Unraveling the hypoxia modulating potential of VEGF family genes in pan-cancer.

Tumor hypoxia, oxygen deprivation state, occurs in most cancers and promotes angiogenesis, enhancing the potential for metastasis. The vascular endothelial growth factor (VEGF) family genes play crucial roles in tumorigenesis by promoting angiogenesis. To investigate the malignant processes triggered by hypoxia-induced angiogenesis across pan-cancers, we comprehensively analyzed the relationships between the expression of VEGF family genes and hypoxic microenvironment based on integrated bioinformatics methods. Our results suggest that the expression of VEGF family genes differs significantly among various cancers, highlighting their heterogeneity effect on human cancers. Across the 33 cancers, VEGFB and VEGFD showed the highest and lowest expression levels, respectively. The survival analysis showed that VEGFA and placental growth factor (PGF) were correlated with poor prognosis in many cancers, including kidney renal cell and liver hepatocellular carcinoma. VEGFC expression was positively correlated with glioma and stomach cancer. VEGFA and PGF showed distinct positive correlations with hypoxia scores in most cancers, indicating a potential correlation with tumor aggressiveness. The expression of miRNAs targeting VEGF family genes, including hsa-miR-130b-5p and hsa-miR-940, was positively correlated with hypoxia. In immune subtypes analysis, VEGFC was highly expressed in C3 (inflammatory) and C6 (transforming growth factor ß dominant) across various cancers, indicating its potential role as a tumor promotor. VEGFC expression exhibited positive correlations with immune infiltration scores, suggesting low tumor purity. High expression of VEGFA and VEGFC showed favorable responses to various drugs, including BLU-667, which abrogates RET signaling, an oncogenic driver in liver and thyroid cancers. Our findings suggest potential roles of VEGF family genes in malignant processes related with hypoxia-induced angiogenesis.

Effect of Alternate Treatment with Intravitreal Corticosteroid and Anti-VEGF for Macular Edema Secondary to Retinal Vein Occlusion.

PURPOSE: To evaluate whether treatment with intravitreal corticosteroid and anti-vascular endothelial growth factor (VEGF) injections alternately can improve treatment outcomes of macular edema (ME) caused by retinal vein occlusion (RVO). METHODS: This dual-center retrospective study included 112 eyes with treatment-naïve ME secondary to RVO that were alternately treated with intravitreal corticosteroid and anti-VEGF injections (33 eyes, alternate group) or treated only with intravitreal anti-VEGF injections (79 eyes, anti-VEGF group) on a pro re nata basis. RESULTS: During the 12-month follow-up period, the alternate group achieved a visual acuity gain of 0.39 logMAR, while the anti-VEGF group achieved a gain of 0.21 logMAR (P=0.042). The alternate group demonstrated a reduction in the central macular thickness of 229.9-µm, while the anti-VEGF group achieved a reduction of 220.1 µm (P=0.887). The alternate group required an average of 5.2 injections, while the anti-VEGF received 4.2 injections (P < 0.001). In a propensity score-matched cohort to compensate for the differences in the injection numbers between the two groups, the alternate group achieved a better visual acuity gain than the anti-VEGF group at month 12 (0.39 logMAR vs. 0.17 logMAR, P=0.048). CONCLUSIONS: In ME secondary to RVO, treatment with intravitreal corticosteroid and anti-VEGF injections alternately resulted in a more favorable visual outcome compared with intravitreal anti-VEGF monotherapy.

Progression of Diabetic Retinopathy and Declining Renal Function in Patients with Type 2 Diabetes.

BACKGROUND: At a university hospital in Korea, we conducted a retrospective study to determine the association of the progression of diabetic retinopathy (DR) with declining renal function in type 2 diabetes. METHODS: We included a total of 1527 patients with type 2 diabetes who followed up in our diabetes clinic and underwent fundus photographic examinations from August 2006 to February 2014. DR was assessed by retinal ophthalmologists using comprehensive ophthalmologic examinations. RESULTS: The baseline prevalence of nonproliferative DR (NPDR) and proliferative DR (PDR) was 26.5% and 14.7%, respectively. Among 1303 patients with no DR and NPDR, 134 (10.3%) patients progressed to NPDR or PDR. The progression group had longer duration of diabetes, higher fasting plasma glucose, higher HbA1c, and a higher rate of ≥20% decline in eGFR during the follow-up period. After multivariate analysis, ≥20% decline in eGFR (odds ratio 2.553, 95% CI 1.219-5.348, p = 0.013) was an independent risk factor for progression of DR in patients with NPDR. CONCLUSION: Declining renal function was independently associated with DR progression in patients with NPDR, suggesting that investigation of DR status should be recommended for patients with declining renal function.

