Mee Yon Lee

Combination therapy of ranibizumab and photodynamic therapy for retinal angiomatous proliferation with serous pigment epithelial detachment in Korean patients: twelve-month results.

Purpose: The purpose of this study was to evaluate the safety and efficacy of combination therapy with intravitreal ranibizumab and photodynamic therapy in the treatment of retinal angiomatous proliferation (RAP) with serous pigment epithelial detachment. Methods: Ten eyes of nine consecutive patients with newly diagnosed RAP were enrolled in this prospective pilot study. A course of combination therapy consisted of three ranibizumab injections at monthly intervals and a single photodynamic therapy, guided by indocyanine green angiography, about 1 week after the first injection. The patients were followed every month for 12 months. Retreatment was administered when a persistent, recurrent, or new RAP lesion was confirmed. Results: Eight of the 9 patients (9 eyes) completed 12 months of follow-up. At the 3-month visit, 8 of the 9 eyes (89%) showed favorable initial responses. After 6 months, recurrent lesions developed in 2 eyes (25%) and a new lesion in one other eye; all showed favorable responses to retreatment. At the 12-month visit, 7 eyes (78%) showed regression of the RAP lesions, among which 5 eyes (56%) required only a single session of combination treatment. The mean best-corrected visual acuity was improved from 20/125 at baseline to 20/63 (P = 0.021), and the mean central foveal thickness was reduced from 353 μm at baseline to 169 μm (P = 0.017). The mean improvement in the best-corrected visual acuity was 3.86 lines. No patient had vision-threatening adverse events. Conclusion: Ranibizumab and photodynamic therapy combination therapy appears to be safe and effective for anatomical and functional improvement in patients with RAP with pigment epithelial detachment. Further evaluation with a larger patient sample and a long-term controlled study is required to compare treatment efficacy with antivascular endothelial growth factor monotreatment.

Intravitreal Foscarnet for the Treatment of Acyclovir-resistant Acute Retinal Necrosis Caused by Varicella Zoster Virus

Purpose: To report of a case of acute retinal necrosis (ARN), successfully treated with intravitreal foscarnet. Methods: Case report. Results: A 40-year-old man diagnosed with varicella zoster virus (VZV)-induced ARN failed standard acyclovir treatment. He was treated subsequently with intravenous foscarnet, but developed acute renal failure after 1 day of treatment. All systemic anti-viral agents were discontinued, and intravitreal foscarnet was administered weekly. After 5 injections, the retinitis was dramatically improved. Conclusions: Intravitreal foscarnet was efficacious in the treatment of acyclovir-resistant ARN caused by VZV. It may be used as the sole treatment in patients with intolerance to systemic administration.

Frosted Branch Angiitis, Presumably Related to Dermatomyositis

Purpose: To report the first case of frosted branch angiitis associated with dermatomyositis in a Korean woman. Methods: Case report. Results: A 42-year-old woman with history of dermatomyositits presented with unilateral decreased visual acuity. Fundus examination showed findings consistent with frosted branch angiits. After 1 month of oral prednisolone, the patient made significant visual recovery with near complete resolution of vascular sheathing. Conclusions: To the best of the authors’ knowledge, this is the first case of frosted branch angiitis associated with dermatomyositis. Dermatomyositis should be considered in the differential diagnosis of patients presenting with frosted branch angiitis.

Incidence and risk factors of massive subretinal hemorrhage in retinal angiomatous proliferation

Objective To evaluate the incidence and associated risk factors of massive subretinal hemorrhage (SRH) in patients with retinal angiomatous proliferation (RAP). Methods A total of 187 eyes of 135 treatment-naıve patients diagnosed with RAP were evaluated retrospectively. Clinical records including the time between the initial visit, last anti-vascular endothelial growth factor (VEGF) treatment, last stable examination, and the date of massive SRH were reviewed. Imaging findings including indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were analyzed. Results Massive SRH developed in 18 eyes (9.6%) a median of 20 months after the initial presentation. Kaplan-Meier survival analysis revealed that the incidence (2.8, 5.8, 13.1, and 21.0% after 1,2,5 and 10 years, respectively) continuously increased. Among 14 eyes with discernable vascular anastomosis on baseline ICGA, 13 (92.8%) showed retinal arteriole involvement. On spectral-domain OCT imaging of the last visit prior to the massive SRH, a layered lamellar tissue complex was noted under the retinal pigment epithelium in 9 of 13 eyes, which was significantly associated with massive SRH[hazard ratio(HR),5.883;P = .010]. The average time between the last stable examination/last injection and the massive SRH was 2 and 5 months, respectively. The patients were treated with anti-VEGF, gas and recombinant tissue plasminogen activator injection; however, all except one eye had visual acuity worse than 20/1000 at the final visit. Conclusions Massive SRH can occur in RAP in the course of anti-VEGF treatment, resulting in severe vision loss. A proactive dosing regimen may be more appropriate for these RAP eyes.

