Hemorrhagic Acalculous Cholecystitis in Pyogenic Spondylodiscitis Patient / 대한췌담도학회지

Hemorrhagic cholecystitis (HC) is a rare form of cholecystitis that may be caused by the progression of either calculous or acalculous cholecystitis, which has been reported sporadically as case reports. Acalculous cholecystitis is often diagnosed late and can be fulminant. HC without gallstones also can have a poor prognosis and be linked to a high mortality rate. Therefore, early detection, hemodynamic monitoring, and prompt treatment are essential to treat bleeding in cholecystitis. We report a case of hemorrhagic acalculous cholecystitis discovered during the examination and point-of-care ultrasound in a patient with pyogenic spondylodiscitis. The patient was referred with a chief complaint of liver dysfunction without bleeding tendencies or risk factors. Ultrasound revealed focal gallbladder wall irregularity, intraluminal membranes, and non-shadowing non-layering intraluminal echoes. Extravascular contrast leakage was exhibited on the computed tomography scan. The patient underwent emergency percutaneous drainage and subsequent cholecystectomy before developing major complications.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Bupivacaine-lidocaine versus Ropivacaine-lidocaine Retrobulbar Anesthesia in Vitreoretinal Surgery

Purpose@#To compare efficacies of bupivacaine-lidocaine and ropivacaine-lidocaine mixtures in terms of inducing retrobulbar anesthesia during vitrectomy. @*Methods@#Sixty patients who underwent retrobulbar anesthesia during vitrectomy were divided into two groups. Patients in group 1 received a mixture of bupivacaine and lidocaine (n = 30); patients in group 2 received a mixture of ropivacaine and lidocaine (n = 30). The effects of the two combinations were retrospectively compared and analyzed. The onset times of analgesia and akinesia were measured. Two hours after surgery, sensory blockade was assessed by touching the corneas with cotton swabs and by communicating with patients. Ocular movement was evaluated in four gaze direction quadrants. A 10-point visual analog pain scale was used to assess pain during and 2 hours after surgery. Intra- and postoperative complications were recorded. @*Results@#The mean analgesia onset times in groups 1 and 2 were 94.62 ± 28.87 and 92.32 ± 35.53 seconds, respectively (p = 0.071); the mean akinesia onset times were 147.89 ± 59.35 and 132.57 ± 76.38 seconds (p = 0.223), respectively. Patients in group 2 reported significantly less postoperative pain and exhibited less postoperative ocular movement, compared with patients in group 1 (both p = 0.002). One patient in group 1 experienced respiratory depression after retrobulbar blockade. @*Conclusions@#When retrobulbar anesthesia is required during vitrectomy, a ropivacaine-lidocaine mixture and a bupivacaine-lidocaine mixture induce anesthesia with similar rapidity. However, the ropivacaine-lidocaine mixture is safer and affords better-quality intra- and postoperative anesthesia.

Association between Vortex Vein Engorgement and Treatment Outcomes of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

Purpose@#To investigate the influence of the number of engorged vortex veins on treatment outcomes in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV) undergoing intravitreal aflibercept monotherapy. @*Methods@#The medical charts of 65 patients with PCV who underwent intravitreal aflibercept injection were reviewed retrospectively. The number of quadrants of vortex vein engorgement was evaluated in the middle phase of ultra-widefield indocyanine green angiography, which was classified as extended engorgement if the dilated choroidal vessels expanded the macula. Associations between treatment outcomes with age, subfoveal choroidal thickness (SFCT), central retinal thickness, and vortex vein engorgement were investigated using univariate and multivariate analyses. @*Results@#There were no significant differences in best-corrected visual acuity (BCVA), SFCT, and central retinal thickness at baseline and 12 months, according to the number of vortex vein engorgement. However, an increase in the number of vortex vein engorgement extending to the macula was associated with a thick SFCT (p = 0.038), a greater number of injections (p = 0.041), low BCVA at 12 months (p = 0.038), and a less dry macula at 12 months (p = 0.026). In the multivariate analysis, the number of quadrants with vortex vein engorgement extending to the macula was significantly associated with BCVA changes at 12 months, total number of injections, and a dry macula at 12 months (p = 0.030, p = 0.030, p = 0.020, respectively). @*Conclusions@#More quadrants with vortex vein engorgement extending to the macula in PCV was associated with unfavorable visual outcomes, a less dry macula at 12 months, and a greater number of injections at 1 year after intravitreal aflibercept injection. Clinicians should keep in mind that vortex vein engorgement extending to the macula may be a new biomarker in predicting treatment outcomes in PCV.

