A Comparison between Intravitreal Bevacizumab Injection and Placement of a Dexamethasone Implant to Treat Retinal Vein Occlusion Macular Edema

Purpose@#We evaluated the macular, functional and structural features of patients with retinal vein occlusion and macular edema. We measured the best-corrected visual acuity (BCVA), central foveal thickness, and the area of the foveal avascular zone area after intravitreal bevacizumab (IVB) treatment and placement of a dexamethasone implant (IVD). @*Methods@#We retrospectively reviewed 36 eyes of 36 patients with retinal vein occlusion and macular edema who underwent IVB treatment (20 eyes) and IVD placement (16 eyes). The parameters mentioned above were compared between the two treatment groups and the normal contralateral eyes after initial stabilization and 1 year later. @*Results@#The BCVA was significantly higher in the IVB than the IVD group after initial stabilization and 1 year later. The intraocular pressure was lower at initial stabilization in the IVB than the IVD group, but no difference was apparent after 1 year. There was no significant between-group difference in the central foveal thickness at any time, but the IVD group required fewer injections during initial stabilization than the IVB group. In terms of the foveal avascular zone area, both the superficial and deep layers of the IVB group increased significantly during the initial stabilization period and then decreased to 1 year; no changes were seen in the IVD group. @*Conclusions@#IVD treatment is associated with fewer injections than IVB treatment and a more stable retinal vasculature, but visual acuity may possibly decrease (because of cataract formation). Although IVB treatment improves visual acuity and reduces macular edema, this may be associated with an increased risk of macular ischemia given the need for repeated injections.

Analysis of the Changes in Retinal Thickness in Eyes Undergoing Vitrectomy with Silicone Oil Tamponade

Purpose@#To investigate changes in the retinal layer thickness in rhegmatogenous retinal detachment (RRD) and intraocular foreign body (IOFB) patients undergoing successful pars plana vitrectomy (PPV) with silicone oil tamponade. @*Methods@#This retrospective study included 28 eyes of 28 patients (RRD: 24 patients; IOFB: 4 patients) that were successfully repaired with PPV with silicone oil tamponade. The thickness measurements of the total retina, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GC-IPL) were performed with swept-source optical coherence tomography in nine Early Treatment Diabetic Retinopathy Study subfields, using the wide three-dimensional mode before and after silicone oil tamponade removal. The measurements were compared and differences were analyzed with respect to normal fellow eyes. @*Results@#The RNFL and GC-IPL thickness measurements decreased remarkably as the silicone oil tamponade period progressed, compared with the thickness of the total retinal layer. The average thicknesses of the total retina, RNFL, and GC-IPL were significantly greater in eyes in which the silicone oil had been removed than in those in which the silicone oil remained. @*Conclusions@#Silicone oil tamponade can change the thickness of the retina layer. The longer the silicone oil is tamponaded, the more significant the reduction in thickness of the inner retinal layer.

Analysis of the Changes in Retinal Thickness in Eyes Undergoing Vitrectomy with Silicone Oil Tamponade

Purpose@#To investigate changes in the retinal layer thickness in rhegmatogenous retinal detachment (RRD) and intraocular foreign body (IOFB) patients undergoing successful pars plana vitrectomy (PPV) with silicone oil tamponade. @*Methods@#This retrospective study included 28 eyes of 28 patients (RRD: 24 patients; IOFB: 4 patients) that were successfully repaired with PPV with silicone oil tamponade. The thickness measurements of the total retina, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GC-IPL) were performed with swept-source optical coherence tomography in nine Early Treatment Diabetic Retinopathy Study subfields, using the wide three-dimensional mode before and after silicone oil tamponade removal. The measurements were compared and differences were analyzed with respect to normal fellow eyes. @*Results@#The RNFL and GC-IPL thickness measurements decreased remarkably as the silicone oil tamponade period progressed, compared with the thickness of the total retinal layer. The average thicknesses of the total retina, RNFL, and GC-IPL were significantly greater in eyes in which the silicone oil had been removed than in those in which the silicone oil remained. @*Conclusions@#Silicone oil tamponade can change the thickness of the retina layer. The longer the silicone oil is tamponaded, the more significant the reduction in thickness of the inner retinal layer.

A Case of Spontaneous Recovery of an Iris Cyst in a Patient with Peritoneal Tuberculosis

PURPOSE: We report a case of spontaneous recovery of an iris cyst with only tuberculosis medication and conservative eye drops when uveitis and angle closure occurred because of a cyst in a patient with peritoneal tuberculosis. CASE SUMMARY: A 49-year-old female who was diagnosed with iritis and treated with steroid eye drops visited our clinic because of decreased visual acuity 1 month prior. There were anterior chamber inflammation cells and an iris cyst completely obstructing the anterior chamber at 12 o'clock. At the time, the patient had been diagnosed with peritoneal tuberculosis in the Department of Internal Medicine and Gynecology and had been treated with surgery and medication. The patient had no past history of glaucoma, but when the iris cyst developed, the intraocular pressure increased to 29 mmHg and anterior inflammatory cells were seen in the range of +1 to +2. The primary lesion of tuberculosis improved and the iris cyst disappeared with treatments involving medication for tuberculosis, steroid eye drops, and glaucoma eye drops, without invasive treatments such as alcohol curettage, laser treatment, or cyst resection. CONCLUSIONS: If an iris cyst is a new lesion of the eye, it is necessary to identify the pattern and cause of the iris cyst first, and if a secondary benign iris cyst is suspected, the primary treatment of the causative disease is necessary rather than prompt invasive treatment.

