Short-term Efficacy and Safety of Ranibizumab for Neovascular Age-related Macular Degeneration in the Real World: A Post-marketing Surveillance Study

PURPOSE: To investigate the short-term efficacy and safety of ranibizumab in the routine clinical setting in patients with neovascular age-related macular degeneration and to analyze the associated factors for visual outcome. METHODS: This was a post-hoc analysis of a ranibizumab regulatory post-marketing surveillance study in which 4,136 patients were enrolled and followed for 12 weeks. Change in best-corrected visual acuity (BCVA), size of choroidal neovascularization, and the presence of hemorrhage and exudate were analyzed and the association between BCVA change and baseline characteristics were investigated. Data on ocular and systemic adverse events were collected. RESULTS: Mean BCVA improved significantly and mean BCVA change was the logarithm of the minimal angle of resolution 0.13 ± 0.01 (p < 0.001). A lower baseline BCVA and younger age were significant predictive factors for visual improvement or maintenance (≥0 lines). For greater visual acuity gain (≥3 lines), no treatment history, lower baseline BCVA, younger age, and classic-type choroidal neovascularization were significant predictive factors. No new safety signals were found. CONCLUSIONS: In this study, conducted in real-world clinical practice with a large number of neovascular age-related macular degeneration patients, visual and anatomical outcomes improved significantly after three monthly ranibizumab treatments. Treatment-naive patients had a higher chance of greater visual gain (≥3 lines) than non-naive patients.

Delayed Absorption of Subretinal Fluid after Retinal Reattachment Surgery and Associated Choroidal Features

PURPOSE: The aim of this study was to investigate the incidence and associated clinical factors of delayed absorption of subretinal fluid (SRF) after surgery for rhegmatogenous retinal detachment. METHODS: This study involved 36 eyes of 36 consecutive patients who underwent successful surgery for rhegmatogenous retinal detachment. A complete ophthalmologic evaluation, including clinical fundus examination, optical coherence tomography, and indocyanine green angiography, was conducted before and after surgery. Delayed absorption was defined as the presence of residual concave SRF or an SRF bleb at 6 months after surgery. Clinical factors and choroidal features on indocyanine green angiography were compared according to the presence and absence of delayed absorption. RESULTS: Eighteen of 36 eyes (50%) showed delayed absorption. Macular involvement and worse preoperative visual acuity were significantly related to the presence of delayed absorption (p = 0.001 and p = 0.034, respectively). On indocyanine green angiography, preoperative choroidal vascular hyperpermeability was noted in 70% of eyes with delayed absorption and in 14% of eyes without it (p = 0.010). CONCLUSIONS: Delayed absorption of SRF after retinal reattachment surgery was not rare, with a 50% of incidence in this study. Macula-off status was significantly related to the incidence of delayed SRF absorption, and choroidal features such as choroidal vascular hyperpermeability might be responsible in part, possibly through the resultant exudative property of choroid.

Change in Subfoveal Choroidal Thickness after Argon Laser Panretinal Photocoagulation / 이화의대지

OBJECTIVES: To evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy. METHODS: This prospective, comparative case series included 21 patients (28 eyes) with severe diabetic retinopathy. All patients underwent three sessions of PRP. The SFCT and macular thickness were measured using EDI-OCT at baseline and one week after completion of 3 sessions of PRP. RESULTS: SFCT before PRP was 318.1±96.5 µm and increased to 349.9±108.3 µm; P=0.001 after PRP. Macular thickness significantly increased at one week after PRP from 273.1±23.9 µm at baseline 295.8±25.3 µm at one week; (P<0.001). No significant relationship between the changes in macular thickness and SFCT was observed (r=−0.13, P=0.52). CONCLUSION: PRP induced increases in both SFCT and macular thickness. Changes in SFCT did not correlate with changes in macular thickness.

Anterior Diabetic Retinopathy Studied by Ultra-widefield Angiography

PURPOSE: To evaluate the prevalence of anterior type diabetic retinopathy (DR) using ultra-widefield fluorescein angiography and to identify the factors associated with anterior type DR incidence. METHODS: A retrospective case review was used in this study. Patients with non-proliferative diabetic retinopathy (NPDR) underwent examination by ultra-widefield fluorescein angiography, and were classified into anterior, posterior, or diffuse DR groups. Anterior DR was defined if diabetic retinal changes were noted only at the location anterior to the imaginary circle bordered by the Early Treatment Diabetic Retinopathy Study seven-standard fields. Correlations between demographic data, as well as systemic and ocular factors, and the incidence of NPDR types were evaluated. RESULTS: Among the 234 eyes of 234 patients with NPDR, 25 eyes (10.7%) demonstrated anterior DR. Anterior DR was observed in 10 eyes (30.3%) of patients having mild NPDR, three eyes (4.8%) of moderate NPDR patients, and in 12 eyes (7.1%) of severe NPDR patients (p < 0.001). The incidence of anterior DR positively correlated with lower hemoglobin A1c levels and with greater high-density lipoprotein levels following multiple logistic regression analysis (p < 0.001). The mean hemoglobin A1c level was 7.03 ± 0.99% in anterior DR, 7.99 ± 1.74% in posterior DR, and 7.94 ± 1.39% in diffuse DR patients (p = 0.003). The mean high-density lipoprotein level was 51.2 ± 12.5 mg/dL in anterior, 49.7 ± 15.2 mg/dL in posterior, and 45.2 ± 13.1 mg/dL in diffuse DR patients (p = 0.010). CONCLUSIONS: Diabetic retinal changes confined to an anterior location were more frequently noted in earlier stages of NPDR. The incidence of DR sparing posterior retinal involvement was related to favorable blood sugar and lipid profiles.

