OBJECTIVE: To analyze the clinical manifestations and causative gene variants of the choroideremia patients, and to help the patients bedifferential diagnosed by whole exome sequencing and provide theoretical basis for their genetic counseling. METHODS: Clinical data of 3 families were collected and genomic DNA was extracted respectively from peripheral blood of patients and related subjects. Exome targeted sequencing was used to screen suspicious gene mutations. Sanger sequencing and quantitative PCR were used to verify the candidate mutations and investigate the mutation carrying status of other members of the family. The candidate mutations were searched through HGMD and PubMed databases for the pathogenicity reports, and the pathogenicity of candidate mutations was judged according to a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. RESULTS: The proband of family 1 is c.1584_1587del (p.Val529Hisfs*6) variant hemizygote, whose daughter carries c.1584_1587del (p.Val529Hisfs*6) heterozygous variation. The proband of family 2 is a hemizygote with deletion of exons 10 to 15 (E10-15del), and her mother and sister carry the E10-15del heterozygous variation. In family 3, the proband is c.544delT (p.Cys182Valfs*14) variant hemizygote, and his mother is c.544delT (p.Cys182Valfs*14) heterozygote, but the father do not detect this variant. All the 3 families were detected pathogenic gene variations of CHM, two of which were known pathogenic variation and one of which was novel CHM gene c.544delT (p.C182Vfs*14) in this study. The c.544delT frameshift mutation of CHM gene can lead to the premature termination of the product protein translation and nonfunctioning protein. It is a pathogenic mutation according to ACMG guidelines. CONCLUSION The findings of this study expand the gene variation spectrum of choroideremia.
Choroideremia/genetics* ; Female ; Heterozygote ; Humans ; Mutation ; Pedigree ; Whole Exome Sequencing

Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral stenoocclusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki’s angiographic staging. Insufficiency of this ‘IC-EC conversion system’ could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.
Angiography ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cerebrovascular Circulation ; Cerebrovascular Disorders ; Choroid ; Dilatation ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Moyamoya Disease ; Posterior Cerebral Artery

PURPOSE: To investigate the short-term efficacy and safety of ranibizumab in the routine clinical setting in patients with neovascular age-related macular degeneration and to analyze the associated factors for visual outcome. METHODS: This was a post-hoc analysis of a ranibizumab regulatory post-marketing surveillance study in which 4,136 patients were enrolled and followed for 12 weeks. Change in best-corrected visual acuity (BCVA), size of choroidal neovascularization, and the presence of hemorrhage and exudate were analyzed and the association between BCVA change and baseline characteristics were investigated. Data on ocular and systemic adverse events were collected. RESULTS: Mean BCVA improved significantly and mean BCVA change was the logarithm of the minimal angle of resolution 0.13 ± 0.01 (p < 0.001). A lower baseline BCVA and younger age were significant predictive factors for visual improvement or maintenance (≥0 lines). For greater visual acuity gain (≥3 lines), no treatment history, lower baseline BCVA, younger age, and classic-type choroidal neovascularization were significant predictive factors. No new safety signals were found. CONCLUSIONS: In this study, conducted in real-world clinical practice with a large number of neovascular age-related macular degeneration patients, visual and anatomical outcomes improved significantly after three monthly ranibizumab treatments. Treatment-naive patients had a higher chance of greater visual gain (≥3 lines) than non-naive patients.
Choroidal Neovascularization ; Exudates and Transudates ; Hemorrhage ; Humans ; Macular Degeneration ; Ranibizumab ; Visual Acuity

BACKGROUND: Because of genetically and phenotypically heterogenous features, identification of causative genes for inherited retinal diseases (IRD) is essential for diagnosis and treatment in coming gene therapy era. To date, there are no large-scale data of the genes responsible for IRD in Korea. The aim of this study was to identify the distribution of genetic defects in IRD patients in Korea. METHODS: Medical records and DNA samples from 86 clinically diagnosed IRD patients were consecutively collected between July 2011 and May 2015. We applied the next-generation sequencing strategy (gene panel) for screening 204 known pathogenic genes associated with IRD. RESULTS: Molecular diagnoses were made in 38/86 (44.2%) IRD patients: 18/44 (40.9%) retinitis pigmentosa (RP), 8/22 (36.4%) cone dystrophy, 6/7 (85.7%) Stargardt disease, 1/1 (100%) Best disease, 1/1 (100%) Bardet-Biedl syndrome, 1/1 (100%) congenital stationary night blindness, 1/1 (100%) choroideremia, and 2/8 (25%) other macular dystrophies. ABCA4 was the most common causative gene associated with IRD and was responsible for causing Stargardt disease (n = 6), RP (n = 1), and cone dystrophy (n = 1). In particular, mutations in EYS were found in 4 of 14 autosomal recessive RP (29%). All cases of Stargardt disease had a mutation in the ABCA4 gene with an autosomal recessive trait. CONCLUSION: This study provided the distribution of genetic mutations responsible for causing IRD in the Korean patients. This data will serve as a reference for future genetic screening and treatment for Korean IRD patients.
Bardet-Biedl Syndrome ; Choroideremia ; Diagnosis ; DNA ; Genetic Testing ; Genetic Therapy ; Humans ; Korea ; Macular Degeneration ; Mass Screening ; Medical Records ; Night Blindness ; Retinal Diseases ; Retinaldehyde ; Retinitis Pigmentosa ; Vitelliform Macular Dystrophy

