Natural Short-term Course of Recurrent Macular Edema Following Intravitreal Bevacizumab Therapy in Branch Retinal Vein Occlusion

PURPOSE: To evaluate the 3-month natural course of recurrent macular edema secondary to branch retinal vein occlusion (BRVO) treated with intravitreal bevacizumab. METHODS: This retrospective, observational study included 36 eyes with macular edema secondary to BRVO. All patients were initially treated with intravitreal bevacizumab for macular edema. Recurrence of macular edema was either not treated (untreated group) or treated with a single intravitreal bevacizumab injection (treated group). Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared at the time of recurrence and 3 months later. RESULTS: At the time of recurrence, the mean CFT and logarithm of the minimum angle of resolution BCVA were 484.9 ± 124.1 µm and 0.58 ± 0.26 in the untreated group (n = 19) and 456.3 ± 126.8 µm and 0.51 ± 0.21 in the treated group (n = 17), respectively. Three months later, the mean CFT and BCVA had changed to 493.7 ± 123.9 µm and 0.62 ± 0.29 in the untreated group and 294.7 ± 104.4 µm and 0.40 ± 0.24 in the treated group, respectively. The differences in CFT and BCVA between the two time points were not significant in the untreated group (p = 0.106 and p = 0.687, respectively), whereas statistically significant differences were noted in the treated group (p = 0.002 and p < 0.001, respectively). CONCLUSIONS: Unlike the first episode of macular edema following BRVO, recurrent macular edema following intravitreal bevacizumab therapy did not spontaneously resolve, suggesting the potential benefit of prompt treatment.

A Case of Staphylococcus lugdunensis Endophthalmitis after Cataract Surgery

PURPOSE: To report a case of Staphylococcus lugdunensis endophthalmitis following cataract extraction and intraocular lens implantation. CASE SUMMARY: A 59-year-old woman presented with unilateral vision impairment and eyeball pain in her left eye, thirteen days after phacoemulsification and posterior chamber intraocular lens implantation. Best-corrected visual acuity of her left eye was 20/200. Slit lamp examination of her left eye revealed a severe conjunctival injection, severe chamber reactions with exudative membranes, hypopyon (about 1 mm) in the anterior chamber, and the fundus was not visible. Before the patient was admitted to the hospital, we cultured samples of aqueous fluid and performed an intravitreal antibiotics injection (vancomycin 1.0 mg/0.1 mL, ceftazidime 2.0 mg/0.1 mL). However, on the next day, because the inflammatory reactions of the anterior chamber and vitreous cavity were not improved and Gram positive cocci was confirmed, we performed a pars plana vitrectomy and an additional intravitreal antibiotics injection (vancomycin 1.0 mg/0.1 mL, dexamethasone 0.5 mg/0.1 mL). Seven days after the surgery, Staphylococcus lugdunensis was identified in the aqueous fluids culture. 11 days after the surgery, her inflammation and symptoms were improved and therefore, she could be discharged. Three months after the surgery, best-corrected visual acuity of her left eye was 20/20 and there was no evidence of recurrence of endophthalmitis and no abnormal findings in her fundus.

Intravitreal Anti-Vascular Endothelial Growth Factor for Retinal Pigment Epithelial Tear in Retinal Angiomatous Proliferation

PURPOSE: To evaluate the treatment outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) therapy for retinal pigment epithelial (RPE) tear in retinal angiomatous proliferation (RAP). METHODS: In the present study we retrospectively analyzed the medical records of 14 patients (14 eyes) diagnosed with RPE tear secondary to RAP treated with intravitreal anti-VEGF. Best-corrected visual acuity (BCVA) when the RPE tear developed was compared with BCVA at 6 months and at the final follow-up. RESULTS: The mean age of the study patients was 75.1 +/- 7.0 years and the mean follow-up period was 23.7 +/- 13.7 months. During the follow-up period, patients were treated with a mean of 2.8 +/- 1.3 intravitreal anti-VEGF injections. The mean logarithm of minimal angle of resolution BCVA when the RPE tear developed, at 6 months and at the final follow-up was 1.25 +/- 0.44, 1.44 +/- 0.56, and 1.65 +/- 0.39, respectively. The BCVA at 6 months was not different from the baseline value (p = 0.258), whereas the BCVA at the final follow-up was significantly worse than the baseline value (p = 0.002). CONCLUSIONS: The prognosis of RPE tear in RAP is poor despite anti-VEGF therapy. This result suggests further investigations regarding the prevention of RPE tear or more effective treatment method for this condition are necessary.

