Taxane-associated retinopathy and radiation-induced optic neuropathy in a young female patient with metastatic breast cancer

To evaluate macular morphology and function in diabetic macular edema (DME) over the course of intravitreal anti-vascular endothelial growth factor (VEGF) treatment with Ranibizumab. A consecutive series of 39 study eyes with centre-involving DME were included in this study. In all subjects, best-corrected visual acuity (BCVA) according ETDRS protocol, fluorescein angiography (FA), microperimetric macular sensitivity (MP) and Spectral Domain optical coherence tomography (SD-OCT) cross-sectional scans were obtained before treatment and after 3 monthly applied intravitreal Ranibizumab injections. Six different morphological qualities [IS/OS layer integrity, outer nuclear layer (ONL) cysts, ONL cyst size, inner nuclear layer (INL) cysts, blocking phenomenon and subretinal fluid] were graded of each cross-sectional OCT scan before and over the course of treatment by two experienced graders. Correlation analyses between functional and morphological parameters were obtained. Mean BCVA increased from 26 ± 14 to 33 ± 13 letters after 3 consecutive monthly applied Ranibizumab injections (p < 0.001). Central retinal thickness (CRT) decreased from 504 ± 144 to 387 ± 122 μm (p < 0.001). Over the course of treatment, IS/OS continuity improved (index: 0.56 ± 0.52 to 0.43 ± 0.49, Z = -1.415, p = 0.157), ONL cyst prevalence and size decreased significantly (index: 0.61 ± 0.44 to 0.56 ± 0.35, Z = -3.41, p = 0.001 and 1.75 ± 0.88 to 1.17 ± 1.05, Z = -4.02, p < 0.001), INL cyst prevalence decreased (index: 0.35 ± 0.52 to 0.28 ± 0.52, Z = -1.60, p = 0.109), blocking phenomenon did not change significantly (index: 00.12 ± 0.16 to 0.13 ± 0.15, Z = -0.45, p = 0.656) and subretinal fluid almost disappeared (index: 0.10 ± 0.24 vs. 0.00 ± 0.01, Z = -2.56, p = 0.011). Correlation analyses revealed highest significant correlations between ONL cyst prevalence and their size and CRT as well as BCVA and MP before treatment and over the course of treatment. ONL cysts and their size as morphological parameters correlate with retinal function measured with BCVA and microperimetry before and over the course of anti-VEGF therapy with Ranibizumab in patients with DME.

Mystery of changing choroidal thickness.

Central serous chorioretinopathy

To assess the interobserver variability (IOV) in indicating retreatment for neovascular Age-related macular degeneration 4 weeks after three Ranibizumab loading doses using spectral domain OCT (SD-OCT) as the primary objective diagnostic tool. Four observers decided for or against 4th Ranibizumab injection in 108 patients by six different rating rounds (RR) based on the SD-OCT findings after the loading doses. Postoperative OCT images were supplemented consecutively with information from a chart review as the 'patients subjective estimation of vision (SE)', the course of best-corrected visual acuity (BCVA) and the preoperative OCT as well as all information collectively. Agreement rates (AR) and Kappa statistics were calculated. Based on post-treatment OCT findings only (RR1), mean reinjection rate of all observers was 37.5%. Adding supplementary information, mean reinjection rate decreased to 20% when all information was available reflecting the 'real' situation (RR 6). Interobserver agreement rates varied from 66.7% to 90.7% depending on rating rounds and interobserver pairs. Mean AR and Kappa values (KV) were as following: AR 81.6%, KV 0.61 (RR1: 'only post-OP OCT'); AR 76.7%, KV 0.33 (RR2: post-OP OCT + SE); AR 80.3%, KV 0.45 (RR3: post-OP OCT + BCVA); AR 80.7%, KV 0.46 (RR4: pre- and post-OP OCT); AR 82.2%, KV 0.49 (RR5: post-OP OCT + SE + BCVA); and finally AR 83.6%, KV 0.47 (RR6: pre- and post-OP OCT + SE + BCVA). The overall mean agreement rate was 80.9% with a Kappa of 0.47. IOV for indicating retreatment after three Ranibizumab loading doses reveals only moderate agreement in Kappa statistics, which seems to be too low considering the high costs for retreatments. More concise guidelines based on the post-treatment OCT scans as the presumably most sensitive and noninvasive objective tool to follow choroidal neovascularization activity by judging the course of sub- and intraretinal fluid are necessary.

