Severe intraocular inflammation after intravitreal injection of bevacizumab.

PURPOSE: To report 5 cases of severe intraocular inflammation that developed after an intravitreal injection of the same lot of bevacizumab. DESIGN: Retrospective case series. PARTICIPANTS: Patients treated with an intravitreal injection of bevacizumab (lot B3003B01). METHODS: The clinical charts of 35 eyes of 35 consecutive patients who were treated with intravitreal injection of lot B3003B01 bevacizumab from December 18, 2008, through January 20, 2009, were reviewed. MAIN OUTCOME MEASURES: Incidence of intraocular inflammation, results of bacterial cultures, best-corrected visual acuity (BCVA), and endothelial cell density. RESULTS: Five (14.3%) of the 35 cases had severe intraocular inflammation, and the inflammation had some characteristics of toxic anterior segment syndrome (TASS). Five of the 5 cases had a predominantly anterior chamber reaction, and 4 of the 5 cases were accompanied by hypopyon. Undiluted samples collected from both the aqueous and vitreous of the 5 cases were culture negative. The BCVA was 0.66+/-0.29 (mean+/-standard deviations) logarithm of the minimum angle resolution (logMAR) units, and the endothelial cell density was 2683.6+/-97.3/mm(2) before the intravitreal bevacizumab. At the final visit, the BCVA was 0.44+/-0.36 logMAR units, and the cell density was 2679.0+/-217.5/mm(2). These differences were not significant (P = 0.171 and 0.964). CONCLUSIONS: These observations indicate that an intravitreal injection of bevacizumab can induce sterile endophthalmitis that has characteristics of TASS.

[Efficacy of treatments on vision-related quality of life in patients with diabetic retinopathy].

PURPOSE: To evaluate changes in the vision-related quality of life in patients with diabetic retinopathy with the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). Patients were categorized into three groups : without treatment, receiving pan-retinal photocoagulation, and those who had vitrectomy. SUBJECTS AND METHODS: Altogether 327 patients (131 without treatment, [observation group]; 60 receiving pan-retinal photocoagulation, [photocoagulation group]; and 136 patients who had vitrectomy, [vitrectomy group]). The VFQ-25 was recorded at the time of entry and 1 year later. The VFQ-25 score was compared between the time of entry and 1 year later for each group and among the three groups at both the time of entry and 1 year later. RESULTS: VFQ-25 scores (mean +/- standard deviations) at the time of entry and 1 year later were 91.3 +/- 7.8 and 92.2 +/- 7.8 in the observation group, 80.7 +/- 15.7 and 77.6 +/-19.1 in the photocoagulation group, and 67.4 +/-17.3 and 75.4 +/- 17.5 in the vitrectomy group. VFQ-25 scores in the observation group and in the photocoagulation group did not change statistically between the time of entry and 1 year later (p = 0.113, 0.169, respectively), while the score of the vitrectomy group increased statistically (p < 0.001). In addition, although VFQ-25 scores were statistically significant among the three groups at the time of entry (p < 0.05), the scores 1 year later were not statistically different between the photocoagulation group and vitrectomy group. CONCLUSIONS: These results suggest that vitrectomy for diabetic retinopathy may be effective in increasing the quality of life of patients with diabetic retinopathy.

[Evaluation of the efficacy of intravitreal gas injection for submacular hemorrhages].

PURPOSE: To evaluate the efficacy of intravitreal gas injection for submacular hemorrhages(SMH). PATIENTS AND METHODS: The records of 29 patients with SMH, who were treated by pneumatic displacement with expansile gas, were reviewed retrospectively. RESULT: In observable cases, SMH had started moving within five days after the procedure. After 6 months visual acuity had been improved 2 or more lines in 23 eyes(79%). The causes of SMH were age-related macular degeneration (17 eyes) and microaneurysm (12 eyes). The larger the size of SMH, had the greater the risk of developing vitreous hemorrhage. Twelve eyes of the 29 eyes required vitrectomy owing to vitreous hemorrhage, insufficient removal of SMH, etc. but this pneumatic procedure often eliminated the need for vitrectomy. The visual acuity of the patients with additional vitrectomy was improved with only pneumatic displacement. None of the patients had serious complications with this pneumatic procedure and the vitrectomy. CONCLUSION: The first choice for SMH is intravitreal gas injection which saves foveal function, and improves the prognosis for better vision.

