Visual outcomes of early and late vitrectomy for breakthrough vitreous hemorrhage associated with exudative age-related macular degeneration and polypoidal choroidal vasculopathy.

To compare the visual outcomes of early and late vitrectomy for breakthrough vitreous hemorrhage (VH) associated with exudative age-related macular degeneration (exudative AMD) and polypoidal choroidal vasculopathy (PCV). A retrospective chart review was performed with data of all patients diagnosed with exudative AMD and PCV-related breakthrough VH who underwent early or late vitrectomy (within or after 3 months, respectively). Demographic data and best-corrected visual acuity (BCVA) at baseline, and 1, 3, 6, and 12 months postoperatively were recorded and analyzed. Overall, 105 eyes with breakthrough VH were examined and categorized in either the early or late vitrectomy group. In the early and late vitrectomy group, LogMAR BCVA improved from 2.15 ±â€…0.08 and 2.07 ±â€…0.14 at baseline to 1.26 ±â€…0.09 and 1.27 ±â€…0.14 at 12 months, respectively (P < .001). Between early and late vitrectomy, the PCV subgroup demonstrated improved LogMAR BCVA at 1 year, but there was no statistically significant (P = .754). Conversely, the LogMAR BCVA improvement at 1 year in the early vitrectomy group demonstrated statistically significant differences from the late vitrectomy group (P = .025) in the exudative AMD subgroup. Both, early and late vitrectomy can improve visual acuity in patients with breakthrough VH secondary to exudative AMD and PCV. However, early vitrectomy is more beneficial for breakthrough VH-associated exudative AMD.

Results of intravitreal dexamethasone implant (Ozurdex®) for retinal vascular diseases with macular edema: An observational study of real-life situations.

To evaluate the efficacy of intravitreal dexamethasone implants (Ozurdex®) for the treatment of macular edema (ME) associated with retinal vascular diseases in real-life situations. This retrospective study included patients with ME associated with retinal vascular occlusion (RVO) or diabetic macular edema (DME) treated with dexamethasone implants. Demographic data, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) at baseline and at 1, 3, and 6 months postoperatively were collected and analyzed, and the adverse events were recorded. Forty-four eyes, 42 patients were included in the study. The mean logMAR BCVA improved from 0.79 ± 0.38 at baseline to 0.60 ± 0.34 (P < 0.001), 0.72 ± 0.38 (P = .002), and 0.72 ± 0.37 (P = .002) at 1, 3, and 6 months, respectively. The CRT decreased from 526.70 ± 159.58 µm at baseline to 279 ± 66.23, 422.91 ± 206.99, and 350.23 ± 151.51 µm at 1, 3, and 6 months, respectively (P < 0.001, all visits). The average number of injections was 1.43 ± 0.5. Nineteen eyes (43.18%) received second injections at an interval of 4.20 ± 0.61 months. The mean logMAR BCVA was greater in RVO than in DME patients and in treatment-naïve eyes than in previously treated ones. The baseline CRT of the reinjection group was significantly higher than that of the single-injection group for both the RVO (P < 0.001) and DME groups (P = .002). Nine eyes (20.45%) with increasing intraocular pressure (IOP) were well controlled with medication, and cataract progression was observed in five eyes (21.73%) during follow-up. The dexamethasone implant was effective for the treatment of macular edema secondary to RVO and DME in terms of visual acuity and CRT improvement over 6 months. The visual acuity was greater in the RVO and treatment-naïve eyes. Reinjection may be associated with a high baseline CRT. The increase in the occurrence of IOP and cataract progression was similar to that reported in previous studies.

The Value of Preoperative Laboratory Investigations in Healthy Individuals Undergoing Elective Cataract Surgeries.