BackgroundFocal choroidal excavation (FCE) is a common concurrent disease with central serous chorioretinopathy (CSC) and choroidal neovascularization (CNV). Photodynamic therapy (PDT) was able to cease the course of CSC with efficacy and safety. To retrospectively observed and followed up a special course in eyes with CSC and concurrent FCE treated by a half-dose of PDT.Case presentationIn this case report analysis, two eyes with CSC and concurrent FCE treated with half-dose PDT, were followed up with monthly retinal fundus examinations. Best corrected visual acuity (BCVA) and ophthalmic fundus examination were examined, including fundus photos, optical coherence tomography (OCT) and angiography. In Case 1, a 46-year-old female has been diagnosed as CSC and concurrent FCE. The baseline BCVA was 10/20. After a half-dose of PDT, complete resolution of SRF was achieved at one-month with stable BCVA. At 3 months, the patient complained of obvious metamorphosis. Multimodal images confirmed the existence of CNV, derived from the FCE, inside the zone of PDT irradiation. The development of CNV stopped promptly 1 month post the injection of ranibizumab. In Case 2, a 39 year-old male was diagnosed as bilateral CSC. The BCVA was 8/20 (od), and 16/20 (os). The multimodal images showed classic CSC manifestation in left eye, but atypical manifestation in right eye with subtle SRF and FCE. Post half-dose treatment, the SRF in left eye completely resolved at three-months, and the BCVA improved to 24/20. However, a lesion of CNV grew in the FCE after 1 month in right eye, with decreased BCVA, 4/20. One month post-injection of ranibizumab, obvious regression was witnessed, with improved BCVA, 6/20. The CNV proceeded to be a scar 2 months after injection. The BCVA maintained at 8/20.ConclusionsIn this study, type II CNV was induced in two cases of CSC concurrent with FCE in 3 months post half-dose PDT. The CNV grew right from the FCE, inside the zone of PDT irradiation.

Sir, Traumatic central serous chorioretinopathy (CSC) is very rare, and there is a few previous report of traumatic CSC worldwide.[1,2] We recently experienced a case of CSC after blunt trauma in the fellow eye, thus, herein report the case. A 39-year-old male presented with ocular pain in his right eye following blunt trauma by a plastic ball hitting his eye 1-day earlier. At initial presentation, his best-corrected visual acuities (BCVA) was 20/25 in the right eye and 20/20 in the left eye. The intraocular pressure was 19 mmHg in both eyes. Slit-lamp examination revealed no red blood cells in the anterior chamber. Fundus examination revealed no abnormality in the right eye. An orbital computed tomography scan showed a blowout fracture of the right orbital floor with a slight dislocation of the orbital contents [Fig. 1]. Optical coherence tomography (OCT) scans were performed in both eyes, which were normal, without any signs of retinal detachment. The patient was observed closely with consecutive fundus examination. Two weeks later, he experienced visual disturbance in the left eye. BCVA was 20/50 in the left eye with metamorphopsia while in right eye it was 20/20. On fundus examination, a serous macular detachment was noted in the left eye [Fig. 2a]. Fluorescein angiography showed a focal retinal pigment epithelial (RPE) leakage [Fig. 2b]. OCT performed on the same day showed elevation of the sensory retina in the macula [Fig. 2c]. One month after the trauma in the right eye, BCVA of left eye returned to 20/20 and the neurosensory retinal detachment resolved on OCT examination. Figure 1 Orbital computed tomography showing linear fracture of the inferior orbital wall with a slight dislocation of the orbital contents Figure 2 (a) Fundus photograph reveals a serous elevation of the retina in the macular area. (b) Fluorescein angiography shows a “smokestack” pattern leakage. (c) Optical coherence tomography shows a serous macular detachment CSC is a multifactorial disease of unknown etiology and has been associated with type A personality, emotional stress, pregnancy, hypertension, psychopharmacological medication, and increased levels of corticosteroids.[3] There has been a suggestion that people with type A personality, who gets intensed and overwhelmed easily by stressful situations, over stimulates sympathoadrenomeullary system, consequently overproduce catecholamine, and increase the release of cortisol resulting in CSC.[4] Our case shows no immediate ophthalmologic signs in the affected eye from the first visit, but presented CSC in the unaffected eye after few days after trauma; however, there still is a possibility that CSC has occurred regardless of trauma. During the first visit interview, many factors have been considered to rule out other factors that may have caused CSC, i.e. any stressful situation, previous diagnosis of CSC, and use of steroids (oral or any other route); however, none of these factors seemed to cause CSC. Therefore, it may conclude that the trauma in the right eye caused an increase in endogenous catecholamines, affecting the opposite eye. This is the first case of blunt trauma related CSC occurring in the unaffected eye in Korea, and it is important to notice that it took less than 1 month to recover, whereas CSC, in general, is known with its slow recovery. In conclusion, although there are no immediate signs of damage in the affected eye after blunt trauma, a careful examination of both eyes within few days followed by regular follow-up is required as CSC may occur in the opposite, unaffected eye. Financial support and sponsorship This study was supported by 2014 Research Grant from Kangwon National University (No. 120140437). Conflicts of interest There are no conflicts of interest.

