Title: efficacy of intravitreal dexamethasone implant on hard exudate in diabetic macular edema.

BACKGROUND: To investigate the effect of intravitreal dexamethasone implant (DEX implant) on hard exudate (HE) accompanying diabetic macular edema (DME). METHODS: This study was a non-comparative non-randomized 1-year prospective interventional study. Patients with DME and HE were treated using DEX implant two or three times. Color fundus photography and optical coherence tomography (OCT) were performed at every visit. HE area was measured semi-automatically from the fundus photographs. RESULTS: Thirty-five patients completed the study. Eleven patients (31.4%) received two injections, while the remaining received three times. HE area (primary outcome) significantly decreased from 1.404±2.094 mm2 (baseline) to 0.212±0.592 mm2 (last visit), which was 24% of the baseline HE area (P<0.001). HE1500 (HE within 1500 µm from the fovea) area also decreased significantly from 0.382±0.467 mm2 to 0.066±0.126 mm2 (P<0.001). Furthermore, anaverage best corrected visual acuity (BCVA) improvement of 4.4 Early Treatment Diabetic Retinopathy Study (ETDRS) letters was observed (from 49.9±18.3 to 54.3±20.4 letters) (P= 0.008). Central macular thickness (CMT) decreased from 455.8±23.6 µm to 366.8±31.1 µm (P=0.009). Repetitive measurements for entire study duration was analyzed using generalized estimating equations (GEE), where BCVA was related to age, CMT, and HE1500 area in multivariate analyses. CONCLUSION: DEX implant could reduce and suppress HE in DME for one year with two or three injections. And centrally located HE area (HE1500 area) is related to vision. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02399657 , Registered 26 March 2015.

One-year Results of Aflibercept Treatment for Polypoidal Choroidal Vasculopathy with Good Visual Acuity.

PURPOSE: To evaluate the one-year efficacy of intravitreal aflibercept injection in polypoidal choroidal vasculopathy (PCV) with best-corrected visual acuity (BCVA) of 20 / 40 or better. METHODS: This was a multicenter retrospective study. The medical records of patients diagnosed with treatment-naïve PCV were retrospectively reviewed. Patients with an initial BCVA of 20 / 40 or better and who had undergone intravitreal aflibercept injection were included. Patients were treated with three consecutive monthly injections, followed by pro re nata regimen according to the clinician's discretion at variable interval visits. The proportions of eyes for which BCVA was maintained (≤ 0.2 logarithm of the minimum angle of resolution change) or improved at 12 months were evaluated. The changes of BCVA, central subfield macular thickness (CSMT), pigment epithelial detachment, and subretinal fluid also were assessed. RESULTS: A total of 86 eyes were included. The mean number of injections for 12 months of treatment was 5.4 ± 1.7. BCVA was maintained or improved in 94.2% (81 / 86) of cases. Mean BCVA (logarithm of the minimum angle of resolution) had changed from the baseline (0.23 ± 0.09) at 3 months (0.21 ± 0.14), 6 months (0.24 ± 0.22), and 12 months (0.20 ± 0.18), but with no statistical significance. CSMT had improved significantly from the baseline (336.1 ± 97.3 µm) at 3 months (223.6 ± 47.22 µm), 6 months (239.6 ± 64.2 µm), and 12 months (223.8 ± 47.9 µm). Pigment epithelial detachment was observed in 93% of cases at the baseline, 72.1% at 3 months, and 69.8% at 12 months, showing a significant decrease at all observation points. Subretinal fluid was observed in 91.9% of cases at the baseline, 20.9% at 3 months, and 29.1% at 12 months, showing a significant decrease at all observation points. CONCLUSIONS: In cases of PCV with good visual acuity, intravitreal aflibercept injections decreased CSMT and were effective in maintaining visual acuity.

Two-year outcomes of the treat-and-extend regimen using aflibercept for treating diabetic macular oedema.

