0.01). Exudative serous macular detachments were resolved completely in all eyes within 3 months. There was no recurrence after PDT during the follow-up period. CONCLUSIONS: PDT using half fluence appeared to be a beneficial treatment option for patients with chronic CSC. Further studies are needed to verify treatment safety as well as the time and rate of recurrences.

The Efficacy of Photodynamic Therapy With Verteporfin for Polypoidal Choroidal Vasculopathy: Retrospective Multi-Center Case Study

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV) in Korean patients. METHODS: Clinical data of patients who were treated with PDT for PCV and followed up for more than 6 months were collected from 14 hospitals around the country. The changes in the best corrected visual acuity, angiographic outcome, retinal thickness measured by optical coherence tomography (OCT), and adverse effects of treatment were evaluated. RESULTS: Eighty six patients (86 eyes) were recruited (male: 75.6%, age: 65.9+/-8.3 years, mean follow-up: 14.8+/-10.2 months). The mean logMAR visual acuity at baseline was 0.55+/-0.32 and did not show any statistically significant difference from the final mean logMAR visual acuity (0.53+/-0.54) (p=0.639). The mean treatment session number of PDT was 2+/-1.2. Visual acuity stabilized or improved in 70.9% of patients. Visual acuity improved by more than 2 lines in 33 eyes (38.4%) and worsened by more than 2 lines in 21 eyes (24.4%) of patients. Vascular leakage decreased in 62.5% of patients in fluorescein angiography and polypoidal lesions disappeared or were reduced in 57.3% of patients in indocyanine green angiography. There was no systemic adverse effect of PDT, but increased subretinal hemorrhage after PDT occurred in 10 eyes (11.6%). CONCLUSIONS: In polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin is safe and effective for preserving visual acuity and reducing vascular leakage and retinal thickness.

Intravitreal Triamcinolone Injection with or Without Bevacizumab for Diabetic Macular Edema

PURPOSE: To compare the effect of intravitreal triamcinolone injection with and without bevacizumab for diabetic macular edema. METHODS: Of 69 patients (69 eyes) diagnosed with diabetic macular edema without any history of other intraocular disease or intraocular operation, 45 eyes (45 patients) were injected with intravitreal triamcinolone (4 mg) and the remaining eyes (24 patients) were injected with triamcinolone (2 mg) and bevacizumab (1.25 mg). The visual acuity and central macular thickness of treated eyes from both groups was measured using OCT, and these measurements were compared between the two groups. RESULTS: There were no statistical differences between the two groups with respect to baseline data. Central macular thickness (CMT) was reduced in both groups, and BCVA improved in both groups. No significant differences were detected in changes in CMT or BCVA between the two groups. CONCLUSIONS: Intravitreal injection of triamcinolone had a beneficial effect on DME in terms of CMT reduction and BCVA improvement. Addition of three consecutive intravitreal bevacizumab injections, however, did not show any significant addictive effect during the follow-up period.

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.

The Effect of Posterior Vitreous Detachment on Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To quantitatively compare the role of posterior vitreous detachment in macular edema associated with branch retinal vein occlusion (BRVO) using OCT. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema was carried out from November 2003 to February 2005. There was posterior vitreous detachment (PVD) in 23 eyes [PVD (+) group], and vitreoretinal attachment on the fovea in 31 eyes [PVD (-) group]. PVD was detected with an indirect ophthalmoscope or 90D lens. The foveal thicknesses of the two groups were measured and compared. RESULTS: The mean foveal thicknesses of the PVD (-) and PVD (+) groups were 398.0+/-217.2 micrometer and 233.6+/-80.6 micrometer, respectively (p=0.000, Mann-Whitney test). The mean BCVA (log MAR) was 0.77+/-0.52 in the PVD (-) group and 0.40+/-0.37 in the PVD (+) group (p=0.002, Mann-Whitney test). CONCLUSIONS: The extent of macular edema associated with BRVO was significantly less in the PVD(+) group and BCVA was significantly better in the PVD (+) group as well.