Dear Editor, Recurrent macular edema (ME) secondary to central retinal venous occlusion (CRVO) is a challenging situation. Recently, newer anti-vascular endothelial growth factor (VEGF) drug, aflibercept (Eyelea®, Bayer Healthcare, Germany), approved by Food and Drug Administration (FDA), has shown good treatment outcomes in randomized clinical trials in patients with ME secondary to CRVO.[1,2] However, this drug is not available in India. Ziv-aflibercept (Zaltrap; Regeneron, New York, USA), anti-VEGF drug, is a recombinant fusion protein with a similar mechanism to aflibercept. It was approved by FDA in August 2012, for the treatment of resistant metastatic colorectal carcinoma. Recently, Mansour et al. reported intravitreal ziv-aflibercept as safe treatment at 4 weeks without any ocular toxicity in patients with diabetic ME and age-related macular degeneration, and they clarified the concerns about the osmolarity of this preparation.[3,4] Here, we present a single case of off-label use of intravitreal Zaltrap® in a patient with recurrent ME secondary to CRVO. Ethics committee approval was taken to report this case. A 64-year-old male presented with a sudden vision loss in both eyes since 1-month. On examination, his best-corrected visual acuity was 20/160 in right and left eye respectively. He was diagnosed to have CRVO with ME and was treated with intravitreal bevacizumab in both eyes. His systemic investigations were within normal limits. During the follow-up of 20 months, he had multiple episodes of recurrent ME and received 12 and 13 anti-VEGF injections in right and left eye respectively, along with one intravitreal triamcinolone injection and peripheral panretinal photocoagulation in both eyes. After a treatment-free interval of 2 months that is, at 22 months of follow-up, he presented with recurrent edema in both eyes with of 20/200 in both eyes. On examination, there was ME in both eyes, with a central macular thickness (CMT) of 834 μ and 938 μ on optical coherence tomography (OCT) [Fig. ​[Fig.1a1a and ​andb].b]. In view of recurrent recalcitrant edema, after obtaining informed consent, he underwent intravitreal Zaltrap® (1.25 mg in 0.05 ml) in both eyes under aseptic conditions, with an interval of 5 days between two eyes. The patient was subsequently followed at postinjection day 1, day 7 and day 30 (1-month). He did not have any symptoms of blurred vision or ocular pain related to injection without any signs of inflammation/toxicity. At 1-month follow-up, his visual acuity improved to 20/100 and 20/159 in his right and left eye respectively. OCT showed a decrease in edema with CMT of 193 μ and 232 μ [Fig. ​[Fig.1c1c and ​andd]d] in right and left eye respectively. As there was no observed clinical toxicity at 1-month follow-up and good clinical response, the patient has been advised to undergo another injection of Zaltrap® in both eyes. Figure 1 Top panel shows severe cystoid macular edema (ME) on spectral domain optical coherence tomography in the right eye (OD) and the left eye (OS) before intravitreal ziv-aflibercept injection. Bottom panel shows significant decrease in ME at 1-month follow-up ... This is the first report of intravitreal Zaltrap® in eyes with ME secondary to CRVO. Our report presents evidence supporting the clinical safety and efficacy of a single intravitreal Zaltrap® injection and supports its use as the primary or second line of anti-VEGF therapy in recalcitrant ME due to CRVO. However, further studies are warranted to evaluate the long-term safety and efficacy of this drug in various situations where anti-VEGF therapy is indicated.

