The HSP90 inhibitor HVH-2930 exhibits potent efficacy against trastuzumab-resistant HER2-positive breast cancer.

Rationale: Resistance to targeted therapies like trastuzumab remains a critical challenge for HER2-positive breast cancer patients. Despite the progress of several N-terminal HSP90 inhibitors in clinical trials, none have achieved approval for clinical use, primarily due to issues such as induction of the heat shock response (HSR), off-target effects, and unfavorable toxicity profiles. We sought to examine the effects of HVH-2930, a novel C-terminal HSP90 inhibitor, in overcoming trastuzumab resistance. Methods: The effect of HVH-2930 on trastuzumab-sensitive and -resistant cell lines in vitro was evaluated in terms of cell viability, expression of HSP90 client proteins, and impact on cancer stem cells. An in vivo model with trastuzumab-resistant JIMT-1 cells was used to examine the efficacy and toxicity of HVH-2930. Results: HVH-2930 was rationally designed to fit into the ATP-binding pocket interface cavity of the hHSP90 homodimer in the C-terminal domain of HSP90, stabilizing its open conformation and hindering ATP binding. HVH-2930 induces apoptosis without inducing the HSR but by specifically suppressing the HER2 signaling pathway. This occurs with the downregulation of HER2/p95HER2 and disruption of HER2 family member heterodimerization. Attenuation of cancer stem cell (CSC)-like properties was associated with the downregulation of stemness factors such as ALDH1, CD44, Nanog and Oct4. Furthermore, HVH-2930 administration inhibited angiogenesis and tumor growth in trastuzumab-resistant xenograft mice. A synergistic effect was observed when combining HVH-2930 and paclitaxel in JIMT-1 xenografts. Conclusion: Our findings highlight the potent efficacy of HVH-2930 in overcoming trastuzumab resistance in HER2-positive breast cancer. Further investigation is warranted to fully establish its therapeutic potential.

Repositioned versus exchanged flanged intraocular lens fixation for intraocular lens dislocation.

This study aimed to compare the outcomes of flanged intraocular lens (IOL) fixation with new IOL exchange after dislocated IOL removal and repositioned dislocated IOL in patients with IOL dislocation. Eighty-nine eyes that underwent flanged IOL fixation were retrospectively included, with 51 eyes in the exchanged IOL group and 38 eyes in the repositioned IOL group. In both groups, best-corrected visual acuity (BCVA) improved at 1, 3, 6, and 12 months postoperatively and did not differ between the two groups at any of these time points. However, at 1 week postoperatively, BCVA in the repositioned IOL group improved compared with baseline, whereas that in the exchanged IOL group did not. Moreover, there were lesser changes in the corneal endothelial cell density (ECD) and corneal astigmatism in the repositioned IOL group than in the exchanged IOL group. The IOL positions, including IOL tilt and IOL decentration, were not different between the groups. Flanged IOL fixation with new IOL exchange and with repositioned dislocated IOL for patients with IOL dislocation had similar visual outcomes and IOL position. However, the latter had a smaller corneal ECD decrease and astigmatic change. This technique was effective in treating IOL dislocation while minimizing corneal injury.

Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7-0 polypropylene flange.

Background: To report a novel surgical technique for recurrent pupillary optic capture after flanged intraocular lens (IOL) fixation. Methods: In this retrospective case series, we detail our use of two parallel 7-0 polypropylene sutures passed between the iris plane and the optic of scleral-fixated IOL to address pupillary optic capture. Flanges were created using ophthalmic cautery to secure it to the sclera without suture. Results: Two eyes with pupillary optic capture underwent a sutureless surgical technique using 7-0 polypropylene flanges. No recurrences of pupillary optic capture were observed during the 1-year follow-up. Conclusion: Our sutureless surgical technique using a 7-0 polypropylene flange was an effective, efficient, and less invasive approach for treating recurrent pupillary optic capture.