Purpose: To evaluate the number of patients with abnormal preoperative laboratory test results and determine the benefits of these tests in healthy individuals scheduled for elective cataract surgeries. Patients and Methods: This study was conducted at Songklanagarind Hospital, Thailand. The data were collected from January 1, 2020, to August 31, 2021. The results of laboratory investigations, consisting of a complete blood count (CBC), including hemoglobin (Hb), hematocrit (Hct), and platelet count; chest X-ray (CXR); electrocardiography (EKG); and anti-human immunodeficiency virus (anti-HIV), were evaluated and analyzed. Additional management actions and rates of postponement or cancellation of surgeries were also evaluated. Results: In total, 401 participants were enrolled in this study. The rates of abnormal investigation results were 40.2% for EKG, 15.5% for CXR, 12.7% for Hb, 11.7% for Hct, 2.0% for platelet count, and 0.2% for anti-HIV. The preoperative tests that required additional management and postponement/cancellation of surgeries were CXR (5.5% and 1.7%, respectively), EKG (2.5% and 0.5%, respectively), and anti-HIV (0.2% and 0%, respectively). Moreover, age ≥60 years was associated with a significantly higher rate of positive preoperative EKG findings (relative risk, 4.64; p = 0.017). Conclusion: The CBC test was not beneficial as a preoperative laboratory investigation for healthy individuals in any age group who were scheduled for elective cataract surgery. However, EKG, CXR, and anti-HIV test results were valuable. Patients aged ≥60 years were at risk of having positive EKG results that could result in cancellation or postponement of surgery.

Timing of Complete Polypoidal Regression after Intravitreous Aflibercept Treatments in Polypoidal Choroidal Vasculopathy.

PURPOSE: To understand timing of complete polypoidal regression on indocyanine green angiography (ICGA) after aflibercept injections for polypoidal choroidal vasculopathy (PCV). DESIGN: Multicenter prospective study. PARTICIPANTS: Adults with treatment-naïve PCV. METHODS: After institutional review board approval, participants were enrolled and followed up for 1 year, from Apr 1, 2016, through Dec 30, 2018, at 2 university-based centers in Thailand. Diagnosis of PCV was based on the Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy criteria. Eligible eyes received fixed-dose aflibercept injections (3 monthly then every 8 weeks), or monthly if fluid persisted on OCT. Photodynamic therapy (PDT) was administered when fluid persisted despite 6 consecutive injections. Indocyanine green angiography was performed at baseline and then every 8 weeks. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline, 6 months, and 1 year. Two retina specialists reviewed posttreatment ICGA, categorized into: complete regression (complete disappearance of polypoidal lesions), partial regression (reduced in size or number), or no regression. Disagreements were resolved through open adjudication. MAIN OUTCOME MEASURES: Timing of complete regression over 1 year. RESULTS: Final analysis included 40 eyes (39 participants; 100% Thai, 59% women; mean age±standard deviation, 64 ± 8.3 years). At baseline, 90% had 5 or more polypoidal lesions. Ninety-five percent received aflibercept monotherapy, and 5% received rescue PDT per protocol. Polypoidal statuses at 1 year were 55% complete, 40% partial, and 5% no regression. Cumulative rates of complete regression at 2, 4, 6, and 12 months were 28%, 33%, 43%, and 55%. Of 22 eyes with complete regression at 1 year, complete regression was identified first at 2, 4, 6, 8, 10, 12 months in 50%, 9%, 18%, 5%, 9%, and 9%, respectively. Cumulative rates of complete regression among these eyes at 2, 6, and 12 months were 50%, 77%, and 100%, respectively. Median duration of complete regression was 3 months (interquartile range, 2-6 months). Median visual acuity improved from 20/125 (Snellen equivalent) to 20/50; median NEI VFQ-25 scores improved from 80 to 93 from baseline to 1 year. CONCLUSIONS: Complete polypoidal regression could occur as early as 2 months after aflibercept injections. Most PCV eyes with complete polypoidal regression at 1 year already showed complete regression within the first 6 months. These findings support consideration of aflibercept for PCV to achieve both anatomic and visual outcomes.

Surgical outcomes and prognostic factors following vitrectomy in acquired immune deficiency syndrome patients with cytomegalovirus retinitis-related retinal detachment.

To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy.A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan-Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success.Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success.Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.

Polypoidal choroidal vasculopathy (PCV): the 4-year review of the real-life treatment experiences.