One-year Results of Aflibercept Treatment for Polypoidal Choroidal Vasculopathy with Good Visual Acuity

Purpose@#To evaluate the one-year efficacy of intravitreal aflibercept injection in polypoidal choroidal vasculopathy (PCV) with best-corrected visual acuity (BCVA) of 20 / 40 or better. @*Methods@#This was a multicenter retrospective study. The medical records of patients diagnosed with treatment-naïve PCV were retrospectively reviewed. Patients with an initial BCVA of 20 / 40 or better and who had undergone intravitreal aflibercept injection were included. Patients were treated with three consecutive monthly injections, followed by pro re nata regimen according to the clinician’s discretion at variable interval visits. The proportions of eyes for which BCVA was maintained (≤ 0.2 logarithm of the minimum angle of resolution change) or improved at 12 months were evaluated. The changes of BCVA, central subfield macular thickness (CSMT), pigment epithelial detachment, and subretinal fluid also were assessed. @*Results@#A total of 86 eyes were included. The mean number of injections for 12 months of treatment was 5.4 ± 1.7. BCVA was maintained or improved in 94.2% (81 / 86) of cases. Mean BCVA (logarithm of the minimum angle of resolution) had changed from the baseline (0.23 ± 0.09) at 3 months (0.21 ± 0.14), 6 months (0.24 ± 0.22), and 12 months (0.20 ± 0.18), but with no statistical significance. CSMT had improved significantly from the baseline (336.1 ± 97.3 μm) at 3 months (223.6 ± 47.22 μm), 6 months (239.6 ± 64.2 μm), and 12 months (223.8 ± 47.9 μm). Pigment epithelial detachment was observed in 93% of cases at the baseline, 72.1% at 3 months, and 69.8% at 12 months, showing a significant decrease at all observation points. Subretinal fluid was observed in 91.9% of cases at the baseline, 20.9% at 3 months, and 29.1% at 12 months, showing a significant decrease at all observation points. @*Conclusions@#In cases of PCV with good visual acuity, intravitreal aflibercept injections decreased CSMT and were effective in maintaining visual acuity.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017–2021)

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab

PURPOSE: To compare the efficacy of intravitreal dexamethasone implants according to previous response to bevacizumab treatment in patients with diabetic macular edema (DME).METHODS: Forty-nine eyes of 49 patients who received intravitreal dexamethasone implants for DME were reviewed retrospectively. Of these patients, 13 were treatment-naïve and 36 had previously received intravitreal injections of bevacizumab. Of the 36 previously treated patients, 24 comprised a refractory group showing no response to previous injections, and 12 comprised a responder group showing a response to previous treatments. The best-corrected visual acuity, central macular thickness (CMT), and retreatment percentages were assessed monthly for 6 months.RESULTS: After the intravitreal dexamethasone implants, visual acuity improved significantly over 6 months in the treatment-naïve group, while in the responder group, a significant improvement in visual acuity was seen at the 2-month follow-up. In the refractory group, there was no significant improvement in visual acuity during the follow-up period. The CMT showed a significant decrease in all three groups, and there was no significant difference in the CMT among the three groups at any time point. Five patients in the treatment-naive group (38.5%), 19 patients in the refractory group (79.2%), and nine patients in the responder group (75.0%) needed retreatment for recurrent macular edema, and there was a significant difference among the three groups in the rate of recurrence (p = 0.034).CONCLUSIONS: In DME patients, intravitreal dexamethasone implants were associated with a significant anatomical improvement irrespective of previous bevacizumab treatment response. However, the treatment-naïve and responder groups showed improvements in visual acuity, whereas the refractory group showed limited improvement.

