Woo Ho Nam

Intravitreal Bevacizumab to Treat Acute Central Serous Chorioretinopathy: Short-Term Effect

Aims: To report the beneficial effect of intravitreal bevacizumab (Avastin) injection in patients with acute central serous chorioretinopathy. Methods: Ten eyes of 10 patients with acute central serous chorioretinopathy received an intravitreal bevacizumab (1.25 mg/0.05 ml) injection. At baseline and follow-up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination and OCT imaging. Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity. Results: All patients showed resolution of neurosensory detachment promptly, and improvement in visual acuity and symptoms within 1 month. In 1 case, fluorescein leakage resolved and neurosensory detachment nearly resolved at 2 weeks after treatment. At 6 months the mean BCVA (LogMAR) had improved from 0.32 to 0.04, which was statistically significant (p = 0.007, Wilcoxon signed ranks test). No recurrence was observed during a 6-month follow-up. Conclusions: Intravitreal bevacizumab injection for acute central serous chorioretinopathy may result in prompt resolution of neurosensory detachment and reduction of angiographic leakage. These short-term results suggest that intravitreal bevacizumab injection may constitute a promising therapeutic option in acute central serous chorioretinopathy.

Evaluation of the central macula in commotio retinae not associated with other types of traumatic retinopathy.

Purpose To report on the anatomical and functional changes to the macula in nine patients suffering from commotio retinae not accompanied by any other types of traumatic retinopathy. Methods Nine injured eyes with commotio retinae were evaluated soon after ocular trauma with ophthalmic examination, including Spectral-domain optical coherence tomography (SD-OCT). In 12 eyes of 6 patients, Humphrey visual field (HVF) and multifocal electroretinogram (mfERG) were performed. Re-examinations were periodically performed for a mean of 26 days. Data from 9 injured eyes were collected and compared to data collected from the 9 non-affected eyes of the same patients. Results SD-OCT revealed no significant differences in the foveal thickness and total macular volume between traumatized and intact eyes in all 9 patients. Only 3 out of the 9 injured eyes showed abnormal findings in SD-OCT images such as discontinuity of the inner/outer segment (IS/OS) junction or abnormal hyper-reflectivity from the IS/OS and retinal pigment epithelium (RPE) lines in the macula. HVF and mfERG results did not show any functional deterioration in the injured eyes compared with intact eyes. During follow-up, the commotio retinae resolved in all 9 eyes. The changes to the outer retinal region detected in 3 patients by SD-OCT were also resolved. Conclusions Acute retinal changes in commotio retinae, not associated with other retinal pathologies, were resolved without histological and functional sequelae. In a few cases of commotio retinae, SD-OCT revealed transient abnormalities mainly observed at the IS/OS and RPE complexes.

Macular hole after intravitreal ranibizumab injection for polypoidal choroidal vasculopathy

A 67‐year‐old man visited the clinic presenting with the complaint of decreased vision in his left eye. Visual acuity of the left eye was 6/6. On fundus examination, an orange polypoidal lesion and retinal pigment epithelial (RPE) detachment were seen. Fluorescein angiography and indocyanine green angiography were performed. There was hyperfluorescence of a clustered polyp‐like lesion. The patient was diagnosed with polypoidal choroidal vasculopathy and we recommended that he be seen again in three months. At this visit, visual acuity of the left eye had decreased to 6/9 and the RPE detachment was aggravated. Intravitreal injection of ranibizumab was performed. One month after the injection, visual acuity of his left eye was 6/96. A macular hole was seen in his left eye and vitrectomy of the left eye was performed. Optical coherence tomography was checked and it showed that the macular hole was closed. Two more intravitreal ranibizumab injections were done on the left eye. Visual acuity of his left eye subsequently improved to 6/18.8.

Cancer-associated Nummular Loss of the Retinal Pigment Epithelium

Purpose To report a case of cancer-associated nummular loss of the retinal pigment epithelium. Methods A 47-year-old man with a history of hepatocellular carcinoma presented with three weeks of bilateral visual loss. His best-corrected visual acuity was 20/40 in each eye. He had multiple round confluent grayish-brown patches at the level of retinal pigment epithelium, and no pigmented choroidal lesions. Fluorescein angiography showed circular areas of transmission defect and indocyanine green angiography showed early hyperfluorescence, corresponding with the multiple round confluent patches. Conclusions We report a case of visual paraneoplastic syndrome which showed nummular loss of the pigment epithelial cells which distinguishes the clinical component of BDUMP syndrome.

Photodynamic Therapy With Verteporfin for Choroidal Neovascularization in Patients with Angioid Streaks

Purpose To evaluate the functional and anatomic outcomes of photodynamic therapy (PDT) for choroidal neovascularization (CNV) in patients with angioid streaks. Methods The authors retrospectively evaluated 6 consecutive patients (6 eyes) with CNV secondary to angioid streaks. All patients were treated with standard PDT with verteporfin protocol. Standardized protocol refraction, visual acuity testing, ophthalmologic examination, color photographs, fluorescein angiograms and indocyanin angiograms were used to evaluate the results of PDT with verteporfin. Main outcome measures were visual acuity and CNV size. Results Their mean age was 61.3±5.50 years (range, 53-68 years). Follow-up time ranged from 12 to 38 months with mean of 20.5±10.91 months. The mean visual acuity at baseline was 20/100 (range 20/25-20/500), and the mean visual acuity at the last examination was 20/320(range 20/125-counting finger). The mean greatest linear dimension (GLD) at baseline was 2400±766.81 µm, and the mean GLD at the last examination was 3483±444.59 µm. Conclusions PDT for CNV associated with angioid streaks seemed to slow down but not prevent the progression of the disease and associated visual loss.

A Case of Retinal Detachment in Colobomatous Macrophthalmos With Microcornea Syndrome

We report a rare case of retinal detachment in colobomatous macrophthalmos with microcornea syndrome. A 25-year-old female who had suffered from poor vision in her left eye since early childhood and high myopia in her right eye (-11 D) visited our clinic because of a sudden deterioration of vision. Examination of the anterior segment showed microcornea with coloboma of the inferior pupil margin in the left iris. Fundus examination of the left eye revealed an inferior choroidal coloboma extending from the optic disc and macula. The patient also had total bullous retinal detachment. Pars plana vitrectomy with silicone oil tamponade was performed, and the retina was reattached. In the very rare condition of colobomatous macropthalmos with microcornea, retinal detachment may develop. Pars plana vitrectomy with additional silicone oil tamponade may be performed to treat this condition.