We report a case of cytomegalovirus (CMV) retinitis after intravitreal bevacizumab injection. A 61-year-old woman with diabetic macular edema developed dense vitritis and necrotizing retinitis 3 weeks after intravitreal bevacizumab injection. A diagnostic vitrectomy was performed. The undiluted vitreous sample acquired by vitrectomy was analyzed by polymerase chain reaction and culture. Polymerase chain reaction of the vitreous was positive for CMV DNA. Other laboratory results did not show evidence of other infectious retinitis and systemic immune dysfunction. Human immunodeficiency virus antibodies were also negative. After systemic administration of ganciclovir, retinitis has resolved and there has been no recurrence of retinitis during the follow-up period of 12 months. Ophthalmologists should be aware of potential risk for CMV retinitis after intravitreal bevacizumab injection.
Angiogenesis Inhibitors/administration & dosage/adverse effects ; Antibodies, Monoclonal, Humanized/administration & dosage/*adverse effects ; Cytomegalovirus/genetics ; Cytomegalovirus Retinitis/diagnosis/*etiology/immunology ; DNA, Viral/analysis ; Diagnosis, Differential ; Female ; Humans ; Immunocompetence/*drug effects ; Intravitreal Injections ; Macular Edema/diagnosis/*drug therapy ; Middle Aged ; Polymerase Chain Reaction ; Vascular Endothelial Growth Factor A/antagonists & inhibitors

PURPOSE: To compare the efficacy between intravitreal bevacizumab and combination treatment (bevacizumab and macular photocoagulation) for the treatment of diabetic macular edema (DME). In addtion, changes of DME type were researched using optical coherence tomography. METHODS: The present study included 90 eyes with bevacizumab injection and 38 eyes with combination treatment. Using chart records, patients were reviewed until 6 months after treatment. The present study compared changes of visual acuity (VA) and macular thickness at each follow up. DME was classified into 4 types and the morphologic pattern was compared. RESULTS: In patients with the bevacizumab injection only, VA improved from 0.29 +/- 0.18 to 0.48 +/- 0.26 at 1 month and returned to 0.32 +/- 0.20 at 6 months after treatment. In the combination treatment, VA improved from 0.32 +/- 0.22 to 0.52 +/- 0.26 at 1 month and returned to 0.36 +/- 0.18 at 6 months after treatment. There was no significant improvement of VA at the final follow-up with either treatment. There was significant decrease of macular thickness except in the mixed DME type. CONCLUSIONS: The combination treatment did not yield better VA or macular thickness reduction at 6 months than bevacizumab injection alone. By classifying and observing the change of DME type, determining the treatment objectively and predicting the effectiveness of treatment can be helpful.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Diabetic Retinopathy/*complications/diagnosis/therapy ; Dose-Response Relationship, Drug ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Intravitreal Injections ; Laser Coagulation/*methods ; Macular Edema/diagnosis/etiology/*therapy ; Male ; Microscopy, Acoustic ; Middle Aged ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity

PURPOSE: To compare the efficacy between intravitreal bevacizumab and combination treatment (bevacizumab and macular photocoagulation) for the treatment of diabetic macular edema (DME). In addtion, changes of DME type were researched using optical coherence tomography. METHODS: The present study included 90 eyes with bevacizumab injection and 38 eyes with combination treatment. Using chart records, patients were reviewed until 6 months after treatment. The present study compared changes of visual acuity (VA) and macular thickness at each follow up. DME was classified into 4 types and the morphologic pattern was compared. RESULTS: In patients with the bevacizumab injection only, VA improved from 0.29 +/- 0.18 to 0.48 +/- 0.26 at 1 month and returned to 0.32 +/- 0.20 at 6 months after treatment. In the combination treatment, VA improved from 0.32 +/- 0.22 to 0.52 +/- 0.26 at 1 month and returned to 0.36 +/- 0.18 at 6 months after treatment. There was no significant improvement of VA at the final follow-up with either treatment. There was significant decrease of macular thickness except in the mixed DME type. CONCLUSIONS: The combination treatment did not yield better VA or macular thickness reduction at 6 months than bevacizumab injection alone. By classifying and observing the change of DME type, determining the treatment objectively and predicting the effectiveness of treatment can be helpful.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Diabetic Retinopathy/*complications/diagnosis/therapy ; Dose-Response Relationship, Drug ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Intravitreal Injections ; Laser Coagulation/*methods ; Macular Edema/diagnosis/etiology/*therapy ; Male ; Microscopy, Acoustic ; Middle Aged ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity

No abstract available.
Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Female ; Glucocorticoids/*administration & dosage ; Humans ; Injections, Intraocular ; Macular Edema/*drug therapy/etiology ; Male ; Middle Aged ; Retinal Vein Occlusion/*complications ; Triamcinolone Acetonide/*administration & dosage ; Vitreous Body

PURPOSE: To compare the effects of intravitreal bevacizumab to those of triamcinolone acetonide injection for the treatment of macular edema secondary to branch retinal vein occlusion. METHODS: This retrospective study included 50 eyes of 50 patients who received a single injection of intravitreal bevacizumab (1.25 mg/0.05 mL, 22 eyes) or triamcinolone acetonide (4 mg/0.1 mL, 28 eyes) as the only treatment for macular edema secondary to branch retinal vein occlusion; all patients had a post-injection follow-up duration of >24 weeks. Best corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) by optical coherence tomography were measured for up to 24 weeks after injection. RESULTS: BCVA was improved at 1, 4, 8,12 weeks post-injection in the bevacizumab group, and at 1, 4, 8 weeks post-injection in the triamcinolone group. No significant difference was found between the two groups except at 12 weeks. CMT decreased significantly within each group, and no significant difference between groups was found. In the bevacizumab group, no elevated IOP was observed, whereas IOP was significantly increased at 4, 8, and 12 weeks after triamcinolone injection; IOP was therefore significantly different between the two groups. CONCLUSIONS: Intravitreal bevacizumab is a comparatively simple treatment method that can effectively improve BCVA and reduce CMT without ocular and systemic complications. Consequently, intravitreal bevacizumab injections may be useful as both an alternative and primary treatment for macular edema secondary to branch retinal vein occlusion.
Adult ; Aged ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Female ; Follow-Up Studies ; Glucocorticoids/*administration & dosage ; Humans ; Injections ; Macular Edema/diagnosis/*drug therapy/etiology ; Male ; Middle Aged ; Retinal Vein Occlusion/*complications/diagnosis ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity ; Vitreous Body

PURPOSE: To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular edema. METHODS: In a retrospective study, 44 eyes with diffuse diabetic macular edema were treated with an intravitreal injection of 4 mg (n=12 eyes), 8 mg (n=17) or 25 mg (n=15) of triamcinolone acetonide (TA). Optical coherence tomography, best-corrected logMAR visual acuity and Goldmann tonometry were performed at baseline, 1 week, and 1, 3, 6, 9 and 12 months after treatment. Mean follow-up was 9.8 months (standard deviation=2.3) with a range of 5-12 months. RESULTS: The duration of intravitreal TA effects on macular thickness and visual acuity increased with increasing dosage. An observed increase in intraocular pressure induced by TA was not significantly associated with dosage. CONCLUSIONS: In patients with diffuse diabetic macular edema who receive intravitreal TA, effects may last longer after a dosage of 25 mg, than after lower doses of 8 mg or 4 mg.
Adult ; Aged ; Aged, 80 and over ; Diabetic Retinopathy/*complications/drug therapy/pathology ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Glucocorticoids/*administration & dosage ; Humans ; Injections ; Intraocular Pressure ; Macular Edema/diagnosis/*drug therapy/etiology ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Vitreous Body

INTRODUCTIONWe report a case in which intravitreal bevacizumab and ranibizumab appeared to have effects in the contralateral, uninjected eye.

CLINICAL PICTUREAn 83-year-old man with macular oedema from branch retinal vein occlusion (BRVO) in the right eye developed neovascular macular degeneration in the left eye. Intravitreal bevacizumab in the left eye improved macular oedema in the right eye temporarily before it recurred. Subsequently, intravitreal ranibizumab in the left eye also resulted in significant reduction of macular oedema in the right eye.

OUTCOMEVision and macular oedema in the right eye improved.

CONCLUSIONBevacizumab and ranibizumab may have therapeutic effects in the uninjected eye, possibly because they may escape from the eye into the systemic circulation.