Objective To evaluate the efficacy and safety of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO). Methods Thirty-nine patients (39 eyes) with ME secondary to RVO were enrolles in this study. Of the patients, 27 were male and 12 were female. The mean age was (41.9±16.3) years. The mean course of disease was (5.0±5.3) months. The best corrected visual acuity (BCVA), intraocular pressure and optical coherence tomography (OCT) were performed. BCVA was measured by Early Treatment Diabetic Retinopathy Study charts. Central macular thickness (CMT) was measured by OCT. The mean BCVA was (13.4±15.3) letters. The mean intraocular pressure (IOP) was (14.1±2.8) mmHg (1 mmHg=0.133 kPa). The mean CMT was (876.1±437.9) μm. Of the 39 eyes, 33 were central RVO, 6 were branch RVO. Patients were categorized into ischemic (18 eyes)/nonischemic (21 eyes) groups and previous treatment (22 eyes)/treatment naive (17 eyes) groups. All eyes underwent intravitreal 0.7 mg Ozurdex injections. BCVA, IOP and CMT were assessed at 1, 2, 3, 6, 9, 12 months after injection. Three months after injection, intravitreal injections of Ozurdex, triamcinolone acetonide or ranibizumab could be considered for patients with ME recurrence or poor treatment effects. Change of BCVA, IOP and CMT were evaluated with paired t test. The presence of ocular and systemic adverse events were assessed. Results BCVA, IOP significantly increased and CMT significantly decreased at 1 month after injection compared to baseline in all groups (t=3.70, 3.69, 4.32, 3.08, 4.25, 6.09, 6.25, 4.02, 5.49, 8.18, 6.54, 5.73; P 0.05); BCVA of non-ischemic RVO group and treatment naive group significantly increased compared to baseline (t=2.27, 2.30; P<0.05); IOP significantly increased and CMT significantly decreased in all groups (t=0.30, 0.13, 4.60, 3.26, 0.64, 1.53, 3.00, 4.87; P<0.05). Twenty-seven eyes (69.2%) experiences ME recurrence (4.5±1.5) months after injection. Most common side-effect was secondary glaucoma. 41.0% eyes had IOP more than 25 mmHg, most of which were lowered to normal range with use of topical IOP lowering drugs. Four eyes (10.3%) presented with significant cataract progression and needed surgical treatment, all were central RVO eyes. No serious ocular or systemic adverse events such as vitreous hemorrhage, retinal detachment or endophthalmitis were noted. Conclusions Intravitreal injection of Ozurdex for patients with ME secondary to RVO is effective in increasing BCVA and lowering CMT in the first few months. Significant treatment effect could be seen at 1 month after injection and was most significant at 2 months after injection. The long-term vision of eyes in non-ischemic RVO group and treatment naive group are better. 69.2% eyes experience ME recurrence at 4 months after injection. Short term adverse events were mostly secondary glaucoma and long term adverse events are mostly cataract progression. Key words: Dexamethasone/therapeutic use; Retinal vein occlusion/drug therapy; Macular edema/drug therapy

To report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long-acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow-up periods of > or = 12 months. Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.

Transient optic disc edema following neodymium: yttrium-aluminum-garnet laser posterior capsulotomy

