Abstract: A case with unilateral acute retinal necrosis (ARN) following herpes simplex virus (HSV) encephalitis was reported. A 40-year-old man presented with unilateral visual loss. He had a history of HSV encephalitis 2 months previously, and had been successfully treated with intravenously acyclovir. The ophthalmologic examination in his left eye suggested ARN syndrome. The best-corrected visual acuity was 20/222. Magnetic resonance imaging (MRI) showed high density signals from the optic chiasm to optic disc. The patient underwent encircling scleral buckling, lensectomy, and vitrectomy with endolaser photocoagulation and silicone oil tamponade. Postoperatively, the high density signals on MRI decreased, the retina maintained attached, and the visual acuity at the final visit improved to 20/20. Unilateral ARN can develop after HSV encephalitis. Acyclovir should be administered over the long term to control the virus.
Abstract: PURPOSE: Leukocytes play a critical role in ocular diseases such as uveitis, diabetic retinopathy, and choroidal neovascularization. Intercellular adhesion molecule (ICAM)-1 is essential for the migration of leukocytes. Control of ICAM-1 expression may lead to therapies for these diseases. Small-interfering ribonucleic acids (siRNAs) are efficient specific modulators of endogenous gene expression. The authors describe the application of siRNA to suppress ICAM-1 expression on the murine neurosensory retina or retinal pigment epithelial (RPE) cells using a hydrodynamics-based transfection technique (HT) and intravitreal injection (IV) in vivo. METHODS: ICAM-1-specific plasmid siRNAs designed from the murine gene sequence were transfected into the retina using HT and IV in vivo. Green fluorescent protein (GFP) expression plasmid vector is used as a transfection marker in the retinal cells. ICAM-1 expression was analyzed by enzyme-linked immunosorbent assay and flow cytometry. ICAM-1 upregulation was induced by retinal laser photocoagulation and streptozotocin (STZ). RESULTS: After the administration of GFP expression plasmid with HT and IV, histologic analysis showed GFP fluorescence in every layer of the murine retina. After photocoagulation, ICAM-1 expression in the neurosensory retina or RPE cells transferred with plasmid ICAM-1 siRNA was significantly decreased compared with cells that were not transfected or cells transferred with scrambled control siRNA. Plasmid siRNAs silenced ICAM-1 expression after STZ administration compared with control or naked siRNA injection. CONCLUSIONS: SiRNA expression mediated by this plasmid causes efficient and specific downregulation of ICAM-1 expression, suggesting that it can be silenced by plasmid siRNA in murine retina in vivo. This technology may lead to novel concepts to reduce retinal neovascular disease by inhibiting leukocyte infiltration.
Abstract: AIMS Type 2 (perifoveal) telangiectasia often is refractory to treatment, because focal targets such as aneurysms are not detected by fluorescein angiography (FA) in these eyes. The authors evaluated the efficacy of indocyanine green angiography (IA)-guided laser photocoagulation and sub-Tenon's capsule injection of triamcinolone acetonide (STTA) for idiopathic macular telangiectasia. METHODS Seven eyes (seven patients; mean age, 72 years) were enrolled, five eyes with type 1 and two eyes with type 2. The mean follow-up was 10.6 months (range 7 to 19). FA and IA were performed with the Heidelberg Retina Angiogram 2. Laser photocoagulation was applied to leaky vessels detected by late-phase IA (wavelength, 577 nm; power, 100-200 mW; spot size, 100-200 microm; and duration, 0.2 s). STTA (20 mg) was injected after photocoagulation. The central macular thickness and macular volume were measured periodically by optical coherence tomography. The logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured. RESULTS IA identified leaky aneurysms or vessels. The final mean logMAR VA and the central macular thickness improved significantly from baseline (p=0.040, p=0.0002, respectively). The VA improved by 0.3 or more logMAR unit in two eyes (29%) and stabilised in five eyes (71%). No adverse effects were reported throughout follow-up. CONCLUSIONS IA can detect microangiopathy in eyes with idiopathic macular telangiectasia. IA-guided laser photocoagulation combined with STTA might be effective for treating types 1 and 2 idiopathic macular telangiectasia. Further studies are needed to access the efficacy of IA-guided photocoagulation for treating type 2 telangiectasia.
