VISUAL AND MORPHOLOGIC OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR DIABETIC MACULAR EDEMA BASED ON OPTICAL COHERENCE TOMOGRAPHY PATTERNS.

PURPOSE: To evaluate the visual and morphologic outcomes of intravitreal ranibizumab (IVR) in eyes with diabetic macular edema (DME) based on the morphologic pattern on optical coherence tomography. METHODS: A prospective and consecutive series of 55 eyes with DME was classified according to OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). Patients received three consecutive monthly injections of IVR and as needed thereafter. The primary outcome was the number of treatments undertaken by DME type over 12 months. Best-corrected visual acuity, retinal thickness, and microstructural changes were also evaluated. RESULTS: The eyes were classified as DRT (n = 23), CME (16), or SRD (16). The mean number of injections over 12 months was significantly different among the groups: DRT (3.69), CME (5.33), and SRD (5.09; P = 0.028). Best-corrected visual acuity of SRD (20/60) was significantly worse than that of the other types (DRT = 20/38; CME = 20/43; P = 0.015) after 12 months. CONCLUSION: Vision gains and retinal anatomy improvement were maintained in all three types during the first year of IVR administration. Especially, DRT maintained a good response to ranibizumab in a fewer number of injections. Disruption of the photoreceptor integrity at the baseline was correlated with poorer visual outcome and occurred more frequently in SRD.

Postoperative occlusion of visual axis with fibrous membrane in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome: a case report.

BACKGROUND: To report a case of postoperative fibrous membrane formation occluding the visual axis in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome. CASE PRESENTATION: A 79-year-old Asian woman with pseudoexfoliation syndrome underwent uneventful phacoemulsification and implantation of one-piece hydrophilic acrylic square-edged intraocular lens (Cristalens) in the right eye. Two months later, she had blurred vision in the right eye with the best-corrected visual acuity (BCVA) of 20/40. Formation of fibrous membrane occluding the capsulorhexis opening with contraction of anterior capsule was observed, which was confirmed by anterior segment optical coherence tomography. Clear visual axis was achieved by lysis of the membrane using Nd:YAG laser. The BCVA improved to 20/20. CONCLUSIONS: Occlusion of the visual axis with fibrous membrane can develop in the presence of anterior capsular phimosis in a patient with pseudoexfoliation syndrome.

Age-related differences in ocular biometry in adult Korean population.

BACKGROUND: To evaluate the relationship between age, axial length (AL), anterior chamber depth (ACD) and corneal steepness (K) in patients with cataract. METHODS: In this retrospective study, medical records of 800 patients (800 eyes) who were diagnosed with cataract and received preoperative ophthalmologic examination were reviewed. Data including age, gender and ocular biometric data including AL, ACD and K were collected and analyzed using univariate and multivariate analyses. RESULTS: Univariate analysis showed increased age has significant correlation with shorter AL (P < 0.001), shallower ACD (P < 0.001) and steeper K (P < 0.001). K value has a negative correlation with AL (P < 0.001). In multivariate analysis, increasing age has a significant association with shorter AL (P < 0.001) and ACD (P < 0.001), although the association between age and K was not significant (P = 0.398). Negative correlation between AL and K remained significant in multivariate analysis (P < 0.001). CONCLUSION: In patients with cataract, older age had significant association with shorter AL and ACD. AL and K had negative correlation.

Delayed unilateral abducens nerve palsy following contralateral post-traumatic epidural hematoma.

A 26-year-old Asian woman presented with diplopia occurring at 1 week after conservative treatment for left temporal bone fracture and left temporo-occipital epidural hematoma (EDH). At presentation, right abducens nerve palsy was observed with esotropia and abduction limitation in the right eye. Six weeks later, the abducens nerve palsy fully recovered with complete absorption of the EDH.

Ferrimonas pelagia sp. nov., isolated from seawater.