This study was performed to investigate the efficacy of the treat-and-extend regimen using aflibercept for treating diabetic macular oedema (DME). This prospective, multicentre, interventional, single-arm, 104-week clinical trial included 48 patients with DME visual impairment. The patients' eyes received five consecutive intravitreal injections (2 mg aflibercept) every four weeks with two-week adjustments based on central subfield macular thickness (CSMT) changes. Injections were deferred when CSMT was stable. The number of injections, best-corrected visual acuity (BCVA), CSMT, and diabetic retinopathy severity scale scores were analysed. Compared to baseline, BCVA improved by + 9.1 letters at 52 weeks and was maintained with + 9.4-letter gain at 104 weeks (P < 0.001). Between baseline and 104 weeks, CSMT decreased from 489 to 298 µm (P < 0.001) and eyes with vision ≥ 20/40 increased from 17.4 to 43.5% (P = 0.007). The mean number of injections decreased from 8.5 in year one to 3.9 in year two. The injection interval was extended to ≥ 12 weeks in 56.5% of patients. The treat-and-extend regimen of aflibercept in DME showed 2-year efficacy comparable to that of fixed dosing regimens. The flexible dosing of this regimen reduced the number of injections in year two while maintaining efficacy.

One-Year Results of Treatment of Diabetic Macular Edema with Aflibercept Using the Treat-and-Extend Dosing Regimen: the VIBIM Study.

INTRODUCTION: The purpose of this study was to report the one-year results of treatment of diabetic macular edema (DME) with aflibercept using a treat-and-extend regimen (TER). METHODS: This was a prospective, multicenter, single-arm study planned for 2 years. The eyes received 5 consecutive intravitreal injections of 2 mg of aflibercept every 4 weeks, and the interval between injections was then adjusted by 2 weeks based on changes in the central subfield macular thickness (CSMT). If the CSMT was worse, stable, or better, the interval was shortened, extended, or maintained, respectively. The primary outcome measure was the change in best-corrected visual acuity (BCVA) from baseline to 104 weeks, and the secondary outcome was the change in BCVA from baseline to 52 weeks. RESULTS: Of the 48 patients enrolled, 46 completed a 1-year visit. BCVA improved significantly by 9.1 letters (95% confidence interval: 5.3-13.0 letters) from 56.2 letters at baseline (p < 0.001), and CSMT decreased by -171.7 µm from 489.4 to 317.7 µm (p < 0.001). The proportion of eyes having 20/40 or better vision increased from 17.4 to 41.3%, and the proportion of eyes that gained ≥15 letters was 28.3%. The mean number of injections was 8.5 times for 52 weeks. Worsening of macular edema did not occur in 76.1% of eyes during the extension period, and the interval between injections was extended to 12 weeks in 73.9% of eyes at 52 weeks. CONCLUSIONS: The TER showed 1-year efficacy comparable to that of the fixed dosing regimen of pivotal trials, and its flexible dosing would prevent overtreatment.

New Method of Quantitative Analysis of Hard Exudate Using Optical Coherence Tomography: Application in Diabetic Macular Edema.

PURPOSE: In the present study, the volume of hard exudates (HEs) was quantitatively measured using optical coherence tomography (OCT) and the agreement and correlation with area of HEs in fundus photography were analyzed. METHODS: The medical records of patients with diabetic macular edema who underwent focal laser treatment and were followed up more than 3 months were retrospectively evaluated. An automated customized program designed for measuring HE volume was used. The HEs in each OCT B-scan binary image were measured using 512 × 128 pixels, 6 mm × 6 mm OCT cube scans. The volume was measured by summing the segmented HEs in each 128 B-scan image. The area was measured in 6 mm x 6 mm fundus photography. The volume and area were measured before and 3 months after the treatment. The agreement of increase and decrease in HEs, and the correlation of volume and area of HEs were analyzed. RESULTS: A total of 35 patients (39 eyes) were included in the study. The volume was significantly reduced from 0.07978 to 0.02565 mm³ at 3 months (p < 0.001). The area was also significantly reduced from 15.35 to 8.60 mm² at 3 months (p < 0.001). The volume was decreased in 34 eyes and increased in 5 eyes. The area was decreased in 37 eyes and increased in 2 eyes. A significant correlation between volume and area was found (p < 0.001) as well as agreement between increase and decrease in volume and area. CONCLUSIONS: In the 3-dimensional quantitative volumetric analysis, the volume and area of HEs were correlated and the direction of increase and decrease was concordant. Considering the distribution of HEs in multiple layers of the retina, volumetric analysis could be considered a substitute for the analysis of HE area.