Effect of Topical Bromfenac as a Treatment of Cystoid Macular Edema Following Pars Plana Vitrectomy

Purpose@#To investigate the functional and anatomical effectiveness of bromfenac sodium hydrate ophthalmic solution for the treatment of cystoid macular edema (CME) after pars plana vitrectomy (PPV). @*Methods@#A retrospective chart review of 53 patients was performed. Thirty-seven eyes received topical 0.1% bromfenac sodium hydrate ophthalmic solution (nonsteroidal anti-inflammatory drug [NSAID] group), and 16 eyes were treated with subtenon triamcinolone acetonide injection (injection group). Of the NSAID group, 27 eyes underwent PPV with cataract surgery, and 10 eyes underwent PPV without cataract surgery. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured at baseline and monthly after treatment initiation over a 6-month period. @*Results@#No significant difference in mean BCVA from baseline was found for either group over the 6-month follow-up. The injection group showed significantly greater improvement in CMT than the NSAID group at 4 months; however, there was no significant difference between the two groups at the 5-month follow-up visit. IOP was significantly higher in the injection group (p = 0.035 at 2 months), but not in the NSAID group. In the NSAID group, neither PPV group, with and without cataract surgery, showed any significant difference in mean BCVA from baseline over the 6 months of follow-up. The baseline CMT was significantly greater in the PPV with cataract surgery group than in the PPV without cataract surgery group (p = 0.023). However, at the 1-month follow-up, no significant difference in mean CMT from baseline values was observed in either group over the remaining follow-up examinations, up to 6 months. @*Conclusions@#Topical bromfenac resulted in an improvement in the BCVA and a reduction in the CMT, with a less adverse effect in the treatment of CME after PPV, regardless of whether cataract surgery was performed at the same time.

Effect of Topical Bromfenac as a Treatment of Cystoid Macular Edema Following Pars Plana Vitrectomy

Purpose@#To investigate the functional and anatomical effectiveness of bromfenac sodium hydrate ophthalmic solution for the treatment of cystoid macular edema (CME) after pars plana vitrectomy (PPV). @*Methods@#A retrospective chart review of 53 patients was performed. Thirty-seven eyes received topical 0.1% bromfenac sodium hydrate ophthalmic solution (nonsteroidal anti-inflammatory drug [NSAID] group), and 16 eyes were treated with subtenon triamcinolone acetonide injection (injection group). Of the NSAID group, 27 eyes underwent PPV with cataract surgery, and 10 eyes underwent PPV without cataract surgery. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured at baseline and monthly after treatment initiation over a 6-month period. @*Results@#No significant difference in mean BCVA from baseline was found for either group over the 6-month follow-up. The injection group showed significantly greater improvement in CMT than the NSAID group at 4 months; however, there was no significant difference between the two groups at the 5-month follow-up visit. IOP was significantly higher in the injection group (p = 0.035 at 2 months), but not in the NSAID group. In the NSAID group, neither PPV group, with and without cataract surgery, showed any significant difference in mean BCVA from baseline over the 6 months of follow-up. The baseline CMT was significantly greater in the PPV with cataract surgery group than in the PPV without cataract surgery group (p = 0.023). However, at the 1-month follow-up, no significant difference in mean CMT from baseline values was observed in either group over the remaining follow-up examinations, up to 6 months. @*Conclusions@#Topical bromfenac resulted in an improvement in the BCVA and a reduction in the CMT, with a less adverse effect in the treatment of CME after PPV, regardless of whether cataract surgery was performed at the same time.

