Combined Anti-VEGF and C3F8 Injection for Large Submacular Hemorrhage Secondary to Age-Related Macular Degeneration

PURPOSE: To evaluate the effect of intravitreal expansile gas (C3F8) with anti-VEGF injection for the treatment of large submacular hemorrhage (SMH) secondary to age-related macular degeneration (ARMD). METHODS: In this report, 18 eyes of 18 patients with large SMH secondary to ARMD were treated with a simultaneous injection of 0.3 cc C3F8 and 0.05 ml anti-VEGF intravitrealy. RESULTS: The mean age was 64.89 +/- 5.68 years and the mean size of SMH was 4.44 +/- 1.25 disc diameters (DD). The minimum follow-up period was 12 months (range: 12-17 months). Mean preoperative best corrected visual acuity (BCVA) was 1.72 +/- 0.56 log MAR which improved significantly to 1.01 +/- 0.68 log MAR at 12 months (p = 0.002). SMH displacement occurred in all eyes. BCVA improved 2 or more lines in 11 eyes (61.1%) and deteriorated in 1 eye (5.6%). CONCLUSIONS: In this report, intravitreal injection of an expansible gas (C3F8) with anti-VEGF produced successful results in anatomical displacement of SMH and early visual improvement.

Spectral-Domain Optical Coherence Tomography Findings in Acute Central Retinal Artery Occlusion

PURPOSE: To evaluate spectral-domain optical coherence tomography (SD-OCT) images of acute central retinal artery occlusion (CRAO). METHODS: Six eyes of 6 patients who were diagnosed with acute CRAO were enrolled in the present study. The main SD-OCT measurements included macular thickness in the macular cube map and retinal thickness in the 5-line raster map. RESULTS: In acute CRAO, macular thickness increased more than that in the normal fellow eye in all cases. SD-OCT images demonstrated increased reflectivity and thickness in the inner retinal layer, especially in the nerve fiber layer and ganglion cell layer. However, in the outer retinal layer, SD-OCT images disclosed decreased reflectivity and increased thickness. The central subfield thickness area image showed normal reflectivity and thickness. The horizontal cross-sectional image showed relatively the same edema ratio between the inner retinal layer and outer retinal layer thickness. There was no cystoid or serous foveal detachment-type edema. CONCLUSIONS: SD-OCT images of CRAO showed increased outer retinal layer thickness and decreased reflectance as well as increased inner retinal layer thickness and reflectance. However, inner segment and outer segment junctions of the photoreceptor and retinal pigment epithelial signal were intact.

A Case of Bilateral Optic Neuritis in Tsutsugamushi Infection

PURPOSE: To report a case of bilateral optic neuritis in a child after tsutsugamushi infection. CASE SUMMARY: An eight-year-old boy diagnosed with tsutsugamushi infection was referred to the ophthalmology clinic at our institution. A typical eschar was detected on his right clavicle. The patient complained of severely decreased visual acuity. The initial best corrected visual acuity (BCVA) in his right eye was 0.08, and in his left eye was negative light perception. Fundus exam showed bilateral optic disc swelling and hyperemia. Optic neuritis was diagnosed after tsutsugamushi infection, and high-dose intravenous steroid therapy was initiated according to the ONTT study protocol. Twelve months after treatment, the right eye BCVA improved to 1.0, but the left eye BCVA was only 0.06. CONCLUSIONS: The authors of the present study experienced a case of bilateral optic neuritis after tsutsugamushi infection with a relatively positive response to the steroid therapy.

Spontaneously Resolved Purtscher's Retinopathy within 24 Hours: Case Report and OCT Review

PURPOSE: To report a case of unilateral Purtscher's retinopathy that spontaneously resolved within 24 hours. CASE SUMMARY: A 54-year-old man presented with decreased visual acuity in his left eye after a vehicle accident. When the accident occurred, his chest region was compressed by the safety belt. The case was diagnosed with Purtscher's retinopathy based on fundus examination, flourescein angiography (FAG) and optical coherent tomography (OCT). At presentation, the best corrected visual acuity (BCVA) was 0.3 in the affected eye. Tiny Purtscher-flecken and macular edema were observed but there was no sign of retinal hemorrhage. Immediately after the trauma, OCT detected abnormally increased hyperreflectivity in the nerve fiber layer and ganglion cell layer, severe cystoid edema and serous foveal detachment. Without any treatment, BCVA was improved to 1.0 within 12 hours. Recovery of visual acuity was followed by improvement of abnormal hyperreflectivity in the nerve fiber layer, cystoid macular edema and serous foveal detachment. CONCLUSIONS: The authors of the present study report a dramatically resolved unilateral Purtscher's retinopathy after blunt chest trauma.

A Case of Ciliary Body Tuberculoma Causing Sclera Melting

PURPOSE: To report a case of ciliary body tuberculoma, which induced scleral melting. CASE SUMMARY: A 32-year-old man, who was diagnosed with miliary pulmonary tuberculosis 1 week earlier, presented with a conjunctival injection and mass on his right eye 3 months in duration. On excisional biopsy, melted sclera and exposed uveal tissue were found; acid-fast stain was positive. Two months after anti-tuberculosis treatment, anterior granulomatous uveitis and granuloma formation on the anterior chamber angle developed. A low-dose systemic steroid therapy was added. Six weeks after systemic steroid therapy, anterior uveitis and granuloma on anterior chamber angle disappeared. CONCLUSIONS: We experienced a case of ocular tuberculosis on the ciliary body. A low-dose systemic steroid along with multi-drug anti-tubercular therapy may be an effective treatment of ciliary body tuberculoma.