Clinical Outcomes of Topical Bromfenac Combined with Intravitreal Aflibercept Injection for Exudative Age-related Macular Degeneration

Purpose@#To evaluate the efficacy of topical bromfenac combined with intravitreal aflibercept (IVA) injection in the treatment of exudative age-related macular degeneration over a 2-year period. @*Methods@#We retrospectively studied 43 patients (43 eyes) with exudative age-related macular degeneration. Patients were included if they received IVA injections under an as-needed protocol and had > 2 years of follow-up. Among the 43 eyes, 25 received only IVA (IVA group), whereas 18 received a combination of IVA and topical bromfenac (bromfenac group). The primary outcome measure was the total number of IVA injections administered over 2 years from the initial injection compared between groups. We also compared changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) between groups. @*Results@#The bromfenac group received a significantly lower number of IVA injections over 2 years (7.4 ± 1.0), compared with the IVA group (9.0 ± 1.9) (p < 0.01). Both groups showed improvements in BCVA and CRT after 2 years compared with their baseline values. However, changes in BCVA and CRT at 2 years did not significantly differ between groups (p = 0.786 and p = 0.905, respectively). @*Conclusions@#Among patients with exudative age-related macular degeneration, the total number of IVA injections over 2 years was lower in the bromfenac group than in the IVA group. More studies are needed to confirm the efficacy of topical bromfenac in a combined treatment regimen.

One-year Clinical Outcome of Topical Bromfenac in Central Serous Chorioretinopathy

Purpose@#To evaluate the efficacy of topical bromfenac in treating central serous chorioretinopathy (CSC) over a 1-year period. @*Methods@#A retrospective analysis was conducted on 57 patients (57 eyes) with CSC followed for > 1 year. Patients were divided into two groups: those treated with bromfenac eye drops twice daily (29 eyes) and a control group (28 eyes). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were measured and compared between the two groups as was the proportion of chronic cases. @*Results@#Significant improvements in CMT and SRF height were noted in both groups over the follow-up period. The bromfenac group demonstrated significantly lower CMT at 6, 9, and 12 months (p = 0.045, 0.042, and 0.023, respectively) and lower SRF height (p = 0.037, 0.048, and 0.046, respectively) compared to the control group. The proportion of chronic cases was significantly lower in the bromfenac group (17.2%) compared to the control group (42.9%, p = 0.035). @*Conclusions@#Topical bromfenac reduced the rate of progression to chronic CSC and showed significant anatomical improvements after 6 months, suggesting its potential as an effective treatment option.

Exudative Retinal Detachment after Pembrolizumab Treatment in Metastatic Cutaneous Melanoma

Purpose@#To report a case of exudative retinal detachment after using pembrolizumab in a patient with metastatic cutaneous melanoma.Case summary: A 67-year-old woman, diagnosed with malignant melanoma of the right thumb and axillary metastasis, presented with bilateral visual disturbance 3 days after adjuvant chemotherapy with pembrolizumab. Her best corrected visual acuity was 0.2 in the right eye and 0.7 in the left, while the intraocular pressure was 14 mmHg in both eyes. Fundus examination showed serous retinal detachment and choroidal detachment in the right eye, as well as a chorioretinal folding in both eyes. Optical coherence tomography showed exudative retinal detachment and choroidal detachment in the right eye, along with choroidal folding in both eyes. The pembrolizumab was stopped immediately, and the patient began treatment with systemic and topical steroids. After 1 month, the visual acuity improved and there was no exudative retinal detachment or choroidal detachment. However, 3 weeks later, exudative retinal detachment recurred in both eyes. The patient started treatment with oral steroids and cyclosporine, which resulted in the resolution of the exudative retinal detachment after 1 month. @*Conclusions@#Exudative retinal detachment may occur as a side effect of pembrolizumab treatment. Therefore, a differential diagnosis and appropriate treatment of ocular side effects are necessary.

Effect of external subretinal fluid drainage on persistent subretinal fluid after scleral buckle surgery in macula-involving rhegmatogenous retinal detachment.

This study aimed to analyze the duration and causes of persistent subretinal fluid (PSF) after scleral buckle (SB) surgery in patients with macula-involving rhegmatogenous retinal detachment (RRD). Sixty-one eyes of 61 patients with macula-involving RRD who underwent SB surgery between 2016 and 2022 were reviewed retrospectively. PSF was confirmed on optical coherence tomography. The PSF duration after surgery and the analysis of relevant ocular and systemic factors were conducted according to the PSF duration. The mean duration of PSF was 5.9 ± 4.6 months in all eyes and 8.1 ± 5.0 months in eyes not treated with external subretinal fluid (SRF) drainage, which was significantly longer than 4.5 ± 3.7 months in those subjected to external SRF drainage. The mean best-corrected visual acuity improved significantly 3 months after surgery. There were significant visual improvements in the external SRF drainage group compared to the non-drainage group during all follow-up periods. Longstanding shallow RRD was significantly associated with longer PSF duration after SB surgery. External SRF drainage during SB surgery can effectively reduce SRF, shorten the duration of PSF, and accelerate visual improvement.

