Influence of Axial Length on Recurrence of Wet Age-related Macular Degeneration after Initial Treatment

PURPOSE: To evaluate the influence of axial length on the recurrence of wet age-related macular degeneration (AMD) after anti-vascular endothelial growth factor therapy. METHODS: A retrospective review of the medical records for 45 eyes of 45 patients, who were diagnosed with neovascular AMD and treated with three ranibizumab injections per month, was performed. Axial length was compared between eyes with (recurrence group) and without (no recurrence group) recurrence of fluid during a 12-month follow-up period. In eyes with recurrence, the association between axial length and the time between the third injection and the first recurrence was also evaluated. RESULTS: The axial length was measured at a mean of 20.6 ± 10.1 months after the diagnosis of neovascular AMD. The mean axial length at that time was 23.33 ± 0.90 mm. The mean axial length was 23.29 ± 0.96 mm in the recurrence group (n = 30) and 23.40 ± 0.79 mm in the no-recurrence group (n = 15). There was no difference in the axial length between the two groups (p = 0.709). In the recurrence group, the period between the third injection and the first recurrence was not associated with axial length (p =0.582). CONCLUSIONS: There was no significant difference in axial length between eyes with and without recurrence after initial treatment for wet AMD. In addition, the time to first recurrence was not significantly associated with axial length. Because the present study was retrospective and the sample size was small, further prospective studies with a better design are needed to more accurately assess the influence of axial length.

The Outcomes After Indocyanine Green-assisted Peeling of the Internal Limiting Membrane in Macular Hole Surgery

PURPOSE: To investigate whether indocyanine green (ICG) staining of the internal limiting membrane (ILM) improves surgical and visual outcomes in macular hole surgery. METHODS: Three consecutive groups of patients with stage 3 and stage 4 macular hole underwent standard vitrectomy. Group I (45 eyes) underwent an adjunctive peeling of ILM stained with intravitreal application of 0.1 ml of 0.5% ICG dye, group II (23 eyes) an adjunctive ILM peeling without use of ICG dye, and group III (23 eyes) no adjunctive technique. Postoperative anatomic closure rates of the hole and the logarithm of the minimal angle of resolution (logMAR) visual acuity improvement were compared among the groups. RESULTS: The mean age was 61 years, and the mean follow-up period was 11 months. The rate of macular hole closure, as determined by optical coherence topography was 70% in group I, 61% in group II, and 61% in group III, and the difference were not statistically significant (p=0.726). The differences between preoperative and postoperative logMAR visual acuities among the three groups were not statistically significant (p=0.898). CONCLUSIONS: Intravitreal ICG-assisted ILM peeling did not improve anatomic outcomes in macular hole surgery. (Ed-confirm, something appears to be missing here)

Short Term Clinical Courses After Panretinal Photocoagulation Treatment in Diabetic Retinopathy Patients

PURPOSE: To investigate the clinical courses after panretinal photocoagulation (PRP) in diabetic retinopathy patients. METHODS: We performed a retrospective study on 138 patients, 229 eyes, who have been treated with the PRP more than a year ago from June 1996 to September 2000. RESULTS: After PRP, 30% of the patients showed decreased visual acuity. The degree of decline in visual acuity was the biggest in the patients who visited 2 weeks after the treatment (p=0.005). Thirty one percent of patients showed complete regression of neovascularization and 25% showed partial regression. Sixty seven percent (38 eyes) of the patients with no previous diabetic control showed visual loss after the treatment. There were also visual losses in 16% (15 eyes) of patients with oral hypoglycemic agents and 33% (27 eyes) with insulin therapy (Spearman correlation, r=0.221, p=0.001). In the case of low visual acuity group (or=20/40). On the other hand, 62% of the patients maintained good visual acuity and only 12% showed low visual acuity in good visual acuity group. Within one year after PRP, 44 eyes (19%) of patients developed macular edema, 51 eye (22%) of patients showed vitreous hemorrhage and 3% developed tractional retinal detachment. Ten (20%) out of 51 eyes which showed vitreous hemorrhage had the operation. CONCLUSIONS: Better visual acuity before PRP and strict diabetic control affect the good prognosis after panretinal photocoagulation.

A Case of Klebsiella Endogenous Endophthalmitis Accompanied by Necrotizing Scleral Perforation

PURPOSE: We report a case of endogenous endophthalmitis caused by Klebsiella pneumoniae, accompanied by orbital cellulitis and necrotizing scleral perforation secondary to liver abscess. METHODS: A fifty three year old woman patient who had received treatment for uveitis in local ophthalmic clinic for five days was referred to this ophthalmologic department in consultation for uncontrolled ocular pain and eyelid swelling accompanied by proptosis. Ten days before admission, she had already received antibiotic medication at internal medicine clinic for abdominal pain and fever. Since her ocular pain along with exophthalmos and eyelid swelling got worse, she received a whole body examination including blood culture, urine test, chest and abdominal radiologic examination to find out infectious focus. In addition, ultrasonography, computed tomography and aqueous culture for ophthalmic examination were performed. Then she was treated with antibiotic medication via systemic and topical route. RESULTS: The Klebsiella pneumoniae was cultured from vitreous in endogenous endophthalmitis accompanied by orbital cellulitis and necrotizing scleral perforation. Although the inflammation was improved with antibiotic medication, she lost her vision. CONCLUSIONS: From the fact that scleral perforation can be complicated by endogenous bacterial endophthalmitis, it is strongly urged that systemic work up such as radiologic examination and blood test be carried out with caution to detect infectious diseases.