Prognostic Factors and Long-term Surgical Outcomes for Exudative Age-related Macular Degeneration with Breakthrough Vitreous Hemorrhage

Purpose@#We sought to evaluate the long-term outcomes for patients with exudative age-related macular degeneration (AMD) undergoing vitrectomy for breakthrough vitreous hemorrhage and to investigate possible prognostic factors. @*Methods@#Consecutive patients treated at two high-volume referral-based tertiary hospitals between July 2006 and Decem-ber 2019 were retrospectively reviewed. Surgery was performed using the standard three-port vitrectomy. The primary out-come was the change in best-corrected visual acuity (BCVA) over long-term follow-up, while secondary outcomes included the assessment of possible prognostic factors. @*Results@#Among 50 eyes from 50 patients included in this study, 23 (46%) were diagnosed with polypoidal choroidal vascu-lopathy (PCV) and 27 (54%) were diagnosed with neovascular AMD. Preoperative vision at the time of vitreous hemorrhage onset was 20 / 3,027 (logarithm of the minimum angle of resolution [logMAR], 2.18 ± 0.34). At 12 months after surgery, the mean BCVA improved to 20 / 873 (logMAR, 1.64 ± 0.76; p < 0.001). At 24 months, the BCVA was 20 / 853 (logMAR, 1.63 ± 0.75; p < 0.001). Univariate analysis revealed that older age (odds ratio [OR], 0.879; p = 0.007] and the presence of submac-ular hemorrhage (OR, 0.081; p= 0.022) were factors associated with a poor 2-year visual outcome. Multivariable regression showed that older age (OR, 0.876; p= 0.026) and neovascular AMD (as compared with PCV) (OR, 0.137; p= 0.014) were significant negative factors influencing the 2-year visual outcome. The mean injection interval prior to vitrectomy was 4.53 months, which extended to 27.64 months after vitrectomy ( p = 0.028). @*Conclusions@#Younger age, the absence of submacular hemorrhage, and PCV type were associated with a favorable 2-year visual outcome after vitrectomy for vitreous hemorrhage in patients with exudative AMD. Overall, vitrectomy resulted in im-proved visual acuity and patients showed a decreased need for anti-vascular endothelial growth factor therapy thereafter.

Anti-vascular Endothelial Growth Factor Treatment of Retinopathy of Prematurity: Efficacy, Safety, and Anatomical Outcomes

PURPOSE: To investigate the efficacy, safety, and anatomical outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) treatment of retinopathy of prematurity (ROP). METHODS: We performed a retrospective review of intravitreal anti-VEGF (bevacizumab or ranibizumab) treatment of 153 eyes (83 infants) diagnosed with ROP at two tertiary hospitals from June 2011 to January 2017. The primary outcome was the rate of recurrence requiring additional treatment; secondary outcomes included incidence of major complications and final refractive error. RESULTS: A total of 101 eyes were treated with bevacizumab, and 52 with ranibizumab. The bevacizumab and ranibizumab groups were characterized by mean birthweights of 941.8 ± 296.1 and 1,257.7 ± 514.5 g, gestational ages at birth of 26.9 ± 1.9 and 28.1 ± 3.2 weeks, and postmenstrual ages at treatment of 40.4 ± 2.4 and 39.2 ± 2.3 weeks, respectively. The two groups differed significantly in birthweights and gestational ages at birth, but not in postmenstrual ages at treatment. The mean follow-up duration was 30.9 ± 18.4 months for the bevacizumab group, and 13.9 ± 12.5 months for ranibizumab. More cases were classified as zone 1 ROP in the ranibizumab group (44.2% vs. 11.9%, p < 0.001). Major surgical interventions included scleral encircling and vitrectomy (one and two eyes, respectively, both in the bevacizumab group). Retinal detachment was noted in one eye treated with bevacizumab. There was no significant difference in the most recent spherical equivalence for the two groups (+0.10 ± 3.66 and +0.22 ± 3.00 diopters for bevacizumab and ranibizumab, respectively). Univariable analysis revealed that only ROP stage influenced the occurrence of major complications (odds ratio, 9.046; p = 0.012). CONCLUSIONS: Intravitreal anti-VEGF treatment of ROP with both bevacizumab and ranibizumab achieved stable retinal vascularization with a low rate of complications and recurrence. Ranibizumab achieved similar anatomical outcomes as bevacizumab, without additional risk for major complications.

