Refractive Errors, Retinal Findings, and Genotype of Tuberous Sclerosis Complex:A Retrospective Cohort Study

Purpose@#To examine the refractive errors, retinal manifestations, and genotype in tuberous sclerosis complex (TSC) patients in a Korean population. @*Materials and Methods@#A total of 98 patients with TSC were enrolled in Severance Hospital for a retrospective cohort study. The number of retinal astrocytic hamartoma and retinal achromic patch within a patient, as well as the size, bilaterality, and morphological type were studied. In addition, the refractive status of patients and the comorbidity of intellectual disability and epilepsy were also examined. @*Results@#Retinal astrocytic hamartoma was found in 37 patients, and bilateral invasion was observed in 20 patients (54%). TSC1 mutation was associated with myopia (p=0.01), while TSC2 mutation was associated with emmetropia (p=0.01). Retinal astrocytic hamartoma was categorized into three morphological types and examined as follows: type I (87%), type II (35%), and type III (14%). Single invasion of retinal astrocytic hamartoma was identified in 32% of the patients, and multiple invasions in 68%. The TSC1/ TSC2 detection rate was 91% (41/45). Among them, TSC1 variant was detected in 23 patients (54%), whereas TSC2 variant was detected in 18 patients (40%). The results showed that TSC2 mutations are correlated with a higher rate of retinal astrocytic hamartoma involvement (all p<0.05), and multiple and bilateral involvement of retinal hamartomas (all p<0.05). However, the size of retinal astrocytic hamartomas, comorbidity of epilepsy, or intellectual disability did not show correlation with the genetic variant. @*Conclusion@#TSC1 variant patients were more myopic, while TSC2 variant patients showed association with more extensive involvement of retinal astrocytic hamartoma.

Voretigene Neparvovec for the Treatment of RPE65-associated Retinal Dystrophy: Consensus and Recommendations from the Korea RPE65-IRD Consensus Paper Committee

Mutations in the RPE65 gene, associated with Leber congenital amaurosis, early-onset severe retinal dystrophy, and retinitis pigmentosa, gained growing attention since gene therapy for patients with RPE65-associated retinal dystrophy is available in clinical practice. RPE65 gene accounts for a very small proportion of patients with inherited retinal degeneration, especially Asian patients. Because RPE65-associated retinal dystrophy shares common clinical characteristics, such as early-onset severe nyctalopia, nystagmus, low vision, and progressive visual field constriction, with retinitis pigmentosa by other genetic mutations, appropriate genetic testing is essential to make a correct diagnosis. Also, fundus abnormalities can be minimal in early childhood, and the phenotype is highly variable depending on the type of mutations in RPE65-associated retinal dystrophy, which makes a diagnostic difficulty. The aim of this paper is to review the epidemiology of RPE65-associated retinal dystrophy, mutation spectrum, genetic diagnosis, clinical characteristics, and voretigene neparvovec, a gene therapy product for the treatment of RPE65-related retinal dystrophy.

Chemokine Receptor Profiles of T Cells in Patients with Age-Related Macular Degeneration

Purpose@#To evaluate the expression of multiple chemokine receptors in peripheral blood T cells from patients with age-related macular degeneration (AMD). @*Materials and Methods@#Peripheral blood mononuclear cells and/or aqueous humor were obtained from 24 AMD patients and 24 age- and sex-matched healthy controls. Chemokine receptor expression on T cells from peripheral blood was determined by multicolor flow cytometry. The levels of chemokines and cytokines in the aqueous humor from 12 AMD patients and six healthy controls were assessed. @*Results@#AMD patients had increased expressions of CCR4 in CD4 + T cells (p=0.007) and CRTh2 in CD8 + T cells (p=0.002), and decreased expressions of CXCR3 in CD4+T cells (p=0.029) and CXCR3, CCR5, and CX 3CR1 in CD8+T cells (p=0.005, 0.019, and 0.007, respectively). Monocyte chemoattractant protein-1 levels were increased in the aqueous humor from AMD patients (p=0.018), while the levels of interleukin (IL)-4 and IL-22 were significantly decreased compared to controls (p=0.018 and 0.041, respectively). @*Conclusion@#The chemokine receptor profiles of T cells are altered in AMD patients compared to healthy controls without noticeable associations with chemokine levels in the aqueous humor. Further evaluation is needed to clarify the role of these alterations in AMD pathogenesis.