A Gram-stain-negative bacterium, designated strain CBA4601(T), was isolated from a seawater sample obtained off the coast of Jeju Island, Korea. The organism grew in the presence of 0-4% (w/v) NaCl and at 20-35 °C and pH 7.0-9.0, with optimal growth in 2% NaCl, and at 25 °C and pH 8.0. Phylogenetic trees based on 16S rRNA gene sequences showed that strain CBA4601(T) was related to the genus Ferrimonas within the class Gammaproteobacteria. 16S rRNA gene sequence similarity between strain CBA4601(T) and Ferrimonas marina A4D-4(T), the most closely related species, was 96.9%. The G+C content of the genomic DNA from strain CBA4601(T) was 54.2 mol%, and the isoprenoid quinones menaquinone 7 (MK-7), ubiquinone 7 (Q-7) and ubiquinone 8 (Q-8) were detected. The major fatty acids were C(17:1)ω8c, C(18:1)ω9c and C(16:0), and the major polar lipids were phosphatidylethanolamine, phosphatidylglycerol and an unidentified ninhydrin-positive phospholipid. On the basis of this taxonomic study using a polyphasic approach, strain CBA4601(T) represents a novel species of the genus Ferrimonas, for which the name Ferrimonas pelagia sp. nov. is proposed. The type strain is CBA4601(T) ( =KACC 16695(T) =KCTC 32029(T) =JCM 18401(T)).

New profiles of posterior pole retinal thickness map in healthy Korean eyes measured by spectral-domain optical coherence tomography.

PURPOSE: To analyze posterior pole retinal thickness using the new Spectralis HRA + OCT protocol and compare two commercially available spectral-domain optical coherence tomography instruments (Spectralis HRA + OCT and Cirrus HD-OCT) in young healthy eyes. METHODS: Retinal thickness in 178 young healthy eyes was measured using the volume scan mode and Posterior Pole Asymmetry Analysis of the Spectralis HRA + OCT and the macular cube 512 × 128 protocol of the Cirrus HD-OCT. Topologic differences in posterior pole retinal thickness between the two spectral-domain optical coherence tomographies were compared, and the relationship between retinal thickness and age or refractive error/axial length was assessed. RESULTS: Mean retinal thickness measurements in all 9 Early Treatment Diabetic Retinopathy Study Report areas were significantly greater with the Spectralis HRA + OCT than with the Cirrus HD-OCT (P < 0.001). Retinal thickness measured with the new Spectralis HRA + OCT protocol positively correlated with refractive error (P < 0.05) and negatively correlated with axial length (P < 0.05), mainly in the temporal areas. As axial length increased and refractive error decreased, retinal thickness decreased significantly at the outer temporal areas compared with the nasal areas (P < 0.05). Foveal thickness measured with the Spectralis HRA + OCT correlated significantly with refractive error (r = -0.151; P = 0.022) and axial length (r = 0.352; P < 0.001). CONCLUSION: Posterior pole retinal thickness measurements in young healthy eyes should provide more detailed standard values for diagnosing and managing retinal disease.

Intravitreal ranibizumab for acute central serous chorioretinopathy.

BACKGROUND/AIMS: To evaluate the effectiveness of intravitreal ranibizumab injection (IVRI) for acute central serous chorioretinopathy (CSC). METHODS: Patients with symptomatic CSC of less than 3 months were prospectively recruited. Patients (n = 20/group) were randomly assigned to IVRI (0.5 mg/0.05 ml) or observation and followed for 6 months. logMAR best-corrected visual acuity (BCVA), fluorescein angiography, indocyanine angiography, and central foveal thickness (CFT) were assessed at baseline and at regular follow-ups. RESULTS: All patients had increased BCVA, decreased CFT, and resolution of the neurosensory detachment. Complete resolution of neurosensory retinal detachment required more time in the observation group (13.0 ± 3.1 vs. 4.2 ± 0.9 weeks; p < 0.001). Mean BCVA and mean CFT improved significantly in both groups, but the changes were not significantly different between groups at 6 months. CONCLUSIONS: IVRI for acute CSC might hasten resolution of neurosensory detachment compared to observation alone. At 6 months, BCVA and CFT did not differ between IVRI and observation groups. Further studies are required to determine the long-term benefits of IVRI.