Intravitreal Anti-vascular Endothelial Growth Factor for Treating Polypoidal Choroidal Vasculopathy with Grape-like Polyp Clusters

PURPOSE: To evaluate 12-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with grape-like polyp clusters. METHODS: This retrospective observational study included 23 eyes of 23 patients who were newly diagnosed with PCV with grape-like polyp clusters, and who were subsequently treated with anti-VEGF monotherapy. The study compares the best-corrected visual acuity (BCVA) of the patients at diagnosis, at 3 months, and at 12 months after diagnosis. In addition, 12-month changes in BCVA values were compared between cases with subfoveal or juxtafoveal polyps and cases with extrafoveal polyps. RESULTS: The baseline, 3-month, and 12-month logarithm of the minimal angle of resolution BCVA was 0.62 ± 0.35, 0.50 ± 0.43, and 0.58 ± 0.48, respectively. Compared to the baseline, patient BCVA was not significantly different at 12 months after diagnosis (p = 0.764). Six eyes (26.1%) gained ≥0.2 logarithm of the minimal angle of resolution BCVA. In cases with subfoveal or juxtafoveal polyps, BCVA values at baseline and at 12 months after diagnosis were 0.66 ± 0.37 and 0.69 ± 0.53, respectively. In cases with extrafoveal polyps, the values were 0.54 ± 0.33 and 0.37 ± 0.31, respectively. Changes in BCVA values were significantly different between the two groups (p = 0.023). CONCLUSIONS: Although anti-VEGF therapy has favorable short-term efficacy for treating PCV with grape-like polyp clusters, long-term visual improvements are generally limited in the majority of afflicted eyes. The presence of subfoveal or juxtafoveal polyps may suggest unfavorable treatment outcomes.

Optical Coherence Tomography-based Diagnosis of Polypoidal Choroidal Vasculopathy in Korean Patients

PURPOSE: To evaluate the efficacy of an optical coherence tomography (OCT)-based diagnosis of polypoidal choroidal vasculopathy (PCV) in Korean patients. METHODS: This retrospective, observational case series included 263 eyes of 263 patients (147 eyes with PCV and 116 eyes with typical exudative, age-related macular degeneration [AMD]) who had been diagnosed with treatment naïve exudative AMD. Eyes with three or more of the following OCT findings were diagnosed with PCV: multiple retinal pigment epithelial detachment (RPED), a sharp RPED peak, an RPED notch, a hyporeflective lumen representing polyps, and hyperreflective intraretinal hard exudates. The OCT-based diagnosis was compared with the gold-standard indocyanine green angiography-based method. The sensitivity and specificity of the OCT-based diagnosis was also estimated. An additional analysis was performed using a choroidal thickness criterion. Eyes with a subfoveal choroidal thickness greater than 300 µm were also diagnosed with PCV despite having only two OCT features. RESULTS: In eyes with PCV, three or more OCT features were observed in 126 of 147 eyes (85.7%), and the incidence of typical exudative AMD was 16 of 116 eyes (13.8%). The sensitivity and specificity of an OCT-based diagnosis were 85.7% and 86.2%, respectively. After applying the choroidal thickness criterion, the sensitivity increased from 85.7% to 89.8%, and the specificity decreased from 86.2% to 84.5%. CONCLUSIONS: The OCT-based diagnosis of PCV showed a high sensitivity and specificity in Korean patients. The addition of a choroidal thickness criterion improved the sensitivity of the method with a minimal decrease in its specificity.

