Intravitreal Bevacizumab Injections for Macular Edema Secondary to Major and Macular Branch Retinal Vein Occlusion

PURPOSE: To compare therapeutic outcome of intravitreal bevacizumab in treating macular edema between major and macular branch retinal vein occlusion (BRVO). METHODS: This retrospective, observational study included 58 eyes from 58 patients with macular edema secondary to BRVO. All patients were treated with intravitreal bevacizumab injection at baseline, followed by further injections as required with monthly follow-up. Central foveal thickness and best-corrected visual acuity (BCVA) were evaluated after treatment between major and macular BRVO during 12 months of follow-up. RESULTS: The mean best-corrected visual acuity (BCVA) in the major BRVO group (39 eyes), expressed as the logarithm of the minimum angle of resolution (logMAR), decreased from 0.66 ± 0.47 to 0.34 ± 0.28 after 12 months of treatment (p = 0.011). Similarly, in the macular BRVO group (19 eyes), the BCVA decreased from 0.60 ± 0.41 to 0.30 ± 0.22 (p = 0.014). The central foveal thickness decreased in the major BRVO group from 498.5 ± 194.3 µm to 311.3 ± 178.5 µm and in the macular BRVO group from 442.4 ± 155.8 µm to 297.2 ± 145.7 µm (p = 0.004 and 0.002, respectively). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. The mean injection number of macular BRVO (2.6 ± 1.6) was significantly lower than that of major BRVO (3.5 ± 1.4, p = 0.021). CONCLUSIONS: The visual acuity improvement achieved after 12 months of intravitreal bevacizumab injection did not differ significantly between major and macular BRVO. However, significantly fewer injections were required for macular BRVO than major BRVO.

Intravitreal Bevacizumab Injections for Macular Edema Secondary to Major and Macular Branch Retinal Vein Occlusion

PURPOSE: To compare therapeutic outcome of intravitreal bevacizumab in treating macular edema between major and macular branch retinal vein occlusion (BRVO). METHODS: This retrospective, observational study included 58 eyes from 58 patients with macular edema secondary to BRVO. All patients were treated with intravitreal bevacizumab injection at baseline, followed by further injections as required with monthly follow-up. Central foveal thickness and best-corrected visual acuity (BCVA) were evaluated after treatment between major and macular BRVO during 12 months of follow-up. RESULTS: The mean best-corrected visual acuity (BCVA) in the major BRVO group (39 eyes), expressed as the logarithm of the minimum angle of resolution (logMAR), decreased from 0.66 ± 0.47 to 0.34 ± 0.28 after 12 months of treatment (p = 0.011). Similarly, in the macular BRVO group (19 eyes), the BCVA decreased from 0.60 ± 0.41 to 0.30 ± 0.22 (p = 0.014). The central foveal thickness decreased in the major BRVO group from 498.5 ± 194.3 µm to 311.3 ± 178.5 µm and in the macular BRVO group from 442.4 ± 155.8 µm to 297.2 ± 145.7 µm (p = 0.004 and 0.002, respectively). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. The mean injection number of macular BRVO (2.6 ± 1.6) was significantly lower than that of major BRVO (3.5 ± 1.4, p = 0.021). CONCLUSIONS: The visual acuity improvement achieved after 12 months of intravitreal bevacizumab injection did not differ significantly between major and macular BRVO. However, significantly fewer injections were required for macular BRVO than major BRVO.

Choroidoretinopathy and Secondary Angle Closure Attack in Systemic Lupus Erythematosus: A Case Report

PURPOSE: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with widespread manifestations that rarely include the eye. We present a case of SLE-associated choroidoretinopathy and secondary angle closure attack in both eyes. CASE SUMMARY: A 58-year-old male was admitted into the urologic department complaining of right scrotal swelling, and then consulted with the ophthalmology department regarding both ocular pain and eye injection. The patient was diagnosed with acute angle closure attack using a slit lamp test and tonometry secondary to choroidoretinitis with choroidal detachment at fundus examination in both eyes. The rheumatologist performed systemic evaluation, including serologic tests, and then diagnosed the patient with SLE. After systemic steroid therapy, intraocular pressure was decreased and choroidal detachment disappeared with improvements of choroidoretinitis in both eyes. CONCLUSIONS: Patients with systemic lupus erythematosus choroidopathy can develop secondary angle closure attack, which can be effectively treated using systemic steroid therapy and antiglaucoma drugs.

Short-term Effectiveness of Intravitreal Triamcinolone Injection for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To evaluate the short-term efficacy of intravitreal triamcinolone (IVTA) injection for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO) refractory to intravitreal bevacizumab injections. METHODS: This retrospective, observational study included 23 eyes of 23 patients with macular edema secondary to BRVO. The patients with macular edema unresponsive to 2 or more consecutive monthly intravitreal bevacizumab injections were treated with IVTA. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before IVTA and 1 month and 3 months after IVTA injections. RESULTS: All patients were previously treated with 3.4 ± 1.2 intravitreal bevacizumab injections. The IVTA injection was performed at 4.3 ± 1.7 weeks after the last bevacizumab injection. The logarithm of the minimal angle of resolution (log MAR) BCVA was also decreased from 0.61 ± 0.45 to 0.52 ± 0.35 after 1 month and to 0.58 ± 0.37 after 3 months of IVTA, although without statistical significance (p = 0.114 and 0.412, respectively). Eight eyes (34.8%) showed more than 3 lines improvement of BCVA and 4 eyes (17.4%) showed stable BCVA increasing 2 lines or less. CFT was significantly improved from 512 ± 166 µm to 310 ± 139 µm after 1 month and to 324 ± 159 µm after 3 months of IVTA injections (p = 0.014 and 0.031, respectively). CONCLUSIONS: IVTA was beneficial in some patients with macular edema secondary to BRVO refractory to intravitreal bevacizumab therapy. This study indicates that IVTA could be considered as a treatment option for refractory macular edema associated with BRVO.

Factors Associated with Screening for Diabetic Retinopathy in Diabetic Patients Aged > or = 40 Years Using the KNHANES IV

PURPOSE: To identify factors associated with care of diabetic retinopathy. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. This survey included 1, 257 people aged 40 years and older with a history of diabetic mellitus who answered questions, "Within one year, have you ever received eye examination (fundus photography) for screening diabetic retinopathy?" Factors that affect care of diabetic retinopathy were identified using multiple logistic regression analysis. RESULTS: Among the 1,257 people aged 40 years and older, 464 (36.9%) received screening for diabetic retinopathy. People aged 65 years and older (aOR = 0.7, 95% CI: 0.51-0.85) with university education (aOR = 0.5, 95% CI: 0.32-0.74) were more likely to undergo screening for diabetic retinopathy compared to those in the reference category (40-64 years old and those who had elementary school or lower education). People living in rural areas were less likely to undergo screening for diabetic retinopathy compared to those living in urban areas (aOR = 1.7, 95% CI: 1.32-2.24). Diabetic retinopathy screening was also associated with self-reported health status (ref: unhealthy [aOR = 1], fair [aOR = 1.7, 95% CI: 1.25-2.23], and healthy [aOR = 1.8, 95% CI: 1.30-2.44]). CONCLUSIONS: To increase nationwide screening rates for diabetic retinopathy, more attention should be given to underserved groups, particularly people aged between 40 and 64 years, those with a low education level, those living in rural areas, and those with a positive attitude toward self-reported health status. These issues highlight the need for a new emphasis in health education and public health policies aimed towards these underserved groups.

The Prismatic Effect on Stereoacuity in Intermittent Exotropia

PURPOSE: To evaluate the effect of acrylic refractive prism and Fresnel membrane prism on stereoacuity in intermittent exotropia. MATERIALS AND METHODS: Stereoacuities of fifty-two patients (mean age, 12.4 years; range 6 to 45 years) with intermittent exotropia were measured using the Titmus and TNO stereotests, while they wore prisms of varying power on nonfixating eye or evenly on each eye. RESULTS: Stereoacuities were significantly reduced with increasing prism power for both prisms, ranging from 8 to 25 prism dipotres. The effects on stereoacuity in single acrylic prism and single Fresnel prism were similar, whereas spilt Fresnel prisms reduced stereoacuity more than spilt acrylic prisms. Spilt prisms were found to have much less effect on stereoacuity than single prisms for both acrylic and Fresnel prisms. CONCLUSION: The use of acrylic refractive prism shared evenly on each eye would be optimal method to minimize the reduction of stereoacuity during the prismatic therapy for intermittent exotropia.

Occurrence and Risk Factors of Decompensation and Additional Treatment in Refractive Accommodative Esotropia

PURPOSE: To examine the occurrence and risk factors of decompensation and the additional treatment of increased hyperopia in refractive accommodative esotropia. METHODS: Seventy children with refractive accommodative esotropia were followed up for at least 2 years. Time of decompensation and additional treatment, initial refractive error, initial deviation, and controlled deviation were all studied. RESULTS: Decompensation and additional treatment occurred on average at 21.8 months and 22.2 months in eight patients, respectively, and constant survival was achieved after 4 years of full correction of the refractive error, as shown on a Kaplan-Meier survival curve. In the decompensation, additional treatment and control groups, initial refractive errors were 3.97+/-1.07D, 4.06+/-1.92D and 4.60+/-1.29D, respectively; initial deviations were 36.25+/-12.75PD, 31.25+/-10.61PD and 26.02+/-8.62PD, respectively; and controlled deviations were 4.50+/-6.30PD, 4.50+/-4.63PD and 2.65+/-4.10PD, respectively. There was a significant difference in initial deviation between the decompensation and control groups (p=0.011). CONCLUSIONS: The treatment of decompensation and increased hyperopia warranted careful follow-up in the first 4 years after treatment, and patients with large initial deviation risked decompensation.

Comparison of Central Corneal Thickness after the Instillation of Topical Anesthetics: Proparacaine versus Oxybuprocaine

PURPOSE: To compare changes in human central corneal thickness after instillation of proparacaine with those after oxybuprocaine instillation, over a period of 10 minutes. METHODS: Eighteen healthy young participants were recruited. Baseline central corneal thicknesses were measured every 30 seconds for 10 minutes using a noncontact specular microscope. Changes in central corneal thickness were measured every 20 seconds for 10 minutes after the administration of one drop of 0.5% proparacaine into the right eye, and one drop of 0.4% oxybuprocaine into the left eye. RESULTS: Mean baseline central corneal thickness was 531 +/- 45 micrometer in the right eye and 531 +/- 42 micrometer in the left. The central corneal thickness after proparacaine instillation increased to 8.6 micrometer (4.5-12.6 micrometer, 95% CI) and then returned to baseline within 80 seconds. Central corneal thickness after oxybuprocaine instillation increased to 7.7 micrometer (3.6-11.2 micrometer, 95% CI) and then returned to baseline within 80 seconds. There was a second transient increase about 5 minute after proparacaine instillation but no additional transient increase after oxybuprocaine instillation. CONCLUSIONS: The severity of oxybuprocaine's effect on central corneal thickness is similar to that of proparacaine. Central corneal thickness instability may occur for 5 minutes after proparacaine administration. Therefore, changes in central corneal thickness after topical anesthetics instillation should be considered when measuring central corneal thickness.