San-Ni Chen

The effect of intravitreal bevacizumab in the treatment of Coats disease in children.

Purpose: The purpose of this study was to determine if intravitreal bevacizumab can reduce subretinal exudates and exudative retinal detachment and facilitate the treatment of Coats disease in children. Methods: Prospective, interventional, and noncomparative case series of three eyes in three children with Coats disease were studied. All eyes received only intravitreal bevacizumab injection as the primary treatment. Ablative procedures, including cryotherapy, traditional continuous wave laser, or subthreshold diode micropulse laser, for diseased vessels were performed after subretinal fluid totally reabsorbed. One supplementary intravitreal bevacizumab injection was given after ablative procedures on the same day. The changes in pre- and postoperative best-corrected visual acuity were recorded. Serial color fundus photography, optical coherence tomography, and B-scan sonography were performed to measure treatment efficacy. Results: After receiving one to three injections, all three patients had subretinal fluid completely reabsorbed. All patients had one session of subsequent ablative procedures for diseased vessels and supplementary intravitreal bevacizumab injection. No patients had recurrent subretinal fluid. Improved visual acuity was noted in two cases but was not detectable in the other. No ocular or systemic complications related to bevacizumab were noted during the entire course of follow-up. Conclusion: Intravitreal bevacizumab appears to be a well-tolerated treatment for children with Coats disease. A favorable response is observed when compared with other treatment modalities. It has the potential as an adjuvant therapy of vascular ablative procedures to improve final vision and facilitate ongoing treatment.

Macular thickness measurements in central retinal artery occlusion by optical coherence tomography.

Purpose: To evaluate the structural features of central retinal artery occlusion by means of optical coherence tomography. Methods: Eleven consecutive patients with acute central retinal artery occlusion and at least 3-month follow-up were enrolled prospectively in this study. The main outcome measures included best-corrected visual acuity, foveal thickness (FT), and total macular volume by optical coherence tomography. Results: Five male and six female patients with central retinal artery occlusion were examined. The mean age was 71.2 ± 8.7 years (range, 59-83 years). Mean FT and total macular volume were 195 ± 26 μm and 6.41 ± 0.33 mm3, respectively, in normal fellow eyes, increased to 299 ± 76 μm and 7.90 ± 0.93 mm3, respectively, at initial examination and declined to 167 ± 30 μm and 4.85 ± 0.68 mm3, respectively, at 3-month follow-up. Mean reduction in FT was 181 ± 61 μm (range, 120-270 μm) in eyes with poor visual outcome and 43 ± 25 μm (range, 15-74 μm) in eyes with fair visual outcome. Statistical analysis revealed that the relationships among visual prognosis and initial FT and initial total macular volume were not significant. Conclusion: Optical coherence tomography provides special information about central retinal artery occlusion. There were marked and variable changes in FT and total macular volume. Limited reduction in macular thickness might indicate a fair visual outcome.

The effect of intravitreal bevacizumab treatment on choroidal metastasis of colon adenocarcinoma--case report.

The effect of intravitreal bevacizumab treatment on choroidal metastasis of colon adenocarcinoma—case report

Treatment of inferior rhegmatogenous retinal detachment by pneumatic retinopexy technique.

Purpose: The purpose of this study was to evaluate the effectiveness of pneumatic retinopexy as an alternative technique for repairing inferior rhegmatogenous retinal detachments. Design: Retrospective, noncomparative, interventional case series. Methods: A review on 13 patients (13 eyes) who had undergone pneumatic retinopexy as the initial procedure for primary retinal detachments with causative break(s) in the inferior one third of retina. After gas injection, all patients were instructed to maintain a lateral recumbent posture with head tilting 10 cm to 30 cm downward. Results: Nine male and 4 female patients (mean age 28.1 years, ranging from 14 to 57) were included in this study. Eleven eyes (84.6%) had myopia of −3 diopters or higher. Macular detachment was found in eight eyes. Pneumatic retinopexy alone resulted in reattachment in 10 eyes (76.9%). Three other eyes needed additional scleral buckling. Final retinal reattachment was achieved in all 13 subjects. Conclusion: Inferior rhegmatogenous retinal detachment can be treated by pneumatic retinopexy with proper head position. More attention to the postoperative stage are required to ensure surgical success.

Intravitreal ranibizumab as salvage therapy in an extremely low-birth-weight infant with rush type retinopathy of prematurity.

