Diagnosing Polypoidal Choroidal Vasculopathy Using Color Fundus Photography, Optical Coherence Tomography, and Optical Coherence Tomography Angiography

Purpose@#To compare the diagnostic accuracy of differentiating polypoidal choroidal vasculopathy (PCV) from exudative age-related macular degeneration (AMD), using color fundus photography (CFP), optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA) without using indocyanine green angiography (ICGA). @*Methods@#Treatment-naive eyes with exudative AMD that underwent CFP, OCT, SS-OCTA, and ICGA imaging before treatment were identified. Images of each patient were categorized into two sets (set A, CFP + OCT; set B, CFP + SS-OCTA). In set B, both the en face and cross-sectional B scans were analyzed. Each set was reviewed by two graders, and it was determined whether the presumed diagnosis was PCV. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for the diagnosis of PCV were assessed for each set by comparing diagnoses that included ICGA. The number of polypoidal lesions in each set was calculated and compared to ICGA. @*Results@#A total of 94 eyes from 94 patients with AMD were included in the study, of which 66.0% were male, and the mean age was 71.8 ± 9.0 years. The PCV diagnosis rate using ICGA was 45.7%. The sensitivity was 0.88 for set A and 0.93 for set B, while the specificity was 0.94 for set A and 0.96 for set B. The AUC was 0.90 (95% confidence interval [CI], 0.83–0.97) for set A and 0.96 (95% CI, 0.90–1.00) for set B. Set A detected 1.28 ± 0.91 polypoidal lesions, while set B detected 1.47 ± 1.01; ICGA showed 1.51 ± 0.86. @*Conclusions@#This study highlights that, without using ICGA, both CFP combined with OCT and CFP combined with SS-OCTA demonstrate high sensitivity, specificity, and AUC in diagnosing PCV. It is evident that SS-OCTA contributes to enhancing sensitivity, specificity, and AUC for PCV diagnosis.

Effects of Blue Light on Eye of Zebra Fish and Protective Role of Polyphenolic Compounds

Purpose@#To investigate the oxidative damage and changes of retinas by blue light through zebrafish and to confirm the protective effect of polyphenol on retina cells using grape seed-derived polyphenols. @*Methods@#To induce oxidative damage and changes of the retina by blue light, blue light LED (10,000 Lux, 480 nm) was added to the zebrafish grown in the dark room after pretreating polyphenols derived from grape seed at various concentrations (0, 0.1, 1, 10 μg/mL, respectively) for 4 days. Changes in retinal thickness and numbers of outer nuclear layer nuclei through hematoxylin & eosin staining were evaluated. @*Results@#Photoreceptor layer thickness of blue light exposed group was significantly thinner than the group without blue light (108.1 ± 27.7 μm vs 41.1 ± 17.0 μm). As pretreated polyphenol concentration increased, photoreceptor layer thickness was increased (41.1 ± 17.0, 56.3 ± 18.6, 90.7 ± 23.7, 99.1 ± 23.1 μm, p < 0.05), and damage to outer nuclear layer nuclei was also decreased. @*Conclusions@#Exposure to blue light is an important factor for increasing oxidative stress in the retina. Grape seed-derived polyphenols have been shown to protect photoreceptor cells and retinal pigment epithelial cells from oxidative stress. This suggests that the antioxidant effect of polyphenol compounds may help suppress the progression of retinal diseases associated with oxidative stress such as age-related macular degeneration.

Correlation between Topographic Progression of Geographic Atrophy and Visual Acuity Changes

Purpose@#To analyze topographic progression of geographic atrophy with different concentric circles centered on the fovea in correlation with decrease of visual acuity. @*Methods@#We retrospectively analyzed 36 eyes of 26 patients diagnosed with geographic atrophy and followed at least 1 year. One millimeter circular area at the foveal center were defined as zone 1, and doughnut shape areas from between 1 and 2 mm to between 5 and 6 mm were defined as zone 2 to 6. Then, changes of geographic atrophy area in each zone were measured with semi-automatic software. Correlation analysis and regression analysis were performed to determine the relationship between changes in visual acuity and atrophic area in each zone. @*Results@#Mean age was 76.9 years and follow-up period were 3.38 years. The mean atrophic area increased from 8.09 to 16.34 mm2 and visual acuity decreased from 0.39 to 0.69 on logarithm of the minimal angle of resolution. Mean change of total geographic atrophy area was not significantly correlated with visual acuity decrease. While geographic atrophy progression within zone 1, 2, and 3 showed significant causal relationship with decrease of visual acuity (all, p < 0.05). @*Conclusions@#In contrast to the total geographic atrophy area, progression of geographic atrophy in parafoveal area was significantly correlated with decrease of visual acuity.

