Treatment outcomes of acute poptoperative infectious endophthalmitis.

BACKGROUND: Acute postoperative endophthalmitis is one of the most severe complications of modern ophthalmic procedures including cataract surgeries, vitrectomy and intravitreal injection (IVI). We evaluated the treatment outcomes of acute postoperative infectious endophthalmitis. METHODS: In this retrospective study, we collected data from 82 patients with acute infectious endophthalmitis within 6 weeks after intraocular surgeries, including cataract surgeries, vitreoretinal surgeries, and IVI, from January 2010 to December 2019. We analyzed the pre-treatment, treatment-related and post-treatment factors that affected visual outcomes. RESULTS: The mean age was 67.65 ± 9.52 years, the proportion of male patients was 56.1%. The mean baseline vision was 1.92 (Snellen Equivalent SE], counting finger [CF]) ± 0.54 logarithm of the minimum angle of resolution (log MAR) and the mean final vision was 0.71 (SE, 39/200) ± 0.80 logMAR. Visual improvement was significant (P < 0.001). The pre-treatment factors affecting final visual outcomes were diabetes, hemodialysis, baseline vision, signs of vitreous opacity, and different surgeries before endophthalmitis; the treatment-related factors affecting visual outcomes were the choice factors between IVI of antibiotics alone and vitrectomy combined with IVI of antibiotics, and the injection numbers of antibiotics; post-treatment factors affecting visual outcomes were complications such as retinal detachment (RD), glaucoma and macular pucker. Furthermore, prior cataract surgery was associated with a better mean final vision of 0.57 (SE, 54/200) ± 0.67 logMAR while prior vitrectomy resulted in the worst mean final vision of 1.38 (SE, 21/500) ± 0.75 logMAR. CONCLUSIONS: The important factors that affected the final visual prognosis, included diabetes, hemodialysis, baseline vision, severity of vitritis, treatment strategies and complications. The treatment outcomes revealed better final vision in prior cataract surgery than vitrectomy.

Surgical outcomes of the removal of posterior segment metallic intraocular foreign bodies.

BACKGROUND: Posterior segment metallic intraocular foreign bodies (IOFBs) are a leading cause of visual morbidity and blindness, especially among young and middle-aged working populations. Here, we aimed to evaluate the surgical outcomes of the removal of such IOFBs that result from injuries. METHODS: In this retrospective study, 39 patients injured by metallic posterior segment IOFBs and who underwent primary repair procedures, vitrectomies, and IOFBs removal with or without procedures for traumatic cataract removal, scleral buckling and intraoperative tamponade application from January, 2008 to January, 2019. We analyzed the preoperative, intraoperative and postoperative related factors that affect the final visual outcomes. RESULTS: The mean age of the 39 patients was 40.51 ± 12.48 years with the male being predominent (100%).The mean preoperative vision measured 1.50 [Snellen Equivalent (SE), 20/645] ± 1.12 logMAR with the mean final vision measuring 0.93 (SE, 20/172) ± 1.09 logMAR. The related factors that were determined to affect the final visual outcomes included preoperative vision (P = 0.025), IOFB-related macula injuries (P = 0.001) and the development of postoperative complications (P = 0.005) especially retinal detachment (P = 0.002) with the mean final vision measuring 2.12 (SE, counting finger to hand motion) ±1.23 logMAR. Concerning the preoperative signs, the patients with preoperative endophthalmitis also obtained poor mean final vision measuring 1.30 (SE,20/400) ± 1.40 logMAR. CONCLUSION: IOFB-related macula injuries and postoperative retinal detachment were important related factors of poor final visual prognoses in cases involving posterior segment metallic IOFBs. Removing IOFB as early as possible may prevent preoperative endophthalmitis which could lead poor final visions even without significance.

AKR1B1-Induced Epithelial-Mesenchymal Transition Mediated by RAGE-Oxidative Stress in Diabetic Cataract Lens.