Aged, 80 and over ; Angiogenesis Inhibitors ; administration & dosage ; therapeutic use ; Antibodies, Monoclonal ; administration & dosage ; therapeutic use ; Antibodies, Monoclonal, Humanized ; Bevacizumab ; Eye ; drug effects ; Humans ; Injections ; Macular Edema ; drug therapy ; etiology ; Male ; Ranibizumab ; Retinal Vein Occlusion ; complications ; Treatment Outcome ; Vitreous Body

To report a case of cytomegalovirus (CMV) retinitis after intravitreal injection of triamcinolone acetonide (IVTA). A 77-year-old woman with macular edema due to central retinal vein occlusion (CRVO) developed peripheral retinitis 4 months after IVTA. A diagnostic anterior chamber paracentesis was performed to obtain DNA for a polymerase chain reaction (PCR) test for viral retinitis. The PCR test was positive for CMV DNA. Other tests for infective uveitis and immune competence were negative. Four months after presentation, gancyclovir was intravitreously injected a total of 5 times, and the retinitis resolved completely. CMV retinitis is a rare complication of local immunosuppression with IVTA. It can be managed with timely injection of intravitreal gancyclovir until recovery from local immunosuppression.
Aged ; Antiviral Agents/therapeutic use ; Cytomegalovirus/genetics ; Cytomegalovirus Retinitis/diagnosis/drug therapy/*etiology ; DNA, Viral/analysis ; Female ; Ganciclovir/therapeutic use ; Humans ; Immunosuppressive Agents/*adverse effects ; Injections ; Macular Edema/drug therapy/etiology ; Polymerase Chain Reaction ; Retinal Vein Occlusion/complications/*drug therapy ; Triamcinolone Acetonide/*adverse effects ; Vitreous Body

A 47 year old male patient visited our hospital with the chief complaint of deterioration of the visual acuity in the left eye. The fundus examination revealed thick hard exudates, multiple aneurysms and telangiectasias of the retinal vessels in the posterior pole. Fluorescein angiography demonstrated massive leakage over an area of the aneurysms. Optical coherence tomography (Stratus OCT; Zeiss-Humphrey, Dubin, CA) revealed diffuse and marked thickening of the retina. Laser photocoagulation was performed under the diagnosis of Coats' disease. However, the treatment could not be performed satisfactorily. On the first and 6th weeks, an intravitreal injection of bevacizumab and triamcinolone acetonide was administered, and laser photocoagulation was again attempted. The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection. At one week after the intravitreal bevacizumab injection, there was no improvement. An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema. Therefore, laser photocoagulation was performed sufficiently on telangiectasias. The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.
Angiogenesis Inhibitors/*therapeutic use ; Antibodies, Monoclonal/*therapeutic use ; Drug Therapy, Combination ; Fluorescein Angiography ; Glucocorticoids/*therapeutic use ; Humans ; Injections ; Laser Coagulation ; Macular Edema/*drug therapy/etiology ; Male ; Middle Aged ; Retinal Diseases/complications/*drug therapy/surgery ; Retinal Vessels/pathology ; Telangiectasis/complications/*drug therapy/surgery ; Tomography, Optical Coherence ; Triamcinolone Acetonide/*therapeutic use ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Vitreous Body

PURPOSE: To compare intravitreal triamcinolone acetonide (IVT) versus natural course in refractory diabetic macular edema. METHODS: In a prospective interventional case series, twenty five eyes with refractory DME which had been allocated to the sham group of a previous clinical trial underwent new examination and optical coherence tomography about 9 months after their first enrollment. Twenty eyes that met the inclusion criteria, visual acuity (VA) < 20/50 and central macular thickness (CMT) > 200 micrometer, were treated by 4 mg IVT. Evaluations were repeated at 2 and 4 months post-injection to imitate the similar examination intervals after sham injection. Corrected visual acuity and macular thickness changes following IVT were compared to the corresponding changes after sham injection (the natural course). RESULTS: Visual acuity changes within and between each period were not statistically significant. Visual acuity decreased 0.08 & 0.09 logMAR by 2 months and 0.06 & 0.04 logMAR by 4 months after sham and IVT injections, respectively. The changes of macular thickness after IVT and sham intervention were not meaningful either. However, the difference between thickness changes by 4 months (52+/-50 micrometer increase after sham vs. 262+/-115 micrometer reduction after IVT) was significant (P=0.014). CONCLUSIONS: Concerning macular thickness, IVT has beneficial effect on refractory diabetic macular edema as opposed to observation. However, considering visual acuity, it does not induce significant difference in comparison to the natural course of the disease.
Diabetic Retinopathy/*complications/pathology ; Female ; Follow-Up Studies ; Glucocorticoids/*administration & dosage ; Humans ; Injections ; Macula Lutea/drug effects/*pathology ; Macular Edema/*drug therapy/etiology/pathology ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Vitreous Body