Correlations between Macular Microvascular Alterations and Peripheral Ischemia in Patients with Branch Retinal Vein Occlusion

Purpose@#We used optical coherence tomography angiography (OCTA) to investigate the correlation between retinal microvascular alteration and peripheral retinal ischemia (evaluated with the aid of ultra-widefield fluorescein angiography [UWFA]) in patients with branch retinal vein occlusion (BRVO). @*Methods@#We retrospectively analyzed 23 eyes of 23 patients with BRVO. Vessel density (VD) and the foveal avascular zone area were measured using OCTA; UWFA was employed to measure the peripheral ischemic area and the ischemic indices (ISIs) of the entire retina and concentric retinal zones. We derived correlations between these factors. Receiver operating characteristic curves were used to predict ISI employing OCTA parameters. @*Results@#The VDs of the superficial capillary plexus (SCP) correlated with the ischemic areas of all retinal zones, and the ISIs of all zones except the far-peripheral area (FPA). The VD of the deep capillary plexus (DCP) correlated significantly with the ischemic areas and ISIs of all retinal zones except those of the FPA. On multivariate linear regression analysis, the VD was significantly correlated with the ISI; when the VDs of the SCP and DCP decreased to 24.7 and 26.1% respectively, this raised a suspicion of severe ischemic conditions with ISI > 10%. @*Conclusions@#A decrease in the BRVO VD was associated with the severity of peripheral ischemia. Our findings may aid identification of high-risk patients who require invasive fluorescein angiography.

Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation

PURPOSE: To report a case of fulminant toxoplasmic chorioretinitis following intravitreal dexamethasone implantation monotherapy in a stabilized toxoplasmic chorioretinitis patient with initial treatment. CASE SUMMARY: A 60-year-old healthy female presented with decreased visual acuity in the left eye. On fundus examination, focal chorioretinitis and yellow-white infiltration were observed. Laboratory work-up, including blood chemistry, complete blood count, and serum serology, was negative; however, toxoplasmic chorioretinitis could not be ruled out. The primary lesion improved with antibiotics and prednisolone treatment. However, the patient did not come in for her follow-up visit, as she had already received an intravitreal dexamethasone implant for recurrent vitreous inflammation elsewhere. On her return, she presented with necrotic retinitis with extensive infiltration. She underwent diagnostic vitrectomy and implant removal. A diagnosis of toxoplasma antigen was confirmed by polymerase chain reaction analysis; the lesions stabilized after anti-toxoplasmic therapy. CONCLUSIONS: Intravitreal dexamethasone implant monotherapy with stabilized toxoplasmic chorioretinitis without systemic antibiotics can lead to fulminant toxoplasmic chorioretinitis and should be used with caution.

A Comparison of Efficacies of Aflibercept and Ranibizumab, Depending on the Angiographic Classification of Polypoidal Choroidal Vasculopathy

PURPOSE: To compare the short-term efficacy of intravitreal aflibercept and ranibizumab treatment according to the subtypes of polypoidal choroidal vasculopathy (PCV) based on indocyanine green angiography (ICGA). METHODS: Fifty-five treatment naïve patients with PCV who underwent intravitreal anti-vascular endothelial growth factor (VEGF) (ranibizumab, 26 eyes; aflibercept, 29 eyes) injection were retrospectively analyzed. Based on ICGA, subjects with feeder and draining vessels were defined as type 1 PCV (33 eyes), and subjects who did not have either feeder or draining vessels, but had branch vascular networks were defined as type 2 PCV (22 eyes). The complete polyp regression was assessed at 3 months after the initial treatment using ICGA. Changes in best-corrected visual acuity (BCVA) and optical coherence tomographic parameters were evaluated at 3 and 6 months. RESULTS: Patients with type 1 PCV showed a higher complete polyp regression percentage (p = 0.034) and better visual improvement (p = 0.017) after three monthly injections compared to patients with Type 2 PCV. At 3 and 6 months, the BCVA was significantly improved in type 1 PCV patients, but not in type 2 PCV patients. In patients with type 1 PCV, the aflibercept-treated group showed a better response in anatomical outcomes (p = 0.020), and complete polyp regression percentage (p = 0.027; dry macula) than the ranibizumab-treated group, and only the aflibercept-treated group showed a significant improvement of BCVA at 3 and 6 months. In patients with type 2 PCV, there were no significant differences in visual and anatomical outcome between the anti-VEGF agents. CONCLUSIONS: Type 1 PCV showed better visual improvement with a higher percentage of polyp regression than type 2 PCV. Anatomical changes were greater in patients treated with aflibercept than with ranibizumab, particularly in patients with type 1 PCV. These results suggest that a consideration of angiographic features is important in establishing a treatment strategy for patients with PCV.