PURPOSE: Cataracts are a major cause of visual acuity deterioration in diabetes mellitus (DM) in developed and developing countries. Studies have demonstrated that overproduction of AKR1B1 and receptor for advanced glycation end products (RAGE) plays a major role in the pathogenesis of diabetic cataracts, but it is unclear whether the prevalence of diabetic cataracts is related to epithelial-mesenchymal transition (EMT) in lens epithelial cells. This study aimed to analyze the role of EMT in cataract formation of DM patients. METHODS: Immunofluorescence and immunohistochemistry assays were used to estimate AKR1B1, RAGE, AMPK, and EMT levels in epithelial human lens of DM or non-DM cataracts. RESULTS: Immunohistochemical staining demonstrated that pathologic phases and N-cadherin expression levels were significantly higher in epithelial human lens of DM (+) compared to DM (-) cataracts. Immunofluorescent staining showed that AKR1B1 and RAGE were significantly higher in epithelial human lens of DM (+) compared to DM (-) cataracts. Interestingly, acetyl superoxide dismutase 2 (AcSOD2) levels were significantly higher in DM patients' lens epithelial cells (LECs), whereas AMPKT172 phosphorylation was significantly increased in non-DM patients. This indicates that AMPKT172 might be related to superoxide reduction and diabetic cataract formation. CONCLUSIONS: Our results suggest that AKR1B1 overexpression can decrease AMPK activation, thereby increasing AcSOD2 and RAGE-induced EMT in epithelial human lens of DM cataracts. These novel findings suggest that AKR inhibitors may be candidates for the pharmacological prevention of cataracts in patients with DM.

Surgical outcomes of centripetal non-fovea-sparing internal limiting membrane peeling for myopic foveoschisis with and without foveal detachment: a follow-up of at least 3 years.

BACKGROUND: We evaluated the surgical outcomes of vitrectomy with non-fovea-sparing internal limiting membrane (ILM) peeling for myopic foveoschisis with a follow-up of at least 3 years. METHODS: In this retrospective study, 32 consecutive eyes with high myopia with or without foveal detachment underwent vitrectomy and centripetal, non-fovea-sparing ILM peeling with gas tamponade for myopic foveoschisis. Outcome measures were visual acuity (VA) and optical coherence tomography findings. RESULTS: Mean axial length was 29.39±1.92 mm; mean follow-up was 42.66 (±8.29) months. Foveoschisis and foveal detachment completely resolved in all eyes postoperatively. Mean central foveal thickness (CFT) improved significantly from 631.88±191.72 to 232.65±69.67 µm, and mean best-corrected visual acuity improved significantly from 0.90 (Snellen equivalent (SE), 20/160)±0.43 logarithm of minimum angle of resolution (logMAR) to 0.43 (SE, 20/54)±0.29 logMAR (both p<0.001; two-tailed, paired t-test). Eyes with foveal detachment (n=10) at baseline had thicker preoperative CFT (737.8±239.83 vs 583.73±147.78 µm; p=0.033) but thinner postoperative CFT (188.20±31.52 vs 252.86±73.29 µm; p=0.012). Eyes without foveal detachment at baseline had significantly better postoperative VA (0.33 (SE, 20/43)±0.18 vs 0.65 (SE, 20/86)±0.37 logMAR; p=0.002). No macular hole or other complications occurred during follow-up. CONCLUSION: Centripetal, non-fovea-sparing ILM peeling with gas tamponade may achieve myopic foveoschisis resolution and vision improvement without macular hole formation during at least 3-year follow-up.

Dapagliflozin Prevents NOX- and SGLT2-Dependent Oxidative Stress in Lens Cells Exposed to Fructose-Induced Diabetes Mellitus.

