Clinical Characteristics at Initial Diagnosis of Korean Patients with Retinitis Pigmentosa

Purpose@#To evaluate the clinical characteristics of Korean patients diagnosed with retinitis pigmentosa. @*Methods@#We retrospectively reviewed the medical records of patients diagnosed with retinitis pigmentosa from January 2014 to December 2019. We evaluated age, gender, the chief complaints, posterior subcapsular cataract status, abnormalities on optical coherence tomography, visual field test results, and electrooculograms. @*Results@#A total of 492 eyes of 246 patients were included. The mean patient age was 48.0 ± 16.0 years and the chief complaints were decreased vision and night blindness. The mean logarithm of the minimal angle of resolution (logMAR) best‐corrected visual acuity (BCVA) was 0.31 ± 0.50. The BCVA was 0.5 or better in 368 eyes (74.8%). A total of 328 (71.0%) of 462 eyes that underwent visual field testing exhibited visual field defects within 10º. The mean Arden ratio was 1.28 ± 0.28 for the 242 eyes that underwent electro‐oculography. Optical coherence tomography revealed vitreomacular traction/an epiretinal membrane, cystoid macular edema, and retinal thinning in 135 (27.4%), 48 (9.8%), and 112 (22.8%) eyes, respectively. The ellipsoid zone was intact in 222 eyes (45.1%), disrupted in 220 (44.7%), and absent in 50 (10.2%). @*Conclusions@#Most patients with retinitis pigmentosa exhibited visual acuity of 0.5 or better, but also had central visual field defects. Various abnormalities were noted on optical coherence tomography of most patients.

The Characteristics and the Clinical Courses of Best Disease in Korean Patients

Purpose@#To evaluate the clinical characteristics and courses of Best disease in Korean patients. @*Methods@#We retrospectively reviewed the medical records of patients with Best disease followed-up for more than 12 months after diagnosis. The disease stage and best-corrected visual acuity (BCVA) at diagnosis, and stage progression during follow-up, were evaluated. The BCVA at diagnosis was compared to that at the final follow-up. The BCVA changes were compared between those evidencing stage progression and not. @*Results@#A total of 16 patients (32 eyes) were enrolled. The mean follow-up period was 52.1 ± 31.8 months. At diagnosis, three eyes had stage 1, nine stage 2, seven stage 3, 11 stage 4, and two stage 5 disease. During follow-up, stage progression was observed in nine eyes (28.1%). The mean logarithm of the minimal angle of resolution (logMAR) BCVA significantly worsened from 0.19 ± 0.19 at baseline to 0.30 ± 0.27 at the final follow-up (p = 0.004). In six eyes (18.8%), a deterioration of logMAR 0.2 or greater was noted. The extent of deterioration was greater in the nine eyes (0.25 ± 0.26) exhibiting stage progression than in the 24 eyes (0.05 ± 0.08) lacking such progression (p = 0.001). @*Conclusions@#The visual acuity of Best disease patients was relatively good at diagnosis. However, stage progression and visual deterioration were noted in some patients. Stage progression was associated with a poor visual prognosis.

The Characteristics and the Clinical Courses of Best Disease in Korean Patients

Purpose@#To evaluate the clinical characteristics and courses of Best disease in Korean patients. @*Methods@#We retrospectively reviewed the medical records of patients with Best disease followed-up for more than 12 months after diagnosis. The disease stage and best-corrected visual acuity (BCVA) at diagnosis, and stage progression during follow-up, were evaluated. The BCVA at diagnosis was compared to that at the final follow-up. The BCVA changes were compared between those evidencing stage progression and not. @*Results@#A total of 16 patients (32 eyes) were enrolled. The mean follow-up period was 52.1 ± 31.8 months. At diagnosis, three eyes had stage 1, nine stage 2, seven stage 3, 11 stage 4, and two stage 5 disease. During follow-up, stage progression was observed in nine eyes (28.1%). The mean logarithm of the minimal angle of resolution (logMAR) BCVA significantly worsened from 0.19 ± 0.19 at baseline to 0.30 ± 0.27 at the final follow-up (p = 0.004). In six eyes (18.8%), a deterioration of logMAR 0.2 or greater was noted. The extent of deterioration was greater in the nine eyes (0.25 ± 0.26) exhibiting stage progression than in the 24 eyes (0.05 ± 0.08) lacking such progression (p = 0.001). @*Conclusions@#The visual acuity of Best disease patients was relatively good at diagnosis. However, stage progression and visual deterioration were noted in some patients. Stage progression was associated with a poor visual prognosis.

