The Effect of Intravitreal Bevacizumab Injection in Eales' Disease

PURPOSE: To report on 2 cases of Eales' disease that were successfully regressed with laser photocoagulation and intravitreal bevacizumab (Avastin; Genetech, Inc, San Francisco, California, USA) injection. CASE SUMMARY: Two male patients (30 years and, 40 years of age,) with a history of recurrent vitreous hemorrhage were diagnosed with Eales' disease. The 2 patients had peripheral retina neovascularization and active phlebitis in fundus fluorescein angiography. No other findings were observed in their eyes in the general examination. Scatter laser photocoagulation and intravitreal bevacizumab injection were performed. After 1 month follow-up, neovascularization completely regressed. There was no complication or recurrent vitreous hemorrhage at the 1 year follow up. CONCLUSIONS: Intravitreal bevacizumab injection, as combination treatment of laser photocoagulation, may be helpful in the regression of neovascularization due to Eales' disease.

Intravitreal Bevacizumab Injection in Adult Coats' Disease

PURPOSE: To report the efficacy of intravitreal bevacizumab injection in adult patients with Coats' disease. CASE SUMMARY: Vascular telangiectasia, microaneurysms, circinate hard exudates, and macular edema were shown in the macula of two patients. Vascular abnormality was limited to < or =6 clock hours in both cases. In case 1, the temporal retina demonstrates filigree-like vessels and capillary nonperfusion. In case 2, the nasal retina demonstrates aneurysmal dilatation and multiple microaneurysms. Intravitreal bevacizumab injection was administered in both cases. After 1 month, macular edema decreased. Laser photocoagulation was performed for vascular telangiectasia, microaneurysms, and capillary nonperfusion area. Then an additional decrease of macular edema was observed. Fluorescein leakage decreased, as well. After 1 month (case 1) and 2 months (case 2), macular edema increased. The second and third intravitreal reinjections were administered to each patient. Macular edema decreased. CONCLUSIONS: We report two rare cases of Coats' disease in adult patients. Intravitreal bevacizumab injection in patients with Coats' disease can result in a rapid decrease of macular edema, which will then lead to rapid visual recovery and an opportunity for effective laser photocoagulation. We recommend that intraviteal bevacizumab injection be used in combination with laser photocoagulation for the treatment of Coats' disease.

Case Report: Endogenous Nocardial Endophthalmitis in a Renal Transplant Recipient

PURPOSE: To report a case of endogenous Nocardia endophthalmitis developed in an immunocompromized patient. METHODS: Case report. RESULTS: A 25 year-old man with terminal stage renal disease who was treated with renal transplantation and immunosuppressive medications, presented with reduced vision in his right eye. Ocular examination showed inflammation of anterior chamber, vitreous opacity and subretinal abscess. Prior to ocular symptom, he had been diagnosed to have Nocarida abscess in the lung, brain and soft tissue. He was treated with systemic antibiotics (Imipenam, TMP/SMX). Retinal lesion was improved to achieve 20/200 vision. CONCLUSIONS: We experienced a case of endogenous endophthalmitis due to systemic Nocardia infection in an immunocompromised patient. To our knowledge, this case was the first report of endogenous Nocardia endophthalmitis in Korea.

Systemic Risk Factors for Postoperative Vitreous Hemorrhage Following Diabetic Vitrectomy

PURPOSE: To determine the incidence of and the systemic risk factors for postoperative vitreous hemor-rhage(PVH). METHOD: The records of 503 consecutive diabetic vitrectomy cases were reviewed. RESULT: Eighty-seven eyes(17.3%) had at least one episode of PVH. Sixty-five eyes(12.9%) had PVH within 3 months after vitrectomy, and the mean onset time of the first episode of PVH was about 13 weeks after vitrectomy. The mean follow-up period was 17.2 months in non-hemorrhage group, and 21.9 months in hemorrhage group. While 34 eyes(29.6%) had spontaneous absorption of blood, 42 eyes(36.5%) required air(or gas)-fluid exchange and 39 eyes(33.9%) vitreous cavity lavage. Using univariate analysis, the factors associated with increased incidence of PVH include type 1 diabetes mellitus(p=0.01), method of glycemia control(p=0.02), anemia(p=0.04), and hypercholesterolemia(p=0.005). Multivariate analysis revealed diabetic nephropathy(p=0.02) and hypercholesterolemia(p=0.01) were the risk factors. Five eyes(1.0%) lost light perception, 7 eyes(1.4%) had rhegmatogenous retinal detachment, and 11 eyes(2.2%) had neovascular glaucoma. CONCLUSION: Vitreous hemorrhage after diabetic vitrectomy occurred in the 17.3%, three quarters of them within 3 months. About one third had spontaneous clearing, and two-thirds required reoperation. Diabetic nephropathy and hypercholesterolemia were the systemic risk factors of vitreous hemorrhage after diabetic vitrectomy.

Postnatal Risk Factors of Retinopathy of Prematurity

In order to investigate the risk factors of retinopathy of prematurity[ROP], we retropspectively reviewed the medical records of 425 premature babies who had been admitted in our neonate intensive care unit between January 1994 and December 1998.After excluding 33 babies who had serious congenital anomalies, 83 out of 392 babies[20.7%]developed various stages of ROP.Gestational age and birthweight were the most significant risk factors. Among postnatal factors use of ventilator for 48 hours orlonger, apnea, and use of surfactant were independently increasing the progression of ROP in a linear logistic regression analysis.Other factors such as history of transfusion and sepsis had a tendency to worsen the retinopathy.On the other hand, fluctuation in blood gas, low apgar score or anemia did not seem to effect the progression of retinopathy. In conclusion, careful monitoring would be warrented when the premature babies had additional risk factors as listed above.