Mi In Roh

Concentration of cytokines in the aqueous humor of patients with naive, recurrent and regressed CNV associated with amd after bevacizumab treatment.

Purpose: To evaluate the concentration of various cytokines in the aqueous humor of patients with naive, recurrent, and regressed choroidal neovascularization (CNV) of age-related macular degeneration after bevacizumab treatment. Methods: Aqueous humor samples were collected from 36 eyes with age-related macular degeneration and 10 controls during cataract surgery. Of 36 patients with age-related macular degeneration, 5 eyes were naïve to bevacizumab injection, 14 eyes had recurrent CNV after bevacizumab treatment, and 17 eyes had regressed CNV after bevacizumab treatment. Cytokines were measured by an immunoassay using multianalyte biochip array technology (Evidence investigator cytokine and growth factor biochip array, RANDOX laboratories Ltd., Crumlin, UK). Results: No significant difference in the cytokine levels was noted between the control group and the naïve CNV group (all P > 0.05). Vascular endothelial growth factor in both naive (66.8 ± 35.1 pg/mL) and recurrent CNV groups (55.7 ± 63.0 pg/mL) was significantly higher compared with regressed CNV group (9.8 ± 12.8 pg/mL, P = 0.025 and P = 0.004, respectively) but was not statistically different from the control group (81.8 ± 43.7 pg/mL, P = 0.310 and P = 0.212, respectively). The aqueous humor level of tumor necrosis factor-&agr; and interleukin (IL)-2 was significantly lower in recurrent CNV group (P = 0.036 and P = 0.019) compared with the control group. In the active CNV patients (recurrent and naïve CNV groups), the aqueous humor levels of IL-6 and IL-8 significantly correlated with the size of CNV (&rgr; = 0.692, P = 0.001 and &rgr; = 0.745, P < 0.001, respectively). Conclusion: Levels of Vascular endothelial growth factor measured in the aqueous humor were significantly related to the disease activity of CNV in age-related macular degeneration. Moreover, IL-2, IL-6, IL-8, and tumor necrosis factor-&agr; may be related to the activity of CNV.

Intravitreal bevacizumab injection for central serous chorioretinopathy.

Purpose: The purpose of this study was to evaluate the effectiveness of intravitreal injection of bevacizumab for treatment of central serous chorioretinopathy. Methods: In this retrospective case series, six patients (six eyes) with central serous chorioretinopathy were treated with an intravitreal injection of bevacizumab. The outcome measures included visual acuity with Early Treatment Diabetic Retinopathy Study letters, central macular thickness measurement with optical coherence tomography, changes in fluorescein angiography, and indocyanine green angiography. Results: The mean age of the patients was 42.3 years and the mean follow-up period was 9.0 months (range, 5–12 months). Mean visual acuity ± standard deviation increased from 40.8 ± 8.3 Early Treatment Diabetic Retinopathy Study letters at baseline to 49.0 ± 5.0 Early Treatment Diabetic Retinopathy Study letters at 1 month (P = 0.046) and to 53.3 ± 5.2 Early Treatment Diabetic Retinopathy Study letters at 3 months (P = 0.028). Mean central macular thickness ± standard deviation decreased from 331.5 ± 93.4 &mgr;m to 164 ± 34 &mgr;m at 3 months (P = 0.043). Leakage on fluorescein angiography and hyperpermeability on indocyanine green angiography decreased in conjunction with improvement in central macular thickness observed by optical coherence tomography. Conclusion: Intravitreal bevacizumab injections resulted in improved visual acuity and anatomical results for central serous chorioretinopathy.

Effects of macular ischemia on the outcome of intravitreal bevacizumab therapy for diabetic macular edema.

