The Nationwide Incidence of Retinal Vein Occlusion Following Dialysis due to End-stage Renal Disease in Korea, 2004 through 2013

Background@#We investigated the incidence and risk of retinal vein occlusion (RVO) in endstage renal disease (ESRD) patients on dialysis in Korea. @*Methods@#In this nationwide cohort study, we used Korean National Health Insurance Service data between 2004 and 2013 for analysis. ESRD patients who started dialysis from 2004 to 2013 and an equal number of controls were selected through propensity score matching. RVO incidence in both cohorts were calculated for 2004–2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to assess the risk of RVO in dialysis cohort. The Kaplan-Meier method was used to generate the cumulative RVO incidence curve.Whether the dialysis modality affects the development of RVO was also evaluated. @*Results@#In this study, 74,551 ESRD patients on dialysis and the same number of controls were included. The incidence of RVO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 7.3/1,000 person-years [PY]; control = 1.9/1,000 PY; P < 0.001). The cumulative-incidence of RVO was also significantly higher in the dialysis cohort than in the control cohort (P < 0.001; log-rank test). However, there was no significant difference in the incidence of RVO between the two dialysis methods (P = 0.550; log-rank test). @*Conclusion@#This study provided epidemiological evidence that receiving dialysis for ESRD could increase the risk of developing RVO. We also found a rapid increase in the incidence of RVO with a longer dialysis period. These results strengthen the relationship between retinal vascular disease and renal function.

Reading Speed after Anti-vascular Endothelial Growth Factor Therapy in Patients with Wet Age-related Macular Degeneration

Purpose@#To demonstrate the changes in reading speed after anti-vascular endothelial growth factor (VEGF) treatment in wet age-related macular degeneration (wAMD) patients. @*Methods@#This retrospective study enrolled wAMD patients who were treated with intravitreal anti-VEGF injection from May 2019 to September 2019. The reading speed was measured before anti-VEGF treatment and at the next injection visit using an iPad application for the assessment of reading speed. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were also analyzed. In addition, we investigated whether the improvement in optical coherence tomography (OCT)-related biomarkers affected the change in reading speed after anti-VEGF injection. As a subgroup analysis, patients were further divided into a loading dose group and a maintenance group. @*Results@#Seventy-four patients were enrolled in this study. In the loading dose group (n = 38), there were significant improvements in BCVA (p = 0.01) and CRT (p = 0.001); additionally, the reading speed improved significantly in two of the four areas (words per minute (WPM) reading [p = 0.035] and WPM speaking [p = 0.013]) after anti-VEGF injection. In the maintenance group (n = 36), BCVA, CRT, and reading speed showed some improvement; however, the results were not statistically significant. In the maintenance group, reading speed improved significantly as the size of the pigment epithelial detachment decreased after anti-VEGF injection. @*Conclusions@#Reading speed may be useful as an index for measuring visual function related to the quality of life of wAMD patients. Precise evaluation and continuous monitoring of OCT biomarkers are necessary for the treatment of wAMD especially in the maintenance group because they can be predictors of reading speed improvement.

The Nationwide Incidence of Retinal Vein Occlusion Following Dialysis due to End-stage Renal Disease in Korea, 2004 through 2013

Background@#We investigated the incidence and risk of retinal vein occlusion (RVO) in endstage renal disease (ESRD) patients on dialysis in Korea. @*Methods@#In this nationwide cohort study, we used Korean National Health Insurance Service data between 2004 and 2013 for analysis. ESRD patients who started dialysis from 2004 to 2013 and an equal number of controls were selected through propensity score matching. RVO incidence in both cohorts were calculated for 2004–2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to assess the risk of RVO in dialysis cohort. The Kaplan-Meier method was used to generate the cumulative RVO incidence curve.Whether the dialysis modality affects the development of RVO was also evaluated. @*Results@#In this study, 74,551 ESRD patients on dialysis and the same number of controls were included. The incidence of RVO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 7.3/1,000 person-years [PY]; control = 1.9/1,000 PY; P < 0.001). The cumulative-incidence of RVO was also significantly higher in the dialysis cohort than in the control cohort (P < 0.001; log-rank test). However, there was no significant difference in the incidence of RVO between the two dialysis methods (P = 0.550; log-rank test). @*Conclusion@#This study provided epidemiological evidence that receiving dialysis for ESRD could increase the risk of developing RVO. We also found a rapid increase in the incidence of RVO with a longer dialysis period. These results strengthen the relationship between retinal vascular disease and renal function.

