Bilateral simultaneous endophthalmitis after immediately sequential bilateral cataract surgery.

Purpose: Immediately sequential bilateral cataract surgery (ISBCS) has recently been considered effective due to faster visual rehabilitation and further improvements in quality of life. We report on the treatment course of a case of early postoperative endophthalmitis in both eyes after ISBCS. Observations: The patient was a 75-year-old woman undergoing anticancer treatment for lung cancer, who had been receiving eye drops for bilateral uveitis and secondary glaucoma since 2019. She underwent ISBCS at another hospital in 2022. In that surgery, the same instruments were used for the surgery of both eyes, without resterilization between eyes. On the night of the following day, she became aware of vision loss in both eyes, and at the examination the next day, hypopyon and corneal edema were found and she was diagnosed with bilateral postoperative endophthalmitis, and referred to our hospital. On the same day, anterior chamber irrigation, posterior capsulotomy, and vitrectomy were performed on both eyes, and the intraocular lenses were preserved. There was no recurrence of postoperative inflammation, and visual acuity was 20/30 in both eyes 6 months after vitrectomy. Conclusion: ISBCS is recommended to be performed with complete aseptic separation of the patient's two procedures. This important rule was not followed in this case. ISBCS should be performed in accordance with accepted protocols, such as those of the International Society of Bilateral Cataract Surgeons, the Royal College of Ophthalmologists, and the Canadian Ophthalmological Society.

A case of herpes zoster ophthalmicus with optic neuritis of the total length of the optic nerve in the orbital space and ischemic optic neuropathy.

Purpose: We herein report a case of optic neuritis and ischemic optic neuropathy associated with herpes zoster ophthalmicus and decreased visual acuity. Observations: A 65-year-old man with no special medical history had a headache on the right side in December 2019, and a few days later, a facial rash appeared on the same side. A dermatologist diagnosed him with herpes zoster ophthalmicus and started antiviral drug therapy. On the same day, he was referred to a local ophthalmologist and was found to have inflammatory signs in his right cornea and conjunctiva. The next day, when he visited the ophthalmologist again, he had decreased visual acuity, optic disc swelling, and fundus hemorrhaging in his right eye, so he was referred to our department. At the first visit to our department, his best-corrected visual acuity was light sense OD, 1.0 OS. His right fundus showed optic disc swelling, spotted fundus hemorrhaging, and dilation/tortuosity of the retinal vein. Fluorescein angiography showed the near absence of optic disc filling as well as delayed retinal vein perfusion in his right eye, and magnetic resonance imaging confirmed high signals in the total length of the right optic nerve in the orbital space using the short inversion-time inversion recovery method. Based on these findings, we diagnosed him with optic neuritis and ischemic optic neuropathy associated with inflammation of the orbital part caused by herpes zoster ophthalmicus. We started systemic administration of antiviral drugs (acyclovir) and oral steroid. However, after treatment, his visual acuity improved only to hand motion OD, and the fundus appearance was ultimately optic atrophy OD. Conclusion and Importance: Various complications can occur with herpes zoster ophthalmicus, however, few reports have described cases of herpes zoster ophthalmicus associated with optic neuritis and ischemic optic neuropathy. Therefore, there is no consensus concerning the ideal treatment for these conditions. By referencing cases involving issues such as orbital apex syndrome and optic neuritis caused by herpes zoster ophthalmicus, antiviral drugs and oral steroids were administered, but the prognosis of the visual acuity was poor.

Treatment of diabetic macular edema in real-world clinical practice: The effect of aging.