Significance of Early Visual Responses to Bevacizumab for Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To determine whether early visual acuity response to intravitreal bevacizumab in macular edema (ME) secondary to branch retinal vein occlusion (BRVO) is associated with 12-month follow-up outcome. METHODS: Sixty treatment-naïve patients (60 eyes) with ME secondary to BRVO treated with intravitreal bevacizumab (1.25 mg) were retrospectively included. Initially, all patients were injected monthly to achieve fluid resolution and followed up with a pro re nata regimen for at least 12 months. The relationship between early (month 1) and late (month 12) visual acuity response (mean change from baseline in best-corrected visual acuity [BCVA]; categorized improvement [<1, 1–3, or ≥3 logMAR lines in BCVA]) was explored. RESULTS: The proportions of eyes with <1, 1-<3, and ≥3-line improvements at 1 month were 19 eyes (31.7%), 17 eyes (28.3%), and 24 eyes (40%), respectively. Within each of the three response categories, the mean BCVA change from baseline at 12 months and onward did not vary by more than 1 line from the observed mean BCVA improvement at 1 month. Inter-cohort differences across the three response categories in mean BCVA change from baseline were statistically significant at each time point. Early BCVA response at 1 month showed significant associations with ≥3 line improvement and BCVA response at 12 months in multiple logistic and linear regression analyses. CONCLUSIONS: Early BCVA responses to bevacizumab are associated with subsequent responses over the entire 12-month duration of treatment.

Analysis of Foveal Microvascular Structures Using Optical Coherence Tomography Angiography in Age-stratified Healthy Koreans

PURPOSE: To evaluate foveal avascular zone (FAZ) microvascular structural changes in healthy Korean subjects stratified by age using optical coherence tomography angiography (OCTA). METHODS: Eighty eyes of 43 healthy volunteer subjects who had 20/20 or better best corrected visual acuity without other ocular or systemic disease except vitreous floaters and dry eye syndrome were enrolled and stratified by age group. To measure FAZ size and vascular density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), OCTA (DRI OCT Triton, Swept Source OCT, Topcon, Tokyo, Japan) scans were performed over fovea-centered 3 × 3 mm² regions, and then compared with central macular thickness (CMT) and subfoveal choroidal thickness. RESULTS: Mean age of the participants was 46.4 ± 16.1 (20–78). The SCP and DCP FAZ sizes were 0.32 ± 0.11 mm² and 0.41 ± 0.14 mm², respectively. There was a significant difference by age group (p < 0.001, p < 0.001), respectively. The FAZ VD for SCP and DCP was 28.96 ± 3.05% and 33.15 ± 3.64%, respectively. There was no difference between age groups (p = 0.118, p = 0.637). Univariate and multiple linear regression analysis showed that the FAZ size of SCP and DCP was significantly correlated with age (p = 0.039, p = 0.002) and CMT (p = 0.007, p = 0.013), respectively. The SCP and DCP FAZ size were positively correlated with age (R² = 0.279, p < 0.001, R² = 0.344, p < 0.001), and negatively correlated with CMT (R2 = 0.354, p < 0.001, R2 = 0.285, p < 0.001), respectively. CONCLUSIONS: The FAZ size of SCP and DCP increased with age and were negatively correlated with CMT. These results suggest that consideration of age and CMT is important when performing the clinical evaluation of FAZ size in healthy subjects.

