Chun-Ju Lin

The effect of intravitreal bevacizumab in the treatment of Coats disease in children.

Purpose: The purpose of this study was to determine if intravitreal bevacizumab can reduce subretinal exudates and exudative retinal detachment and facilitate the treatment of Coats disease in children. Methods: Prospective, interventional, and noncomparative case series of three eyes in three children with Coats disease were studied. All eyes received only intravitreal bevacizumab injection as the primary treatment. Ablative procedures, including cryotherapy, traditional continuous wave laser, or subthreshold diode micropulse laser, for diseased vessels were performed after subretinal fluid totally reabsorbed. One supplementary intravitreal bevacizumab injection was given after ablative procedures on the same day. The changes in pre- and postoperative best-corrected visual acuity were recorded. Serial color fundus photography, optical coherence tomography, and B-scan sonography were performed to measure treatment efficacy. Results: After receiving one to three injections, all three patients had subretinal fluid completely reabsorbed. All patients had one session of subsequent ablative procedures for diseased vessels and supplementary intravitreal bevacizumab injection. No patients had recurrent subretinal fluid. Improved visual acuity was noted in two cases but was not detectable in the other. No ocular or systemic complications related to bevacizumab were noted during the entire course of follow-up. Conclusion: Intravitreal bevacizumab appears to be a well-tolerated treatment for children with Coats disease. A favorable response is observed when compared with other treatment modalities. It has the potential as an adjuvant therapy of vascular ablative procedures to improve final vision and facilitate ongoing treatment.

Treatment of inferior rhegmatogenous retinal detachment by pneumatic retinopexy technique.

Purpose: The purpose of this study was to evaluate the effectiveness of pneumatic retinopexy as an alternative technique for repairing inferior rhegmatogenous retinal detachments. Design: Retrospective, noncomparative, interventional case series. Methods: A review on 13 patients (13 eyes) who had undergone pneumatic retinopexy as the initial procedure for primary retinal detachments with causative break(s) in the inferior one third of retina. After gas injection, all patients were instructed to maintain a lateral recumbent posture with head tilting 10 cm to 30 cm downward. Results: Nine male and 4 female patients (mean age 28.1 years, ranging from 14 to 57) were included in this study. Eleven eyes (84.6%) had myopia of −3 diopters or higher. Macular detachment was found in eight eyes. Pneumatic retinopexy alone resulted in reattachment in 10 eyes (76.9%). Three other eyes needed additional scleral buckling. Final retinal reattachment was achieved in all 13 subjects. Conclusion: Inferior rhegmatogenous retinal detachment can be treated by pneumatic retinopexy with proper head position. More attention to the postoperative stage are required to ensure surgical success.

Clinical characteristics and surgical management of familial exudative vitreoretinopathy-associated rhegmatogenous retinal detachment.

Purpose The purpose of this study was to report the clinical characteristics and surgical outcome of familial exudative vitreoretinopathy–associated rhegmatogenous retinal detachment. Methods Retrospective interventional case series of patients with familial exudative vitreoretinopathy–associated rhegmatogenous retinal detachment. All cases had preoperative and postoperative clinical evaluations. Eyes were divided into three groups: no, moderate, and severe foveal dragging according to the status of fovea. Scleral buckling procedures or vitrectomy was performed to attach the retina. Results Twenty-four eyes in 22 patients were included in this study. The male to female ratio was 18:4. The average age was 16.42 ± 5.48 years. There were 14, 5, and 5 eyes in the no, moderate, and severe foveal dragging groups, respectively. Proliferative vitreoretinopathy was present in only one eye in the severe foveal dragging group. In the subgroup of eyes without foveal dragging, neither proliferative vitreoretinopathy, posterior located breaks, nor giant tears were noted. All eyes needed only scleral buckle to reattach the retina. In the subgroup with moderate foveal dragging, posterior located break was noted in one eye, which was the only eye in this group that needed vitrectomy besides scleral buckle to attach the retina. In eyes with severe foveal dragging, Stage D proliferative vitreoretinopathy was noted in one eye and posterior located break in one eye. Encircling buckle and vitrectomy were necessary in all eyes. The average number of operation is 1.1, 1.2, and 2.4 for each of the three groups, respectively. Final visual acuity improved in 23 of 24 eyes. Final retinal attachment was obtained in 95.8% of eyes (23 of 24). Conclusion Male predominance and juvenile onset are the main characteristics in familial exudative vitreoretinopathy–associated rhegmatogenous retinal detachment. Surgical success rates are comparable to rhegmatogenous retinal detachment unassociated with familial exudative vitreoretinopathy in cases without severe foveal dragging and are worse in the group with severe foveal dragging.

