Changes in the Ganglion Cell-inner Plexiform Layer after Consecutive Intravitreal Injections of Anti-vascular Endothelial Growth Factor in Age-related Macular Degeneration Patients

Late Postoperative Opacification of Multifocal Intraocular Lens after Vitrectomy in a Diabetic Patient

PURPOSE@#We report a case of late opacity of an AT LISA intraocular lens after vitrectomy in a diabetic patient.CASE SUMMARY: A 61-year-old man presented with blurring in the left eye. He had undergone bilateral phacoemulsification and intraocular lens implantation 6 years ago, and vitrectomy with SF₆ gas tamponade in the left eye due to rhegmatogenous retinal detachment 3 years ago. The patient was diagnosed with pre-existing diabetes, hypertension, and coronary heart disease. Examination of the left eye showed round and centrally located whitish fine granular deposits on the surface of the intraocular lens, and zonular rupture from the 3 to 6 o'clock position. The intraocular lens in the right eye was clear. The corrected vision was 0.9 in the right eye and 0.5 in the left eye. The intraocular lens was explanted from the left eye together with the capsular bag, and was examined under light microscopy, histochemical analysis, and with scanning electron microscopy equipped with an energy dispersive X-ray spectroscopy detector with light element capabilities.@*CONCLUSIONS@#This study was the first to report late postoperative opacity in the multifocal intraocular lens, AT LISA 809M. The possibility of intraocular lens opacity in patients with underlying disease or in those undergoing vitrectomy should be explained prior to corrective procedures.

Comparison of the Recurrence of RRD in PPV Combined Cataract Surgery with PPV Alone, and Risk Factors in PPV Combined Cataract Surgery

PURPOSE: To compare the recurrence percentage and risk factors of recurrence in rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) by in two groups of patients according to combined cataract surgery. METHODS: The recurrence percentage of RRD and risk factors after PPV over 20 years, performed by a single surgeon from January 1997 to September 2016, were retrospectively evaluated by classification into two groups according to combined cataract surgery. The risk factors were the patients' factors (age and sex), duration of disease, preoperative visual analyses, posterior capsular tears (PCR) during cataract surgery, the tamponade used, retinal detachment ranges, macular status, number and position of retinal tears, proliferative vitreoretinopathy (PVR) grade, and vitreous opacity. A total of 158 cases were included in the study. RESULTS: The recurrence percentage of RRD was not associated with combined cataract surgery. In the combined cataract surgery group, PCR (p = 0.020), inferior retinal tears (p = 0.037), and PVR above grade B (p = 0.037) were associated with the recurrence of RRD using univariate logistic regression analyses, but PCR (odds ratio 1.880, p = 0.021) was the only significant risk factor for RRD using multivariate logistic regression analyses. CONCLUSIONS: Cataract surgery can be performed at any time, but there should be consideration of the recurrence of RRD if there was PCR during combined cataract surgery.

Effects of Intravitreal Injection of Bevacizumab or Ranibizumab on Systemic Circulation

PURPOSE: The purpose of this study was to evaluate the systemic effects of ranibizumab and bevacizumab by examining the plasma levels of anti-vascular endothelial growth factor (anti-VEGF) and VEGF before and after a single intravitreal injection. METHODS: Twenty-eight eyes of 28 patients with various retinal diseases were enrolled. Seventeen eyes received an injection of intravitreal bevacizumab, and 11 eyes received an injection of ranibizumab. Blood samples were collected just before and 1 day, 1 week, and 1 month after injection. Concentrations of anti-VEGF and VEGF in plasma were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: In the bevacizumab group, anti-VEGF concentration before the injection was 91.0 ng/mL, while those at 1 day, 1 week, and 1 month post-injection increased to 153.6, 196.3, and 140.3 ng/mL, respectively (p 0.05 for all). VEGF level also showed no significant change. VEGF concentration before the injection was 80.9 pg/mL, while those at 1 day, 1 week and 1 month post-injection were 96.7, 106.3, 106.1 pg/mL, respectively (p > 0.05 for all). CONCLUSIONS: Contrary to ranibizumab, intravitreal bevacizumab significantly lowers plasma VEGF level in patients with various retinal diseases. The study suggests the consideration of the systemic effects of intravitreal bevacizumab injection.