Relationship between Clinical Features of Diabetic Retinopathy and Systemic Factors in Patients with Newly Diagnosed Type II Diabetes Mellitus

Background@#We investigated the relationship between clinical features of diabetic retinopathy (DR) and systemic factors in patients with newly diagnosed type II diabetes mellitus (T2DM). @*Methods@#Retrospective review of newly diagnosed T2DM-patients who underwent complete ophthalmic examinations at the time of T2DM diagnosis were conducted. We reviewed DM related systemic factor data and investigated systemic factors related to the presence of DR at T2DM diagnosis. In DR patients, the relationship between DR severity and systemic factors was analyzed. @*Results@#Of 380 patients, forty (10.53%) patients had DR at the initial ophthalmologic examination. Glycated hemoglobin (HbA1C), fasting plasma glucose (FPG), urine albumin to creatinine ratio (UACR), and urine microalbumin level were significantly higher in DR patients than in patients without DR. In the multivariate logistic regression analysis, high HbA1C was a significant risk factor for the presence of DR at new T2DM diagnosis (odds ratio, 2.372; P < 0.001). HbA1C, FPG, UACR, and urine microalbumin level showed significantly positive correlations with DR severity. @*Conclusion@#In patients with newly diagnosed T2DM, 10.53% have DR at initial ophthalmologic examination and high HbA1C, FPG, UACR and urine microalbumin levels. These factors are significantly positively correlated with DR severity. Therefore, more careful fundus examination is needed for newly diagnosed T2DM patients with high HbA1C, FPG, UACR, and urine microalbumin levels.

Vitrectomy Combined with Intraoperative Dexamethasone Implant for the Management of Refractory Diabetic Macular Edema

PURPOSE: To evaluate the 1-year results of vitrectomy performed in combination with intraoperative dexamethasone implant for tractional and nontractional refractory diabetic macular edema (DME). METHODS: Thirteen eyes from 13 subjects who were diagnosed with tractional DME and 17 eyes from 17 subjects who were diagnosed with nontractional refractory DME underwent vitrectomy and dexamethasone implant injection. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) during the one year following vitrectomy were evaluated in each group. Additionally, changes in intraocular pressure and other complications were investigated postoperatively. RESULTS: In eyes with tractional DME, a statistically significant improvement in BCVA was noted at 3, 6, and 12 months, and a statistically significant improvement in CMT was noted at 1, 3, 6, and 12 months from baseline after vitrectomy (p < 0.05). In eyes with nontractional refractory DME, a statistically significant improvement in BCVA was noted at 12 months, but there were no significant improvements in CMT despite the tendency to decrease from baseline. Sixteen (53.3%) of the 30 eyes included in this study showed intraocular pressure elevation, which was addressed using antiglaucoma medication, and there were no other severe complications. CONCLUSIONS: Vitrectomy combined with intraoperative dexamethasone implant may be safe and effective in treating DME, especially tractional DME. In this study, patients with nontractional DME required more additional treatments and time for anatomical and functional improvement compared to patients with tractional DME.

Refractory Outcomes after Cataract Surgery in Acute Primary Angle-closure Glaucoma Patients Treated with Laser Iridotomy

PURPOSE: To analyze the accuracy of ocular biometry and prediction of postoperative refraction after cataract surgery in acute primary angle-closure glaucoma (ACG) patients treated with laser iridotomy (LI). METHODS: We retrospectively reviewed the medical records of 44 patients who underwent cataract surgery after LI due to ACG (ACG group), and 37 patients who underwent cataract surgery without ocular disease other than cataract (control group) from January 2015 to May 2018. An Acrysof® single piece (SN60WF) was used as the intraocular lens. We performed preoperative ocular biometry and intraocular lens power calculations using AL-Scan®. The accuracy of the postoperative refractive power prediction was analyzed according to the anterior chamber depth (ACD) and axial length (AL). RESULTS: The preoperative ACD was 2.29 ± 0.32 mm in the ACG group and 3.15 ± 0.27 mm in the control group (p 2.31 mm in the ACG group (0.27 ± 0.20 D) and control group (0.27 ± 0.20 D). There was no significant difference in the mean absoluter error between each formula in patients with an AL of 22.1 mm in the ACG and control groups. CONCLUSIONS: Among patients treated with LI due to ACG, those patients with an ACD > 2.31 mm showed no difference in refractory prediction compared to the control group. However, in patients with an ACD < 2.30 mm, the refractory prediction may be inaccurate when using the Haigis formula, a fourth-generation formula that takes into account the ACD.

