Ik Soo Byon

Triamcinolone-Induced Intraocular Pressure Elevation: Intravitreal Injection for Macular Edema and Posterior Subtenon Injection for Uveitis

Purpose To assess the effect of intravitreal and posterior subtenon injections of triamcinolone acetonide (TA) on intraocular pressure (IOP). Methods we reviewed 42 consecutive eyes after intravitreal TA injection (IVTA) and 43 eyes following posterior subtenon TA injection (PSTA). All cases had a minimum follow-up time of three months. After injection, the value and time of the maximal IOP, the amount of IOP elevation and the needs of the medication were assessed. Results The IOP increased significantly (p<0.001) from 16.3±2.5 mmHg preoperatively to a mean maximum of 21.7±5.3 mmHg in the IVTA group, and from 15.3±4.5 mmHg to 20.6±3.0 mmHg in the PSTA group. An elevation in the IOP of more than 5 mmHg from the baseline IOP was seen in 52.4% of the IVTA group at a mean time of 3.1 weeks postoperatively, and 44.2% of the PSTA group displayed an IOP elevation at 5.9 weeks. Conclusions Both developed significant elevations of IOP, but this appeared at a later date in the PSTA group. Careful follow-up after local injection of steroids is necessary.

Perfluoro-n-octane–assisted Single-layered Inverted Internal Limiting Membrane Flap Technique for Macular Hole Surgery

Vitrectomy became the standard treatment of macular hole after its introduction by Kelly and Wendel.1 Although progression of surgical techniques and diagnostic tools have improved the anatomical outcomes of macular hole surgery, postoperative visual recovery is usually limited.2–4 Furthermore, surg

Clinical features of infectious endophthalmitis in South Korea: a five-year multicenter study.

BackgroundTo investigate clinical features of infectious endophthalmitis over five years in a South Korean population.MethodsMedical records of consecutive patients diagnosed with infectious endophthalmitis at eight institutions located in Gyeongsangnam-do and Pusan city between January 1, 2004 and July 31, 2010 were reviewed.ResultsA total of 197 patients were diagnosed and treated. An average of 30.0 infectious endophthalmitis per year was developed. The annual incidence rate of postoperative endophthalmitis during 2006 ~ 2009 was 0.037%. The ratios of male to female and right to left were 50.2%: 49.8 % and 54.8%: 43.2%, respectively. Eighth decade and spring were the peak age (36.6%) and season (32.0%) to develop the infectious endophthalmitis. The most common past history in systemic disease was hypertension (40.4%), followed by diabetes (23.4%). Cataract operation (60.4%) was the most common cause, among which most of them was uneventful phacoemulsification (95.9%). Corneal laceration (51.6%) and liver abscess (42.9%) were the most common causes of traumatic and endogenous endophthalmitis, respectively. The percentages of patients with initial and final visual acuity less than counting fingers were 62.6% and 35.2%, respectively. Treatment with vitrectomy with or without intravitreal antibiotics injection was administered to 72.6% of patients, while 17.3% received intravitreal antibiotics only.ConclusionsOur study revealed that the development of infectious endophthalmitis was related with seasonal variation and increased during our study period. Pars plana vitrectomy was preferred for the treatment of infectious endophthalmitis in South Korea.

Regional Choroidal Thickness Changes in Branch Retinal Vein Occlusion with Macular Edema

Purpose: To investigate regional changes in choroidal thickness in branch retinal vein occlusion (BRVO) patients with macular edema. Methods: Choroidal thickness in the subfoveal, occlusive, and nonocclusive areas in BRVO eyes was measured using enhanced depth imaging by spectral domain optical coherence tomography. The choroidal thickness was compared with the corresponding values both in the fellow eye and in normal controls at baseline. Regional changes in choroidal thickness were then evaluated in the BRVO eyes after intravitreal bevacizumab (IVB) injections. Results: Regional choroidal thickness was measured in 57 eyes at baseline. The mean choroidal thickness of the occlusive area was significantly higher than that of the nonocclusive, subfoveal, and corresponding areas in the fellow eyes and normal controls (p < 0.001). The choroidal thickness in the occlusive area correlated with the retinal thickness in both the central and occlusive areas (rho = 0.590, p < 0.001, and rho = 0.351, p = 0.011, respectively), but not with visual acuity. After IVB, the choroidal thickness in the occlusive area had decreased significantly (p = 0.004), but remained higher than that of other areas (p < 0.001 and p = 0.026). Conclusion: In acute BRVO eyes, the choroid is thicker in the occlusive area. This difference is correlated with the severity of macular edema, but not with visual acuity. Bevacizumab reduces choroidal thickness, but does not restore normal values.

Perfluoro-n-octane Assisted Free Internal Limiting Membrane Flap Technique for Recurrent Macular Hole.