Comparison of Focal and Conventional Verteporfin Photodynamic Therapy for Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).METHODS: This study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.RESULTS: The mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).CONCLUSIONS: Focal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.

Long-term Results of Taking Anti-oxidant Nutritional Supplement in Intermediate Age-related Macular Degeneration

PURPOSE: We prospectively investigated clinical changes and long-term outcomes after administration of the drugs recommended by the Age-Related Eye Disease Study-2 to patients with intermediate age-related macular degeneration (AMD). METHODS: This prospective multicenter study enrolled 79 eyes of 55 patients taking lutein and zeaxanthin. The primary endpoint was contrast sensitivity; this was checked every 12 months for a total of 36 months after treatment commenced. The secondary endpoints were visual acuity, central macular thickness, and drusen volume; the latter two parameters were assessed using spectral domain optical coherence tomography. RESULTS: The mean patient age was 72.46 ± 7.16 years. Contrast sensitivity gradually improved at both three and six cycles per degree. The corrected visual acuity was 0.13 ± 0.14 logMAR and did not change significantly over the 36 months. Neither the central macular thickness nor drusen volume changed significantly. CONCLUSIONS: Contrast sensitivity markedly improved after treatment, improving vision and patient satisfaction. Visual acuity, central retinal thickness, and drusen volume did not deteriorate. Therefore, progression of AMD and visual function deterioration were halted.

Comparison of Ranibizumab and Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

PURPOSE: To assess the effectiveness and safety of intravitreal ranibizumab compared with bevacizumab for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: This was a retrospective study of 80 eyes with macular edema associated with BRVO. Patients received either 0.5 mg of ranibizumab (n = 24) or 1.25 mg of bevacizumab (n = 56) intravitreally. Both groups received three initial monthly injections followed by as-needed injections. The best-corrected visual acuity, central subfield thickness, mean number of injections, and retreatment rate were evaluated monthly for 6 months after the initial injection. RESULTS: The best-corrected visual acuity significantly improved from logarithm of the minimal angle of resolution (logMAR) 0.55 ± 0.26 at baseline to 0.24 ± 0.26 at 6 months in the ranibizumab group (p < 0.001) and from logMAR 0.58 ± 0.21 at baseline to 0.29 ± 0.25 at 6 months in the bevacizumab group (p < 0.001), which is not a statistically significant difference (p = 0.770). The mean reduction in central subfield thickness at 6 months was 236 ± 164 µm in the ranibizumab group (p < 0.001) and 219 ± 161 µm in the bevacizumab group (p < 0.001), which is not also a statistically significant difference (p = 0.698). The mean numbers of ranibizumab and bevacizumab injections were 3.25 ± 0.53 and 3.30 ± 0.53, respectively (p = 0.602). In addition, after the three initial monthly injections, the retreatment rates for ranibizumab and bevacizumab injections were 20.8% and 26.7%, respectively (p = 0.573). CONCLUSIONS: Both ranibizumab and bevacizumab were effective for the treatment of BRVO and produced similar visual and anatomic outcomes. In addition, the mean number of injections and the retreatment rates were not significantly different between the groups.

Features of Long-Standing Korean Type 2 Diabetes Mellitus Patients with Diabetic Retinopathy: A Study Based on Standardized Clinical Data

