injections on ganglion cell-inner plexiform layer (GCIPL) thickness in patients with age-related macular degeneration (AMD).METHODS: This retrospective study included patients with continuous anti-VEGF treatment who were administered at least three consecutive injections for unilateral neovascular AMD. The GCIPL thickness of the study eyes was compared before and after treatment and with healthy fellow eyes using spectral-domain optical coherence tomography. We also evaluated best-corrected visual acuity, age, and intraocular pressure.RESULTS: In total, 96 eyes of 48 patients (14 females and 34 males; mean ± standard deviation [SD] age, 70.10 ± 8.89 years) with mean number of 6.29 (SD ± 3.76) anti-VEGF injections and a mean follow-up period of 24.93 months (SD ± 19.86) were included in the study. After three consecutive intravitreal injections of anti-VEGF, the mean GCIPL thickness was significantly reduced from 70.50 (SD ± 14.06) to 65.97 (SD ± 13.91) µm. Borderline or nonsignificant decrease was also observed in GCIPL thickness for each sector. At the end of the study, the mean GCIPL thickness was further reduced to 62.56 (SD ± 16.30) µm, and significant decreases were also observed in all other sectors compared with baseline.CONCLUSIONS: It has been observed that GCIPL thickness can decrease with only three consecutive anti-VEGF injections as well as with long-term treatment in AMD patients.]]>
Endothelial Growth Factors ; Female ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Degeneration ; Male ; Ranibizumab ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To compare the intraocular pressure (IOP) in diabetic macular edema (DME) patients and macular edema associated with branch retinal vein occlusion (BRVO) patients after intravitreal preservative-free Triamcinolone injection.METHODS: This study included 36 patients diagnosed with DME and 44 patients diagnosed with BRVO with macular edema. Both groups were treated with intravitreal preservative-free Triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection, and we compared the IOPs of the two groups determined before injection and at 1, 2, 3, and 6 months after injection. We also compared the IOP elevation ratios and durations, and central foveal thickness (CFT) changes using optical coherence tomography.RESULTS: In both groups, there was no statistical significance in the IOP before injection and at 1, 2, 3, and 6 months after injection. However, the IOP elevation ratio in the DME patients (38.9%) was significantly higher than that in the BRVO patients (15.9%) (p = 0.02). The duration of IOP elevation in the DME patients (1.14 ± 1.85 months) was significantly longer than that in the BRVO patients (0.30 ± 1.20 months) (p = 0.03). When the IOP was not controlled, we used IOP-lowering agents, and two patients in the DME were treated with glaucoma surgery. There was no statistical significance in the CFT before injection and at 1, 2, or 3 months after injection between the two groups (p = 0.72, p = 0.26, p = 0.66, p = 0.34, respectively). However, the CFT after 6 months was 328 ± 103 µm in the DME group and 434 ± 189 µm in the BRVO; this difference was significant (p < 0.01).CONCLUSIONS: Intravitreal injection of preservative-free Triamcinolone was effective in the treatment of both DME patients and macular edema patients associated with BRVO. Furthermore, Triamcinolone was more safely injected in macular edema associated with BRVO patients than in DME patients.
Glaucoma ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Retinal Vein Occlusion ; Retinal Vein ; Retinaldehyde ; Tomography, Optical Coherence ; Triamcinolone

PURPOSE: Intraocular lymphoma can be divided into primary and secondary usually involving B-cell lymphoma. Intraocular T-cell lymphoma is mostly secondary lymphoma while primary intraocular T-cell lymphoma is extremely rare. We report a case of primary T-cell lymphoma. CASE SUMMARY: A 62-year-old male without any systemic disease presented with a floater in the right eye. A fundus examination showed multiple whitish retinal infiltrations in the right eye. Intraocular lymphoma was suspected, and systemic examination was performed, but all results were normal. During steroid treatment, previous lesions were enlarged, new lesions developed, and a diagnosis of primary T-cell lymphoma was made by diagnostic vitrectomy. Consecutive intravitreal injections of methotrexate were performed. After eight injections, the vitreous and retinal lesions improved but we decided to terminate the injections due to corneal epitheliopathy. The corneal epitheliopathy was recovered and the patient is currently undergoing periodic follow-ups without progression of the lesion. CONCLUSIONS: Although intraocular T-cell lymphoma is a rare condition, this primary T-cell type should be considered when an intraocular lymphoma lesion is suspected.
Diagnosis ; Follow-Up Studies ; Humans ; Intraocular Lymphoma ; Intravitreal Injections ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, T-Cell ; Male ; Methotrexate ; Middle Aged ; Retinaldehyde ; T-Lymphocytes ; Vitrectomy

PURPOSE: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. CASE SUMMARY: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. CONCLUSIONS: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.
Aged ; Angiography ; Brain ; Carotid Artery, Internal ; Collateral Circulation ; Eyelids ; Humans ; Injections, Intravenous ; Intraocular Pressure ; Magnetic Resonance Imaging ; Methylprednisolone ; Ophthalmology ; Ophthalmoplegia ; Oral Medicine ; Prone Position ; Pupil Disorders ; Retina ; Retinal Artery Occlusion ; Spine ; Visual Acuity

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; Aqueous Humor ; Blindness ; Cataract ; Cellulitis ; Cornea ; Corneal Edema ; Endophthalmitis ; Erythema ; Eye Infections ; Eyelids ; Humans ; Inflammation ; Intravitreal Injections ; Lens Implantation, Intraocular ; Male ; Necrosis ; Panophthalmitis ; Phacoemulsification ; Recurrence ; Streptococcus ; Visual Acuity ; Vitrectomy

PURPOSE: To evaluate long-term intraocular pressure (IOP) and risk of IOP elevation after intravitreal injection of ranibizumab or aflibercept in patients with age-related macular degeneration (AMD). METHODS: From January 2013 to December 2016, we retrospectively reviewed patients who underwent intravitreal ranibizumab or aflibercept injections for AMD. IOP was measured before injection and 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, and 1 year after injection. Sustained IOP elevation was defined when the final IOP increased by 6 mmHg more than the pre-injection IOP, and when there were two consecutively measured values > 21 mmHg. The risk factors were then analyzed. RESULTS: Using Kaplan-Meier survival analysis, sustained IOP elevation occurred in 9 of 80 eyes (11.3%) in 1 year, and the mean survival time was 11.50 months after injection. Five eyes (12.8%) of the ranibizumab group and four eyes (9.8%) of the aflibercept group had mean survival times of 11.39 and 11.61 months, respectively. The log-rank test showed no significant difference between the two groups (p = 0.659). A significant risk factor for sustained IOP elevation was a history of primary open-angle glaucoma (p = 0.035). CONCLUSIONS: The incidence of sustained IOP elevation was not significantly different between the two groups. Clinicians should therefore carefully monitor the IOP before and after intravitreal ranibizumab or aflibercept injections, especially in AMD patients with primary open-angle glaucoma.
Glaucoma, Open-Angle ; Humans ; Incidence ; Intraocular Pressure ; Intravitreal Injections ; Macular Degeneration ; Ranibizumab ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: To report the short-term effects of intravitreal bevacizumab alone, low-dose bevacizumab combined with low-dose triamcinolone injection, and intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA, USA) injection in patients with macular edema following central retinal vein occlusion (CRVO). METHODS: The medical records of 70 patients (70 eyes) with macular edema secondary to CRVO were reviewed retrospectively. Of these, 25 eyes (IVB group) were injected with intravitreal bevacizumab, 23 eyes (intravitreal low-dose bevacizumab and triamcinolone injection [IVB+IVTA] group) were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL), and 20 eyes (intravitreal dexamethasone implant [IVD] group) were injected with an intravitreal dexamethasone implant. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) of treated eyes were measured before injection and at 1 month and 3 months after injection. RESULTS: Groups were similar in age and gender distribution. At 1 month, the CMT of all groups was significantly lower, and the BCVA of all groups had increased significantly in patients with CRVO; there were no significant differences among the three groups (p = 0.246, p = 0.974). At 3 months, the CMT and BCVA had improved significantly only in the IVD and IVB+IVTA groups; the short-term effect was comparable to the IVD group. IOP showed no significant change at 3 months after injection for all groups. CONCLUSIONS: Considering various clinical variables in the treatment of macular edema associated with CRVO, intravitreal injection of bevacizumab, low-dose bevacizumab combined with triamcinolone, and dexamethasone implants may be used selectively.
Bevacizumab ; Dexamethasone ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Medical Records ; Retinal Vein Occlusion ; Retinal Vein ; Retrospective Studies ; Triamcinolone ; Visual Acuity

PURPOSE: To report a case of a 60-year-old female with rhegmatogenous retinal detachment, presenting with suprachoroidal hemorrhage after vitrectomy. CASE SUMMARY: A 60-year-old woman visited our clinic complaining of floaters, flashing, and blurred vision. Best-corrected visual acuity was 0.1 in her left eye, and fundus examination of her left eye revealed macula-involved retinal detachment with a retinal break at the superotemporal quadrant. She underwent cataract surgery, 23-gauge transconjunctival sutureless vitrectomy, and 14% C3F8 gas tamponade under general anesthesia. One hour after anesthesia recovery, she suddenly complained of severe pain in her left eye. The intraocular pressure measured after removal of the pressure patch from her left eye was as high as 58 mmHg. Her ocular pain improved spontaneously within 10 minutes, and the intraocular pressure decreased to 8 mmHg. Fundus examination of her left eye revealed a reddish-brown raised lesion, suggesting suprachoroidal hemorrhage. She was placed in a prone position with a pressure patch over her left eye. Bleeding through the sclerotomy site was observed 1 day after surgery. Subsequently, hemorrhagic choroidal detachment of her left eye continued to decrease without deterioration. Three weeks after surgery, the patient received an intravitreal injection of 100% C3F8 gas into her left eye. At 3 months after surgery, best-corrected visual acuity had improved to 0.8 in her left eye, and the retina was stable. CONCLUSIONS: Suprachoroidal hemorrhage may be suspected in a patient complaining of severe ocular pain after vitrectomy.
Anesthesia ; Anesthesia, General ; Cataract ; Choroid ; Female ; Hemorrhage ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Middle Aged ; Prone Position ; Retina ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Visual Acuity ; Vitrectomy

PURPOSE: To report a case of candida endogenous endophthalmitis in healthy women who had received extraction of wisdom tooth. CASE SUMMARY: A 65-year-old medically healthy woman who had received extraction of wisdom tooth two weeks ago, presented with floater symptoms in her left eye. Best-corrected visual acuity was 20/40 and intraocular pressure was 17 mmHg in her left eye. Inflammatory cells were found in the anterior chamber and vitreous. Fluorescein angiography showed multiple hypofluorescence without vascular leakage. With provisional diagnosis of intermediate uveitis, she was prescribed oral steroid for two weeks. After that, inflammatory cells in anterior chamber was reduced but vitreous imflammatory cell was increased and fundus examination detected newly developed infiltrated lesion at superotemporal area. The patient was presumed to have fungal endophthalmitis and immediate intravitreal voriconazole injection was performed. Three days after intravitreal voriconazole injection, diagnostic vitrectomy and intravitreal voriconazole injection were performed. Vitreous cultures revealed the growth of Candida albicans. Despite the treatment, inflammatory response in anterior chamber and vitreous rapidly increased and visual acuity was decreased to hand movement. We changed anti-fungal agent, voriconazole to Amphotericin B. Additional three-time intravitreal injection was done and therapeutic vitrectomy with oil injection were performed. After treatment, the patient's fundus markedly improved and inflammatory response was decreased. CONCLUSIONS: This case report shows candida endophthalmitis in healthy woman who had received extraction of wisdom tooth. So to diagnose endophthalmitis, patient's medical history should carefully be checked including dental care history who presented with vitreous inflammation and inflammatory infiltrated lesion at fundus.
Aged ; Amphotericin B ; Anterior Chamber ; Candida ; Candida albicans ; Dental Care ; Diagnosis ; Endophthalmitis ; Female ; Fluorescein Angiography ; Hand ; Humans ; Inflammation ; Intraocular Pressure ; Intravitreal Injections ; Molar, Third ; Uveitis, Intermediate ; Visual Acuity ; Vitrectomy ; Voriconazole

PURPOSE: To report the effects of combined low dose bevacizumab and low dose triamcinolone intravitreal injection compared with single bevacizumab intravitreal injection in patients with macular edema secondary to branch retinal vein occlusion. METHODS: Thirty eyes of 30 patients diagnosed with branch retinal vein occlusion were evaluated. The combined injection group (15 eyes of 15 patients) was treated with intravitreal injection of combined low dose bevacizumab (0.625 mg/0.025 mL) and low dose triamcinolone (1 mg/0.025 mL). The single injection group (15 eyes of 15 patients) was treated with intravitreal injection of bevacizumab (1.25 mg/0.05 mL). The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. RESULTS: In the combined injection group, the BCVA increased significantly at 1 month, 2 months, and 3 months after injection (p < 0.05). However, in the single injection group, the BCVA increased significantly only at 3 months after injection (p < 0.05). In both groups, the CMT decreased significantly at 1 month, 2 months, and 3 months after injection (p < 0.05). The IOP showed no significant change at 3 months after injection (p > 0.05) in both groups. The BCVA, CMT, and IOP after injection showed no significant differences between the combined injection group and the single injection group (p > 0.05). CONCLUSIONS: The combined intravitreal injection of low dose bevacizumab and low dose triamcinolone may be useful and safe for the treatment of macular edema secondary to branch retinal vein occlusion.
Bevacizumab ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Retinal Vein Occlusion ; Retinal Vein ; Retinaldehyde ; Triamcinolone ; Visual Acuity