Intravitreal Anti-vascular Endothelial Growth Factor Injections to Treat Neovascular Age-related Macular Degeneration: Long-term Treatment Outcomes

PURPOSE: We assessed the visual and anatomical outcomes, and the safety profile of long-term intravitreal anti-vascular endothelial growth factor (VEGF) injections (aflibercept, ranibizumab, and bevacizumab) given to treat neovascular age-related macular degeneration (NAMD). METHODS: We analyzed medical records collected over 7 years of treatment-naive NAMD patients who received outpatient clinic-based intravitreal anti-VEGF injections. All were treated employing either “treat-and-extend” or “as needed” protocols at the discretion of the retinal specialist. The number of injections, adverse events associated with injection, and measures of visual acuity (VA), central foveal thickness (CFT), and intraocular pressure (IOP) were recorded. RESULTS: Overall, we assessed 196 eyes of 196 patients (average age 68.6 ± 9.6 years; 77 females). Patients received an average of 17.3 ± 13.5 injections over 78.0 ± 16.5 months of clinical follow-up. The initial mean VA (logMAR) was 0.75 ± 0.58 and the CFT was 349.7 ± 152.6 µm. Both parameters exhibited maximal improvements at the 6-month visit (p < 0.05). However, the clinical outcomes worsened over the 7-year clinical course; the best-corrected visual acuity (BCVA) was 0.91 ± 0.78 and the CFT was 284.5 ± 105.8 µm at 7 years. The BCVA at 7 years was significantly correlated with the initial BCVA. IOP-related events increased 11-fold and anterior chamber reactions increased 3-fold over the years, but no significant complications such as endophthalmitis were recorded. CONCLUSIONS: The use of intravitreal anti-VEGF agents was associated with initial visual improvements over 6 months but did not prevent the worsening of NAMD over 5 years. The BCVA at the initial visit was a strong predictor of the final BCVA. A more intensive injection schedule might improve long-term outcomes.

Clinical Outcome of Small Incision Lenticule Extraction including Visual Quality Analysis

PURPOSE: To present the clinical outcomes of small incision lenticule extraction (SMILE) including visual quality analysis in Korean patients with myopia METHODS: The medical records of 228 eyes of 116 patients who underwent SMILE in HanGil Eye Hospital LASIK Center from May 2014 to Feb 2015 and were followed-up for at least 3 months was analyzed retrospectively. The patients were followed up at 1 day, 1 week, 1 month, and 3 months after the operation. Refractive value, visual acuity, intraocular pressure, and visual quality were measured at each visit RESULTS: Preoperatively, uncorrected distant visual acuity was 0.01 ± 0.02 in log MAR, spherical equivalent was -5.03 ± 1.72 diopters, intraocular pressure was 15.85 ± 2.85 mm Hg, and the objective scattering index (OSI) value was 0.68 ± 0.49. The postoperative uncorrected distant visual acuity was 0.13 ± 0.10, 0.05 ± 0.08, 0.04 ± 0.09, and 0.02 ± 0.04 and OSI was 2.16 ± 1.89, 1.25 ± 0.64, 1.14 ± 0.69, and 0.81 ± 0.36 at 1 day, 1 week, 1 month, and 3 months after the operation, respectively. The postoperative intraocular pressure was 12.55 ± 3.74 mm Hg, 13.03 ± 4.35 mm Hg, 11.65 ± 2.49 mm Hg at 1 week, 1 month, and 3 months after the operation. The efficacy of refractive surgery 3 months after the operation was 0.97 ± 0.11, the safety was 0.99 ± 0.10, and predictability was 99.56% and 100.00% at the range of ±0.5 diopters and ± 1.0 diopter, respectively. CONCLUSIONS: The SMILE operation showed comparable clinical outcomes with conventional refractive surgery in terms of efficacy, safety, and predictability. Intraocular pressure and visual quality normalized gradually throughout the 3-month postoperative period.

Clinical Outcome of Small Incision Lenticule Extraction including Visual Quality Analysis

PURPOSE: To present the clinical outcomes of small incision lenticule extraction (SMILE) including visual quality analysis in Korean patients with myopia METHODS: The medical records of 228 eyes of 116 patients who underwent SMILE in HanGil Eye Hospital LASIK Center from May 2014 to Feb 2015 and were followed-up for at least 3 months was analyzed retrospectively. The patients were followed up at 1 day, 1 week, 1 month, and 3 months after the operation. Refractive value, visual acuity, intraocular pressure, and visual quality were measured at each visit RESULTS: Preoperatively, uncorrected distant visual acuity was 0.01 ± 0.02 in log MAR, spherical equivalent was -5.03 ± 1.72 diopters, intraocular pressure was 15.85 ± 2.85 mm Hg, and the objective scattering index (OSI) value was 0.68 ± 0.49. The postoperative uncorrected distant visual acuity was 0.13 ± 0.10, 0.05 ± 0.08, 0.04 ± 0.09, and 0.02 ± 0.04 and OSI was 2.16 ± 1.89, 1.25 ± 0.64, 1.14 ± 0.69, and 0.81 ± 0.36 at 1 day, 1 week, 1 month, and 3 months after the operation, respectively. The postoperative intraocular pressure was 12.55 ± 3.74 mm Hg, 13.03 ± 4.35 mm Hg, 11.65 ± 2.49 mm Hg at 1 week, 1 month, and 3 months after the operation. The efficacy of refractive surgery 3 months after the operation was 0.97 ± 0.11, the safety was 0.99 ± 0.10, and predictability was 99.56% and 100.00% at the range of ±0.5 diopters and ± 1.0 diopter, respectively. CONCLUSIONS: The SMILE operation showed comparable clinical outcomes with conventional refractive surgery in terms of efficacy, safety, and predictability. Intraocular pressure and visual quality normalized gradually throughout the 3-month postoperative period.

Comparison of Clinical Outcomes in Implantable Collamer Lens Implantation between AQUA ICL(R) and Conventional ICL

PURPOSE: To compare the clinical outcomes between AQUA ICL(R) (V4C) and conventional implantable collamer lens (ICL, V4B) in patients with high myopia. METHODS: We compared preoperative and postoperative visual acuities, spherical equivalent, intraocular pressure, postoperative vault and visual quality assessed using optical quality analyzing system (OQAS(R)) between 20 eyes implanted with ICL (V4B) and 22 eyes implanted with AQUA ICL(R) (V4C). RESULTS: Visual acuity (log MAR) and spherical equivalent at postoperative 3 months were 0.06 +/- 0.09 and -0.26 +/- 0.17 D in the V4B group and 0.03 +/- 0.03 and -0.23 +/- 0.19 D in the V4C group, respectively. There was no statistical difference in visual acuity and spherical equivalent between the 2 groups (p > 0.05). Postoperative intraocular pressure (IOP) elevated significantly in both groups until 6 hours after the operation (p 0.05). V4C resulted in lower IOP than V4B 6 hours postoperatively. In ICL (V4B) and AQUA ICL(R) (V4C) groups, the objective scattering index (OSI) was 1.29 +/- 0.90 and 1.36 +/- 0.68, modulation transfer function (MTF) cut off value was 29.62 +/- 11.31 c/deg and 29.61 +/- 9.56 c/deg and Sterhl ratio was 0.18 +/- 0.07 and 0.17 +/- 0.04, respectively, 3 months postoperatively. None of these values were significantly different between the 2 groups. CONCLUSIONS: AQUA ICL(R) (V4C) implantation is an effective, convenient and safe surgery for myopia correction and yields better outcome than ICL (V4B) in terms of early postoperative IOP.

A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.