Comparison of Short-Term Clinical Outcomes between Intravitreal Ranibizumab and Aflibercept in Retinal Angiomatous Proliferation

PURPOSE: To evaluate the 6-month outcomes of intravitreal ranibizumab and aflibercept treatment for patients with retinal angiomatous proliferation (RAP). METHODS: A retrospective review of medical records of 28 patients (31 eyes) diagnosed with RAP was performed. All patients were initially treated with 3 consecutive intravitreal ranibizumab or aflibercept injections after diagnosis. Additional treatment was performed when exudation recurred. The best-corrected visual acuity (BCVA) and central foveal thickness were measured before the first injection and 3 and 6 months after the first injection. The values measured before the treatment were compared with those after treatment. RESULTS: Sixteen eyes were treated with ranibizumab and 15 eyes with aflibercept. The logarithm of minimal angle of resolution (log MAR) values of BCVA before the first injection and 3 and 6 months after the first injection were 0.78 +/- 0.50, 0.47 +/- 0.30 and 0.59 +/- 0.41 in the ranibizumab group and 0.96 +/- 0.52, 0.83 +/- 0.52 and 0.74 +/- 0.56 in the aflibercept group, respectively. Central foveal thickness was 315.75 +/- 115.44, 188.38 +/- 57.33 and 218.50 +/- 96.49 microm in the ranibizumab group and 249.00 +/- 74.88, 143.73 +/- 32.73 and 196.73 +/- 94.08 microm in the aflibercept group, respectively. BCVA was significantly improved and central foveal thickness was significantly reduced at 6 months (p < 0.05) compared to measurements before the first injection in both groups. However, BCVA improvement and central foveal thickness were not significantly different between the 2 groups. CONCLUSIONS: Both intravitreal ranibizumab and aflibercept treatments were beneficial for both normalizing macular thickness and improving visual acuity in patients with RAP. The efficacy of the 2 drugs was not noticeably different.

Analysis of Referred 113 Patients with Endophthalmitis after Cataract Surgery and Associated Prognostic Factors

PURPOSE: To evaluate factors affecting final visual acuity by analyzing patients referred with infectious endophthalmitis after cataract surgery. METHODS: A retrospective investigation of clinical notes of 113 patients referred with endophthalmitis following cataract surgery was conducted from January 2008 to December 2013. To evaluate factors affecting final visual acuity, initial visual acuity, onset of endophthalmitis after the cataract surgery, types of treatment, presence of hypopyon and culture results were investigated. RESULTS: Of the 113 patients, visual acuities at presentation were hand motions or less in 75 patients (66.3%) and final visual acuities after treatments were 0.5 or better in 73 patients (64.6%). Cases with initial visual acuity of hand motions or better achieved favorable outcomes whereas cases with gram-negative infection or endophthalmitis occurring within 2 days postoperatively showed poor prognosis. Statistically, vitrectomy versus intraocular antibiotic injection as primary means of treatment showed no differences in final visual acuity in patients with initial visual acuity of hand motion or better. CONCLUSIONS: Visual acuities at presentation, type of cultured organism and onset of endophthalmitis after cataract surgery are significantly related to visual prognosis. Advantages of initial vitrectomy versus intraocular antibiotic injections were unclear and further investigations are necessary to clarify these issues.

The Efficacy of Intravitreal Aflibercept in Submacular Hemorrhage Secondary to Wet Age-related Macular Degeneration

PURPOSE: To evaluate the efficacy of intravitreal aflibercept monotherapy in submacular hemorrhage (SMH) secondary to wet age-related macular degeneration (AMD). METHODS: This study included 25 eyes in 25 patients with SMH involving the fovea secondary to wet-AMD. All patients were treated with three consecutive monthly intravitreal aflibercept (2.0 mg/0.05 mL) injections, followed by as-needed reinjection. They were followed for at least 6 months. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and area of SMH were measured at diagnosis, as well as at 3 and 6 months after treatment initiation. RESULTS: The BCVA significantly improved from 0.79 ± 0.41 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.54 ± 0.41 logMAR at 6 months (p < 0.001). BCVA ≥3 lines and stable vision were observed in 96% of the eyes. The CFT significantly decreased from 560.8 ± 215.3 µm at baseline to 299.8 ± 160.2 µm at 6 months (p < 0.001). The area of SMH significantly decreased from 10.5 ± 7.1 mm² at baseline to 1.8 ± 6.5 mm² at 6 months (p < 0.001). The BCVA, CFT, and area of SMH at baseline, as well as duration of symptoms, all correlated with BCVA at the 6-month follow-up. CONCLUSIONS: Intravitreal injection of aflibercept is an effective treatment option for patients with SMH secondary to wet-AMD; however, there may be limited efficacy in eyes with large SMH area and cases in which treatment is delayed.