Morphological change of inner retinal layer on spectral-domain optical coherence tomography following macular hole surgery.

BACKGROUND/AIMS: To investigate the morphological changes of the inner retinal layer by spectral-domain optical coherence tomography (OCT) after idiopathic full-thickness macular hole (MH) surgery. METHODS: In a retrospective study, the authors evaluated 52 eyes of 49 patients with MH closed following vitrectomy. All patients were followed postoperatively for more than 6 months. Cross-sectional and retinal surface images were obtained using Cirrus high-definition OCT before and after surgery. In 24 of the 52 eyes, fundus autofluorescence (FAF) was analyzed. RESULTS: The incidence of dissociated optic nerve fiber layer (DONFL) increased gradually over time after surgery. 57.7% had defects of only the retinal nerve fiber layer (RNFL) and 30.8% had defects in the inner plexiform layer at 6 months after surgery. Postoperative best-corrected visual acuity did not differ significantly based on the depth of the DONFL (p = 0.299). There were no changes in FAF in the area with DONFL. CONCLUSIONS: DONFL is characterized by progressive defects that are not limited to RNFL thickness. The healing process after vitrectomy for MH is not limited in the RNFL affecting deeper structural changes. Further investigations are required to evaluate the pathophysiological mechanism of inner retinal change after MH surgery.

Characteristics and phylogenetic analysis of the complete mitochondrial genome of Microstomus achne.

Microstomus achne (Jordan and Starks, 1904) is an economically valuable flatfish belonging to the family Pleuronectidae and the only flatfish that inhabits Korea. Here, we report on the complete mitochondrial genome of M. achne and the phylogenetic relationship between close species. The mitogenome is 16,971 bp long and encodes 13 protein-coding genes (PCGs), 22 transfer RNAs, and two ribosomal RNAs. The phylogenetic analysis showed that M. achne clustered with Glyptocephalus stelleri, which supports the conclusion that M. achne belongs to the family Pleuronectidae. The results of this study provide a better understanding of M. achne.

The study on the complete mitochondrial genome of Acanthopsetta nadeshnyi and its phylogenetic position.

Pleuronectidae is a well-studied familyin the order Pleuronectiformes. In contrast, genetic research on the flatfish Acanthopsetta nadeshnyi of the Pleuronectidae family is limited. This study reports the complete mitogenome of A. nadeshnyi. The mitogenome was 17,206 bases long and included 13 protein-coding genes (PCGs), 22 transfer RNA (tRNA) genes, two ribosomal RNA (rRNA) genes, and a putative control region. Phylogenetic analysis based on the nucleotide sequences of the 13 PCGs confirmed that A. nadeshnyi belongs to the Pleuronectidae family.

Cloning, heterologous expression, and enzymatic characterization of cathepsin L from starfish (Asterina pectinifera).

To determine the role of cathepsin L in Echinoderms, starfish (Asterina pectinifera) cathepsin L (ApCtL) was cloned. The results of RT-PCR analysis indicated that the expression of ApCtL in all of the tissues. The pro-mature enzyme of ApCtL, proApCtL, was expressed in Escherichia coli, and cathepsin activity was detected by cleaving of synthetic fluorogenic peptide substrates and gelatin zymography.

Atypical vitelliform macular dystrophy misdiagnosed as chronic central serous chorioretinopathy: case reports.