PURPOSE: The purpose of this article was to study the real-life treatment results of polypoidal choroidal vasculopathy (PCV). DESIGN: This was a retrospective study. METHODS: Patients with presumed age-related macular degeneration were reviewed, and PCV diagnosis was made using the EVEREST study criteria. Outcomes were changes in visual acuity (VA) and central retinal thickness, time between treatments, follow-up time, and number of treatments. RESULTS: The prevalence of PCV was 30.8%. At the beginning, 195 eyes received monotherapy of anti-vascular endothelial growth factor (anti-VEGF) injections, either bevacizumab or ranibizumab, and only six eyes received the combination of anti-VEGF injection and photodynamic therapy (PDT) at the time of the first treatment. During the follow-up, some patients received "rescue or add-on" PDT when they had a poor response after anti-VEGF injections. After 4 years, the average number of injections was 8.25 and 9.15 for the anti-VEGF monotherapy and the combination groups, respectively. The average time between the first anti-VEGF injections and the first PDT was 21.4 months. The average VA in the anti-VEGF monotherapy group increased by 1.5 letters, whereas it decreased by 0.95 letters in the combination group (P=0.48). CONCLUSION: The review demonstrated the same visual outcomes between the combination therapy of anti-VEGF injections and rescue or add-on PDT vs monotherapy anti-VEGF injections in PCV treatment. When compared with EVEREST II and Planet studies, the "initial" or "rescue or add-on PDT" might have different effects on the final visual outcomes.

Color Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography in Diagnosing Polypoidal Choroidal Vasculopathy.

PURPOSE: To determine sensitivity and specificity of polypoidal choroidal vasculopathy (PCV) diagnosis using color fundus photography (CFP), optical coherence tomography (OCT), and fundus fluorescein angiography (FFA) without indocyanine green angiography (ICGA). DESIGN: Validity analysis. METHODS: Treatment-naïve eyes with serous/serosanguinous maculopathy undergoing CFP, OCT, FFA, and ICGA imaging before treatment at a university hospital in Thailand (January 1, 2013 to June 30, 2015) were identified. Images of each subject were categorized into 4 sets (set A: CFP; set B: CFP+OCT; set C: CFP+FFA; set D: CFP+OCT+FFA). Six graders, 3 from Thailand (PCV endemic area) and 3 from the United States (nonendemic area), individually reviewed each set (without ICGA), and determined if the presumed diagnosis was PCV. In parallel, 2 other graders confirmed if each case had PCV or not using EVEREST criteria (including ICGA). Sensitivity and specificity of a PCV diagnosis with each set (without ICGA) were analyzed compared with diagnoses including ICGA. RESULTS: Of 119 study eyes (113 subjects, 57% male, mean age ± SD 59.9 ± 13.8 years), definite PCV diagnosis was 40.3%. Sensitivity of sets A, B, C, D: 0.63 (95% confidence interval [CI]: 0.47-0.76), 0.83 (95% CI: 0.69-0.92), 0.54 (95% CI: 0.39-0.68), 0.67 (95% CI: 0.51-0.79); specificities: 0.93 (95% CI: 0.84-0.97), 0.83 (95% CI: 0.72-0.91), 0.97 (95% CI: 0.89-0.99), 0.92 (95% CI: 0.82-0.97); accuracies: 0.81 (95% CI: 0.73-0.88), 0.83 (95% CI: 0.76-0.90), 0.79 (95% CI: 0.73-0.87), 0.82 (95% CI: 0.74-0.88). Discrepancies between Thai and US graders existed through sets A, C, and D. CONCLUSIONS: These data suggest that without ICGA, fundus photography combined with OCT provides high sensitivity and high specificity to diagnose PCV; adding FFA does not improve accuracy.

The Impact of Vision Impairment (IVI) Questionnaire; Validation of the Thai-Version and the Implementation on Vision-Related Quality of Life in Thai Rural Community.

The objective of this study is to validate the Thai-version of the impact of vision impairment (IVI) questionnaire and to evaluate its impact on vision-related quality of life (VRQoL) in southern Thailand. The IVI questionnaire was translated into Thai according to WHO translation guidelines. In addition to the routine ophthalmological examinations, a Thai version of the IVI questionnaire was administered to all participants. A total of 120 patients with visual impairment who presented at Songklanagarind hospital, Songkhla province, were enrolled in the study; 30 had age-related macular degeneration (AMD), 30 had cataract, 30 had diabetic retinopathy, 30 had glaucoma, and 30 non-visually impaired individuals comprised the control group. Statistical analysis demonstrated the Thai-version IVI questionnaire is valid and reliable to evaluate the VRQoL of the Thai patients through three subscales: (i) mobility and independence, (ii) reading and accessing information, and (iii) emotional well-being. The results demonstrated high consistency in all subscales with Cronbach's alpha ranging from 0.787 to 0.849. Rasch analysis revealed the validity of the Thai-version IVI to assess VRQoL through all three subscales. Test-retest reliability was also high (intraclass correlation coefficient = 0.96). The composite score of the IVI was significantly higher in participants with visual impairment compared with healthy participants. Moreover, the subscale scores of reading and accessing information, and emotional well-being were highest in participants with AMD. While the subscale scores of mobility and independence were highest among those with either cataracts or diabetic retinopathy. The symptoms of the common vision impairment diseases are associated with an adverse impact on VRQoL in a clinic-based population as demonstrated in this study.