Purpose: To describe OCT findings in pediatric uveitis patients and analyze visual acuity changes over time. Methods: A retrospective chart review of pediatric patients (0 to 18 years old) seen at the Emory Eye Center between 2008 and June 2020 with a diagnosis of uveitis and OCT imaging available was conducted. Data collected included demographic data, uveitis etiology, anatomical uveitis location, best-corrected visual acuity (BCVA), findings on OCT, and treatment. Results: There were 204 patients and 327 eyes with a diagnosis of pediatric uveitis and at least one OCT on record. The average age was 11.5 years with 57% females (116), 43% Black (87) and 33% Caucasian (68). 137 (67%) patients had bilateral uveitis with the majority, 194 (95%), with a non-infectious etiology. Anatomical location of uveitis was anterior, intermediate, anterior/intermediate, posterior, or panuveitis in 42%, 24%, 9%, 10%, and 15% respectively. At baseline on OCT, there were 222 normal eyes, 19 eyes with an epiretinal membrane (ERM), 53 eyes with macular edema, 14 eyes with both macular edema and ERM, and 19 eyes with subretinal fibrosis. On mixed model analysis controlling for the correlation that exists between eyes of the same subject, the worst initial BCVA was seen in eyes with epiretinal membrane and macular edema, followed by macular edema eyes, subretinal fibrosis, and eyes with an ERM with a logMAR BCVA of 0.95, 0.75, 0.73, and 0.50 respectively (p<0.0001). Notably, with most abnormal OCT findings, BCVA improved over 24 months except for ERM eyes, which showed a logMAR BCVA change of 0.50 to 0.60 (p<0.0001). In a sub-analysis of patients with macular edema with or without subretinal fluid (SRF), there was no difference between baseline clinical characteristics or BCVA in patients who had SRF. Conclusions: OCT imaging in pediatric uveitis is important for diagnosis and monitoring progression of sight- threatening complications. Pediatric uveitis cases show a high proportion of bilateral involvement and prevalence of complications leading to worse BCVA, which demonstrates that prompt treatment and continued monitoring via OCT imaging can prevent ocular sequelae leading to blindness.

A 75-year-old man presented with a 6-week history of left eye acute vision loss first noticed while driving his boat. The patient denied any headache, pain with eye movement, or eye trauma. He had bilateral uneventful cataract extraction 7 years before presentation and underwent a yttrium aluminum garnet (YAG) laser capsulotomy of the left eye at the onset of the blurry vision with no improvement. He has a history of diabetes mellitus, atrial fibrillation, and prostate cancer. Medication included metformin, apixaban, tadalafil, and multivitamins. The patient is a former smoker who quit smoking at the age of 35 years and is a mild social alcohol drinker. The best-corrected visual acuity (BCVA) was 20/50 in the right eye and 20/400 in the left eye. Ishihara color plates showed 10/10 in the right eye and 0/10 in the left eye with a left relative afferent pupillary defect (RAPD). Slitlamp examination revealed moderate opacification of the right posterior capsule and normal-looking optic discs. The visual field (VF) showed a cecocentral scotoma in the left eye. Brain and orbital MRI with contrast showed no optic nerve enhancement or atrophy of the left eye. Blood workup was negative for anti-myelin oligodendrocyte glycoprotein (MOG), anti-aquaporin-4 antibody (AQP4-Ab), rapid plasma reagin (RPR), fluorescent treponemal antibody test absorption test (FTA-ABS), angiotensin-converting enzyme (ACE), lysozyme, and nutritional and toxic blood panel. Despite the negative workup, the patient was started on 1-g intravenous methylprednisolone (IVMP) daily for 5 days, with some improvement in right eye color vision and brightness, without any changes in the left eye. Three weeks later, the BCVA was 20/100 in the right eye and 20/400 in the left eye. Ishihara color plates were 3/10 in the right eye and 0/10 in the left eye with trace left RAPD. Fundus examination showed bilateral optic disc pallor. Visual fields showed cecocentral scotoma, the left eye worse than the right eye. YAG capsulotomy right eye was performed without any improvement in vision. At that point, it was a case of unexplained sequential vision loss of 9-week duration. Full-field electroretinography (ffERG) and serum paraneoplastic antibody panel were unremarkable. Leber hereditary optic neuropathy (LHON) testing panel (Athena Diagnostics) came back positive for T14484C ND6 mitochondrial mutation. The patient was started on off-label use idebenone 300 mg 3 times daily.1 Six months later, his BCVA was 20/300 in the right eye and 20/350 in the left eye with bilateral cecocentral scotomas. Optical coherence tomography (OCT) of the optic nerve head revealed temporal thinning of the retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL) analysis showed diffuse thinning of the ganglion cell complex. After 5 years of annual follow-up, the patient reported stable vision. The BCVA remained at 20/300 in the right eye and 20/350 in the left eye. Repeated visual field testing (Fig. 1) showed central scotoma in the right eye and cecocentral scotoma in the left eye; RNFL (Fig. 2A) and GCL thicknesses (Fig. 2B) were unchanged. Fundus examination showed temporal pallor of the optic disc in both eyes (Fig. 2C).FIG. 1.: Automated visual field testing (AVF) showing central scotoma in the right eye and centrocecal scotomas in the left eye at the last follow-up visit.FIG. 2.: A. RNFL thickness shows mostly temporal loss. B. Diffuse GCL thinning. C. Fundus photographs showing temporal pallor of both optic nerves. GCL, ganglion cell layer; RNFL, retinal nerve fiber layer.To the best of our knowledge, our case is one of the most delayed onsets of patients with T14484C LHON and underscores that LHON should be considered in the differential diagnosis of subacute blindness, even in older patients. The 3 most common mutations responsible for 90% of LHON are G11778A, T14484C, and G3460A. LHON usually affects male patients more than female patients and presents in the second to fourth decade of life but can present at any age.2 The oldest reported ages of onset of visual loss were a 76-year-old man with 11778 mutation,3 a 75-year-old man with 3460 mutation,3 and a 57-year-old man with 14484 mutation associated with longitudinal extensive myelitis.4 The inciting factors for visual loss in patients with one of the typical mutations for LHON are not fully known. Apart from alcohol and smoking, for which a correlation was demonstrated,2,5 many other nonspecific triggers have been described in some case reports. Except for the very late age of onset, our case has typical sequential subacute vision loss of LHON with typical clinical findings in the clinical examination and ancillary testing. In addition, there were no triggering factors other than the very remote smoking history and social alcohol consumption which could cause a cumulative effect on the optic nerves.

