A Case of Atypical Cytomegalovirus Corneal Endotheliitis after Intravitreal Triamcinolone Injection

Purpose@#We present an atypical case of cytomegalovirus corneal endotheliitis after intravitreal triamcinolone injection.Case summary: A 61-year-old man presented with decreased visual acuity after intravitreal triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection for cystoid macular edema following cataract surgery. Ocular examination revealed elevated intraocular pressure, diffuse keratic precipitates with corneal edema, and anterior chamber inflammation. These findings were suggestive of viral corneal endotheliitis. Polymerase chain reaction analysis of the anterior chamber aqueous humor detected cytomegalovirus DNA. Consequently, the patient was diagnosed with cytomegalovirus corneal endotheliitis. He was treated with oral valganciclovir (Valcyte®, Roche, Basel, Switzerland) at a dose of 1,800 mg/day for 3 weeks as an induction phase, followed by 900 mg/day for 3 weeks as a remission phase. This treatment regimen led to significant improvement in corneal edema and anterior chamber inflammation with complete restoration of visual acuity. @*Conclusions@#It is important to note that cytomegalovirus endotheliitis can occur after intravitreal triamcinolone injection and can present in an atypical rather than a typical form.

Ten-year Results after Conventional Corneal Cross-linking in Korean Patients with Progressive Keratoconus

Purpose@#To evaluate the long-term effects of conventional corneal cross-linking in patients with progressive keratoconus. @*Methods@#A total of 18 eyes of 9 patients diagnosed with keratoconus were analyzed retrospectively. One eye was diagnosed with progressive keratoconus and conventional corneal crosslinking was performed. The other eye was classified as non-progressive and remained untreated. All patients were assessed with best corrected visual acuity (BCVA), maximum keratometry (Kmax), mean keratometry (Kmean), corneal astigmatism, and corneal thickness. Clinical data were collected before the procedure and at 1, 3, 6 months and 1 to 10 years after the procedure. @*Results@#The BCVA significantly improved from 0.63 ± 0.18 logarithm of the minimum angle of resolution (logMAR) to 0.46 ± 0.25 logMAR at 10 years after conventional corneal crosslinking (p = 0.027). The Kmax and Kmean decreased from 65.90 ± 9.43 D and 52.82 ± 5.16 D to 62.83 ± 8.16 D and 51.52 ± 5.18 D, respectively (p = 0.021, p = 0.028, respectively). Corneal astigmatism decreased from 6.97 ± 2.21 D to 5.53 ± 1.64 D (p = 0.008). The thinnest corneal thickness decreased from 435.11 ± 53.37 μm to 369.22 ± 64.00 μm 1 month after the procedure (p = 0.008), and gradually improved over time. At 10 years, the thinnest corneal thickness increased to 410.11 ± 61.32 μm (p = 0.097). In the untreated eyes, the mean keratometry significantly increased after 4 years of follow-up, but other factors did not change significantly. Although corneal opacity persisted for up to 10 years in 3 eyes of the treatment group, there was no significant difference of BCVA compared to the treated eyes without corneal opacity (p = 0.714). @*Conclusions@#In patients with progressive keratoconus, conventional corneal crosslinking is a safe and effective procedure that suppresses long-term progression.

Comparison of Ranibizumab and Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

PURPOSE: To assess the effectiveness and safety of intravitreal ranibizumab compared with bevacizumab for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: This was a retrospective study of 80 eyes with macular edema associated with BRVO. Patients received either 0.5 mg of ranibizumab (n = 24) or 1.25 mg of bevacizumab (n = 56) intravitreally. Both groups received three initial monthly injections followed by as-needed injections. The best-corrected visual acuity, central subfield thickness, mean number of injections, and retreatment rate were evaluated monthly for 6 months after the initial injection. RESULTS: The best-corrected visual acuity significantly improved from logarithm of the minimal angle of resolution (logMAR) 0.55 ± 0.26 at baseline to 0.24 ± 0.26 at 6 months in the ranibizumab group (p < 0.001) and from logMAR 0.58 ± 0.21 at baseline to 0.29 ± 0.25 at 6 months in the bevacizumab group (p < 0.001), which is not a statistically significant difference (p = 0.770). The mean reduction in central subfield thickness at 6 months was 236 ± 164 µm in the ranibizumab group (p < 0.001) and 219 ± 161 µm in the bevacizumab group (p < 0.001), which is not also a statistically significant difference (p = 0.698). The mean numbers of ranibizumab and bevacizumab injections were 3.25 ± 0.53 and 3.30 ± 0.53, respectively (p = 0.602). In addition, after the three initial monthly injections, the retreatment rates for ranibizumab and bevacizumab injections were 20.8% and 26.7%, respectively (p = 0.573). CONCLUSIONS: Both ranibizumab and bevacizumab were effective for the treatment of BRVO and produced similar visual and anatomic outcomes. In addition, the mean number of injections and the retreatment rates were not significantly different between the groups.

A Case of Conjunctival Lithiasis with Clinical Manifestations of Superior Limbic Keratoconjunctivitis

PURPOSE: To report a case of conjunctival lithiasis with clinical manifestations of superior limbic keratoconjunctivitis. CASE SUMMARY: A 40-year-old male complained of pain, foreign body sensation and injection in the left eye lasting 1 month. The slit-lamp examination revealed injection of the superior bulbar conjunctiva, linear corneal band opacity, fine punctate staining and epithelial defect in the superior cornea area. After eversion of the left upper eyelid, there were many various-sized conjunctional concretions and inflammation in the superior tarsal conjunctiva. Therefore, we considered conjunctival lithiasis-induced clinical manifestations of superior limbic keratoconjunctivitis and then removed the conjunctival concretions using a 30-gauge needle. After the procedures, artificial tears, antibiotic eye drops, steroid eye drops and a therapeutic contact lens were applied. After 1 week, all symptoms and signs improved and there was no recurrence for 4 months. CONCLUSIONS: Mechanical stimulation by severe conjunctival lithiasis can induce clinical manifestations of superior limbic keratoconjunctivitis. Therefore, in patients with clinical manifestations of superior limbic keratoconjunctivitis, conjunctival lithiasis should be considered by observing the superior tarsal conjunctiva more closely.