Peripapillary Choroidal Thickness Change of Polypoidal Choroidal Vasculopathy after Anti-vascular Endothelial Growth Factor

PURPOSE: To investigate the peripapillary choroidal thickness (PCT) of polypoidal choroidal vasculopathy (PCV) and exudative age-related macular degeneration (AMD) and to evaluate their responses to anti-vascular endothelial growth factor (VEGF). METHODS: Thirty eyes with PCV and 25 eyes with exudative AMD who were treatment naïve were included in this study. PCT and subfoveal choroidal thickness were evaluated both before and after intravitreal anti-VEGF. RESULTS: The initial mean PCT of PCV (153.78 ± 56.23 µm) was thicker than that of exudative AMD (88.77 ± 23.11 µm, p < 0.001). Temporal, superior, nasal, and inferior PCTs of PCV were all thicker than those observedin exudative AMD (all p < 0.05). After anti-VEGF, the mean PCT of PCV was significantly reduced (134.17 ± 41.66 µm, p < 0.001), but the same was not true not in exudative AMD (86.87 ± 22.54 µm, p = 0.392). PCTshowed a similar tendency in all quadrants. CONCLUSIONS: PCV exhibits a thick choroid in the peripapillary region. PCT decreases after anti-VEGF in PCV but not in exudative AMD. In exudative AMD, subfoveal choroidal thickness decreased, but that in the peripapillary region did not.

Angiographically Documented Macular Ischemia after Single Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion

This report describes a case of angiographically documented foveal avascular zone (FAZ) enlargement after a single intravitreal injection of bevacizumab for macular edema secondary to central retinal vein occlusion (CRVO). A 71-year-old female was treated with an intravitreal bevacizumab injection for macular edema following CRVO. Despite successfully decreased edema one month after injection, the postinjection best-corrected visual acuity immediately decreased from 20/40 to 20/1000 (Snellen equivalent). The FAZ area increased from 0.37 mm² to 3.11 mm² (8.4-fold increase). While intravitreal anti-vascular endothelial growth factor is effective and should be considered as a first-line treatment for macular edema secondary to CRVO, it may aggravate macular ischemia.

Dexamethasone Intravitreal Implant Rescue Treatment for Bevacizumab Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To evaluate the prognostic factors and outcomes of dexamethasone intravitreal implant (DEX implant) for intravitreal bevacizumab refractory macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: This was a retrospective, interventional case series. Medical records were reviewed, and a total of 38 eyes that were treated with DEX implant for macular edema secondary to BRVO that did not respond to at least two consecutive intravitreal bevacizumab injections (IBIs) were included. Best-corrected visual acuity (BCVA), central subfield macular thickness, and central subfoveal choroidal thickness were evaluated at baseline, 2 months, and 6 months after DEX implantation. RESULTS: Patients had undergone an average of 6.32 ± 4.66 prior IBI treatments. The average BCVA improved from 0.53 ± 0.26 to 0.41 ± 0.25 and 0.44 ± 0.23 logarithm of the minimal angle of resolution (logMAR) at 2 and 6 months, respectively (p < 0.001). The average central subfield macular thickness was 504.00 ± 121.54 µm at baseline and changed to 293.21 ± 74.17 µm and 427.28 ± 119.57 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.002). Average central subfoveal choroidal thickness was 237.46 ± 92.21 µm at baseline and changed to 204.75 ± 74.74 µm and 226.86 ± 90.77 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.455). Twenty-two eyes (58%) gained ≥0.1 logMAR at 2 months, while 16 eyes showed no improvement. Low BCVA at symptom presentation, low baseline BCVA, and shorter duration of macular edema were correlated with increased BCVA after treatment. CONCLUSIONS: The DEX implant improves functional and anatomical outcomes for up to 6 months in about half of the patients treated with IBI refractory macular edema secondary to BRVO, particularly in patients with low initial and baseline BCVA.

Effect of a Preservative-free Dorzolamide/Timolol Fixed Combination on Elevated Intraocular Pressure after Vitrectomy