Dear Editor, As we know, diabetic papillopathy (DP) is an uncommon condition in diabetic patients, and traditionally considered to be a self-limiting disease [1]. In recent case reports, treatment with a single injection of intravitreal triamcinolone acetate or intravitreal inhibitor of vascular endothelial growth factor was effective in reducing disc swelling and shortening the course [2–6]. However, self-healing cases and treated cases are rare in optic atrophy, which results in best-corrected visual acuity (BCVA) not reaching 1.0 (leading BCVA only reached 0.8). We reported a case of diabetic papillopathy that demonstrated a rapid and complete visual recovery when intravitreal bevacizumab was administered with an intravitreal triamcinolone injection. A 37-year-old Chinese male with a 9-year history of poorly controlled Type 2 diabetes mellitus presented with a 1-month history of decreased vision without pain in his right eye. Six months earlier, the patient had undergone grid pattern retinal photocoagulation, and received oral prednisone in doses decreasing from 30 mg per day for 3 weeks for clinically significant optic swelling in his left eye. His BCVA was 0.2 in the right eye (OD) and 0.4 in the left eye (OS). The intraocular pressure (IOP) was 17 mmHg in both eyes (OU). There was no afferent pupillary defect. An anterior segment examination was unremarkable. A posterior segment examination showed mild non-proliferative diabetic retinopathy without macular edema and a pale optic disc OS. An OD fundus examination was significant for a swollen optic disc (Fig. 1a). Optical coherent tomography (OCT) revealed a significant increase in retinal nerve fiber layer (RNFL) thickness without macular edema (Fig. 1b). Glycosylated hemoglobin was 11.2 %. Arterial blood pressure was 118/70 mmHg. An MRI scan of the brain was normal. A diagnosis of DP was made in the right eye. After receiving consent from the patient for a trial of triamcinolone and off-label use of bevacizumab, the patient received an intravitreal injection of bevacizumab (1.25 mg/0.05 ml) and triamcinolone (4 mg/0.1 ml). One week post-injection, the patient’s visual acuity OD had improved to 0.8, and the disc swelling disappeared. Six weeks post-injection, his visual acuity had improved to 1.0, and a fundus examination revealed no disc swelling (Fig. 1c and d). One year after the injection, the right eye visual acuity remained at 1.0 with normal IOP. In the case of the 37-year-old Chinese male, we used a combination of anti-VEGF and anti-inflammatory therapies to treat the DP. Compared with reports of single anti-VEGF [4–6] or anti-inflammatory [2, 3] treatment cases, this patient experienced a more rapid visual improvement 1 week after the intravitreal injection, and his BCVA improved from 0.2 J. Feng : J.<F. Qu :Y.<R. Jiang (*) Department of Ophthalmology, People’s Hospital, Peking University, 11 Xizhimen South Street, Xicheng District, 100044 Beijing, China e-mail: drjyr@vip.sina.com