Purpose: To evaluate the effects of macular ischemia on visual outcomes in patients with diabetic macular edema (DME), after intravitreal bevacizumab injections. Methods: Data on 59 eyes of 53 consecutive patients treated with intravitreal bevacizumab for DME were retrospectively reviewed. Data from preoperative fluorescein angiography (FA) tests were examined. Patients with an enlarged foveal avascular zone (FAZ), ≥1000 &mgr;m, or a broken perifoveal capillary ring at the border of the FAZ, with a distinct area of capillary nonperfusion within one disk diameter of the foveal center in the transit phase of fluorescein angiography, were defined as having macular ischemia. The patients were thus divided into two groups: with or without macular ischemia. Early Treatment Diabetic Retinopathy Study (ETDRS) scores, and foveal thicknesses measured using third generation ocular coherence tomography (OCT), were evaluated at baseline and at 1 month and 3 months after treatment. Results: At 3 months after treatment, the mean visual acuity (VA) score decreased from a baseline VA of 0.52 ± 0.27 (approximate Snellen equivalent, 20/63) to 0.57 ± 0.21 (20/80) in the ischemic group. In the nonischemic group, by contrast, the VA improved from 0.66 ± 0.34 (20/100) at baseline to 0.59 ± 0.33 (20/80) at 3 months post-treatment. Nine of 18 eyes (50%) in the ischemic group, but only 9 of 41 eyes (21%) in the nonischemic group, experienced visual losses of ≥1 line on the ETDRS chart (P = 0.031, Pearson chi-square test). Four eyes (22%) in the ischemic group, but only 2 eyes (5%) in the nonischemic group, lost ≥3 lines (P = 0.042, Pearson chi-square test). Conclusion: Macular ischemia may have a negative effect on short term visual outcomes after intravitreal bevacizumab injections in patients with DME.

Repeated intravitreal injection of bevacizumab for clinically significant diabetic macular edema.

Purpose: Intravitreal bevacizumab (Avastin®) induces a transient improvement in diabetic macular edema, necessitating repeated injections. Here, we report the results of repeated administration of intravitreal bevacizumab for the treatment of clinically significant macular edema in 31 eyes of 24 patients. Methods: At preinjection and 1, 6, and 12 (±1) weeks postinjection, visual acuity (VA) with Early Treatment of Diabetic Retinopathy Study (ETDRS) and central macular thickness (CMT) evaluated using optical coherence tomography were compared with independent and paired t-tests. Results: VA and CMT were not significantly different before initial and repeated injections (administered at an interval of 22.06 ± 11.15 [SD] weeks). At 6 weeks after the first injection, VA increased significantly by 3.72 ± 8.02 ETDRS letters (P = 0.019), and CMT was markedly decreased by 93.30 ± 210.33 &mgr;m (P = 0.022), which returned to near baseline at 12 weeks. At 6 weeks after the second injection, VA increased significantly by 3.97 ± 7.46 ETDRS letters (P = 0.006) and CMT decreased considerably by 118.77 ± 178.58 &mgr;m (P = 0.001). At 12 weeks after the second injection, we observed a decrease in VA with recurrence of macular edema. Conclusions: Repeated administration of intravitreal bevacizumab (1.25 mg) may lead to the improvement of VA and CMT in patients with clinically significant macular edema.

Mycobacterium abscessus Keratitis after LASIK with IntraLase® Femtosecond Laser

A healthy 38-year-old woman developed 2 white spots in her left eye 2 weeks after bilateral laser in situ keratomileusis (LASIK) using the IntraLase® femtosecond laser. Initial treatment included levofloxacin 0.5% but was unsuccessful. The surgeon irrigated the interface and repositioned the flap due to a worsened lesion. She was referred to us after the keratitis had not improved. The flap was lifted for collection of the specimen and irrigation of the interface. The keratitis was treated with intensive topical clarithromycin 1%, amikacin 1.25% and oral clarithromycin, which improved her clinical condition. She developed a toxic reaction to amikacin 1.25%, which was replaced by moxifloxacin 0.5%. Mycobacterium abscessus was identified. The keratitis resolved over 2 months. Five months after treatment, the patient had a visual acuity of 20/20 with correction. Nontuberculous mycobacteria should be considered as an etiologic agent, even in cases of infectious keratitis after LASIK using the femtosecond laser.

Features of Optical Coherence Tomography Are Predictive of Visual Outcomes after Intravitreal Bevacizumab Injection for Diabetic Macular Edema

Purpose: To identify optical coherence tomography (OCT) patterns of diabetic macular edema (DME) predictive of visual outcomes after intravitreal bevacizumab (IVB; Avastin®) injection. Methods: We retrospectively examined 56 consecutive eyes that were given IVB injections for DME alongside the preoperative macular OCT data. Using this information, we categorized the eyes into 2 groups: group 1 showing diffuse patterns; group 2 demonstrating cystoid macular edema (CME). Result: The mean follow-up period was 11.66 ± 3.98 months. Group 1 eyes gained 0.04 ± 9.27 ETDRS letters (p = 0.984), while group 2 eyes gained 5.79 ± 9.98 ETDRS letters (p = 0.005). Mean macular thickness decreased by 72.79 ± 145.74 µm in group 1 (p = 0.014) and by 223.71 ± 224.52 µm in group 2 (p< 0.001). Conclusion: Patients showing CME upon OCT achieved greater improvements in visual acuity and macular thickness after IVB injection than patients with diffuse macular edema. The type of macular edema shown by OCT may provide an objective guideline in predicting the response of DME to IVB injection.