Suppression of TNBC metastasis by doxazosin, a novel dual inhibitor of c-MET/EGFR.

BACKGROUND: Triple-negative breast cancer (TNBC) is characterized by aggressive growth and a high propensity for recurrence and metastasis. Simultaneous overexpression of c-MET and EGFR in TNBC is associated with worse clinicopathological features and unfavorable outcomes. Although the development of new c-MET inhibitors and the emergence of 3rd-generation EGFR inhibitors represent promising treatment options, the high costs involved limit the accessibility of these drugs. In the present study, we sought to investigate the therapeutic potential of doxazosin (DOXA), a generic drug for benign prostate hyperplasia, in targeting TNBC. METHODS: The effect of DOXA on TNBC cell lines in vitro was evaluated in terms of cell viability, apoptosis, c-MET/EGFR signaling pathway, molecular docking studies and impact on cancer stem cell (CSC)-like properties. An in vivo metastatic model with CSCs was used to evaluate the efficacy of DOXA. RESULTS: DOXA exhibits notable anti-proliferative effects on TNBC cells by inducing apoptosis via caspase activation. Molecular docking studies revealed the direct interaction of DOXA with the tyrosine kinase domains of c-MET and EGFR. Consequently, DOXA disrupts important survival pathways including AKT, MEK/ERK, and JAK/STAT3, while suppressing CSC-like characteristics including CD44high/CD24low subpopulations, aldehyde dehydrogenase 1 (ALDH1) activity and formation of mammospheres. DOXA administration was found to suppress tumor growth, intra- and peri-tumoral angiogenesis and distant metastasis in an orthotopic allograft model with CSC-enriched populations. Furthermore, no toxic effects of DOXA were observed in hepatic or renal function. CONCLUSIONS: Our findings highlight the potential of DOXA as a therapeutic option for metastatic TNBC, warranting further investigation.

Flash-Induced High-Throughput Porous Graphene via Synergistic Photo-Effects for Electromagnetic Interference Shielding.

Porous 2D materials with high conductivity and large surface area have been proposed for potential electromagnetic interference (EMI) shielding materials in future mobility and wearable applications to prevent signal noise, transmission inaccuracy, system malfunction, and health hazards. Here, we report on the synthesis of lightweight and flexible flash-induced porous graphene (FPG) with excellent EMI shielding performance. The broad spectrum of pulsed flashlight induces photo-chemical and photo-thermal reactions in polyimide films, forming 5 × 10 cm2-size porous graphene with a hollow pillar structure in a few milliseconds. The resulting material demonstrated low density (0.0354 g cm-3) and outstanding absolute EMI shielding effectiveness of 1.12 × 105 dB cm2 g-1. The FPG was characterized via thorough material analyses, and its mechanical durability and flexibility were confirmed by a bending cycle test. Finally, the FPG was utilized in drone and wearable applications, showing effective EMI shielding performance for internal/external EMI in a drone radar system and reducing the specific absorption rate in the human body.

Primary and additional treatment preference in aggressive retinopathy of prematurity and type 1 retinopathy of prematurity.

OBJECTIVE: This study aimed to evaluate the preference for antivascular endothelial growth factor (anti-VEGF) versus laser ablation therapy as primary and additional treatment in aggressive retinopathy of prematurity (ROP) and type 1 ROP. METHODS: This multicentre retrospective study was conducted at nine medical centres across South Korea. A total of 94 preterm infants with ROP who underwent primary treatment between January 2020 and December 2021 were enrolled. All eyes were classified as having type 1 ROP or aggressive ROP. Data on the zone, primary treatment chosen, injection dose, presence of reactivation and additional treatment were collected and analysed. RESULTS: Seventy infants (131 eyes) with type 1 ROP and 24 infants (45 eyes) with aggressive ROP were included. Anti-VEGF injection was selected as the primary treatment in 74.05% of the infants with type 1 ROP and 88.89% with aggressive ROP. Anti-VEGF injection was selected as the ROP was located in zone I or posterior zone II, and laser ablation was selected when it was located in zone II. The anti-VEGF injection doses varied and tended to be higher in the aggressive ROP group. Infants with aggressive ROP were 2.08 times more likely to require additional treatment than those with type 1 ROP. When ROP reactivation occurred, laser therapy was preferred as an additional treatment. CONCLUSION: In Korea, the preference for anti-VEGF therapy or laser therapy differed according to ROP subtype, zone and primary or secondary treatment. These findings suggest that ROP treatment are considered according to ROP subtype, location and reactivation.