BACKGROUND: This is part of a prospective study carried out as a national project to secure standardized public resources for type 2 diabetes mellitus (T2DM) patients in Korea. We compared various characteristics of long-standing T2DM patients with diabetic retinopathy (DR) and macular edema (ME). METHODS: From September 2014 to July 2015, T2DM patients with disease duration of at least 15 years were recruited at a single university hospital. Clinical data and samples were collected according to the common data elements and standards of procedure developed by the Korean Diabetes Association Research Council. Each participant was assessed by ophthalmologists for DR and ME. RESULTS: Among 220 registered patients, 183 completed the ophthalmologic assessment. DR was associated with longer disease duration (odds ratio [OR], 1.071; 95% confidence interval [CI], 1.001 to 1.147 for non-proliferative diabetic retinopathy [NPDR]) (OR, 1.142; 95% CI, 1.051 to 1.242 for proliferative diabetic retinopathy [PDR]) and the use of long-acting insulin (OR, 4.559; 95% CI, 1.672 to 12.427 for NPDR) (OR, 4.783; 95% CI, 1.581 to 14.474 for PDR), but a lower prevalence of a family history of cancer (OR, 0.310; 95% CI, 0.119 to 0.809 for NPDR) (OR, 0.206; 95% CI, 0.063 to 0.673 for PDR). ME was associated with higher glycosylated hemoglobin levels (OR, 1.380; 95% CI, 1.032 to 1.845) and the use of rapid-acting insulin (OR, 5.211; 95% CI, 1.445 to 18.794). CONCLUSION: Various clinical features were associated with DR and ME. Additional epidemiological and biorepository-based studies using this cohort are being conducted to deepen our understanding of diabetic complications in Korea.

The Repeatability of Retinal Layer Thickness Measurements with Spectral-Domain Optical Coherence Tomography in Normal Eyes

PURPOSE: To evaluate the repeatability of retinal layer thickness measurements in normal eyes imaged using spectral domain optical coherence tomography (SD-OCT). METHODS: Sixty-eight eyes of 34 healthy subjects were enrolled in this study. Imaging was performed 4 times using 9 × 9 mm macular scans with SD-OCT (RS 3000 Advance HD OCT, NIDEK, Gamagori, Japan) at the same visit by an experienced examiner. After automatic retinal segmentation (layering) in 5 layers, the thickness of each layer was calculated. Macular thickness of 9 Early Treatment of Diabetic Retinopathy Study (ETDRS)-like regions was obtained. Repeatability for each of the 9 subfield areas was calculated by their repeatability coefficients and intraclass correlation coefficients (ICCs). RESULTS: There was no significant difference in average retinal thickness and each retinal layer thickness between all measurements acquired by the experienced examiner. The ICCs of retinal layer thickness ranged from 0.826 to 0.847 for the ganglion cell layer + inner plexiform layer, inner nuclear layer + outer plexiform layer and outer nuclear layer + external limiting membrane in the fovea. The ICCs were greater than 0.909 for the other intra-retinal layers in all 9 ETDRS subfield thickness between all measurement pairs. CONCLUSIONS: Excellent repeatability was observed for SD-OCT retinal segmented layer thickness measurements in healthy subjects.

Long-term Outcomes of Diabetic Macular Edema Following Initial Intravitreal Ranibizumab Injection Based on Morphologic Pattern

PURPOSE: To evaluate the 3-year visual and morphological outcomes of diabetic macular edema (DME) based on the morphological pattern observed on optical coherence tomography (OCT) after intravitreal ranibizumab injections. METHODS: Thirty-two eyes of 32 patients with DME were classified according to the following OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All patients received 3 consecutive monthly intravitreal injections of 0.5 mg ranibizumab. After 3 injections, patients received ranibizumab or dexamethasone implantation as needed. The primary outcome was the number of treatments received based on the DME type over 36 months. Best-corrected visual acuity (BCVA), central subfoveal thickness, and macular volume changes were also evaluated. RESULTS: The eyes were classified as DRT (n = 16), CME (6), or SRD (10). The mean number of injections over 3 years was significantly different among the groups: DRT (4.25), CME (7.5), SRD (7.6; p = 0.048). The number of patients who did not need additional treatment after the initial 3 injections was 13 with DRT (81.3%), 2 with CME (33.3%), and 5 with SRD (50%; p = 0.045). BCVA at 36 months significantly improved from baseline in the DRT group (p = 0.003). The CME group showed the worst BCVA among the groups (p = 0.023). Six patients who received intravitreal dexamethasone implantation showed no significant improvement of BCVA but significant decrease in macular volume from 12 to 36 months. CONCLUSIONS: Clinical courses varied according to the morphological pattern of DME after intravitreal ranibizumab injection, and patients with DRT maintained visual and anatomical improvement with fewer injections over 36 months. Additional dexamethasone implantation showed limited effect in reducing macular edema with persistent macular cystic change, but no significant improvement in visual acuity.