Clinical Outcomes of Eyes with Submacular Hemorrhage Secondary to Age-related Macular Degeneration Treated with Anti-vascular Endothelial Growth Factor

PURPOSE: To evaluate the long-term outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy for patients diagnosed with submacular hemorrhage secondary to exudative age-related macular degeneration. METHODS: This retrospective, observational study included 49 patients (49 eyes) who initially presented with submacular hemorrhage associated with exudative age-related macular degeneration and who were followed-up for at least 24 months. Only eyes that were treated with intravitreal anti-VEGF monotherapy were included in the study. Best-corrected visual acuity (BCVA) measurements obtained at diagnosis, six months, and the final visit were compared. The associations of BCVA at the final visit with baseline BCVA, BCVA at six months, symptom duration, hemorrhage extent, and central foveal thickness were also analyzed. RESULTS: Over the course of follow-up (mean, 32.1 +/- 8.5 months), an average of 5.1 +/- 2.2 anti-VEGF injections were administered. Recurrent hemorrhage was noted in 13 eyes (26.5%). The mean logarithm of the minimal angle of resolution BCVA at diagnosis, six months, and the final visit were 1.40 +/- 0.52, 0.87 +/- 0.64, and 1.03 +/- 0.83, respectively. Both baseline BCVA (p = 0.012) and BCVA at six months (p < 0.001) were significantly associated with BCVA at the final visit. CONCLUSIONS: Improved visual acuity was maintained for more than two years with intravitreal anti-VEGF monotherapy. BCVA at six months is a useful clinical index to predict long-term visual prognosis.

Swept Source Optical Coherence Tomography Findings in Gas-Filled Eyes after Macular Hole Surgery

PURPOSE: To investigate the ability to determine the postoperative status of macular hole (MH) in gas-filled eyes using swept source optical coherence tomography (SS-OCT). METHODS: Ten eyes of 10 patients who underwent vitrectomy, internal limiting membrane peeling and gas tamponade for idiopathic MH were included in this study. The macular area was examined using SS-OCT on postoperative days 1, 2 and 30. RESULTS: MH status was assessed in 6 eyes (60%) on postoperative day 1 and MH closure was confirmed in 5 of the 6 eyes (83%). MH remained closed in all 5 eyes at 1 month after surgery. Only gas-retinal interface was obtained in 4 eyes (40%) and unclosed MH was found in 1 of the 4 eyes (25%) at 1 month after surgery. CONCLUSIONS: The MH status can be determined using SS-OCT in the early postoperative period even in gas-filled eyes. Confirming early MH closure with SS-OCT can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates.

Outcomes of Relaxing Retinectomy in Patients with Proliferative Vitreoretinopathy

PURPOSE: To report the outcomes of relaxing retinectomy for retinal detachment in patients with proliferative vitreoretinopathy (PVR). METHODS: Sixty-four cases of relaxing retinectomy for PVR with a minimum follow-up of 6 months were retrospectively reviewed. The outcomes included achievement of complete retinal reattachment, PVR recurrence, the mean number of additional operations, visual acuity and incidence of postoperative complications. We analyzed the influence of intraoperative factors including lens status, retinectomy extent, additional scleral buckling, and tamponade agent on primary retinal reattachment. RESULTS: Complete retinal reattachment was achieved in 47 eyes (74.3%) without an additional surgery. PVR recurred in 19 eyes (29.7%) and an additional operation was performed in 17 eyes (26.6%). Fifty-seven (89.1%) eyes showed complete retinal reattachment and 40 eyes (62.5%) had visual acuity of 0.02 or more at the final follow-up visit. Hypotony was the major complication and developed in 10 eyes (15.6%). Eyes undergoing smaller ( or = 180degrees) retinectomy or gas tamponade (p = 0.043 and 0.013, respectively). CONCLUSIONS: Relaxing retinectomy is a useful technique for retinal detachment with PVR, but risk of recurrent proliferation or hypotony should be considered.