Comparison between refractive outcomes between macula-on and macula-off retinal detachments after phaco-vitrectomy.

PURPOSE: To evaluate axial length (AL) measurements and refractive outcomes in vitrectomy combined with cataract operation for rhegmatogenous retinal detachment (RRD) with wholly detached macula. STUDY DESIGN: Retrospective, consecutive, comparative, clinical study. METHODS: We reviewed the data of patients treated by vitrectomy combined with cataract operation for RRD. The group "Attach" (n=31) consisted of eyes in which retina was not detached within 1.5 disc diameters from the foveal center, and the group "Detach" (n=33) consisted of eyes in which that area was detached entirely. Only those eyes inthe group "Detach", only the eyes (n=20) which AL were measured similar to those fellow eyes were compared to the group "Attach" (n=31). Refractive shift (RS) was defined as the average of the difference between postoperative spherical equivalent (SE) and predicted SE. RESULTS: AL was well measured by A-scan ultrasonography (A-scan) in all 31 eyes of the group "Attach" and their RS was ‒0.57 diopters (D). AL was measured by A-scan similar to the fellow eye in 20 of 33 eyes (60.6%) of the group "Detach", and the RS was ‒0.09 D. The AL difference as much as central subfield macular thickness (about 300um) can make this difference of RS (0.48 D, P=0.025) CONCLUSION: When AL can be measured by A-scan similar to its fellow eye in RRD with wholly detached macula, RS would be smaller than that of the wholly attached macula after phacovitrectomy. It assumed that AL was measured from the RPE under the detached macula in RRD with wholly detached macula.

Posterior Vitreous Structures Evaluated by Swept-source Optical Coherence Tomography with En Face Imaging.

PURPOSE: To evaluate posterior vitreous structures using swept-source (SS) optical coherence tomography (OCT) with en face imaging. METHODS: We retrospectively reviewed OCT images of healthy individuals who did not have intra-ocular disease. We obtained high-definition horizontal and vertical line scans crossing the fovea and 3D scans using SS-OCT, with the 3D scan centered between the fovea and the optic-nerve head. An enhanced vitreous visualization function was used to highlight vitreous structures. En face mode was used to measure the area of Martegiani (AM) and bursa premacularis (BP). We performed all measurements using a built-in function of the viewing software. RESULTS: We enrolled 24 eyes from 12 healthy individuals. The mean patient age was 28.7 ± 4.6 years (range, 24 to 39 years). The mean AM and BP areas were 5.73 ± 0.88 and 18.76 ± 6.95 mm², respectively. In en face imaging, AM shape was most frequently a vertical oval (18 / 22, 81.8%), while the predominant BP shape was round (16 / 20, 80.0%). AM was in contact with the optic disc, either at the temporal-disc margin (13 eyes, 59.1%) or the nasal optic-disc margin (9 eyes, 40.9%). CONCLUSIONS: Posterior vitreous structures, such as AM and BP, were readily visualized using en face imaging with SS-OCT. Investigating normal vitreous configuration might help in understanding changes in vitreous structures associated with retinal pathology.

ASSOCIATION BETWEEN TANGENTIAL CONTRACTION AND EARLY VISION LOSS IN IDIOPATHIC EPIRETINAL MEMBRANE.

