Effects of Subcutaneous Methotrexate in Patients with Refractory Uveitis and Chorioretinitis.

PURPOSE: Methotrexate (MTX) is an immunosuppressive agent used to treat noninfectious inflammatory eye conditions and is generally administered orally for ocular inflammatory diseases. When used in rheumatological diseases, subcutaneous administration has been reported to show higher efficacy than oral administration. Therefore, this study aimed to evaluate the effect of subcutaneous MTX in patients with refractory uveitis or choroiditis who did not respond to other immunosuppressive agents. METHODS: A retrospective case series study was performed between January and December 2018. Patients with uveitis or chorioretinitis who showed little to no treatment response for 6 months or more with conventional immunosuppressive agents were treated with MTX, administered subcutaneously. After 6 months of treatment, patients were evaluated to determine whether complete suppression of inflammation sustained for ≥28 days was achieved in both eyes and whether improvement can be confirmed by fluorescein angiography (FAG). RESULTS: Subcutaneous MTX treatment was performed on 18 patients: 11 had intermediate uveitis and seven had posterior uveitis. In the intermediate uveitis patient group, five patients (50% of the group excluding one patient who dropped out) showed improvement in FAG and three patients (30%) showed complete suppression of inflammation. In the posterior uveitis group, two out of seven patients (excluding two patients who dropped out) showed an improvement, two patients in the group showed little change, and one patient showed aggravation of FAG findings. CONCLUSIONS: The study confirmed that in patients with uveitis or chorioretinitis who had a refractory response to treatment with other immunosuppressive agents, subcutaneous MTX showed improved treatment efficacy.

One-year outcomes of fixed-dosing Aflibercept therapy for pre treated and naive polypoidal choroidal vasculopathy patient.

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is a type of age-related macular degeneration that can cause permanent vision loss. The purpose of this paper was to report the one-year outcomes of fixed-dosing aflibercept therapy for the treatment of PCV. METHODS: This was a prospective, single-arm, interventional case series study of 25 PCV patients; 12 pre-treated and 13 treatment-naïve patients. The patients were treated and monitored for 12 months. Each patient was administered with an aflibercept (2.0 mg) injection every month for the first 3 months (the loading phase), and thereafter, once every 2 months. At every follow-up visit, best-corrected visual acuity (BCVA) test, fundus examination, and optical coherence tomography for measuring the central subfield macular thickness (CSMT) were performed. Fluorescein and indocyanine green angiography were conducted at baseline and at 4 and 12 months. RESULTS: After 12 months of aflibercept therapy, the mean BCVA of the patients significantly improved from 65.48 letters at baseline to 69.91 letters (p=0.001), and the CSMT significantly decreased from 406.92 um at baseline to 276.12 um (p< 0.001). Additionally, ten patients (40%) showed complete polyp regression. The treatment-naïve patients showed a statistically significant improvement in BCVA from 66.58 letters at baseline to 76.36 letters at 12 months, and a significant decrease in CSMT, from 462 to 243 um. In the pre-treated group, there was no change in BCVA (64.46 letters), and the decrease in CSMT from 356.08 to 303.69 um was not statistically significant. CONCLUSIONS: The fixed-dosing aflibercept regimen is effective for treating patients with PCV and is more effective in treatment-naïve patients than in pre-treated patients. TRIAL REGISTRATION: Clinical Research Information Service (CRiS), Republic of Korea. Identifer: KCT0005798, Registered: Jan 20, 2021. Retrospectively registered, URL: https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=18546.

Comparison of Solar Radiation and Myopia Occurrence in South Korean Children.

PURPOSE: To investigate the association between regional solar radiation and myopia occurrence in South Korean children. MATERIALS AND METHODS: A population-based cross-sectional study using data of 1218 children aged 7-9 years from the Korea National Health and Nutritional Examination Survey was conducted from January 1, 2008, to December 31, 2012. Myopia prevalence and the mean spherical equivalent were estimated; myopia was defined as spherical equivalent refraction <-1.5 D. Data regarding solar radiation and sunshine duration were collected from 21 national monitoring stations in South Korea. Multiple logistic regression analyses and multiple linear regression analyses were used to evaluate the associations. However, the most important covariate, the time spent outdoors, was not measured and could not be used. RESULTS: In the entire cohort of 1218 participants, solar radiation and sunshine duration were significantly associated with the mean spherical equivalent (P=0.001 and P=0.014, B = 0.088 and B = 0.069, respectively) and solar radiation was significantly associated with myopia prevalence (P=0.008). And, a negative but not statistically significant association between sunshine duration and myopia prevalence was observed (P=0.064, respectively). CONCLUSIONS: Solar radiation and sunshine duration are associated with the mean spherical equivalent and myopia prevalence in South Korean children.

Spherical aberration reduction in nuclear cataracts.

PURPOSE: To measure higher-order aberrations (HOAs) in nuclear cataracts and to investigate spherical aberration changes with nuclear cataract progression. METHODS: A total of 102 eyes of older subjects (>50 years) were classified based on the nuclear opalescence (NO) grading of the Lens Opacities Classification System III: Group 1 (< NO2, 35), 2 (NO2, 23), 3 (NO3, 23), and 4 (≥ NO 4:21 eyes). Wave front measurements were performed with a Hartmann-Shack aberrometer. To investigate lenticular spherical aberration, HOAs were examined in 28 eyes before and after phacoemulsification, followed by insertion of an aberration-free intraocular lens. The relationship between lens opacity grade and ocular and lenticular spherical aberrations were investigated. RESULTS: Mean spherical aberrations in groups 1, 2, 3, and 4 were 0.25 ± 0.10, 0.16 ± 0.13, 0.12 ± 0.15, and 0.10 ± 0.20 µm, respectively, and showed a significant difference with nuclear opacity grading (p = 0.001). The spherical aberration showed negative associations with nuclear opacity grading (r = -0.408, p < 0.001). The predominant change in HOAs after phacoemulsification was an increase in spherical aberration, and 86 % of lenticular spherical aberrations were presumed to have negative values. The lenticular spherical aberration was negatively correlated with nuclear opacity severity (r = -0.409, p = 0.031). CONCLUSIONS: Ocular spherical aberration decreases with the progression of nuclear cataracts due to the negative correlation between lenticular spherical aberration and nuclear opacity severity.