PURPOSE: To verify the effect of preservative-free Dorzolamide/Timolol fixed combination (PFDTC) on intraocular pressure (IOP) elevation after vitrectomy. METHODS: We retrospectively reviewed medical records of 33 patients who used PFDTC after pars plana vitrectomy. All patients' visual acuity and IOP was measured and symptoms of conjunctival irritation were investigated through survey and slit lamp examination. RESULTS: Before vitrectomy, the mean IOP was 13.6 ± 4.4 mm Hg which was elevated to 31.7 ± 5.4 mm Hg after vitrectomy (p < 0.001) and applying eyedrop lowered the mean IOP to 17.2 ± 7.0 mm Hg (p < 0.001). Regardless of tamponade material type, all elevated IOP decreased (p < 0.001) and the IOP of all 33 eyes did not rise to over 30 mm Hg again. No additional surgery for IOP control was needed during two-month follow-up period. Of the 33 patients using PFDTC, patients who felt discomfort were five (15.2%) and no patients showed side effects severe enough to stop use of eyedrop. CONCLUSIONS: PFDTC is an anti-glaucomatic agent which can reduce the IOP by inhibiting aqueous humor production. Without need for additional surgery, the eyedrop can effectively lower elevated post-vitrectomy IOP, with expectation of good patient compliance due to low risk of conjunctival irritation.

Non-Paraneoplastic Autoimmune Retinopathy: The First Case Report in Korea

Autoimmune retinopathy (AIR) is an immune-mediated retinopathy, resulting from an immunologic process caused by the aberrant recognition of retinal antigens as autoantigens. The diagnosis of AIR involves the detection of antiretinal antibodies with concurrent clinical and electrophysiological evidence of retinopathy. A 40-year-old patient presented with progressive loss of bilateral vision over several months. A fundus examination was unremarkable. Spectral domain optical coherence tomography revealed a blurred photoreceptor ellipsoid zone at the subfoveal region in both eyes with more prominent disruption in the left eye. Full-field electroretinography (ERG) showed relatively normal rod and cone responses in the right eye, and decreased photopic bwaves with minimal attenuation of a-waves in the left eye. Multifocal ERG demonstrated slightly reduced amplitude of the inner segment ring in the right eye and decreased amplitudes and delayed latencies of all modalities in the left eye. The patient was suspected to have AIR and it was supported by positive Western blots for 23-kDa protein, enolase (46-kDa), aldolase (40-kDa), 62-kDa and 78-kDa proteins and by immunohistochemical staining of human retinal bipolar and ganglion cells. Despite the immunosuppressive treatment, the destruction of the retinal photoreceptors progressed, and immunosuppressive interventions produced very little visual improvement. We report on what is, to the best of our knowledge, the very first case of serologically confirmed nonparaneoplastic AIR in Korea.

Correlation between Fluorescein Angiographic Findings and Visual Acuity in Behcet Retinal Vasculitis

PURPOSE: To identify significant fluorescein angiographic (FA) characteristics associated with visual acuity (VA) in Behcet retinal vasculitis. MATERIALS AND METHODS: Retrospective review of 86 eyes of 48 patients (age: 35.6+/-10.2 years) with Behcet retinal vasculitis were performed. VA and FA findings as well as correlation between them were assessed. RESULTS: The mean initial VA of eyes with posterior pole-involved vasculitis (63 eyes; 73.3%) was significantly worse than that of those with peripheral vasculitis (23 eye; 26.7%) (logarithm of the minimum angle of resolution VA: 0.554+/-0.572 vs. 0.078+/-0.148; p<0.0001). Subgroup analysis revealed a more severe and diffuse pattern of vascular leakage in posterior pole-involved vasculitis compared to peripheral vasculitis (p<0.0001). Retinal vascular leakage (beta=0.345; p<0.0001), optic disc hyperfluorescence (beta=0.147; p=0.032), and macular leakage (beta=0.107; p=0.047) were significantly associated with worse initial VA. During the follow up (mean: 33.3+/-17.9 months), the change of leakage showed no significant correlation with change of VA in posterior pole-involved vasculitis (tau=0.199, p=0.092). CONCLUSION: Posterior pole involvement, the degree of retinal vascular leakage, optic disc hyperfluorescence, and macular leakage are significantly associated with VA in Behcet retinal vasculitis.

Intraocular Lens Power Estimation in Combined Phacoemulsification and Pars Plana Vitrectomy in Eyes with Epiretinal Membranes: A Case-Control Study