Chondroblastoma of foot bones; a clinicopathological study of 29 cases confirming the diagnostic utility of H3K36M and H3G34W antibodies at an uncommon site.

OBJECTIVE: Chondroblastoma (CB) is a benign cartilaginous bone neoplasm which commonly occurs in long bones of adolescents. CB can uncommonly involve foot. Its mimics include both benign and malignant lesions. H3K36M immunohistochemical (IHC) stain is a helpful tool for establishing the diagnosis of CB in such challenging situations. In addition, H3G34W IHC stain helps to rule out giant cell tumor which is the closest differential of CB. Our objective was to describe the clinicopathological features and frequencies of H3K36M, H3G34W and SATB2 IHC stains in CB of foot. MATERIALS AND METHODS: We reviewed H&E slides and blocks of 29 cases diagnosed as "chondroblastoma" of foot at our institutions. RESULTS: Patient's age ranged from 6 to 69 (mean: 23.3 and median: 23) years. Males were almost 5 times more commonly affected than females. Talus and calcaneum were involved in 13 (44.8 %) cases each. Microscopically, tumors were composed of polygonal mononuclear cells and multinucleated giant cells and chondroid matrix. Other histological features included aneurysmal bone cyst-like (ABC-like) change (44.8 %), osteoid matrix (31 %), chicken-wire calcification (20.7 %), and necrosis (10.3 %). H3K36M was expressed in 100 % and SATB2 in 91.7 % cases. H3G34W was negative in all cases, where performed. One out of 11 patients with follow up information developed local recurrence after 48 months. CONCLUSION: CB in foot occur at an elder age and show more frequent ABC-like changes as compared to long bones. Males are affected ~5:1 as compared to 2:1 in long bones. H3K36M are H3G34W are extremely useful diagnostic markers for CB, especially elderly (aged or higher) patients and we report the largest series of foot CB cases confirmed by immunohistochemistry.

Management of Steroid-Induced Glaucoma in a Patient with Pyoderma Gangrenosum.

Pyoderma gangrenosum (PG) is an uncommon inflammatory skin disorder typically presenting as painful skin ulcers, which may also exhibit extracutaneous findings. PG can occur at the site of trauma or surgery, which is known as the pathergic phenomenon. A 36-year-old man developed bilateral steroid-induced glaucoma after prolonged systemic immunosuppressive treatment for cutaneous pyoderma gangrenosum. After successful Ahmed glaucoma valve implantation surgery with donor scleral patch graft in the right eye, the same surgery failed repeatedly in the left eye and complicated with the prolonged conjunctival necrosis and the exposure of the donor scleral patch graft. Under the impression of ocular involvement of PG, microinvasive glaucoma surgery (MIGS) with XEN® Gel Stent was performed in the left eye; the conjunctival bleb was successfully formed without conjunctival necrosis, and intraocular pressure was well maintained. Ophthalmic surgery can be complicated in patients with PG, and the surgical option should be selected prudently to minimize surgical trauma. MIGS, as a minimally invasive surgical technique, could offer an advantage for patients with PG.

MULTIPLE-SESSION SUBTHRESHOLD MICROPULSE LASER THERAPY FOR EXUDATIVE PERIFOVEAL VASCULAR ANOMALOUS COMPLEX: A CASE REPORT.

PURPOSE: To report a case of exudative perifoveal vascular anomalous complex treated with a 532-nm subthreshold micropulse laser unresponsive to intravitreal injections. METHODS: A case report. RESULTS: A 65-year-old woman presented with blurred vision in the left eye for 1 month. An isolated perifoveal aneurysm surrounded by retinal hemorrhages and hard exudates was revealed in fundus examination, and optical coherent tomography showed a round lesion with a hyperreflective wall, subretinal fluid, and an intraretinal cyst. She was diagnosed with exudative perifoveal vascular anomalous complex and received four intravitreal injections. However, her best-corrected visual acuity decreased, and an aneurysmal lesion with macular edema persisted for approximately 6 months. Three sessions of 532-nm subthreshold micropulse laser therapy around the aneurysm were applied because the intravitreal injection treatment was ineffective. Since the last session, macular edema disappeared, the involuted lesion remained substantially stable without recurrence, and her best-corrected visual acuity improved without visual field defect. CONCLUSION: To our knowledge, this is the first report of a successful subthreshold micropulse laser treatment for an exudative perifoveal vascular anomalous complex lesion, and it could be a safe and effective method for the patient unresponsive to intravitreal injections.