Comparison of systemic conditions at diagnosis between central retinal vein occlusion and branch retinal vein occlusion.

OBJECTIVE: To compare systemic conditions at the time of diagnosis between patients with central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). DESIGN: This study included patients diagnosed with CRVO or BRVO between February 2009 and August 2017 at three branch hospitals of Hallym University Medical Center. Demographic and anthropometric variables, systemic comorbidity profiles, and laboratory findings at diagnosis were collected from a clinical data warehouse system, and were compared between the CRVO and BRVO groups. RESULT: Four hundred and seventeen patients with CRVO and 1,511 patients with BRVO were included. The mean age was 61.8 ± 13.9 years, which was comparable between two groups (P = .332). Female proportion was higher in the BRVO group (55.0%) than in the CRVO group (48.0%; P = .013). Diabetes mellitus (P = .017) and chronic kidney disease (P = .004) were more prevalent in the CRVO group. Serum homocysteine level was abnormally high in 23.5% of CRVO patients and in 8.4% of BRVO patients (P < .001). Blood urea nitrogen and serum creatinine levels were abnormally elevated in more subjects with CRVO (P = .002). CONCLUSION: CRVO is associated with higher prevalence of diabetes mellitus and chronic kidney disease, as well as with elevated serum homocysteine level. These results might suggest a difference between the pathophysiologies of CRVO and BRVO.

Diabetic retinopathy is a prognostic factor for progression of chronic kidney disease in the patients with type 2 diabetes mellitus.

Since both retinopathy and nephropathy are major diabetic microvascular complications, we investigated whether severity of diabetic retinopathy (DR) has adverse effects on renal function and albuminuria in the patients with type 2 diabetes mellitus (DM). We screened 2,197 adult patients with type 2 DM who had undergone fundus exam between August 2006 and February 2014. Among them, 1,592 subjects with available serial renal function and albuminuria measurement were included in the analysis. DR status was classified as no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). The risk of CKD progression was assessed according to DR severity. A total of 384 (24.1%) had NPDR and 202 (12.7%) had PDR at either eye. The mean follow-up period was 5.6±2.1 years. DR was associated with lower body mass index, lower plasma hemoglobin, lower serum albumin level, longer duration of DM, poorer control of blood sugar, lower estimated glomerular filtration rate (eGFR), and greater amount of albuminuria. Interestingly, baseline DR severity was associated with faster renal function decline and greater albuminuria progression. In multivariate analysis, NPDR had 2.9 times and PDR had 16.6 times higher risk for CKD progression. Our findings showed that baseline DR severity is a prognostic factor for future CKD progression in type 2 DM patients. Therefore, clinicians must evaluate DR severity at the first visit and closely monitor renal function and albuminuria in the subjects with severe DR.

Optical Quality Assessment in Patients with Macular Diseases Using Optical Quality Analysis System.

Macular diseases cause vision loss, as the macula is the functional center for vision. In this study we assessed optical quality in eyes with macular diseases and evaluated the effectiveness of the Optical Quality Analysis System (OQAS) to detect macular diseases. We analyzed 88 eyes of 88 patients with macular diseases (51 men and 37 women; mean age: 65.24 ± 12.96 years) and 43 eyes of 43 control subjects (11 men and 32 women; mean age: 54.70 ± 15.03 years). The macular diseases included age-related macular disease (n = 62), diabetic macular edema (n = 19), and retinal vein occlusion (n = 7). We measured the objective scattering index (OSI), modulation transfer function (MTF), Strehl ratio, and predicted visual acuities (PVAs) at 100, 20, and 10% contrast levels in both groups using OQAS. We measured the retinal thickness in the macular disease group on optical coherence tomography. The macular disease and control groups significantly differed in OSI, MTF, Strehl ratio, and PVAs at 20 and 10% contrast levels (p < 0.05). In the macular disease group, retinal thickness correlated with OSI (r = 0.370, p < 0.001) and MTF (r = -0.264, p = 0.014). In conclusion, optical quality was worse in the patients with macular diseases compared to the control subjects, and retinal thickness affected optical quality. Therefore, the distortion of macular shape may contribute to vision disturbance in patients with macular diseases.

