Ho Min Lew

Lack of positive effect of intravitreal bevacizumab in central serous chorioretinopathy: meta-analysis and review

PurposeTo review and evaluate the effects of intravitreal bevacizumab injection (IVB) in centralserous chorioretinopathy (CSC) by meta-analysis.Patients and methodsClinical controlled studies that evaluated the effect of IVB in CSC were identified through systematic searches of Embase, PubMed, and the Cochrane Central Register of Controlled Trials. Data on the best-corrected visual acuity (BCVA) in logMAR and central macular thickness (CMT) in μm at baseline and 6 months after IVB were extracted and compared with those treated by simple observation.ResultsFour clinical controlled studies were included in the meta-analysis. The IVB injection group achieved better BCVA at a follow-up of 6 months. However, the analysis showed that there were no significant differences of BCVA at 6 months after injection between IVB group and the observation group (−0.02 logMAR, 95% CI −0.14 to 0.11, P=0.80). The analysis of the reduction in CMT revealed that the difference between groups was not statistically significant (−8.37 μm, 95% CI −97.26 to 80.52, P=0.85). No report assessed severe complications or side effects of IVB in patients with CSC.ConclusionsMeta-analysis failed to verify the positive effect of IVB in CSC based on the epidemiological literature published to date.

A prospective study of blood pressure and intraocular pressure changes in hypertensive and nonhypertensive patients after intravitreal bevacizumab injection.

Purpose: To evaluate the changes in blood pressure and intraocular pressure (IOP) in patients with and without hypertension after intravitreal bevacizumab (Avastin) injection. Methods: This study examined 135 (74 nonhypertensive vs. 61 hypertensive) consecutive patients treated with an intravitreal injection of 1.25 mg bevacizumab for retinal vascular diseases prospectively over a 6-month period. All the hypertensive patients were on medication, and only patients with controlled hypertension after consultation with cardiology specialists were included. Intraocular pressure and blood pressure were measured before and 30 minutes, 1 day, 1 week, 3 weeks, and then every month after the bevacizumab injection. Results: The mean baseline systolic and diastolic pressures were significantly higher in the hypertensive group (systolic P = 0.001, diastolic P = 0.023). None of the systolic and diastolic values after injection differed significantly from the baseline values in the hypertensive group. By contrast, the 30-minute systolic values were significantly higher than baseline (P < 0.05), and the 1-day diastolic values were lower than before injection in the nonhypertensive group (P < 0.05). The mean baseline IOP of the nonhypertensive and hypertensive groups was similar (P = 0.08). The mean IOP 30 minutes after injection was significantly higher than the baseline mean IOP (P < 0.05), and the mean IOPs at 1 day and 1 week were significantly lower than before injection in both groups (P < 0.05). Conclusion: Intravitreal bevacizumab injection is safe in terms of blood pressure and IOP in both hypertensive and nonhypertensive patients after 6 months of follow-up.

Relationship between ocular pulse amplitude and glaucomatous central visual field defect in normal-tension glaucoma.

Purpose:To investigate the relationship between central visual field (VF) defects and ocular pulse amplitude (OPA) in early normal-tension glaucoma (NTG). Patients and Methods:This retrospective study included 100 eyes of 100 subjects: 54 NTG patients whose mean deviations were better than −7.00 dB and 46 normal subjects. OPA was measured by dynamic contour tonometry. NTG patients were divided into 2 subgroups according to VF tests: the central VF-invading and the central VF-sparing groups. Ocular parameters including OPA, intraocular pressure (IOP), and indices of VF tests were analyzed in glaucoma patients and normal subjects. Results:There was no difference in the OPA between the NTG and normal groups. However, IOP and OPA of the central VF-invading group (14.4±2.87 and 2.9±0.78 mm Hg) were higher than those of the central VF-sparing group (12.7±2.52 and 2.0±0.80 mm Hg; P=0.025 and P<0.001, respectively). OPA, but not IOP, showed a positive correlation with the VF test indices that represented central field defects (r=0.494, P<0.001). Conclusions:Increased OPA was related to more centrally located VF defects in NTG patients with mild VF defects.

Changes in Ocular Manifestations of Behçet Disease in Korean Patients over Time: A Single-center Experience in the 1990s and 2000s

Abstract Purpose: To analyze chronological changes in ocular manifestations of Behçet’s disease (BD) in Korean patients. Methods: Ocular findings were retrospectively analyzed from medical records of patients diagnosed with BD between 1994 and 2010 and divided into two groups according to the date of their first visit to our ophthalmology department. Group A began care between 1994 and 2000, and Group B between 2004 and 2010. Results: Fifty-six patients (83 eyes) were included in analyses. There was a significant decrease in the number of complete BD cases in Group B compared to Group A, and fewer patients had genital lesions in Group B. Mean visual acuity was better, and more patients had good vision in Group B than in Group A at the one and two year follow-up. Conclusions: The severity of BD has decreased over the past two decades, allowing BD patients with ocular involvement to have better visual prognoses.

Retinal artery occlusion in a healthy pregnant patient.

Purpose We report a case of branch retinal artery occlusion (BRAO) in a healthy pregnant woman. Methods A 29-year-old pregnant woman presented with decreased vision in her left eye. She had a pale retina with macular edema consistent with BRAO. An extensive workup was performed to determine an etiologic factor. All test results were within normal limits except for her factor VIII activity. Her visual acuity improved from finger counting to 20/30 over 2 months without any treatment. Results This case suggests that BRAO can occur in healthy patients without any systemic or ocular disorders. Conclusions BRAO can occur in healthy patients without any systemic or ocular disorders, despite an extensile evaluation.

Central retinal vein occlusion in an otherwise healthy child.

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Changes in Corneal and Conjunctival Sensitivity, Tear Film Stability, and Tear Secretion After Strabismus Surgery

PURPOSE Some patients complain of a foreign body sensation, a burning sensation, or dryness after strabismus surgery. We prospectively investigated the changes in corneal and conjunctival sensitivity, tear film stability, and tear secretion after strabismus surgery. PATIENTS AND METHODS Corneal and conjunctival sensitivity were assessed with an esthesiometer, tear film breakup time was measured, and the Schirmer test was performed prospectively (preoperatively and 1 week, 1 month, and 3 months postoperatively) in 83 patients (124 eyes) who underwent strabismus surgery at our institution. RESULTS There were no significant changes in corneal sensitivity, tear film stability, or tear secretion after strabismus surgery (P > .05). Conjunctival sensitivity decreased significantly after strabismus surgery (P < .05). CONCLUSION Discomfort and dryness after strabismus surgery do not seem to be related to changes in corneal sensitivity, tear film stability, or tear secretion.

Serous Retinal Detachment Following Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection

We report a case of serous retinal detachment following combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in subfoveal choroidal neovascularization (CNV). A 53-year-old woman was diagnosed with subfoveal CNV secondary to age-related macular degeneration (AMD) and treated with combined PDT and intravitreal bevacizumab injection. One day after treatment, the patient experienced a sudden decline of vision and optical coherence tomography (OCT) showed serous retinal detachment involving the macula. She was managed conservatively with an oral steroid beginning on the second day of the combined treatment and the subretinal fluid started to decrease one week following the initiation of steroids. This case suggests that combined PDT and intravitreal injection of bevacizumab can be associated with serous retinal detachment. Additional studies are needed to establish the safety and complications following this treatment regimen.

Effect of Intravitreal Bevacizumab (Avastin®) Therapy in Malignant Hypertensive Retinopathy: A Report of Two Cases

PURPOSE Malignant hypertensive retinopathy is a rare, but serious, complication of uncontrolled systemic hypertension for which no treatment has been established yet. We report 2 patients with malignant hypertensive retinopathy who recovered promptly following intravitreal bevacizumab injection. METHODS Intravitreal bevacizumab (1.25 mg/0.05 mL) was injected in 4 eyes of 2 patients having malignant hypertensive retinopathy with optic disc edema, macular edema, and retinal exudates. A complete ophthalmic examination, including the best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT), and fluorescein angiography (FAG), was performed before and after the treatments. RESULTS Two eyes in 1 patient received two intravitreal injections of bevacizumab, whereas 2 eyes in the other patient received a single treatment. All 4 eyes had improvement of macular edema on OCT at 1 month and decreased fluorescein leakage on FAG 3 months after the treatment, which led to improvements in the BCVA in 3 eyes. In 1 eye with foveal atrophy, no change in the BCVA occurred despite the improved macular edema on OCT. CONCLUSIONS The results suggest that intravitreal bevacizumab injections might be a useful adjunctive treatment of malignant hypertensive retinopathy in some selected cases. However, further studies are mandatory to determine the safety and the efficacy of such injections in this disease.

Comparison of the topographic ablation zone after photorefractive keratectomy for myopia using two different excimer lasers.

PurposeTo compare the topographic features of eyes treated with photorefractive keratectomy (PRK) for myopia using two different excimer lasers.MethodsA total of 65 eyes in 39 patients treated with PRK (6.0-mm optical zone) using Technolas 217C and VISX S4 excimer lasers were evaluated retrospectively to determine the size of the topographic ablation zone.ResultsThe zones ablated using the VISX S4 had shorter diameters in both axes (−0.89±0.73, −1.59±0.49 mm; both P=0.00), whereas those ablated using the Technolas 217C had a longer diameter in the major axis (0.96±0.63 mm; P=0.00) and a shorter diameter in the minor axis (−0.39±0.59 mm; P=0.00). The theoretical ablated zone was a circle with a diameter of 6.0 mm. The Technolas 217C group tended to have oval cuts in comparison with the VISX S4 group, and the difference between the programmed (6.0 mm) and topographic diameters was significant in both groups.ConclusionsThere was a difference between the programmed and postoperative topographic diameters of the ablation zone. The postoperative ablation zone differed in shape and size according to the type of excimer laser.