Ahmed Valve Implantation with Adjunctive Mitomycin C and 5-Fluorouracil: Outcomes at 2 Years

PURPOSE: To evaluate the outcomes of Ahmed valve implantation in neovascular glaucoma patients who received intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU) after 24 months of follow-up. METHODS: A total of 40 eyes from 40 patients with neovascular glaucoma who received antiglaucomatous medication without previous glaucoma surgery were included in the present study. The patients were divided into 2 groups. The control group (20 eyes) underwent Ahmed valve implantation only and the study group (20 eyes) underwent Ahmed valve implantation and received intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of 3 consecutive visits where intraocular pressure (IOP) was over 18 mmHg; 2) 20% IOP reduction from baseline; 3) the final number of topical medications was not reduced by at least two from baseline; 4) the need for additional surgery; or 5) the occurrence of a serious complication. RESULTS: In the control group, the cumulative success rate was 19.1% at 24 months. The cumulative success rate in the study group was 43.7% at 24 months. Serious complications such as endophthalmitis, valve exposure, or prolonged hypotony were not observed. CONCLUSIONS: The adjunctive use of intraoperative MMC and postoperative 5-FU with Ahmed valve implantation resulted in a high success rate and good IOP control and did not cause serious complications during the follow-up period.

The Effect of Internal Limiting Membrane Peeling on Retinal Vein Occlusion Induced Macular Edema

PURPOSE: To evaluate the effect of pars plana vitrectomy with indocyanine green-assisted peeling of the internal limiting membrane (ILM) on visual acuity in macular edema in RVO patients. METHODS: Twenty-three eyes of 23 patients were treated consecutively (male: female=7:16). Thirteen patients were BRVO, and ten patients were CRVO. Vitrectomy that involved peeling the ILM with the assistance of indocyanine dye was performed in all 23 eyes. A visual acuity change of 2 lines or more was regarded as significant. We compared preoperative BCVA and postoperative BCVA. RESULTS: Improvement of visual acuity was observed in 13 eyes (8 eyes in BRVO, 5 eyes in CRVO) of 23 total eyes (56.5%). No change in visual acuity was observed in 5 eyes (3 eyes in BRVO, 2 eyes in CRVO). Worsening of visual acuity was observed in 5 eyes (2 eyes in BRVO, 3 eyes in CRVO). CONCLUSIONS: Pars plana vitrectomy with ILM peeling in patients with macular edema induced by RVO showed visual improvement in 56.5% of the cases in our study (61.5% in BRVO, 50% in CRVO). PPV with ILM peeling may be an effective procedure in reducing macular edema due to RVO.

Early Result of Femtosecond Laser Assisted Descemet's Membrane Stripping Endothelial Keratoplasty

PURPOSE: To report the first cases of Descemet's stripping endothelial keratoplasty in patients with pseudophakic bullous keratopathy. METHODS: Four eyes of 4 patients who had corneal edema from pseudophakic bullous keratopathy were enrolled. We performed femtosecond laser-assisted Descemet's membrane stripping endothelial keratoplasty (DSEK). We then evaluated preoperative and postoperative best corrected visual acuities (BCVA), manifest refractions, keratometries, topographic astigmatisms, corneal pachymetries, and perioperative complications. RESULTS: The mean follow-up period was 6 months. Three of the four eyes had successful transplantations. Since the operation, these patients have shown improvement in visual acuity and have recovered from corneal edema. However, in one patient, the transplanted corneal disc was dislocated, and he needed an additional procedure for reattachment. CONCLUSIONS: The lack of corneal incisions or sutures in DSEK was helpful for maintaining corneal curvature and globe integrity after surgery. The surgery resulted in rapid visual rehabilitation and prevented suture-induced complications. With a femtosecond laser, we could prepare donor cornea in an automated and standardized fashion. In conclusion, femtosecond laser-assisted DSEK has significant advantages over standard penetrating keratoplasty for patients with pseudophakic bullous keratopathy.

Two Cases of Intrapapillary Hemorrhage with Adjacent Peripapillary Subretinal Hemorrhage

PURPOSE: To report two cases of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH). METHODS: A 15-year-old boy and a 13-year-old girl who had sudden the sensation of floaters underwent ophthalmic examination including fundus examination, fundus photographs, fluorescein angiography, Goldmann visual field test, B-scan ultrasonography, and optical coherence tomography. RESULTS: Initial corrected visual acuities were 20/20 and 20/25. Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage was found upon fundus examination. Blocked fluorescence due to peripapillary subretinal hemorrhage was found by fluorescein angiography. Intrapapillary and peripapillary subretinal hemorrhage was spontaneously resolved without treatment in eight weeks later. CONCLUSIONS: Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) is a benign and self limiting disease. It is important to diagnose and differentiate IHAPSH from the other diseases.