PURPOSE: To investigate the clinical features associated with early visual loss in patients with idiopathic epiretinal membrane. METHODS: Patients with idiopathic epiretinal membrane with visual acuity of ≥20/40, intact ellipsoid zone, and follow-up duration of at least 24 months were included in this retrospective age-matched control study. The disk-fovea-vascular (DFV) distance, central macular thickness, membrane configuration, and ellipsoid zone were assessed using fundus photography and spectral domain optical coherence tomography. RESULTS: We analyzed the progression group (n = 15; vision loss ≥2 lines because of membrane progression) and the control group (n = 30; age matched). Compared with the controls, the mean DFV distance decreased (P < 0.001), central macular thickness increased (P = 0.017), and the ratio of the follow-up and baseline DFV distances (traction index of membrane) was significantly lower (P = 0.001) in the progression group. No differences were observed in the follow-up membrane configuration and ellipsoid zone. Factors associated with early vision loss were the DFV distance change (ρ = 0.657; P = 0.008) and traction index of membrane (ρ = -0.636; P = 0.011). Their area under receiver-operating characteristic curves were significant (DFV distant change: 0.915, traction index of membrane: 0.910, respectively; P < 0.001, both). CONCLUSION: Assessing the DFV distance is useful in quantifying the tangential contraction of macula and the prediction of vision loss in idiopathic epiretinal membrane.

Gender Differences in the Relationship between Sex Hormone Deficiency and Soft Drusen.

PURPOSE: To investigate the association between sex hormone deficiency and soft drusen in women and men. MATERIALS AND METHODS: We retrospectively reviewed the medical records and fundus photographs of subjects who underwent a health screening for additional examination of climacterium and age-related changes including sex hormone status. In women, sex hormone deficiency was defined as cessation of menstruation that had lasted for at least 12 months and follicular stimulating hormone (FSH) levels ≥ 25 mIU/mL; in men, it was defined as testosterone levels ≤ 3.5 ng/mL. The subjects were divided into two groups-the soft drusen and control groups-based on the presence of soft drusen in the fundus photographs. The total drusen area was measured using ImageJ™ software. RESULTS: Of total 2036 subjects, 638 (271 women; 367 men) were included. Two hundred thirteen subjects (33.4%) had soft drusen (97/271 women, 116/367 men). In women, sex hormone deficiency was more common in the soft drusen group than in the control group (P < 0.001); this was not the case in men. Multivariate logistic regression analysis revealed that sex hormone deficiency was an independent risk factor for soft drusen in women (P < 0.001; odds ratio [OR] = 3.494), as was age (P < 0.001; OR = 1.092). A long post-menopausal period was a risk factor for large soft drusen (≥ 125 µm). (P < 0.001; OR = 1.220). Age was significantly associated with total drusen area in both women (P = 0.022; ß = 0.406) and men (P = 0.015; ß = 0.246). CONCLUSIONS: Sex hormone deficiency and its duration were significantly associated with the development and progression of soft drusen in women but not in men. It may be necessary to assess and manage the sex hormone deficiency in women with age-related macular degeneration.

Exclusive Use of Air as Gas Tamponade in Rhegmatogenous Retinal Detachment.

PURPOSE: To investigate outcomes of vitrectomy for rhegmatogenous retinal detachment (RRD) using air exclusively as the gas tamponade. METHODS: This retrospective, interventional, consecutive case series involved reviewing medical records of patients that underwent vitrectomy and gas tamponade for RRD between January 2013 and December 2015. Patients whose eyes were treated exclusively with air tamponade since July 2014 were assigned to the air group, while those treated with heterogeneous gas agents before June 2014 were assigned to the control group. The primary outcome was the primary reattachment rate. Best-corrected visual acuity (BCVA) and duration to detect redetachments were assigned as the secondary outcomes. RESULTS: The air group and the control group included 71 and 72 eyes, respectively. The primary reattachment rate was 94.4% in the air group and there was no significant difference with 94.4% in the control group (p = 0.951). BCVA was significantly better in the air group at 1 month (p = 0.021) but not at 3 months postoperatively (p = 0.561). Redetachments were recognized earlier in the air group (9.3 ± 0.5 days) compared with those in the control group (21.3 ± 7.4 days) (p = 0.041). CONCLUSIONS: In cases of simple RRD with sufficient removal of subretinal fluid, air could be considered for use as gas tamponade. This trial is registered with KCT0002358.