One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion

PURPOSE: In the present study, 1-year outcome of intravitreal dexamethasone implant in macular edema secondary to central retinal vein occlusion (CRVO) was evaluated. METHODS: The medical records of 22 patients (22 eyes) with macular edema secondary to CRVO were reviewed retrospectively. All patients were treated with intravitreal dexamethasone implant more than twice a year and followed up at least for 1 year from the first dexamethasone implant injection. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured every 2 months after the first injection. Adverse effects, including cataract formation and elevation of IOP, were analyzed. RESULTS: The mean patient age was 64.3 ± 9.5 years and 10 patients (45.5%) were male. The average number of injections was 2.4 ± 0.6 and the interval between the first and second injection was 22.0 ± 6.4 weeks. The mean BCVA (log MAR) was 0.82 ± 0.50 and 0.72 ± 0.62 at baseline and after 1 year, respectively. Vision was significantly improved for 8 months after the first injection (p < 0.05). However, vision was not different from baseline after 1 year. The CMT was significantly decreased compared to baseline (p < 0.001). Subgroup analysis revealed that BCVA was improved and CMT decreased significantly when intravitreal dexamethasone concentration was presumed sufficient. Moreover, CMT decreased significantly in hypertensive and ischemic groups compared with normotensive and non-ischemic groups, respectively (p < 0.001). Elevated IOP was observed in 6 eyes (27.3%), but all 6 eyes became normal after topical agent was applied. Cataract formation was observed in 3 eyes (13.6%). CONCLUSIONS: Intravitreal dexamethasone implant resulted in visual acuity stabilization and macular edema reduction in patients having macular edema secondary to CRVO without significant adverse events.

Intravitreal Dexamethasone Implant for Macular Edema in Branch Retinal Vein Occlusion According to Previous Responses to Bevacizumab

PURPOSE: To compare the efficacy of intravitreal dexamethasone implant according to previous responses to Bevacizumab treatment in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Sixty eyes of 60 patients who received an intravitreal dexamethasone implant for ME secondary to BRVO and followed up for at least 6 months were retrospectively reviewed. Of these, 31 patients were treatment naïve and 29 patients had previously received intravitreal injection of anti-vascular endothelial growth factor (VEGF). Out of these previously-treated patients, 17 patients were categorized as a refractory group who did not respond to previous injection and 12 patients were categorized as a responder group who showed recurrent ME despite a good response to previous anti-VEGF treatment. The best corrected visual acuity (BCVA), central macular thickness (CMT) and recurrence of ME were assessed monthly for 6 months. RESULTS: At each 3-month follow-up, the BCVA improved significantly from baseline in the naïve group, while the refractory group and the responder group showed significant improvement for only 2 months. At each 3-month follow-up, the CMT showed significant decreases in every group. However, the mean change in CMT from baseline showed significant differences between the 3 groups at month 3 (p < 0.001). During follow-up, 18 eyes in the naïve group (58.1%), 16 eyes in the refractory group (94.1%), and 6 eyes in the responder group (50.0%) received retreatment for the recurrence of ME, and there was a significant difference in the retreatment rate between the three groups (p = 0.016). CONCLUSIONS: Intravitreal dexamethasone implant showed early good functional and anatomical improvements irrespective of the response to the previous treatment in patients with ME secondary to BRVO. However, when treating the refractory group, more careful observation and intensive retreatment are required, considering the short duration of its efficacy.

Analysis of Efficacy of Intravitreal Aflibercept According to Subfoveal Choroidal Thickness in Polypoidal Choroidal Vasculopathy

PURPOSE: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch's membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes. RESULTS: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 µm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 µm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 µm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively). CONCLUSIONS: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.

Surgical Outcomes of Transconjunctival 25-Gauge Plus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