AIMS/INTRODUCTION: In older patients, the management of diabetic macular edema (DME) can be complicated by comorbidities, geriatric syndrome, and socioeconomic status. This study aims to evaluate the effects of aging on the management of DME. MATERIALS AND METHODS: This is a real-world clinical study including 1,552 patients with treatment-naïve center-involved DME. The patients were categorized into 4 categories by age at baseline (C1, <55; C2, 55-64; C3, 65-74; and C4, ≥75 years). The outcomes were the change in logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA) and central retinal thickness (CRT), and the number of treatments from baseline to 2 years. RESULTS: From baseline to 2 years, the mean changes in logMAR BCVA from baseline to 2 years were -0.01 in C1, -0.06 in C2, -0.07 in C3, and 0.01 in C4 (P = 0.016), and the mean changes in CRT were -136.2 µm in C1, -108.8 µm in C2, -100.6 µm in C3, and -89.5 µm in C4 (P = 0.008). Treatments applied in the 2 year period exhibited decreasing trends with increasing age category on the number of intravitreal injections of anti-VEGF agents (P = 0.06), selecting local corticosteroid injection (P = 0.031), vitrectomy (P < 0.001), and laser photocoagulation outside the great vascular arcade (P < 0.001). CONCLUSIONS: Compared with younger patients with DME, patients with DME aged ≥75 years showed less frequent treatment, a lower BCVA gain, and a smaller CRT decrease. The management and visual outcome in older patients with DME would be unsatisfactory in real-world clinical practice.

Racemose hemangioma complicated with macular macroaneurysm rupture.

PURPOSE: To describe a rare case of racemose hemangioma which developed spontaneous macular macroaneurysm (MA) rupture and vitreaous hemorrhage. OBSERVATIONS: A 29-year-old healthy asian female visited our hospital and a racemose hemangioma was found in the left eye. At presentation, the best corrected visual acuity (BCVA) was 30/20 in her left eye. At 9 years after the first visit, MA-like lesion was noted in the macular area. After that, vitreous and subretinal hemorrhage appeared in the left eye. The patient underwent simultaneous vitrectomy and cataract surgery, but vitreous re-hemorrhage occurred two days after the operation. To avoid re-hemorrhage, silicone oil (SO) tamponade was added in the second vitrectomy. Two years after the second operation, SO was removed and postoperative BCVA in the left eye was 20/200 without re-bleeding in the vitreous. CONCLUSIONS AND IMPORTANCE: Although retinal hemorrhages have been reported in the patients with a racemose hemangioma, in our case the macular MA rupture occurred at 9 years after the first visit. Congenital retinal arteriovenous anastomosis can show a change in vascular shape in some cases, thus it is important to observe carefully.

A Case of Cyclodialysis after Microhook Trabeculotomy Treated with Vitreous Surgery.

We report a case of cyclodialysis with decreased visual acuity after microhook trabeculotomy (mTLO) successfully treated by vitreous surgery. A 41-year-old man had been medically treated for primary open-angle glaucoma in both eyes. He was scheduled to undergo mTLO due to progression of visual field impairment and unstable intraocular pressure in his right eye. His preoperative best-corrected visual acuity (BCVA) was 0.4 OD, and the intraocular pressure was unstable, ranging from 12 to 27 mm Hg. On the day after the operation, a shallow anterior chamber developed, and a low intraocular pressure occurred. His visual acuity continued to decrease, and cyclodialysis was confirmed by ultrasonic biomicroscopy. No improvement was obtained with medical treatment, and his BCVA dropped to 0.08 OD, while his intraocular pressure remained at 2-3 mm Hg. Three months later, a second surgery was performed by combining cataract surgery with intraocular lens implantation, vitrectomy, cryopexy for the pars plana of the ciliary body, and 20% SF6 gas tamponade. Two weeks after the reoperation, the intraocular pressure had been normalized to 12 mm Hg, and the BCVA had returned to 0.3. We successfully treated cyclodialysis as a complication after mTLO by vitreous surgery that led to the recovery of the visual acuity and intraocular pressure.

Proliferative diabetic retinopathy without preoperative pan-retinal photocoagulation is associated with higher levels of intravitreal IL-6 and postoperative inflammation.