Effect of grape seed proanthocyanidin extract on hard exudates in patients with non-proliferative diabetic retinopathy.

PURPOSE: To evaluate the efficacy and safety of orally administered grape seed proanthocyanidin extract (GSPE) in patients with non-proliferative diabetic retinopathy (NPDR). METHODS: In this randomized (1:2:2), multicentre, double-blind trial, patients (n = 124; age: 40-78 years) were administered placebo, calcium dobesilate (CD; 750 mg/d), or GSPE (150 mg/d) orally for up to 12 months. All patients had retinal thickening with hard exudates (HEs) that met predefined criteria; the median best-corrected visual acuity was 0.8, as assessed using the Snellen visual acuity card. The main outcome measure was an improvement in HEs by at least 1 grade on a 10-grade severity scale. This was evaluated using fundus photography over 1 year. RESULTS: The rate of improvement in the HE severity was higher in the GSPE group than in the CD group. No statistically significant difference existed among the study groups in optical coherence tomography parameters, such as central subfield macular thickness and total macular volume (TMV). However, in the GSPE group, TMV after 9 months of treatment was significantly decreased compared with that at baseline. The GSPE group showed a significantly greater improvement in HE severity than did the placebo or CD group. Four cases in the GSPE group and 2 in the CD group were determined to have developed potential treatment-related adverse reactions, which were all gastrointestinal in nature. CONCLUSIONS: Oral GSPE therapy for 1 year improved HEs in patients with NPDR. The efficacy of GSPE for HEs was higher than that of oral CD in the study patients.

New Strategy of Visual Acuity Assessment by Consecutively-sized Landolt Ring Symbol.

In this paper, novel visual acuity test strategy is proposed. Unlike conventional way, an instructor shows a subject the magnifying image of Landolt ring through the monitor. By adapting multiple reliability verification system using feedback, instructor can get the vision acuity data with higher accuracy and resolution. It can detect at least 5 more distributed vision between representative vision widely known before. As the new system require less than half of the space than before, it is not only more accurate but also efficient.

Risk factors for retinal microvascular impairment in type 2 diabetic patients without diabetic retinopathy.

OBJECTIVES: To determine the risk factors for retinal microvascular impairment on optical coherence tomography angiography (OCT-A) in type 2 diabetic patients without clinical diabetic retinopathy (DR). METHODS: This retrospective and cross-sectional study enrolled 74 diabetic patients without clinically evident DR for the study group and 34 healthy subjects for the control group. OCT-A parameters were measured to determine vascular density (VD) and the foveal avascular zone (FAZ) size in the superficial and deep capillary plexuses (SCP/DCP) of the retina. Clinical data were collected on sex, age, diabetes duration, hemoglobin A1c (HbA1c), hypertension, dyslipidemia, low-density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate (eGFR) and smoking status. Multiple linear regression analyses were performed to represent the associated clinical variables with OCT-A parameters in diabetic patients. RESULTS: In comparison between the study and control groups, the VD in the SCP and DCP were significantly lower in diabetic patients compared to the controls (P = 0.022 and 0.003, respectively). The FAZ size in the SCP and DCP were significantly greater in diabetic patients compared to the controls (P = 0.035 and <0.001, respectively). In age- and sex-adjusted multiple regression analyses for the diabetic patients, dyslipidemia and hypertension were negatively associated with SCP-VD (ß = -0.357, P = 0.002; ß = -0.239, P = 0.039, respectively). Current smoking was correlated with lower DCP-VD (ß = -0.255, P = 0.043). Greater SCP-FAZ size was associated with dyslipidemia and greater LDL-C (ß = 0.254, P = 0.013; ß = 0.232, P = 0.029, respectively), and greater DCP-FAZ size, with lower eGFR and greater LDL-C (ß = -0.355, P = 0.004; ß = 0.235, P = 0.037, respectively). CONCLUSIONS: Diabetic patients without clinical DR showed lower VD and greater FAZ size in the SCP and DCP compared to healthy controls. In diabetic patients without clinical DR, dyslipidemia and/or high LDL-C were important risk factors for retinal microvascular impairment. Hypertension, current smoking and lower eGFR also contributed to microvascular impairment.