PURPOSE: To evaluate the long-term treatment outcomes of bevacizumab therapy in patients with myopic choroidal neovascularization (CNV). METHODS: A retrospective review was performed of medical records regarding 43 eyes with myopic CNV that were treated with intravitreal bevacizumab injection. Visual acuity at diagnosis was compared with that measured at the final follow-up; the incidence and timing of re-activation were evaluated. In addition, factors associated with final follow-up were analyzed. RESULTS: Mean patient age was 39.3 ± 12.9 years and mean spherical equivalent (SE) was −11.9 ± 4.4 diopters. Patients were followed-up at a mean of 42.1 ± 17.0 months. Re-activation of the lesion was noted in 17 eyes (39.5%). The mean time to first re-activation was 19.5 ± 15.4 months from the time that resolution of subretinal fluid/retinal fluid was confirmed after initial treatment. The mean visual acuity (the logarithm of the minimal angle of resolution) was 0.40 ± 0.25 at diagnosis and 0.26 ± 0.31 at the final follow-up. Visual acuity at the final follow-up was significantly improved when compared with the baseline value (p = 0.005). Patient age (p < 0.001), SE (p = 0.003), and visual acuity at diagnosis (p < 0.001) were significantly associated with visual acuity at the final follow-up. CONCLUSIONS: Bevacizumab therapy was a useful method for long-term treatment of myopic CNV. The observation of relatively late re-activation after the initial treatment suggests a need for continuous long-term follow-up.
Bevacizumab ; Choroid ; Choroidal Neovascularization ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Methods ; Myopia ; Retrospective Studies ; Visual Acuity

PURPOSE: To evaluate the clinical presentations of focal choroidal excavation and to report long-term outcomes of cases without retinal disorders at the initial presentation. METHODS: A retrospective review of medical records was performed for patients diagnosed with focal choroidal excavation. Concomitant retinal disorders at the initial presentation were identified. In cases without retinal disorders, the development of retinal disorders during follow-up was also evaluated. RESULTS: Forty-five eyes in 45 patients were examined in this study. Focal choroidal excavation was accompanied with retinal disorders in 16 eyes (35.6%). In the remaining 29 eyes, only focal choroidal excavation was noted without any accompanying retinal disorders. The accompanying retinal disorders included choroidal neovascularization (n = 8), central serous chorioretinopathy (n = 4), epiretinal membrane (n = 1), macular hole (n = 1), branch retinal vein occlusion (n = 1), and uveitis (n = 1). Of the 29 eyes without retinal disorders, 22 were followed up for a mean period of 33.5 ± 18.2 months. Consequently, choroidal neovascularization was found to have developed in one eye at 59 months, and subretinal fluid had developed in two eyes at 17 and 28 months, respectively. CONCLUSIONS: Focal choroidal excavation was accompanied by retinal disorders in 35.6% of the included patients. In patients without retinal disorders, the development of a retinal disorder was noted in some eyes, suggesting the need for long-term regular follow-up in patients diagnosed with focal choroidal excavation.
Central Serous Chorioretinopathy ; Choroid ; Choroidal Neovascularization ; Epiretinal Membrane ; Follow-Up Studies ; Humans ; Medical Records ; Retinal Perforations ; Retinal Vein Occlusion ; Retinaldehyde ; Retrospective Studies ; Subretinal Fluid ; Uveitis

