Intravitreal Bevacizumab for the Treatment of Optic Disc Edema in a Patient with POEMS Syndrome

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Short-term Effect and Safety of a Single Intravitreal Brolucizumab in Refractory Neovascular Age-related Macular Degeneration

Purpose: To assess effect of brolucizumab in Korean patients, and also analyze incidence of intraocular inflammation (IOI) rate, clinical features, treatment and prognosis. Methods: We reviewed EMR chart of history of brolucizumab injection patients retrospectively in Severance Hospital. Total 101 eyes of 92 patients were included. Patients consist of 80 wet age-related macular degeneration (wAMD) and 21 polypoidal choroidal vasculopathy (PCV). Demographic data, best corrected visual acuity (BCVA), anatomical features as central macular thickness, subretinal fluid (SRF), intraretinal fluid (IRF), height of pigment epithelium detachment (PED) through optical coherence tomography, incidence of IOI and their clinical feature, treatment, prognosis were assessed. Results: BCVA and subfoveal choroidal thickness of patients showed no statistical significancy. Central macular thickness, IRF and PED height showed statistically significant effect in 1 month after injection. SRF was improved significantly during 2 months of follow up. In subgroup analysis of PCV group, BCVA, subfoveal choroidal thickness, IRF showed no statistical significance. Central macular thickness and SRF showed improvement throughout 2 months. PED height showed 1 month of statistically significant effectiveness. There were six cases (5.9%) of IOI in total 101 eyes of brolucizumab injection cases. One case (0.99%) among IOI patients showed non-occlusive vasculitis. There was no case of occlusive vasculitis in our study. All cases were resolved after steroid treatment, topical or combination of topical and subtenon injection. Conclusions: Intravitreal injection of brolucizumab in Korean wAMD patients and PCV subgroups refractory to other anti-VEGF showed effectiveness in central macular thickness, IRF, SRF, and PED height. Incidence of IOI was 5.9% and no case of severe visual acuity deterioration. All IOI cases were resolved after topical or subtenon triamcinolone injection.ope

Optic Atrophy in a Patient With Atypical Pantothenate Kinase-Associated Neurodegeneration.

Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive neurodegeneration with brain iron accumulation and characterized by extrapyramidal signs, vision loss, and intellectual decline. PKAN is caused by mutations in the PANK2 gene, which codes for a mitochondrial enzyme that phosphorylates vitamin B5 in the first reaction of the coenzyme A biosynthetic pathway. Visual failure in this disorder is typically due to pigmentary retinopathy. Yet our patient, a 13-year-old girl with PKAN, developed bilateral optic atrophy and the appearance of the retina and electroretinography were normal. Optic atrophy is a rare finding in patients with PKAN. It is important for the clinician to consider PKAN in the differential diagnosis of patients presenting with signs of extrapyramidal dysfunction, cognitive decline, and vision loss because of optic atrophy.restrictio

Effect of Co-Implantation of a Capsular Tension Ring on Clinical Outcomes after Cataract Surgery with Monofocal Intraocular Lens Implantation

PURPOSE: The objective was to evaluate the effect of co-implantation of a preloaded capsular tension ring (CTR) and aberration-free monofocal intraocular lens (IOL) on clinical outcomes and visual quality after cataract surgery. MATERIALS AND METHODS: Patients who underwent cataract surgery were randomized into two groups that were implanted with a CTR and IOL (group 1, 26 eyes) or an IOL only (group 2, 26 eyes). At 1 and 3 months after surgery, visual acuity, refractive errors, refractive prediction errors, ocular aberrations, and modulation transfer function (MTF) were analyzed. At 3 months postoperatively, anterior chamber depth (ACD) and contrast sensitivity were evaluated. RESULTS: Group 1 showed greater hyperopic shift, which caused the refractive prediction error at 3 months after surgery to be significantly different between the two groups (p=0.049). Differences in ACD between the preoperative and postoperative periods tended to be greater in group 1 than in group 2. At 3 months postoperatively, internal MTF values at 20, 25, and 30 cycles per degree were significantly better in group 1 than in group 2 (p=0.034, 0.017, and 0.017, respectively). Contrast sensitivity showed comparable results at almost all spatial frequencies between the groups. CONCLUSION: Regarding visual acuity and quality, both groups showed comparable results. Co-implantation of a CTR and aberration-free monofocal IOL was associated with hyperopic refractive outcomes. Surgeons should consider the position of the IOL when planning co-implantation of a CTR and IOL.ope

INTRAVITREAL RANIBIZUMAB THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND THE RISK OF STROKE: A National Sample Cohort Study

PURPOSE: To evaluate the risk of stroke after ranibizumab treatment for neovascular age-related macular degeneration. METHODS: National registry data for 1,025,340 random subjects in the year 2002 were used. The ranibizumab group comprised patients diagnosed with neovascular age-related macular degeneration and treated with ranibizumab between 2009 and 2013 (n = 467). The two types of comparison groups were defined as comorbidity-matched controls (n = 2,330) comprised of randomly selected patients (5 per age-related macular degeneration patient), who were matched to the ranibizumab group according to sociodemographic factors, hypertension, atrial fibrillation, and the Charlson comorbidities index, and sociodemographic-matched controls (n = 2,331) matched according to sociodemographic factors only. Each sampled patient was tracked until 2013. The Cox proportional hazard regression was used. RESULTS: Stroke occurred in 6.6% of the ranibizumab group versus 7.0% of the comorbidity-matched controls and 6.7% of the sociodemographic-matched controls; these differences were not statistically significant. The overall incidence of stroke was similar for the ranibizumab group versus the comorbidity-matched controls and sociodemographic-matched controls, based on the multivariable Cox regression (hazard ratio = 0.88; 95% confidence interval, 0.60-1.30; hazard ratio = 0.95, 95% confidence interval, 0.64-1.41, respectively). CONCLUSION: Ranibizumab treatment for neovascular age-related macular degeneration did not increase the overall risk of stroke, compared with comorbidity-matched controls or sociodemographic-matched controls.restrictio

Effect of trabeculectomy on the accuracy of intraocular lens calculations in patients with open-angle glaucoma

BACKGROUND: The objective of the study is to examine the effect of trabeculectomy on intraocular lens power calculations in patients with open-angle glaucoma (OAG) undergoing cataract surgery. DESIGN: The design is retrospective data analysis. PARTICIPANTS: There are a total of 55 eyes of 55 patients with OAG who had a cataract surgery alone or in combination with trabeculectomy. METHODS: We classified OAG subjects into the following groups based on surgical history: only cataract surgery (OC group), cataract surgery after prior trabeculectomy (CAT group), and cataract surgery performed in combination with trabeculectomy (CCT group). MAIN OUTCOME MEASURES: Differences between actual and predicted postoperative refractive error. RESULTS: Mean error (ME, difference between postoperative and predicted SE) in the CCT group was significantly lower (towards myopia) than that of the OC group (P?=?0.008). Additionally, mean absolute error (MAE, absolute value of ME) in the CAT group was significantly greater than in the OC group (P?=?0.006). Using linear mixed models, the ME calculated with the SRK II formula was more accurate than the ME predicted by the SRK T formula in the CAT (P?=?0.032) and CCT (P?=?0.035) groups. CONCLUSIONS: The intraocular lens power prediction accuracy was lower in the CAT and CCT groups than in the OC group. The prediction error was greater in the CAT group than in the OC group, and the direction of the prediction error tended to be towards myopia in the CCT group. The SRK II formula may be more accurate in predicting residual refractive error in the CAT and CCT groups.restrictio