Role of intraretinal cysts in the prediction of postoperative closure and photoreceptor damages of the idiopathic full-thickness macular hole.

BACKGROUND: To determine whether it would be effective in predicting the results of the postoperative full-thickness macular hole (FTMH) closure when intraretinal cyst (IRC) is present. METHODS: Case-control study. Patients with idiopathic FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were retrospectively reviewed. Preoperative spectral-domain optical coherence tomography was undertaken in all patients. The new parameter, macular hole closing factor (MHCF) was defined as the base diameter - (arm length + IRC height) by adding IRC to the existing parameter. After surgery, patients were classified and analyzed according to the type of hole closure and the damage of photoreceptor. RESULTS: Of the 35 patients, 28 (80.00%) had type 1 closure and seven (20.00%) had type 2 closure. There was a significant difference in postoperative BCVA (P < 0.01), base diameter (P = 0.037), arm length (P = 0.045), and IRC height (P = 0.011) between the two groups. In the type 1 closure, they were further divided into two subgroups according to photoreceptor damage, and it was confirmed that there were significant differences in postoperative BCVA (P = 0.045), hole height (P = 0.048), and IRC height (P = 0.046) in the two subgroups. As for the new parameters, a significant difference between the three groups was confirmed (P < 0.01). CONCLUSION: IRC may help predict hole closure along with the known horizontal parameters. Therefore, the new parameter containing both two factors can help predict not only hole closure but also damage to photoreceptors that affects postoperative visual prognosis.

Does intravitreal injections of bevacizumab for age-related macular degeneration affect long-term intraocular pressure?

PURPOSE: To evaluate the long-term intraocular pressure (IOP) changes after intravitreal injection of bevacizumab for age-related macular degeneration. PATIENTS AND METHODS: A total of 83 eyes that received intravitreal injections of bevacizumab for age-related macular degeneration were enrolled. IOP measurements at baseline, 6, 12, 18, and 24 months, and at the last follow-up after injection were analyzed. On the basis of the median number of injections, the changes in IOP were compared. RESULTS: The mean number of injections was 3.71±1.62. There was no significantly higher elevation than baseline IOP (14.11±2.76 mm Hg) after multiple intravitreal injections of bevacizumab (P>0.05). In the group which had ≥4 injections, mean IOP measurements were not higher compared with the group which had <4 injections during the follow-up period (P>0.05). In the patients with preexisting glaucoma (3 eyes), there were no significant increases of IOP during the follow-up period. CONCLUSIONS: IOP elevation was not observed during the long-term follow-up period. In addition, the numbers of injection and preexisting glaucoma did not affect IOP changes.

Extrafoveal changes following intravitreal bevacizumab injections for macular edema secondary to branch retinal vein occlusion: an mfERG and OCT study.

PURPOSE: To evaluate the functional and structural changes of extrafoveal macula after intravitreal bevacizumab (IVB) injection in patients with macular edema due to branch retinal vein occlusion (BRVO) using multifocal electroretinogram (mfERG) and optical coherence tomography (OCT). METHODS: A total of 19 eyes of 19 patients with macular edema due to BRVO received three consecutive IVB injections with a 6-week interval. Spectral domain optical coherence tomography (SD-OCT), mfERG, and fluorescein angiography (FA) were performed at baseline. The macular area was divided into four quadrants (Q1-Q4) based on FA. The mean retinal thickness (MRT) and mfERG parameters in each of the four quadrants were measured at baseline and 4 weeks after the third injection. RESULTS: The MRT in the four quadrants improved significantly after IVB injections (p < 0.01 for Q1 and Q2, p < 0.05 for Q3 and Q4) compared to baseline. The significant improvements in mfERG responses were seen in Q1 and Q2. In Q1, there were 68 and 56% improvement in N1 and P1 amplitude, respectively (p < 0.01). N1 and P1 amplitude in Q2 increased significantly by 43 and 46%, respectively, compared to baseline (p < 0.05). The MRT and P1 amplitude were significantly correlated at baseline in Q1 and Q2, but no significant correlations were found after three IVB injections. CONCLUSIONS: The injection of IVB improved functional and structural outcomes in the primarily affected half of the extrafoveal macula effectively. The measurements of structural and functional changes using mfERG and OCT may be appropriate for monitoring the effects of IVB injection in BRVO patients.

Aqueous humor concentrations of vascular endothelial growth factor and pigment epithelium-derived factor in high myopic patients.