The effect of intravitreal bevacizumab and transpupillary thermotherapy on choroidal metastases and literature review

Aims: To represent the effects of transpupillary thermotherapy (TTT) and intravitreal bevacizumab on choroidal metastases and review the literature. Settings and Design: A retrospective, interventional, noncomparative case series. Materials and Methods: A retrospective, interventional, noncomparative case series of five eyes in three patients with choroidal metastases was conducted. Fundus findings of choroidal metastases were divided into two types: Solitary or diffuse type. The size of the tumor was termed small (<10 mm diameter), medium (10–15 mm diameter) or large (>15 mm diameter). All eyes received one session of TTT followed by 3 weekly intravitreal bevacizumab injections as an adjuvant therapy. The parameters of treatment for TTT were 1.2–3 mm spot size, 150–300 mW, 60 s with the whole lesion covered confluently. The changes in preoperative and postoperative best-corrected visual acuity (BCVA) were recorded. Serial color fundus photography and optical coherent tomography were performed to measure the treatment efficacy. Results: All eight choroidal metastases were solitary type. The size of six tumors was small, the size of one tumor was medium, and the size of one tumor was large. All five eyes of the three patients had improvement of BCVA after treatment. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71%. Optical coherence tomography revealed complete resolution of serous retinal detachment. There was no recurrence after 6 months follow-up. Conclusions: TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients. Despite the retrospective nature of our study, the absence of control group and the size limitation that, of course, limit the statistical power, TTT combined with intravitreal bevacizumab seems to be efficient in providing another cost-reducing and time-saving treatment option for patients with choroidal metastases. The antineoplastic properties of bevacizumab make it a viable adjunctive therapy. Studies with more cases and a longer follow-up period are warranted.

Successful treatment of toxoplasmosis-associated choroidal neovascular lesions with bevacizumab and antiparasitic therapy.

PURPOSE To report the effects of oral trimethoprim/sulfamethoxazole and intravitreal bevacizumab injection in the treatment of ocular toxoplasmosis-associated choroidal neovascular lesions (CNV). METHODS This was a noncomparative, nonrandomized, consecutive case series. All eyes with ocular toxoplasmosis-associated CNV received one intravitreal bevacizumab injection under the coverage of oral trimethoprim/sulfamethoxazole. The changes in best-corrected visual acuity were recorded. Serial fundus photography, fluorescein angiography, optical coherence tomography, and indocyanine green angiography were performed to measure the treatment efficacy. RESULTS Three eyes of two patients with a history of ocular toxoplasmosis had active CNV demonstrated by fluorescein angiography and optical coherence tomography. Each was treated with oral trimethoprim/sulfamethoxazole and one intravitreal bevacizumab injection. Best-corrected visual acuity, fundus photographs, fluorescein angiography, optical coherence tomography, and indocyanine green angiography all showed favorable results. No ocular or systemic complications were noted. In all three eyes, the CNV subsided and vision improved. CONCLUSION Oral trimethoprim/sulfamethoxazole is an effective and less expensive antibiotic against Toxoplasma gondii. Intravitreal bevacizumab injection appears to be a well-tolerated treatment for toxoplasmosis-associated CNV and has the potential as an adjuvant therapy to improve final vision. More cases and further studies are required.