Clinical Outcomes of Idiopathic Epiretinal Membrane Removal in Patients 80 Years or Older

PURPOSE: To evaluate clinical outcomes of idiopathic epiretinal membrane removal in patients ≥ 80 years of age.METHODS: A retrospective review of medical records was performed with 56 patients who underwent vitrectomy and removal of idiopathic epiretinal membrane. In the ≥ 80 years of age group (n = 28), the best-corrected visual acuity (BCVA) and central macular thickness (CMT) before surgery were compared with those at the final follow-up. The amount of change in the BCVA after surgery was also compared between the ≥ 80 years of age group and the < 80 years of age group (n = 28).RESULTS: In the ≥ 80 years of age group, the mean follow-up period was 19.1 ± 17.0 months. Before surgery, 11 eyes were pseudophakic and 17 eyes were phakic. Combined cataract surgery was performed with epiretinal membrane removal in all 17 phakic eyes. The mean logarithm of the minimal angle of resolution BCVA was 0.75 ± 0.30 before surgery, which improved to 0.50 ± 0.30 at the final follow-up (p < 0.001). The CMT was 458.0 ± 79.7 µm before surgery, which decreased to 367.2 ± 83.4 µm at the final follow-up (p < 0.001). There was no significant difference in the amount of change in the BCVA after the surgery between the ≥ 80 years of age group and the < 80 years of age group (p = 0.547).CONCLUSIONS: In patients with idiopathic epiretinal membrane who were ≥ 80 years of age, the visual acuity was improved or maintained, and was accompanied with anatomical improvement after epiretinal membrane removal with or without cataract surgery. These results suggest the usefulness of epiretinal membrane removal in older patients.

Clinical Presentations of Focal Choroidal Excavation and Results of Long-term Follow-up

PURPOSE: To evaluate the clinical presentations of focal choroidal excavation and to report long-term outcomes of cases without retinal disorders at the initial presentation. METHODS: A retrospective review of medical records was performed for patients diagnosed with focal choroidal excavation. Concomitant retinal disorders at the initial presentation were identified. In cases without retinal disorders, the development of retinal disorders during follow-up was also evaluated. RESULTS: Forty-five eyes in 45 patients were examined in this study. Focal choroidal excavation was accompanied with retinal disorders in 16 eyes (35.6%). In the remaining 29 eyes, only focal choroidal excavation was noted without any accompanying retinal disorders. The accompanying retinal disorders included choroidal neovascularization (n = 8), central serous chorioretinopathy (n = 4), epiretinal membrane (n = 1), macular hole (n = 1), branch retinal vein occlusion (n = 1), and uveitis (n = 1). Of the 29 eyes without retinal disorders, 22 were followed up for a mean period of 33.5 ± 18.2 months. Consequently, choroidal neovascularization was found to have developed in one eye at 59 months, and subretinal fluid had developed in two eyes at 17 and 28 months, respectively. CONCLUSIONS: Focal choroidal excavation was accompanied by retinal disorders in 35.6% of the included patients. In patients without retinal disorders, the development of a retinal disorder was noted in some eyes, suggesting the need for long-term regular follow-up in patients diagnosed with focal choroidal excavation.

