Purpose: To describe successful treatment of cytomegalovirus immune recovery retinitis, with similarity to acute retinal necrosis, in patients with acquired immunodeficiency syndrome (AIDS) in the immune recovery stage.Case summary: A 37-year-old man, diagnosed with AIDS 5 years prior, visited our clinic with a chief complaint of visual disturbance in his right eye for 1 week. Slit lamp examination revealed severe inflammation; a light gray retinal lesion with a clear border was present in the inferotemporal area of the peripheral retina. Antiviral (ganciclovir) and oral steroid treatments were initiated. Blood test results indicated that the CD4+ T-cell count was 222/μL. Polymerase chain reaction analysis of anterior puncture findings showed a positive result for cytomegalovirus. Clinical findings were suggestive of acute retinal necrosis, but the patient's condition and examination were also suggestive of cytomegalovirus retinitis in the immune recovery stage. One month after treatment, retinal detachment was observed; surgery was performed. There was no recurrence for 3 years after the second operation and the patient remained in stable condition. Conclusions In the immune recovery stage, non-specific cytomegalovirus retinitis accompanied by inflammation may exhibit fundus findings similar to acute retinal necrosis. We report a rare case of cytomegalovirus immune recovery retinitis where normal vision was restored via systemic drug treatment and surgery.

Purpose: To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED).Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient’s intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition. Conclusions It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.

Purpose: This study investigated the 1-year outcomes of a treat-and-extend regimen of ranibizumab for exudative age-related macular degeneration and examined the clinical results when drug treatment was changed within the same period. Methods: This retrospective analysis included 32 eyes first diagnosed with wet age-related macular degeneration and treated for more than 1 year with a treat-and-extend regimen of ranibizumab, as well as 24 eyes treated by changing from ranibizumab to aflibercept within the same period. The injection number, maximum injection interval, change in central retinal thickness, and best-corrected visual acuity were assessed in all eyes. Results: In 32 eyes that received a treat-and-extend regimen of ranibizumab, the mean best-corrected visual acuity improved from 59.46 ± 15.13 to 68.00 ± 12.48 at 12 months (p < 0.0001). The mean central retinal thickness decreased from 409 ± 141 μm to 273 ± 89 μm at 12 months (p < 0.0001). The average number of injections per year was 7.2 ± 0.85. One complication related to the 12 months of injections was a tear in the retinal pigment epithelium; no systemic complications were observed. Of 24 eyes that underwent a change in medication, the rate of maintenance or improvement in initial visual acuity was 83% (10 eyes). The central retinal thickness was initially 371.58 ± 109.96 μm, but improved to 290.33 ± 58.66 μm in 12 eyes that received three injections of aflibercept. Conclusions At 1 year, good outcomes were obtained using treat-and-extend ranibizumab for exudative age-related macular degeneration. When the treatment was changed to aflibercept within the same period, vision was often maintained and short-term anatomical improvement was evident.

Purpose: To evaluate the results of treatment according to the method of intravitreal injection of bevacizumab for macular edema due to branch retinal vein occlusion (BRVO). Methods: The clinical records of macular edema patients were analyzed retrospectively for a total of 62 eyes of 62 patients who were injected with bevacizumab into the vitreous as the first treatment for BRVO. Best-corrected visual acuity (BCVA), the findings of spectral-domain optical coherence tomography before and after injection, and prognosis-related factors were evaluated for 21 eyes that received the initial three monthly loading treatments and the 41 eyes that did not. Results: Significant improvement in BCVA was observed in the group having received the initial three injections compared with the group who did not receive the injections at 3, 6, and 12 months (p = 0.025, p = 0.019, and p = 0.008, respectively). The central macular thickness (CMT) showed greater improvement in the initial three injections group than the group without at 6 months (p = 0.034). Multivariate regression showed that the duration from the onset, the three loadings, BCVA, disorganization of the retinal inner layer (DRIL), and choroidal thickness were predictors related to visual gain (p = 0.044, p = 0.047, p = 0.004, p = 0.045, and p = 0.034, respectively). Age, three loadings, BCVA, and DRIL were predictors related to final visual acuity (p = 0.045, p = 0.046, p = 0.002, and p = 0.034, respectively). Duration from the onset, CMT, and choroidal thickness were predictors related to CMT improvement (p = 0.042, p = 0.009, and p = 0.015, respectively). Conclusions In macular edema of BRVO, the initial three monthly intravitreal injections of bevacizumab provided superior treatment outcomes regarding short-term functional and anatomical improvements and long-term functional improvement, compared with methods that did not treat with the initial three monthly injections.

Purpose: To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED).Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient’s intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition. Conclusions It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.