PURPOSE: To evaluate the accuracy of postoperative refractive outcomes of combined phacovitrectomy for epiretinal membrane (ERM) in comparison to cataract surgery alone. MATERIALS AND METHODS: Thirty-nine eyes that underwent combined phacovitrectomy with intraocular lens (IOL) implantation for cataract and ERM (combined surgery group) and 39 eyes that received phacoemulsification for cataract (control group) were analyzed, retrospectively. The predicted preoperative refractive aim was compared with the results of postoperative refraction. RESULTS: In the combined surgery group, refractive prediction error by A-scan and IOLMaster were -0.305+/-0.717 diopters (D) and -0.356+/-0.639 D, respectively, compared to 0.215+/-0.541 and 0.077+/-0.529 in the control group, showing significantly more myopic change compared to the control group (p=0.001 and p=0.002, respectively). Within each group, there was no statistically significant difference in refractive prediction error between A-scan and IOLMaster (all p>0.05). IOL power calculation using adjusted A-scan measurement of axial length based on the macular thickness of the normal contralateral eye still resulted in significant postoperative refractive error (all p<0.05). Postoperative refraction calculated with adjusted axial length based on actual postoperative central foveal thickness change showed the closest value to the actual postoperative achieved refraction (p=0.599). CONCLUSION: Combined phacovitrectomy for ERM resulted in significantly more myopic shift of postoperative refraction, compared to the cataract surgery alone, for both A-scan and IOLMaster. To improve the accuracy of IOL power estimation in eyes with cataract and ERM, sequential surgery for ERM and cataract may need to be considered.

Resveratrol Inhibits Hypoxia-Induced Vascular Endothelial Growth Factor Expression and Pathological Neovascularization

PURPOSE: To investigate the effects of resveratrol on the expression of hypoxia-inducible factor 1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) in human adult retinal pigment epithelial (ARPE-19) cells, and on experimental choroidal neovascularization (CNV) in mice. MATERIALS AND METHODS: ARPE-19 cells were treated with different concentrations of resveratrol and then incubated under hypoxic conditions with subsequent evaluation of cell viability, expression of HIF-1alpha, and expression of VEGF. The effects of resveratrol on the synthesis and degradation of hypoxia-induced HIF-1alpha were evaluated using inhibitors of the PI3K/Akt/mTOR and the ubiquitin proteasome pathways. In animal studies, CNV lesions were induced in C57BL/6 mice by laser photocoagulation. After 7 days of oral administration of resveratrol or vehicle, which began one day after CNV induction, image analysis was used to measure CNV areas on choroidal flat mounts stained with isolectin IB4. RESULTS: In ARPE-19 cells, resveratrol significantly inhibited HIF-1alpha and VEGF in a dose-dependent manner, by blocking the PI3K/Akt/mTOR signaling pathway and by promoting proteasomal HIF-1alpha degradation. In mice experiments, orally administered resveratrol significantly inhibited CNV growth in a dose-dependent manner. CONCLUSION: Resveratrol may have therapeutic value in the management of diseases involving pathological neovascularization.

Reversal of Early Central Retinal Vein Occlusion by Alleviating Optic Nerve Edema with an Intravitreal Dexamethasone Implant

This case describes the reversal of early central retinal vein occlusion (CRVO) with disc swelling after intravitreal dexamethasone implant (Ozurdex) injection. A 44-year-old female presented with sudden-onset intermittent blurred vision in her left eye. Fundus examination revealed multiple retinal hemorrhages without macular edema (ME). Two weeks later, an increased number of retinal hemorrhages with severe disc swelling were noted with still no sign of ME. An intravitreal dexamethasone implant was injected. Five days later, there were improvements in disc swelling and retinal hemorrhage. One month later, her subjective visual symptoms were completely improved, and fundus examination revealed marked improvement along with almost complete resolution of disc swelling. Intravitreal dexamethasone implant injection may potentially change the natural course of CRVO progression and its various subsequent complications.

Intravitreal Bevacizumab Injection for Serous Retinal Detachment Associated with Leber's Idiopathic Stellate Neuroretinitis

PURPOSE: To report the effectiveness of intravitreal bevacizumab treatment for serous retinal detachment associated with Leber's idiopathic stellate neuroretinitis. CASE SUMMARY: A 56-year-old male visited our clinic complaining of visual disturbance for three days in his right eye. His best corrected visual acuity was 0.5. Relative afferent pupillary defect and pain when moving eyes were noted in his right eye as well as inflammatory cells in the vitreous cavity. On funduscopic examination, disc swelling with hemorrhage and stellate-shaped hard exudates were noted at the perifovea. Ishihara color vision test showed anomalous trichromacy in his right eye. Hyperfluorescence around the disc was observed on fundus fluorescein angiography. Optical coherence tomography showed disc swelling with serous retinal detachment at the fovea. Inferior altitudinal scotoma was noted on visual field examination. The patient underwent intravitreal bevacizumab injection and topical steroid medication. After six days, the patient's symptoms and disc swelling improved, and decreased subretinal fluid was observed. After six weeks, his best corrected visual acuity was 1.0. Nine weeks later, visual field examination showed nonspecific scotoma. CONCLUSIONS: Intravitreal bevacizumab injection is useful for treating serous retinal detachment associated with Leber's idiopathic stellate neuroretinitis.