PURPOSE: To evaluate anatomical and visual results of transconjunctival 25-gauge plus pars plana vitrectomy (PPV) in the management of primary rhegmatogenous retinal detachment (RRD). METHODS: A retrospective analysis of 46 eyes of 46 patients who underwent transconjunctival 25-gauge plus PPV for primary RRD repair between January 2013 and May 2013 with a minimum of 3-month follow-up was performed. Data collected for the study included patient demographics, lens status, preoperative visual acuity, macular status, and location and number of primary breaks. Main outcome measures were anatomical reattachment rate, postoperative visual acuity, operation time, and postoperative complications. RESULTS: The study included 30 men and 16 women. The mean age of the patients was 54.3 years. The locations of retinal breaks were 24 (52.2%) eyes in the superior half, 15 (32.6%) eyes in the inferior half, and 7 (15.2%) eyes on both sides. The macula-on RRD was present preoperatively in 21 (45.7%) of 46 eyes. Of the 33 (71.7%) phakic eyes, 18 (39.1%) underwent combined phacoemulsification, intraocular lens implantation, and PPV. Two different tamponades, C3F8 gas and silicone oil were used in this study. C3F8 gas was injected in the 33 (71.7%) eyes, and the remaining eyes were filled with silicone oil (1,300 centistokes for 11 eyes, 5,700 centistokes for 2 eyes). Mean operation time was 48.8 +/- 13.2 minutes. Retinal reattachment was achieved in 45 (97.8%) of 46 eyes at 3 months. Mean best-corrected visual acuity improved from 1.33 +/- 1.20 log MAR preoperatively to 0.68 +/- 0.94 log MAR postoperatively (p < 0.001). Postoperative complications included transient intraocular pressure elevation in 6 (13.1%) eyes and posterior capsular opacity in 3 (6.5%) eyes. CONCLUSIONS: It seems that transconjunctival 25-gauge plus PPV can be a safe and effective option for surgical management of RRD.

Silicone Oil with Short-Term Prone Position in Macular Hole Retinal Detachment Surgery in High Myopia

PURPOSE: To evaluate the result of vitrectomy with internal limiting membrane peeling and silicone oil tamponade with short term face-down positioning in highly myopic patients with retinal detachment due to macular hole. METHODS: Eleven eyes of highly myopic patients with retinal detachment caused by macular hole were retrospectively reviewed. All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and silicone oil tamponade with short term (1-3 days) face-down positioning. Silicone oil was removed between 6 and 12 months postoperatively. Outcomes included best-corrected visual acuity, retinal reattachment rate, macular hole closure, and complications. RESULTS: The mean age of patients was 63.3 +/- 8.3 years. During the silicone oil period, all 11 eyes (100%) had complete retinal attachment. After silicone oil removal, retinal detachment recurred in 2 eyes (18.2%). Macular hole closure was observed in 8 eyes (72.7%). The best corrected visual acuity (log MAR) improved from 1.99 +/- 0.94 before surgery to 1.33 +/- 0.62 at final visit. CONCLUSIONS: Pars plana vitrectomy, internal limiting membrane peeling and silicone oil tamponade with short term face-down positioning was effective in treating retinal detachment caused by macular hole in highly myopic eyes.

Three Cases of Focal Choroidal Excavation in the Macula Detected by Spectral-Domain Optical Coherence Tomography

PURPOSE: To report the clinical finding of 3 patients with focal choroidal excavation in the macula detected by spectral-domain optical coherence tomography (SD-OCT). CASE SUMMARY: Five eyes of 3 patients with focal choroidal excavation detected by SD-OCT were enrolled in the present study. All patients had myopia (average refractive power -5.60 diopter). Two of the 3 patients had focal choroidal excavation in both eyes. All 5 eyes revealed foveal pigmentary changes on fundus examination. The excavation area in the autofluorescence image was hypofluorescent. Fluorescein angiographic finding was normal to various degrees of hyperfluoresence. Indocyanine green angiography revealed hypofluoresence at the excavation area. The excavation involoved from the retinal pigment epithelium layer to the external limiting membrane or outer nuclear layer and average choroidal thickness at excavation were statistically thinner than the uninvolved area based on SD-OCT (p = 0.002). Retinoschisis, serous pigment epithelial detachment and choroidal neovascularziation (CNV) were detected individually in 3 eyes. The other 2 eyes had no specific abnormalities. CONCLUSIONS: During the follow-up period, the choroidal excavation remained relatively stable in 4 of 5 eyes, but CNV developed in 1 eye. Therefore, intravitreal bevacizumab injection was performed. Longer follow-up periods are necessary to determine the etiology, clinical course and visual prognosis of eyes with focal choroidal excavation.