Purpose: This study investigated the 1-year outcomes of a treat-and-extend regimen of ranibizumab for exudative age-related macular degeneration and examined the clinical results when drug treatment was changed within the same period. Methods: This retrospective analysis included 32 eyes first diagnosed with wet age-related macular degeneration and treated for more than 1 year with a treat-and-extend regimen of ranibizumab, as well as 24 eyes treated by changing from ranibizumab to aflibercept within the same period. The injection number, maximum injection interval, change in central retinal thickness, and best-corrected visual acuity were assessed in all eyes. Results: In 32 eyes that received a treat-and-extend regimen of ranibizumab, the mean best-corrected visual acuity improved from 59.46 ± 15.13 to 68.00 ± 12.48 at 12 months (p < 0.0001). The mean central retinal thickness decreased from 409 ± 141 μm to 273 ± 89 μm at 12 months (p < 0.0001). The average number of injections per year was 7.2 ± 0.85. One complication related to the 12 months of injections was a tear in the retinal pigment epithelium; no systemic complications were observed. Of 24 eyes that underwent a change in medication, the rate of maintenance or improvement in initial visual acuity was 83% (10 eyes). The central retinal thickness was initially 371.58 ± 109.96 μm, but improved to 290.33 ± 58.66 μm in 12 eyes that received three injections of aflibercept. Conclusions At 1 year, good outcomes were obtained using treat-and-extend ranibizumab for exudative age-related macular degeneration. When the treatment was changed to aflibercept within the same period, vision was often maintained and short-term anatomical improvement was evident.

Purpose: To evaluate the results of treatment according to the method of intravitreal injection of bevacizumab for macular edema due to branch retinal vein occlusion (BRVO). Methods: The clinical records of macular edema patients were analyzed retrospectively for a total of 62 eyes of 62 patients who were injected with bevacizumab into the vitreous as the first treatment for BRVO. Best-corrected visual acuity (BCVA), the findings of spectral-domain optical coherence tomography before and after injection, and prognosis-related factors were evaluated for 21 eyes that received the initial three monthly loading treatments and the 41 eyes that did not. Results: Significant improvement in BCVA was observed in the group having received the initial three injections compared with the group who did not receive the injections at 3, 6, and 12 months (p = 0.025, p = 0.019, and p = 0.008, respectively). The central macular thickness (CMT) showed greater improvement in the initial three injections group than the group without at 6 months (p = 0.034). Multivariate regression showed that the duration from the onset, the three loadings, BCVA, disorganization of the retinal inner layer (DRIL), and choroidal thickness were predictors related to visual gain (p = 0.044, p = 0.047, p = 0.004, p = 0.045, and p = 0.034, respectively). Age, three loadings, BCVA, and DRIL were predictors related to final visual acuity (p = 0.045, p = 0.046, p = 0.002, and p = 0.034, respectively). Duration from the onset, CMT, and choroidal thickness were predictors related to CMT improvement (p = 0.042, p = 0.009, and p = 0.015, respectively). Conclusions In macular edema of BRVO, the initial three monthly intravitreal injections of bevacizumab provided superior treatment outcomes regarding short-term functional and anatomical improvements and long-term functional improvement, compared with methods that did not treat with the initial three monthly injections.

Purpose: To investigate the bacterial culture, clinical characteristics, and prognosis associated with infectious endophthalmitis in western Gyeongsangnam-do. Methods: This study was a retrospective review of the medical records of 98 eyes that presented with infectious endophthalmitis from 2010 to 2019. All patients were analyzed for the type of causative bacteria, treatment method, and the visual prognosis. Results: The bacterial cultures (n = 98 eyes) revealed bacterial growth in 67 eyes (68.4%). The most commonly isolated causative microorganism was Gram-positive Staphylococcus epidermidis (14.3%). As a result of analyzing the best corrected visual acuity (VA) based on 1.0 (logMAR), baseline VA was worse than counting fingers, and whether pars plana vitrectomy was undertaken showed a difference in the final visual acuity (p < 0.001, p = 0.021). Conclusions Exogenous endophthalmitis occurs frequently after cataract surgery, and S. epidermidis is the most common causative agent, but a good visual prognosis resulted. Liver abscess was a common extraocular source of endogenous endophthalmitis and Klebsiella pneumonia was the most common causative agent for a poor visual prognosis.

Purpose: To investigate the bacterial culture, clinical characteristics, and prognosis associated with infectious endophthalmitis in western Gyeongsangnam-do. Methods: This study was a retrospective review of the medical records of 98 eyes that presented with infectious endophthalmitis from 2010 to 2019. All patients were analyzed for the type of causative bacteria, treatment method, and the visual prognosis. Results: The bacterial cultures (n = 98 eyes) revealed bacterial growth in 67 eyes (68.4%). The most commonly isolated causative microorganism was Gram-positive Staphylococcus epidermidis (14.3%). As a result of analyzing the best corrected visual acuity (VA) based on 1.0 (logMAR), baseline VA was worse than counting fingers, and whether pars plana vitrectomy was undertaken showed a difference in the final visual acuity (p < 0.001, p = 0.021). Conclusions Exogenous endophthalmitis occurs frequently after cataract surgery, and S. epidermidis is the most common causative agent, but a good visual prognosis resulted. Liver abscess was a common extraocular source of endogenous endophthalmitis and Klebsiella pneumonia was the most common causative agent for a poor visual prognosis.

PURPOSE: Due to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC. MATERIALS AND METHODS: The study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort. RESULTS: Overall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827. CONCLUSION: Our current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.
Aged ; Asian Continental Ancestry Group ; Humans ; Logistic Models ; Male ; Middle Aged ; *Nomograms ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/surgery