[Influence of vitrectomy for diabetic retinopathy on health-related quality of life].

PURPOSE: To evaluate the vision-related quality of life (QOL) in patients undergoing vitrectomy for diabetic retinopathy with the Japanese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). SUBJECTS AND METHODS: Subjects were 87 patients undergoing vitrectomy for diabetic retinopathy of vitreous hemorrhage, macular edema, or fibrovascular membrane, only for the subject eye, or for subjects undergoing vitrectomy for the fellow eye within 6 months or later. The VFQ-25 date was recorded one month before and 6 months after the vitrectomy. The VFQ-25 data were compared before and after the vitrectomy. The subjects were classified by the pathological condition: 41 eyes with vitreous hemorrhage, 28 eyes with macular edema, and 18 eyes with fibrovascular membrane. RESULTS: The average VFQ-25 scores of all the patients increased in almost all of the 12 subscales. Vitrectomy for vitreous hemorrhage was most effective in improving the VFQ-25 score, in improving 10 of the 12 subscales in the VFQ-25, and in increasing VFQ-25 scores to almost the same level as in phacoemulsification and foldable intraocular lens implantation for cataract patients in both eyes. CONCLUSION: NEI VFQ-25 quantitatively clarified that vitrectomy for diabetic retinopathy is effective in increasing the QOL of diabetic retinopathy patients.

[Efficacy of vitreous surgery for uveal effusion syndrome].

PURPOSE: To evaluate the efficacy of pars plana vitrectomy for uveal effusion syndrome retrospectively. SUBJECTS AND METHODS: Six patients (six eyes) with uveal effusion syndrome(UE) underwent vitrectomy followed by internal drainage of subretinal fluid, fluid-gas exchange, and pan-retinal photocoagulation. Three of these cases with nanophthalmos underwent silicone oil injection. RESULTS: The retina became reattached in all cases. The silicone oil was not removed in two of the three cases with nanophthalmic eyes. Two cases of the three cases with nanophthalmic eyes needed to perform full thickness sclerostomy additionally, and in one case subchoroidal hemorrhage occurred. The visual acuity finally improved in five out of the six eyes. CONCLUSIONS: In cases of uveal effusion without nanophthalmic, vitrectomy hastens quick reattachment of the retina and may result in better visual outcome. But in cases of nanophthalmic eyes, it would be better to perform sclerostomy first.

[New biconcave prism contact lens for vitreous surgery in gas-filled eyes].

PURPOSE: To obtain a surgical contact lens with adequate operative field in vitreous surgery of gas-filled eyes. METHODS: We designed a new biconcave prism contact lens for gas-filled eyes by improving the material and the design of the lens (prism angle, radius and area of front concave of the lens). The operative field was calculated by a simulation using the ray tracing method for cases of simultaneous phaco-vitrectomy surgery, vitrectomy of pseudophakic eyes, and vitrectomy without phaco-surgery. For this study, a prototype of the newly designed lens was made and used for vitrectomy of gas-filled eyes. RESULTS: The calculated operative field was about 47 degrees (central angle) for vitrectomy of pseudophakic eyes and vitrectomy without phaco-surgery. In cases of simultaneous phaco-vitrectomy surgery, the operative field can be varied continuously from 47 to 145 degrees (central angle) by adjusting the viscoelastic material in the anterior chamber. Appropriate visual field, good binocular vision, and visibility of the peripheral region were obtained in the vitrectomy of gas-filled eyes. CONCLUSION: The newlydesigned contact lens is useful for viewing the fundus during the vitrectomy of gas-filled eyes.

