Comparison of Very Low Fluence and Low Fluence Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

PURPOSE: To investigate the safe, effective light dose for photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC). METHODS: Thirty-eight eyes of 37 patients with chronic CSC were recruited for this study. From November 2009 to July 2010 and from April 2011 to February 2012, PDT was performed using 50% and 25% of the full light dose in 27 eyes of 27 patients (group I) and 11 eyes of 10 patients (group II), respectively. The minimum follow-up period was 6 months. Mean change in best corrected visual acuity (BCVA) and central retinal thickness, hyperpermeability change from abnormal choriocapillaris, success rate, recurrence rate, and complications were analyzed. RESULTS: Group I showed that BCVA (log MAR) improved significantly from 0.33 +/- 0.17 to 0.14 +/- 0.15 at 6 months (p < 0.001). However, there was no significant improvement of BCVA (p = 0.050) in group II. One eye out of 27 eyes (3.7%) in group I and 5 eyes out of 11 eyes (45.5%) in group II showed recurrence at the 6-month follow-up (p = 0.016). After initial PDT, hyperpermeability from abnormal choriocapillaris reduced or disappeared at 95.5% in group I and 54.5% in group II at month 3 (p = 0.016). No patient in either group experienced severe adverse events. CONCLUSIONS: PDT performed with 50% of the full light dose appears to be a more useful method in the treatment of chronic CSC, with less frequent recurrence, than PDT using 25% of the full light dose.

Macular Edema Following Branch Retinal Vein Occlusion: A Comparison of Natural Course and Treatment with Intravitreal Bevacizumab Injection

PURPOSE: To assess long-term comparisions of intravitreal bevacizumab injection (IVB group) with natural course (Natural course group) in patients with macular edema after branch retinal vein occlusion (BRVO). METHODS: Fifty-seven patients were included in this retrospective study and were followed-up for at least 12 months. Patients in the Natural course group (27 eyes of 27 patients) were enrolled before February 2007, and patients in the IVB group (30 eyes of 30 patients) underwent intravitreal bevacizumab injection as-needed after February 2007. The main efficacy outcome was reported as the mean change from baseline best corrected visual acuity (BCVA), and all patients were measured at the initial visit and after 1, 3, 6, and 12 months. Retreatment criteria included central subfield macular thickness (CSMT) greater than 300 microm or increased CSMT of at least 100 microm between visits. RESULTS: There were no statistically significant differences in age or initial BCVA between the 2 groups. Mean changes of BCVA at initial visit and at 3 and 12 months were 0.61 +/- 0.48, 0.44 +/- 0.46 and 0.34 +/- 0.40 in the Natural course group and 0.67 +/- 0.40, 0.31 +/- 0.26 and 0.27 +/- 0.25 in the IVB group, respectively. Improvement in BCVA was observed in both groups at 12 months, although the IVB group improved significantly more at 3 months and not at 12 months (p = 0.018, p = 0.187, respectively). CONCLUSIONS: More frequent bevacizumab injection schedule appears necessary to achieve better long-term visual outcome for patients with macular edema following BRVO.

Bilateral Serous Retinal Detachment as a Presenting Sign of Acute Lymphoblastic Leukemia

We present a case of bilateral serous retinal detachment (SRD) as a presenting sign of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). A 45-year-old woman presented with decreased vision and was found to have bilateral serous retinal detachment. Peripheral blood smears revealed leukocytosis of 53.9x10(3)/microliter with 64.6% lymphoblasts. A bone marrow aspirate revealed the presence of lymphoblasts. Cytogenetic and molecular genetic analysis detected a reciprocal translocation between chromosome 9 and 22, t(9;22) (q34;q11). A diagnosis of Ph+ ALL was made. Following systemic chemotherapy, the bilateral SRD resolved completely with full recovery of vision. The sudden appearance of SRD should raise suspicion for leukemia. Prompt recognition of this disease is important for early systemic treatment and restoration of visual function.

Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion

We report three cases of neovascular glaucoma secondary to central retinal artery occlusion (CRAO) which were effectively managed with intravitreal bevacizumab (IVB) followed by panretinal photocoagulation (PRP). Neovascular glaucoma without peripheral anterior synechiae developed between one and five weeks following CRAO onset. All patients received 0.75 mg (0.03 ml) IVB. In all patients, complete regression of the iris and anterior chamber angle neovascularization was confirmed within one week. PRP was applied two weeks after the injection. The follow-up period was four to seven months (average, five months). Intraocular pressure was controlled in all patients using topical antiglaucoma medications alone. However, one patient experienced a recurrence of neovascularization three months after the initial combination treatment. This patient received another IVB injection and additional PRP, and the recurrent neovascularization resolved. There were no local or systemic adverse events in any patients. Therefore, intravitreal bevacizumab may be an effective adjunct in the treatment of neovascular glaucoma associated with CRAO.

Application of Intravitreal Bevacizumab for Circumscribed Choroidal Hemangioma

We report 3 cases of circumscribed choroidal hemangioma (CCH) effectively managed with intravitreal bevacizumab. One patient (case 1) who had recurrent CCH (1.6 mm in thickness) with prior laser photocoagulation was treated with intravitreal bevacizumab alone. Two patients (case 2 and 3) who had CCH (2.4 mm and 2.2 mm in thickness, respectively) with recent visual impairment were treated with bevacizumab followed by photodynamic therapy (PDT). Ophthalmic evaluations included visual acuity, ophthalmoscopic examination, fluorescein angiography, ultrasonography, and optical coherence tomography. Patients were followed up for 6-9 months. After therapy, all patients showed improved visual acuity due to complete resorption of subretinal fluid and macular edema. Ultrasonography demonstrated a reduction of the thickness of CCH in case 1 and complete regression of the lesions in case 2 and 3. No patient showed tumor recurrence. Intravitreal bevacizumab, alone or in combination therapy with PDT, may be a useful alternative for the treatment of symptomatic CCH with subretinal fluid.

A Case of Oculomotor Nerve Palsy and Choroidal Tuberculous Granuloma Associated with Tuberculous Meningoencephalitis

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.

A Case of Chronic Monocular Solar Retinopathy / 영남의대학술지

Solar retinopathy is a rare but well-recognized clinical entity of macular damage, caused by viewing a solar eclipse or direct sun gazing. A 21-year-old man gazed at the sun for approximately thirty seconds at noon using a monocular telescope with his left eye. Forty-eight hours after sun gazing, the patient experienced symptoms of blurred vision and central scotoma in the left eye. Eight months after sun gazing, the visual acuity decreased from 1.0 to 0.1 in the left eye and the fundus examination showed a round, yellowish-white discoid lesion at the left fovea. Fluorescein angiography showed an early window defect in the fovea of the left eye, that persisted without size change during the late phase resulting from atrophy of the retinal pigment epithelium. A small, central scotoma of the left eye was also found in the visual field test. The visual acuity was unchanged at the end of a one-year follow-up period.