Multiple Serous Chorioretinopathy after Facial Herpes Zoster

PURPOSE: To report a case of multiple serous chorioretinopathy after facial herpes zoster. CASE SUMMARY: A 48-year-old male visited our clinic due to visual disturbance in the left eye which occurred 3 days after left facial pain and vesicles. Chemosis and multiple serous retinal detachments were found. The patient was diagnosed with multiple serous chorioretinopathy due to herpes zoster virus and was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 9 days and herpes eye ointment 5 times daily. After the initial treatment, oral prednisolone 60 mg was given daily for 6 days. Skin lesions were cleared, and abnormal fundus and visual acuity improved after treatment. CONCLUSIONS: Ophthalmopathy including multiple serous chorioretinopathy should be considered in managing herpes zoster ophthalmicus patients.

Ocular and Systemic Manifestation of Amaurosis Fugax: Six-Year Observational Study

PURPOSE: To investigate the prevalence of ocular and systemic disease causing amaurosis fugax and to discuss the ocular and systemic manifestation of each disease. METHODS: Consecutive patients who had amaurosis fugax were retrospectively studied from 2007 to 2013. Carotid evaluation using Doppler was performed in all patients. Ocular and medical histories were taken and bilateral ophthalmic evaluation performed. RESULTS: This study included 35 patients. The mean age of patients was 63 years and 27 patients were male; 29 unilateral and 6 bilateral eyes were involved. Associated systemic disease included hypertension (54.3%) and diabetes mellitus (34.2%). The most frequent cause of amaurosis fugax was retinal artery occlusion (28.6%) followed by ocular ischemic syndrome (22.9%), other vascular diseases (11.4%), and retinal vein occlusion (5.7%). The remaining 31.4% patients with amaurosis fugax had no vascular disease. Clinically significant stenosis of the internal carotid artery was observed in 16 patients (45.7%) and 6 of these patients (37.5%) had retinal artery occlusion disease. CONCLUSIONS: Prevalence and clinical manifestation of amaurosis fugax is very complex. Patients with transient visual disturbance are at risk for retinal artery occlusion, ocular ischemic syndrome and other diseases which cause visual loss. Therefore, careful history taking and urgent systemic and ophthalmic evaluations should be performed.

Vitreous Web after Pars Plana Vitrectomy and Bevacizumab Injection

PURPOSE: To report a case of vitreous inflammation (vitreous web) after intravitreal bevacizumab injection accompanying pars plana vitrectomy (PPV) for the treatment of proliferative diabetic retinopathy with vitreous hemorrhage. CASE SUMMARY: A 41-year-old female who underwent panretinal photocoagulation for diabetes mellitus (DM) retinopathy presented with decreased visual acuity in her right eye which was caused by vitreous hemorrhage. The patient underwent PPV with intravitreal bevacizumab injection. One day after surgery, the vitreous hemorrhage cleared and there was no inflammation in the anterior segment; however, multiple inflammatory white strands (vitreous web) were found in the vitreous cavity. She was diagnosed with non-infectious endophthalmitis and treated with topical steroid and additional oral steroids, resulting in clearance of the vitreous web on postoperative day 4. One month later, vitreous hemorrhage occurred in the other eye. PPV without bevacizumab injection cleared the vitreous hemorrhage with no evidence of vitreous web. CONCLUSIONS: Vitreous web-like inflammation can occur after intravitreal bevacizumab injection accompanying PPV for the treatment of DM vitreous hemorrhage. After eliminating infectious endophthalmitis based on lack of pain, conjunctival injection, anterior chamber hypopyon, and inflammatory cells, the web can be cleared without invasive intravitreal antibiotics injections.

Structural Recovery of the Detached Macula after Retinal Detachment Repair as Assessed by Optical Coherence Tomography

PURPOSE: To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD). METHODS: We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT. RESULTS: The mean duration of macular detachment was 15.5 +/- 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 +/- 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017). CONCLUSIONS: Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.

