Short-Term Outcomes following "Switching" to Monthly Ranibizumab in Neovascular Age-Related Macular Degeneration Showing Insufficient Response to Bimonthly Aflibercept

Background/Objectives. To evaluate the efficacy of switching to monthly ranibizumab in neovascular age-related macular de generation (nAMD) showing an insufficient response to bimonthly aflibercept. Subjects/Methods. A total of 13 nAMD eyes showing an insufficient treatment response to three successive aflibercept injections were enrolled through a retrospective chart review. After switching, three consecutive monthly intravitreal ranibizumab injections were performed. *e main outcome measurements included the best-corrected visual acuity (BCVA), central retinal thickness (CRT), presence of intraretinal fluid (IRF), and subretinal fluid (SRF) using optical coherence tomography (OCT) and were measured every month. Results. CRT and logMAR VA were 349.62 ± 223.51 μm and 0.50 ± 0.23 at the baseline and 274.69 ± 148.77 μm and 0.46 ± 0.24, 311.54 ± 192.90 μm and 0.45 ± 0.20 at 1 month after the first and third ranibizumab injections, respectively. *e CRT decrease during three ranibizumab injections was statistically significant (38.08 ± 69.52 μm, p � 0.033). Change in VA was not statistically significant. *e percentage of eyes with SRF was 100% at baseline and 53.8%, 76.9%, and 69.2% one month after each ranibizumab injections. *e percentage of eyes with IRF was 38.5% at baseline and 23.1%, 23.1%, and 15.4%, respectively, after switching. Conclusion. Switching to monthly ranibizumab in nAMD showing an insufficient response to bimonthly aflibercept led to immediate anatomical improvement. It can be considered in countries where the healthcare insurance system limits the minimum injection interval of aflibercept.ope

Long-term outcomes of focal laser photocoagulation for the treatment of polypoidal choroidal vasculopathy

Aim: To evaluate the long-term effect and safety of focal laser photocoagulation treatment in eyes with polypoidal choroidal vasculopathy (PCV). Methods: Medical records of 13 eyes of 13 patients with PCV were followed-up for more than 2y after focal laser photocoagulation treatment. The patients were diagnosed with PCV using indocyanine green angiography, and eyes with other comorbid ocular diseases were excluded. The measurement outcomes of the study were the post-treatment regression and recurrence of polyps, complications, and changes in visual acuities. Paired t-test was performed to compare visual outcome before and after the treatment. Results: The mean age of the 13 patients was 70.2±5.5y, and the follow-up period was 72.3±31.0 (range, 25-118)mo. Three eyes had juxtafoveal polyps and 10 eyes had extrafoveal polyps. Of the 13 eyes, 9 eyes (69.2%) had regression of polyps 1.7±1.2 (range, 0.9-4)mo after focal laser photocoagulation. Five eyes (55.6%) showed recurrence of polyps during the follow-up periods, and the recurrence period was 12.8±18.9 (range, 1.9-48)mo. Mild subretinal hemorrhage occurred in two eyes (15.4%) 27 and 72d after laser treatment, respectively. There were no statistically significant differences in visual acuities at baseline; 1, 2, 3y post-treatment (all P>0.05); and last follow-up (0.63±0.5, 0.73±0.70, 0.67±0.57, 0.75±0.7, and 0.95±0.8 logMAR, respectively). Conclusion: Focal laser photocoagulation is beneficial for early regression of polyps in eyes with PCV and does not result in significant submacular hemorrhage during the long-term follow-up. Furthermore, it can be primarily considered in eyes with PCV with extrafoveal or juxtafoveal polyps to regress risky polyps as well as to maintain visual acuity without serious hemorrhagic complications.ope

Paired comparisons of mutational profiles before and after brachytherapy in asian uveal melanoma patients

Uveal melanoma(UM) is the most common primary intraocular malignancy in adults. However, the incidence of UM in Asia is 10 to 20 times less than in Western populations. Therefore, for the first time, we report our whole exome sequencing (WES) data analysis to discover differences in the molecular features of Asian and Western UM, and to determine the disparities between the primary tumor before brachytherapy and enucleated samples after brachytherapy. WES of 19 samples (13 primary tumors, 5 enucleation samples after brachytherapy, and 1 liver metastasis) from 13 patients diagnosed with UM and treated between 2007 and 2019 at the Yonsei University Health System (YUHS) were analyzed using bioinformatics pipelines. We identified significantly altered genes in Asian UM and changes in mutational profiles before and after brachytherapy using various algorithms. GNAQ, BAP1, GNA11, SF3B1 and CYSLTR2 were significantly mutated in Asian UM, which is similar that reported frequently in previous Western-based UM studies. There were also similar copy number alterations (M3, 1p loss, 6p gain, 8q gain) in both groups. In paired comparisons of the same patients, DICER1 and LRP1B were distinctly mutated only in tumor samples obtained after brachytherapy using rare-variant association tests (P = 0.01, 0.01, respectively). The mutational profiles of Asian UM were generally similar to the data from previous Western-based studies. DICER1 and LRP1B were newly mutated genes with statistical significance in the regrowth samples after brachytherapy compared to the primary tumors, which may be related to resistance to brachytherapy.ope

Clinical characteristics, risk factors, and surgical outcomes of secondary macular hole after vitrectomy

Secondary macular hole(MH) formation after vitrectomy is rare and its risk factors and pathogenesis are not clearly understood. This retrospective study was conducted to identify the risk factors of this complication and assess outcomes at 2 tertiary centres. The primary outcomes were the clinical characteristics associated with development of secondary MH, which included the primary diagnosis for initial vitrectomy, features on optical coherence tomography, and adjuvant surgical techniques used during the initial surgery. Secondary outcomes included the change in best-corrected visual acuity(BCVA), clinical factors associated with the need for re-operations for MH closure and prognostic factors for the visual outcomes. Thirty-eight eyes out of 6,354 cases (incidence 0.60%) developed secondary MH after undergoing vitrectomy for various vitreoretinal disorders over an 11-year period, most frequently after initial surgery for retinal detachment(RD) (9 eyes) and secondary epiretinal membrane (6 eyes). The mean age was 57.1 years (range: 17.8-76.7), and the mean follow-up was 51.1 months (range: 6.8 to 137.6). Prior to secondary MH formation, development of ERM was the most common OCT feature (19 eyes, 50%), and no cases of cystoid macular oedema (CME) were observed. A greater proportion of eyes with secondary MH had long axial lengths (32% ≥26 mm vs 5% of eyes ≤22 mm). MH closure surgery was performed in 36 eyes and closure was achieved in 34 (success rate 94%, final BCVA 20/86), with ≥3-line visual gain in 18 cases. BCVA at MH onset (OR = 0.056, P = 0.036), BCVA at post-MH surgery month 3 (OR = 52.671, P = 0.011), and axial length ≥28 mm (OR = 28.487, P = 0.030) were associated with ≥3-line visual loss; a history of macula-off RD (OR = 27.158, P = 0.025) was associated with the need for multiple surgeries for MH closure. In conclusion, secondary MH occurs rarely but most commonly after vitrectomy for RD. Patients with axial length ≥28 mm and poor BCVA at 3 months post-operation may have limited visual prognosis; those with a history of macula-off RD may require multiple surgeries for hole closure.ope

Refractive Outcomes of 4-Year-old Children after Intravitreal Anti-vascular Endothelial Growth Factor versus Laser Photocoagulation for Retinopathy of Prematurity

PURPOSE: To compare long-term refractive outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) versus laser photocoagulation treatment for retinopathy of prematurity (ROP). METHODS: A total of 52 eyes from 27 ROP patients treated at two tertiary referral-based hospitals from August 2006 to December 2013 were reviewed. The primary outcome was refractive error measured at the age of 4 years, accounting for within-patient inter-eye correlation. Secondary outcomes included the recurrence rate and treatment complications. RESULTS: The mean age at refraction was 4.7 ± 0.3 years in the laser group (n = 30) and 4.4 ± 0.3 years in the anti-VEGF group (n = 22). No significant differences were noted in gestational age, birthweight, post-menstrual age at treatment, or ROP stage/zone distribution between groups. Mean spherical equivalent was also not significantly different (-1.0 diopters in the laser group and -0.3 diopters in the injection group, p = 0.603). Clustered regression analysis revealed that only gestational age was significantly correlated with mean spherical equivalent (p < 0.001; 95% confidence interval, -0.007 to -0.002). Recurrence was noted in four eyes (13.3%) in the laser group, but this difference was not significant (p = 0.128). There were no major systemic complications reported in either group. CONCLUSIONS: Treatment type, whether laser or anti-VEGF injection, does not appear to influence long-term refractive outcomes in ROP. Concern regarding refractive outcomes should not be the most important factor when selecting ROP treatment modality.ope