PURPOSE: Intravitreal cytokine levels and differences in the severity of postoperative inflammation in patients with proliferative diabetic retinopathy (PDR) were compared between subjects treated with pan-retinal photocoagulation (PRP) prior to undergoing vitreous surgery and those treated similarly during the surgery. SUBJECTS AND METHODS: We examined 130 eyes of PDR patients who underwent an initial surgical procedure at Hirosaki University Hospital. A total of 67 out of the 130 eyes were treated with PRP prior to surgery (preoperative group), while 63 underwent similar treatment during surgery (intraoperative group). Vitreous fluid was collected at the start of the vitreous surgical procedure. Following vitrectomy, intraoperative PRP was completed during the surgery in the intraoperative group. This procedure was added to the peripheral part as needed in the preoperative group. The results for the levels of 27 cytokines, including vascular endothelial growth factor (VEGF), were measured using multiplex assays and compared between the groups. For determining postoperative inflammation, eyes in which fibrin was observed for 3 days or longer in the anterior chamber or vitreous cavity were considered to have fibrin deposition. The rate of fibrin deposition was compared between these groups. RESULTS: Among the vitreous cytokines examined, there was no significant difference in the VEGF levels between the groups (p = 0.70). In contrast, the IL-6 level was significantly higher in the intraoperative group (2813.2 ± 6022.2 vs. 1248.5 ± 1442.2 pg/ml, p = 0.048). Furthermore, the fibrin deposition rate was significantly higher in the intraoperative (44.4%) versus the preoperative group (14.9%) (p = 0.0002). CONCLUSION: Severe postoperative inflammation was frequently seen in patients who did not undergo preoperative PRP, which may have been due to the performance of the procedure during the surgery. Moreover, these results may also be associated with a higher level of intravitreal IL-6.

The qualitative assessment of optical coherence tomography and the central retinal sensitivity in patients with retinitis pigmentosa.

PURPOSE: To analyze the relationships between qualitative and quantitative parameters of spectral-domain optical coherence tomography (SD-OCT) and the central retinal sensitivity in patients with retinitis pigmentosa (RP). MATERIALS AND METHODS: Ninety-three eyes of 93 patients were finally enrolled, with a median age (quartile) of 58 (24.5) years. We assessed the patients using SD-OCT and the 10-2 program of a Humphry Field Analyzer (HFA). As a qualitative parameter, two graders independently classified the patients' SD-OCT images into five severity grades (grades 1-5) based on the severity of damage to the photoreceptor inner and outer segments (IS/OS) layer. As quantitative parameters, we measured the IS-ellipsoid zone (IS-EZ) width, IS/OS thickness, outer nuclear layer (ONL) thickness, central macular thickness (CMT, 1 and 3 mm) and macular cube (6 × 6 mm) volume and thickness. The central retinal sensitivity was defined by the best-corrected visual acuity (BCVA; logMAR), average sensitivities of the central 4 (foveal sensitivity [FS]) and 12 (macular sensitivity [MS]) points of the HFA 10-2 program and the mean deviation (MD) of the 10-2 program. Spearman's correlation was used to assess the association between both qualitative and quantitative parameters and variables of the central retinal sensitivity. In addition, we performed a multiple regression analysis using these parameters to identify the parameters most strongly influencing the central retinal sensitivity. RESULTS: The IS/OS severity grade was significantly correlated with the BCVA (ρ = 0.741, P < 0.001), FS (ρ = -0.844, P < 0.001), MS (ρ = -0.820, P < 0.001) and MD (ρ = -0.681, P < 0.001) and showed stronger correlations to them than any other quantitative parameters including the IS-EZ width, IS/OS thickness, ONL thickness, CMTs and macular cube volume/thickness. Furthermore, a step-wise multiple regression analysis indicated that the IS/OS severity grade was more strongly associated with the BCVA (ß = 0.659, P < 0.001), FS (ß = -0.820, P < 0.001), MS (ß = -0.820, P < 0.001) and MD (ß = -0.674, P < 0.001) than any other quantitative parameters. The intraclass correlation coefficient between two graders indicated substantial correlation (κ = 0.70). DISCUSSION: The qualitative grading of OCT based on the severity of the IS/OS layer was simple and strongly correlated with the central retinal sensitivity in patients with RP. It may be useful to assess the central visual function in patients with RP, although there is some variation in severity within the same severity grade.

Modified Intraocular Lens Intrascleral Fixation Technique Using Two Vitrectomy Ports as Lens Haptic Fixation Sites.