Investigation of Surgical Techniques for Optimization of Long-Term Outcomes of LCP-Based Retinal Prosthesis Implantation.

PURPOSE: To investigate reproducible surgical techniques to optimize the long-term safety of liquid crystal polymer (LCP)-based retinal prosthesis implantation. METHODS: An LCP-based retinal prosthesis is fabricated monolithically on a single-body LCP substrate with all components, including the package and electrode array. We implanted the electrode array into the suprachoroidal space and anchored the package and transition part to the sclera in rabbits (n = 11). The safety profile was assessed upon the completion of the surgery and postoperatively. RESULTS: The surgical procedures for implantation of the entire system were easily performed in nine eyes (81.8%) without any intraoperative complications. In the other two eyes (18.2%), surgical complications related to electrode insertion, including optic nerve damage and retinal tear, arose. In 10 eyes (90.9%), the devices were well tolerated for at least 3 months. However, in most eyes (nine; 81.8%), two complications began to appear after 3 months, postoperatively, including conjunctival erosion or dehiscence over the package or transition part. The electrode arrays were maintained safely in the suprachoroidal space after surgery without any complications, regardless of the status of the extraocular components in all cases except two intraoperative complications. CONCLUSIONS: We established safe and reproducible surgical techniques for implantation of our LCP-based retinal prosthesis into the suprachoroidal space. Although issues related to surgical technique or device configuration were identified, further technical solutions would improve the long-term safety of device implantation. TRANSLATIONAL RELEVANCE: This study presents successful implantation of LCP-based retinal prosthesis. The technical solutions will permit an optimization of surgical techniques.

Foveal microvasculature features of surgically closed macular hole using optical coherence tomography angiography.

BACKGROUND: To describe the features of foveal microvasculature using optical coherence tomography angiography (OCTA) and to determine the related clinical factors in eyes with surgically closed macular hole (MH). METHODS: A retrospective case series of 18 patients with unilateral MH was reviewed. The patients maintained complete hole closure after vitrectomy with inner limiting membrane (ILM) peeling for at least 12 months. The healthy fellow eyes were studied as controls. The foveal microvasculature of both eyes was examined by OCTA. The area of the foveal avascular zone (FAZ) and the vascular density (VD) ratio in the superficial and deep capillary plexuses (SCP and DCP) were determined after surgery. Several clinical factors including age, stage and dimensions of MH, papillofoveal distance, the extent of nasal displacement of the fovea after surgery, postoperative central foveal thickness, and outer-retina integrity were evaluated to determine any relationships with the OCTA parameters. RESULTS: The mean FAZ area in both the SCP and DCP (0.29 ± 0.11 mm2 and 0.39 ± 0.14 mm2) was significantly smaller than those of the controls (0.45 ± 0.14 mm2 and 0.62 ± 0.22 mm2) (p = 0.001 and <0.001, respectively). The mean VD ratio in the SCP (0.270 ± 0.349) was similar to that of the controls (0.321 ± 0.189) (p = 0.231); however, that in the DCP (0.321 ± 0.189) was significantly lower than that of the controls (0.331 ± 0.119) (p = 0.025). Only the extent of nasal displacement of the fovea was correlated with the DCP FAZ-area difference values between the study group and the controls (correlation coefficient = 0.577; p = 0.012). CONCLUSIONS: After successful MH surgery, the FAZ area in both the SCP and DCP was smaller and the VD ratio of the DCP was lower, suggesting a possible DCP vulnerability to tractional stress. As the FAZ area of the DCP in closed-MH eyes became smaller than that in the controls, the fovea was less displaced toward the optic disc, possibly reflecting a lack of retinal redundancy caused by horizontal stretching accompanied by foveal displacement.