PURPOSE: To compare the aqueous humor levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in high myopic eyes and control eyes. METHODS: Aqueous humor samples were collected from 21 highly myopic eyes of 20 patients (high myopia group) and from 30 cataract eyes of 30 patients with no choroidal neovascularization (CNV) or other ocular or systemic diseases (control group). Of the 21 high myopic eyes, 13 had no complications secondary to high myopia (high myopia with no complications group), 3 had posterior staphyloma (high myopia with staphyloma group), and 5 had chorioretinal atrophy (high myopia with chorioretinal atrophy group). The aqueous humor levels of VEGF and PEDF were determined by using commercially available enzyme-linked immunosorbent assay kits. RESULTS: Aqueous humor levels of VEGF were significantly lower in the high myopia group compared to that in the control group (p<0.001). VEGF levels decreased with an increase in the axial length (p<0.001). PEDF levels tended to be higher in the high myopia group compared to that in the control group; however, the difference was not significant. Three high myopia groups had significantly lower VEGF/PEDF ratios than the control group (p=0.000, 0.002, and 0.005). CONCLUSIONS: Aqueous humor levels of VEGF in the high myopia group were significantly lower than those in the control group. The differing levels of VEGF and PEDF in the high myopia and control groups suggest that high myopia disrupts the VEGF/PEDF balance in retinal pigment epithelium (RPE) cells.

Oral alcohol administration disturbs tear film and ocular surface.

PURPOSE: To investigate whether ethanol administration disturbs the tear film and ocular surface. DESIGN: Case-control study. PARTICIPANTS: Twenty healthy male subjects were recruited. Ethanol was administered to 10 subjects and another 10 subjects served as controls. METHODS: Twenty healthy male subjects with no ocular disease were recruited. Ethanol (0.75 g/kg) was administered orally at 8 pm for 2 hours to 10 subjects. MAIN OUTCOME MEASURES: The tear film and ocular surface were evaluated at 6 pm before drinking, at midnight, and immediately (6 am) and 2 hours (8 am) after waking the next morning. Tear osmolarity, ethanol concentration in tears and serum, Schirmer's test results, tear film break-up time (TBUT), corneal punctuate erosion, and corneal sensitivity were measured. RESULTS: Ethanol was detected in tears and serum at midnight, but it was not detected the next morning. The mean tear osmolarity level increased in the alcohol group at midnight compared with that in the control group (P<0.001). The alcohol group showed a significantly shorter TBUT compared with the control group after drinking alcohol (P<0.001 at 12 am, P<0.001 at 6 am, and P = 0.002 at 8 am). There were significantly higher fluorescein staining scores in the alcohol group compared with those in the control group at 6 am and 8 am (P = 0.001 and P<0.001, respectively). No significant change was shown in corneal sensitivity or Schirmer's test results in either group. CONCLUSIONS: Orally administered ethanol was secreted into the tears. Ethanol in tears induced tear hyperosmolarity and shortened TBUT and triggered the development of ocular surface diseases. Similar changes could exacerbate signs and symptoms in patients with ocular surface disease.

Evaluation of the central macula in commotio retinae not associated with other types of traumatic retinopathy.

PURPOSE: To report on the anatomical and functional changes to the macula in nine patients suffering from commotio retinae not accompanied by any other types of traumatic retinopathy. METHODS: Nine injured eyes with commotio retinae were evaluated soon after ocular trauma with ophthalmic examination, including Spectral-domain optical coherence tomography (SD-OCT). In 12 eyes of 6 patients, Humphrey visual field (HVF) and multifocal electroretinogram (mfERG) were performed. Re-examinations were periodically performed for a mean of 26 days. Data from 9 injured eyes were collected and compared to data collected from the 9 non-affected eyes of the same patients. RESULTS: SD-OCT revealed no significant differences in the foveal thickness and total macular volume between traumatized and intact eyes in all 9 patients. Only 3 out of the 9 injured eyes showed abnormal findings in SD-OCT images such as discontinuity of the inner/outer segment (IS/OS) junction or abnormal hyper-reflectivity from the IS/OS and retinal pigment epithelium (RPE) lines in the macula. HVF and mfERG results did not show any functional deterioration in the injured eyes compared with intact eyes. During follow-up, the commotio retinae resolved in all 9 eyes. The changes to the outer retinal region detected in 3 patients by SD-OCT were also resolved. CONCLUSIONS: Acute retinal changes in commotio retinae, not associated with other retinal pathologies, were resolved without histological and functional sequelae. In a few cases of commotio retinae, SD-OCT revealed transient abnormalities mainly observed at the IS/OS and RPE complexes.

Macular hole after intravitreal ranibizumab injection for polypoidal choroidal vasculopathy.