Avellino corneal dystrophy exacerbated after LASIK: scanning electron microscopic findings.

Purpose: To evaluate the ultrastructure of the cornea of Avellino corneal dystrophy (ACD) exacerbated by LASIK. Methods: Three ACD patients with exacerbation of granular corneal deposits after LASIK underwent surgical removal of the corneal flap. The corneal flap was processed for scanning electron microscopy (SEM). Results: SEM of all patients showed abnormal granular clusters in the fibrils of the corneal flap. Conclusion: Laser in situ keratomileusis induces corneal collagen abnormalities and adhesions of granular material in ACD patients.

Retinal Detachment and Proliferative Vitreoretinopathy

In normal eyes, retinal detachment (RD) occurs at a rate of approximately 5 per 100,000 people per year and the frequency of proliferative vitreoretinopathy (PVR) remains largely unchanged in primary RD, with the incidence ranging from 5.1 to 11.7%. PVR is the most common cause of failed repair of rhegmatogenous RD, and risk factors for PVR are related to several well-known pre-, intra-, and postoperative clinical situations. Current methods of surgical management of RD and PVR are pneumatic retinopexy, scleral buckling, and pars plana vitrectomy (PPV). Surgical success rates for PVR have improved as techniques and instruments of vitrectomy evolved. However, despite these advances, more than one fourth of initially successful cases results in redetachment due to recurrent vitreoretinal traction. Retinal pigment epithelial cells are the key factor in triggering PVR development. In addition, soluble mediators and the extracellular matrix components play a critical role in cellular events, including proliferation and tissue contraction which occur in PVR. Although PPV remains a critical component of the treatment in RD and PVR, ongoing efforts seek to identify adjuvant therapies that might inhibit PVR development. Recent studies have therefore been directed toward pharmacologic inhibition of cellular proliferation and membrane contraction with drugs such as daunorubicin, 5-fluorouracil, and heparin. More detailed understanding of the pathophysiology underlying PVR may lead to the development of effective prophylactic and/or adjunctive therapies. Further work is necessary to identify optimal adjunctive therapies for the management of RD and PVR.

Deposits of transforming growth factor-beta-induced protein in granular corneal dystrophy type II after LASIK.

Purpose: To analyze components of the deposits in the corneal flap interface of granular corneal dystrophy type II (GCD II) patients after laser in situ keratomileusis (LASIK). Methods: Four corneal GCD II specimens displaying disease exacerbation after LASIK were analyzed. Three of these specimens included the recipient corneal button after penetrating keratoplasty or deep lamellar keratoplasty for advanced GCD II after LASIK. The fourth specimen, a similar case of GCD II after LASIK, included the amputated corneal flap. Specimens were processed for histopathologic and immunohistochemical analyses. Results: Corneal stromal deposits in the LASIK flaps of all specimens were stained with 3 anti-transforming growth factor-β-induced protein (TGFBIp) antibodies. The deposits displayed bright red color staining with Masson trichrome; however, negative staining was seen with Congo red, suggesting that hyaline is the main component localizing to the TGFBIp deposits rather than amyloid. Conclusions: Amorphous granular material deposited along the interface of the LASIK flap in GCD II corneas is composed mainly of hyaline deposits.

Prevalence of and risk factors for asteroid hyalosis in Seoul, Korea.

Purpose: To estimate the prevalence of asteroid hyalosis (AH) in Seoul, Korea, and to identify risk factors for the condition. Methods: A cross-sectional study with review of fundus photographs of subjects who received a health check-up between January 2006 and December 2006 at the Yonsei Medical Examination Center yielded 9,050 available cases (aged 40 years or older). AH was diagnosed retrospectively by the presence of cream-white spherical bodies within the vitreous, as seen in the fundus photographs. Results: The estimate prevalence of AH was 0.36%. Multivariate analysis showed that the prevalence of AH was significantly higher in older patients and in those with stroke history, hypertension history, and high serum lipid levels. Conclusion: AH was relatively uncommon with the estimate prevalence of 0.36% in Seoul, Korea. The prevalence of AH correlated with age, stroke history, hypertension history, serum triglyceride levels, and low-density lipoprotein levels, with no gender bias. AH was not significantly associated with a history of diabetes, gout, heavy drinking, or current smoking.