[Effect of repeated intravitreal bevacizumab injections for secondary macular edema of branch retinal vein occlusion].

PURPOSE: To evaluate the effects of intravitreal bevacizumab (IVB) injections for secondary macular edema of branch retinal vein occlusion (BRVO). SUBJECTS AND METHODS: We treated 91 patients (91 eyes) with IVB injections (1.25 mg/0.05 ml), including 27 eyes which received two injections. Visual acuity and central retinal thickness (CRT) were measured at 1, 4, 8 and 12 weeks after injection. RESULTS: The mean visual acuity and CRT improved from 0.25 (610.8 microm) at baseline to 0.47 (238.4 microm) 4 weeks after injection and 0.45 (368.7 microm) after 12 weeks. Twenty seven eyes among the total of 91 eyes had a second injection due to recurrence or worsened metamorphopsia. In these cases, mean visual acuity and CRT improved from 0.33 (483.7 microm) at baseline to 0.44 (234.3 microm) 4 weeks after injection and 0.42 (296.8 microm) after 12 weeks. Comparing the efficacy by the number of treatments, visual acuity and CRT improved more significantly in a first time treatment group. CONCLUSIONS: IVB injection is generally effective, but recurrence occurred in 26/47 eyes based on CRT. The second injection is effective, however, its effect is weak when compared with the first injection.

Optical quality measurements of hydrophobic acrylic intraocular lenses.

PURPOSE: To compare the optical quality of several models of hydrophobic acrylic intraocular lenses (IOLs). METHODS: Modulation transfer function (MTF) measurements were performed using a model eye system on four models of hydrophobic acrylic IOLs. Models tested were the AcrySof SA60AT, MA60AC, and MA60BM (Alcon, Ft Worth, Tex), as well as the model VA-60BB (Hoya, Tokyo, Japan). For benchmarking, the Alcon model MZ60BD polymethylmethacrylate (PMMA) lens was also measured. Three lenses of each model were tested at frequencies of 50 and 100 line pairs (lp)/mm (corresponding to 20/40 and 20/20, respectively). RESULTS: With a 3-mm aperture, the Alcon AcrySof models had mean MTF values ranging from 58.5% to 60.3% at 100 lp/mm and 78.0% to 79.7% at 50 lp/mm. The Hoya model VA-60BB provided statistically significantly lower (P<.05) MTF values than the Alcon AcrySof models at both frequencies (47.3 +/- 1.2% at 100 lp/mm and 71.8 +/- 1.9% at 50 lp/mm). With a 5-mm aperture, the Alcon AcrySof models had MTF values ranging from 32.9% to 34.3% at 100 lp/mm and 45.2% to 46.7% at 50 lp/mm. Under these larger aperture conditions, the Hoya model VA-60BB also had statistically significantly lower MTF values (20.9 +/- 0.8% at 100 lp/mm and 27.2 +/- 1.1% at 50 lp/mm). Under both apertures and frequencies, the Alcon PMMA lens had statistically significantly higher MTF values than the Hoya lens and statistically significant lower MTF values than all AcrySof models. CONCLUSIONS: Using both 3- and 5-mm aperture settings as well as frequencies corresponding to 20/20 and 20/40 vision, statistically significantly higher MTF values were obtained for AcrySof lenses, which were greater than the PMMA lens, which were greater than the Hoya model VA-60BB. The differences in MTF values between lens models are more exaggerated with a 5-mm aperture and may highlight differences in lens manufacturing processes.

Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases.

BACKGROUND: To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). CASES: Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. OBSERVATION: Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. CONCLUSION: Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.

Clinicopathological features of dacryolithiasis in Japanese patients: frequent association with infection in aged patients.

Purpose. The purpose of this study is to elucidate the clinicopathological features of dacryolithiasis and prevalence of associated infection in Japanese patients. Materials and Methods. Out of 13,471 outclinic patients from 2006 to 2011, 268 patients were scheduled to be performed dacryocystorhinostomy (DCR) due to dacryocystitis with nasolacrimal duct obstruction. Actually 266 patients underwent dacryocystorhinostomy (DCR) and two patients were cured by only ophthalmic examination. Dacryoliths were found in 17 cases (6.3%). Among 17 cases of dacryolithiasis, three patients were male, and 14 were female. The age of the patients ranged from 32 to 82 (mean 67) years, and 13 cases (76%) were more than 65 years of age. Pathological examination disclosed the infectious agents in 9 cases (53%), and all patients with infection were more than 65 years of age. Special stains revealed colonies of fungus, suspicious of Aspergillus, in 6 cases and gram-positive rods, and suspicious of Actinomyces, in 3 cases. Conclusions. The current study showed the frequent association of infection with dacryolithiasis in aged Japanese patients. This should be taken into the consideration for the treatment of dacryolithiasis.

Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy.

PURPOSE: To investigate long-term results of vitrectomy for the removal of submacular hard exudates in patients with diabetic maculopathy. METHODS: Thirteen eyes of 10 patients with diabetic maculopathy underwent vitrectomy to remove submacular hard exudates from December 1993 to March 1999. The mean preoperative logMAR visual acuity +/- SD was 1.54 +/- 0.43. Preoperatively, the exudates ranged from 0.5 to 3 disk diameters (average, 1.25 disk diameters). Exudates were removed using subretinal forceps through a minimal paramacular retinotomy after vitrectomy. In all cases, 20% SF6 gas tamponade was added. The mean postoperative observation period was 43.2 months. RESULTS: Visual acuity was improved in 7 eyes (54%) 1 year after surgery; however, visual acuity over longer periods was improved in only 5 eyes (38%) as compared with the preoperative findings. The mean final visual acuity +/- SD was 1.62 +/- 0.59, which did not show statistically significant improvement over that in the control group. Although submacular hard exudates and macular edema disappeared during the postoperative period, atrophic or degenerative changes occurred in many cases. CONCLUSION: Visual improvement could not be obtained for a long period after removing submacular hard exudates in most of the patients, suggesting that diabetic maculopathy should be treated before massive exudate deposits appear in the macula.