Chiharu Shima

Complications in patients after intravitreal injection of bevacizumab

Purpose:  To report complications in patients after intravitreal injection of bevacizumab to treat ocular diseases associated with vascular endothelial growth factor.

Efficacy of intravitreal injection of bevacizumab for severe retinopathy of prematurity: a pilot study

Aim: The aim of the study was to evaluate the short-term efficacy of intravitreal injections of bevacizumab for severe retinopathy of prematurity (ROP). Methods: A retrospective chart review was conducted of 23 consecutive eyes (stage 3, three eyes; 4A, 18 eyes; 4B, two eyes) of 14 patients with vascularly active ROP considered at high risk for progression or development of tractional retinal detachment despite conventional laser ablation therapy. Patients received an intravitreal injection of bevacizumab (0.5 mg), either as the initial treatment (15 eyes) or at the end of vitrectomy (eight eyes). Results: After injection of bevacizumab as the initial treatment, reduced neovascular activity was seen on fluorescein angiography in 14 of 15 eyes. In three eyes, a tractional retinal detachment developed or progressed after bevacizumab injection. No other ocular or systemic adverse effects were identified. Vitrectomy was performed in 20 eyes and the retina was reattached after one surgery in 18 eyes. Multiple surgeries were necessary in two eyes, resulting in retinal reattachment. Conclusion: There results suggest that intravitreal injection of bevacizumab seems to be associated with reduced neovascularisation without apparent ocular or systemic adverse effects, and is thus beneficial for treating severe ROP that is refractory to conventional laser therapy.

Microincision Vitrectomy Surgery and Intravitreal Bevacizumab as a Surgical Adjunct to Treat Diabetic Traction Retinal Detachment

PURPOSE To investigate the feasibility and efficacy of microincision vitrectomy surgery (MIVS) combined with intravitreal bevacizumab (IVB) as a surgical adjunct for treating traction retinal detachment (TRD) secondary to severe proliferative diabetic retinopathy (PDR). DESIGN Retrospective, comparative, consecutive, interventional case series. PARTICIPANTS Seventy-one eyes of 59 consecutive patients who underwent primary vitrectomy for diabetic TRD and were followed up for more than 6 months after surgery. METHODS Eyes that received IVB (1 mg) as a preoperative adjunct followed by MIVS (IVB/MIVS group) from November 2005 through December 2007 were compared with eyes that underwent conventional 20-gauge pars plana vitrectomy (20-g PPV group) from September 2003 through October 2005. MAIN OUTCOME MEASURES Primary and ultimate anatomic success, intraoperative and postoperative complications, and final visual success with at least 6 months of follow-up. RESULTS This series included 38 eyes (33 patients) in the IVB/MIVS group and 33 eyes (26 patients) in the 20-g PPV group. The primary and ultimate anatomic success rates (95% vs. 91% and 100% in both groups, respectively) and the mean visual acuity changes did not differ significantly between groups; the surgical time and intraoperative bleeding in the IVB/MIVS group decreased significantly compared with the 20-g PPV group (P<0.001). The rate of visual improvement of 3 lines or more at the 6-month follow-up was 68% in the IVB/MIVS group and 49% in the 20-g PPV group, respectively. Progression of the preexisting TRD after IVB occurred in 7 eyes (18%). Absence of previous laser photocoagulation (P = 0.025) and the presence of a ring-shaped fibrovascular membrane (P = 0.013) were relevant findings in eyes with these IVB-induced complications. CONCLUSIONS Intravitreal bevacizumab plus MIVS offers comparable anatomic success compared with conventional 20-gauge PPV in patients with TRD resulting from severe PDR. This technique shortens the surgical time with fewer intraoperative complications and favorable visual recovery. However, caution should be taken because of rapid progression of the preexisting TRD after IVB in some patients. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Vitreous Levels of Angiopoietin-1 and Angiopoietin-2 in Eyes With Retinopathy of Prematurity