Comparison of Intraocular Pressure Measurements Obtained Using Three Tonometers after Descemet Membrane Stripping Endothelial Keratoplasty

Purpose@#To compare the level of agreement between the Goldmann applanation tonometer (GAT), iCare IC200 rebound tonometer (IRT), and noncontact tonometer (NCT) in patients who underwent Descemet membrane stripping endothelial keratoplasty (DSEK), and to identify factors contributing to variations in intraocular pressure (IOP) measurements among the three tonometers. @*Methods@#We retrospectively analyzed the medical records of 41 patients who underwent DSEK. IOP was measured using NCT, IRT, and GAT, in this order. We evaluated the level of agreement among IOP measurements using the three tonometers, and analyzed whether clinical factors affected the results. @*Results@#We analyzed 49 eyes of 41 patients (average age: 62.0 years). The IOP values measured by IRT and NCT were lower than those measured by GAT, although the difference was not significant (p = 0.098 and p = 0.320, respectively). A Bland-Altman plot showed greater agreement between IOP measurements obtained by IRT and GAT than those obtained by NCT and GAT. In multivariate regression analysis, the IOP measured by GAT (β = 0.215, p = 0.022), corneal curvature (β = -1.692, p = 0.037), and postoperative duration (β = 0.042, p = 0.018) affected the difference in IOPs measured by GAT and IRT. The IOP measured by GAT (β = 0.301, p = 0.013) and corneal curvature (β = -2.670, p = 0.010) affected the difference in IOP measurements obtained by GAT and NCT. @*Conclusions@#In DSEK eyes, IRT showed good agreement and high correlation with GAT, suggesting that it is useful for IOP measurement. However, the IOP measured by GAT, corneal curvature, and postoperative duration should be considered when measuring IOP with an IRT.

Hyperviscosity Syndrome-related Retinopathy in a Patient with Waldenström Macroglobulinemia

Purpose@#We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved. @*Conclusions@#In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.

A Case of Orbital Infarction Syndrome in a Patient with Hemophagocytic Lymphohistiocytosis

Purpose@#To report a case of orbital infarction syndrome in a patient with hemophagocytic lymphohistiocytosis (HLH).Case summary: A 70-year-old woman with diabetes mellitus and hypertension was referred to the Department of Ophthalmology for sudden-onset left upper eyelid ptosis after being diagnosed with HLH. After 3 days, the best corrected visual acuity in the right eye was 0.8, while there was no light perception in the left eye. In the left eye, the ocular motility examination showed limitations in all fields of gaze. On fundus examination, optic disc pallor, retinal hemorrhage, and narrowed retinal arteries were observed in the left eye. Fluorescein angiography showed no blood flow in the retinal arteries and veins in the left eye. On neck computed tomography angiography, the left distal internal carotid artery was narrowed. Orbit computed tomography showed exophthalmos and extraocular muscle hypertrophy in the left eye. Orbit magnetic resonance imaging confirmed optic nerve edema, enhancement of the optic nerve sheath, and high signal intensity of the intraocular fat in the left eye. Slit-lamp examination revealed ischemia of the anterior segment and ischemic necrosis of the eyelid in the left eye. The patient was diagnosed with orbital infarction syndrome. @*Conclusions@#Several factors may lead to ischemia of the orbital tissues in patients with HLH, including coagulopathy, an increased incidence of blood clots, and inflammation in the orbit. It is necessary to consider the possibility of orbital infarction syndrome when HLH patients present with visual loss, ocular movement limitations, and anterior segment ischemia.

Surgical Outcomes of Hammer-Chisel and Drill Techniques to Create Superior Bony Ostium During Endoscopic Dacryocystorhinostomy

Purpose@#We introduce a “cold steel” hammer-chisel technique for endoscopic dacryocystorhinostomy, then compare postoperative outcomes between this technique and a drill technique. @*Methods@#This study included 191 patients (297 eyes) with nasolacrimal duct stenoses or obstructions who underwent endoscopic dacryocystorhinostomy using the hammer-chisel or drill technique. Surgical outcomes were compared via follow-up screening for epiphora and anatomical complications such as granuloma and fibrous membrane formation, canalicular obstruction, and synechiae. @*Results@#Postoperative anatomical complications occurred in 29 eyes (18.6%) in the hammer-chisel group and 51 eyes (36.2%) in the drill group (p = 0.001). The anatomical failure rate was higher in the drill group [28 eyes (19.9%)] than in the hammer-chisel group [18 eyes (11.5%); p = 0.038]. Functional failure was observed in 13 eyes (8.3%) in the hammer-chisel group and 13 eyes (9.2%) in the drill group (p = 0.787). The mean operation time was significantly longer in the drill group (35.5 ± 10.4 minutes vs. 25.4 ± 9.1 minutes) (p < 0.001). @*Conclusions@#During endoscopic dacryocystorhinostomy, osteotomy with a hammer-chisel is more successful and leads to fewer complications than osteotomy with a drill.

