Eung Suk Kim

Photodynamic therapy combined with intravitreal injection of vascular endothelial growth factor antibody for polypoidal choroidal vasculopathy.

Background/Aims: To evaluate the efficacy of photodynamic therapy (PDT) combined with intravitreal injection of anti-vascular-endothelial-growth-factor (anti-VEGF) antibody in patients with polypoidal choroidal vasculopathy (PCV). Methods: Twenty-two eyes of 22 patients with PCV followed for 12 months after combination therapy with PDT and anti-VEGF were retrospectively reviewed. Patients received intravitreal anti-VEGF (1.25 mg bevacizumab or 0.5 mg ranibizumab) within 7 days after PDT. Retreatment with PDT and intravitreal anti-VEGF injections, or with intravitreal anti-VEGF alone, was performed when indicated. The main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Results: Mean logMAR BCVA was 0.43 at baseline and 0.45, 0.36, 0.30 and 0.28 at 1, 3, 6 and 12 months, respectively, after the initial combination therapy. Mean BCVA was significantly improved at 6 and 12 months after treatment (p < 0.05). Mean CFT was 269.4 µm at baseline and 180.1, 136.7, 127.5 and 139.6 µm at 1, 3, 6 and 12 months, respectively, after the initial combination therapy. CFT decreased significantly throughout the follow-up period. At 12 months, mean BCVA improved by 1.5 lines, and mean CFT decreased by 129.8 µm. Polypoidal lesions disappeared in 7 of the 13 eyes in which indocyanine green angiography was performed at 12 months. No changes in the branching vascular network were observed in any of these 13 eyes. Patients were treated with PDT a mean of 1.3 times and injected with intravitreal anti-VEGF a mean of 3.4 times over the 12-month period. Conclusion: Combined PDT and intravitreal anti-VEGF may improve visual acuity and decrease CFT at 12 months. Large long-term prospective studies are needed to evaluate the efficacy and safety of combination therapy.

Optical coherence tomography angiography analysis of foveal microvascular changes and inner retinal layer thinning in patients with diabetes

Aim To evaluate the correlation between inner retinal layer thinning and the foveal microvasculature in type 2 diabetes using optical coherence tomography angiography (OCTA). Methods A cross-sectional study involved 155 diabetic eyes. All patients were divided into two groups based on diabetic retinopathy (DR) grade: no DR (NDR, n=80) and mild-to-moderate non-proliferative DR (NPDR, n=75). Foveal avascular zone (FAZ) area, FAZ circularity index, FAZ perimeter, vessel density and perfusion index of parafoveal and perifoveal area were calculated using OCTA. The thickness of the macular ganglion cell/inner plexiform layer (mGCIPL) was measured using OCT. Results In both superficial and deep retinal capillary layers (SRL and DRL), FAZ areas in the NDR (0.38 mm2 , 0.49 mm2) and NPDR (0.38 mm2, 0.48 mm2) were greater than those in the control (0.33 mm2, 0.43 mm2). The FAZ circularity index, vessel density and perfusion index in the NDR (0.63, 17.8/mm, 0.32) and NPDR (0.63, 17.5/mm, 0.32) were smaller than those in the control (0.69, 19.6/mm, 0.39). mGCIPL thickness was significantly correlated with FAZ area in the SRL and DRL, as well as with FAZ circularity index, vessel density and perfusion index in the NDR and NPDR. In multivariate regression analysis, the FAZ circularity index (OR=12.2) and vessel density of the parafovea (OR=1.95) were correlated with mGCIPL thinning. Conclusion OCTA revealed that early foveal microcirculatory alterations in diabetic eyes were related to mGCIPL thickness, regardless of the presence of DR. The decrease in FAZ circularity and parafoveal vessel density were highly correlated with mGCIPL thinning.

Change of retinal pigment epithelial atrophy after anti-vascular endothelial growth factor treatment in exudative age-related macular degeneration.

Purpose: The study aimed to investigate the quantitative changes of retinal pigment epithelial (RPE) atrophy during a 24-month follow-up period of anti-vascular endothelial growth factor (VEGF) for exudative age-related macular degeneration (AMD). Materials and Methods: This is a retrospective study. Sixty-five eyes of 62 consecutive patients with naοve exudative AMD who had received treatment with anti-VEGF therapy and followed for more 24 months were enrolled. All patients received three initial monthly injections of anti-VEGF (ranibizumab or bevacizumab), followed by pro re nata or treat-and-extend protocol. Color fundus image, optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy. Multiple regression analysis was performed to investigate the predictive factors found during univariate analysis to identify an association with increased RPE atrophic areas. Results: The mean number of anti-VEGF treatments was 9.18. RPE atrophic area was 1.293 ± 1.298 mm 2 at baseline and enlarged to 2.394 ± 1.940 mm 2 after 24 months, which differed significantly (P = 0.001). Multiple regression analysis revealed that larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF treatments were associated with increased RPE atrophic areas. Conclusions: RPE atrophy progresses in eyes with exudative AMD during anti-VEGF treatment. Larger areas of RPE atrophy at month 4 and larger numbers of anti-VEGF injections were associated with an increased risk of progression of RPE atrophy the following treatment. These findings may be useful to clinicians using intravitreal anti-VEGF for the treatment of exudative AMD, both for selecting an appropriate treatment plan and for predicting the progression of RPE atrophy.