To evaluate the effect of verteporfin photodynamic treatment (PDT) on choroidal thickness in patients with central serous chorioretinopathy (CSC). Choroidal thickness was measured with enhanced depth imaging- optical coherence tomography (EDI-OCT) before and after verteporfin PDT (full-dose verteporfin, half-light dose) in 16 eyes in 16 patients with serous detachment of the fovea secondary to extrafoveal angiographic fluorescein leakage. Treatment was confined to the area of leakage, whereas choroidal thickness before and after treatment was assessed over a larger area of the fundus using OCT. Complete resolution of the serous detachment was seen in all 16 eyes within 1 month of extrafoveal PDT, while choroidal thickness in the area where PDT was applied decreased from 407 μm [mean; 95% confidence interval (CI(95) ) 356-458 μm] to 349 μm (mean; CI(95) 300-399 μm; p < 0.0001), and subfoveal choroidal thickness was reduced from 421 μm (mean; CI(95) 352-489 μm) to 346 μm (mean; CI(95) 278-414 μm; p = 0.0001). Initially, subfoveal choroidal thickness was significantly increased in the treated eye compared with the healthy fellow eye (mean 324 μm; CI(95) 273-376 μm; p = 0.0003), but after treatment, the difference was not significant. Photodynamic therapy of active CSC was followed by choroidal thickness reduction, not only locally but also at considerable distance from the treated area. Thus, the process that causes choroidal thickening in CSC appears to spread laterally within the choroid.

Objective To investigate the effects of intravitreous injection of conbercept for macular edema secondary to retina1vein occlusion(RVO) during 6 months period. Methods A retrospective clinical study. 34 patients (34 eyes) were included in this study, who were diagnosed with macular edema due to retinal vein occlusion by ophthalmologic examination, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography and other methods. The best corrected visual acuity (BCVA) was examined using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The average logMAR BCVA was 0.90±0.68, and the mean macular central retinal thickness (CMT) was (672.27±227.51) μm before treatment. All subjects received intravitreal injection of 0.5 mg conbercept (0.05 ml) at the first visit. Injections were repeated based on the visual acuity changes and the OCT findings. 34 eyes received 69 times of injection, the average number of injections was 2.03±1.03. BCVA, OCT were examined before and after treatment using the same method. BCVA and CMT changes, drugs and treatments associated cardiac and cerebral vascular accident, intraocular pressure elevation, retinal tears, retinal detachment, endophthalmitis and other complications after treatment were observed. Linear correlation analysis was used to analyze the correlation between prognosis BCVA and baseline BCVA, correlation between prognosis BCVA and baseline CMT, and also correlation between BCVA and CMT at different time points before and after treatment. Results At 1 week and 1, 2, 3, 6 months after treatment, the average logMAR BCVA was 0.65±0.61, 0.56±0.61, 0.46±0.55, 0.56±0.71, 0.44±0.48 respectively. During 1, 2, 3, 6 months after treatment, the mean logMAR BCVA were improved with statistically significant difference (Z=34.029, 47.294, 41.338, 43.603; P 0.05). At 1 week and 1, 2, 3, 6 months after treatment, the average CMT was (285.89±96.69), (256.65±143.39), (278.68±156.92), (290.11±188.17), (217.15±48.04) μm respectively. At 1 week and 1, 2, 3, 6 months after treatment, the mean CMT were all decreased with statistically significant difference (Z=68.500, 98.735, 93.235, 91.132, 109.162; P 0.05). Before and 3, 6 months after treatment, BCVA was negatively correlated with CMT (r=0.491, 0.416, 0.386; P 0.05). Systemic adverse reactions and persistent intraocular pressure elevation, iatrogenic cataract, retinal detachment, retinal tear, endophthalmitis and ocular complications were never found in the follow-up period. Conclusion Intravitreal conbercept is a safe and effective approach for RVO, which can significantly improve visual acuity and reduce CMT. Key words: Retinal vein occlusion/drug therapy; Macular edema /drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Tomography, optical coherence