A Case of Cancer-Associated Retinopathy with Small Cell Lung Cancer

PURPOSE: To report a case of cancer-associated retinopathy developed in a patient with small cell lung cancer, which is a kind of paraneoplastic syndrome. METHODS: A 78-year-old woman presented complaining of decreased visual acuity and visual field that had developed about 15 days previously. She was diagnosed with small cell lung cancer 1.5 years ago and underwent 3 cycles of chemotherapy. At presentation, the best-corrected visual acuity was hand motion in both eyes and there was no afferent pupillary defect. Slit-lamp biomicroscopic examination revealed no specific abnormality in the anterior segment of either eye, and intraocular pressure was normal. Posterior segment examination demonstrated remarkable arteriolar narrowing in both eyes, but there was little doubt about the presence of an optic nerve lesion such as optic disc edema or pallor. RESULTS: Fluorescein angiography and brain magnetic resonance imaging (MRI) revealed no significant abnormalities. However, electroretinograms (ERG) demonstrated marked reduction in the a and b waves. Visual evoked response was delayed for the latency period. She was treated with systemic steroid, after which her visual acuity gradually improved.

Intravitreal versus Posterior Subtenon Injection of Triamcinolone Acetonide for Diabetic Macular Edema

PURPOSE: To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. METHODS: This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. RESULTS: Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. CONCLUSIONS: The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.

Risk Factors of Posterior Synechia of the Iris after Performing Vitrectomy and Cataract Surgery Simultaneously

PURPOSE: Performing simultaneous vitrectomy and cataract procedure has become a widely accepted treatment for cataract patients with vitreoretinal diseases. We evaluated the risk factors of posterior synechia of the iris after such a combined surgery. METHODS: We selected the 149 eyes of 149 patients and reviewed the relationship between posterior synechia of the iris and preoperative condition of patients, intraoperative procedures, and postoperative findings. RESULTS: Twenty-six eyes (17.4%) developed posterior synechia; the risk ratio for female patients was 3.382 (95% CI: 1.014-11.277); in patients with uveitis history it was 9.987 (95% CI: 2.329-42.821); in patients with postoperative anterior chamber hyphema it was 17.477 (95% CI: 1.828-167.144); in patients with postoperative anterior chamber fibrin deposition it was 23.52 (95% CI: 2.938-188.299). In cases with silicone-oil tamponade the risk ratio was 8.531 (95% CI: 2.287-31.831) times higher; and in cases with C3F6 gas tamponade it was 15.786 (95% CI: 3.456-72.101) times higher than those with balanced salt solution tamponade. CONCLUSIONS: Risk factors of posterior synechia of the iris after a combined vitrectomy and cataract procedure were being female, uveitis history, silicone-oil tamponade, C3F6 gas tamponade, postoperative anterior chamber hyphema, and postoperative anterior chamber fibrin deposition.

Endogenous candidal endophthalmitis associated with flame burn injury and advanced gastric cancer

PURPOSE: We report a case of candidal endophthlmitis developed in a patient with advanced gastric cancer who recently injured by flame burn. He was treated successfully with intravitreous and intravenous antifungal agents. METHODS: A 40-year-old man visited with complaints of decreased binocular visual acuity 7 weeks after third degree flame burn injury to 25% of body surface. Indirect ophthalmoscope showed findings of fungal endophthalmitis and upper gastro-intestinal endoscopic examination diagnosed of fungal esophagitis and advanced gastric cancer. He was treated with amphotericin B intranvitreously and fluconazole and amphotericin B intravenously. RESULTS: His visual acuity was improved to 20/50 (OD), 20/30 (OS) following 4 weeks after treatment and intraocular inflammation was decreased. After 5 months, he recovered his visual acuity as 20/25 (OD), 20/20 (OS), and had no inflammation in anterior chamber and vitreous.

A Case of Serologically Confirmed Ocular Toxocariasis with Peripheral Granuloma in a 34-year Old Woman

No Abstract Available.