BACKGROUND: To report two cases of atypical vitelliform macular dystrophy misdiagnosed as chronic central serous chorioretinopathy. CASE PRESENTATION: Two patients with incidentally discovered abnormalities of the retina without specific symptoms were referred to our hospital for consultation. Bilateral macula atrophic lesions were observed and optical coherence tomography revealed serous retinal detachment in the macula. Fluorescein angiography showed multiple leakages around the central hypofluorescent area and indocyanine green angiography showed partially dilated choroidal vessels. Fundus autofluorescence (FAF) showed a decreasing pattern of autofluorescence in the subretinal fluid area, and increasing autofluorescence at the border of the serous retinal detachment. Both patients were diagnosed with chronic central serous chorioretinopathy. Photodynamic therapy and intravitreal bevacizumab injection were administered for engorged choroidal vessels during follow-up, but neither patient showed improvement in symptoms or ophthalmologic findings. Based on re-evaluation by fundus photography, optical coherence tomography, fluorescein angiography, and comparison of the results of FAF with the first visit, vitelliform macular dystrophy was suspected and a definite diagnosis was made by electrooculography and genetic testing. CONCLUSION: In patients with continuous serous retinal detachment without response to photodynamic therapy or intravitreal bevacizumab injection, careful fundus exam and FAF can be used to diagnose atypical vitelliform macular dystrophy.

Intravitreal ranibizumab for macular edema secondary to retinal vein occlusion.

BACKGROUND/AIMS: To investigate the effects of intravitreal ranibizumab treatment for macular edema (ME) secondary to retinal vein occlusion (RVO) and the relationship between spectral-domain optical coherence tomography (SD-OCT) findings and visual outcome after successful resolution of ME. METHODS: Forty consecutive eyes with ME secondary to branch RVO (BRVO; 29 eyes of 29 patients) or central RVO (CRVO; 11 eyes of 11 patients) were included in a prospective study and treated with 3 initial intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Retreatment was based on visual acuity changes and OCT findings. Patients with complete resolution of ME were classified into two groups according to final best-corrected visual acuity (BCVA) of better than 0.30 logMAR (group 1) or poorer than 0.30 logMAR (group 2), and SD-OCT findings were analyzed at baseline and at 12 months. RESULTS: In patients with BRVO, mean BCVA at 12 months (0.19 ± 0.18) was significantly better than that at baseline (0.76 ± 0.37; p = 0.000). The mean number of injections was 4.4 ± 1.2. In patients with CRVO, the mean BCVA at 12 months (0.39 ± 0.23) was slightly improved from that at baseline (0.84 ± 0.68), but the difference was not significant (p = 0.063). Patients with CRVO received a mean number of 6.1 ± 1.4 injections of ranibizumab. Baseline SD-OCT more frequently detected the foveal inner/outer segment (IS/OS) line and external limiting membrane (ELM) in group 1 (p = 0.003) than in group 2 (p = 0.012). Preservation of the foveal IS/OS line (odds ratio = 5.400; p = 0.036) and ELM (odds ratio = 7.312; p = 0.016) at baseline correlated with good final visual outcome. CONCLUSION: Intravitreal ranibizumab injections effectively treat ME secondary to RVO. Good visual outcome was associated with preservation of the foveal IS/OS line and ELM at baseline.

Imported intraocular gnathostomiasis with subretinal tracks confirmed by western blot assay.

We report a case of intraocular gnathostomiasis diagnosed by western blot assay in a patient with subretinal tracks. A 15-year-old male patient complained of blurred vision in the right eye, lasting for 2 weeks. Eight months earlier, he had traveled to Vietnam for 1 week and ate raw wild boar meat and lobster. His best-corrected visual acuity was 20/20 in both eyes and anterior chamber examination revealed no abnormalities. Fundus examination showed subretinal tracks in the right eye. Fluorescein angiography and indocyanine green angiography showed linear hyperfluorescence of the subretinal lesion observed on fundus in the right eye. Ultrasound examination revealed no abnormalities. Blood tests indicated mild eosinophilia (7.5%), and there was no abnormality found by systemic examinations. Two years later, the patient visited our department again for ophthalmologic evaluation. Visual acuity remained 20/20 in both eyes and the subretinal tracks in the right eye had not changed since the previous examination. Serologic examination was performed to provide a more accurate diagnosis, and the patient's serum reacted strongly to the Gnathostoma nipponicum antigen by western blot assay, which led to a diagnosis of intraocular gnathostomiasis. This is the first reported case of intraocular gnathostomiasis with subretinal tracks confirmed serologically using western blot in Korea.

