PURPOSE: To evaluate the effectiveness of a dexamethasone intravitreal implant (Ozurdex(R)) in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone. METHODS: We reviewed 9 eyes of 9 patients with diabetic macular edema treated with dexamethasone intravitreal implant. The patients were included in the study if presenting with refractory diabetic macular edema of more than 3 months despite combined treatment of intravitreal bevacizumab injection with posterior subtenon triamcinolone injection or intravitreal triamcinolone injection. We assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography at initial visit and 1, 3 and 4 months. RESULTS: The mean follow-up was 6.7 +/- 2.2 months. The baseline mean BCVA was 0.81 +/- 0.47 logarithm of the minimum angle of resolution (log MAR), which improved to 0.61 +/- 0.37 log MAR (p = 0.017), 0.57 +/- 0.38 log MAR (p = 0.011) and 0.62 +/- 0.36 log MAR (p = 0.027) at 1 month, 3 months and 4 months, respectively. The baseline mean CMT was 558.0 +/- 110.32 microm and decreased to 325 +/- 64.21 microm (p = 0.008) and 300.22 +/- 59.46 microm (p = 0.008) at 1 month and 3 months, respectively, then increased to 468.44 +/- 150.85 microm (p = 0.058) at 4 months after injection. CONCLUSIONS: Dexamethasone intravitreal implant showed short-term efficacy in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone and produced significant improvements in BCVA and CMT until 3 months after injection. The CMT then increased, but BCVA was sustained until the fourth month.
Dexamethasone* ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema* ; Tomography, Optical Coherence ; Triamcinolone ; Visual Acuity ; Bevacizumab

PURPOSE: To describe the morphologic characteristics of macular edema in branch retinal vein occlusion (BRVO) by using of optical coherence tomography (OCT) and to investigate the correlation between tomographic features and visual acuity (VA) METHODS: Thirty-one eyes of 30 patients with BRVO underwent a detailed history, ophthalmoscopic examination, fluorescein angiographic evaluation, and OCT examination. RESULTS: There were 4 patterns of macular edema: cystoid macular edema with serous retinal detachment (13 eyes, 41.9%), cystoid macular edema (11 eyes, 35.5%), diffuse macular edema with serous retinal detachment (4 eyes, 12.9%), and diffuse macular edema (3 eyes, 9.7%). The foveal thickness, retinal volume and logMAR scale of best corrected visual acuity were significantly difference within the pattern of macular edema (Kruskall-Wallis test, P<0.05) and the presence of serous retinal detachment. CONCLUSIONS: Optical coherence tomography (OCT) is a useful imaging technique for monitoring the retinal thickness and tomographic changes in macular edema of branch retinal vein occlusion. Further research is required to investigate if either the pattern of macular edema or the presence of serous retinal detachment is a prognostic factor in treatment response and to choose differential treatment approaches for different tomographic features.
Fluorescein ; Humans ; Macular Edema* ; Retinal Detachment ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Tomography, Optical Coherence* ; Visual Acuity

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 microm at baseline to 203 microm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.
Angiogenesis Inhibitors/*administration & dosage ; Angioid Streaks/*complications ; Antibodies, Monoclonal/*administration & dosage ; Choroidal Neovascularization/*drug therapy/*etiology/physiopathology ; Female ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macula Lutea/drug effects/pathology ; Middle Aged ; Tomography, Optical Coherence ; Visual Acuity/drug effects

PURPOSE: DiGeorge syndrome (chromosome 22q11.2 deletion syndrome) is a syndrome of multiple congenital anomalies characterized by hypoplasia or aplasia of the thymus and parathyroid, cardiovascular malformation, immune deficiency, cleft palate, characteristic facial features, and hypocalcemia. Ocular findings of DiGeorge syndrome are posterior embryotoxon, retinal vascular tortuosity, strabismus, ptosis, amblyopia and tilted optic disc. The authors present a case of DiGeorge syndrome with ocular manifestation not reported previously in Korea. Case summary: A six-year old female diagnosed with DiGeorge syndrome was referred to the authors' department within the hospital. The chief complaint was blurring vision in both eyes. Best corrected visual acuity of the right eye was 0.5 and of the left eye was 0.63. Cycloplegic refraction revealed high hyperopia and astigmatism in both eyes (OD: +7.25 Dsph; -2.5 Dcyl axis 180degrees, OS: +6.25 Dsph; -3.75 Dcyl axis 180degrees). In addition, hypertelorism, ptosis and tortuous retinal vessels during fundus examination were noted. CONCLUSIONS: Upon the initial diagnosis of DiGeorge syndrome in children, a comprehensive ocular examination is necessary because other ocular conditions may exist which can affect the visual development of the patient.
Amblyopia ; Astigmatism ; Axis, Cervical Vertebra ; Child ; Cleft Palate ; DiGeorge Syndrome ; Eye ; Female ; Humans ; Hyperopia ; Hypertelorism ; Hypocalcemia ; Korea ; Retinal Vessels ; Retinaldehyde ; Strabismus ; Thymus Gland ; Vision, Ocular ; Visual Acuity

BACKGROUND: Intrathecal opioid, a useful adjunct to prolong analgesic effects, potentiates spinal anesthesia. The present study was designed to evaluate the effect of intrathecal fentanyl on the hypnotic requirements of propofol during spinal anesthesia. METHODS: Sixty patients scheduled for elective urologic surgery under spinal anesthesia were randomly assigned to one of four groups. In Group 1 (n =15), spinal anesthesia was performed with hyperbaric bupivacaine 10 mg, in Group 2 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 10microgram, in Group 3 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 20microgram, and in Group 4 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 30microgram. After performing spinal anesthesia, the target plasma concentration of propofol was set at 2.0microgram/ml. Effect site concentration (Ce) was measured when the BIS's reached 80 or 70. Ce was titrated to maintain a BIS of 70-80. Observer's sedation scoring (OAA/S), systolic and diastolic pressures, SpO2 and total infusion dose were measured every 10 minutes for 1 hour. RESULTS: Ce's at a BIS of 80 were 1.2+/-0.3microgram/ml (Group 1), 1.0+/-0.3microgram/ml (Group 2), 0.9+/-0.2microgram/ml (Group 3), and 0.8+/-0.2microgram/ml (Group 4), respectively. Ce's at a BIS of 70 were 1.6+/-0.2microgram/ml (Group 1), 1.5+/-0.4microgram/ml (Group 2), 1.2+/-0.3microgram/ml (Group 3), and 1.2+/-0.3microgram/ml (Group 4), respectively. Ce's of Group 3 and Group 4 at BISs of 70 and 80 were significantly lower than those of Group 1 (P<0.05), and the propofol requirements of Groups 3 and 4 to maintain a BIS of 70-80 were significantly less than those of Group 1 (P<0.05). CONCLUSIONS: These results indicate that adding more than 20microgram of fentanyl to hyperbaric bupivacaine for spinal anesthesia reduces the hypnotic requirement of propofol.
Anesthesia, Spinal* ; Bupivacaine ; Fentanyl* ; Humans ; Plasma ; Propofol*

PURPOSE: To describe a case of symptomatic rifabutin-related uveitis with hypopyon and vitreous opacity in apatient with acquired immunodeficiency syndrome infected with Mycobacterium tuberculosis. CASE SUMMARY: A 33-year-old male patient with acquired immunodeficiency syndrome was referred to our clinic for abruptly decreased vision in his right eye. Multi-drug therapy with rifabutin was administered for 5 weeks to treat tuberculosis enteritis and pulmonary tuberculosis. Visual acuity of the right eye was hand motion and hypopyon as well as vitreous opacity was found in ocular examinations. Other serologic tests, anterior chamber paracentesis and lumbar puncture test were normal. Rifabutin was immediately stopped and topical steroid and cycloplegics were administered, which resulted in resolution of the hypopyon, vitreous opacity and visual acuity. Four weeks after the initial episode, rifabutin was restarted to treat the pulmonary tuberculosis and rifabutin-related uveitis relapsed in the opposite eye. CONCLUSIONS: Rifabutin-related uveitis should be considered in cases of uveitis in immunosuppressive patients, especially in acquired immunodeficiency syndrome patients. Underlying disease and medication history should be carefully assessed.
Acquired Immunodeficiency Syndrome ; Adult ; Anterior Chamber ; Enteritis ; Eye ; Hand ; Humans ; Male ; Mycobacterium tuberculosis ; Mydriatics ; Paracentesis ; Rifabutin ; Serologic Tests ; Spinal Puncture ; Tuberculosis ; Tuberculosis, Pulmonary ; Uveitis ; Vision, Ocular ; Visual Acuity

PURPOSE: To evaluate the clinical features of neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy and the effect of Ahmed valve implantation. METHODS: The medical records of 217 eyes of 178 patients who had undergone pars plana vitrectomy for proliferative diabetic retinopathy were reviewed. The clinical data on preoperative, intraoperative, and postoperative factors of these patients were compared with that of those who developed neovascular glaucoma (20 eyes of 18 patients) after vitrectomy. The effect and complications of Ahmed valve implantation were also reviewed. RESULTS: The type 1 diabetes, the presence of NVD, grade of NVE, grade of preoperative PRP, presence of postoperative vitreous hemorrhage, and postoperative tractional retinal detachment were significantly correlated with the development of neovascular glaucoma. Ahmed valve implantation in these patients was effective in controlling intraocular pressure and improving visual acuity. Complications of the Ahmed valve implantation were hyphema, tube exposure, recurrent vitreous hemorrhage, hypotony, and choroidal effusion. CONCLUSIONS: The risk factors for the development of neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy were evaluated. Ahmed valve implantation in these patients is considered an effective treatment for controlling intraocular pressure.
Choroid ; Diabetic Retinopathy* ; Glaucoma, Neovascular* ; Humans ; Hyphema ; Intraocular Pressure ; Medical Records ; Retinal Detachment ; Risk Factors ; Traction ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: To report a case of endophthalmitis after 25-gauge transconjunctival sutureless vitrectomy. METHODS: A 60-year-old male patient underwent 25-gauge transconjunctival sutureless vitrectomy through the epiretinal membrane. He was diagnosed as endophthalmitis on 7th postoperative day. Immediate vitrectomy and intravitreal antibiotics injection was done. RESULTS: Coagulase-negative staphylococcus was identified in vitreous culture and incarcerated vitreous through the previous unsutured sclerotomies were found. During vitrectomy, we found generalized retinal necrosis and vascular occlusion with retinal hemorrhage, cheese like thick membrane firmly adherent to the retina due to inflammatory response. The organism was sensitive to antibiotics administered. After treatment, inflammatory response was controlled and the retina became stable but the visual outcome was poor. CONCLUSIONS: Vitreous incarceration through unsutured sclerotomy may occur after 25-gauge transconjunctival sutureless vitrectomy. This can be a possible conduit for bacteria in the eye and be a cause of endophthalmitis. Sutureless sclerotomy should be carefully monitered and managed postoperatively.
Anti-Bacterial Agents ; Bacteria ; Cheese ; Endophthalmitis* ; Epiretinal Membrane ; Humans ; Male ; Membranes ; Middle Aged ; Necrosis ; Retina ; Retinal Hemorrhage ; Retinaldehyde ; Staphylococcus ; Vitrectomy*

Menopause is the time at which menstruation stops in women. After menopause, women are more susceptible to some diseases, especially osteoporosis and cardiovascular disease. Vitamin D has a protective effect against osteoporosis by facilitating the absorption of calcium and affecting parathyroid hormone. Vitamin D also affects cardiovascular function by lowering the blood pressure, which affects the renin–angiotensin system and alters the low-density lipoprotein receptor activity. This paper discusses supplemental vitamin D in postmenopausal women with osteoporosis and cardiovascular disease.
Absorption ; Blood Pressure ; Calcium ; Cardiovascular Diseases ; Female ; Humans ; Menopause ; Menstruation ; Osteoporosis ; Parathyroid Hormone ; Receptors, Lipoprotein ; Vitamin D* ; Vitamins*

PURPOSE: To evaluate the efficacy of intravitreal injections of triamcinolone acetonide (TA) at the end of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: We analyzed 50 patients (52 eyes) who underwent PPV for treatment of PDR and received an intravitreal injection of 4 mg TA at the end of surgery. The study group (Group 1) was compared with a control group (Group 2, 46 patients, 51 eyes) (matched with the study group for preoperative parameters) who underwent PPV without intravitreal injection of TA. RESULTS: In Group 1, the grade of anterior chamber cells at postoperative days 1 and 7 was significantly lower than that of Group 2. There was slight mean IOP elevation in Group 1 at postoperative weeks 2, 3, 4, and 8, but it was not statistically significant. Forty-four eyes (84.6%) from Group 1 showed better visual acuity at the last follow-up than at the preoperative visit (Group 1). Thirty-two eyes (62.8%) from Group 2 showed better visual acuity at the last follow-up than at the preoperative visit. The degree of visual improvement was 0.75 logMAR in Group 1 and 0.59 logMAR in Group 2. Vitreous hemorrhage occurred in 9 eyes (17.3%) from Group 1 and in 19 eyes (37.3%) from Group 2. However, the differences in the occurrence of neovascularization in iris and neovascular glaucoma between two groups were not statistically significant. CONCLUSIONS: Intravitreal TA injection at the end of PPV seems to be effective in improving visual acuity and decreasing early postoperative inflammation and the frequency of vitreous hemorrhage.
Anterior Chamber ; Diabetic Retinopathy* ; Follow-Up Studies ; Glaucoma, Neovascular ; Humans ; Inflammation ; Intravitreal Injections ; Iris ; Triamcinolone Acetonide* ; Triamcinolone* ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage