Young Hee Yoon

Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results

OBJECTIVE To evaluate the safety and efficacy of 1 or 2 treatments with dexamethasone intravitreal implant (DEX implant) over 12 months in eyes with macular edema owing to branch or central retinal vein occlusion (BRVO or CRVO). DESIGN Two identical, multicenter, prospective studies included a randomized, 6-month, double-masked, sham-controlled phase followed by a 6-month open-label extension. PARTICIPANTS We included 1256 patients with vision loss owing to macular edema associated with BRVO or CRVO. METHODS At baseline, patients received DEX implant 0.7 mg (n = 421), DEX implant 0.35 mg (n = 412), or sham (n = 423) in the study eye. At day 180, patients could receive DEX implant 0.7 mg if best-corrected visual acuity (BCVA) was <84 letters or retinal thickness was >250 μm. MAIN OUTCOME MEASURES The primary outcome for the open-label extension was safety; BCVA was also evaluated. RESULTS At day 180, 997 patients received open-label DEX implant. Except for cataract, the incidence of ocular adverse events was similar in patients who received their first or second DEX implant. Over 12 months, cataract progression occurred in 90 of 302 phakic eyes (29.8%) that received 2 DEX implant 0.7 mg injections versus 5 of 88 sham-treated phakic eyes (5.7%); cataract surgery was performed in 4 of 302 (1.3%) and 1 of 88 (1.1%) eyes, respectively. In the group receiving two 0.7-mg DEX implants (n = 341), a ≥ 10-mmHg intraocular pressure (IOP) increase from baseline was observed in (12.6% after the first treatment, and 15.4% after the second). The IOP increases were usually transient and controlled with medication or observation; an additional 10.3% of patients initiated IOP-lowering medications after the second treatment. A ≥ 15-letter improvement in BCVA from baseline was achieved by 30% and 32% of patients 60 days after the first and second DEX implant, respectively. CONCLUSIONS Among patients with macular edema owing to BRVO or CRVO, single and repeated treatment with DEX implant had a favorable safety profile over 12 months. In patients who qualified for and received 2 DEX implant injections, the efficacy and safety of the 2 implants were similar with the exception of cataract progression. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.

Correlation of Microperimetry with Fundus Autofluorescence and Spectral-Domain Optical Coherence Tomography in Repaired Macular Holes

PURPOSE To investigate the correlation of microperimetry with fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT), and visual acuity (VA) in order to better characterize visual outcomes after successful macular hole (MH) surgery. DESIGN Cross-sectional case series. METHODS Postoperative VA, microperimetry, FAF, and SD-OCT images from 23 eyes of 23 patients who underwent successful MH surgery were obtained. FAF images were examined using the Heidelberg retina angiograph 2, and foveal structure and macular sensitivity were evaluated with SD-OCT and microperimetry. The mean retinal sensitivities within the central 9 degrees (microperimetry, mean), the retinal sensitivity of the foveal center (microperimetry, center), and the difference between the values obtained for the foveal center or mean of study and fellow eyes (microperimetry, centerdiff and microperimetry, meandiff, respectively) were measured with microperimetry. RESULTS Microperimetry (mean) was well correlated with microperimetry (center) in both study and fellow eyes. Poor postoperative VA was correlated with large microperimetry (meandiff). Following successful MH surgery, FAF of all eyes decreased markedly. There was a positive correlation between microperimetry (centerdiff) and degree of FAF of study eyes. However, a decrease in FAF after MH surgery was not correlated well with either degree of defect in the junction between photoreceptor inner and outer segment (IS/OS) or central retinal thickness on SD-OCT. CONCLUSIONS The amount of remaining FAF is related to macular sensitivity as measured by microperimetry after successful MH surgery. Function of photoreceptors and retinal pigment epithelium as well as integrity can be estimated by measuring the decrease in FAF after successful MH surgery. Moreover, functional correlation with microperimetry provides both morphologic and functional information on repaired MHs.

Ocular Sarcoidosis in a Korean Population

The aim of current study was to evaluate the incidence and characteristics of ocular sarcoidosis in a Korean population. We conducted a retrospective study of 104 consecutive patients with biopsy-proven sarcoidosis seen at Asan Medical Center in Seoul, Korea, from 1993 to 2007. Medical records, photographs, and fluorescein angiograms were reviewed. Of 104 patients, 22 (21%) had intraocular involvement with female predominance (86%, M:F=3:19). Of the 39 eyes with ocular involvement, 16 (41%) eyes had isolated anterior uveitis, 12 (31%) eyes had intermediate uveitis, 6 eyes (15%) had panuveitis with retinal vasculitis, and 5 (13%) eyes had panuveitis with punched multifocal choroiditis. Mean duration of ophthalmologic follow-up was 62 months. All ocular inflammation was well managed with topical steroid and/or systemic steroid with relatively good final visual outcomes. Ocular complications such as cataract (12 eyes, 30%), glaucoma (6 eyes, 15%), vitreous opacity (1 eye, 3%), cystoid macular edema (3 eyes, 7%), neovascularization (2 eye, 5%), and epiretinal membrane (4 eye, 10%) were related to ocular sarcoidosis. In Korea, where sarcoidosis is very rare, our study indicates relatively low ocular and predominantly non posterior segment involvement with relatively good visual prognosis.