Treatment of Serous Retinal Detachment Associated with Choroidal Ischemia with Intravitreal Bevacizumab Following Brain Surgery

No abstract available.

Identifiable Peripheral Retinal Lesions Using Ultra-Widefield Scanning Laser Ophthalmoscope and Its Usefulness in Myopic Patients

PURPOSE: To investigate identifiable peripheral retinal lesions in patients with myopia or high myopia and to evaluate the usefulness of ultra-widefield scanning laser ophthalmoscope in retina clinic settings. METHODS: We evaluated fundus images of 149 patients acquired using an ultra-widefield scanning laser ophthalmoscope. Manual fundus examination by a retinal specialist was performed and sensitivity and specificity were calculated by comparing the findings of the two different fundus examination methods. RESULTS: Variable peripheral retinal lesions were observed: lattice degeneration (24.1% in myopia, 36.6% in high myopia), white without pressure (17.7% in myopia, 20.7% in high myopia), retinal break (5.1% in myopia, 7.5% in high myopia) and retinal detachment (1.3% in myopia, 4.2% in high myopia). The incidence of lattice degeneration was significantly higher in myopic eyes than in highly myopic eyes (p = 0.043). The examination sensitivities were as follows: lattice degeneration (84.2% in myopia, 91.0% in high myopia), white without pressure (100.0% in both myopia and high myopia), retinal break (75.0% in myopia, 43.8% in high myopia) and retinal detachment (100.0% in myopia, 66.7% in high myopia). The examination specificities were 100.0% in all cases. CONCLUSIONS: Diagnostic sensitivities of ultra-widefield scanning laser ophthalmoscope were 90.8% in patients with myopia, 91.0% in patients with high myopia and 90.9% in totally myopic patients, which were relatively high values. Therefore, the ultra- widefield scanning laser ophthalmoscope is useful as auxiliary equipment for myopic patients in retina clinic settings.

Identifiable Peripheral Retinal Lesions Using Ultra-Widefield Scanning Laser Ophthalmoscope and Its Usefulness in Myopic Patients

PURPOSE: To investigate identifiable peripheral retinal lesions in patients with myopia or high myopia and to evaluate the usefulness of ultra-widefield scanning laser ophthalmoscope in retina clinic settings. METHODS: We evaluated fundus images of 149 patients acquired using an ultra-widefield scanning laser ophthalmoscope. Manual fundus examination by a retinal specialist was performed and sensitivity and specificity were calculated by comparing the findings of the two different fundus examination methods. RESULTS: Variable peripheral retinal lesions were observed: lattice degeneration (24.1% in myopia, 36.6% in high myopia), white without pressure (17.7% in myopia, 20.7% in high myopia), retinal break (5.1% in myopia, 7.5% in high myopia) and retinal detachment (1.3% in myopia, 4.2% in high myopia). The incidence of lattice degeneration was significantly higher in myopic eyes than in highly myopic eyes (p = 0.043). The examination sensitivities were as follows: lattice degeneration (84.2% in myopia, 91.0% in high myopia), white without pressure (100.0% in both myopia and high myopia), retinal break (75.0% in myopia, 43.8% in high myopia) and retinal detachment (100.0% in myopia, 66.7% in high myopia). The examination specificities were 100.0% in all cases. CONCLUSIONS: Diagnostic sensitivities of ultra-widefield scanning laser ophthalmoscope were 90.8% in patients with myopia, 91.0% in patients with high myopia and 90.9% in totally myopic patients, which were relatively high values. Therefore, the ultra- widefield scanning laser ophthalmoscope is useful as auxiliary equipment for myopic patients in retina clinic settings.

Spectral-domain Optical Coherence Tomography of Combined Hamartoma of the Retina and Retinal Pigment Epithelium in Neurofibromatosis

A 5-year-old girl was diagnosed with neurofibromatosis type 2 (NF-2) due to multiple neurofibromas, cafe-au-lait spots, and schwannomas of the brain. During ophthalmologic evaluation, a posterior subcapsular cataract and a gray-green colored subretinal lesion were found in right eye. Fluorescein angiography (FA) revealed a combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). At age 9, she underwent cataract surgery. At this time FA and spectral-domain optical coherence tomography (SD-OCT) were taken. The SD-OCT showed an elevated hyperreflective mass in the retina with prominent attenuation of the inner and outer retina, but minimal attenuation in the photoreceptor layers. The underlying retina appeared to be disorganized and thick (791 microm). This is the first case report of SD-OCT imaging of a CHRRPE associated with NF-2 in a pediatric patient. By using SD-OCT in this patient, we could obtain detailed tumor characteristics, and SD-OCT may be helpful in the diagnosis and management of CHRRPE.