Abstract: We present a case of retinitis pigmentosa with vitreoretinal traction-associated retinal detachment. The retinal detachment was detected in the nasal periphery. No retinal breaks and no active vascular leakage were observed by fundus scopy and fluorescein angiography, respectively. However, 8 months later, the tractional retinal detachment was spontaneously resolved with posterior vitreous detachment.
Abstract: PURPOSE: To evaluate the incidence and risk factors of intraocular pressure (IOP) elevation following triamcinolone acetonide (TA) administration. METHODS: In this retrospective observational case series, patients (224 eyes of 202 patients) with diffuse diabetic macular edema (66 eyes), branch retinal vein occlusion (39 eyes), central retinal vein occlusion (25 eyes), exudative age-related macular degeneration (49 eyes), myopic choroidal neovascularization (10 eyes), uveitis (30 eyes), or other conditions (5 eyes) were administered an intravitreal or posterior sub-Tenon capsule injection, or both, of TA. Sub-Tenon capsule injection was performed on 106 eyes (STTA group). Intravitreal injection was performed on 118 eyes (IVTA group), of which 85 eyes underwent simultaneous intravitreal and sub-Tenon capsule injections. Mean follow-up after TA administration was 15.9 +/- 10.4 (range, 3-39) months. The sub-Tenon capsule injection and intravitreal injection of TA were compared with respect to the frequency of IOP elevation and the time between TA administration and the initial IOP elevation, and the possible risk factors responsible for IOP elevation were identified. RESULTS: There was no significant difference in frequency of IOP > 21 mmHg between the STTA group and the IVTA group (P = 0.0588). There was, however, a significant difference in the frequency of IOP > 30 mmHg between the two groups (P = 0.0004). In the IVTA group, more patients needed antiglaucoma medication than in the STTA group (P = 0.0052). The incidence rate of IOP elevation within 1 week after TA administration in the IVTA group was significantly higher than in the STTA group (P = 0.0154). Risk factors for IOP elevation included higher baseline IOP (P < 0.0001), younger patients (P = 0.0095), and simultaneous administration of sub-Tenon capsule and intravitreal injections (P = 0.0228). CONCLUSIONS: Careful follow-up of IOP is required after TA injections.
Abstract: PURPOSE: To investigate the incidence of posterior subcapsular cataract after topical administration of triamcinolone acetonide. METHODS: A retrospective, case-control study was conducted in 44 phakic eyes of 38 paients who underwent administration of triamcinolone acetonide. The mean age was 64 +/- 10.4 (39-89). Only posterior sub-Tenon injection was performed. Evaluation of posterior subcapsular cataract was performed by slit lamp microscopy, and risk factors of the posterior subcapsular cataract progression were studied. RESULTS: Eight eyes (18%) had posterior subcapsular cataract progression in the 12 months after triamcinolone acetonide injection. Five eyes (11%) required cataract surgery. The mean time to the cataract progression was 8.8 +/- 3.7 months. There was no significant difference in the posterior cataract progression between the frequency of injection, the causes of disease, and the age (p = 0.3806, 0.6561, 0.7470). CONCLUSION: The progression of posterior subcapsular cataract is an important complication in the long-term topical administration of triamcinolone acetonide.