Baseline Predictors of Visual Acuity and Retinal Thickness in Patients with Retinal Vein Occlusion

This study investigated the baseline predictors of best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6 months in patients with treatment-naïve branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). This multicenter, interventional case series included 208 BRVO and 123 CRVO patients with follow-up period of 6 months or more. Outcome measures of BCVA (logMAR) included absolute change from baseline and a gain or loss of ≥ 0.3 from baseline. Outcome measures of CRT included absolute change from baseline and a measurement of ≤ 250 µm or ≥ 400 µm at 6 months. Univariate and multiple regression analyses were done to find baseline predictors. For BRVO, younger age, worse baseline BCVA, and shorter duration of symptom were associated with more gain in BCVA. For CRVO, worse baseline BCVA was associated with more gain in BCVA. For CRT outcomes, higher baseline CRT predicted greater decrease at 6 months in both BRVO and CRVO. Younger age and better baseline BCVA were associated with an increased likelihood of measurement of a ≤ 250 µm outcome for BRVO and CRVO, respectively. For CRVO, smoking was associated with greater decrease from baseline and decreased likelihood of measurement of a CRT ≥ 400 µm at 6 months. In conclusion, several baseline factors including age, symptom duration, and baseline BCVA and CRT are associated with BCVA and CRT outcomes at 6 months, which may help to predict disease course for RVO patients. Graphical Abstract

Dexamethasone intravitreal implant in the silicone oil–filled eye for the treatment for recurrent macular oedema associated with ankylosing spondylitis: a case report

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A case of Purtscher retinopathy associated with stent-assisted coil embolization of a middle cerebral artery aneurysm.

Purpose. This article reports a case of Purtscher retinopathy following therapeutic coil embolization of a middle cerebral artery (MCA) aneurysm. Methods. Case report. Results. A 53-year-old woman with a history of stent-assisted coil embolization in her left MCA unruptured aneurysm presented with a visual disturbance about 3 hours after the procedure. Her left eye vision was 20/40. Fundus examination of the left eye showed an intraretinal hemorrhage and multiple whitish retinal lesions. The spectral-domain optical coherence tomography (OCT) examination showed focal thickness around the whitish lesions and a hemorrhage site. Three weeks later, the retinal whitish lesions decreased but new multiple intraretinal hemorrhages were found near the previous whitish lesions. Fluorescein angiography revealed the obstruction of an arteriole at the posterior pole. After 5 weeks, all lesions in the fundus photography and OCT were almost gone and her left visual acuity was 20/20. Conclusions. A thorough understanding of clinical findings and mechanism of this disorder, including the possibility of direct emboli during coil embolization rather than secondary emboli from the postoperative coil-thrombus complex formed in the aneurysm after the procedure, is therefore necessary to prevent unwanted ocular complications after coil embolization.

Histological heterogeneity between primary and metastatic cancer in a pathologic confirmed case of isolated optic disc metastasis of prostate adenocarcinoma

Metastatic choroidal cancer was first described by Pearls [1]. Since then, many studies have reported intraocular metastasis in the uveal tract, optic nerve, and optic disc [2–5]. However, solitary optic disc metastasis from prostate cancer is extremely rare. To the best of our knowledge, only three cases of optic disc involvement from prostate cancer have been reported previously [3–5] Nevertheless, the clinical features of these three cases are similar to the features of optic nerve infiltration, and include optic disc edema and optic nerve thickening, rather than the features of solitary mass-like lesions. Furthermore, physicians tend to diagnose the optic disc mass clinically without pathologic confirmation [2]. A vitrectomy-based biopsy has only been conducted by Fukuda et al. to treat metastatic pulmonary carcinoma in the optic disc [6]. In addition, as far as the authors know, the histological and immunohistochemical consistencies between primary and secondary tumors have never been studied in intraocular metastasis. Thus, we report a case of isolated prostate adenocarcinoma metastasis of the optic disc without choroidal involvement and its histopathological heterogeneity. Case report

Highly suspected primary intraocular lymphoma in a patient with rheumatoid arthritis treated with etanercept: a case report

BackgroundTo describe a case of highly suspected primary intraocular lymphoma (PIOL) in a patient using etanercept for the treatment of rheumatoid arthritis.Case presentationA 50-year-old female patient presented with decreased vision in her left eye that lasted for a week. She had a 15-year history of seropositive rheumatoid arthritis (RA), and had been taking weekly etanercept for the preceding 8 months. Funduscopic examination and SD-OCT showed a swollen ellipsoid zone (EZ) and a retinal pigment epithelium (RPE) irregularity of the right eye. We also noted EZ disruption and a RPE irregularity in the left eye. As subretinal infiltration was aggravated in the right eye after the initial treatment, we completed a vitrectomy. Vitreous cytology revealed PIOL with positive CD20 immunostaining. She was treated with serial intravitreal methotrexate injections and systemic chemotherapy. After the treatment, subretinal infiltration and subRPE deposits were decreased in the right eye with no evidence of recurrence in either eye.ConclusionsThis case suggests a potential relationship between immunosuppression with anti-TNFα medication, and increased risk for lymphoma, especially in patients with underlying rheumatologic disorders and especially in patients with suspected chronic refractory uveitis.