Endogenous Mycotic Endophthalmitis In An Immunocompetent Postpartum Patient

PURPOSE The purpose of this study was to report endogenous mycotic endophthalmitis in an immunocompetent postpartum patient who has undergone perineotomy in childbirth. METHODS A 29-year-old immunocompetent postpartum woman had floaters in the left eye 2 weeks after childbirth. She denied ocular trauma, previous intraocular surgery, or intravenous drug use. The best-corrected visual acuity was 20/100 in the left eye. Anterior chamber cells, keratic precipitates, vitreous cells, and retinal infiltration were found. Endogenous endophthalmitis was highly suspected. The survey for infectious source was negative, but the culture of aqueous humor showed the presence of Cladosporium species. Pars plana vitrectomy and intravitreal 1 -μg fluconazole injection were performed. The culture of the vitreous disclosed Candida albicans. Intravitreal injections with 5 μg amphotericin-B and 0.1 mg voriconazole were given subsequently. Intravenous voriconazole 200 mg twice daily was administered for 2 weeks and was shifted to the oral form for 4 more weeks. RESULTS A residual retinal exudate resolved during follow-up. The best-corrected visual acuity was 20/25 in the left eye 10 months later. CONCLUSION This is the first case that illustrates the occurrence of endogenous mycotic endophthalmitis culture proved by Candida and Cladosporium in an immunocompetent patient. Early detection and appropriate treatment preserved vision.

Negative Mantoux test in a patient with definite pulmonary and ocular tuberculosis

The case is reported of a patient with pulmonary and ocular tuberculosis presenting with blurred vision in both eyes. A 27-year-old well-nourished male nursing-home resident with a previous history of traumatic intracerebral hemorrhage was brought to the ophthalmological clinic due to progressively blurred vision. His best-corrected visual acuity was 20/400 in the right eye with only light perception in the left eye. Fundus examinations revealed retinal segmental periphlebitis and hemorrhagic retinitis in the right eye and dense vitreous hemorrhage in the left eye. The Mantoux test was negative; however, the results of an interferon gamma release assay were positive. Ocular tuberculosis was suspected. Although he had never had any respiratory symptoms, his chest radiograph and computed tomography scan showed a multiple centrilobular glandular and ground-glass appearance with air-space consoli dations and atelectasis in both lower lobes. Pulmonary tuberculosis was confirmed by a positive acid-fast stain of a bronchial alveolar lavage sample. A GEN-PROBE amplified Mycobacterium tuberculosis direct test of the vitreous fluids was also positive. Ocular tuberculosis was confirmed. After treatment for tuberculosis and vitrectomies, his final best-corrected visual acuity improved to 20/30 in the right eye and 20/200 in the left eye. Ocular tuberculosis is rarely reported as the primary presentation of systemic tuberculosis in young patients. A negative Mantoux test may lead to misdiagnosis and delayed treatment. Doctors should become more familiar with the manifestations of systemic tuberculosis and use advanced diagnostic tools in cases of clinical suspicion.

Use Of Aflibercept For The Management Of Refractory Pseudophakic Macular Edema In Irvine-gass Syndrome And Literature Review

Background/Purpose: To present the patient treated for pseudophakic cystoid macular edema with intravitreal aflibercept. Methods: Interventional case report. Case: An 83-year-old woman presented with decreased vision 1 month after uneventful cataract surgery. After failure to respond to posterior subtenons triamcinolone and three Ranibizumab injections, the patient responded to one intravitreal aflibercept injection. Recurrence occurred two months later, and therefore three monthly injections were then given. Again the patient responded although recurrence occurred two months after treatment. The patient refused further treatment. Conclusion: Intravitreal aflibercept may be effective for the treatment of pseudophakic cystoid macular edema.

Occlusive retinal vasculitis secondary to Behçet's disease.

A 25-year-old man presented with left eye visual impairment. He had received immunotherapy due to spiking fever; recurrent oral ulcers, and arthralgia followed by red skin nodules. His condition was stabilised using oral prednisolone and cyclosporine at a rheumatologic clinic. However, left eye blurring vision (20/30) appeared after tapering cyclosporine. Vitritis (figure 1A) was accompanied by retinal infiltrates and branch retinal vein occlusions. Extensive perivenous sheathing with intraretinal haemorrhages was associated with the occlusive retinal vasculitis (figure 1B). The fluorescein angiography revealed retinal non-perfusion (figure 2 …

Rescue vitrectomy with blocked artery massage and bloodletting for branch retinal artery occlusion

A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset. After the surgery, his vision improved to 20/25. Fundoscopy showed reperfused retina, and optical coherence tomography revealed resolved retinal edema. RAO is an ophthalmological emergency; however, no standard guideline is available. Vitrectomy with blocked retinal artery massage and bloodletting showed favorable results in this case of BRAO with a large embolus. More prospective clinical trials are needed for setting up the standard treatment.