In Kyung Oh

Inflammatory and Angiogenic Factors in the Aqueous Humor and the Relationship to Diabetic Retinopathy

Purpose: To determine the relationship between the aqueous concentrations of inflammatory and angiogenic factors and the severity of diabetic retinopathy and diabetic macular edema. Methods: Aqueous samples were obtained from 50 eyes of diabetic patients and 28 eyes of nondiabetic subjects. The aqueous levels of inflammatory factors, including IL-1β, TNF-α, MCP-1, IP-10, IL-8, IL-6, and VEGF were measured with multiplex bead array assays. The aqueous levels of cytokines were investigated according to the severity of diabetic retinopathy and diabetic macular edema measured by optical coherence tomography. Results: The aqueous levels of MCP-1, IP-10, IL-8, and VEGF were higher in eyes of diabetic patients than in eyes of nondiabetic subjects. The aqueous levels of MCP-1 and IP-10 were elevated in eyes with severe NPDR and PDR compared to eyes with less severe DR and eyes of nondiabetic subjects. There was a trend toward elevated IL-8 levels in eyes with severe NPDR compared to eyes of nondiabetic subjects. The aqueous levels of VEGF were markedly elevated in eyes with PDR that had not received PRP compared to eyes with severe NPDR. Eyes with PDR that had received PRP treatment showed higher MCP-1 and IP-10 levels than eyes with PDR that had not received PRP treatment. The aqueous levels of IL-6 were positively correlated with TMV and CSMT in eyes with DR. Conclusions: Elevation of MCP-1, IP-10, and IL-8 levels in eyes with severe NPDR suggests that inflammatory change precedes the development of neovascularization in PDR. The positive correlation between the aqueous levels of IL-6 and macular thickness indicates that IL-6 may play a central role in the development of diabetic macular edema.

Intravitreal versus Posterior Subtenon Injection of Triamcinolone Acetonide for Diabetic Macular Edema

Purpose To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. Methods This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. Results Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. Conclusions The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.

Retinal Pigment Epithelial Tear After Half Fluence PDT for Serous Pigment Epithelial Detachment in Central Serous Chorioretinopathy

Retinal pigment epithelial tears may occur after photodynamic therapy (PDT) in various diseases. The authors report a case of a retinal pigment epithelial tear after half light intensity (300 mW/cm2) PDT in a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy. A 52-year-old woman with a large serous pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy in the left eye received her first PDT treatment using verteporfin with a spot size of 6,640 microm, a duration of 83 seconds, and half (300 mW/cm2) of the standard 600 mW/cm2 light intensity, where the delivered PDT light dose was only 25 J/cm2. Two weeks later, visual acuity improved to 20/30. However, a large crescent-shaped retinal pigment epithelial tear was found during fundus examination. Even 50% reduced light fluence PDT can produce a retinal pigment epithelial tear in pigment epithelial detachment associated with chronic atypical central serous chorioretinopathy.

Risk Factors of Iris Posterior Synechia Formation after Phacovitrectomy with Three-Piece Acrylic IOL or Single-Piece Acrylic IOL

Aims: To identify the risk factors of posterior iris synechia formation after phacovitrectomy with posterior chamber single-piece acrylic intraocular lens (IOL; Acrysof® SA60AT) or 3-piece acrylic IOL (Acrysof® MA60BM) implantation. Methods: We selected 153 eyes of 153 patients treated by phacovitrectomy between March 2000 and August 2006 and retrospectively reviewed the relationship between iris posterior synechiae and various factors, such as IOL type, tamponade, preoperative iris posterior synechiae, major indications for surgery, axial length and preoperative anterior chamber (AC) depth. Results: IOL type (p = 0.0447), C3F8 gas tamponades (p = 0.0074), preoperative iris posterior synechiae (p = 0.0001) and postoperative AC fibrin deposition (p = 0.0303) were significantly associated with postoperative iris posterior synechiae by multiple logistic regression analysis. The odds ratio (OR) for single-piece IOL versus 3-piece IOL was 2.658 (95% confidence interval, CI: 1.010–6.993), the OR for C3F8 gas versus balanced salt solution was 4.051 (95% CI: 1.455–11.281), for the presence of preoperative iris posterior synechiae 12.868 (95% CI: 3.511–47.165), and the OR for postoperative AC fibrin deposition was 6.012 (95% CI: 1.186–30.468). Conclusion: Preoperative iris posterior synechiae, C3F8 gas tamponade, postoperative AC fibrin deposition and the single-piece IOL could increase the rates of iris posterior synechiae after phacovitrectomy.