Perfluoro-n-octane Assisted Free Internal Limiting Membrane Flap Technique for Recurrent Macular Hole Vitrectomy combined with removal of the internal limiting membrane (ILM) and gas tamponade is considered a standard procedure for macular hole. Hole closure is not sufficient for the recovery of vision but is necessary to ensure good visual acuity and prevent further vision loss. It is challenging to achieve hole closure in cases of chronic large macular holes or in highly myopic eyes. Recently, various surgical techniques using the ILM have been introduced to improve the surgical outcomes in such cases. The inverted ILM flap technique, first described by Michalewska et al, has shown improved functional and anatomical outcomes. Our group has reported a similar technique, whereby the macular hole is covered with a singlelayered ILM flap using perfluoro-n-octane (PFO) to stabilize the flap during fluid–air exchange. However, these procedures are not feasible in cases where the ILM around the macular hole has already been removed, such as cases of recurrent macular hole or failed surgery. Herein, the authors describe a modified technique for covering a recurrent macular hole with a free flap of the ILM with the assistance of PFO.

TOPOGRAPHIC CHANGES OF THE MACULA AFTER CLOSURE OF IDIOPATHIC MACULAR HOLE.

Purpose: To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. Methods: This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2–4 mm and outer; 4–6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. Results: The average displacement was 57.2 &mgr;m at an angle of −3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 &mgr;m) than in the outer ring (35.3 &mgr;m, P < 0.001), and larger in the temporal sectors than in the corresponding nasal sectors (P ⩽ 0.008). Inferior and superior displacement was noted in the superior and inferior sectors, respectively. Multiple regression analysis revealed that basal horizontal macular hole diameter and size of internal limiting membrane removal were independent factors of displacement. Conclusion: The macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.

Intravitreal triamcinolone acetonide for rebound phenomenon after high-dose intravenous steroid treatment in Vogt-Koyanagi-Harada disease

The authors report two cases of rebound phenomenon treated with intravitreal triamcinolone acetonide in Vogt-Koyanagi-Harada (VKH) disease. Patients in the acute phase of VKH disease were treated with high-dose intravenous (IV) methylprednisolone (1 g/day) for 3 days. Serous retinal detachment decreased and visual acuity improved during IV steroid treatment. After switching to oral steroid treatment, choroiditis and visual acuity worsened. An injection of triamcinolone acetonide (4 mg) into the vitreous resulted in gradual resolution of subretinal fluid and improvement of visual acuity. Systemic steroids were tapered to discontinuation without a relapse of inflammation. Adjuvant intravitreal triamcinolone is useful in the management of the rebound phenomenon in VKH disease.

Natural History of Idiopathic Epiretinal Membrane in Eyes with Good Vision Assessed by Spectral-Domain Optical Coherence Tomography

Purpose: To investigate the natural history of idiopathic epiretinal membrane (ERM) in eyes with good visual function using optical coherence tomography (OCT). Methods: Sixty-two eyes of 58 patients with idiopathic ERM, visual acuity of 20/40 or better, and no significant metamorphopsia were included. The best corrected visual acuity (BCVA), central macular thickness (CMT), membrane configuration, and ellipsoid zone signal data over 24 months were retrospectively analyzed. Based on OCT findings, ERM configurations were categorized as global attachment (GA), partial attachment (PA), pseudohole, and vitreomacular traction (VMT). Results: The mean BCVA and CMT did not change significantly between baseline and 24 months. GA, PA, pseudohole, and VMT types were observed in 33, 19, 9, and 1 eye at baseline, and in 20, 22, 10, and 1 eye at 24 months, respectively. A membrane configuration change was noted in 24 eyes (38.7%) during follow-up, and the distribution shifted from GA to the other types (p < 0.001). Six eyes had visual loss due to membrane progression, and 4 eyes had spontaneous membrane separation. Of the 10 eyes with progression or separation, 6 were of the PA type. Conclusions: Although the BCVA remains stable over 2 years in most idiopathic ERM eyes with good visual function at baseline, the membrane configuration may change, affecting visual acuity. The GA type would be an early stage, and the PA type is prone to changes in visual acuity.

Reduced-Fluence Photodynamic Therapy in Polypoidal Choroidal Vasculopathy Nonresponsive to Ranibizumab

BACKGROUND AND OBJECTIVE To evaluate the effect of reduced-fluence photodynamic therapy (PDT) on polypoidal choroidal vasculopathy (PCV) unresponsive to intravitreal ranibizumab. PATIENTS AND METHODS Patients with PCV unresponsive to ranibizumab administered 3 months consecutively who then received reduced-fluence PDT were retrospectively surveyed. Nonresponders were defined as patients having no reduction in intraretinal and/or subretinal fluid after 3 consecutive treatments. RESULTS In total, 22 of 104 eyes (21.2%) were non-responders, and 16 of 22 nonresponders received reduced-fluence PDT. Nine eyes achieved complete fluid resolution, and six had reduced but persistent fluid. In one eye, fluid persisted at 6 months despite an additional anti-vascular endothelial growth factor (anti-VEGF) injection after reduced-fluence PDT. Mean macular thickness decreased significantly at 3 and 6 months after PDT, but the mean visual acuity was worse than baseline. CONCLUSION Reduced-fluence PDT in nonresponders gradually decreased intraretinal and/or subretinal fluid over several months but did not maintain visual acuity.

Optic perineuritis secondary to acute retinal necrosis.

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