Therapeutic Efficacy of Spironolactone for Central Serous Chorioretinopathy

Purpose@#To evaluate the therapeutic effects and safety of oral spironolactone (SPRL) in patients with central serous chorioretinopathy (CSC). @*Materials and Methods@#The medical records and imaging data of patients diagnosed with CSC and treated with SPRL were retrospectively reviewed. Central macular thickness (CMT), subretinal fluid (SRF) height, subfoveal choroidal thickness (SFCT), and best-corrected visual acuity (BCVA) at baseline, at 1, 3, and 6 months, and at the last visit after the treatment were analyzed. @*Results@#In total, 103 patients with 107 eyes were included. The mean age of the patients was 51.5±9.3 years, and 77 (72.0%) were male. The mean follow-up duration was 48.6±40.2 weeks. The mean duration of oral SPRL therapy was 15.5±13.4 weeks. CMT, SRF height, and SFCT improved significantly at 1, 3, and 6 months after SPRL therapy and at the last follow-up. BCVA, however, showed no significant change at any time point. The rate of complete resolution of SRF at 1 month was higher in those with chronic CSC than in those with acute CSC (21.1% vs. 6.0%, respectively). Recurrence occurred in 14 (13.1%) eyes after the complete resolution of SRF. Older age (p=0.001), a greater number of previous intravitreal bevacizumab injections (p=0.006), and poor initial visual acuity (p=0.048) were associated with recurrence. No permanent adverse effects were observed. @*Conclusion@#Oral SPRL showed therapeutic benefits in patients with CSC in terms of SRF resolution, but relatively frequent recurrence was observed, especially in older patients.

Short-Term Outcomes of the First in Vivo Gene Therapy for RPE65-Mediated Retinitis Pigmentosa

Here, we report early treatment outcomes of gene therapy for early onset retinitis pigmentosa (RP) (Leber congenital amaurosis) associated with biallelic RPE65 mutation in a 30-year-old female patient. Initially, her visual acuity (VA) was 20/200, and her visual field (VF) was severely constricted to the center in the left eye. Her electroretinography showed nearly extinct signals. Full-field stimulus threshold test (FST) revealed diminished dark-adapted light sensitivity. Voretigene neparvovec-rzyl (VN) is the first in vivo viral gene therapy agent to be approved. At 3 months after subretinal injection of VN in the left eye, VA, VF, and FST showed sustained improvement. She did not exhibit any signs of adverse effects from the treatment. Gene therapy for RP proved to be an effective and safe treatment in an advanced case of RPE65-associatied early onset RP.

Acute Retinal Necrosis Masked by Clinical Features of Orbital Inflammation

Purpose@#To describe a case of acute retinal necrosis with clinical features of orbital inflammation.Case summary: A 33-year-old female presented with right eye injection, chemosis, and pain. At the first visit, the uncorrectedvisual acuity and intraocular pressure of her right eye were 20/20 and 20 mmHg, respectively. Slit-lamp examination showed inflammatorycell 2+ in the anterior chamber of the right eye; an evaluation of the peripheral retina was not conducted. The nextday, computed tomography (CT) was performed due to aggravation of the orbital inflammation. High-dose intravenous methylprednisoloneinjection was initiated on the finding of posterior scleritis with orbital inflammation on CT scans; peripheral retinalnecrosis and obstructive vasculitis were also noted. Clinically determined to be acute retinal necrosis, the patient began systemicantiviral therapy. A diagnostic anterior chamber paracentesis was positive for herpes simplex virus type 2 by polymerasechain reaction. The patient was treated with intravenous acyclovir and intravitreal injections of foscarnet, as well as barrier lasertherapy. After two weeks of treatment, the patient was discharged with oral valacyclovir. During the three months of follow-up,the visual acuity of the right eye was hand motion, due to chronic optic disc swelling with chronic macular edema and maculardegeneration. Neither eye showed retinal lesion progression. @*Conclusions@#Rarely, acute retinal necrosis is accompanied by clinical manifestations of orbital inflammation. Therefore, if patientshave uveitis with orbital inflammation, it is important to consider the possibility of acute retinal necrosis and to examine theperipheral retina carefully.