Influence of Patent Ductus Arteriosus and Its Treatment on Retinopathy of Prematurity

PURPOSE: This study investigated the influence of patent ductus arteriosus (PDA) and its treatment on incidence and progression of retinopathy of prematurity (ROP). METHODS: The authors retrospectively reviewed the medical records of 408 infants who underwent screening examinations for ROP at the Neonatal Intensive Care Unit of our hospital. RESULTS: The total incidence of ROP was 23.5% (96 out of 408) and the patients that needed treatment were 7.4% (30 out of 408). The mean birth weight and gestational age was 1406.1 grams and 30.67 weeks in patients without ROP, and 979.8 grams and 27.46 weeks in patients with ROP, respectively. In both total and very low birth weight (VLBW) patients, the incidence of ROP was higher in the PDA group than the non-PDA group, but the PDA group was an independent risk factor only in the VLBW group (p = 0.033). The incidence of threshold disease was not significantly different between the PDA and control groups (p = 0.757). There was no significant difference of incidence of ROP and threshold disease among the 3 treatment groups for PDA. CONCLUSIONS: In VLBW patients, the presence of PDA increased the risk of ROP and its progression, thus more attention is needed for PDA patients. However, there was no significant difference in ROP incidence and progression according to different PDA treatment methods.

Comparisons of Clinical Results after Implantation of Three Aspheric Intraocular Lenses

PURPOSE: To compare the clinical 3 months postoperative results of three different 1-piece aspheric intraocular lenses (IOLs): AcrySof IQ SN60WF (Alcon Laboratories, INC, Fort Worth, TX), TECNIS 1-piece ZCB00 (AMO Inc., Santa Ana, CA) and the newly developed enVista MX60 (Bausch & Lomb, Rochester, NY). METHODS: In a total of 62 eyes, 1 of the 3 1-piece aspheric IOLs, AcrySof IQ SN60WF, TECNIS 1-piece ZCB00 or enVista MX60 was implanted after cataract extraction. Best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and spherical equivalent were assessed 3 months postoperatively. Total spherical aberration, high order aberration, and modulation transfer function were analyzed. RESULTS: There were no significant differences of UCVA, BCVA, the accuracy of postoperative refractive power, and modulation transfer function among the 3 IOLs. Higher order aberrations of the entire eye and internal optics showed almost no significant differences. CONCLUSIONS: The newly developed IOL, enVista MX60, showed equivalent clinical outcomes as both AcrySof IQ SN60WF and TECNIS 1-piece ZCB00.

Pharmacogenetic Influence of LOC387715/HTRA1 on the Efficacy of Bevacizumab Treatment for Age-Related Macular Degeneration in a Korean Population

PURPOSE: The purpose of this study was to determine the pharmacogenetic effects of complement factor H (CFH) Y402H, LOC387715 and high-temperature requirement factor A1 (HTRA1) genotypes on the treatment of exudative age-related macular degeneration (AMD) by intravitreal bevacizumab injection in a Korean population. METHODS: Seventy-five patients diagnosed with exudative AMD were treated with intravitreal bevacizumab (2.5 mg) monotherapy. All patients received three initial intravitreal bevacizumab injections every four weeks and were then treated "as needed" based on clinical findings, optical coherence tomography and fluorescein angiography during the 12 month follow-up period after the third injection. RESULTS: The difference in visual acuity improvement among the three genotypes of LOC387715 were statistically significant at six months post-treatment (logarithm of the minimum angle of resolution; TT, 0.346; GT, 0.264; GG, 0.188; p = 0.037). Among the LOC387715 genotypes, the number of additional injections was lower in patients who had the risk T allele (GG, 2.143; GT, 2.000; TT, 1.575; p = 0.064). There was no significant difference between visual acuity and central macular thickness change in the CFH Y402H polymorphism group during the 12 month follow-up period. However, the TC group of CFH Y402H required more additional bevacizumab injections than the TT group (TT, 1.517; TC, 3.363; p = 0.020). CONCLUSIONS: This study demonstrated that different LOC387715/HTRA1 genotypes resulted in different bevacizumab treatment responses on exudative AMD. Patients with the risk allele had an improved treatment response and less need for additional injections. However, patients with the CFH Y402H risk allele needed more additional injections of bevacizumab in order to improve visual acuity. This study illustrates how pharmacogenetic factors may help determine treatment modality and dosing. This could ultimately provide basic data for 'personalized medicine' in AMD.