A 67-year-old man visited the clinic presenting with the complaint of decreased vision in his left eye. Visual acuity of the left eye was 6/6. On fundus examination, an orange polypoidal lesion and retinal pigment epithelial (RPE) detachment were seen. Fluorescein angiography and indocyanine green angiography were performed. There was hyper-fluorescence of a clustered polyp-like lesion. The patient was diagnosed with polypoidal choroidal vasculopathy and we recommended that he be seen again in three months. At this visit, visual acuity of the left eye had decreased to 6/9 and the RPE detachment was aggravated. Intravitreal injection of ranibizumab was performed. One month after the injection, visual acuity of his left eye was 6/96. A macular hole was seen in his left eye and vitrectomy of the left eye was performed. Optical coherence tomography was checked and it showed that the macular hole was closed. Two more intravitreal ranibizumab injections were done on the left eye. Visual acuity of his left eye subsequently improved to 6/18.8.

Intravitreal bevacizumab to treat acute central serous chorioretinopathy: short-term effect.

AIMS: To report the beneficial effect of intravitreal bevacizumab (Avastin) injection in patients with acute central serous chorioretinopathy. METHODS: Ten eyes of 10 patients with acute central serous chorioretinopathy received an intravitreal bevacizumab (1.25 mg/0.05 ml) injection. At baseline and follow-up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination and OCT imaging. Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity. RESULTS: All patients showed resolution of neurosensory detachment promptly, and improvement in visual acuity and symptoms within 1 month. In 1 case, fluorescein leakage resolved and neurosensory detachment nearly resolved at 2 weeks after treatment. At 6 months the mean BCVA (LogMAR) had improved from 0.32 to 0.04, which was statistically significant (p = 0.007, Wilcoxon signed ranks test). No recurrence was observed during a 6-month follow-up. CONCLUSIONS: Intravitreal bevacizumab injection for acute central serous chorioretinopathy may result in prompt resolution of neurosensory detachment and reduction of angiographic leakage. These short-term results suggest that intravitreal bevacizumab injection may constitute a promising therapeutic option in acute central serous chorioretinopathy.

A case of retinal detachment in colobomatous macrophthalmos with microcornea syndrome.

We report a rare case of retinal detachment in colobomatous macrophthalmos with microcornea syndrome. A 25-year-old female who had suffered from poor vision in her left eye since early childhood and high myopia in her right eye (-11 D) visited our clinic because of a sudden deterioration of vision. Examination of the anterior segment showed microcornea with coloboma of the inferior pupil margin in the left iris. Fundus examination of the left eye revealed an inferior choroidal coloboma extending from the optic disc and macula. The patient also had total bullous retinal detachment. Pars plana vitrectomy with silicone oil tamponade was performed, and the retina was reattached. In the very rare condition of colobomatous macropthalmos with microcornea, retinal detachment may develop. Pars plana vitrectomy with additional silicone oil tamponade may be performed to treat this condition.

Cancer-associated nummular loss of the retinal pigment epithelium.

PURPOSE: To report a case of cancer-associated nummular loss of the retinal pigment epithelium. METHODS: A 47-year-old man with a history of hepatocellular carcinoma presented with three weeks of bilateral visual loss. His best-corrected visual acuity was 20/40 in each eye. He had multiple round confluent grayish-brown patches at the level of retinal pigment epithelium, and no pigmented choroidal lesions. Fluorescein angiography showed circular areas of transmission defect and indocyanine green angiography showed early hyperfluorescence, corresponding with the multiple round confluent patches. CONCLUSIONS: We report a case of visual paraneoplastic syndrome which showed nummular loss of the pigment epithelial cells which distinguishes the clinical component of BDUMP syndrome.

Photodynamic therapy with verteporfin for choroidal neovascularization in patients with angioid streaks.

PURPOSE: To evaluate the functional and anatomic outcomes of photodynamic therapy (PDT) for choroidal neovascularization (CNV) in patients with angioid streaks. METHODS: The authors retrospectively evaluated 6 consecutive patients (6 eyes) with CNV secondary to angioid streaks. All patients were treated with standard PDT with verteporfin protocol. Standardized protocol refraction, visual acuity testing, ophthalmologic examination, color photographs, fluorescein angiograms and indocyanin angiograms were used to evaluate the results of PDT with verteporfin. Main outcome measures were visual acuity and CNV size. RESULTS: Their mean age was 61.3+/-5.50 years (range, 53-68 years). Follow-up time ranged from 12 to 38 months with mean of 20.5+/-10.91 months. The mean visual acuity at baseline was 20/100 (range 20/25-20/500), and the mean visual acuity at the last examination was 20/320(range 20/125-counting finger). The mean greatest linear dimension (GLD) at baseline was 2400+/-766.81 micrometer, and the mean GLD at the last examination was 3483+/-444.59 micrometer. CONCLUSIONS: PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss.