PURPOSE: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia. CASE SUMMARY: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. CONCLUSIONS: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.
Aged ; Anemia ; Bevacizumab ; Biopsy ; Bone Marrow ; Dexamethasone ; Drug Therapy ; Epistaxis ; Humans ; Hypertension ; Lymphoma ; Macular Edema ; Retinal Hemorrhage ; Retinal Vein* ; Veins ; Visual Acuity ; Waldenstrom Macroglobulinemia*

Diabetic macular edema is one of the most common causes of visual acuity impairment in adults. Various treatment modalities are currently used. They include laser therapy, intravitreal or periocular injection of steroid, intravitreal injection of anti-vascular endothelial growth factor, and pars plana vitrectomy. Introduction of newer therapeutic agents, such as ranibizumab and aflibercept has changed the paradigm of treatment approaches for diabetic macular edema. However, traditional treatment methods, such as laser photocoagulation and vitrectomy, are still being used effectively in certain situations. Each treatment modality has its own unique mode of action, and has advantages and disadvantages at the same time. Given multiple mechanisms are involved in the development of diabetic macular edema, a combination treatment approach is often employed rather than using only one of the treatment modalities. In this review, treatment outcomes of each approach are summarized and combination approaches are discussed.
Adult ; Bevacizumab ; Dexamethasone ; Endothelial Growth Factors ; Humans ; Injections, Intraocular ; Intravitreal Injections ; Laser Therapy ; Light Coagulation ; Macular Edema* ; Ranibizumab ; Visual Acuity ; Vitrectomy

BACKGROUND: Limited data exist on real-world treatment patterns for diabetic macular edema (DME) in Korea. In this study, we investigated DME treatment patterns from 2009 to 2014 and the impact of baseline treatment on healthcare resource utilization and visual acuity (VA) outcomes. METHODS: A retrospective cohort chart review of DME patients treated at 11 hospital ophthalmology clinics between January 1, 2012 and December 31, 2013 was conducted. We collected data on demographics, healthcare resource utilization (clinic visits, treatment visits, and visits for ocular investigations), distribution of DME treatments, and VA. RESULTS: Overall, 522 DME patients (men, 55.2%; mean age, 59 years; mean HbA1c [n = 209], 8.4%) with 842 DME eyes were evaluated. For all treatments, healthcare resource utilization was significantly higher during the first 6 months versus months 7–12, year 2, or year 3 (P ≤ 0.001), but was highest for patients whose first treatment was an anti-vascular endothelial growth factor (VEGF) treatment (visits/quarter; anti-VEGF, 1.9; corticosteroids, 1.7; laser, 1.4). Use of macular laser therapy decreased (44% to 8%), whereas use of anti-VEGF injections increased (44% to 69%) during the study period. However, VA improvement was not commensurate with healthcare resource utilization of anti-VEGF treatment (mean VA gain, 2.7 letters). CONCLUSION: A trend toward increasing use of intravitreal anti-VEGF injections for DME treatment was observed in Korea. However, the frequency of dosing and monitoring was lower in clinical practice versus major clinical trials, which may have led to the less-than-favorable improvements in visual outcomes.
Adrenal Cortex Hormones ; Cohort Studies ; Delivery of Health Care ; Demography ; Endothelial Growth Factors ; Humans ; Intravitreal Injections ; Korea ; Laser Therapy ; Macular Edema ; Ophthalmology ; Practice Patterns, Physicians' ; Retrospective Studies ; Visual Acuity

Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.
Acetazolamide/*administration & dosage ; Administration, Oral ; Adult ; Corneal Dystrophies, Hereditary/*drug therapy/pathology ; Diuretics/*administration & dosage ; Humans ; Macular Edema/*drug therapy/pathology ; Male ; Retinal Diseases/*drug therapy/pathology ; Tomography, Optical Coherence ; Treatment Outcome

PURPOSE: To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures. METHODS: Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome. RESULTS: The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 +/- 0.91 (range, 0 to 3) and 1.94 +/- 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients <65 and > or =65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients <65, there was a significant difference in the average VAS pain scores between groups (p = 0.003). However, for patients > or =65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078). CONCLUSIONS: Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.
Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Bevacizumab/*administration & dosage ; Diabetic Retinopathy/drug therapy/physiopathology ; Female ; Humans ; *Intravitreal Injections ; Macular Degeneration/drug therapy/physiopathology ; Macular Edema/drug therapy/physiopathology ; Male ; Middle Aged ; Pain Measurement ; Ranibizumab/*administration & dosage ; Retinal Vein Occlusion/drug therapy/physiopathology

PURPOSE: To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures. METHODS: Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome. RESULTS: The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 +/- 0.91 (range, 0 to 3) and 1.94 +/- 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients <65 and > or =65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients <65, there was a significant difference in the average VAS pain scores between groups (p = 0.003). However, for patients > or =65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078). CONCLUSIONS: Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.
Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Bevacizumab/*administration & dosage ; Diabetic Retinopathy/drug therapy/physiopathology ; Female ; Humans ; *Intravitreal Injections ; Macular Degeneration/drug therapy/physiopathology ; Macular Edema/drug therapy/physiopathology ; Male ; Middle Aged ; Pain Measurement ; Ranibizumab/*administration & dosage ; Retinal Vein Occlusion/drug therapy/physiopathology

PURPOSE: To compare the short-term effects of intravitreal triamcinolone acetonide (IVTA) with those of intravitreal bevacizumab (IVB) injection for diabetic macular edema (DME). METHODS: The present retrospective, comparative case study included 58 eyes of 35 consecutive patients (IVTA group, 20 eyes; IVB group, 38 eyes) with DME. IVTA (4 mg) or IVB (1.25 mg) injection was performed under local anesthesia. The effects of injection for DME were evaluated using best-corrected visual acuity (BCVA), central macular thickness (CMT) by optical coherence tomography and intraocular pressure (IOP) by applanation tonometer. Patients underwent eye examinations, including BCVA, CMT, and IOP at pre-injection, 2, 4, and 8 weeks after injection. RESULTS: BCVA (logarithm of the minimum angle of resolution) +/- SD at pre-injection, 2, 4, and 8 weeks after injection was 0.67 +/- 0.40, 0.56 +/- 0.35 (p = 0.033), 0.55 +/- 0.33 (p = 0.041), and 0.43 +/- 0.31 (p = 0.001) in the IVTA group and 0.51 +/- 0.31, 0.42 +/- 0.26 (p = 0.003), 0.43 +/- 0.32 (p = 0.001), and 0.43 +/- 0.27 (p = 0.015) in the IVB group, respectively. CMT (microm) +/- SD at pre-injection, 2, 4, and 8 weeks after injection was 400.4 +/- 94.9, 332.8 +/- 47.4 (p = 0.002), 287.5 +/- 49.1 (p = 0.007), and 282.5 +/- 49.6 (p = 0.043) in the IVTA group and 372.6 +/- 99.5, 323.2 +/- 72.4 (p = 0.077), 360.9 +/- 50.3 (p = 0.668), 368.2 +/- 88.6 (p = 0.830) in the IVB group, respectively. CONCLUSIONS: The effects of IVTA for BCVA were more favorable than were those of IVB and were consistent throughout the eight weeks after injection. IVTA significantly reduced CMT during the eight weeks after injection, while IVB did not.
Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Diabetic Retinopathy/*drug therapy ; Female ; Glucocorticoids/*administration & dosage ; Humans ; Intravitreal Injections ; Macular Edema/*drug therapy ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage

A 54-year-old female patient who had been undergoing anti-cancer chemotherapy and radiotherapy for seven years after surgery for left breast cancer visited our clinic for visual disturbance in the right eye at nine months after paclitaxel administration. The best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. The patient was diagnosed with maculopathy due to paclitaxel administration based on the finding of cystoid macular edema in the right eye on fundus examination and optical coherence tomography; however, no leakage was detected on fluorescein angiography. Thus, drug replacement was planned. On the other hand, no abnormal finding was observed in the left eye. However, as the anti-cancer effect of paclitaxel is significant, replacing paclitaxel with another agent was not warranted; therefore, maintenance therapy with methazolamide was performed before and after administering the anti-cancer agent. Aggravation of cystoid macular edema was prevented, and vision improvement was achieved by oral maintenance therapy with methazolamide. In addition, the same fundus findings as shown in the right eye were detected in the left eye at 16 months after paclitaxel administration. After administering methazolamide, macular thickness was reduced, and vision was improved in the left eye. Paclitaxel administration was discontinued due to cutaneous metastasis from the breast cancer, and another anti-cancer agent was then administered. No subsequent cystoid macular edema has occurred.
Antineoplastic Agents, Phytogenic/*adverse effects ; Breast Neoplasms/drug therapy ; Diuretics/*therapeutic use ; Female ; Humans ; Macular Edema/*chemically induced/*drug therapy ; Methazolamide/*therapeutic use ; Middle Aged ; Paclitaxel/*adverse effects ; Visual Acuity

PURPOSE: To evaluate the efficacy of vitrectomy for persistent diabetic macular edema after laser photocoagulation or intravitreal triamcinolone injections and to determine the demographic and ocular factors that influence functional and anatomical outcomes. METHODS: We retrospectively evaluated 55 eyes (51 patients) that had persistent diffuse macular edema after laser photocoagulation or intravitreal triamcinolone injections. We compared preoperative and postoperative best corrected visual acuity and macular thickness by Optical Coherence Tomography and investigated factors including patient's age, presence of vitreomacular traction, grade of diabetic retinopathy, and intraoperative internal limiting membrane removal that may influence the surgical results. RESULTS: The mean preoperative BCVA (log MAR) was 0.91+/-0.40 (0.8-1.2). The BCVA improved to 0.72+/-0.39 (0.3-1.2). The mean preoperative macular thickness was 440+/-130 (202-805) micrometer and the mean macular thickness decreased to 306+/-97 (136-580) micrometer postoperatively. The eyes showed statistically significant improvement in BCVA and central macular thickness (p<0.001). Preoperative better BCVA was associated with an improved postoperative visual acuity. (p=0.04). No other covariates were found to be statistically significant factors for prognosis of postoperative BCVA. CONCLUSIONS: In eyes with persistent diabetic macular edema after laser or IVTA injections, vitrectomy was effective for decreasing macular thickness and improvement of vision. The visual improvement after vitrectomy was associated with the preoperative better BCVA.
Adult ; Aged ; Diabetic Retinopathy/*surgery/therapy ; Female ; Humans ; Injections ; Laser Coagulation ; Macular Edema/*surgery/therapy ; Male ; Middle Aged ; Retreatment ; Retrospective Studies ; Treatment Outcome ; Triamcinolone/administration & dosage/therapeutic use ; *Vitrectomy ; Vitreous Body

We encountered a patient with cystoid macular edema (CME) secondary to paclitaxel use. A 57-year-old man presented with gradual decreased bilateral vision. His chemotherapeutic regimen consisted of bevacizumab, paclitaxel (175 mg/m2 for 5 months), and carboplatin. Optical coherence tomography imaging revealed bilateral CME greater than 500 microm. However, one year later, visual acuity was improved, best-corrected Snellen visual acuity was 40 / 80 in each eye, and CME was spontaneously improved. Our study confirmed that macular edema associated with paclitaxel use shows spontaneous resolution and improvement of visual acuity after a change of chemotherapeutic regimen.
Adenocarcinoma/drug therapy ; Antineoplastic Agents, Phytogenic/*adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Humans ; Lung Neoplasms/drug therapy ; Macular Edema/*chemically induced ; Male ; Middle Aged ; Paclitaxel/*adverse effects ; Remission, Spontaneous ; Tomography, Optical Coherence ; Visual Acuity