PURPOSE: Cataracts in patients with diabetes mellitus (DM) are a major cause of blindness in developed and developing countries. This study aims to examine whether the generation of reactive oxygen species (ROS) via the increased expression of glucose transporters (GLUTs) and the receptor for advanced glycation end products (RAGE) influences the cataract development in DM. METHODS: Lens epithelial cells (LECs) were isolated during cataract surgery from patients without DM or with DM, but without diabetic retinopathy. In a rat model, fructose (10% fructose, 8 or 12 weeks) with or without dapagliflozin (1.2 mg/day, 2 weeks) treatment did induce DM, as verified by blood pressure and serum parameter measurements. Immunofluorescence stainings and immunoblottings were used to quantify the protein levels. Endogenous O2˙¯ production in the LECs was determined in vivo with dihydroethidium stainings. RESULTS: We investigated that GLUT levels in LECs differed significantly, thus leading to the direct enhancement of RAGE-associated superoxide generation in DM patients with cataracts. Superoxide production was significantly higher in LECs from rats with fructose-induced type 2 DM, whereas treatment with the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin prevented this effect in fructose-fed rats. Protein expression levels of the sodium/glucose cotransporter 2 (SGLT2), GLUT1, GLUT5, the nicotinamide adenine dinucleotide phosphate reduced form (NADPH) oxidase subunit p67-phox, NOX2/4 and RAGE were upregulated in fructose-fed animals, whereas dapagliflozin treatment reversed these effects. CONCLUSIONS: In rats with fructose-induced DM, dapagliflozin downregulates RAGE-induced NADPH oxidase expression in LECs via the inactivation of GLUTs and a reduction in ROS generation. These novel findings suggest that the SGLT2 inhibitor dapagliflozin may be a candidate for the pharmacological prevention of cataracts in patients with DM.

SURGICAL OUTCOMES IN EYES WITH EXTREMELY HIGH MYOPIA FOR MACULAR HOLE WITHOUT RETINAL DETACHMENT.

PURPOSE: The authors evaluated surgical outcomes in eyes with extremely high myopia for macular hole (MH) without retinal detachment. METHODS: In this retrospective study, 14 eyes with axial lengths of ≥30.0 mm underwent vitrectomy and internal limiting membrane (ILM) peeling with or without inverted ILM flap insertion for MH without retinal detachment (October 2009-June 2016). Outcome measures were MH closure confirmed by optical coherence tomography, best-corrected visual acuity, and complications. RESULTS: The mean axial length was 30.69 ± 0.76 mm. The overall final closure rate was 85.7% (12/14 eyes); the mean follow-up was 17.29 (±20.20) months. Primary anatomical MH closure after 1 operation was achieved in three of eight eyes (37.5%) without an inverted ILM flap and was achieved in six of six eyes (100%) with inverted ILM flap insertion (P = 0.031). There was no reopening of MH during follow-up. Mean visual acuity improved significantly from 1.10 ± 0.43 logarithm of the minimum angle of resolution (Snellen equivalent, 20/254) to 0.84 ± 0.50 logarithm of the minimum angle of resolution (Snellen equivalent, 20/138) (P = 0.046; 2-tailed, paired t-test). Only 1 eye developed an MH-associated retinal detachment 4.5 years after previously failed MH surgery; reattachment was achieved after a second operation. CONCLUSION: Patients with extremely high myopia obtained anatomical and functional improvements from MH surgery; inverted ILM flap insertion achieved significantly higher primary success rates in MH closure.

FIVE-YEAR OUTCOMES OF INTRAVITREAL INJECTION OF RANIBIZUMAB FOR THE TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION.

PURPOSE: To evaluate the 5-year outcomes, efficacy, and safety of intravitreal ranibizumab injections for the treatment of myopic choroidal neovascularization. METHODS: The medical records of 18 consecutive eyes of 14 patients who received intravitreal injections of ranibizumab for myopic choroidal neovascularization with a follow-up of 5 years were retrospectively reviewed. Outcomes included best-corrected visual acuity, total number of treatments, and complications. RESULTS: The average number of injections over 5 years was 4.56 ± 3.52. Ten eyes (55.56%) had no need for treatment after the first year. Mean best-corrected visual acuity improved from 0.59 ± 0.47 logarithm of the minimum angle of resolution (Snellen equivalent, 6/24) at baseline to 0.32 ± 0.35 logarithm of the minimum angle of resolution (Snellen equivalent, 6/13) at 1 year, and to 0.38 ± 0.42 logarithm of the minimum angle of resolution (Snellen equivalent, 6/15) at 2 years (P = 0.001 and 0.020, respectively; paired t-test). After 2 years, although mean best-corrected visual acuity remained better than baseline, the difference was not statistically significant. At 5 years, vision improved by at least 1 line for 61.11% of eyes and by more than 3 lines for 33.33%. The final visual acuity of 2 eyes was worse than baseline because of disease activity and profound chorioretinal atrophy, which increased in six eyes. No complications were noted. CONCLUSION: Intravitreal ranibizumab was safe and effective for treating myopic choroidal neovascularization. Only 44% of eyes required retreatment after the first year, and vision improved in more than 60% of eyes over 5 years.

What is the predictor of surgical mortality in adult colorectal perforation? The clinical characteristics and results of a multivariate logistic regression analysis.

PURPOSE: Colorectal perforations are a serious condition associated with a high mortality. The aim of this study was to describe the clinical characteristics and identify predictors for the surgical mortality in adult patients with colorectal perforation, thereby achieving better outcomes. METHODS: A retrospective study of adult patients diagnosed with colorectal perforation operated was performed. The clinical variables that might influence the surgical mortality were first analyzed, and the significant variables were then analyzed using a logistic regression model. RESULTS: A total of 423 patients were identified, and the surgical mortality rate was 36.9 %. The most common etiology was diverticulitis (38.2 %). The highest etiology-specific mortality was for colorectal cancer (61.5 %) and ischemic proctocolitis (59.8 %). In a logistic analysis, the significant predictors for the surgical mortality were ≥3 comorbidities (p = 0.034), preoperation American Society of Anesthesiologists score ≥4 (p = 0.025), preoperative sepsis or septic shock (p < 0.001), colorectal cancer or ischemic proctocolitis (p = 0.035), reoperation (p = 0.041), and Hinchey classification grade IV (p = 0.024). CONCLUSION: We demonstrated that ≥3 comorbidities, a preoperation American Society of Anesthesiologists score ≥4, preoperative sepsis or septic shock, colorectal cancer or ischemic proctocolitis, reoperation, and Hinchey classification grade IV are predictors for the surgical mortality in the adult cases of colorectal perforation. These predictors should be taken into consideration to prevent surgical mortality and to reduce potentially unnecessary medical expenses.

Risk Factors of Hyphema following Surgeries for Primary Rhegmatogenous Retinal Detachment.

PURPOSE: This study aimed to evaluate the risk factors for hyphema complicating primary rhegmatogenous retinal detachment (RRD) surgeries and to analyze outcomes. METHODS: In this retrospective comparative study, we included 1,011 consecutive eyes. Two groups were compared according to the occurrence of postoperative hyphema. RESULTS: Postoperative hyphema occurred in 32 eyes (3.17%). High myopia was significantly related to the occurrence of hyphema (odds ratio [OR] 3.396, 95% confidence interval [CI] 1.502-7.675; p = 0.003). Combined scleral buckling and vitrectomy (SB + VT) was associated with a significantly higher incidence of hyphema (OR 21.266, 95% CI 4.855-93.152; p < 0.001). The final anatomical success rate did not differ significantly between the group with and the group without occurrence of hyphema; however, the primary anatomical success rate was worse in the eyes with hyphema. CONCLUSIONS: High myopia and combined SB + VT were risk factors for hyphema after RRD surgeries. The occurrence of hyphema did not affect the final anatomical success rate at 6 months.

Comparison of laparoscopic versus open surgery in a three-stage operation for obstructive left-sided colorectal cancer.

BACKGROUND: Treatment for obstructive left-sided colorectal cancer (OLCC) typically consists of a three-staged procedure. During the first stage, the obstruction is managed with diversion colostomy. Traditionally in the second stage, we perform open resection for the primary tumor. In this study, we evaluated the feasibility of laparoscopic resection of OLCC with diversion colostomy in terms of operative results and short-term outcomes. METHODS: A total of 20 patients underwent laparoscopic resection for OLCC (study group), 48 patients underwent open resection for OLCC (control group 1), and 53 patients underwent laparoscopic resection for non-OLCC (control group 2). Afterwards, results from the procedures were obtained and clinical data were analyzed. RESULTS: The operative time was significantly longer in the study group than in the control group 1 (153 minutes vs. 126 minutes, p = 0.041), and the length of hospitalization was shorter in the study group than in the control group 1 (5.3 days vs. 7.6 days, p = 0.032). Regarding the operative results and short-term outcomes, there were no significant differences between the study group and control group 2. Colostomy retraction was a specific morbidity which occurred in two patients of the study group. CONCLUSION: Laparoscopic resection of OLCC with diversion colostomy is feasible. Abdominal cavity adhesion is only limited. We strongly recommend that laparoscopic resection should be performed at least 2 weeks after diversion colostomy, and the plastic rod should be left in place during the pneumoperitoneum to reduce the risk of colostomy retraction.

Measurement of peritoneal fluid urea nitrogen and creatinine levels is useful to detect iatrogenic urinary tract leakage in colorectal surgery.

BACKGROUND: Increased peritoneal drainage after colorectal surgery is a common problem. Measurement of peritoneal fluid urea nitrogen (UN) and creatinine (Cr) is a diagnostic tool to detect the urinary tract leakage (UTL). We evaluated its application in colorectal surgery. METHODS: We conducted a retrospective chart review study. We enrolled patients with iatrogenic UTL, and measured their UN and Cr levels in peritoneal fluid and compared them with those in blood and urine. Meanwhile, we assigned patients without UTL to a control group and compared clinical parameters of both groups. RESULTS: Twenty-three patients with iatrogenic UTL were recruited. The overall incidence was 0.5%. UN level in peritoneal fluid (322 ± 56 mg/dL) was significantly higher than that in blood (18.7 ± 4.0 mg/dL, p < 0.001); Cr level in peritoneal fluid (69.7 ± 14.3 mg/dL) was also significantly higher than that in blood (1.5 ± 0.5 mg/dL, p < 0.001). UN level in peritoneal fluid was significantly higher in the iatrogenic UTL group than in the control group (322 mL/dL vs. 9.3 mL/dL, p < 0.001); Cr level in peritoneal fluid was also significantly higher (69.7 mg/dL vs. 0.98 mg/dL, p < 0.001). CONCLUSION: When increased peritoneal drainage is found postoperatively in colorectal surgery, measurement of UN and Cr levels in peritoneal fluid can be a useful diagnostic tool to determine intraperitoneal iatrogenic UTL.

Two-year outcome of intravitreal injections of ranibizumab for myopic choroidal neovascularization.

PURPOSE: To evaluate the 2-year outcome, efficacy, and safety of intravitreal ranibizumab injections for myopic choroidal neovascularization (CNV). METHODS: We retrospectively reviewed the medical records of 28 consecutive eyes that received intravitreal injections of ranibizumab for myopic CNV with a 24-month follow-up. Retreatment was performed as needed in eyes with persistent or recurrent CNV. Patient demographic data, best-corrected visual acuity (BCVA), CNV findings on fluorescent angiography, central macular thickness on optical coherence tomography, total number of treatments, and complications were recorded. RESULTS: Mean baseline BCVA was 0.53±0.32 logMAR [Snellen equivalent (SE), 6/20], and improved significantly to 0.28±0.32 logMAR (SE, 6/11) at 1 year and 0.29±0.28 logMAR (SE, 6/12) at 2 years (both P<0.01, Wilcoxon signed-rank test). The average number of total injections over 2 years was 3.32 (SD 2.13). A mean of 2.82 injections were performed in the first year, and 0.50 in the second year. Twenty-three eyes (82.1%) had no need for treatment during the second year of follow-up. Mean improvement from the baseline was 2.57 Snellen lines (SD 2.35) at 1 year, and 2.29 lines (SD 2.69) at 2 years. At 2 years, 11 eyes (39.3%) showed a gain of at least 3 lines after treatment. No complications were noted after treatment. CONCLUSIONS: Intravitreal ranibizumab injection was safe and effective in treating myopic CNV, with visual improvement maintained over 2 years.

One-year outcome of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization.