Clinical parameters related to metamorphopsia outcome in patients with resolved central serous chorioretinopathy using M-CHARTS: retrospective cohort study.

BACKGROUND: The purpose of this study was to determine the clinical parameters related to metamorphopsia outcome in patients with resolved central serous chorioretinopathy (CSCR). METHODS: The charts of 36 eyes with resolved CSCR were retrospectively reviewed. We measured metamorphopsia using M-CHARTS after resolution of serous retinal detachment. We analyzed the relationship between metamorphopsia outcome and clinical parameters including age, visual acuity, chronicity of CSCR, symptom duration and several spectral-domain optical coherence tomography findings using univariate and multivariate forward logistic regression analyses. RESULTS: The M-CHARTS detected metamorphopsia in 19 eyes (52.8 %). In the univariate analysis, the eyes with metamorphopsia were, relative to those without metamorphopsia, significantly associated with a greater proportion of chronic-recurrent CSCR, initial and final irregularities of retinal pigment epithelium, longer symptom duration, thinner final thickness of central fovea and outer nuclear layer, and final disruption of external limiting membrane (ELM), photoreceptor inner and outer segment junction and cone outer segment tip line (P = 0.003, 0.037, 0.019, 0.003, 0.013, 0.015, <0.001, 0. 012 and 0.002, respectively). However, in the multivariate analysis, chronic-recurrent CSCR (OR 22.5, P = 0.019) and final disrupted ELM (OR 82.6, P = 0.004) were the independent clinical parameters related to poor metamorphopsia outcome. CONCLUSIONS: Residual metamorphopsia was detected using M-CHARTS in about half of patients (52.8 %) with resolved CSCR. Chronic-recurrent CSCR and final disrupted ELM were the independent clinical parameters related to poor metamorphopsia outcome in patients with resolved CSCR.

Klebsiella Endophthalmitis as Retinal Vasculitis with Prostatic Abscess.

PURPOSE: To describe an unusual case of endogenous Klebsiella endophthalmitis associated with prostatic abscess in an immunocompetent patient. CASE REPORT: A 59-year-old previously healthy man presented with rapidly progressive retinal vasculitis in the left eye. He received an empirical antibiotic and antiviral agent intravenously followed by oral prednisolone until the etiology was identified; however, intraocular inflammation in the left eye continued to worsen, followed by the development of subretinal abscess in the contralateral eye. Finally, a diagnosis of endogenous Klebsiella endophthalmitis associated with prostatic abscess was made through a culture of the vitreous acquired by diagnostic vitrectomy. However, we could not save the vision of the left eye despite the intensive treatment with intravenous and intravitreal injections of antibiotics. CONCLUSIONS: Rapidly progressive retinal vasculitis could be an initial sign of endogenous Klebsiella endophthalmitis even in an immunocompetent patient.

Neurosyphilis initially presenting as hemorrhagic exudative optic neuropathy in an immunocompetent patient.

We describe an unusual case of hemorrhagic exudative optic neuropathy as an initial presentation of neurosyphilis in an immunocompetent patient. The clinicians have to be alert to consider a diagnosis of syphilitic optic neuropathy in cases with hemorrhagic exudative optic neuropathy.

A miniaturized, eye-conformable, and long-term reliable retinal prosthesis using monolithic fabrication of liquid crystal polymer (LCP).

A novel retinal prosthetic device was developed using biocompatible liquid crystal polymer (LCP) to address the problems associated with conventional metal- and polymer-based devices: the hermetic metal package is bulky, heavy, and labor-intensive, whereas a thin, flexible, and MEMS-compatible polymer-based system is not durable enough for chronic implantation. Exploiting the advantageous properties of LCP such as a low moisture absorption rate, thermobonding, and thermoforming, we fabricate a small, light-weight, long-term reliable retinal prosthesis that can be conformally attached on the eye-surface. A LCP fabrication process using monolithic integration and conformal deformation was established enabling miniaturization and a batch manufacturing process as well as eliminating the need for feed-through technology. The functionality of the fabricated device was tested through wireless operation in saline solution. Its efficacy and implantation stability were verified through in vivo animal tests by measuring the cortical potential and monitoring implanted dummy devices for more than a year, respectively.

Toxicity profile of temozolomide in the treatment of 300 malignant glioma patients in Korea.