Sudden bilateral vision loss as the sole manifestation of posterior reversible encephalopathy syndrome from acute uremia: Clinical case report

Rationale: Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity associated with vasogenic edema. Symptoms may include headache, seizures, altered mental status, and visual impairment. Patients with PRES generally present with neurological deficits. Patient concerns: Here, we report an unusual case of a 42-year-old man who presented with sudden bilateral vision loss without any other neurologic symptoms. Diagnoses: He was diagnosed with PRES secondary to acute uremia. Interventions and outcomes: Our patient experienced a dramatic improvement in visual acuity, blood chemistry values, and magnetic resonance imaging findings following repeated hemodialysis. Lessons: Sudden bilateral vision loss may be the sole manifestation of PRES, particularly in patient with risk factors for PRES. Awareness of this variation of the clinical symptoms of PRES is important to facilitate its recognition.

Late emergence of macular sparing in a stroke patient: Clinical Case Report

Rationale: Occlusive cerebrovascular disease is the most common cause of homonymous hemianopia (HH) with macular sparing. Patient concerns: A 61-year-old man came to our ophthalmology clinic complaining of right-side hemianopia. Ophthalmic examination, visual field (VF) examination, and brain magnetic resonance imaging (MRI) were performed. Diagnoses: He had right HH without macular sparing on the initial VF test. And brain MRI 6 days after the visual symptoms began revealed a left occipital infarction. Interventions and Outcomes: Thirty-seven days after the onset, his follow-up 24-2 VF examination showed HH with bilateral macular sparing, which was not apparent in the initial VF examination. About 4 months after the stroke, his central 10-2 VF examination also showed HH with bilateral macular sparing. Lessons: We report a case of HH with a dramatic improvement in central vision several days after an occipital infarction. To our knowledge, this is the first case to show macular sparing developing after several days.

Comparison of Nd: YAG capsulotomy rate between 1-piece and 3-piece acrylic intraocular lenses

Abstract The aim of the study is to compare Nd:YAG capsulotomy rate between acrylic 1- and 3-piece intraocular lenses. Among 924 eyes of 762 patients who received cataract surgery, we selected the 303 patients (404 eyes) implanted with an SN60WF 1-piece intraocular lens (Alcon, Fort Worth, TX) or a YA-60BBR 3-piece intraocular lens (Hoya Co., Tokyo, Japan). For intraindividual comparison, we enrolled the 17 patients implanted with an SN60WF in 1 eye and a YA-60BBR in the contralateral eye. We compared Nd:YAG capsulotomy rate between acrylic 1- and 3-piece intraocular lenses 24 months after the operation. Of the 404 eyes in this study, Nd:YAG capsulotomy was performed in 20 of 268 eyes (7.5%) in the SN60WF 1-piece intraocular lens group and 24 of 136 eyes (17.6%) in the YA-60BBR 3-piece intraocular lens group; the difference was statistically significant (P = .002). Among the 17 patients (34 eyes) who were implanted with 2 different inraocular lenses, Nd:YAG capsulotomy was performed in only 2 eyes (12%) in the SN60WF group and 9 eyes (53%) in the YA-60BBR group; the difference was statistically significant (P = .020). The authors found a significantly greater incidence of Nd:YAG capsulotomy in eyes who received 3-piece lenses compared with those who received 1-piece lenses.

Two Cases of Endogenous Endophthalmitis That Progressed to Globe Rupture

1. Niemi G. Advantages and disadvantages of adrenaline in regional anaesthesia. Best Pract Res Clin Anaesthesiol 2005;19:229-45. 2. Park KH, Kim YK, Woo SJ, et al. Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA Ophthalmol 2014;132:714-23. 3. Lazzeri D, Agostini T, Figus M, et al. Blindness following cosmetic injections of the face. Plast Reconstr Surg 2012;129:995-1012. 4. Savino PJ, Burde RM, Mills RP. Visual loss following intranasal anesthetic injection. J Clin Neuroophthalmol 1990;10:140-4. 5. Webber B, Orlansky H, Lipton C, Stevens M. Complications of an intra-arterial injection from an inferior alveolar nerve block. J Am Dent Assoc 2001;132:1702-4.