Vascular Displacement in Idiopathic Macular Hole after Single-layered Inverted Internal Limiting Membrane Flap Surgery.

PURPOSE: To compare vascular displacement in the macula after surgical closure of idiopathic macular hole (MH) after single-layered inverted internal limiting membrane (ILM) flap technique and conventional ILM removal. METHODS: This retrospective study included patients who underwent either vitrectomy and ILM removal only or vitrectomy with single-layered inverted ILM flap for idiopathic MH larger than 400 µm from 2012 to 2015. A customized program compared the positions of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of 6 × 6 mm optical coherence tomography volume scans were registered to calculate the scale. Retinal vessel displacement was measured as a vector value by comparing its location in 16 sectors of a grid partitioned into eight sectors in two rings (inner, 2 to 4 mm; outer, 4 to 6 mm). The distance and angle of displacement were calculated as an average vector and were compared between the two groups for whole sectors, inner ring, outer ring, and for each sector. RESULTS: Twenty patients were included in the ILM flap group and 22 in the ILM removal group. There were no statistical differences between the groups for baseline characteristics. The average displacement in the ILM flap group and the ILM removal group was 56.6 µm at -3.4° and 64.9 µm at -2.7°, respectively, for the whole sectors (p = 0.900), 76.1 µm at -1.1° and 87.3 µm at -0.9° for the inner ring (p = 0.980), and 37.4 µm at -8.2° and 42.7 µm at -6.3° for the outer ring (p = 0.314). There was no statistical difference in the displacement of each of the sectors. CONCLUSIONS: Postoperative topographic changes showed no significant differences between the ILM flap and the ILM removal group for idiopathic MH. The single-layered ILM flap technique did not appear to cause additional displacement of the retinal vessels in the macula.

Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes.

PURPOSE: The aim of this study was to evaluate the efficacy of the perfluoro-n-octane-assisted single-layered inverted internal limiting membrane (ILM) flap for large macular holes (MHs). METHODS: We reviewed idiopathic MHs >400 µm. The patients were divided into ILM peeling (group P, 51 eyes) and ILM flap (group F, 41 eyes). Closure of MHs, best-corrected visual acuity (BCVA), and postoperative optical coherence tomography findings were analyzed. RESULTS: MH closure was achieved in 88.2% in group P and in 100% in group F (p = 0.032). SF6 and air was used most frequently in groups P and F, respectively. Both had a significant improvement in BCVA, which was better in group F until 3 months, but not at 6 months. At 6 months, the ellipsoid zone and external limiting membrane were restored with no significant difference. CONCLUSION: The single-layered inverted ILM flap was better for the closure of large MHs than ILM peeling, without using long-acting gas that prevents early rehabilitation.

Comparison of vitrectomized with nonvitrectomized eyes after subtenon injection of triamcinolone acetonide to treat diabetic macular edema: Retrospective comparative Analysis of an interventional case series.