Spontaneous resolution of a unilateral cataract in an adult: A case report.

RATIONALE: Cataracts are a disease that is usually caused by aging and involve the irreversible degeneration of the lens material. On the other hand, transient cataracts have also been reported, mainly due to systemic hyperglycemia, which often occurs bilaterally. However, reports of the spontaneous regression of unilaterally occurring cataracts in patients with normal blood glucose levels are rare. Here, we report a rare case of spontaneous regression of unilateral posterior subcapsular cataracts in an adult with normal blood glucose levels. PATIENT CONCERNS: A 42-year-old woman presented with distorted vision in her right eye. The patient was taking medication for diabetes, and her blood sugar level was well-controlled. DIAGNOSIS: Upon examination, her uncorrected visual acuity and best-corrected visual acuity were 20/70 in her right eye. Slit lamp microscopy revealed fine, feathery, and streak-like posterior subcapsular opacities. Color fundus photography revealed a star-shaped shadow due to the cataract, and no diabetic retinopathy was observed. Her two hour postprandial glucose level was 115 mg/dL. The patient was diagnosed with posterior subcapsular cataracts, and cataract surgery was planned. The patient was scheduled to visit the clinic again after seven days. INTERVENTIONS: Close observation for one week without any intervention. OUTCOMES: After one week, most of the posterior subcapsular opacities disappeared, and the uncorrected visual acuity and best-corrected visual acuity in the right eye improved to 20/40 and 20/30, respectively. LESSONS: This case report demonstrates that unilateral posterior subcapsular cataracts may spontaneously regress in patients with normal blood glucose levels. Therefore, it is important to check whether cataracts improve spontaneously through short-term close follow-up before planning cataract surgery to avoid unnecessary surgery.

Characterization and phylogenetic analysis of the complete mitochondrial genome of Notostomum cyclostomum.

Notostomum cyclostomum is a parasite that lays eggs on the snow crab shells and causes various diseases by parasitizing fish. Although there have been some studies on the life history of this parasite and the associated fish diseases, little is known about the molecular biology of this parasite. Thus, here we report the mitochondrial genome of N. cyclostomum, which is 16,972 bp long and contains 13 mitochondrial protein-coding genes (PCGs), 22 transfer RNA (tRNA) genes, two ribosomal RNA (rRNA) genes, and a putative control region with a 92% AT-rich sequences between tRNA-R and tRNA-H. Phylogenetic analysis using 13 PCGs confirmed that N. cyclostoum belongs to the family Pisciodlidae. This is the first study revealing the complete mitochondrial genome sequence of N. cyclostomum.

The complete mitochondrial genome of Pseudopleuronectes herzensteini.

Pseudopleuronectes herzensteini belonging to Pleuronectiformes (family Pleuronectidae) is important in the fishery industry. However, the molecular biology of this valuable fish has hardly been reported. Thus, here we report the complete mitochondrial genome of P. herzensteini. The mitochondrial DNA (mtDNA) of P. herzensteini is 16,719 bp long and contains 13 mitochondrial protein-coding genes (PCGs), 22 transfer RNA (tRNA) genes, two ribosomal RNA (rRNA) genes, and a putative control region between tRNA-P and tRNA-F distinguished by a single short noncoding region. Phylogenetic analysis using PCGs confirmed that this mtDNA sequence belongs to the family Pleuronectidae. This is the first study reporting the complete mitochondrial genome sequence of P. herzensteini.

Two-year results of photodynamic therapy combined with intravitreal anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy.