Clinical Manifestation of Retinal Pigment Epithelial Tear after Treatment of Age-Related Macular Degeneration

PURPOSE: To determine the risk factors of retinal pigment epithelial (RPE) tears developed after treatment of exudative age-related macular degeneration (AMD) and to report its clinical manifestations. METHODS: A retrospective, consecutive chart review was performed for all patients with exudative AMD treated with intravitreal anti-vascular endothelial growth factor (VEGF) antibody or photodynamic therapy (PDT) between March 2010 and January 2013. The main outcome measures were the time from first injection to development of the RPE tear and pre- and post-RPE tear visual acuity. The visual acuity conservational interval was defined between the time the RPE tear occurred and the time visual acuity decreased 5 letters or more from pre-RPE tear visual acuity. RESULTS: A total of 219 eyes were treated with intravitreal bevacizumab, ranibizumab or PDT. Ten eyes from 10 patients developed a RPE tear (4.6%); 7 were occult choroidal neovasculization (CNV) and 3 were polypoidal choroidal vasculopathy (PCV). The average age of the RPE tear patients was 75.4 years which is statistically greater than the others (65.7) (p = 0.001). Ninety percent (9/10) of the RPE tears occurred within the first 12 weeks after treatment started. Five patients conserved their visual acuity for approximately 4 months after the RPE tear occurred. However, all 10 patients had poor visual acuity within 1 year of the follow-up period. CONCLUSIONS: RPE tears occur after intravitreal anti-VEGF antibody or PDT treatments for exudative AMD in elderly patients. Visual acuity could be conserved in the early period after a RPE tear occurred but decreased within the next year.

Complicated Ophthalmopathy in Herpes Zoster Ophthalmicus Including Vitreous Opacity, Retinal Hemorrhage and Optic Neuropathy

PURPOSE: To introduce a case of complicated ophthalmopathy in herpes zoster ophthalmicus including vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. CASE SUMMARY: A 59-year-old man visited our clinic because of visual disturbance in the right eye which occurred after right facial pain and vesicles. There were inflammatory cells in the anterior chamber, retinal hemorrhage in the retina and vitreous opacity was found. Track-like high signal intensity along the right optic nerve was found on T1 MRI. Partial filling defect of optic disc was observed on fluorescein angiography (FAG). The patient was diagnosed with herpes zoster ophthalmicus complicated by anterior uveitis and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. The patient was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 5 days and Herpesid eye ointment 5 times daily. After the initial treatment, oral acyclovir 400 mg was given 3 times daily for 14 days. Skin symptoms and fundus findings improved but the visual acuity did not improve because of optic atrophy. CONCLUSIONS: Ophthalmopathy including anterior uveitis, vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis should be considered in herpes zoster ophthalmicus patients.

The Surgical Outcome of Metallic Intraocular Foreign Body due to Trauma

PURPOSE: To investigate the outcome of surgery for a metallic intraocular foreign body and prognostic factors for visual acuity. METHODS: A retrospective chart review was performed on 47 eyes of 47 patients who underwent surgical removal of a metallic intraocular foreign body (IOFB) after eyeball laceration between 2000 and 2010. We investigated the location and size of eyeball lacerations, the location of IOFB, the clinical findings at initial examination, surgical methods and best corrected visual acuity. We analyzed the prognostic factors for final visual acuity. RESULTS: The mean age was 45 years, and the most common cause of IOFB was lawnmower use. Cornea (77%) was the most frequently involved structure, and hyphema (72%) was the most common finding at initial slit lamp examination. Retina was the most common site of IOFB. The average visual acuity was 0.17 +/- 0.49 before surgery, and the final visual acuity was 0.23 +/- 0.39. Good visual prognosis was observed when the initial visual acuity was good or when the IOFB was located in the anterior segment, but the prognosis was poor when there was a vitreous opacity compromised with endophthalmitis at initial examination. CONCLUSIONS: An IOFB should be removed as soon as possible. Good initial visual acuity and anterior segment IOFB are good prognostic factors of visual outcome.