Health resource utilization and the economic burden of patients with wet age-related macular degeneration in Thailand.

AIM: To determine healthcare resource utilization and the economic burden associated with wet age-related macular degeneration (AMD) in Thailand. METHODS: This study included patients diagnosed with wet AMD that were 60 years old or older, and had best corrected visual acuity (BCVA) measured at least two times during the follow-up period. We excluded patients having other eye diseases. Two separate sub-studies were conducted. The first sub-study was a retrospective cohort study; electronic medical charts were reviewed to estimate the direct medical costs. The second sub-study was a cross-sectional survey estimating the direct non-medical costs based on face-to-face interviews using a structured questionnaire. For the first sub-study, direct medical costs, including the cost of drugs, laboratory, procedures, and other treatments were obtained. For the second sub-study, direct non-medical costs, e.g. transportation, food, accessories, home renovation, and caregiver costs, were obtained from face-to-face interviews with patients and/or caregivers. RESULTS: For the first sub-study, sixty-four medical records were reviewed. The annual average number of medical visits was 11.1±6.0. The average direct medical costs were $3 604±4 530 per year. No statistically-significant differences of the average direct medical costs among the BCVA groups were detected (P=0.98). Drug costs accounted for 77% of total direct medical costs. For direct non-medical costs, 67 patients were included. Forty-eight patients (71.6%) required the accompaniment of a person during the out-patient visit. Seventeen patients (25.4%) required a caregiver at home. The average direct non-medical cost was $2 927±6 560 per year. There were no statistically-significant differences in the average costs among the BCVA groups (P=0.74). Care-giver cost accounted for 87% of direct non-medical costs. CONCLUSION: Our study indicates that wet AMD is associated with a substantial economic burden, especially concerning drug and care-giver costs.

Photoreceptor disruption in central serous chorioretinopathy treated by half-dose photodynamic therapy.

BACKGROUND: To evaluate photoreceptor disruption in patients with central serous chorioretinopathy (CSC) treated by half-dose photodynamic therapy (PDT). METHODS: A total of 29 patients with symptomatic CSC were recruited and underwent half-dose verteporfin PDT covering the leakage sites as observed via fundus fluorescein angiography. The primary outcome was the percentage of patients with the presence of photoreceptor disruption, and the secondary outcome was the correlation between photoreceptor disruption and visual results at the 1-year follow-up. RESULTS: Photoreceptor disruption was identified in 13 eyes (44.8%) 12 months after treatment. Twenty-seven patients experienced best-corrected visual acuity (BCVA) improvement after PDT, while two patients showed stable BCVA. The mean BCVA in patients with photoreceptor disruption at the baseline and every follow-up visit was significantly lower than that of patients without photoreceptor disruption. However, there was no correlation between the presence or absence of photoreceptor disruption and the improvement of visual acuity because the BCVA gain at the last follow-up visit between the two groups was not significant (P = 0.69). No potential ocular complication was encountered in the study. CONCLUSION: Photoreceptor disruption was found in about 45% of CSC patients treated by PDT, which ultimately resulted in poor visual outcomes. However, a half-dose PDT might not affect or modify the photoreceptor function because it gave the same pattern of visual recovery in patients with and without photoreceptor cell loss.

Pattern of uveitis in a university-based referral center in southern Thailand.

PURPOSE: To identify the characteristics (demographics, anatomical classification, diagnoses, and treatment) of all uveitis patients who were seen at our newly started Uveitis and Ocular Inflammatory Disease Clinic over a two-year period. METHODS: The computerized uveitis database files and medical records for all new consecutive patients seen at our Uveitis and Ocular Inflammatory Disease Clinic from January 2010 through December 2011 were included. RESULTS: A total of 254 patients were seen during the study period. Anterior uveitis and panuveitis were most frequently found, each accounting for around 35% of cases. Specific diagnoses were established in 70.9% of patients and the top five most common specific diagnoses were VKH (11%), HLA-B27-associated anterior uveitis (7.9%), Behçet disease (7.1%), toxoplasmosis (7.1%), and herpetic anterior uveitis (4.7%). CONCLUSION: In this setting, the authors found VKH to be the most common diagnosis in the noninfectious uveitis group. Regarding infectious uveitis, toxoplasmosis ranked the most common diagnosis.