Intravitreal Anti-vascular Endothelial Growth Factor for Newly Diagnosed Symptomatic Polypoidal Choroidal Vasculopathy with Extrafoveal Polyps

PURPOSE: To evaluate the 12-month outcome of anti-vascular endothelial growth factor (VEGF) treatment for extrafoveal polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective observational study included 32 eyes of 32 patients newly diagnosed with extrafoveal PCV (polyps located more than 500 microm from the center of the fovea). Patients were treated with intravitreal ranibizumab, bevacizumab, or both. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) at diagnosis and at 12 months were compared. Eyes were divided into two groups according to the presence of submacular hemorrhage. The BCVA in each group was compared at baseline and at 12 months. RESULTS: During the 12-month study period, patients received an average of 4.0 +/- 1.1 anti-VEGF injections. The BCVA at baseline, three-month post-diagnosis, and 12-month post-diagnosis was 0.59 +/- 0.40, 0.34 +/- 0.38, and 0.38 +/- 0.38, respectively. The BCVA at 12 months was significantly better than the baseline value (p = 0.002). The CFT at baseline, three-month, and 12-month post-diagnosis was 477.1 +/- 194.2 microm, 214.5 +/- 108.8 microm, and 229.8 +/- 106.1 microm, respectively. The CFT at 12 months was significantly lower than the baseline value (p < 0.001). A significant improvement in BCVA was noted in eyes with and without submacular hemorrhage (n = 13, p = 0.032 and n = 19, p = 0.007, respectively). CONCLUSIONS: Anti-VEGF therapy was beneficial in extrafoveal PCV, regardless of the presence of submacular hemorrhage.

Short-Term Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To evaluate short-term outcomes of intavitreal dexamethasone implant in macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: A retrospective review of medical records was performed for 24 patients (24 eyes) who were diagnosed with macular edema secondary to BRVO. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured before the injection and at 1 and 3 months after the injection. The values measured before and after the treatment were compared. In addition, the association between duration of symptoms and 3-month changes in BCVA was evaluated. RESULTS: In 24 eyes, the logarithm of minimal angle of resolution BCVA before the injection and 1 and 3 months after the injection was 0.56 +/- 0.25, 0.42 +/- 0.26 and 0.45 +/- 0.27, respectively. The CFT was 550.2 +/- 116.5 microm, 270.3 +/- 101.5 microm, and 356.6 +/- 173.7 microm, respectively. When compared with the baseline values, the BCVA at 3 months was significantly improved (p = 0.018) and the CFT was significantly decreased (p < 0.001). There was a significant negative association between the duration of symptoms and 3-month changes in BCVA (p = 0.032, r = -0.375). Elevated intraocular pressure was observed in 3 eyes (12.5%). CONCLUSIONS: Intravitreal dexamethasone implant was found effective in treating macular edema secondary to BRVO. However, rebound macular edema and deterioration in visual acuity after 1 month suggest further studies with longer follow-ups are necessary.

Risk Factors for Retinal Breaks in Patients with Symptom of Floaters

PURPOSE: To identify the risk factors of retinal breaks in patients with symptoms of floaters and to determine the associations between those risk factors and retinal breaks. METHODS: A retrospective chart review of patients who visited with the symptom of vitreous floaters between July 2012 and October 2012 was performed. Patient information, such as age, sex, symptoms (e.g., multiple floaters and flashing), duration of symptoms, refractive error, and complete eye examination were recorded. The patients were divided into 2 groups: the control group had symptoms of floaters with no retinal breaks and the retinal breaks group had symptoms of floaters with retinal breaks. The chi-square test and univariate logistic regression were used for statistical analysis. RESULTS: A total of 1744 eyes were examined in this study, including 1706 eyes in the control group and 38 eyes in the retinal breaks group. Univariate analysis revealed that patients with high myopia and multiple floaters showed increased risk of retinal breaks by 3.4 and 4.4 times, respectively, when compared to patients with a single floater alone. Lattice degeneration and vitreous or retinal hemorrhage increased the risk of retinal breaks by 10.8 and 37.5 times when compared to eyes that did not have lattice degeneration or vitreous or retinal hemorrhage. During the follow-up period after laser photocoagulation, a new retinal tear was found in 2 patients (2/38, 5.3%). CONCLUSIONS: Vitreous or retinal hemorrhage, lattice degeneration, multiple floaters, and high myopia are risk factors of retinal breaks in patients with the symptom of floaters. Therefore, it is important for ophthalmologists to be aware of these risk factors and the patients at risk should be encouraged to attend follow-up examinations.

