No abstract available.
Humans ; Laser Therapy/methods ; Magnetic Resonance Imaging ; Male ; Orbital Cellulitis/*complications/diagnosis ; Retinal Vein Occlusion/diagnosis/*etiology/surgery ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: The purpose of the study was to differentiate ischemic central retinal vein occlusion (CRVO) from nonischemic CRVO during the early acute phase using plasma homocysteine as a biochemical marker. METHODS: Fasting plasma homocysteine, serum vitamin B12, and folate levels were measured in 108 consecutive unilateral elderly adult (age >50 years) ischemic CRVO patients in the absence of local and systemic disease and compared with a total of 144 age and sex matched nonischemic CRVO patients and 120 age and sex matched healthy control subjects. RESULTS: Homocysteine level was significantly increased in the patients with ischemic CRVO in comparison with nonischemic CRVO patients (p = 0.009) and also in comparison with control subjects (p < 0.001). Analysis also showed that hyperhomocysteinemia was associated with increased incidence of ischemic CRVO (odds ratio, 18) than that for nonischemic CRVO (odds ratio, 4.5). Serum vitamin B12 and folate levels were significantly lower (p < 0.001) in CRVO patients compared to the control but were not significantly different between nonischemic and ischemic CRVO patients (p > 0.1). CONCLUSIONS: Hyperhomocysteinemia can be regarded as useful in differentiating nonischemic and ischemic CRVO during the early acute phase in absence of local and systemic disease in the elderly adult (age >50 years) population.
Acute Disease ; Aged ; Biomarkers/*blood ; Case-Control Studies ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Hyperhomocysteinemia/blood/*complications/diagnosis ; Male ; Middle Aged ; Prospective Studies ; Retinal Vein Occlusion/complications/*diagnosis ; Time Factors

PURPOSE: To compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: We reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase. RESULTS: Totals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups. CONCLUSIONS: Although IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Female ; Follow-Up Studies ; Glucocorticoids/administration & dosage ; Humans ; Intravitreal Injections ; Laser Therapy/*methods ; Macular Edema/diagnosis/etiology/*therapy ; Male ; Middle Aged ; Recurrence ; Retinal Vein Occlusion/*complications/diagnosis/therapy ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Visual Acuity

PURPOSE: To compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: We reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase. RESULTS: Totals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups. CONCLUSIONS: Although IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Female ; Follow-Up Studies ; Glucocorticoids/administration & dosage ; Humans ; Intravitreal Injections ; Laser Therapy/*methods ; Macular Edema/diagnosis/etiology/*therapy ; Male ; Middle Aged ; Recurrence ; Retinal Vein Occlusion/*complications/diagnosis/therapy ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Visual Acuity

PURPOSE: To evaluate patients' self-recognition of reduced visual acuity due to recurring macular edema in retinal vein occlusion. METHODS: A retrospective review of medical records of patients who were diagnosed with recurring macular edema secondary to retinal vein occlusion was performed. The proportion of patients who recognized reduced visual acuity due to the recurrence of macular edema and who visited the hospital before the scheduled follow-up date was determined. Parameters including age, sex, diagnosis, visual acuity before recurrence of macular edema, and extent of visual acuity reduction due to recurrence of macular edema were compared in patients who recognized a reduction in visual acuity and those who did not. The proportion of patients who visited the hospital promptly was also determined. RESULTS: Forty eyes of 40 patients were included in the analysis. Sixteen and 24 patients were diagnosed with central retinal vein occlusion and branch retinal vein occlusion, respectively. Twenty-one patients (52.5%) recognized reduced visual acuity due to recurring macular edema. These patients were younger (59.2 +/- 7.6 vs. 64.8 +/- 9.4 years, p = 0.046), had better visual acuity before recurrence of macular edema (0.52 +/- 0.48 vs. 1.02 +/- 0.46, p = 0.002), and exhibited a greater reduction in visual acuity after recurrence of macular edema (0.34 +/- 0.24 vs. 0.14 +/- 0.13, p = 0.003). Only four patients visited the hospital before the scheduled follow-up date, and all of these patients lived relatively close to the hospital. CONCLUSIONS: For prompt treatment of recurring macular edema, more intensive education about the self-estimation of visual acuity is necessary, particularly for elderly patients who have relatively poor visual acuity. In addition, a simple and easy way to identify the recurrence of macular edema at the local clinic should be established for patients who live relatively far from the hospital.
Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Macular Edema/*diagnosis/etiology/physiopathology ; Male ; Middle Aged ; *Patient Readmission ; Recurrence ; Retinal Vein Occlusion/*complications/diagnosis/physiopathology ; Retrospective Studies ; Tomography, Optical Coherence ; *Visual Acuity

Branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO) rarely cause neovascular glaucoma (NVG). A 58-year-old woman with hypertension and type 2 diabetic mellitus complained of progressive visual loss in her right eye for the previous 3 months. At initial examination, visual acuity was 20 / 63 in the right eye. Angle neovascularization was observed and the intraocular pressure (IOP) was 30 mmHg in her right eye. Fundus examination and fluorescein angiography showed BRAO combined with BRVO. We immediately injected intravitreal and intracameral bevacizumab in her right eye. The next day, we performed scatter photocoagulation in the nonperfusion area. One month later, visual acuity was 20 / 20 in her right eye and the IOP was 17 mmHg with one topical antiglaucoma agent. The neovascularization had regressed completely. We report a case of unilateral NVG which was caused by BRAO with concomitant BRVO and advise close ophthalmic examination of the iris and angle in BRVO with BRAO.
Diagnosis, Differential ; Female ; Fluorescein Angiography ; Fundus Oculi ; Glaucoma, Neovascular/diagnosis/*etiology/physiopathology ; Humans ; Intraocular Pressure ; Middle Aged ; Retinal Artery Occlusion/*complications/diagnosis ; Retinal Vein Occlusion/*complications/diagnosis

We investigated the demographic characteristics and risk factors of Korean patients with naIve central or branch retinal vein occlusion (CRVO or BRVO). This study enrolled 41 clinical sites throughout Korea and included 557 consecutive patients with retinal vein occlusion (RVO) from May through November 2010. A total of 557 patients with new-onset RVO participated in this study. Two hundred and three (36.4%) patients were diagnosed with CRVO and 354 (63.6%) patients were diagnosed with BRVO. Comparisons between the two groups showed that the prevalence of diabetes mellitus was significantly higher in CRVO patients and hypertension was significantly higher in BRVO patients (P = 0.001 and 0.002, respectively). Poor baseline visual acuity was significantly associated with female and old age in BRVO patients (P = 0.002 and 0.013, respectively), whereas the wide intraretinal hemorrhage (CRVO, P = 0.029; BRVO, P < 0.001) and the macular ischemia (CRVO, P < 0.001; BRVO, P < 0.001) were associated with both groups. The study results show the clinical features of RVO in Korean patients. Hypertension is strongly associated with BRVO and diabetes mellitus is more strongly associated with CRVO in Korean patients with RVO. As the first nationwide study performed by the Korean Retinal Society, the results of this study can be applied to future studies on RVO.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; Demography ; Diabetes Complications ; Female ; Humans ; Hypertension/complications ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Regression Analysis ; Republic of Korea ; Retinal Hemorrhage/complications ; Retinal Vein Occlusion/complications/*diagnosis ; Risk Factors ; Sex Factors ; Young Adult

INTRODUCTIONThis study aims to compare the long-term efficacy of 25-gauge vitrectomy to that of intravitreal bevacizumab (IVB) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).

MATERIALS AND METHODSThe medical records of 46 eyes of 46 consecutive patients were reviewed. Twenty-seven eyes underwent 25-gauge vitrectomy (VIT Group) and 19 eyes received 1.25 mg of IVB (IVB Group). The best-corrected visual acuities (BCVAs) in logarithm of minimum angle resolution units and central macular thicknesses (CMTs) were evaluated before and 3, 6, and 12 months after the initial treatment.

RESULTSThere was no significant difference in the pre-treatment BCVA and CMT between the 2 groups. In the VIT Group, the preoperative BCVA was 0.59 and the CMT was 587.3 μm and the BCVA was 0.35 and the CMT was 286.6 μm, 12 months after the vitrectomy. Both values were significantly (P <0.05) better at 12 months than the preoperative values. In the IVB Group, the average number of IVB was 2.4 during the 1-year period. The BCVA was 0.69 and the CMT was 590.9 μm before the IVB, and the BCVA was 0.36 and the CMT was 360.1 μm, 12 months after the initial IVB. The improvements of these 2 parameters were significant (P <0.05) at 12 months after the initial IVB. The differences in the BCVA and CMT at 12 months between the 2 groups were not significant.

CONCLUSIONThese results suggest that the 25-gauge vitrectomy and IVB have similar effects in improving the BCVA and CMT in eyes with ME secondary to BRVO. However, IVB often required several injections to preserve the improvement.

Aged ; Angiogenesis Inhibitors ; therapeutic use ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Bevacizumab ; Female ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macula Lutea ; pathology ; Macular Edema ; etiology ; therapy ; Male ; Middle Aged ; Retinal Vein Occlusion ; complications ; Retrospective Studies ; Treatment Outcome ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors ; Visual Acuity ; Vitrectomy ; methods

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

A 60-year-old woman who had experienced two episodes of amaurosis fugax in her right eye presented with vision loss. Two weeks earlier, at a private clinic, she was diagnosed with impending central retinal vein occlusion (CRVO) of the right eye and received an intravitreal injection of bevacizumab. Two weeks after this injection she was diagnosed with ischemic CRVO. At 11-weeks post-presentation, extremely ischemic features were observed with fluorescein angiographic findings of severe vascular attenuation and extensive retinal capillary obliteration. At 22-weeks post-presentation she was diagnosed with neovascular glaucoma; she experienced no visual improvement over the following several months.
Antibodies, Monoclonal/*administration & dosage ; Disease Progression ; Female ; Fluorescein Angiography ; Glaucoma, Neovascular/complications ; Humans ; Injections, Intraocular ; Ischemia/diagnosis/*etiology/physiopathology ; Middle Aged ; Retinal Vein Occlusion/*complications/*drug therapy/physiopathology ; *Retinal Vessels ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/drug effects ; Vitreous Body