INTRODUCTION: We developed a new technique that uses two of the vitrectomy ports as intraocular lens (IOL) haptic fixation sites and compared that with a conventional T-fixation method. METHODS: A total of 33 eyes were retrospectively divided into the port-fixation (n=21) and conventional (n=12) groups. For the port-fixation group, supranasal and inferotemporal trocars (25-gauge) were placed in the center of a T-shaped lamellar scleral incision 2 mm from the corneal limbus and a supratemporal trocar at 3.5 mm. Following a vitrectomy, along with lens or IOL extraction as needed, the infusion cannula was changed from an inferotemporal to supratemporal trocar. The first IOL haptic and trocar were then simultaneously withdrawn from the eye by grasping with vitreoretinal forceps, with the same performed for the second IOL haptic and trocar, after which the infusion cannula was removed. In the conventional group, 2 T-shaped scleral incisions and three trocars were separately placed. RESULTS: Postoperatively, transient ocular hypotension and hypertension were observed in a few eyes in both groups. At 6 months after surgery, astigmatism was 1.71±1.13 D in the port-fixation group and 2.21±1.78 D in the conventional group (p=0.40, t-test). CONCLUSION: This new technique may be effective because of the lower number of scleral wounds.

Real-world management of treatment-naïve diabetic macular oedema: 2-year visual outcome focusing on the starting year of intervention from STREAT-DMO study.

BACKGROUND/AIMS: To investigate the yearly change of real-world outcomes for best corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve diabetic macular oedema (DMO). METHODS: Retrospective analysis of aggregated, longitudinal medical records obtained from 27 retina specialised institutions in Japan from Survey of Treatment for DMO database. A total of 2049 treatment-naïve centre involving DMO eyes of which the initial intervention started between 2010 and 2015, and had been followed for 2 years, were eligible. As interventions, antivascular endothelial growth factor (VEGF) agents, local corticosteroids, macular photocoagulation and vitrectomy were defined. In each eye, baseline and final BCVA, the number of each intervention for 2 years was extracted. Each eye was classified by starting year of interventional treatment. RESULTS: Although baseline BCVA did not change by year, 2-year improvement of BCVA had been increased, and reached to +6.5 letters in the latest term. There is little difference among starting year about proportions of eyes which BCVA gained >15 letters, in contrast to those which lost >15 letters were decreased by year. The proportion of eyes receiving anti-VEGF therapy was dramatically increased, while those receiving the other therapies were gradually decreased. The proportion of eyes which maintained socially good vision of BCVA>20/40 has been increased and reached to 59.0% in the latest term. CONCLUSION: For recent years, treatment patterns for DMO have been gradually but certainly changed; as a result, better visual gain, suppression of worsened eyes and better final BCVA have been obtained. Anti-VEGF therapy has become the first-line therapy and its injection frequency has been increasing.

Intraoperative choroidal detachment occurring in a case of perforating ocular injury.

PURPOSE: To describe an intraoperative choroidal detachment due to balanced salt solution (BSS) leakage through the exit wound in a case with perforating ocular injury. OBSERVATIONS: The patient was a 22-year-old man who suffered from a left eye injury caused by a piece of wire during work. Vitrectomy was started after closure of the scleral wound, but surgical procedure could not be continued, as BSS leakage occurred into the subretinal and supra-choroidal spaces, resulting in a narrowed vitreous cavity, as we were slow to recognize the presence of the perforating ocular injury in this patient. Fluid-air exchange and air-silicone oil exchange in the vitreous cavity were performed to finish the initial surgery. Three weeks later, the reoperation was performed to remove silicone oil and insert an intraocular lens into the bag. Presently, 1 year 5 months following the second surgery, corrected visual acuity is 20/50. CONCLUSIONS AND IMPORTANCE: Our findings indicate that BSS can leak through the exit wound into the subretinal and supra-choroidal spaces intraoperatively in a case of perforating ocular injury.

Real-world management of treatment-naïve diabetic macular oedema in Japan: two-year visual outcomes with and without anti-VEGF therapy in the STREAT-DME study.