Influence of Image Compression on the Interpretation of Optical Coherence Tomography in Diabetic Macular Edema

PURPOSE: To evaluate the influence of image compression on optical coherence tomography (OCT) images in eyes with diabetic macular edema (DME). METHODS: Twenty eyes of 30 patients diagnosed with DME were included in this retrospective observational case series. Horizontal OCT scans centered at the center of the fovea were conducted using spectral-domain OCT (Spectral OCT/SLO(R)). The images were exported to Tag Image File Format (TIFF) and then transformed to 10, 5, and 1 quality of Joint Photographic Experts Group (JPEG) format using Photoshop. OCT images were taken before and after intravitreal bevacizumab injection. The presence of intraretinal fluid, foveolar detachment, and photoreceptor inner segment/outer segment (IS/OS) disruption were evaluated in each image. RESULTS: The mean (+/- standard deviation) size of TIFF images and 10, 5 and 1 quality JPEG images were 1712.0, 183.3 +/- 6.8, 90.9 +/- 4.3, 42.8 +/- 1.4 kilobytes (KB), respectively, before the injection and 1712.0, 189.5 +/- 9.1, 94.9 +/- 5.6, 43.4 +/- 1.8 KB, respectively, after the injection. The presence of intraretinal fluid, foveolar detachment, and photoreceptor IS/OS disruption identified in TIFF images was also identified in the compressed JPEG images. CONCLUSIONS: Quality of retinal OCT image did not influence the estimation of DME despite the JPEG image being compressed to approximately 1/40 of the original TIFF image size.

Characteristics and Surgical Outcome of Macular Holes Developing after Rhegmatogenous Retinal Detachment Repair

PURPOSE: To report the characteristics and surgical outcome of macular holes (MHs) that develop after rhegmatogenous retinal detachment (RRD) repair. METHODS: A retrospective chart review was performed in patients who developed a new full-thickness macular hole after RRD repair between May 2010 and July 2013. For eyes that underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for MH repair, main outcomes included macular attachment status and postoperative visual acuity. RESULTS: Fourteen full-thickness MHs were detected in a series of 2,815 eyes (0.49% prevalence) that had undergone prior RRD surgery. Ten MHs developed after primary vitrectomy and four after scleral bucking surgery. The fovea was detached in eight of the 14 eyes at the time of RRD. Fourteen of 14 eyes were managed by pars plana vitrectomy, internal limiting membrane peeling, and intravitreal gas tamponade, and 12 of 14 eyes achieved MH closure. Mean preoperative Snellen best-corrected visual acuity (BCVA) was 20/63 (+/-0.25). Nine of 14 eyes had an improvement in visual acuity of at least two Snellen lines, and five eyes remained unchanged. CONCLUSIONS: In this small retrospective study, the secondary MHs were found predominantly in foveal detachments after RRD repair, most commonly occurring after primary vitrectomy. In conclusion, the surgical outcome and postoperative visual acuity improvement were satisfactory, although the final BCVA depended on the macular status during the RRD.

Patient's Self-recognition of Reduced Visual Acuity Due to Recurrence of Macular Edema and Prompt Visitation to the Hospital in Retinal Vein Occlusion

PURPOSE: To evaluate patients' self-recognition of reduced visual acuity due to recurring macular edema in retinal vein occlusion. METHODS: A retrospective review of medical records of patients who were diagnosed with recurring macular edema secondary to retinal vein occlusion was performed. The proportion of patients who recognized reduced visual acuity due to the recurrence of macular edema and who visited the hospital before the scheduled follow-up date was determined. Parameters including age, sex, diagnosis, visual acuity before recurrence of macular edema, and extent of visual acuity reduction due to recurrence of macular edema were compared in patients who recognized a reduction in visual acuity and those who did not. The proportion of patients who visited the hospital promptly was also determined. RESULTS: Forty eyes of 40 patients were included in the analysis. Sixteen and 24 patients were diagnosed with central retinal vein occlusion and branch retinal vein occlusion, respectively. Twenty-one patients (52.5%) recognized reduced visual acuity due to recurring macular edema. These patients were younger (59.2 +/- 7.6 vs. 64.8 +/- 9.4 years, p = 0.046), had better visual acuity before recurrence of macular edema (0.52 +/- 0.48 vs. 1.02 +/- 0.46, p = 0.002), and exhibited a greater reduction in visual acuity after recurrence of macular edema (0.34 +/- 0.24 vs. 0.14 +/- 0.13, p = 0.003). Only four patients visited the hospital before the scheduled follow-up date, and all of these patients lived relatively close to the hospital. CONCLUSIONS: For prompt treatment of recurring macular edema, more intensive education about the self-estimation of visual acuity is necessary, particularly for elderly patients who have relatively poor visual acuity. In addition, a simple and easy way to identify the recurrence of macular edema at the local clinic should be established for patients who live relatively far from the hospital.