PURPOSE: To evaluate and compare the 12-month outcomes of two different initial dosing regimens of intravitreal ranibizumab for myopic choroidal neovascularization (CNV). METHODS: We retrospectively reviewed the medical records of 46 consecutive, treatment-naive eyes which received intravitreal ranibizumab for subfoveal and juxtafoveal CNV secondary to pathologic myopia with a follow-up of 12 months. Two groups were created according to different initial dosing regimens: group 1 included 25 eyes treated by a single intravitreal injection; group 2 included 21 eyes treated by three consecutive monthly injections. Additional injections were performed if needed. Patients' demographic data, best-corrected visual acuity (BCVA), recurrence of CNV and total number of treatments were recorded and evaluated. RESULTS: There was no significant difference between two groups among baseline demographic data. At 12 months, the mean logMAR BCVA improved from 0.58 to 0.23 in group 1 and from 0.55 to 0.22 in group 2 (both p < 0.001; Wilcoxon signed-rank test). The mean logMAR BCVA at 12 months did not differ significantly. The average number of injections was 2.32 (SD 1.22) in group 1 and 3.57 (SD 1.12) in group 2 (p = 0.001; two-tailed t-test). During the follow-up, 17 of 25 eyes in group 1 and 5 of 21 eyes in group 2 received additional injections (p = 0.004). CONCLUSIONS: Similar visual improvement was achieved in both groups. Although the eyes with a loading dose of 3 monthly injections required a higher number of total injections over 1 year, there was a much lower rate of retreatment needed.

The effect of autologous serum on vitrectomy with internal limiting membrane peeling for idiopathic macular hole.

PURPOSE: We sought to evaluate the effects of intraoperative adjunctive autologous serum in idiopathic full-thickness macular hole surgeries, and to compare the surgical outcomes with a no-serum control group. METHODS: In this retrospective, case-control study, 38 consecutive eyes received vitrectomy with internal limiting membrane removal for idiopathic full-thickness macular holes. Two groups were created according to the use of autologous serum. Outcome measures were visual acuity (VA), closure of the macular hole confirmed by optical coherence tomography, and surgical complications. RESULTS: Anatomical closure of the macular hole was achieved in 18 of 19 eyes (94.7%) in the vitrectomy with the autologous serum group, and in 18 of 19 eyes (94.7%) in the control group. The closure rates did not differ significantly between 2 groups (P=1.000; the Fisher's exact test). At the final follow-up, the mean logMAR VA improved significantly in both groups (SD, standard deviation) [from 1.08 (0.21) to 0.47 (0.21) in vitrectomy with the serum group and from 1.01 (0.32) to 0.44 (0.30) in the control group (both P<0.001; 2 tailed, paired t test)]. There was no significant difference between these 2 groups in terms of visual outcomes (P=0.738; 2-tailed t test). There were no surgical complications, such as retinal detachment and endophthalmitis. CONCLUSIONS: The outcome of macular hole surgery did not differ both anatomically and functionally regardless of the use of adjuvant autologous serum. There seemed to be no additive effect with autologous serum.

Tumor seeding after diagnostic vitrectomy for choroidal metastasis in breast cancer.

Choroidal metastasis is the most common type of intraocular tumor in adults, and in females the most common primary site is the breast. We report a case of unilateral choroidal metastasis with exudative retinal detachment as the initial presentation of recurrent breast cancer, and subsequent ophthalmic metastasis following diagnostic vitrectomy. A 49-year-old woman with a 7-year-history of well-treated bilateral breast cancer had been suffering from blurred vision in the left eye for 1 week. Ocular examination was normal except for superotemporal retinal detachment in the left eye. Neither retinal break nor choroidal mass was seen. The patient received scleral buckling and pneumatic retinopexy without significant improvement. Fluorescein angiography revealed a suspected choroidal metastasis in the left eye, but ocular ultrasonography did not show a visible choroidal mass. Two consecutive diagnostic vitrectomies with cytology could not confirm malignancy. A systemic workup was also negative. Six months later, two tumor masses were noted over two of the sclerotomy wounds of the left eye. Pathology showed adenocarcinoma compatible with invasive ductal carcinoma of the breast. Ocular metastasis may present as infiltrative choroidal lesions with exudative retinal detachment without a visible mass. Invasive procedures, such as fine-needle aspiration biopsy and diagnostic vitrectomy, may risk tumor seeding.

Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case-control study using optical coherence tomography.

BACKGROUND: We sought to evaluate the surgical outcomes of macular hole without retinal detachment in high myopia to assess anatomical closure of macular holes using optical coherence tomography (OCT) and to compare these results with those from controls. METHODS: In this retrospective case-control study, 42 consecutive eyes of 41 patients received vitrectomy with internal limiting membrane removal for macular hole without retinal detachment between August 2008 and September 2010. Two groups were created: eight eyes with high myopia (-6.00 diopters of refractive error or greater and axial length longer than 26.0 mm) and 34 eyes without high myopia. Diagnosis and staging of macular hole were defined by biomicroscopy findings and confirmed by OCT. Outcome measures were visual acuity (VA), closure of the macular hole and complications. RESULTS: Anatomical closure of the macular hole confirmed by OCT was less favorable and was achieved in only five of eight eyes (62.5%) with high myopia, compared to 32 of 34 eyes (94.1%) in the control group (p = 0.040; Fisher's exact test). At the final follow-up, the mean logMAR VA improved significantly in the group with high myopia, from 0.92 to 0.63 (p = 0.023; two-tailed, paired t test); in the control group, it improved from 1.02 to 0.48 (p < 0.001; two-tailed, paired t test). There was no significant difference between the 2 groups in visual outcomes (p = 0.17; two-tailed t test). However, in pseudophakic eyes, the mean of the final VA was worse in highly myopic eyes (0.74 logMAR) than in control eyes (0.40 logMAR) (p = 0.016; two-tailed t test). The only complication was peripheral retinal detachment in one eye in the highly myopic group (12.5%). CONCLUSIONS: Both groups benefited from macular hole surgery, with significant visual improvement. However, complete closure of the macular hole and visual outcomes after internal limiting membrane removal were less successful in highly myopic eyes.

The 12-month outcome of three consecutive monthly intravitreal injections of ranibizumab for myopic choroidal neovascularization.

PURPOSE: The aim of this study was to evaluate the 12-month outcomes, efficacy, and safety of three consecutive monthly intravitreal ranibizumab injections for myopic choroidal neovascularization (CNV). METHODS: We retrospectively reviewed the medical records of 25 consecutive eyes that received a loading dose of three consecutive monthly intravitreal injections of ranibizumab for myopic CNV between February, 2008, and March, 2010, with a follow-up of 12 months. Eyes with persistent or recurrent CNV after 3 months received additional ranibizumab injections as needed. Patients' demographic data, best corrected visual acuity (BCVA), CNV findings on fluorescent angiography (FAG), central macular thickness (CMT) on optical coherence tomography (OCT), total number of treatments, and complications were recorded. RESULTS: Mean baseline BCVA was 0.73 logarithm of the minimum angle of resolution (logMAR) (standard deviation [SD] 0.63), and improved significantly to 0.42 logMAR (SD 0.43) at 1 month, 0.38 logMAR (SD 0.47) at 2 months, 0.34 logMAR (SD 0.43) at 3 months, and 0.34 logMAR (SD 0.40) at 12 months (all P<0.001, Wilcoxon signed-rank test). The average number of injections was 3.44 (SD 0.92). At 12 months, mean improvement was 2.88 lines (SD 2.35), and 20 eyes (80%) showed a gain of at least one line after treatment. At 3 months, OCT showed significant reduction in CMT (P=0.012, two-tailed t-test), and FAG showed significant reduction of mean CNV size from 0.3 (SD 0.16) to 0.19 (SD 0.12) disc area (P=0.007, two-tailed t-test). No angiographic leakage was evident at 3 months in 21 eyes (84%); four eyes (16%) required additional injections for persistent leakage. Two eyes (8%) had recurrent CNV during follow-up and required retreatment. No complications were noted after treatment. CONCLUSIONS: An initial loading dose of three ranibizumab injections is safe and effective in treating myopic CNV, with visual improvement maintained over 12 months.