BACKGROUND/AIMS: To evaluate the 2-year efficacy of photodynamic therapy (PDT) combined with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in patients with polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-two eyes of 22 patients with PCV followed up for ≥24 months after PDT and anti-VEGF combination therapy were retrospectively reviewed. The patients received intravitreal anti-VEGF (1.25 mg bevacizumab or 0.5 mg ranibizumab) within 7 days after PDT. Eyes were retreated with PDT and anti-VEGF injection, or with only anti-VEGF injection, when indicated. Main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS: The mean baseline BCVA (0.43±0.33 logarithm of the minimum angle of resolution, logMAR) was 0.28±0.24 at 12 months (p<0.05 vs. baseline) and 0.39±0.28 at 24 months (not significant). At 24 months, BCVA improved by ≥0.3 logMAR in 27.3% of the eyes, did not significantly decrease in 59.1%, and decreased by ≥0.3 logMAR in 13.6%. The mean CFT was 269.4±134.5 µm at baseline and significantly decreased to 139.6±45.8 µm (12 months) and 199.6±72.9 µm (24 months). PDT was administered 1.45±0.86 times and anti-VEGF injected 4.45±1.36 times over the 24-month period. CONCLUSION: Combined PDT and anti-VEGF injection were effective for 2 years in PCV patients. Visual acuity significantly improved during year 1, but the benefit diminished in year 2. Further investigations are required to determine how to prolong the therapeutic effect of combination therapy for PCV.

Effect of intravitreal bevacizumab based on optical coherence tomography patterns of diabetic macular edema.

AIM: To compare the effects of intravitreal bevacizumab on different morphologic patterns of diabetic macular edema (DME) classified using optical coherence tomography (OCT). MATERIALS AND METHODS: Medical records for 65 eyes of 48 patients were retrospectively reviewed, and each subject was classified as one of three DME types according to the OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD). Subjects were given three monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml). The clinical course of best-corrected visual acuity (BCVA) with a logarithm of the minimum angle of resolution chart and central foveal thickness (CFT) using OCT was monitored for 12 months after the injections. On follow-up, injections were repeated if DME remained or was aggravated. RESULTS: Of the 65 eyes with DME, 29 eyes were of the DRT type, 21 of the CME type, and 15 of the SRD type. Before the injection, CFT and BCVA were, respectively, 377.1 ± 145.9 µm and 0.54 ± 0.36 in the DRT type, 427.7 ± 143.1 µm and 0.59 ± 0.42 in the CME type, and 485.1 ± 187.1 µm and 0.65 ± 0.27 in the SRD type; there was no significant difference in CFT and BCVA between DME types (p > 0.05). At 6 months, the changes in BCVA and CFT differed significantly between OCT types (p < 0.05). At 12 months, changes in CFT and BCVA from baseline were not significantly different between groups (p > 0.05). The DRT type was associated with a greater reduction in the CFT and greater BCVA improvement than the CME or SRD types. CONCLUSIONS: Three monthly injections of intravitreal bevacizumab seem to be effective treatment in the first 6 months, but the therapeutic effect is temporary and repeated injections of bevacizumab should be considered to maintain the therapeutic effect after 6 months. In addition, intravitreal injection of bevacizumab was more effective in the DRT type than in the CME or SRD types of DME.

Complete mitochondrial DNA sequence of Norwegian skates (Raja brachyuran Lafont, 1871) imported to Korea.

In this study, the complete mitochondrial genome of Norwegian skates imported to Korea was sequenced with a circular molecule of 17,121 bp, which consisted of 13 protein-coding genes (PCGs), 2 ribosomal RNAs, 22 transfer RNA genes, and a control region (D-loop). And among these sequences, 193 bp sequence in the D-loop of the genus Raja suggested the possibility of being used as a genetic marker for classification of Raja and Dipturus species. The BI phylogenetic tree by using the nucleotide sequences of 13 PCGs from 15 available mitogenomes of family Rajidae confirmed also that Norwegian skates imported to Korea form a group with Raja brachyura species with high branch value, and that this was a species of Raja brachyura. As above, these results would be expected to provide for the further understanding on the phylogenetic relationship, taxonomic classification and phylogeography of the family Rajidae.