Treatment Results of Treatment-naïve Neovascular Age-related Macular Degeneration in Patients Over 85 Years of Age

Purpose@#To investigate the characteristics and treatment results of patients aged ≥ 85 years who were diagnosed with treatment-naïve neovascular age-related macular degeneration (nAMD). @*Methods@#The medical records of patients diagnosed with treatment-naïve nAMD who were ≥ 85 years old at the time of diagnosis with at least 12 months follow-up were retrospectively reviewed. The number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) and agents used during the entire period were investigated. Best-corrected visual acuity and optical coherence tomography results before and after treatment were analyzed. Visual acuity of the fellow eye was also collected. @*Results@#A total of 40 eyes of 40 patients with mean age of 87.5 ± 2.4 were included in the study. The mean logarithm of the minimal angle of resolution visual acuity was 0.85 ± 0.57, and the mean of the fellow eye was 0.93 ± 0.99. Compared to before the treatment, there was no significant difference after intravitreal injection in terms of visual acuity. Central retinal thickness showed significant reduction at all time points after treatment. @*Conclusions@#In patients aged ≥ 85 years at the time of diagnosis, intravitreal injections of anti-VEGF prevented deterioration of visual acuity and showed successful anatomical outcomes. Especially, many had poor visual acuity in the fellow eye, suggesting the importance of maintaining visual acuity. Therefore, active treatment is necessary in the elderly.

Morning Glory Syndrome associated with Autosomal Dominant Alport Syndrome with a Heterozygous COL4A4 Mutation

Morning glory syndrome (MGS) is a rare congenital optic disc anomaly with a characteristic fundal finding with severe visual impairment. It may occur in association with various systemic manifestations, even though most of the reported cases were isolated. A 6-year-old male visited the nephrology clinic with a history of microscopic hematuria and at the age of 12 years, he was diagnosed thin glomerular basement membrane nephropathy by kidney biopsy. After the following years, the patient had progressive deterioration of visual acuity, and diagnosed as MGS. Whole Exome Sequencing of this patient and his mother revealed heterozygous COL4A4 mutations [c.81_86del (p.Ile29_Leu30del)]. It is more reasonable to consider MGS seen in this patient as a coincidental finding of autosomal dominant Alport syndrome. To our knowledge, this case represents the first case report of autosomal dominant Alport syndrome associated with MGS.

Choroidal Thickness Analysis in Primary Rhegmatogenous Retinal Detachment

Purpose@#We analyzed the choroidal thickness in the subfoveal area and area of retinal detachment (RD) in monocular primary rhegmatogenous retinal detachment (RRD) patients and compared the RD eye with the fellow eye. @*Methods@#We retrospectively analyzed, optical coherence tomography data of both eyes at the first visit in patients who underwent surgery for monocular RRD from January 2013 to December 2016. Choroidal thickness was examined manually in the subfoveal and RD areas by two independent ophthalmologists; subjects without data from at least one of the two investigators were excluded. @*Results@#Ninety-five subjects were included in this study. Of the 95 RD eyes, 61 (64.2%) and 44 (46.3%) eyes showed macula and fovea invasion, respectively. The subfoveal choroidal thickness was statistically significant in the RD eye compared with the fellow eye (244.7 ± 79.0 µm vs. 220.1 ± 78.9 µm; p < 0.001). Moreover, the choroidal thickness of the RD area in the RD eye was thicker compared with the non-detachment area and corresponding area in the fellow eye (273.8 ± 53.4 µm vs. 215.2 ± 44.0 µm and 233.3 ± 56.7 µm, respectively; p < 0.001). @*Conclusions@#In the primary RRD eye, the choroidal thickness in the detachment area was thicker than that of the fellow eye. Further studies are needed to investigate the mechanism of choroidal thickness change and its impact on RD.

Choroidal Vascularity Index in Rhegmatogenous Retinal Detachment

Purpose@#To analyze the choroidal vascularity index (CVI) in an eye with retinal detachment and the fellow eye of a patient with monocular primary rhegmatogenous retinal detachment (RRD). @*Methods@#We retrospectively analyzed optical coherence tomography data of both eyes at the first visit of patients who underwent surgery for monocular RRD from January 2017 to January 2018. The subfoveal CVIs of the RD eye, the fellow eye, and the postoperative 3-months RD eye were analyzed using Image J software by two independent ophthalmologists. @*Results@#Forty-five subjects were included. Of the 45 RD eyes, 25 eyes (55.6%) showed macula invasion. The subfoveal CVI was statistically lower in the RD eye compared with the fellow eye (65.61 ± 3.37 vs. 67.28 ± 3.44, respectively; p = 0.024). In the macula-on RD group, the preoperative subfoveal CVI was statistically higher than the subfoveal CVI of postoperative 3 months (67.62 ± 2.35 vs. 65.84 ± 3.04, respectively; p = 0.009). However, the preoperative subfoveal CVI was statistically lower than the subfoveal CVI of postoperative 3 months in the macula-off RD group (64.01 ± 3.21 vs. 66.69 ± 2.64, respectively; p < 0.001). @*Conclusions@#In primary RRD eyes, the subfoveal CVI was lower in the RD eye compared to the fellow eye. In macula-off RD eyes, the subfoveal CVI was lower in preoperative RD eyes compared to postoperative RD eyes. The subfoveal CVI was higher in the preoperative RD eyes compared to postoperative RD eyes in macula-on RD eyes. Further studies are needed to investigate the effects of RD on changes in the lumina and stoma in the choroid.