Non-vitrectomizing vitreous surgery and adjuvant intravitreal tissue plasminogen activator for non-recent massive premacular hemorrhage.

Massive premacular hemorrhage can cause sudden visual loss. We sought to evaluate the efficacy, safety and visual outcome of nonvitrectomizing vitreous surgery with intravitreal tissue plasminogen activator (t-pa) for long-lasting thick premacular hemorrhage. This retrospective, interventional study examined three consecutive eyes of three patients who received nonvitrectomizing vitreous surgery with intravitreal t-pa for the treatment of non-recent massive premacular hemorrhage. Detailed ophthalmoscopic examinations were performed pre- and postoperatively to evaluate the visual outcome, the resolution of premacular hemorrhage and the changes in lenticular opacity.In all three eyes, the premacular hemorrhage cleared after the procedure. Final best-corrected visual acuities improved from 6/30 to 6/10 in patient 1, 2/60 to 6/4 in patient 2, and 3/60 to 6/6 in patient 3. Operated and fellow eyes did not differ in terms of nuclear sclerosis. No complications from the procedure were noted.In these selected cases, nonvitrectomizing vitreous surgery with intravitreal t-pa was an effective and safe alternative treatment for non-recent massive premacular hemorrhage.

Vitreous hemorrhage complicating intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage.

PURPOSE: To evaluate the clinical factors associated with vitreous hemorrhage (VH) complicating intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage, and analyze visual outcomes. METHODS: In this retrospective, comparative study, 120 consecutive eyes underwent intravitreal tissue plasminogen activator (50 µg) and perfluoropropane (0.3 mL) injection for submacular hemorrhage secondary to different causes. We recorded their demographic data, visual acuity, complications, and further treatment after VH. Two groups created according to the occurrence of VH were compared to identify possible risk factors. RESULTS: Breakthrough VH occurred in 18 eyes (15%). The size of submacular hemorrhage was significantly positively related to the occurrence of VH (P for trend <0.001). Among etiology, idiopathic polypoidal choroidal vasculopathy (IPCV) was associated with a significantly higher incidence of VH (odds ratio, 15.63; 95% confidence interval, 2.30-106.15; P = 0.005). Age-related macular degeneration was much less likely than other causes to result in VH (odds ratio, 0.121; 95% confidence interval, 0.023-0.642; P = 0.013). Best and final visual acuity improved significantly from initial visual acuity in both groups (P < 0.05). CONCLUSION: A large area of submacular hemorrhage (≥10 disk areas) and IPCV were risk factors for VH after injection. The occurrence of VH did not affect final visual outcome.

Risk factors for endogenous endophthalmitis secondary to klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan.

PURPOSE: To identify the risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess. METHODS: We conducted a retrospective review of medical records of 602 patients admitted with K. pneumoniae liver abscess from January 1991 to November 2009. Variables included age, sex, history, month of onset, systemic condition, initial and final visual acuities, slit-lamp biomicroscopy, intraocular pressure, fundus, course and treatment. RESULTS: Endophthalmitis was identified in 42 patients (53 eyes). Nineteen eyes (35.8%) had final vision of counting fingers or better. Diabetes was significantly associated with the development of endophthalmitis (P = 0.003) and poor visual outcome (P = 0.019). Poor initial vision (worse than counting fingers) was also significantly related to the poor visual outcome of endophthalmitis (P < 0.001). Subgroup analysis of 9 vitrectomy cases showed that progressive anterior chamber reaction might be related to poor visual outcome. Moreover, patients whose disease onset was in winter were slightly more likely to develop endophthalmitis (P = 0.088). CONCLUSION: Although the prognosis of endogenous K. pneumoniae endophthalmitis is generally poor, some eyes might be saved if treated early enough. Diabetes is a significant risk factor for the development of endogenous endophthalmitis and poor visual outcome in patients with K. pneumoniae liver abscess. Early vitrectomy might be considered in patients whose anterior chamber inflammation did not respond well to intravitreal antibiotics.