Long-term Visual Outcome of Arteriovenous Adventitial Sheathotomy on Branch Retinal Vein Occlusion Induced Macular Edema

Purpose To evaluate long-term visual outcome of arteriovenous adventitial sheathotomy in BRVO-induced macular edema. Methods The visual outcomes of 8 patients following vitrectomy with arteriovenous adventitial sheathotomy for BVO-induced macular edema (surgery group) were retrospectively evaluated. The three year post-operative visual acuity of the surgery group was compared with that of the conservatively managed controls. Results All patients were followed for a minimum of 36 months. Mean BCVA (logMAR) in the surgery group changed from 1.10± 0.34 to 1.19±0.70 and to 0.80±0.36 at 12 and 36 months, respectively (p=0.959 at 12 months, p=0.018 at 36 months). In the control group, visual acuity improved from 1.15±0.43 to 0.43±0.44 and to 0.43±0.39 at 12 and 36 months, respectively (p=0.015 at 12 months, at p=0.003 at 36 months). A strong trend toward better visual acuity at 12 months and final examination was observed for controls. (surgery vs. control group, p=0.052 at 12 months, p=0.066 at 36 months). Conclusions Considering the favorable natural course of BVO and the unproven effect of reperfusion on macular edema, surgical efficacy of arteriovenous adventitial sheathotomy requires further evaluation.

Periocular abscess caused by Pseudallescheria boydii after a posterior subtenon injection of triamcinolone acetonide.

BackgroundA posterior subtenon injection of triamcinolone acetonide is an alternative to intravitreal injection in diabetic macular edema and is known to have fewer vision-threatening complications. Here, we report a case of periocular abscess following posterior subtenon injection of triamcinolone.MethodsA 62-year-old woman who had diabetic macular edema and disc neovascularization underwent a posterior subtenon injection of triamcinolone acetonide and panretinal laser photocoagulation. One month later a periocular abscess was noted in the inferotemporal area adjacent to the scleral wall. Pus was removed by fine-needle aspiration, and microbiologic cultures identified Pseudallescheria boydii. The patient was given systemic and subconjunctival treatment with itraconazole. However, conjunctival infection and anterior chamber inflammation worsened, and another posterior subtenon abscess was found.ResultsDespite long-term systemic and topical itraconazole therapy, retinal detachment and vitreous opacity were shown on B-scan, and atrophic bulbi resulted.ConclusionsPseudallescheria boydii infection of the eye and orbit can result in a poor visual outcome. Prompt surgical debridement and drainage of the abscess, along with appropriate antifungal therapy based on susceptibility testing, must be mandatory.

Risk Factors for Retinal Hemorrhage after Photodynamic Therapy in Age-Related Macular Degeneration

Background: Subretinal or intraretinal hemorrhage may occur after photodynamic therapy (PDT). However, risk factors for post-PDT hemorrhage have not yet been investigated. Methods: We reviewed the medical records of patients who had undergone PDT for subfoveal choroidal neovascularization secondary to age-related macular degeneration. Primary outcomes were the occurrences of hemorrhages at 2 and 12 weeks after PDT. To identify the risk factors of hemorrhages after treatment, ocular and systemic factors were investigated. The secondary outcome was visual acuity. Results: Ninety-two eyes from 92 patients were analyzed. New hemorrhages developed in 9 (9.8%) within 2 weeks and in 8 (8.3%) between 2 and 12 weeks after PDT. Hypertension [odds ratio (OR) 356.9, 95% confidence interval (CI) 3.7–34,487.1], minimally classic lesion (OR 53.4, 95% CI 2–1,429) and advanced age (OR 1.2, 95% CI 1–1.5) were related to hemorrhagic events within 2 weeks after PDT. A tendency toward recurrent hemorrhage was noted after repeat treatments (p < 0.05). Forty-four percent of the patients with a hemorrhagic event within 2 weeks after PDT experienced decreased vision. Conclusion: Hypertension, minimally classic lesion, advanced age and a previous hemorrhagic event were associated with the development of hemorrhage within 2 weeks after PDT.

Diurnal Variation of the Incidence of Symptomatic Branch Retinal Vein Occlusion

Aim: To investigate the diurnal variation that is related to the incidence of branch retinal vein occlusion (BRVO). Methods: This is a cross-sectional study. 72 consecutive patients who were newly diagnosed with BRVO were precisely questioned about the time of their symptom onset. The clinical history, systemic illnesses, ocular findings, and body mass index were obtained for each patient. Results: Analysis of the diurnal variation of symptom onset showed a distribution with the peak in the period from 6 a.m. to noon compared with all the other time periods (p < 0.001). Multivariate analysis showed that involvement of the superior retina was the only factor that influenced the onset time of BRVO. Conclusion: Patients with symptomatic BRVO frequently noted their visual deterioration in the morning, which is the same as the other types of ocular and systemic vascular disease. Our results may be helpful for understanding the pathophysiology of BRVO. Our findings require conformation and further studies on this subject are certainly warranted.