High-dose antioxidants for central serous chorioretinopathy; the randomized placebo-controlled study.

BACKGROUND: To determine the efficacy of high-dose antioxidants in the acute stage of central serous chorioretinopathy (CSC). METHODS: This was a randomized placebo-controlled study. The patients with acute CSC (onset within 6 weeks) were randomized to receive either high-dose antioxidant tablets (study group A) or placebo tablets (control group B) for 3 months or until the complete resolution of subretinal fluid. After 3 months, additional treatment with laser or photodynamic therapy (PDT) was considered if any fluorescein leakage persisted. The outcomes measured were the changes in visual acuity (VA) and central macular thickness (CMT), the number of patients with subretinal fluid at each follow-up time, the number of patients with fluorescein leakage at the end of the 3rd month and patients who received additional treatments. RESULTS: Fifty-one of 58 patients (88%) completed the follow-up criteria. The baseline demographic data were comparable in both groups. At the end of the 3rd month, the VA and CMT showed no statistical difference between the groups but the patients in group A has less fluorescein leakage and additional treatments than in group B (p = 0.027 and 0.03). CONCLUSION: The high-dose antioxidants for acute CSC did not show any benefits in VA and CMT. However, the drugs might decrease the chance for fluorescein leakage and additional treatments at the end of the 3rd month.

The one-year results of half-dose photodynamic therapy with verteporfin in chronic or recurrent central serous chorioretinopathy.

OBJECTIVE: To evaluate the one-year results of half-dose photodynamic therapy with verteporfin in chronic or recurrent central serous chorioretinopathy (CSC). MATERIAL AND METHOD: A Retrospective, consecutive case series. Twenty-seven eyes of 27 patients with chronic symptomatic CSC or recurrent CSC underwent photodynamic therapy (PDT) with half-dose (3 mg/m2) verteporfin. The demographic data such as age, side, gender spot sizes of laser photodynamic therapy (PDT) were recorded. The primary outcomes were the best correct visual acuity (BCVA), central foveal thickness using the optical coherence tomography (OCT) and complication were recorded as secondary outcome at baseline, month 1,3,6 and 12 post PDT RESULTS: At 12 months after half-dose PDT the mean logMAR BCVA improved from 0.32 to 0.18 (p = 0.001), the mean central foveal thickness decreased from 375.52 microm to 186.52 mirom (p < 0.001). The results also showed significant improvement of logMAR BCVA and decreased central foveal thickness after 1 month (0.32 to 0.22, p = 0.003 and 375.52 microm to 175.41 microm, p < 0.001) and maintained the results until one-year follow-up. Twenty-five eyes (92.59%) showed complete resolution of subretinal fluid at 1 month, 27 patients (100%) showed complete resolution at 3 month and all sustained the complete resolution until the last visit. No serious complications were recorded during and after the treatment. CONCLUSION: The half-dose PDT in area of fluorescein leakage is one of the effective treatment options for chronic or recurrent CSC, especially in patients who cannot be performed by focal laser photocoagulation. The treatment sustained the good visual results and has no serious complications up to one-year.

Validity of the Watzke-Allen test after a surgery for idiopathic full thickness macular hole.

OBJECTIVE: To evaluate the role and validity of the Watzke-Allen test in following up patients after surgeries for an idiopathic full-thickness macular hole (FTMH). DESIGN: A prospective interventional analytical study MATERIAL AND METHOD: Patients with idiopathic FTMH were consecutively recruited. A comparative analysis between preoperative and post operative visual acuity, macular hole status and Watzke-Allen slit beam test results was performed using a Chi-square test and a random intercept mixed model. RESULTS: Twenty-one patients with an average age of 65.90 +/- 6.05 years were included in the present study. Three months after surgery, macular holes were surgically closed in 13 eyes (61.9%) and still open in eight eyes (38.1%). An improvement in metamorphopsia, according to Watzke-Allen test results, was found in 61.53% of patients with closed holes and 87.5% of those with open holes. There was no statistically significant correlation between the Watzke-Allen test and the restorative status of a macular hole post surgery CONCLUSION: The Watzke-Allen test is a useful subjective assessment of visual function for diagnosis in patients with idiopathic FTMH. However the test is not beneficial in the post operative follow-up of patients.