PURPOSE: To report a case of choroidal neovascularization in a Best disease patient treated with intravitreal bevacizumab injection and followed up with optical coherence tomography angiography (OCTA). CASE SUMMARY: A 20-year-old female visited our clinic with decreased visual acuity of the left eye for 6 months. On optical coherence tomography (OCT), subretinal fluid and hyperreflective subretinal clumps were observed in the macula of the right eye. Subretinal hemorrhage and subretinal fluid were observed in the left eye. Choroidal neovascularization in the left eye was observed using OCTA, fluorescein angiography, and indocyanine green angiography. A full-field electroretinogram was normal in both eyes, but an electrooculogram revealed that the Arden ratio was 1.564 in the right eye and 1.081 in the left eye. Intravitreal bevacizumab injection was performed in the left eye. At 6 months after the intravitreal injection, the best-corrected visual acuity of the left eye had recovered to 20/20. OCT revealed that subretinal fluid reduced and choroidal neovascularization was stable. After 12 months, visual acuity of the left eye was maintained at 20/20, but OCTA revealed that choroidal neovascularization had increased. CONCLUSIONS: Choroidal neovascularization associated with Best disease can improve by intravitreal bevacizumab injection, and the changes in choroidal neovascularization can be followed using OCTA.
Angiography ; Bevacizumab ; Choroid ; Choroidal Neovascularization ; Electrooculography ; Female ; Fluorescein Angiography ; Hemorrhage ; Humans ; Indocyanine Green ; Intravitreal Injections ; Subretinal Fluid ; Tomography, Optical Coherence ; Visual Acuity ; Vitelliform Macular Dystrophy ; Young Adult

PURPOSE: To report a case of fulminant toxoplasmic chorioretinitis following intravitreal dexamethasone implantation monotherapy in a stabilized toxoplasmic chorioretinitis patient with initial treatment. CASE SUMMARY: A 60-year-old healthy female presented with decreased visual acuity in the left eye. On fundus examination, focal chorioretinitis and yellow-white infiltration were observed. Laboratory work-up, including blood chemistry, complete blood count, and serum serology, was negative; however, toxoplasmic chorioretinitis could not be ruled out. The primary lesion improved with antibiotics and prednisolone treatment. However, the patient did not come in for her follow-up visit, as she had already received an intravitreal dexamethasone implant for recurrent vitreous inflammation elsewhere. On her return, she presented with necrotic retinitis with extensive infiltration. She underwent diagnostic vitrectomy and implant removal. A diagnosis of toxoplasma antigen was confirmed by polymerase chain reaction analysis; the lesions stabilized after anti-toxoplasmic therapy. CONCLUSIONS: Intravitreal dexamethasone implant monotherapy with stabilized toxoplasmic chorioretinitis without systemic antibiotics can lead to fulminant toxoplasmic chorioretinitis and should be used with caution.
Anti-Bacterial Agents ; Blood Cell Count ; Chemistry ; Chorioretinitis ; Dexamethasone ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Inflammation ; Intravitreal Injections ; Middle Aged ; Polymerase Chain Reaction ; Prednisolone ; Retinitis ; Toxoplasma ; Toxoplasmosis ; Visual Acuity ; Vitrectomy

PURPOSE: To report a case of extensive choroidal effusion following the Valsalva maneuver under consecutive general anesthesia. CASE SUMMARY: A 41-year-old man who underwent panretinal photocoagulation with proliferative diabetic retinopathy had pars plana vitrectomy and endolaser photocoagulation under general anesthesia due to vitreous hemorrhage. Urology cooperated as the patient had hematuria; the day after the operation, he was transferred to the urology department. Two days after vitrectomy, the patient had an urgent transurethral bladder tumor resection under general anesthesia with suspicion of bladder tumor. At 6 days postoperatively, extensive choroidal effusion was observed from 8 to 10 o'clock on fundus examination and ultrasonography. On day 23 after urological surgery, the choroidal effusion had disappeared without treatment. CONCLUSIONS: Consecutive general anesthesia requires caution, as it is not only burdensome to the body as a whole but may also cause choroidal effusion in the eye.
Adult ; Anesthesia, General ; Choroid ; Diabetic Retinopathy ; Hematuria ; Humans ; Light Coagulation ; Ultrasonography ; Urinary Bladder Neoplasms ; Urology ; Valsalva Maneuver ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To report a rare case of Sjögren's reticular retinal dystrophy. CASE SUMMARY: A 54-year-old male presented with blurred vision and metamorphopsia in both eyes since a few years prior to his initial visit. There was a bilateral reticular network of yellow deposits throughout the posterior pole on fundus examination, which was hyperautofluorescent in fundus autofluorescence photographs. The pigment alterations were more visible with fluorescein angiography, which showed hypofluorescent lesions with hyperfluorescent borders. Spectral-domain optical coherence tomography showed elevations of the outer retina associated with the presence of subretinal hyperreflective material. Based on the conclusive correlation with clinical features, we diagnosed Sjögren's reticular retinal dystrophy. CONCLUSIONS: Sjögren's reticular retinal dystrophy is characterized by its specific pigment changes at the level of clinical manifestations and the retinal pigment epithelium. In cases of Sjögren's reticular retinal dystrophy, close monitoring is required because it has a lifetime risk of choroidal neovascularization.
Choroidal Neovascularization ; Fluorescein Angiography ; Humans ; Macular Degeneration ; Male ; Middle Aged ; Retina ; Retinal Dystrophies ; Retinal Pigment Epithelium ; Retinaldehyde ; Tomography, Optical Coherence ; Vision Disorders