Effect of Intravitreal Bevacizumab on Vascular Endothelial Growth Factor Expression in Patients with Proliferative Diabetic Retinopathy

PURPOSE: To investigate the effect of bevacizumab (Avastin; Genentech, San Francisco, CA, USA) on vascular endothelial growth factor (VEGF) expression and inflammation in fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR). MATERIALS AND METHODS: Fibrovascular membranes from 19 eyes of 18 patients with PDR were studied using immunohistochemistry and analyzed in the following 3 groups; group 1: 4 inactive PDR eyes, group 2: 10 active PDR eyes treated preoperatively with adjunctive intravitreal bevacizumab, group 3: five active PDR eyes not treated preoperatively with bevacizumab. Immunohistochemical staining for VEGF, CD31 and CD68 were done. RESULTS: The immunoreactivity to VEGF and CD 31-positive blood vessels was significantly higher in membranes from group 3 than group 1 (p = 0.007 for VEGF, 0.013 for CD 31-positive vessels). Intravitreal bevacizumab caused a reduction in VEGF expression and vascular densities in 4 out of 10 (40%) excised membranes from eyes with PDR. However, six membranes (60%) in group 2 still demonstrated relatively strong VEGF expression and high vascular density. Infiltration of macrophages was observed in 16 out of the 19 membranes, and the density of macrophages was increased in group 2 compared with group 1 (p = 0.043). CONCLUSION: Intravitreal bevacizumab injections caused some reduction in VEGF expression and vascular densities in a limited number of active PDR patients. A single intravitreal bevacizumab injection may not be enough to induce complete blockage of VEGF and pathologic neovascularization in active PDR patients. Repeated injections, panretinal photocoagulation and/or PPV may be necessary following intravitreal bevacizumab to reinforce the anti-VEGF effect of the drug.

The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

A Choroidal Schwannoma Confirmed by Surgical Excision

Schwannomas rarely present as intraocular tumors and are often misdiagnosed as malignant melanoma. We describe a choroidal schwannoma confirmed by sclerouvectomy. A 30-year-old woman presented with a large nonpigmented intraocular mass of the choroid in the right eye and underwent surgical excision by sclerouvectomy. Histologically, the tumor was composed of a mixture of cellular solid components (Antoni A) and loose myxoid components (Antoni B). The tumor was eventually diagnosed as a schwannoma. Currently available ancillary studies are still of little value in definitively differentiating schwannomas from other choroidal tumors. In the case of atypical findings for a malignant melanoma, a benign neoplasm should be included in the differential diagnosis. This patient avoided enucleation by first having the mass excised. We are unaware of previous reports in which a choroidal schwannoma was diagnosed by surgical excision.

The Efficacy of Photodynamic Therapy With Verteporfin for Polypoidal Choroidal Vasculopathy: Retrospective Multi-Center Case Study

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV) in Korean patients. METHODS: Clinical data of patients who were treated with PDT for PCV and followed up for more than 6 months were collected from 14 hospitals around the country. The changes in the best corrected visual acuity, angiographic outcome, retinal thickness measured by optical coherence tomography (OCT), and adverse effects of treatment were evaluated. RESULTS: Eighty six patients (86 eyes) were recruited (male: 75.6%, age: 65.9+/-8.3 years, mean follow-up: 14.8+/-10.2 months). The mean logMAR visual acuity at baseline was 0.55+/-0.32 and did not show any statistically significant difference from the final mean logMAR visual acuity (0.53+/-0.54) (p=0.639). The mean treatment session number of PDT was 2+/-1.2. Visual acuity stabilized or improved in 70.9% of patients. Visual acuity improved by more than 2 lines in 33 eyes (38.4%) and worsened by more than 2 lines in 21 eyes (24.4%) of patients. Vascular leakage decreased in 62.5% of patients in fluorescein angiography and polypoidal lesions disappeared or were reduced in 57.3% of patients in indocyanine green angiography. There was no systemic adverse effect of PDT, but increased subretinal hemorrhage after PDT occurred in 10 eyes (11.6%). CONCLUSIONS: In polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin is safe and effective for preserving visual acuity and reducing vascular leakage and retinal thickness.