Macular Gradient Measurement in Myopic Posterior Staphyloma Using Optical Coherence Tomography

PURPOSE: To evaluate clinical characteristics and the macular gradient in myopic posterior staphyloma with time domain (TD) optical coherence tomography (OCT). METHODS: Sixty-four staphyloma eyes of 40 patients were examined. Macular gradient (tangent theta) and the location of staphyloma were assessed with OCT imaging. The macular gradient was measured at points 1 mm and 2 mm distant from the fovea. The relationships of the macular gradient with age, axial length, and spherical equivalent were analyzed. RESULTS: In 8 eyes (12.5%), the bottoms of the staphylomas were in the fovea, and there was no macular gradient. However, in the other 56 eyes (87.5%), the bottoms of the staphylomas were not in the foveal area, and macular gradients existed. Staphylomas were commonly located in the infero-nasal retinal area. The mean macular gradient (tangent theta) was 0.26 +/- 0.08 at 1 mm distance from the fovea and 0.28 +/- 0.10 at 2 mm. No significant relationships were observed between macular gradient and axial length, patient age, or spherical equivalent. CONCLUSIONS: TD OCT reveals staphyloma location. If the location is outside of the fovea, a macular gradient exists and can be measured by OCT. Axial length measurement error may occur in eyes with poor visual fixation and steep macular gradients.

A Case of Endogenous Aspergillus Endophthalmitis Associated with Mycotic Cerebral Aneurysm

PURPOSE: To report a case of a endogenous Aspergillus endophthalmitis associated with mycotic cerebral aneurysmal rupture. CASE SUMMARY: A 51-year-old woman was referred to our retina clinic for decreased visual acuity in the left eye. The patient had previously undergone a liver transplant for liver cirrhosis and hepatocellular carcinoma. On fundus examination, vitreous opacities with a yellowish-white subretinal abscess were observed. There were no abnormal findings except the positive sign in the laboratory serum Aspergillus antigen test performed on admission. Based on the suspicion of endogenous endophthalmitis, pars plana vitrectomy was performed with intravitreal antibiotics injection to treat fungal and bacterial infections. There was no growth in either the vitreous or anterior chamber culture. After vitrectomy, visual acuity improved and the inflammation subsided. However, by the three-week follow-up, acute-onset left hemiplegia with a right hemisphere cerebral hemorrhage had occurred. Cerebral magnetic resonance angiography showed multiple mycotic aneurysms characterized by a large and fusiform appearance. The patient was treated with neuro-embolization and was stabilized with minimal sequalae. CONCLUSIONS: Although the immunocompromised endophthalmitis patient can be treated using proper management, brain lesions such as mycotic aneurysm may exist and should be carefully considered.

Time-Lag between Subretinal Fluid and Pigment Epithelial Detachment Reduction after Polypoidal Choroidal Vasculopathy Treatment

PURPOSE: The goal of the present research was to study post-treatment changes in polypoidal choroidal vasculopathy (PCV) shown by optical coherence tomography (OCT). METHODS: The study included 12 patients with naive PCV. Photodynamic therapy and 3 consecutive intravitreal bevacizumab injections at 6-week intervals were given. Best corrected visual acuity, subretinal fluid (SRF), pigment epithelium detachment (PED), central macular thickness (CMT), and total macular volume (TMV) were measured before and after treatment as assessed by Stratus OCT3. RESULTS: After treatment, the SRF height decreased earlier than the PED height. The SRF diameter decreased with statistical significance. However, the PED diameter did not show a statistically significant improvement, persisting at pre-treatment levels. Both CMT and TMV decreased significantly after treatment. CONCLUSIONS: After PCV treatment, SRF and PED stabilized, as shown by OCT. However, the PED treatment response was both delayed and refractory compared to the SRF response. The small change in post-treatment PED diameter may suggest the possibility of PCV recurrence.

Comparison of Part-time Occlusion Therapy and Intermittent Atropine Penalization Therapy for Amblyopic Children of School Age

PURPOSE: To compare the outcome of part-time occlusion therapy and intermittent atropine penalization therapy in amblyopic school-age patients. METHODS: In the present study, the authors retrospectively analyzed school-age amblyopic patients treated with part-time occlusion therapy (Group 1) and intermittent atropine penalization therapy (Group 2) as primary treatments. Age, visual acuity (logMAR) and interocular acuity differences at the beginning of treatment, cause of amblyopia, depth of amblyopia, and compliance for treatment were analyzed. Visual acuity and the lines of improvement from baseline visual acuity in the amblyopic eye were compared between the two groups with high compliance. RESULTS: The number of patients was 43 in Group 1 and 23 in Group 2. Age and the baseline visual acuity were not significantly different between Group 1 and Group 2. Group 2 had a higher level of compliance than did Group 1 (91.7; 63.4%), but there was no statistical difference between the groups (p=0.064). The visual acuity (logMAR, 0.27:0.05, p=0.020) and the lines of improvement of the amblyopic eye at the final follow-up (2.7:4.2 lines, p=0.010) were better in Group 1 than in Group 2 with high compliance. CONCLUSIONS: In amblyopic school-age children, part-time occlusion therapy could be conducted as primary treatment in cases with high compliance. Intermittent atropine penalization therapy can be attempted if there is low compliance in occlusion therapy.