Long-term surgical outcomes of Ahmed valve implantation in refractory glaucoma according to the type of glaucoma.

BACKGROUND: We evaluated the long-term efficacy and surgical outcomes of Ahmed glaucoma valve (AGV) implantation in patients with refractory glaucoma by glaucoma type. METHODS: In total, 135 eyes of 135 patients diagnosed with refractory glaucoma and underwent AGV implantation between 2002 and 2018 were reviewed retrospectively. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of antiglaucoma medications were investigated at baseline and follow-up. The cumulative probability of qualified success according to the glaucoma type was evaluated at 12, 24, 36, and 60 months postoperatively. RESULTS: The mean IOP of all patients was 35.7 ± 11.7 mmHg, which was significantly reduced 12.7 ± 7.0 mmHg at 1 week, 16.2 ± 7.5 mmHg at 2 weeks, 17.6 ± 6.8 mmHg at 1 month, 17.5 ± 6.4 mmHg at 3 months, 16.1 ± 6.0 mmHg at 6 months, 16.7 ± 8.0 mmHg at 12 months, 16.4 ± 6.6 mmHg at 24 months, 15.6 ± 5.0 mmHg at 36 months, and 15.6 ± 5.6 mmHg at 60 months after surgery (p < 0.001, respectively). The mean number of antiglaucoma medications was 3.7 ± 1.3, which significantly decreased to 0.4 ± 0.9 at 1 week, 0.3 ± 0.8 at 2 weeks, 0.7 ± 0.9 at 1 month, 1.1 ± 1.1 at 3 months, 1.4 ± 1.0 at 6 months, 1.5 ± 1.1 at 12 months, 1.6 ± 1.2 at 24 months, 1.7 ± 1.2 at 36 months, and 1.8 ± 1.3 at 60 months after surgery (p < 0.001, respectively). The mean BCVA significantly improved from postoperative 2 weeks. Although 71 (52.6%) eyes had postoperative complications, the cumulative probability of surgical success was 72.6% at 12 months, 66.7% at 24 months, and 63.7% at 36 and 60 months. According to the glaucoma type, the success rate of AGV implantation was more than 50% even after 60 months follow-up, except subgroup of neovascular glaucoma (NVG) due to retinal vein occlusion (RVO). CONCLUSIONS: AGV implantation in patients with refractory glaucoma was, after long-term follow-up, successful overall. Therefore, AGV implantation can be an effective surgical option to reduce the IOP and number of antiglaucoma medications and to improve visual acuity for various glaucoma types.

Exogenous Fungal Endophthalmitis by Exophiala xenobiotica Infection after Cataract Surgery

Purpose@#To report a case of fungal endophthalmitis secondary to Exophiala xenobiotica after cataract surgery.Case summary: A 79-year-old male presented with decreased visual acuity in the left eye 8 months after cataract surgery. He was diagnosed with uveitis and received subtenon triamcinolone injection, which has a temporary effect. Three months after the injection, his visual acuity had decreased, such that best-corrected visual acuity (BCVA) of the left eye was hand motion. Anterior chamber cells with hypopyon and severe vitritis with vitreous haze were observed in the left eye. We considered the possibility of endophthalmitis after cataract surgery, and repetitive anterior chamber irrigation with culture was conducted to identify pathogens. Systemic and intravitreal antifungal agents were injected after the isolation of Exophiala xenobiotica. However, there was no improvement of the endophthalmitis, and he underwent pars plana vitrectomy. Although inflammatory symptoms disappeared after surgery, black lesions in the corneal incision site were identified 3 months postoperatively. Ultimately, surgical debridement and anterior chamber injections of antifungal agents were performed for recurring endophthalmitis. After the surgery, there was no inflammation of the anterior chamber or vitreous cavity. The BCVA of the left eye improved to 0.5. @*Conclusions@#Ophthalmologists should consider the possibility of fungal endophthalmitis in patients who suffer from uveitis-like symptoms after cataract surgery.