A Case of Sympathetic Ophthalmia after 23-Gauge Transconjunctival Sutureless Vitrectomy

No abstract available.

A Case of Sympathetic Ophthalmia after 23-Gauge Transconjunctival Sutureless Vitrectomy

No abstract available.

Changing Trends in Surgery for Retinal Detachment in Korea

PURPOSE: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013. METHODS: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001. RESULTS: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001). CONCLUSIONS: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.

Herpes Zoster Ophthalmicus in Patients Younger than 50 Years Versus 50 Years and Older

PURPOSE: To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients under 50 years of age versus patients 50 years of age or older at the time of diagnosis. METHODS: A retrospective chart review was performed of 102 patients who were diagnosed with HZO between January 1, 2008 and December 31, 2010. Baseline demographics and clinical characteristics between patients with an onset of HZO under the age of 50 years and patients with an onset of HZO at the age of 50 years or older were compared. RESULTS: Similar numbers of patients were affected with HZO in the younger and older age groups (n = 44, 43.1%, vs. n = 58, 56.9%). The mean +/- SD of age was 50.6 +/- 21.8 years (range, 3-89 years) and the most common decade of HZO onset was between 50 and 59 years. Gender and disease laterality were not statistically different between the 2 groups. No significant difference was found regarding the presence of any ocular manifestation between the groups; however, anterior uveitis was more frequent in the younger patients (p = 0.04). The number of patients with immunosuppressive therapy was higher in the younger age group (p = 0.01). CONCLUSIONS: HZO-affected patients under the age of 50 years and older than 50 years were equally distributed, with the most common decade of onset between the age of 50 and 59 years. Younger patients had a higher incidence of anterior uveitis and immunosuppressive therapy due to underlying systemic diseases.

Reproducibility of Ocular Response Analyzer and Comparison with Goldmann Applanation Tonometer and Non-Contact Tonometer

PURPOSE: To evaluate the inter- and intra-observer variability of ocular response analyzer (ORA) measurements, and to evaluate the relationships among the intraocular pressures (IOPs) obtained by ORA, Goldmann applanation tonometer (GAT) and non-contact tonometer (NCT). METHODS: The present study included 45 normal eyes from 45 volunteers. Three masked observers performed ORA measurements. NCT and GAT measurements were performed by one independent observer. The reproducibility of ORA was assessed by ANOVA-based intraclass correlation coefficient (ICC) and coefficient of variation (CV). Comparison among the tonometers was performed using the Bland-Altman plot and paired t-test. RESULTS: The ICC for inter-observer reproducibility of ORA parameters was 0.90 to 0.97. The corresponding CV values were 13.2% to 19.1%. The intra-observer ICC values for IOP cc were 0.78 to 0.88. CV was 11.2% to 16.8%. For CRF, ICC values were 0.80 to 0.84 with CV values as 11.6% to 15.9%. For CH, ICC values were 0.74 to 0.82 and CV values were 13.0% to 15.9%. The difference in mean IOP values between IOP cc and IOP g was statistically significant (p = 0.04). However, no difference was found among other tonometers, and only IOP cc did not result in significant correlation with central corneal thickness (CCT) (p = 0.38). CONCLUSIONS: The intra- and inter-observer reproducibility was substantial for IOP cc, IOP g, CH and CRF, for all observers. Additionally, IOP measured with ORA did not result in significant differences from GAT and NCT.

Reduction of Influenza A (H1N1) Virus Through a Leukoreduction Filter / 대한수혈학회지

BACKGROUND: Leukoreduction can reduce the risk of HLA alloimmunization, recurrent febrile nonhemolytic transfusion reactions, and several transfusion-transmitted infectious diseases, including cytomegalovirus infection. Transmission of the new influenza A (H1N1) virus through transfusion may be a concern. We evaluated the effect of filtration with a leukoreduction filter on H1N1 genomes. METHODS: To evaluate the effect of filtration by a leukoreduction filter on H1N1 genomes, we analyzed pre- and post-filtered samples from nasopharyngeal swabs and 10 positive plasma samples using real time RT-PCR. RESULTS: The 10 samples (nasopharyngeal swabs and plasma) contained H1N1 RNA, and filtration with a leukoreduction filter reduced these levels (threshold cycle values from 31.42+/-2.06 to 38.84+/-1.47 in nasopharyngeal swabs, from 35.63+/-2.19 to 39.38+/-2.65 in plasma samples). CONCLUSION: Filtration with a leukoreduction filter can reduce H1N1 genome levels, but may not be completely sufficient for total eradication of this pathogen.