BACKGROUND/AIMS: To investigate real-world outcomes for best-corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve, centr-involving diabetic macular oedema (DME). METHODS: Retrospective analysis of longitudinal medical records obtained from 27 institutions specialising in retinal diseases in Japan. A total of 2049 eyes with treatment-naïve DME commencing intervention between 2010 and 2015 who were followed for 2 years were eligible. Interventions for DME included anti-vascular endothelial growth factor (VEGF) therapy, local corticosteroid therapy, macular photocoagulation and vitrectomy. Baseline and final BCVA (logMAR) were assessed. Eyes were classified by the treatment pattern, depending on whether anti-VEGF therapy was used, into an anti-VEGF monotherapy group (group A), a combination therapy group (group B) and a group without anti-VEGF therapy (group C). RESULTS: The mean 2-year improvement of BCVA was -0.04±0.40 and final BCVA of >20/40 was obtained in 46.3% of eyes. Based on the treatment pattern, there were 427 eyes (20.9%) in group A, 807 eyes (39.4%) in group B and 815 eyes (39.8%) in group C. Mean improvement of BCVA was -0.09±0.39, -0.02±0.40 and -0.05±0.39, and the percentage of eyes with final BCVA of >20/40 was 49.4%, 38.9%, and 52.0%, respectively. CONCLUSION: Following 2-year real-world management of treatment-naïve DME in Japan, BCVA improved by 2 letters. Eyes treated by anti-VEGF monotherapy showed a better visual prognosis than eyes receiving combination therapy. Despite treatment for DME being selected by specialists in consideration of medical and social factors, a satisfactory visual prognosis was not obtained, but final BCVA remained >20/40 in half of all eyes.

Intraocular lens intracapsular fixation with unilateral loop suture for 180 degree Zinn's zonule dialysis.

We developed intraocular lens (IOL) fixation procedure that only uses one suture during Zinn's zonule dialysis portion of the combined surgery for IOL intracapsular fixation and unilateral loop suture for preserving the lens capsule. We treated 15 eyes in 15 patients which were confirmed to have almost 180° zonular dialysis during cataract surgery. After removing the lens, a scleral flap was created on the dialysis side. A straight needle for suturing was then inserted into the anterior chamber from the opposite side of the dialysis. The needle was used to attach the equatorial segment of the capsule on the dialysis side from the inside to the outside and then pull the suture thread under the scleral flap. After the thread was bound to a preceding loop of IOL, the IOL was inserted into the bag. Our procedure was found to be simple and less invasive, as our technique required no vitrectomy to be performed.

Macular edema associated with intraocular ointment after cataract surgery.

PURPOSE: To report a case with macular edema associated with uveitis, a decreased corneal endothelial cell density, and vitreous opacity caused by migrated intraocular antibiotic ointment after uneventful cataract surgery. OBSERVATIONS: A 63-year-old man underwent uneventful sutureless superior clear corneal phacoemulsification and implantation of an intraocular lens in his right eye. Eleven months later, he complained of blurred vision when he gazed downward. Three months later, uveitis, vitreous opacity, and retinal hemorrhage were noted. Optical coherence tomography and fluorescein angiography demonstrated macular edema in the right eye. A slit-lamp examination revealed many tiny oily deposits on the iris surface. One month later, a globular oily droplet was detected at the 12 o'clock position of the iridocorneal angle. Because the corneal endothelial cell density appeared to be progressively decreased, the oily droplet was removed, and the anterior chamber was irrigated with a balanced salt solution using an irrigation-aspiration cannula. After surgery, the macular edema, vitreous opacity, and retinal hemorrhage disappeared. CONCLUSIONS AND IMPORTANCE: In this case, ofloxacin ointment had presumably migrated into the anterior chamber through a corneal incision after cataract surgery. The fact that the droplet of ointment was able to be detected more than one year after the cataract surgery suggests that dispersed tiny droplets can slowly coalesce into a globular droplet and wander between the anterior and posterior chambers, thereby causing uveitis, corneal endothelial cell damage, and macular edema. The removal of the intraocular ointment resolved these complications. This is the second report of intraocular ointment causing macular edema.

Macular Hole Caused by Retained Subfoveal Perfluorocarbon that Subsequently Closed After Its Spontaneous Resolution: A Case Report.