Fourteen Anti-vascular Endothelial Growth Factor Injections for Age-related Macular Degeneration: Ending Period and Clinical Outcome

PURPOSE: To evaluate the clinical course of patients who had completed 14 ranibizumab or aflibercept monocular treatments. METHODS: Retrospective medical record analysis was performed to 24 patients who were diagnosed with monocular neovascular age-related macular degeneration and had completed 14 ranibizumab or aflibercept monocular injections, allowed by the Korean National Health Care system. Time to completion was measured along with the percentage and timing of medication switch. Best-corrected visual acuity (BCVA) was measured at the time of diagnosis, after 3-loading injections, and the time of completion. Additionally, we searched for any other factors that had influenced the time to completion. RESULTS: The average time to completion of 14 injections was 32.3 ± 6.2 months (21–48 months). The switching was performed in 17 eyes (70.8%), and it was done after 9.4 ± 2.1 injections (4–14 injections) with prior medication. After 14 injections, the BCVA improved in 6 eyes (25.0%), unchanged in 8 eyes (33.3%), and worsened in 10 eyes (41.7%). Complete resolution of intraretinal fluid and subretinal fluid after 3 loading injections were observed in 20 eyes, and it was significantly related to time to the first recurrence and time to the completion of 14 injections (p = 0.007, r = 0.583). CONCLUSIONS: The average time to completion of 14 injections was 32.3 months, and switching of medication was performed in 70.8%. Longer time to the first recurrence was related to longer completion time. This study will provide useful facts when informing the patients their future treatment plans under the Korean Health Care system.

The Efficacy of Intravitreal Aflibercept in Submacular Hemorrhage Secondary to Wet Age-related Macular Degeneration

PURPOSE: To evaluate the efficacy of intravitreal aflibercept monotherapy in submacular hemorrhage (SMH) secondary to wet age-related macular degeneration (AMD). METHODS: This study included 25 eyes in 25 patients with SMH involving the fovea secondary to wet-AMD. All patients were treated with three consecutive monthly intravitreal aflibercept (2.0 mg/0.05 mL) injections, followed by as-needed reinjection. They were followed for at least 6 months. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and area of SMH were measured at diagnosis, as well as at 3 and 6 months after treatment initiation. RESULTS: The BCVA significantly improved from 0.79 ± 0.41 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.54 ± 0.41 logMAR at 6 months (p < 0.001). BCVA ≥3 lines and stable vision were observed in 96% of the eyes. The CFT significantly decreased from 560.8 ± 215.3 µm at baseline to 299.8 ± 160.2 µm at 6 months (p < 0.001). The area of SMH significantly decreased from 10.5 ± 7.1 mm² at baseline to 1.8 ± 6.5 mm² at 6 months (p < 0.001). The BCVA, CFT, and area of SMH at baseline, as well as duration of symptoms, all correlated with BCVA at the 6-month follow-up. CONCLUSIONS: Intravitreal injection of aflibercept is an effective treatment option for patients with SMH secondary to wet-AMD; however, there may be limited efficacy in eyes with large SMH area and cases in which treatment is delayed.

Clinical Outcomes of Eyes with Submacular Hemorrhage Secondary to Age-related Macular Degeneration Treated with Anti-vascular Endothelial Growth Factor

PURPOSE: To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with submacular hemorrhage secondary to exudative age-related macular degeneration. METHODS: This retrospective, observational study included 49 patients (49 eyes) who initially presented with submacular hemorrhage associated with exudative age-related macular degeneration and who were followed-up for at least 24 months. Only eyes that were treated with intravitreal anti-VEGF monotherapy were included in the study. Best-corrected visual acuity (BCVA) measurements obtained at diagnosis, six months, and the final visit were compared. The associations of BCVA at the final visit with baseline BCVA, BCVA at six months, symptom duration, hemorrhage extent, and central foveal thickness were also analyzed. RESULTS: Over the course of follow-up (mean, 32.1 +/- 8.5 months), an average of 5.1 +/- 2.2 anti-VEGF injections were administered. Recurrent hemorrhage was noted in 13 eyes (26.5%). The mean logarithm of the minimal angle of resolution BCVA at diagnosis, six months, and the final visit were 1.40 +/- 0.52, 0.87 +/- 0.64, and 1.03 +/- 0.83, respectively. Both baseline BCVA (p = 0.012) and BCVA at six months (p < 0.001) were significantly associated with BCVA at the final visit. CONCLUSIONS: Improved visual acuity was maintained for more than two years with intravitreal anti-VEGF monotherapy. BCVA at six months is a useful clinical index to predict long-term visual prognosis.