PURPOSE To determine the vitreous levels of angiopoietin (Ang)-1 and Ang-2 in eyes with retinopathy of prematurity (ROP), and to determine the correlation between the 2 levels. DESIGN Retrospective case-control study. METHODS Forty-eight eyes with stage 4 ROP were studied. Six eyes with congenital cataract were used as controls. The ROP eyes were classified by the vascular activity into highly (n = 22), moderately (n = 15), and mildly (n = 11) vascular-active ROP. Eyes with highly vascular-active ROP initially received 0.5 mg of intravitreal bevacizumab (IVB) and underwent vitrectomy within 1 week. The others underwent vitrectomy without IVB. Vitreous samples were collected at the beginning of vitrectomy, and the vitreous levels of Angs were measured by enzyme-linked immunosorbent assay. RESULTS The mean concentrations of Ang-1 and Ang-2 were 201.9 and 7832.1 pg/mL in highly vascular-active ROP eyes, 216.1 and 7731.2 pg/mL in moderately vascular-active ROP eyes, 533.8 and 1685.9 pg/mL in mildly vascular-active ROP eyes, and 0 and 41.5 pg/mL in control eyes. The vitreous Ang-1 level was significantly higher (P < .05) in highly, moderately, and mildly vascular-active ROP eyes than in control eyes. The vitreous Ang-2 level was significantly higher (P < .05) in highly and moderately vascular-active ROP eyes than in control eyes. There was a significant negative correlation (r = -0.406; P = .040) between the Ang-1 and Ang-2 levels in moderately and mildly vascular-active ROP eyes. CONCLUSIONS The balance of Ang-1 and Ang-2 in the vitreous may be important in the pathogenesis of ROP.

Chandelier illumination to complete Descemet stripping through severe hazy cornea during Descemet-stripping automated endothelial keratoplasty

We describe a technique that uses chandelier illumination during Descemet-stripping automated endothelial keratoplasty (DSAEK) in severe bullous keratopathy. A 25-gauge or 27-gauge chandelier illumination fiber inserted through the corneal side port serves as sclera-scattering illumination from the sclerocorneal margin and endoillumination from the anterior chamber and provides excellent visibility for Descemet stripping and intraocular manipulation without obstruction by a hazy cornea. In cases complicated by dense cataract, the chandelier fiber can be inserted transconjunctivally into the pars plana, providing sufficient retroillumination to perform phacoemulsification with intraocular lens implantation combined with Descemet stripping for a DSAEK triple procedure. Because of the powerful illumination and hands-free nature of the chandelier fiber, Descemet membrane can be visualized clearly and stripped as 1 sheet without inadvertent complications. This new technique is safe and might encourage surgeons to perform DSAEK in challenging cases.

A case of iridoschisis associated with plateau iris configuration.

Iridoschisis is a rare condition characterized by bilateral separation of the layers of the iris stroma, typically in the inferior quadrants. Glaucoma, mainly angle-closure glaucoma with pupillary block, occurs in approximately 50% of cases. In the current report, we describe a case of iridoschisis associated with plateau iris confi guration. To the best of our knowledge, this is the fi rst report of iridoschisis associated with plateau iris confi guration.

A case of iris melanocytoma transformed to malignant melanoma

Visualization of a conjunctival cyst capsule may be compromised by cyst rupture and conjunctival bleeding during the cyst excision. Previous reports have proposed use of trypan blue with 2.3% sodium hyaluronate for better delineation of the cyst outline. An earlier report suggested use of ICG alone. Indocyanine green has been used in various ocular procedures, such as capsular staining and bleb fi ltration. Because it is an extraocular procedure, use of ICG in conjunctival cyst excision should have few, if any, side effects. Sodium hyaluronate is added with the ICG to aid retention of the cyst structure. Theoretically, 2.3% sodium hyaluronate has a higher viscosity, and thus, the use of a solution of this concentration leads to better retention of the cyst structure than does use of 1% sodium hyaluronate. However, in the case reported here, use of 1% sodium hyaluronate achieved the same staining effect. To our knowledge, this is the fi rst report of the use of ICG and 1% sodium hyaluronate in conjunctival cyst capsule staining for excision. Indocyanine green is a good alternative to trypan blue as it is more readily available and less expensive. In the present case, it also resulted in good retention of the cyst structure despite being used in conjunction with the relatively less viscous 1% sodium hyaluronate. We recommend the use of ICG with sodium hyaluronate during conjunctival cyst excision.

Lens-Sparing Vitrectomy Effective for Reattachment of Newly Developed Falciform Retinal Detachment in a Patient With Norrie Disease

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