A Case Report of Primary Vitrectomy in Multiple Bilateral Retinal Capillary Hemangiomas Accompanying Epiretinal Membrane

PURPOSE: To report the clinical result of pars plana vitrectomy (PPV) as the primary treatment in a patient with multiple bilateral retinal capillary hemangiomas (RCH) accompanying epiretinal membrane (ERM). CASE SUMMARY: A 17-year-old female patient visited our clinic for decreased bilateral vision 4 days in duration. At the first visit, the vision in her right eye was 20/25 and, 20/100 in her left eye. Bilateral multiple retinal capillary hemangiomas were observed at the peripheral retina in both eyes on fundus examination, fluorescein angiography (FAG) and optical coherence tomography (OCT). ERM and associated macular edema (ME) were noted in her left eye. For her left eye, focal laser photocoagulation (PC) was performed 6 times. ME was decreased and her vision improved to 20/25. However, 3 months after the initial visit, her vision decreased to 20/400 accompanied with exacerbated ERM and ME. Therefore, PPV was performed in her left eye. ERM and associated ME were decreased and her vision improved to 20/25 after 18 months. PPV was performed in the right eye immediately after her vision worsened (best corrected visual acuity, BCVA 20/40) and ERM occurred. After 15 months later, vision in her right eye improved to 20/20 and ERM was also decreased.

Characteristic Findings of Optical Coherence Tomography in Retinal Angiomatous Proliferation

PURPOSE: To identify the unique pathologic findings of retinal angiomatous proliferation (RAP) in optical coherence tomography (OCT). METHODS: Retrospectively, 29 eyes of 25 patients with age-related macular degeneration and complicated RAP were analyzed. All 29 eyes had choroidal neovascularization (CNV) in the area of pigment epithelial detachment (PED) or adjacent to it, which was visible with fluorescein angiography or indocyanine green angiography. Cross-sectional images were obtained by OCT scanning through the CNV lesions. RESULTS: Six distinctive findings of OCT included drusen (100%), inner retinal cyst (80%), outer retinal cyst (68%), fibrovascular PED (84%), serous retinal detachment (40%), and PED (68%). CONCLUSIONS: Through analysis of OCT findings, we revealed six different types of lesions distinctive of RAP which may provide helpful diagnostic information for subsequent treatment and predicting the prognosis of RAP.

Comparison of 20, 23 and 25 Gauge Vitreoretinal Surgical Instruments

PURPOSE: To investigate the diameter, the infusion and aspiration rate of 20-, 23- and 25-gauge vitreous cutters, and compare the theoretical and practical intraocular pressure (IOP) change according to the height of the bottle. METHODS: A vitreous cutter was disassembled to measure the actual external and internal diameter. The infusion rate was measured at the height of 40, 60, 80, 100 and 120 cm and the suction rate was measured at a pressure of 100, 200, 300, 400 and 500 mm Hg for each gauge. IOP during the operation was calculated according to the bottle height and the actual IOP was measured using a mercury sphygmomanometer. RESULTS: The external diameter of the 20-, 23- and 25-gauge was 900, 596, and 500 mm, respectively, and the internal diameter was 670, 450, and 380 mm, respectively. The infusion rate increased in direct proportion to the bottle height. The aspiration rate increased as the pressure increased. However, the increment of the infusion and aspiration rate in the 20-gauge vitreous cutter was the highest and decreased in the 23- and 25-gauge, in that order. IOP was calculated as 29, 44, 59 and 74 mm Hg when the bottle height was at 40, 60, 80 and 100 cm, respectively, and was measured 34, 50, 62 and 74 mm Hg, respectively. CONCLUSIONS: The infusion and aspiration rates per outer diameter in the 23- and 25-gauge vitreous cutters and infusions using cannula were lower than in the 20-gauge vitreous cutter. The difference of the infusion and aspiration rates per diameter between the 23- and 25-gauge vitreous cutters and infusions was not significant.