Comparison of Ranibizumab and Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

Purpose To assess the effectiveness and safety of intravitreal ranibizumab compared with bevacizumab for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). Methods This was a retrospective study of 80 eyes with macular edema associated with BRVO. Patients received either 0.5 mg of ranibizumab (n = 24) or 1.25 mg of bevacizumab (n = 56) intravitreally. Both groups received three initial monthly injections followed by as-needed injections. The best-corrected visual acuity, central subfield thickness, mean number of injections, and retreatment rate were evaluated monthly for 6 months after the initial injection. Results The best-corrected visual acuity significantly improved from logarithm of the minimal angle of resolution (logMAR) 0.55 ± 0.26 at baseline to 0.24 ± 0.26 at 6 months in the ranibizumab group (p < 0.001) and from logMAR 0.58 ± 0.21 at baseline to 0.29 ± 0.25 at 6 months in the bevacizumab group (p < 0.001), which is not a statistically significant difference (p = 0.770). The mean reduction in central subfield thickness at 6 months was 236 ± 164 µm in the ranibizumab group (p < 0.001) and 219 ± 161 µm in the bevacizumab group (p < 0.001), which is not also a statistically significant difference (p = 0.698). The mean numbers of ranibizumab and bevacizumab injections were 3.25 ± 0.53 and 3.30 ± 0.53, respectively (p = 0.602). In addition, after the three initial monthly injections, the retreatment rates for ranibizumab and bevacizumab injections were 20.8% and 26.7%, respectively (p = 0.573). Conclusions Both ranibizumab and bevacizumab were effective for the treatment of BRVO and produced similar visual and anatomic outcomes. In addition, the mean number of injections and the retreatment rates were not significantly different between the groups.

Postoperative occlusion of visual axis with fibrous membrane in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome: a case report

BackgroundTo report a case of postoperative fibrous membrane formation occluding the visual axis in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome.Case presentationA 79-year-old Asian woman with pseudoexfoliation syndrome underwent uneventful phacoemulsification and implantation of one-piece hydrophilic acrylic square-edged intraocular lens (Cristalens) in the right eye. Two months later, she had blurred vision in the right eye with the best-corrected visual acuity (BCVA) of 20/40. Formation of fibrous membrane occluding the capsulorhexis opening with contraction of anterior capsule was observed, which was confirmed by anterior segment optical coherence tomography. Clear visual axis was achieved by lysis of the membrane using Nd:YAG laser. The BCVA improved to 20/20.ConclusionsOcclusion of the visual axis with fibrous membrane can develop in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome.

Atypical epiretinal tissue in full-thickness macular holes: pathogenic and prognostic significance

Background To elucidate the clinical characteristics of a full-thickness macular hole (FTMH) with atypical epiretinal tissue (AET), and expand the spectrum of pathogenesis of MH. Methods This study involved 225 consecutive eyes of 211 patients who underwent surgery for an idiopathic FTMH. Eyes were divided into two groups according to the presence of AET. Tomographic features at baseline, closure rate of the MH and visual outcomes were compared between the two groups. Results AET was detected in 26 (11.6%) among 225 eyes. Overall closure of the MH was noted in 92.3% of eyes with AET and 99.5% of eyes without AET at 12 months postoperatively (p=0.003). At 12 months postoperatively, the mean logarithm of the minimum angle of resolution visual acuity in eyes with and without AET was 0.38 and 0.21, respectively (p=0.046). At baseline, eyes with AET more frequently had splitting of the inner retina but fewer intact photoreceptors compared with eyes without AET (19.2% vs 2.5%, and 57.7% vs 89.9%, p<0.001, respectively). Conclusions The presence of AET in an FTMH was related to poorer anatomical success and less visual recovery after surgery, suggesting that AET reflects a chronic pathogenic process involving more severe damage to the foveal tissue.

Comment on: Comparison of serum sodium and potassium levels in patients with senile cataract and age-matched individuals without cataract.

Sir, We read with great interest the study by Mathur and Pai[1] entitled, “Comparison of serum sodium and potassium levels in patients with senile cataract and age‐matched individuals without cataract,” in which the authors showed that higher serum sodium level is associated with increased risk of senile cataract. We believe that the authors should be congratulated for the great work as the results suggested that high sodium intake could be a risk factor of senile cataract, and underlined the importance of low salt diet, which is in accordance with a recent study on a large population in Korea.[2]

Decompression retinopathy after intravitreal bevacizumab and anterior chamber paracentesis in a patient with neovascular glaucoma

Cite this article as: Lo Giudice G, Catania AG, Galan A. Adaptive optics study of photoreceptors layer damage from presumed sun exposure: A case report. Indian J Ophthalmol 2016;64:860-1. This is an open access article distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Cataract surgery through the small pupil

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