Tomographic Structural Changes of the Inner Retina after Internal Limiting Membrane Peeling for Idiopathic Epiretinal Membrane

Purpose@#To investigate the tomographic structural changes in the retinal layers after internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM). @*Methods@#Sixty-nine eyes treated with vitrectomy and ILM peeling for idiopathic ERM were analyzed. Parafoveal retinal thickness was measured at baseline and 6 months after surgery. @*Results@#Total retinal thickness decreased significantly in the nasal and temporal subfields after surgery (p < 0.001), whereas the inner nuclear layer and outer nuclear layer showed nasal thickening (all, p < 0.001). The postoperative temporalasal subfield thickness ratio of each layer was significantly lower than that of fellow eyes. Eyes with larger ILM peeling showed a significantly lower temporalasal subfield thickness ratio (p = 0.033) than those with smaller sizes. @*Conclusions@#The retinal thickness of each layer showed anatomical changes from ILM peeling and ERM removal. Nasal parafoveal thickening and temporal thinning occurred in the inner retinal architecture, which might be affected by ILM peeling size.

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.

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.

Bilateral Anterior Ischemic Optic Neuropathy after Gastrointestinal Bleeding

PURPOSE: To introduce a case of bilateral anterior ischemic optic neuropathy (AION) after blood loss due to gastrointestinal bleeding. CASE SUMMARY: A 50-year-old male patient with a history of type 1 diabetes mellitus and alcoholic liver cirrhosis presented with 3 days of melena and 1 day of general weakness and dizziness. Initial hemoglobin level was 4.7 g/dL and blood pressure was 100/55 mm Hg. On esophagogastroduodenoscopy, a peptic ulcer with evident recent bleeding was observed. After transfusion of packed red blood cells and endoscopic hemostasis of bleeding, his general condition improved but he complained of blurred vision in both eyes which developed immediately after the onset of melena. Initial best-corrected visual acuity (BCVA) was 0.5 in his right eye and 0.6 in the left eye. On fundus examination, swollen optic disc with blurred margin was noted and he had constricted visual fields. On follow-up, the patient received posterior subtenon triamcinolone injection in his right eye. After the procedure, the BCVA was improved to 0.8 in both eyes, but he still had bilateral pale optic disc with constricted visual field. CONCLUSIONS: In the case of visual loss after recent blood loss, AION should be considered as a diagnosis, which can present as bilateral involvement.

A Case of Intravitreal Cysticercosis with Neovascular Glaucoma

PURPOSE: To introduce a case of intravitreal cysticercosis presenting as neovascular glaucoma. CASE SUMMARY: A 42-year-old female who lives in the Philippines visited our clinic complaining of reduced visual acuity and decreased visual field in her right eye. She was treated at another clinic for neovascular glaucoma and posterior uveitis. Initial best-corrected visual acuity was 0.7 and intraocular pressure was 13 mm Hg with Goldmann applanation tonometry. Slit lamp examination showed inflammatory cells in the anterior chamber and vitreous with florid new vessel on iris. On fundus examination, a cystic lesion without movement was observed in the superonasal vitreous as well as tractional band. As other retinal vascular diseases were not observed on fluorescein angiography, the patient was diagnosed with secondary neovascular glaucoma due to cysticercosis. After a single course of intravitreal bevacizumab injection and cyst removal with pars plana vitrectomy, the best-corrected visual acuity was 0.5 and intraocular pressure was 14 mm Hg without recurrence of iris neovascularization during the 3 months of follow-up.