This study evaluated the toxicity profiles of temozolomide in the treatment of malignant glioma as either concurrent or adjuvant chemotherapy. We retrospectively reviewed the medical records of 300 malignant glioma patients treated with temozolomide in two medical institutions in Korea between 2004 and 2010. Two hundred nine patients experienced a total of 618 toxicities during temozolomide therapy. A total of 84.8% of the 618 toxicities were Common Terminology Criteria for Adverse Events (CTCAE) grade 1 or 2, while 15.2% were grade 3 or 4. Among the hematologic toxicities, thrombocytopenia (13.7%), anemia (11.0%), and AST/ALT increases (7.0%) were common. Among the non-hematologic toxicities, nausea (44.3%), vomiting (37.0%), and anorexia (14.3%) were the three most common toxicities. There was no mortality due to temozolomide. Although temozolomide showed many types of toxicities, the majority of the toxicities were tolerable and of lower grade. Gastrointestinal troubles are the most common toxicities in Korean patients treated with temozolomide.

Low-fluence photodynamic therapy versus ranibizumab for chronic central serous chorioretinopathy: one-year results of a randomized trial.

PURPOSE: To compare the efficacy and safety between low-fluence photodynamic therapy (PDT) and the intravitreal ranibizumab in the treatment of chronic central serous chorioretinopathy (CSC). DESIGN: Prospective, randomized, single-center, parallel-arm, controlled trial. PARTICIPANTS: Thirty-four eyes of 32 patients with chronic CSC with >6 months' duration of symptoms or recurrent CSC were randomly placed into the low-fluence PDT group (n = 18) or the ranibizumab group (n = 16). INTERVENTION: The patients underwent a single session of low-fluence PDT or 3 consecutive monthly injections of ranibizumab. Rescue treatment was available from month 3 if the subretinal fluid (SRF) persisted or recurred after primary treatment; low-fluence PDT was given to the ranibizumab group and intravitreal ranibizumab to the low-fluence PDT group. MAIN OUTCOME MEASURES: The primary outcome was the proportion of eyes with complete resolution of SRF without rescue treatment. Secondary outcomes included the mean changes in logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA), central retinal thickness (CRT), and angiographic findings from baseline to 12 months. RESULTS: At month 12, 16 eyes (88.9%) of the low-fluence PDT group maintained complete resolution of SRF without rescue treatment versus 2 eyes (12.5%) in the ranibizumab group (P <0.001). Two eyes (11.1%) in the low-fluence PDT group and 11 eyes (68.8%) in the ranibizumab group met the criteria for rescue treatment (P = 0.001). In the low-fluence PDT group, the mean decrease in CRT from baseline was significantly greater than that in the ranibizumab group until month 6 (P <0.05), but the differences became insignificant thereafter. The improvement in BCVA from baseline was superior in the low-fluence PDT group to that in the ranibizumab group, but the differences were not statistically significant except at month 3 (P = 0.025). On indocyanine green angiography, a significantly greater proportion of the low-fluence PDT group (16 eyes; 88.9%) showed a marked reduction in choroidal hyperpermeability after primary treatment than that of the ranibizumab group (0 eyes; P <0.001). No serious adverse events related to the drugs or procedures were observed. CONCLUSIONS: This study represents the overall superiority of low-fluence PDT compared with intravitreal ranibizumab in the treatment of chronic CSC.

Levetiracetam compared with valproic acid for the prevention of postoperative seizures after supratentorial tumor surgery: a retrospective chart review.