유리체강내 브롤루시주맙 주사시술 후 발생한 망막 혈관염: 국내 첫 보고

Purpose: We present the first case of retinal vasculitis following intravitreal brolucizumab injection in South Korea. Case summary: A 76-year-old man with a medical history of hypertension who had been diagnosed with polypoidal choroidal vasculopathy of the left eye was treated with anti-vascular endothelial growth factor (VEGF) agents. Fifteen intravitreal ranibizumab, 17 aflibercept, and 12 bevacizumab injections were administered. On April 27, 2021, the anti-VEGF agent was switched to brolucizumab. Eight weeks after the first brolucizumab injection, the patient visited our clinic with conjunctival redness and cloudiness of vision in his left eye. A mild inflammatory reaction with grade 0.5 + cells was observed in both the anterior and vitreous chambers. Fundus photography showed cotton wool spots in the inferior and superior arcade, indicating acute retinal ischemia. Moderate leakage was observed at the optic disc along with cotton wool spots lesions and peripheral retinal capillaries on fluorescein angiography. Optical coherence tomography angiography (OCTA) showed significant reduction of vessel density (VD) in the superficial layers. The patient was treated with oral prednisolone (30 mg) and topical corticosteroids to relieve inflammation and vasculitis. After 1 week of treatment, the patient’s symptoms, inflammation, and cotton wool spots on the vascular arcades had regressed, and the VD of the superficial layers on OCTA had normalized. Conclusions: This is the first reported case of retinal vasculitis following intravitreal brolucizumab injection in South Korea. We suggest that VD of the superficial layers that is visible on OCTA can be a useful index to diagnose and track brolucizumab-induced retinal vasculitis.ope

Intravitreal dexamethasone implant for central retinal vein occlusion without macular edema

BACKGROUND: To evaluate the efficacy of an intravitreal dexamethasone (IVD) implant (Ozurdex®) for the treatment of central retinal vein occlusion (CRVO) without macular edema (ME). METHODS: A retrospective cohort study was designed, and 20 eyes of 20 patients diagnosed with non-ischemic CRVO without ME were included. A total of 10 CRVO eyes were observed without treatment, and another 10 CRVO eyes received a single IVD injection at baseline. Mean changes in pathomorphologic parameters of fundus and optical coherence tomography parameters were measured at baseline and at 1, 3, 6, and 12 months. RESULTS: The decreases in venous tortuosity (p = 0.014 for superior; 0.036 for inferior arcades) and width (p = 0.024 for superior; 0.003 for inferior arcades) from baseline to 12 months after injection were significantly greater in the treated group than the observed group. The improvements in RNFL swelling (p = 0.010) and retinal hemorrhage (p = 0.006) were also significantly greater in the treated group. Visual symptom improvement was significantly faster in the treated group (p = 0.001). In two cases, IVD injection resulted in complete resolution of cilioretinal artery occlusion associated with the CRVO, leading to complete visual recovery in 1 week. None of the treated eyes showed signs of ME development, ischemia progression, or neovascularization. CONCLUSIONS: IVD implant was significantly effective in improving venous engorgement, retinal hemorrhage, RNFL swelling, and visual symptoms by presumed alleviation of disc swelling and venous outflow. This treatment may be a considerable treatment option in CRVO patients with no ME.ope

Simple technique for the rescue and refixation of a partially disenclavated retropupillary iris claw intraocular lens

AIM: To describe and compare pathologic findings in eyes enucleated after superselective ophthalmic arterial chemotherapy (SOAC) or SOAC with intravenous chemotherapy (IVC) for retinoblastoma. METHODS: Medical records between January 1st, 2014 and June 31st, 2017 were retrospectively analyzed, and pathologic findings were recorded. This study included 36 eyes from 22 (61.1%) male and 14 (38.9%) female patients. Nineteen of 36 (52.8%) eyes received SOAC (mean=3, range=1-7) as primary treatment, and 17 of 36 (47.2%) eyes received SOAC (mean=3.7, range=1-10) after IVC (mean=6.1, range=2-11). Tumor extension including choroidal invasion (n=9, 25%), optic nerve invasion (n=5, 13.9%) and anterior segment invasion (n=5, 13.9%) were recorded. RESULTS: Histopathologic evidence of ischemic damage in the retina and choroid was found in 28 (77.8%) eyes. Thrombosed blood vessels were identified in 9 (25%) eyes, including orbital artery in the retrobulbar orbit (n=1), intrascleral vessels (n=4), and chorioretinal vessels (n=6). Fibrotic changes were found in extraocular muscles (n=5, 13.9%) and optic nerve (n=5, 13.9%). Varying degrees of scleral degeneration were found in all eyes. In statistical analysis, there was no significant difference in clinical and pathologic changes between SOAC group and SOAC with IVC group except for optic nerve invasion (P=0.047). CONCLUSION: SOAC for retinoblastoma can result in ocular toxicity, and SOAC with IVC did not increase the toxicity but reduced the incidence of optic nerve invasion.ope