Risk factors of ocular involvement in children with mitochondrial respiratory chain complex defect / 소아과

PURPOSE: Mitochondrial dysfunction can present with various symptoms depending on the organ it has affected. This research tried to analyze the ophthalmologic symptoms and ophthalmologic examination (OE) results in patients with mitochondrial disease (MD). METHODS: Seventy-four patients diagnosed with mitochondrial respiratory chain complex defect with biochemical enzyme assay were included in the study. They were divided into 2 groups based on the OE results by funduscopy and were analyzed on the basis of their clinical features, biochemical test results, morphological analysis, and neuroimaging findings. RESULTS: Thirty-seven (50%) of the 74 MD patients developed ophthalmologic symptoms. Abnormal findings were observed in 36 (48.6%) patients during an OE, and 16 (21.6%) of them had no ocular symptoms. Significantly higher rates of prematurity, clinical history of epilepsy or frequent apnea events, abnormal light microscopic findings in muscle pathology, diffuse cerebral atrophy in magnetic resonance imaging, and brainstem hyperintensity and lactate peaks in magnetic resonance spectroscopy were noted in the group with abnormal OE results. CONCLUSION: Although the ophthalmologic symptoms are not very remarkable in MD patients, an OE is required. When the risk factors mentioned above are observed, a more active approach should be taken in the OE because a higher frequency of ocular involvement can be expected.

Ocular manifestations in Leigh syndrome / 소아과

PURPOSE: Leigh syndrome is a typical type of mitochondrial disease. This study was conducted to analyze the types of ophthalmologic symptoms and results of funduscopy conducted in the ophthalmologic examination of patients with Leigh syndrome. METHODS: Funduscopy was conducted on 24 subjects, who were chosen among those diagnosed as having mitochondrial respiratory chain complex defect and who were clinically suitable for the criteria of Leigh syndrome. Their clinical features, ophthalmologic symptoms, and ophthalmologic examination results were retrospectively analyzed. RESULTS: Of the 24 patients with Leigh syndrome, 11 developed ophthalmologic symptoms and no abnormal finding was observed in 13. The most frequent abnormal finding was visual disturbance in 5 patients. Funduscopy revealed abnormal findings in 17 patients; retinal pigmentation was the most frequent abnormality and was seen in 9 patients. CONCLUSION: Funduscopy can be an important screening test to find ophthalmologic abnormalities among patients with mitochondrial disease (MD), including those patients whose ophthalmologic symptoms are inconspicuous. It is predicted that an improved screening test can be made in the future that will identify risk factors related to ophthalmologic symptoms.

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.

Visually evoked potential in children with mitochondrial respiratory chain defects / 소아과

PURPOSE: Mitochondrial disorders are a clinical entity characterized by diverse symptoms and signs of involvement of various systems. Furthermore, the disorders are known to show ophthalmologic manifestations as well as neurological findings. Visually evoked potential is a sensitive measure to check the integrity of the visual pathway. In this study, we have investigated the value of visually evoked potential in mitochondrial disorders with respiratory chain defects. METHODS: Nineteen patients diagnosed with mitochondrial respiratory chain complex I defect as confirmed by spectrophotometric enzyme assay in muscle samples were enrolled for this study. The patients underwent a visually evoked potential study. We classified the results into four groups and compared these with clinical ophthalmologic findings. RESULTS: Among the 19 patients, 14 showed abnormal visually evoked potential findings. Seven patients showed abnormal clinical ophthalmologic findings. All patients with abnormal ophthalmologic findings showed abnormal visually evoked potential findings. Among the 12 patients with normal ophthalmologic findings, seven showed abnormal results in visually evoked potential. CONCLUSION: Visually evoked potential study could be used as an effective screening tool for mitochondrial disorders to detect ophthalmologic and neurological abnormalities.

Cytomegalovirus Retinitis After Intravitreous Triamcinolone Injection in a Patient with Central Retinal Vein Occlusion

To report a case of cytomegalovirus (CMV) retinitis after intravitreal injection of triamcinolone acetonide (IVTA). A 77-year-old woman with macular edema due to central retinal vein occlusion (CRVO) developed peripheral retinitis 4 months after IVTA. A diagnostic anterior chamber paracentesis was performed to obtain DNA for a polymerase chain reaction (PCR) test for viral retinitis. The PCR test was positive for CMV DNA. Other tests for infective uveitis and immune competence were negative. Four months after presentation, gancyclovir was intravitreously injected a total of 5 times, and the retinitis resolved completely. CMV retinitis is a rare complication of local immunosuppression with IVTA. It can be managed with timely injection of intravitreal gancyclovir until recovery from local immunosuppression.

Estimated Prevalence and Risk Factor for Age-related Maculopathy

PURPOSE: To assess the estimate prevalence and risk factors for age-related maculopathy (ARM) in Seoul, Korea. PATIENTS AND METHODS: We examined 9,530 subjects with, 40 years of age or older between January 2006 and December 2006 in Seoul, Korea. Subjects underwent fundus photography, clinical examinations (including blood analyses), and completed detailed questionnaires. Fundus images were graded according to definitions from the Wisconsin Age-Related Maculopathy Grading System. RESULTS: ARM was present in 235 subjects, corresponding to an estimate prevalence of 2.46%. Hepatitis B infection (positive status for HBsAg and HBcAb), serum triglyceride levels and high density lipoprotein levels remained as significant risk factors after age-adjustment. Multivariate analyses showed that the prevalence of ARM was significantly higher in older subjects [odds ratio (OR) 1.134; 95% CI 1.114-1.154] and those who were seropositive for hepatitis B surface antigen (OR 2.566; 95% CI 1.519-4.335). CONCLUSION: The estimated prevalence of ARM was 2.46%. Age and hepatitis B infection may increase the risk of ARM.

Imaging Techniques for the Diagnosis of Primary Uveal Melanoma

PURPOSE: To investigate various imaging techniques for the diagnosis of primary uveal melanomas in Korean patients. METHODS: We retrospectively reviewed the medical records of 35 eyes in 35 patients (22 males, 13 females) diagnosed with uveal melanomas between September 2004 and December 2006. The findings of fundus photographs, ultrasonography, CT scan, MRI, and PET scan were documented. RESULTS: A/B scan ultrasonography showed typical findings of uveal melanomas in 74.3% (26 eyes) of the patients. On CT scan, the mass appeared as a homogenous hyperdense lesion, and on MRI, the typical signal of hyperintensity on the T1-weighted image and hypointensity on the T2-weighted image was seen in 89.3% (25 eyes), with contrast enhancement in only 46.4% (13 eyes) of the patients. A PET scan revealed positive tumor uptake in 22.7% (5 eyes) of the patients. CONCLUSIONS: Although ultrasonography is the most useful and accurate method for the diagnosis of uveal melanoma, it provides more atypical cases in Korean patients than Caucasian patients. CT scans and MRI can be used for a differential diagnosis, but the diagnostic efficacy of PET scans is low.

Photodynamic Therapy for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

PURPOSE: To investigate the effects of repeated photodynamic therapy (PDT) for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD) in Korean patients. METHODS: Clinical data of patients who were treated with repeated (3 times or more) PDT for subfoveal choroidal neovascularization secondary to AMD and followed up for more than 6 months were collected from 17 hospitals around the country. Visual outcomes at 12 and 24 months, follow-up were compared between subtypes of choroidal neovascularization. The factors related to final visual prognosis and PDT-related adverse effects were evaluated. RESULTS: 244 patients (244 eyes) were recruited (male: 60%, age: 67.7+/-9.1 years). The portion of patients with predominantly classic, minimally classic, and occult without classic choroidal neovascularization was 57%, 13%, and 24%, respectively and that of patients with visual improvements or less than moderate visual loss at 24 months follow-up were 28%, 38%, 30% and 47%, 56%, and 65%, respectively. Baseline visual acuity and age were significantly related to the final visual prognosis (p<0.05). PDT-related adverse events developed in 15 (6.1%) patients, but most were mild and transient. CONCLUSIONS: Repeated PDT for subfoveal choroidal neovascularization secondary to AMD has effects comparable to those of previous prospective, controlled trials without any significant safety concerns in Korea.