Non-human Immunodeficiency Virus-related Ocular Syphilis in a Korean Population: Clinical Manifestations and Treatment Outcomes

PURPOSE: To describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection. METHODS: A total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed. RESULTS: The mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis. CONCLUSIONS: Visual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.

Cytoprotective Effect of Polyphenolic Compounds against Oxidative Stress in Cultured Retinal Pigment Epithelial Cells

PURPOSE: Grape seed-derived polyphenols (GSPs) provide a concentrated source of polyphenols having antioxidant capacity. In this study we investigated the cytoprotective effect of GSP against oxidative stress-induced cell damage in cultured human retinal pigment epithelial (RPE) cells. METHODS: Cultured adult retinal pigment epithelium (ARPE)-19 cells were incubated with GSP from Vitis vinifera (0.1, 0.5, 1, 5 or 10 microg/mL) for 24 hours and treated with hydrogen peroxide (H2O2, 0.4 mM) for 24 hours to induce oxidative stress. Cell viability was measured using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Intracellular reactive oxygen species (ROS) was quantified using 2',7'-dichlorofluorescein diacetate (DCF-DA) fluorescence. RESULTS: The percentage of viable RPE cells was significantly lower in cultures treated with H2O2 0.4 mM than in control cultures. GSP significantly reduced H2O2-induced cell death in a dose dependent manner. GSP at 0.1, 0.5, 1, 5 and 10 microg/mL significantly reduced cell mortality due to the treatment with H2O2. Intracellular ROS production increased significantly in cultures treated with H2O2 0.4 mM compared with control. There was a significant dose-dependent decrease in intracellular ROS levels after treatment of RPE with GSP. CONCLUSIONS: GSP, a natural polyphenolic compound, can protect RPE cells from H2O2-induced oxidative stress and reduce intracellular ROS production by scavenging free radicals. This suggests potential effects of polyphenolic compounds against retinal diseases associated with oxidative stress.

Preferences and Trends in the Treatment of Diabetic Retinopathy in Korea and Japan

PURPOSE: To evaluate preferences and trends in the management of diabetic retinopathy in Korea and Japan. METHODS: An Internet survey comprised of 49 questions was sent to the members of Korean Retina Society (KRS) and Japanese Society of Ophthalmic Diabetology (JSOD). The survey was conducted during the period between June 2012 and July 2012. RESULTS: Ninety-one of 210 members of the KRS (43%) and 120 of 754 members of the JSOD (16%) participated in the survey. For diffuse diabetic macular edema, 'intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) followed by focal laser treatment' was the most preferred treatment in Korea (48%), while 'sub-tenon steroid injection followed by focal laser treatment' was the most common procedure in Japan (33%). Vitrectomy was the second most common procedure in Japan (18%). In contrast, none of the KRS members preferred vitrectomy in this situation. For refractory diabetic macular edema, however, vitrectomy with or without the use of anti-VEGF was chosen in 75% of the KRS members. In Japan, vitrectomy without the use of intravitreal injection of anti-VEGF or steroid was relatively more preferred. Small-gauge (G) vitrectomy using either a 23 G or 25 G needle was popular in both countries (90% in Korea, 64% in Japan). CONCLUSIONS: Although the trends in diagnostic and surgical environments were similar in Korea and Japan, the preferred treatment approaches for diabetic macular edema were different. Sub-tenon steroid injection and vitrectomy were preferred in Japan, while anti-VEGF injection was most commonly employed in Korea.

A Case of Repeated Dexamethasone Implantation in a Suspected Patient with IRVAN Syndrome

PURPOSE: In the present study, a case of repeated intravitreal dexamethasone implantation for a suspected idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome associated with recurrent exudative retinal detachment and macular edema is reported. CASE SUMMARY: A 39-year-old female who underwent steroid pulse therapy due to Vogt-Koyanagi-Harada disease in the left eye was referred for exudative retinal detachment and macular edema. Best corrected visual acuity (BCVA) was 1.0 in the right eye and 0.5 in the left eye. Cystoid macular edema combined with serous retinal detachment was observed on spectral-domain optical coherence tomography. Fluorescein angiography revealed neovascularization and multiple macroaneurysms with fluorescein leakage in the left peripapillary area. Severe peripheral capillary non-perfusion and fluorescein leakage were also observed in both eyes. Intravitreal dexamethasone implantation was performed in the left eye and macular edema showed wax-and-wane pattern. No edema was observed after 4 additional dexamethasone implantations, however, preretinal hemorrhage occurred in the peripapillary area during treatment. Seventeen months after initiation of treatment, BCVA was 0.6 in the left eye and dry macula was maintained. CONCLUSIONS: Repeated intravitreal dexamethasone implantation was effective for recurrent macular edema in a patient suspected with IRVAN syndrome.