Biochemically-verified Smoking Rate Trends and Factors Associated with Inaccurate Self-reporting of Smoking Habits in Korean Women

BACKGROUND: Lung cancer is a major cause of Korean female mortality and is clearly associated with smoking. The Korean National Health and Nutrition Examination Survey (KNHANES IV-2,3), which included both self-reports of smoking and urinary cotinine data, revealed a significant discrepancy between the prevalence of self-reported and biochemically-verified female smokers. The factors associated with accurate self-reporting of current smoking status remain poorly understood, however. MATERIALS AND METHODS: We assessed the prevalence of smoking in KNHANES using both self-report and urinary cotinine data. Subsequently, using univariate and multivariate tests, we assessed whether age, intensity of smoking, marital status, relationship with cohabitants, education, occupation, residential area, or annual household income were associated with inaccurate self- reporting in Korean females. We also investigated whether the prevalence of inaccurate self-reports changed over the survey period, 2008-2009. RESULTS: The prevalence of self-reported smoking was 47.8% in males and 6.6% in females. By contrast, the prevalence of smoking as assessed by urinary cotinine levels was 52.2% in males and 14.5% in females. Of the 746 females with urinary cotinine levels >50 ng/ml, 407 (56.0%) provided inaccurate self-reports. In a multivariate model, age group(40-49: OR 3.54, 95%CI 1.42-8.86, p=0.007; ref :20- 29), cotinine intensity(OR 0.999, 95%CI 0.998-0.999, p<0.001), marital status (married but without spouse: OR 0.37, 95%CI 0.15-0.94, p=0.037; ref :never married), relationship with cohabitants (living with a spouse and unmarried child: OR 2.63, 95%CI 1.44-4.80, p=0.002; living with 2 generations except unmarried child: OR 2.53, 95%CI 1.09-5.87, p=0.030; living with ≥ 3 generations: OR 3.25, 95%CI 1.48-7.10, p=0.003; ref :spouse only) and education(college or higher: OR 2.73, 95%CI 1.04-7.18, p=0.042; ref :elementary or less) were independently associated with inaccurate self-reports. CONCLUSIONS: The trend of smoking prevalence of Korean females is likely to decrease. However, an elevated prevalence of inaccurate self-reports by females remains. Factors related to the intensity of smoking and family status appear to influence whether a Korean female provides an accurate self-report when asked about smoking behavior.ope

Lateral Decubitus Position for Pediatric Nd:YAG Laser Capsulotomy under General Anesthesia

Purpose To report a successful case of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy performed in a noncompliant pediatric patient using the lateral decubitus position and a conventional slit-lamp-based laser system under general anesthesia. Case summary Progression of a thick posterior capsular opacity with associated vision loss (best-correct visual acuity of 0.1) was detected in a nine-year-old child with a past history of cataract surgery in his right eye. Diagnosed with pediatric uveitis at the age of five, he had been treated previously using a combination of topical and systemic corticosteroids, which led to the development of the cataract and subsequent surgery 16 months later. Severe photophobia prevented outpatient-based laser treatment, and the patient underwent our modified procedure. Under general anesthesia, the patient was placed in a lateral decubitus position with the use of a long intubation tube. The height of the bed and table-based laser system was adjusted so as to minimize strain when positioning the child’s head. Successful laser capsulotomy was performed within 10 minutes, and the entire anesthesia time was less than 30 minutes. The patient experienced immediate improvement in symptoms, showing a visual acuity of 1.0, which has been sustained as of his most recent visit, 3 months postoperatively. The patient experienced no ocular or anesthesia- related complications. Conclusions Nd:YAG laser capsulotomy performed by careful positioning (lateral decubitus) under general anesthesia is a viable strategy for the safe and efficient removal of posterior capsular opacities in children with poor compliance.ope