Choroidal Thickness Analysis in Primary Rhegmatogenous Retinal Detachment

Purpose@#We analyzed the choroidal thickness in the subfoveal area and area of retinal detachment (RD) in monocular primary rhegmatogenous retinal detachment (RRD) patients and compared the RD eye with the fellow eye. @*Methods@#We retrospectively analyzed, optical coherence tomography data of both eyes at the first visit in patients who underwent surgery for monocular RRD from January 2013 to December 2016. Choroidal thickness was examined manually in the subfoveal and RD areas by two independent ophthalmologists; subjects without data from at least one of the two investigators were excluded. @*Results@#Ninety-five subjects were included in this study. Of the 95 RD eyes, 61 (64.2%) and 44 (46.3%) eyes showed macula and fovea invasion, respectively. The subfoveal choroidal thickness was statistically significant in the RD eye compared with the fellow eye (244.7 ± 79.0 µm vs. 220.1 ± 78.9 µm; p < 0.001). Moreover, the choroidal thickness of the RD area in the RD eye was thicker compared with the non-detachment area and corresponding area in the fellow eye (273.8 ± 53.4 µm vs. 215.2 ± 44.0 µm and 233.3 ± 56.7 µm, respectively; p < 0.001). @*Conclusions@#In the primary RRD eye, the choroidal thickness in the detachment area was thicker than that of the fellow eye. Further studies are needed to investigate the mechanism of choroidal thickness change and its impact on RD.

Choroidal Vascularity Index in Rhegmatogenous Retinal Detachment

Purpose@#To analyze the choroidal vascularity index (CVI) in an eye with retinal detachment and the fellow eye of a patient with monocular primary rhegmatogenous retinal detachment (RRD). @*Methods@#We retrospectively analyzed optical coherence tomography data of both eyes at the first visit of patients who underwent surgery for monocular RRD from January 2017 to January 2018. The subfoveal CVIs of the RD eye, the fellow eye, and the postoperative 3-months RD eye were analyzed using Image J software by two independent ophthalmologists. @*Results@#Forty-five subjects were included. Of the 45 RD eyes, 25 eyes (55.6%) showed macula invasion. The subfoveal CVI was statistically lower in the RD eye compared with the fellow eye (65.61 ± 3.37 vs. 67.28 ± 3.44, respectively; p = 0.024). In the macula-on RD group, the preoperative subfoveal CVI was statistically higher than the subfoveal CVI of postoperative 3 months (67.62 ± 2.35 vs. 65.84 ± 3.04, respectively; p = 0.009). However, the preoperative subfoveal CVI was statistically lower than the subfoveal CVI of postoperative 3 months in the macula-off RD group (64.01 ± 3.21 vs. 66.69 ± 2.64, respectively; p < 0.001). @*Conclusions@#In primary RRD eyes, the subfoveal CVI was lower in the RD eye compared to the fellow eye. In macula-off RD eyes, the subfoveal CVI was lower in preoperative RD eyes compared to postoperative RD eyes. The subfoveal CVI was higher in the preoperative RD eyes compared to postoperative RD eyes in macula-on RD eyes. Further studies are needed to investigate the effects of RD on changes in the lumina and stoma in the choroid.

Clinical Manifestations of Syphilitic Uveitis in the Korean Population

PURPOSE: In recent, years, an increase of syphilis infections has become an issue in Korea as well as globally. Herein, we report a recent clinical manifestation of syphilitic uveitis in a Korean population. METHODS: Over a 5-year period (2007-2012), we collected and analyzed the medical records of 16 patients with syphilitic uveitis in three tertiary eye clinics in Pusan. Sixteen patients were confirmed to have syphilis based on serological tests. Retrospective chart review was performed to determine the best corrected visual acuity, anterior and posterior segments, and treatment regimen, as well as ancillary test results including fluorescein angiogram (FAG). RESULTS: Of the 16 patients, 12 were males and four were females. The mean age of the patients was 51.16 years. Non-granulomatous anterior uveitis was observed in nine eyes (47.4%). Vitritis was the most frequently observed posterior segment finding (16 eyes, 84.2%). Retinal vasculitis and chorioretinitis were found in 11 (57.9%) and five eyes (26.3%), respectively. All patients had negative results in the serum HIV antibody test. Of the 16 patients, 15 were treated with penicillin or ceftriaxone due to neurosyphilis. Mean visual acuity improved from 1.33 +/- 1.1 to 0.58 +/- 0.68 after treatment. CONCLUSIONS: Clinical manifestation of syphilitic uveitis in Korean patients is different from occurrences in Western countries. Ophthalmological findings of syphilitic uveitis are diverse; thus, serological testing for syphilis is recommended for all uveitis patients. Further research regarding long-term treatment, relapse of syphilitic uveitis, and complications is necessary.

Vogt-Koyanagi-Harada Disease in a Pregnant Patient Successfully Treated with Intravitreal Triamcinolone Injection

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. CASE SUMMARY: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. CONCLUSIONS: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.