PURPOSE: Triamcinolone acetonide (TA) is an alternative option for diabetic macular edema thanks to its cost-benefit ratio and unique delivery route. We performed this study to compare vitrectomized with nonvitrectomized eyes treated with subtenon TA injection for diabetic macular edema. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone subtenon TA injection for diabetic macular edema treatment. The patients were divided into two groups: Vitrectomized and nonvitrectomized. Visual acuity and central subfield macular thickness (CSMT) were analyzed before injection, at 1 and 3 months after injection. RESULTS: Visual acuity in vitrectomized group improved significantly at 1 month (P = 0.002), but this improvement regressed after 3 months. In the nonvitrectomized group, visual acuity did not improve significantly after 1 month, but it did after 3 months (P = 0.019). The CSMT decreased significantly in both groups at 1 and 3 months (P < 0.001). There were no significant differences between the groups at either 1 or 3 months with regard to either visual improvement or change in CSMT. CONCLUSION: Subtenon TA injection could be an alternative treatment option for diabetic macular edema, both in vitrectomized and in nonvitrectomized eyes. TA seems to take effect earlier and decay faster in vitrectomized eyes.

Functional end-arterial circulation of the choroid assessed by using fat embolism and electric circuit simulation.

The discrepancy in the choroidal circulation between anatomy and function has remained unsolved for several decades. Postmortem cast studies revealed extensive anastomotic channels, but angiographic studies indicated end-arterial circulation. We carried out experimental fat embolism in cats and electric circuit simulation. Perfusion defects were observed in two categories. In the scatter perfusion defects suggesting an embolism at the terminal arterioles, fluorescein dye filled the non-perfused lobule slowly from the adjacent perfused lobule. In the segmental perfusion defects suggesting occlusion of the posterior ciliary arteries, the hypofluorescent segment became perfused by spontaneous resolution of the embolism without subsequent smaller infarction. The angiographic findings could be simulated with an electric circuit. Although electric currents flowed to the disconnected lobule, the level was very low compared with that of the connected ones. The choroid appeared to be composed of multiple sectors with no anastomosis to other sectors, but to have its own anastomotic arterioles in each sector. Blood flows through the continuous choriocapillaris bed in an end-arterial nature functionally to follow a pressure gradient due to the drainage through the collector venule.

TOPOGRAPHIC CHANGES OF THE MACULA AFTER CLOSURE OF IDIOPATHIC MACULAR HOLE.

PURPOSE: To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. METHODS: This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2-4 mm and outer; 4-6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. RESULTS: The average displacement was 57.2 µm at an angle of -3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 µm) than in the outer ring (35.3 µm, P < 0.001), and larger in the temporal sectors than in the corresponding nasal sectors (P ≤ 0.008). Inferior and superior displacement was noted in the superior and inferior sectors, respectively. Multiple regression analysis revealed that basal horizontal macular hole diameter and size of internal limiting membrane removal were independent factors of displacement. CONCLUSION: The macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.

TREAT-AND-EXTEND REGIMEN USING RANIBIZUMAB FOR POLYPOIDAL CHOROIDAL VASCULOPATHY: One-Year Results.

PURPOSE: To investigate the efficacy of a treat-and-extend regimen (TER) using ranibizumab to treat polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively reviewed the medical records of 29 patients with PCV, who had been treated with a TER for 1 year. The primary outcome was the proportion of eyes that did not lose ≥3 best-corrected visual acuity (BCVA) lines. The number of intravitreal injections and recurrences as well as the maximum treatment interval without recurrence were analyzed. RESULTS: The mean BCVA improved from 0.64 ± 0.42 logMAR (median, 20/80) at baseline to 0.30 ± 0.31 logMAR (median, 20/30) at 12 months (P < 0.001). The mean central subfield macular thickness improved from 307.0 ± 70.2 µm to 237.5 ± 64.4 µm (P < 0.001). None of the subjects lost ≥3 lines, and 15 (51.7%) gained ≥3 lines. The mean number of injections was 7.0. The mean maximum treatment interval without recurrence was 10.0 weeks. After the loading phase, 12 eyes (41.4%) showed no recurrence. Seven eyes (24.1%) demonstrated disease activity at 12 months, and 4 (13.8%) of them were never dry during the entire 12-month follow-up duration. CONCLUSION: The TER effectively improved visual acuity in PCV while reducing the number of injections.

Neonatal Bacterial Conjunctivitis in Korea in the 21st Century.