An Overview of Ophthalmologic Survey Methodology in the 2008-2015 Korean National Health and Nutrition Examination Surveys

The Korea National Health and Nutrition Examination Survey (KNHANES) is a national program designed to assess the health and nutritional status of the noninstitutionalized population of South Korea. The KNHANES was initiated in 1998 and has been conducted annually since 2007. Starting in the latter half of 2008, ophthalmologic examinations were included in the survey in order to investigate the prevalence and risk factors of common eye diseases such as visual impairment, refractive errors, strabismus, blepharoptosis, cataract, pterygium, diabetic retinopathy, age-related macular degeneration, glaucoma, dry eye disease, and color vision deficiency. The measurements included in the ophthalmic questionnaire and examination methods were modified in the KNHANES IV, V, and VI. In this article, we provide detailed information about the methodology of the ophthalmic examinations in KNHANES in order to aid in further investigations related to major eye diseases in South Korea.

The Effect of Prophylactic IOP-Lowering Medication after Intravitreal Dexamethasone Implantation

PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.

The Effect of Prophylactic IOP-Lowering Medication after Intravitreal Dexamethasone Implantation

PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.

Macular Hole Formation after Pars Plana Vitrectomy for the Treatment of Valsalva Retinopathy: A Case Report

We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.

Macular Hole Formation after Pars Plana Vitrectomy for the Treatment of Valsalva Retinopathy: A Case Report

We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.

Effects of Macular Ischemia and Early Treatment on Visual Outcome in Branch Retinal Vein Occlusion

PURPOSE: To evaluate the effects of macular ischemia and early treatment on the visual outcomes of patients with branch retinal vein occlusion (BRVO). METHODS: This study retrospectively reviewed the records of 42 patients who were treated with an intravitreal bevacizumab injection for BRVO, repeated 3 times at 6-week intervals and were whose data available for a follow-up period of at least 4 years. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) results before treatment and at 6, 12, 24, 36 and 48 months after the 3 serial injections, were measured. We assessed macular ischemia, time to the first treatment, and the relationship of these with BCVA. RESULTS: Mean BCVA (log MAR) was significantly improved from 0.67 +/- 0.43 at baseline to 0.30 +/- 0.30 at 48 months (p 6 weeks) treatment groups in BCVA and mean change in BCVA after 48 months. There was statistically significant (p 6 weeks) treatment groups with macular ischemia in BCVA after 48 months. CONCLUSIONS: In patients with BRVO, a significant visual improvement was maintained after intravitreal bevacizumab injections, despite the presence of macular ischemia. Early treatment (within 6 weeks) is more effective for maintaining and improving visual acuity. Similar results in the macular ischemia group confirmed the importance of early treatment.

Imported Intraocular Gnathostomiasis with Subretinal Tracks Confirmed by Western Blot Assay

We report a case of intraocular gnathostomiasis diagnosed by western blot assay in a patient with subretinal tracks. A 15-year-old male patient complained of blurred vision in the right eye, lasting for 2 weeks. Eight months earlier, he had traveled to Vietnam for 1 week and ate raw wild boar meat and lobster. His best-corrected visual acuity was 20/20 in both eyes and anterior chamber examination revealed no abnormalities. Fundus examination showed subretinal tracks in the right eye. Fluorescein angiography and indocyanine green angiography showed linear hyperfluorescence of the subretinal lesion observed on fundus in the right eye. Ultrasound examination revealed no abnormalities. Blood tests indicated mild eosinophilia (7.5%), and there was no abnormality found by systemic examinations. Two years later, the patient visited our department again for ophthalmologic evaluation. Visual acuity remained 20/20 in both eyes and the subretinal tracks in the right eye had not changed since the previous examination. Serologic examination was performed to provide a more accurate diagnosis, and the patient's serum reacted strongly to the Gnathostoma nipponicum antigen by western blot assay, which led to a diagnosis of intraocular gnathostomiasis. This is the first reported case of intraocular gnathostomiasis with subretinal tracks confirmed serologically using western blot in Korea.