We report the effects of intravitreal ranibizumab as salvage therapy in an extremely low–birth-weight (ELBW) infant with rush type retinopathy of prematurity (ROP). This case was a girl of 23 weeks gestational age weighing 480 g at birth. At a postconceptual age of 33 weeks, she presented with zone 1, stage 3 ROP with plus disease. Despite intravitreal bevazucimab and laser photocoagulation, extraretinal fibrovascular proliferation persisted. Intravitreal 0.25 mg (0.025 ml) ranibizumab was injected OU. After treatment, extraretinal fibrovascular proliferation disappeared. Fundus examination showed flat retinas and normal vasculature in both eyes. She has been followed up for 2 years. Intravitreal ranibizumab injection seems effective and well tolerated as salvage therapy in an ELBW infant with rush type ROP. No short-term ocular or systemic side effects were identified. More cases and longer follow-up are mandatory.

Clinical characteristics and surgical management of familial exudative vitreoretinopathy-associated rhegmatogenous retinal detachment.

Purpose The purpose of this study was to report the clinical characteristics and surgical outcome of familial exudative vitreoretinopathy–associated rhegmatogenous retinal detachment. Methods Retrospective interventional case series of patients with familial exudative vitreoretinopathy–associated rhegmatogenous retinal detachment. All cases had preoperative and postoperative clinical evaluations. Eyes were divided into three groups: no, moderate, and severe foveal dragging according to the status of fovea. Scleral buckling procedures or vitrectomy was performed to attach the retina. Results Twenty-four eyes in 22 patients were included in this study. The male to female ratio was 18:4. The average age was 16.42 ± 5.48 years. There were 14, 5, and 5 eyes in the no, moderate, and severe foveal dragging groups, respectively. Proliferative vitreoretinopathy was present in only one eye in the severe foveal dragging group. In the subgroup of eyes without foveal dragging, neither proliferative vitreoretinopathy, posterior located breaks, nor giant tears were noted. All eyes needed only scleral buckle to reattach the retina. In the subgroup with moderate foveal dragging, posterior located break was noted in one eye, which was the only eye in this group that needed vitrectomy besides scleral buckle to attach the retina. In eyes with severe foveal dragging, Stage D proliferative vitreoretinopathy was noted in one eye and posterior located break in one eye. Encircling buckle and vitrectomy were necessary in all eyes. The average number of operation is 1.1, 1.2, and 2.4 for each of the three groups, respectively. Final visual acuity improved in 23 of 24 eyes. Final retinal attachment was obtained in 95.8% of eyes (23 of 24). Conclusion Male predominance and juvenile onset are the main characteristics in familial exudative vitreoretinopathy–associated rhegmatogenous retinal detachment. Surgical success rates are comparable to rhegmatogenous retinal detachment unassociated with familial exudative vitreoretinopathy in cases without severe foveal dragging and are worse in the group with severe foveal dragging.

Inhibition of Corneal Neovascularization with the Combination of Bevacizumab and Plasmid Pigment Epithelium-Derived Factor-Synthetic Amphiphile INTeraction-18 (p-PEDF-SAINT-18) Vector in a Rat Corneal Experimental Angiogenesis Model

Bevacizumab, a 149-kDa protein, is a recombinant humanized monoclonal antibody to VEGF. PEDF, a 50-kDa glycoprotein, has demonstrated anti-vasopermeability properties. In this study, we demonstrated that the combination of bevacizumab and plasmid pigment epithelium-derived factor-synthetic amphiphile INTeraction-18 (p-PEDF-SAINT-18) has a favorable antiangiogenic effect on corneal NV. Four groups (Group A: 0 μg + 0 μg, B: 0.1 μg + 0.1 μg, C: 1 μg + 1 μg, and D: 10 μg + 10 μg) of bevacizumab + p-PEDF-SAINT-18 were prepared and implanted into the rat subconjunctival substantia propria 1.5 mm from the limbus on the temporal side. Then, 1 μg of p-bFGF-SAINT-18 was prepared and implanted into the rat corneal stroma 1.5 mm from the limbus on the same side. The inhibition of NV was observed and quantified from days 1 to 60. Biomicroscopic examination, western blot analysis and immunohistochemistry were used to analyze the 18-kDa bFGF, 50-kDa PEDF and VEGF protein expression. No inhibition activity for normal limbal vessels was noted. Subconjunctival injection with the combination of bevacizumab and p-PEDF-SAINT-18 successfully inhibited corneal NV. The bFGF and PEDF genes were successfully expressed as shown by western blot analysis, and a mild immune response to HLA-DR was shown by immunohistochemistry. We concluded that the combination of bevacizumab and p-PEDF-SAINT-18 may have more potent and prolonged antiangiogenic effects, making it possible to reduce the frequency of subconjunctival bevacizumab administration combined with a relatively safe profile and low toxicity.