In vivo observation of internal limiting membrane in an eye with macular hole.

PURPOSE: To determine whether an internal limiting membrane (ILM) in the foveal area with a full-thickness idiopathic macular hole (MH) was intact. DESIGN: Interventional case report. METHODS: The ILM was stained with indocyanine green and peeled with forceps during pars plana vitrectomy for a full-thickness MH with a cuff. The stained membrane over the MH was carefully examined to determine whether a hole was present. RESULTS: The ILM was clearly observed by indocyanine green staining during pars plana vitrectomy; no hole was detected in the membrane over the MH. CONCLUSIONS: A full-thickness MH with a cuff can occur in the absence of a hole in the ILM.

Technique to alter field of view during vitrectomy with phacoemulsification and aspiration in gas-filled eye.

PURPOSE: To describe a method to alter the angular field of view of the fundus in gas-filled eyes during pars plana vitrectomy and phacoemulsification with aspiration and intraocular lens implantation. v Description of a new surgical method. METHODS: The amount of viscoelastic material injected into the capsule is regulated, altering posterior capsule curvature. RESULTS: The visual field can be varied from 5 to 108 degrees. Surgery on more than 300 eyes with rhegmatogenous retinal detachment and cataract using this technique has been successful with no complications. CONCLUSIONS: This method effectively controls the field of view in gas-filled eyes.

Vitrectomy without scleral buckling for proliferative vitreoretinopathy.

PURPOSE: To determine whether complete vitrectomy with vitreous shaving and without scleral buckling (SB) is efficacious for the treatment of proliferative vitreoretinopathy (PVR). METHODS: Eight consecutive patients who underwent vitrectomy with vitreous shaving and without SB for the treatment of PVR were studied. The PVR were classified as grade C3 in one eye, D1 in three eyes, D2 in three eyes, and D3 in one eye. The vitreous was used for gas tamponade for all of the cases. The anatomic success rate and the visual acuity before and after the surgery were analyzed. RESULTS: The anatomic success rate after the first vitrectomy was 75%, and 100% after the second operation. Preoperatively, the visual acuity was less than counting fingers in 63% and less than 20/200 in 88% of the eyes. Postoperatively, the visual acuity was 20/200 or better in 88%, and 20/100 or better in 63% of the cases. CONCLUSIONS: Vitrectomy with vitreous shaving without SB achieved approximately the same rate of anatomic success as vitrectomy with SB in eyes with PVR. Visual acuity was significantly improved postoperatively.

Foveal sensitivity and fixation stability before and after macular translocation with 360-degree retinotomy.

PURPOSE: To evaluate the functional changes of the fovea by scanning laser ophthalmoscopy (SLO) fundus perimetry after macular translocation with 360-degree retinotomy, and to determine whether the preoperative macular function estimated by the sensitivity of the fovea and the stability of fixation can predict visual acuity after the surgery. METHODS: Macular translocation with 360-degree retinotomy and simultaneous torsional muscle surgery were performed on 25 eyes of 25 patients with choroidal neovascularization. The index of foveal sensitivity (Isens) and the index of fixation stability (Ifix) before and after surgery were calculated from the microperimetric data. The preoperative Isens and Ifix were compared with postoperative Isens and Ifix, respectively. The correlations of preoperative Isens and Ifix with the visual acuity after the translocation surgery (VApost) were calculated. RESULTS: Isens increased in 14 (56%) of 25 eyes. Ifix improved in 10 (40%) of 25 eyes. The preoperative Isens and VApost were moderately correlated (r = 0.434, P = 0.0295), while the preoperative Ifix and VApost were highly correlated (r = - 0.530, P = 0.0057). CONCLUSION: An increase in foveal sensitivity and an improvement in the fixation stability were demonstrated quantitatively by microperimetry. The preoperative foveal sensitivity and fixation stability were correlated with the postoperative visual acuity. Microperimetry using SLO can be used to investigate foveal function before and after the translocation and to predict the postoperative visual acuity.