PURPOSE: To investigate the microbial cause and antibiotic susceptibility of neonatal bacterial conjunctivitis in Korean patients in the 21st century. METHODS: We retrospectively reviewed the medical records of patients diagnosed with neonatal bacterial conjunctivitis between January 2000 and December 2015. We recorded the organism, antibiotic susceptibility, and antibiotics used. RESULTS: A total of 82 neonates were included in the study (53 males and 29 females), with a mean age of 17.5 ± 7.1 days. The most commonly isolated organisms were Staphylococcus aureus (43 cases, 52.4%), coagulase-negative staphylococci (11 cases, 13.4%), Staphylococcus epidermidis (11 cases, 13.4%), Serratia marcescens (4 cases, 4.9%), Pseudomonas aeruginosa (4 cases, 4.9%), and Enterobacter cloacae (3 cases, 3.7%). We found no cases of Neisseria gonorrhoeae or Chlamydia trachomatis infection. Resistance to methicillin (83.7%), macrolide (81.4%), and aminoglycoside (23.3%) was observed in patients with S. aureus infection. Conjunctivitis that did not improve with erythromycin or tobramycin generally improved with the additional use of tosufloxacin. CONCLUSIONS: The prevalence of neonatal gonococcal or chlamydial conjunctivitis has decreased in the 21st century. However, methicillin-resistant S. aureus has been increasing, but these cases are responsive to tosufloxacin.

Ocular toxocariasis presenting as bilateral scleritis with suspect retinal granuloma in the nerve fiber layer: a case report.

BACKGROUND: This report details ocular toxocariasis presenting as bilateral scleritis with suspect retinal granuloma in the nerve fiber layer. CASE PRESENTATION: The patient presented with scleritis, which did not improve with systemic steroid. Intraocular pressure was elevated, and well demarcated hyper-reflective round lesion were noted in both eyes. He had a history of general ache and concurrent onset of ocular symptoms the day after eating raw meat. Systemic work-ups revealed no remarkable abnormalities except antibody for toxocara. Oral albendazole and steroid were prescribed. The inflammation and swellings resolved without recurrence. In the current case, scleritis with suspect granuloma in the nerve fiber layer seems to be caused by toxocara. CONCLUSION: Ocular toxocariasis can be presented as atypical features. Serologic exams for toxocariasis would be considered not only in typical features but also in other uveitis or scleritis, particularly when the patient has a related history.

Intravitreal pharmacokinetics after posterior subtenon triamcinolone acetonide injection in vitrectomized rabbit eyes.

PURPOSE: To investigate the intraocular pharmacokinetics of triamcinolone acetonide (TA) injected into the posterior subtenon of vitrectomized rabbit eyes. METHODS: Vitrectomy was performed on the right eyes of 35 rabbits. Triamcinolone acetonide (40 mg/mL) was injected into the posterior subtenon space of both eyes. Five rabbits each were killed at days 1, 3, 7, 14, 28, 56, and 84. Both eyes were enucleated. The vitreous was isolated, and TA concentration was measured. RESULTS: In vitrectomized eyes, the intravitreal concentrations of TA were 1763, 822.9, 321.5, 113.3, 35.5, 14.4, and 6.7 ng/mL, respectively, at the time points indicated above; the concentrations in nonvitrectomized eyes were 397.8, 360.4, 154.4, 48.5, 30.7, 15.2, and 8.0 ng/mL, respectively. Triamcinolone acetonide concentrations were significantly higher in the vitrectomized eyes at days 1, 3, 7, and 14. The terminal half-life of intravitreal TA was 23.3 days in the vitrectomized eyes and 28.9 days in the nonvitrectomized eyes. CONCLUSION: Intravitreal absorption and excretion of TA in the posterior subtenon space are increased after vitrectomy. Although the terminal half-life of TA was shorter, higher early concentration and similar effective duration were achieved in the vitrectomized eyes.