Short-Term Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To evaluate short-term outcomes of intavitreal dexamethasone implant in macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: A retrospective review of medical records was performed for 24 patients (24 eyes) who were diagnosed with macular edema secondary to BRVO. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured before the injection and at 1 and 3 months after the injection. The values measured before and after the treatment were compared. In addition, the association between duration of symptoms and 3-month changes in BCVA was evaluated. RESULTS: In 24 eyes, the logarithm of minimal angle of resolution BCVA before the injection and 1 and 3 months after the injection was 0.56 +/- 0.25, 0.42 +/- 0.26 and 0.45 +/- 0.27, respectively. The CFT was 550.2 +/- 116.5 microm, 270.3 +/- 101.5 microm, and 356.6 +/- 173.7 microm, respectively. When compared with the baseline values, the BCVA at 3 months was significantly improved (p = 0.018) and the CFT was significantly decreased (p < 0.001). There was a significant negative association between the duration of symptoms and 3-month changes in BCVA (p = 0.032, r = -0.375). Elevated intraocular pressure was observed in 3 eyes (12.5%). CONCLUSIONS: Intravitreal dexamethasone implant was found effective in treating macular edema secondary to BRVO. However, rebound macular edema and deterioration in visual acuity after 1 month suggest further studies with longer follow-ups are necessary.

Surgical outcomes of 2 3-gauge vitrectomy for the management of lens fragments dropped into the vitreous cavity during cataract surgery

To assess the clinical features and surgical outcomes of 23-Gauge [G] vitrectomy for lens fragments dropped into the vitreous during cataract surgery. A retrospective, non-comparative, interventional case series at a single medical center. The medical records of 45 eyes from 45 consecutive patients who were referred to our hospital for surgical retrieval of phacoemulsification dropped lens fragments and who underwent 23-G vitrectomy were retrospectively reviewed. Data pertaining to patient demographics, pre- and post-operative Snellen visual acuity, and postoperative complications were recorded. Factors associated with dropped lens fragments were also examined. Mean patient age was 68.18 +/- 11.47 years. The preoperative and postoperative mean logarithm of minimum angle of resolution [logMAR] visual acuity was 1.91 +/- 0.59 [Snellen equivalent 0.06 +/- 0.15] and 0.42 +/- 0.51 [Snellen equivalent 0.54 +/- 0.31], respectively. Forty-two eyes [93.3%] had dislocated lens fragments <50% of the total lens size. Two eyes [4.4%] had a large and hard lens nucleus, which necessitated the use of a 20-G fragmatome to efficiently and completely remove the lens material. At the final examination, 30 eyes [66.6%] had a visual acuity better than 20/40. Post-vitrectomy complications included elevated IOP for at least 3 months [n = 5 eyes, 11.1%], intraocular lens dislocation [n = 2 eyes, 4.4%], and cystoid macular edema [n = 1 eye, 2.2%]. No cases of postoperative endophthalmitis or retinal detachment were observed. A 23-G vitrectomy is safe and efficient for the surgical management of dropped lens fragments following cataract surgery

Intravitreal Anti-vascular Endothelial Growth Factor for Typical Exudative Age-related Macular Degeneration in Eyes with Good Baseline Visual Acuity

PURPOSE: To investigate 12-month treatment outcomes of anti-vascular endothelial growth factor therapy in eyes with typical exudative age-related macular degeneration with good baseline visual acuity. METHODS: This retrospective observational case series included 18 eyes (18 patients) with typical exudative age-related macular degeneration with a baseline best-corrected visual acuity of 20 / 25 or better. Patients were treated with anti-vascular endothelial growth factor monotherapy during the 12-month follow-up period. Baseline visual acuity and central foveal thickness were compared to the values at 12 months. RESULTS: Patients received an average of 4.4 +/- 1.3 intravitreal anti-vascular endothelial growth factor injections. The mean logarithm of minimum angle of resolution visual acuity was 0.08 +/- 0.04, 0.08 +/- 0.07, 0.12 +/- 0.09, and 0.16 +/- 0.11 at baseline, three months, six months, and 12 months, respectively. Visual acuity at 12 months was significantly worse than the baseline value at diagnosis (p = 0.017), and the mean central foveal thickness at the defined time points was 270.2 +/- 55.6, 204.4 +/- 25.4, 230.1 +/- 56.3, and 216.8 +/- 48.7 microm, respectively. The central foveal thickness at 12 months was significantly less than the baseline value at diagnosis (p = 0.042). CONCLUSIONS: Deterioration in visual acuity was noted in eyes with typical exudative age-related macular degeneration with good baseline visual acuity, suggesting the need for close patient monitoring and prompt treatment even in patients with good baseline visual acuity.

Characteristics and Surgical Outcome of Macular Holes Developing after Rhegmatogenous Retinal Detachment Repair

PURPOSE: To report the characteristics and surgical outcome of macular holes (MHs) that develop after rhegmatogenous retinal detachment (RRD) repair. METHODS: A retrospective chart review was performed in patients who developed a new full-thickness macular hole after RRD repair between May 2010 and July 2013. For eyes that underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for MH repair, main outcomes included macular attachment status and postoperative visual acuity. RESULTS: Fourteen full-thickness MHs were detected in a series of 2,815 eyes (0.49% prevalence) that had undergone prior RRD surgery. Ten MHs developed after primary vitrectomy and four after scleral bucking surgery. The fovea was detached in eight of the 14 eyes at the time of RRD. Fourteen of 14 eyes were managed by pars plana vitrectomy, internal limiting membrane peeling, and intravitreal gas tamponade, and 12 of 14 eyes achieved MH closure. Mean preoperative Snellen best-corrected visual acuity (BCVA) was 20/63 (+/-0.25). Nine of 14 eyes had an improvement in visual acuity of at least two Snellen lines, and five eyes remained unchanged. CONCLUSIONS: In this small retrospective study, the secondary MHs were found predominantly in foveal detachments after RRD repair, most commonly occurring after primary vitrectomy. In conclusion, the surgical outcome and postoperative visual acuity improvement were satisfactory, although the final BCVA depended on the macular status during the RRD.

Incidence of New Choroidal Neovascularization in Fellow Eyes of Patients Treated for Age-Related Macular Degeneration

PURPOSE: To investigate the development of new choroidal neovascularization in fellow eyes of patients treated for unilateral exudative age-related macular degeneration (AMD). METHODS: Three hundred fourteen patients who were first diagnosed with unilateral exudative AMD and treated with intravitreal bevacizumab or ranibizumab were studied retrospectively. RESULTS: New exudative AMD developed in 7.0% of fellow eyes after 1 year, 10.8% after 2 years and 13.7% after more than 2 years. According to the subtype of exudative AMD, there were no significant differences between classic CNV, occult or minimally classic CNV, and PCV in the incidence of new exudative AMD. After 2 years, a higher conversion rate was found in the bevacizumab-treated group than the ranibizumab-treated group. CONCLUSIONS: The cumulative incidence of involvement in fellow eyes with exudative AMD was 13.7% over 2 years.

Effect of Intravitreal Injection as a Primary Treatment in Cystoid Macular Edema after Cataract Surgery

PURPOSE: To report the clinical manifestations of intravitreal triamcinolone injection as a primary treatment method for patients with cystoid macular edema after cataract surgery. METHODS: The present retrospective study was comprised of patients diagnosed with cystoid macular edema after cataract surgery performed between March 2006 and March 2008. To treat the edema, intravitreal triamcinolone injection was administered. Best corrected visual acuity (BCVA) and central macular thickness were measured, and complications as well as efficacy of the treatment were evaluated. RESULTS: Twelve eyes were selected for the present study with a mean patient age of 67.3 years. The average period between cataract surgery and diagnosis of cystoid macular edema was 7.6 weeks. All 12 eyes received an intravitreal triamcinolone injection, and the patients were followed up for an average of 6.7 months. BCVA (log MAR) was changed from 0.29 +/- 0.12 to 0.11 +/- 0.09, showing statistically significant improvement (p = 0.000). The OCT showed that the average CMT was statistically decreased from 390.58 +/- 94.98 microm to 165.17 +/- 39.95 microm (p = 0.001). No complications were reported after the procedure, and vision and edema improved after one month in all 12 eyes. CONCLUSIONS: After performing intravitreal triamcinolone injection as a primary treatment method for cystoid macular edema which developed after cataract surgery, rapid recovery and improvement of vision and macular thickness were confirmed in all 12 eyes.

Comparison of Two Doses of IVB and Prognostic Factor on Myopic CNV : 1-Year Outcome

PURPOSE: To compare the efficacy of 3 consecutive monthly intravitreal bevacizumab (IVB) injections (fixed regimen group) with a single IVB injection (PRN group) on patients with myopic choroidal neovascularization (CNV) and to determine the prognostic factors associated with IVB injection outcomes. METHODS: 23 Twenty-three eyes in 21 patients with myopic CNV (14 eyes in the fixed regimen group and 9 eyes in the PRN group) treated with IVB were studied retrospectively. Best corrected visual acuity (BCVA), central macular thickness (CMT), the size of CNV prior to the initial IVB injection, CMT at the completion of treatment, and the number of IVB injections during the study period was measured. RESULTS: IVB resulted in improved BCVA and decreased CMT in both groups, and the differences before and after IVB injections were significantly correlated. Average injection time in the fixed regimen group and PRN group was 3.4 +/- 0.9 and 1.5 +/- 0.7 respectively, and was not statistically significant (p = 0.16). Differences between the groups in BCVA (p = 0.83) and CMT (p = 0.38) were not significantly correlated. Among the variables measured prior to IVB injection that affected final BCVA was age (p = 0.01). CONCLUSIONS: In the present study, a single injection of IVB compared to 3 consecutive IVB injections in patients with myopic CNV resulted in similar outcomes. In the future, these results can be considered as a reference when designing treatments for myopic CNV patients.

Comparison of Two Doses of IVB and Prognostic Factor on Myopic CNV : 1-Year Outcome

PURPOSE: To compare the efficacy of 3 consecutive monthly intravitreal bevacizumab (IVB) injections (fixed regimen group) with a single IVB injection (PRN group) on patients with myopic choroidal neovascularization (CNV) and to determine the prognostic factors associated with IVB injection outcomes. METHODS: 23 Twenty-three eyes in 21 patients with myopic CNV (14 eyes in the fixed regimen group and 9 eyes in the PRN group) treated with IVB were studied retrospectively. Best corrected visual acuity (BCVA), central macular thickness (CMT), the size of CNV prior to the initial IVB injection, CMT at the completion of treatment, and the number of IVB injections during the study period was measured. RESULTS: IVB resulted in improved BCVA and decreased CMT in both groups, and the differences before and after IVB injections were significantly correlated. Average injection time in the fixed regimen group and PRN group was 3.4 +/- 0.9 and 1.5 +/- 0.7 respectively, and was not statistically significant (p = 0.16). Differences between the groups in BCVA (p = 0.83) and CMT (p = 0.38) were not significantly correlated. Among the variables measured prior to IVB injection that affected final BCVA was age (p = 0.01). CONCLUSIONS: In the present study, a single injection of IVB compared to 3 consecutive IVB injections in patients with myopic CNV resulted in similar outcomes. In the future, these results can be considered as a reference when designing treatments for myopic CNV patients.

