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Purpose@#The aim of this study was to evaluate the risk factors associated with glaucoma or ocular hypertension (OHT) in patients taking oral corticosteroids for extended periods, and to aid in managing intraocular pressure (IOP) in patients with these risk factors. @*Methods@#A cross-sectional study was performed involving 690 patients who visited a tertiary referral hospital and had been using oral corticosteroids for more than six months. Patients' demographics, tonometry results, drug type, dosage, duration, ophthalmic history, and the use of glaucoma eye drops were analyzed to determine the risk factors associated with glaucoma or OHT. @*Results@#In a generalized linear model analysis comparing patients' eyes diagnosed with glaucoma or ocular hypertension to those without such diagnoses, no statistical difference was observed between the two groups in terms of drug type, age, and duration of oral corticosteroid use. However, the dosage was found to be statistically significant (odds ratio 1.09, p = 0.0294). @*Conclusions@#No difference in the incidence of glaucoma or OHT was found based on the type of oral steroid, age, or duration of use. However, a higher incidence of glaucoma and OHT was observed among patients taking higher doses of oral steroids. Therefore, it is suggested that using lower doses of oral steroids may be more beneficial for managing IOP.
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Purpose@#To report a case of metastatic breast cancer to the optic nerve with a favorable response to an increased dose of intravitreal bevacizumab injection.Case summary: A 60-year-old female presented to our clinic with blurred vision in her left eye for 3 weeks. The patient had a history of intraductal breast cancer carcinoma, metastasized to the mediastinum lymph nodes, liver, and bone and had received palliative chemotherapy and radiotherapy for 16 months. At her first presentation, best-corrected visual acuity of the left eye was 20/50 and the intraocular pressure was 11 mmHg. A yellowish elevated mass with hemorrhage at the optic disc with peripapillary swelling was observed in the left eye. Fluid at the subperipapillary and subfoveal areas and choroidal thickening with folds were observed with optic coherence tomography. The patient was diagnosed as having breast cancer metastasis to the optic nerve head. Three monthly intravitreal bevacizumab injections (0.05 mL, 1.25 mg) were administered, but showed limited effect. Two more intravitreal bevacizumab injections having twice the concentration of the previous dose (0.1 mL, 2.50 mg) were given. Tumor infiltration of the optic nerve head decreased, and serous retinal detachment subsided. No malignant cancer cells were detected in the anterior chamber. @*Conclusions@#We report a rare case of breast cancer metastasis to the optic nerve. Administering intravitreal bevacizumab injections with twice the dosage concentration could be an alternative treatment option, to alleviate exudative retinal detachment associated with metastatic tumor progression to the optic nerve head.
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We sought to analyze the efficacy of adalimumab in active noninfectious uveitis, and evaluate its efficacy and safety for the management of refractory noninfectious uveitis in Korean patients. A retrospective observational study was conducted. A total of 23 eyes of 14 Korean patients with noninfectious uveitis refractory to conventional treatment, including corticosteroid and immunosuppressive agents, were treated with adalimumab between December 2017 and February 2020. The primary outcomes were vitreous haziness grades, anterior chamber cell grades, and central macular thickness measured prior to injection and at 1, 3, 6, and 12 months after the first adalimumab injection. Among the 23 eyes, 14 eyes (60.9%) were diagnosed with panuveitis and 9 eyes (39.1%) with posterior uveitis [mean follow-up period: 22.3 months (7–27)]. The most common etiologic diagnoses requiring adalimumab injection were Behçet's disease (9 eyes, 39.1%), followed by undifferentiated inflammation (6 eyes, 26.1%), Vogt-Koyanagi-Harada disease (3 eyes, 13.0%), psoriasis (2 eyes, 8.7%), serpiginous chorioretinopathy (2 eyes, 8.7%), and systemic lupus erythematosus (1 eye, 4.3%). At the 1-year follow-up after the first injection, anterior chamber cell grade decreased from 0.5±0.4 to 0.3±0.4, and vitreous haziness grade decreased from 1.1±1.1 to 0.3±0.5 (p<0.05). Central macular thickness improved from 347.2±98.1 µm to 264.3±61.1 µm (p<0.05). Adalimumab injection in patients with refractory noninfectious uveitis decreased the anterior chamber cell grade, vitreous haziness grade, and central macular thickness with no severe side effect. Overall, adalimumab injection may, therefore, be an effective and relatively safe treatment modality for noninfectious uveitis in Korean patients.