Electrophysiologic changes after intravitreal ranibizumab injection for the treatment of choroidal neovascular membrane (CNVM).

PURPOSE: To determine the pattern of electroretinographic change after an intravitreal ranibizumab (Lucentis(®)) injection for the treatment of choroidal neovascular membrane (CNVM). PATIENTS AND METHODS: A prospective interventional case series of patients treated by intravitreal ranibizumab injection. Best corrected visual acuity, optical coherence tomography (OCT), and multifocal electroretinography (mfERG) were assessed prior to treatment, and 2 weeks, 1 and 3 months after treatment. Primary outcome was the functional change in amplitude and implicit time by mfERG and secondary outcome was the structural change in macular thickness by optical coherence tomography (OCT). RESULTS: Twenty-six eyes from 25 consecutive patients were enrolled. At 3 months after treatment, the mean visual acuity (VA) improved from 1.06 to 0.84 logMAR (P = 0.034) and the mean macular thickness decreased from 389.7 to 264.4 microns (P = 0.003). The mean implicit time of the central zone showed an improvement at 3 months after treatment when compared with the response at baseline (P = 0.024) and at 1 month (P = 0.013) but the mean amplitude showed no significant change. In subgroup analysis, the eyes with initial visual acuity (VA) ≥ 20/200 had a significant improvement in mean implicit time of the peripheral zone at 2 weeks after treatment (P = 0.028). The OCT revealed a significant decrease (P < 0.003) in macular thickness at 1 and 3 months postoperatively. CONCLUSION: The mean implicit time of the central zone improved significantly at 3 months after treatment, whereas the mean amplitude showed no significant change. The macular thickness decreased significantly after the treatment, while VA improved to a lesser extent.

A variety of atypical manifestations in giant cell arteritis.

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of large and medium size vessels in the elderly. A new-onset headache is the most frequent symptom. An anterior ischemic optic neuropathy (AION) is one of the most common causes of permanent visual loss. There are four cases with unusual presentation of giant cell arteritis, scalp abscess, prolonged transient monocular visual loss (TMVL), bilateral central retinal artery occlusion (CRAO), and chronic ear pain. All patients had pathologically proven giant cell arteritis, and three of them progressed to blindness in the end. Scalp abscess is a rare sign in GCA. Delay in diagnosis because confusion of the abscess after scalp ischemia with other cutaneous lesions may result in death. TMVL is the forewarning symptom of AION or CRAO in GCA. Early recognition of TMVL is important to make early diagnosis of GCA to prevent blindness. Spontaneous ear pain is extremely rare, and reports have documented delay in diagnosis of GCA resulting in irreversible blindness.

The response pattern of intravitreal triamcinolone injection for non-AMD macular edema.

OBJECTIVE: To determine the pattern of functional and anatomical responses after intravitreal triamcinolone (IVTA) for macular edema in diabetic retinopathy, retinal vein occlusion, uveitis, and macular telangiectasia. MATERIAL AND METHOD: A Retrospective interventional study was carried out between January 2004 and July 2006. Thirty-eight eyes from 36 patients who had undergone an IVTA injection for macular edema from etiologies other than age-related macular degeneration (non-AMD macular edema) were included in the present study. Visual improvement and retinal thickness were the main outcomes. Potential complications, including increased intraocular pressure (IOP), intraocular bleeding, and postoperative endophthalmitis were also recorded. RESULTS: The mean pre-operative logarithm of Minimum Angle of Resolution (logMAR) visual acuity (VA) was 1.0 with an average macular thickness of 463.2 +/- 141.4 microns and mean IOP of 12.9 +/- 2.7 mmHg. The macular thickness rapidly decreased in the first week after an injection with a trough at two months (p < 0.001) and began to rise thereafter. The overall VA started to improve significantly at one month and lasted for two months. The IOP significantly increased from the mean baseline during the first two months in 31.6%, which could be controlled only by the medication. No other serious complications were observed. CONCLUSION: IVTA has the potential to improve both functional and anatomical outcomes in non-AMD macular edema. The decrease in macular thickness occurs from one week after an injection but the visual function improves more slowly and has a short-time effect.