Cinical Manifestations and Prognosis of Cytomegalovirus Retinitis

PURPOSE: Cytomegalovirus (CMV) retinitis is common in patients with immunodeficient conditions caused by acquired immunodeficiency syndrome (AIDS), cytotoxic chemotherapy and immunosuppresive treatment. The purpose of this study was to assess the clinical manifestations and prognosis of CMV retinitis cases. METHODS: Thirty-one eyes of 21 patients who were diagnosed with CMV retinitis were retrospectively reviewed. The clinical manifestations and prognosis of all patients were analyzed. RESULTS: The average age of patients was 24.4+/-19.8 years. Eight patients were female and 13 patients were male. The predisposing conditions of patients were leukemia (nine patients), immunosuppressed conditions due to organ transplantation (three patients), AIDS (two patients) and other (seven patients). Eleven patients exhibited bilateral disease. The mean follow-up period was 31.3 months, and there were no differences between mean initial visual acuity (0.70+/-0.31) and mean visual acuity (0.77+/-0.20) at final visit. The major causes of visual loss were retinitis and atrophic changes involving the macula. Although retinitis was successfully treated with anti-viral agents in all cases, cataract (10 eyes, 31.3%), cystoid macular edema (four eyes, 12.5%), retinal detachment (two eyes, 6.3%), epiretinal membrane (two eyes, 6.3%) and immune recovery uveitis (two eyes, 6.3%) developed after the initial treatment. CONCLUSIONS: Although the visual prognosis of CMV retinitis was relatively good after administration of appropriate antiviral therapy, clinicians should remain alert for the development of late complications, including retinal detachment, cystoid macular edema and immune recovery uveitis.

Central Photoreceptor Viability and Prediction of Visual Outcome in Patients with Idiopathic Macular Holes

PURPOSE: To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs). METHODS: Data from 55 eyes with idiopathic MHs which had been sealed by vitrectomy were retrospectively reviewed. Correlation analysis was conducted between postoperative visual acuity (V(postop), logarithm of the minimum angle of resolution [logMAR]) and preoperative factors, including four OCT parameters: the anticipated length (A) devoid of photoreceptors after hole closure, MH height (B), MH size (C), and the grading (D) of the viability of detached photoreceptors. Additionally, the formula for the prediction of visual outcome was deduced. RESULTS: V(postop) was determined to be significantly correlated with the preoperative visual acuity (V(preop)) and OCT parameters A, C, and D (p<0.001). Based on the correlation, the formula for the prediction of V(postop) was derived from the most accurate regression analysis: V(postop)=0.248xV(preop)+1.1x10(-6)xA(2)-0.121xD+0.19. CONCLUSIONS: The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.

A Novel Therapeutic Target in Inflammatory Uveitis: Transglutaminase 2 Inhibitor

PURPOSE: Our goal was to investigate the effects of inhibition of transglutaminase 2 (TGase 2) on endotoxin-induced uveitis (EIU) METHODS: EIU was induced in female Lewis rats by single footpad injections of 200 microgram of lipopolysaccharide (LPS). TGase 2 inhibitors were administered intraperitoneally 30 minutes before and at the time of LPS administration. Rats were sacrificed 24 hours after injection, and the effects of the TGase 2 inhibitors were evaluated by the number of intraocular inflammatory cells present on histologic sections and by measuring the TGase 2 activity and TGase products in the aqueous humor (AqH). TGase 2 substrates were also assayed in AqH from uveitis patients. RESULTS: Clinical indications of EIU, the number of cells present on histologic sections, and TGase 2 activity in AqH increased in a time-dependent manner, peaking 24 hours after LPS injection. Inflammation in EIU was significantly reversed by treatment with TGase inhibitors. A 23-kDa cross-linked TGase substrate was identified in the AqH from EIU rats and uveitis patients. MALDI-TOF analysis showed that this substrate in uveitis patients was human Ig kappa chain C region. CONCLUSIONS: TGase 2 activity and its catalytic product were increased in the AqH of EIU rats. TGase 2 inhibition attenuated the degree of inflammation in EIU. Safe and stable TGase inhibitors may have great potential for the treatment of inflammatory uveitis.