Unusual optical coherence tomography and fundus autofluorescence findings of eclipse retinopathy.

A 63-year-old female patient complained of dimness in the central field of vision in the left eye after viewing an annular partial eclipse without adequate eye protection on 22 July 2009. Fundoscopy showed a wrinkled macular surface. Fundus autofluorescence study revealed well-demarcated hyperautofluorescence at the fovea. Optical coherence tomography demonstrated tiny intraretinal cysts. Fluorescein angiography and indocyanine green angiography were unremarkable. Epimacular membrane developed in the following month with deteriorated vision. Vitrectomy, epiretinal membrane and internal limiting membrane peeling were performed. Vision was restored to 20/20 after the operation. Direct sun-gazing may damage the retinal structures resulting in macular inflammation and increased focal metabolism, which explains the hyperautofluorescence. It may also induce epimacular membrane. Fundus autofluorescence might represent a useful technique to detect subtle solar-induced injuries of the retina. The visual prognosis is favorable but prevention remains the mainstay of treatment. Public health education is mandatory in reducing visual morbidity.

Progressive outer retinal necrosis associated with occlusive vasculitis in acquired immunodeficiency syndrome

A 45-year-old man, a case of acquired immunodeficiency syndrome, received a highly active antiretroviral therapy at the outpatient service for 4 years without regular follow-up. He experienced progressively blurred vision for 6 months and a cutaneous zoster on his back 3 months ago. He was diagnosed with progressive outer retinal necrosis by polymerase chain reaction-restriction fragment length polymorphism using an aqueous humor sample, which revealed an existence of varicella zoster virus. He was given a combination of systemic, intravitreal antiviral and a highly active antiretroviral therapy. Occlusive vasculitis, an unusual finding for progressive outer retinal necrosis, developed in both eyes 1 week after the secondary intravitreal injection. Unfortunately, his vision deteriorated to no light perception in both eyes within 2 weeks. Progressive outer retinal necrosis is characterized clinically as showing minimal or no inflammation in the aqueous and vitreous humors, absence of retinal vasculitis, and patches of yellowish spots located deep in the retina. Physicians should pay attention to this rare case of progressive outer retinal necrosis associated occlusive vasculitis with very poor prognosis in spite of aggressive treatment.

Successful treatment of toxoplasmosis-associated choroidal neovascular lesions with bevacizumab and antiparasitic therapy.

PURPOSE To report the effects of oral trimethoprim/sulfamethoxazole and intravitreal bevacizumab injection in the treatment of ocular toxoplasmosis-associated choroidal neovascular lesions (CNV). METHODS This was a noncomparative, nonrandomized, consecutive case series. All eyes with ocular toxoplasmosis-associated CNV received one intravitreal bevacizumab injection under the coverage of oral trimethoprim/sulfamethoxazole. The changes in best-corrected visual acuity were recorded. Serial fundus photography, fluorescein angiography, optical coherence tomography, and indocyanine green angiography were performed to measure the treatment efficacy. RESULTS Three eyes of two patients with a history of ocular toxoplasmosis had active CNV demonstrated by fluorescein angiography and optical coherence tomography. Each was treated with oral trimethoprim/sulfamethoxazole and one intravitreal bevacizumab injection. Best-corrected visual acuity, fundus photographs, fluorescein angiography, optical coherence tomography, and indocyanine green angiography all showed favorable results. No ocular or systemic complications were noted. In all three eyes, the CNV subsided and vision improved. CONCLUSION Oral trimethoprim/sulfamethoxazole is an effective and less expensive antibiotic against Toxoplasma gondii. Intravitreal bevacizumab injection appears to be a well-tolerated treatment for toxoplasmosis-associated CNV and has the potential as an adjuvant therapy to improve final vision. More cases and further studies are required.