Photodynamic therapy for AMD and non-AMD patients: two-year results in Thais.

OBJECTIVE: To determine the long-term effect of photodynamic therapy (PDT) with verteporfin for age-related macular degeneration (AMD) and non-AMD in Thailand and to compare with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study. MATERIAL AND METHOD: The data of patients who received PDT between July 2003 and December 2004 and had completed two-year follow-up were prospectively reviewed. Treated eyes were classified into two main groups, the AMD (group 1) and non-AMD (group 2) groups. The AMD group was further divided into three subgroups, group 1A, AMD with subfoveal choroidal neovascularization (CNV) and TAP/VIP compatible if they followed the recommendation guidelines characteristics, group 1B, AMD with subfoveal CNV and TAP/VIP incompatible, and group 1C, AMD with non-subfoveal CNV. The main outcomes were visual acuity change, number of treatments and the comparison with the first year results. RESULTS: Of 56 eyes, 46 eyes (82.14%) had completed 24-month follow-up. Thirty-four eyes had CNV-related AMD and 12 eyes were non-AMD. At the 24-month follow-up, mean visual acuity change in group 1A, 1B, 1C were increased 0.25 (p = 0.13), 0.05 (p = 0.52), and 0.28 (p = 0.003), respectively. The total number of treatments in the first and second year was 1.8 and 0.1 in group 1A, 2.3 and 0.1 in group 1B, 1.5 and 0.25 in group 1C. CONCLUSION: PDT was effective in Thai patients for the two-year follow-up even if they were not compatible with TAP/VIP criteria. The treatment demonstrated stabilization or less visual loss in long-term results.

Photodynamic therapy for AMD and non-AMD patients: one-year results in Thais.

OBJECTIVE: To evaluate the effect of photodynamic therapy (PDT) with verteporfin for age-related macular degeneration (AMD) and non-AMD in Thais, and compare with the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study. MATERIAL AND METHOD: The authors prospectively evaluated all data of 51 eyes of 51 patients who had undergone PDT and accomplished a 1-year follow up. The assessments were divided into two categories: group 1 included three subsets of AMD, and group 2 was non-AMD. The first group classified into three subgroups: group 1A: AMD with subfoveal choroidal neovascularization (CNV) and TAP/VIP compatible with recommendation guidelines characteristics, group 1B: AMD with subfoveal CNV and TAP/VIP incompatible, and group 1C: AMD with non-subfoveal CNV. The measurement outcomes comprised of the baseline characteristics, change in visual acuity, and number of treatments. RESULTS: Thirty-eight eyes had CNV-related AMD and 13 eyes were non-AMD. At the 12-month examination, the mean visual acuity change in group 1A, 1B, 1C had increased 0.19 (p = 0.077), 0.14 (p = 0.076), and 0.24 (p = 0.003), respectively. The number of treatments was 1.8 in group 1A, 2.3 in group 1B, and 1.5 in group 1C. CONCLUSION: PDT is beneficial to Thai patients with AMD at first year even if they were not compatible with TAP/VIP criteria.

Pars plana vitrectomy with silicone oil or gas endotamponade in HIV-related rhegmatogenous retinal detachments in Thai patients.

OBJECTIVE: To evaluate the efficacy and results of pars plana vitrectomy with endotamponade for retinal detachments caused by necrotizing retinitis in HIV patients. MATERIAL AND METHOD: The data of patients with HIV-related retinal detachment who underwent pars plana vitrectomy with silicone oil or gas endotamponade between January 2003 and June 2005 were retrospectively reviewed The outcome measures were demographic data, anatomical, and visual results. RESULTS: Of all 24 eyes from 20 patients, 19 eyes underwent pars plana vitrectomy with silicone oil tamponade and 5 eyes with long-acting gas tamponade. Mean follow up time was 13 months (range 2-33 months). The overall anatomical success was 83% (84% and 80% with silicone oil and gas tamponade, respectively). Final best corrected visual acuity was equal or better than 5/200 in 12 eyes (50%). Forty-six percent had stabled or improved vision at the end of follow-up. CONCLUSION: Pars plana vitrectomy with silicone oil or gas tamponade gives the high anatomical success rate in the repair of retinal detachments caused by necrotizing retinitis in HIV patients. There were the same reattachment rate and visual results between the two tamponade groups. However, the use of gas tamponade may be effective in patients with highly active antiretroviral therapy (HAART).