A Case of Central Serous Chorioretinopathy after Tadalafil Treatment

PURPOSE: To describe a patient who presented with central serous chorioretinopathy after 2 months of tadalafil administration without any other underlying disease or medication. CASE SUMMARY: A 49-year-old male patient was transferred from a local clinic with metamorphopsia and decreased visual acuity in the right eye. His visual acuity was 6/20 in the right eye and 18/20 in the left eye. The fundus examination showed a large serous detachment between the superior and inferior blood vessel arcades in the right retina. In his medical history, he used tadalafil three times a week for 2 months. His medication was then stopped, and a follow-up examination was scheduled. After 2 months, a fundus examination showed resolution of the subretinal fluid, and his corrected visual acuity recovered to 20/20. CONCLUSIONS: Tadalafil (Cialis®) is a phosphodiesterase (PDE)-5 inhibitor and predominantly prescribed for the treatment of erectile dysfunction. PDE–5 inhibitors may be potent vasodilators in the retina and choroid, and may induce choroidal vessel engorgement leading to leakage across the retinal pigment epithelium and accumulation of subretinal fluid in selected patients. When making a diagnosis as central serous chorioretinopathy, the physician should confirm the causative drugs that are easy to miss, by performing a thorough review of the patient's medical history and promptly terminating the causative drugs.

Efficacy of Optical Coherence Tomography Angiography in Measuring the Foveal Avascular Zone Area in Patients with Branch Retinal Vein Occlusion

PURPOSE: To evaluate the efficacy of optical coherence tomography angiography (OCTA) by measuring the foveal avascular zone (FAZ) area in patients with branch retinal vein occlusion (BRVO). METHODS: Thirty four eyes of 34 patients with BRVO were retrospectively reviewed. The area of the FAZ was calculated using fluorescein angiography (FAG) and OCTA. The FAZ area was divided into two groups according to the presence of macular edema, which was determined based on the central foveal thickness (300 µm), and then the measured areas were compared. RESULTS: Pearson's correlation analysis revealed a significant positive correlation between FAG and the superficial capillary plexus (SCP) in OCTA with or without macular edema (r = 0.845, p = 0.001). However, there was not a significant correlation between FAG and the deep capillary plexus (DCP) in OCTA (r = 0.001, p = 0.996). In addition, the FAZ area measured by FAG and OCTA in the SCP showed a significant agreement between the two methods (intraclass correlation coefficient [ICC] = 0.916, p = 0.001). However, there was no significant relation found for the FAZ area between FAG and OCTA in the DCP (ICC = 0.001, p = 0.501). CONCLUSIONS: In the patients with BRVO, OCTA can be used to measure the FAZ areas in both the SCP and DCP, beyond measurement of the FAZ area at the two-dimensional cross section used during FAG. The FAZ area in the SCP via OCTA showed a statistically significant correlation with the FAZ area determined by FAG, but there was no such correlation in the DCP. That said, the FAZ area in the DCP was positively correlated with a decrease in visual acuity among the patients, which may be an indicator of visual prognosis.

Pattern Laser Trabeculoplasty Intraocular Pressure Reduction Efficacy in Open-Angle Glaucoma Patients on Medical Therapy

PURPOSE: To assess the effectiveness and safety of Pattern Laser Trabeculoplasty (PLT) in patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). METHODS: Twenty-six eyes in patients with POAG and 14 eyes in patients with NTG were targeted in this study. The intraocular pressure (IOP) for each patient needed to be reduced within proper ranges. The clinical outcome was assessed by IOP at 1 week, 1 month, 3 months, 6 months and 9 months after PLT. RESULTS: The mean (+/- standard deviation) IOP in the POAG group was 20.7 +/- 4.1 mm Hg before treatment. After PLT, the IOPs in POAG group were 16.4 +/- 3.1 mm Hg, 16.9 +/- 3.8 mm Hg, and 16.5 +/- 5.2 mm Hg at 1, 6 and 9 months, respectively, and the pressure remained stabled over 9 months of post-procedural follow-up. However, no statistical difference in IOP reduction was observed in the NTG group before and after treatment. CONCLUSIONS: PLT provides a possibility to decrease additional medical therapy in patients with POAG. In addition, PLT can be considered as an auxiliary therapy for POAG patients who tolerate maximal medical therapy prior to undergoing surgical treatment.

The Analysis of the Clinical Findings and Effects of Biodegradable Collagen Matrix in Trabeculectomy

PURPOSE: To observe the effects of biodegradable collagen matrix (OculusGen(TM)) on filtering bleb formation and maintenance and to investigate its clinical effects and usefulness in trabeculectomy. METHODS: Ophthalmologic examinations were preformed 1 day, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months postoperatively in the case and control groups. The clinical findings of the filtering bleb were observed, and the clinical effects measured by mean intraocular pressure and complications were evaluated in both groups. RESULTS: The success rates were 76% in the case group and 88% in the control group, and there were no significant differences between the case and control groups. In the case group, postoperative conjunctival injection persisted for more than 1 month with increasing severity, while ultrasound biomicroscopy revealed increased echogenicity of the subconjuctival and tenon tissue with no definite space-occupying effect. CONCLUSIONS: Trabeculectomy utilizing collagen matrix showed similar clinical results compared to the current traditional trabeculectomy; slit-lamp and ultrasound biomicroscopy findings did not reveal any advantageous changes to filtering bleb function.