Abstract: PURPOSE: To report three cases of early-onset macular hole secondary to a ruptured retinal arterial macroaneurysm. METHODS: Case reports. RESULTS: The patients were diagnosed with a subretinal hemorrhage with macular involvement. A macular hole was confirmed during the first fundus examination in two cases, and after vitreous surgery to remove a sub-internal limiting membrane (ILM) hemorrhage overlying the macula in the third case. All cases were probably complicated with a macular hole immediately after the rupture of a macroaneurysm. The distance from the macroaneurysm to the fovea was 2250 microm or less. All cases had a submacular hemorrhage and retinal detachment around the macular hole. In cases 2 and 3, vitrectomy with peeling of the ILM and SF6 gas tamponade led to closure of the macular hole; the macular hole remained open in case 1 without vitrectomy. Independent of anatomic repair of macular holes, the final best-corrected visual acuity (VA) was less than 20/67 in all cases. CONCLUSIONS: Early-onset macular hole formation secondary to a ruptured retinal arterial macroaneurysm occurs mechanically due to the proximity between the macroaneurysm and the fovea. Current and previous reports have suggested that any VA improvement was likely to be limited, at least in older patients.
Abstract: PURPOSE: To determine the risk factors for intraocular pressure (IOP) elevation after the injection of triamcinolone acetonide (TA). DESIGN: Retrospective interventional case-control study. METHODS: SETTING: Multicenter. PATIENT POPULATION: Four hundred and twenty-seven patients. OBSERVATION PROCEDURES: Intraocular pressure levels after TA treatment by the sub-Tenon capsule injection (STI; 12 mg, 20 mg, or 40 mg), intravitreal injection (IVI; 4 mg or 8 mg), or the combination of STI (20 mg) and IVI (4 mg), and IOP levels after two TA treatments. MAIN OUTCOME MEASURE: Risk factors for IOP levels of 24 mm Hg or higher. RESULTS: Younger age (hazards ratio [HR], 0.96/year; P < .0001), IVI (HR, 1.89/year; P < .0001), and higher baseline IOP (HR, 1.15/mm Hg; P = .003) were identified as risk factors. Dose dependency was shown in STI-treated eyes (HR, 1.07/mg; P = .0006), as well as after IVI (HR, 1.64/mg; P = .013). The combination of STI and IVI was a significant risk factor (HR, 2.27; P = .003) compared with STI alone. In eyes receiving two TA treatments, IVI (HR, 2.60; P = .010), higher IOP elevation after the first injection (HR, 1.18/mm Hg; P = .011), and increased dosage of STI (HR, 1.07/mm Hg; P = .033) were risk factors. CONCLUSIONS: Younger age, higher baseline IOP, IVI, and increased TA dosage were associated with TA-induced IOP elevation. IOP elevation after repeated TA injection was frequently associated with eyes treated with IVI, high IOP elevation after the first injection, and high doses of STI.
Abstract: AIMS: To compare the efficacy ofa combination therapy of triamcinolone acetonide (TA) administration with and without vitrectomy in eyes with macular edema associated with branch retinal vein occlusion over a 1-year period. METHODS: A retrospective, case-control study was conducted in 15 eyes of 15 patients with macular edema associated with branch retinal vein occlusion. Eight eyes underwent simultaneous intravitreal and posterior sub-Tenon capsule injections of TA (TA-injected group). Seven eyes underwent vitrectomy with intravitreal or simultaneous posterior sub-Tenon capsule injection of TA (vitrectomy with TA group). Macular thickness and visual acuity were measured before and at 1, 3, 6 and 12 months after the therapy. RESULTS: Twelve months after the therapy, mean visual acuity improved significantly from baseline in both the TA-injected (p = 0.0069) and vitrectomy with TA groups (p = 0.0145). Macular thickness also improved significantly in both the TA-injected (p = 0.0065) and vitrectomy with TA groups (p = 0.0058). At 12 months after the therapy, there was no significant difference in visual acuity and macular thickness between the two groups (p = 0.3308 and 0.3711, respectively). At the early postoperative stage (1 and 3 months after the therapy), the central macular thickness in the TA-injected group was significantly less than that in the vitrectomy with TA group (p = 0.0140 and 0.0275, respectively); there was no significant difference in visual acuity between the two groups (p = 0.0796 and 0.3753, respectively). CONCLUSION: TA injection without vitrectomy was as effective as a combination therapy of TA injection with vitrectomy.