INTRODUCTION: Antiepileptic drugs are commonly given for perioperative prophylaxis after brain tumor surgery, and there has been growing interest in levetiracetam, a second-generation antiepileptic drug. This retrospective study compared the seizure outcomes, side effects and durability of levetiracetam with valproic acid after a craniotomy for supratentorial brain tumors. METHODS: Between 2009 and 2012, 282 consecutive patients with a supratentorial brain tumor underwent a craniotomy at Seoul National University Bundang Hospital. Of these patients, 51 (18.1%) and 231 (81.9%) were pre-operatively administered levetiracetam and valproic acid, respectively. The postoperative seizure outcomes (within 1 month after surgery) and the long-term side effects of both drugs were evaluated. RESULTS: Of the 51 patients in the levetiracetam group, 4 (7.8%) experienced postoperative seizures after brain tumor surgery, and 15 (6.5%) of the 231 patients in the valproic acid group experienced postoperative seizures (p = 0.728). The long-term complication rate of the valproic acid group (26.8%; 62/231) was significantly higher than that of the levetiracetam group (9.8%; 5/51) [p = 0.010]. In the valproic acid group, 10 hepatotoxicities, 20 hyperammonemias and 10 hematologic abnormalities (6 thrombocytopenias, 3 pancytopenias, and 1 leucopenia) occurred. Moreover, 89 patients (38.5%) in the valproic acid group changed or added other anticonvulsants because of side effects or uncontrolled seizures, whereas only 9 patients (17.6%) in the levetiracetam group changed or added other anticonvulsants (p = 0.005). CONCLUSIONS: The postoperative seizure control rates of levetiracetam and valproic acid were not statistically significantly different; however, levetiracetam may be superior to valproic acid in terms of its safety and durability after supratentorial tumor surgery.

Cytomegalovirus retinitis after intravitreal bevacizumab injection in an immunocompetent patient.

We report a case of cytomegalovirus (CMV) retinitis after intravitreal bevacizumab injection. A 61-year-old woman with diabetic macular edema developed dense vitritis and necrotizing retinitis 3 weeks after intravitreal bevacizumab injection. A diagnostic vitrectomy was performed. The undiluted vitreous sample acquired by vitrectomy was analyzed by polymerase chain reaction and culture. Polymerase chain reaction of the vitreous was positive for CMV DNA. Other laboratory results did not show evidence of other infectious retinitis and systemic immune dysfunction. Human immunodeficiency virus antibodies were also negative. After systemic administration of ganciclovir, retinitis has resolved and there has been no recurrence of retinitis during the follow-up period of 12 months. Ophthalmologists should be aware of potential risk for CMV retinitis after intravitreal bevacizumab injection.

Preferential hyperacuity perimeter and prognostic factors for metamorphopsia after idiopathic epiretinal membrane surgery.

PURPOSE: To document changes in metamorphopsia via preferential hyperacuity perimeter and to identify prognostic factors related to favorable metamorphopsia outcome after idiopathic epiretinal membrane surgery. DESIGN: Prospective, consecutive, interventional case series. METHODS: We prospectively included 29 eyes of 27 patients who underwent successful vitrectomy for idiopathic epiretinal membrane. All eyes underwent examinations before surgery and at 2 weeks and 1, 3, and 6 months after surgery. Metamorphopsia was assessed by using a preferential hyperacuity perimeter. Several clinical factors were analyzed to reveal relationships with final metamorphopsia outcome, including the duration of symptoms, best-corrected visual acuity, and spectral-domain optical coherence tomography findings. Spectral-domain optical coherence tomography findings included assessment of central foveal thickness, and the integrity of the photoreceptor inner segment and outer segment (IS/OS) junction. RESULTS: At baseline, preferential hyperacuity perimeter detected areas of distortion in 15 eyes (51.7%). At 6 months after surgery, there was significant reduction in metamorphopsia (P = .001), which was paralleled with significant improvement of best-corrected visual acuity and reduction of central foveal thickness (P < .001). At 6 months after surgery, the degree of metamorphopsia was related significantly to the severity of preoperative metamorphopsia and central foveal thickness at baseline (ρ = 0.856; P < .001; ρ = 0.412; P = .027; respectively). Eyes with broadly disrupted IS/OS junction of more than 200 µm before surgery revealed significantly poorer postoperative metamorphopsia than those with intact or narrowly disrupted IS/OS junction (P = .001). However, duration of symptoms and baseline best-corrected visual acuity were not correlated with final metamorphopsia (P = .625 and P = .052, respectively). CONCLUSIONS: Significant reduction of metamorphopsia paralleled the improvement of best-corrected visual acuity and central foveal thickness until 6 months after idiopathic epiretinal membrane surgery. The significant predictors for postoperative metamorphopsia outcome were the degree of preoperative metamorphopsia, central foveal thickness, and the photoreceptor IS/OS junction integrity at baseline.