INTRODUCTION: To prevent local reduction in retinal function caused by retained subretinal perfluorocarbon liquid (PFCL), it has been noted that removal of PFCL under the fovea should be considered, with a vitrectomy selected for such removal. CASE REPORT: A vitrectomy was performed for traumatic retinal detachment during which PFCL was temporarily used as an intraocular tamponade for retina flattening. Following surgery, subfoveal PFCL was retained beneath the retina. Two months later, a macular hole developed and visual acuity decreased to 20/100, for which a vitrectomy was planned as treatment. However, the macular hole spontaneously closed and visual acuity eventually recovered to 20/25. CONCLUSION: Our findings indicate that PFCL retained underneath the retina in the macular region can cause a macular hole, though spontaneous discharge may subsequently occur, leading to resolution.

Level of Vascular Endothelial Growth Factor in the Vitreous Fluid of Proliferative Diabetic Retinopathy Patients and Prognosis after Vitrectomy.

PURPOSE: The aim of this study was to evaluate the relationship between the intravitreal vascular endothelial growth factor (VEGF) level and prognosis of proliferative diabetic retinopathy (PDR). METHODS: The study involved 136 eyes of 114 PDR patients who underwent an initial vitrectomy between 2006 and 2008. Intravitreal VEGF levels were determined using Bio-Plex® (Bio-Rad), with levels of 5,000 pg/mL or more classified as high-VEGF (45 eyes) and levels lower than 5,000 pg/mL as low-VEGF (91 eyes). Diabetic control, PDR severity, and frequency of postoperative complications were compared between the groups. RESULTS: There was no significant difference in preoperative status between the groups. In the low-VEGF group, a reoperation was required due to postoperative complications in 2 eyes (2.2%); 1 with vitreous hemorrhage (VH) and 1 with retinal detachment (RD). In contrast, a reoperation was required in 8 eyes (17.8%) in the high-VEGF group; 3 with VH, 2 with RD, and 3 with neovascular glaucoma. The difference between the groups was significant. There was a statistically lower postoperative corrected visual acuity logMAR (6 months after surgery) in the high-VEGF than in the low-VEGF group (p = 0.02, unpaired t test). CONCLUSION: Current findings indicate that careful observation is needed in patients with elevated VEGF levels.

Profiles of Inflammatory Cytokines in the Vitreous Fluid from Patients with Rhegmatogenous Retinal Detachment and Their Correlations with Clinical Features.

Purpose. To characterize the profiles for inflammatory cytokines in the vitreous fluid from patients with rhegmatogenous retinal detachment (RRD) by comparing those of other vitreoretinal diseases and to analyze the correlation between intravitreal cytokines and clinical features. Materials and Methods. Vitreous fluid was obtained at the time of surgery from 28 RRD eyes. Vitreous fluid was similarly collected from patients with macular hole (MH), epiretinal membrane, proliferative diabetic retinopathy (PDR), and retinal vein occlusion as controls. Twenty-seven cytokines were measured. Intravitreal cytokine profiles in RRD were characterized by comparing these with those in other vitreoretinal diseases. We also analyzed the correlations between vitreous cytokines and clinical features. Results. There were statistical differences in the MCP-1, MIP-1ß, and IP-10 between the RRD and MH, while the IL-6 and IL-8 exhibited levels that were between those for the PDR and MH. MIP-1ß was significantly correlated to both the extent and duration of the RRD, while IL-8 was significantly correlated to the extent of the RRD. Conclusions. MCP-1, MIP-1ß, and IP-10 may modify the pathologic features of RRD. The levels of these cytokines are related in part to the clinical features and the level of photoreceptor damage.

Acute posterior multifocal placoid pigment epitheliopathy and granulomatous uveitis following influenza vaccination.

PURPOSE: To report a case of acute placoid multifocal posterior pigment epitheliopathy (APMPPE) following influenza vaccination. The patient exhibited granulomatous uveitis during the recovery phase. OBSERVATIONS: A woman in her thirties developed flu-like symptoms seven days after receiving an influenza vaccination. Approximately 2 weeks later, the patient reported with conjunctival injection, blurred vision, and pain in her left eye. She was examined in our clinic, and the best-corrected visual acuity was 20/15 OD and 20/20 OS. Multiple whitish spots were observed bilaterally in the deep retinal layer along with edema of the left optic disc. Both indocyanine green and fluorescein angiographic findings suggested a diagnosis of APMPPE. Although APMPPE lesions were gradually resolved after one month, keratic precipitates, anterior chamber and vitreous cellular infiltration, iris and angle nodules, and macular edema were observed and were treated with topical steroid eye drops. No systemic disorders including sarcoidosis, tuberculosis, and Wegener's granulomatosis were present. CONCLUSION AND IMPORTANCE: As influenza vaccinations are administered worldwide, ophthalmologists should be aware of the ocular side effects following vaccination. Although rare, the possibility of APMPPE occurrence following influenza vaccination should be considered; additionally, the recovery phase of APMPPE may be associated with granulomatous uveitis that requires steroid therapy.