Clinical Course after Intravitreal Bevacizumab Injection in Ischemic Central Retinal Vein Obstruction

PURPOSE: To determine the clinical outcome of intravitreal bevacizumab injection in patients with ischemic central retinal vein obstruction (CRVO). METHODS: The present study was conducted retrospectively on 56 eyes of 56 patients who were diagnosed with CRVO and classified according to ischemic and non-ischemic type and underwent an intravitreal bevacizumab injection. The present study measured changes in visual acuity and central macular thickness, neovascularization in the anterior segment, development of neovascular glaucoma and other clinical complications. RESULTS: The average number of bevacizumab injections in both groups was 2.07 and 1.62 in the ischemic type. No patients developed neovascular glaucoma in the non-ischemic type group, 14 of 26 eyes in the ischemic type group developed neovascular glaucoma and the mean time to diagnosis was 28.75 weeks. log MAR visual acuity of the ischemic type group prior to injection was 1.56 +/- 0.65 on average which improved to 1.44 +/- 0.97 (p = 0.45). CONCLUSIONS: Intravitreal bevacizumab injection improves the condition of cystic macular edema clinically, but does not affect the development of neovascular glaucoma and improvement of visual acuity in ischemic type CRVO.

Primary Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection for Neovascular Age-related Macular Degeneration

PURPOSE: To investigate the efficacy of the combined treatment of photodynamic therapy (PDT) with verteporfin and intravitreal bevacizumab in patients with neovascular age-related macular degeneration. METHODS: Forty-five eyes received a single session of PDT following three intravitreal bevacizumab (1.25 mg) injections at six-week intervals (IVB+PDT group). Twenty-seven eyes received three intravitreal bevacizuamb (1.25 mg) injections only at six-week intervals (IVB group). RESULTS: After the six months of follow up, the mean BCVA (LogMAR) changed significantly from 0.62+/-0.34 to 0.56+/-0.33 in the IVB group (p=0.03) and from 0.61+/-0.33 to 0.48+/-0.21 in the IVB+PDT group (p=0.001). The mean BCVA was more improved in the IVB+PDT group (p=0.049). The mean CMT changes were significant in both groups immediately after treatment, but there was no significant difference at six months between the two groups. Ten eyes (37.0%) in the IVB group and 12 eyes (26.7%) in the IVB+PDT group required retreatments during the six months of follow-up (p=0.02). CONCLUSIONS: Significant improvement in visual acuity and reduction in central macular thickness over a six-months period were observed in both groups. The mean visual acuity was significantly better and the rate of reinjections after the initial treatment schedule was lower in the IVB+PDT group.

Incidence and Characteristics of Acute Endophthalmitis Associated With Intravitreal Injection

PURPOSE: To evaluate the incidence, causative organism, clinical features, and visual outcomes of acute endophthalmitis following intravitreal injection. METHODS: For all intravitreal triamcinolone acetonide, bevacizumab, and lucentis injections performed in our outpatient clinic between January 2006 and June 2008, the number of injections, indications, type of administered drugs, and method of injection were investigated. The medical records of the patients with acute endoththalmitis were reviewed retrospectively. RESULTS: The total number of intravitreal injections was 10,153. The incidence of acute endophthalmitis for all intravitreal injections was 0.020% (2/10,153) with 0.030% (1/3,383) for the triamcinolone acetonide, 0.015% (1/6,552) for the bevacizumab, and 0.000% (0/218) for the ranibizumab drug injections. Streptococcus species were confirmed in the bacterial culture of two eyes with acute endotphthalmitis. After early vitrectomy and intravitreal antibiotics injection, one eye maintained vision but the other eye developed phthisis. CONCLUSIONS: Although the incidence of acute endophthalmitis following intravitreal injections performed in outpatient clinics is very low, due to the potentially fatal visual outcome after endophthalmitis, careful attention to aseptic injection technique is mandatory.

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.