A case of childhood vitrectomy performed for dense vitreous hemorrhage secondary to leukemia therapy and tumor lysis syndrome.

PURPOSE: To report a case of vitrectomy performed in a child with dense massive vitreous hemorrhage due to secondary acute myelogenous leukemia (AML) and tumor lysis syndrome. CASE: A 4-year-old boy with clear-cell renal cell carcinoma was successfully treated with chemotherapy in 2011. However, in May 2012, he developed secondary AML. Although he was treated with combined chemotherapy and radiation, tumor lysis syndrome occurred with renal and heart failure complications. After an ultrasound examination by pediatricians found bilateral subretinal protrusions, he was referred to our clinic. Fundus examinations confirmed that the protrusions were bilateral subretinal or choroidal hemorrhages. A few weeks later, dense vitreous hemorrhages occurred bilaterally, and he completely lost vision in both eyes. Electroretinograms were extinguished in both eyes. After improvement of his general condition, we performed a 25-gauge vitrectomy combined with lens extraction in his left eye in December 2012. After removal of the vitreous hemorrhage, we found the subretinal hemorrhage had already been absorbed, leaving a mottled fundus color. However, the optic disc was not pale. Nine months after the surgery, his best-corrected visual acuity finally improved to 0.1. CONCLUSION: We successfully treated a case of severe vitreous hemorrhage secondary to leukemia therapy and tumor lysis syndrome using 25-gauge vitrectomy. This procedure may be safe and effective to perform, even in children with complications.

Effects of intravitreal injection of bevacizumab on inflammatory cytokines in the vitreous with proliferative diabetic retinopathy.

BACKGROUND: To investigate the effects of preoperative intravitreal injection of bevacizumab (IVB) on the levels of 27 inflammatory cytokines, including interleukins (ILs) and vascular endothelial growth factor. METHODS: From among 200 patients who had proliferative diabetic retinopathy and underwent vitrectomy in our department from September 2009 to October 2010, 8 study subjects met the enrollment criteria in which both eyes at nearly equivalent stages underwent vitrectomy. The first vitrectomy for each patient was performed without IVB (control group), whereas the second vitrectomy on the contralateral eye was performed with IVB treatment (1.25 mg/0.05 mL) 3 days before surgery (IVB group). Undiluted vitreous fluid was collected at the start of each vitrectomy. A multiplex assay was used to simultaneously determine the levels of 27 inflammatory cytokines and growth factors. RESULTS: Mean vascular endothelial growth factor levels were significantly lower in the IVB group (519.69 pg/mL) than in the control group (11,807.44 pg/mL) (P = 0.012, Wilcoxon signed rank test). Moreover, the mean levels (IVB/control, pg/mL) of IL-1RA (38.50/62.31, P = 0.036), IL-5 (27.75/34.00, P = 0.018), IL-10 (433.63/1,995.94, P = 0.012), IL-12 (246.69/1,033.69, P = 0.012), IL-13 (707.50/1,450.38, P = 0.012), and interferon γ (71.13/84.69, P = 0.036) were significantly lower in the IVB group. No other significant differences were observed in the levels of the other 20 cytokines and growth factors between the 2 groups. CONCLUSION: Preoperative IVB reduced not only the intravitreal vascular endothelial growth factor level but also the intravitreal levels of other inflammatory cytokines, including IL-1RA, IL-5, IL-10, IL-12, IL-13, and interferon γ. These results indicate the interaction of some cytokines in the vitreous fluid of proliferative diabetic retinopathy patients and suggest the possibility that preoperative IVB may not only reduce vascular proliferation by its direct antivascular endothelial growth factor effect but also modulate the inflammatory response through putative cytokine networks. None of the other cytokines examined were elevated after IVB.