Intravitreal Ziv-Aflibercept versus Bevacizumab for Naïve Central Retinal Vein Occlusion with Macular Edema: An Interim Analysis of a Randomized Non-Inferiority Trial.

Purpose: To compare the efficacy of intravitreal ziv-aflibercept (IVZ) and bevacizumab (IVB) injections for the treatment of macular edema secondary to central retinal vein occlusion. Methods: Participants were randomly assigned 1:1 to receive 3 monthly IVZ (1.25 mg/0.05 mL) or IVB (1.25 mg/0.05 mL) followed by the pro-re-nata protocol for persistent or recurrent macular edema. The primary outcomes were best-corrected visual acuity and central subfield thickness. An interim analysis was planned when half of the participants completed the follow-up. Results: Twenty-four participants were recruited. At 6 months, mean best-corrected visual acuity in the IVB and IVZ groups improved from 1.23 ± 0.64 to 0.76 ± 0.56 logMAR (p = 0.003) and from 1.13 ± 0.59 to 0.53 ± 0.26 logMAR (p = 0.003), respectively. The percentage of visual improvement and reduction in central subfield thickness in the IVZ group were insignificantly better than those in the IVB group (44.41 ± 26.72 vs 39.64 ± 24.22%; p = 0.65) and (51.94 ± 20.35 vs 45.78 ± 24.71%; p = 0.51), respectively. Although the mean number of injections was lower in the IVZ group (4.55 ± 1.29 vs 4.82 ±1.33), the difference was not statistically significant (p = 0.68). No ocular or systemic adverse events were observed. Conclusion: The interim analysis demonstrated that the visual and anatomical results of IVZ were insignificantly better than those of IVB at 6 months of follow-up. The results also showed that IVZ was non-inferior to IVB for anatomical improvement but inconclusive for visual improvement. Clinical Trial Registration: (identifier: TCTR20191205008).

Clinical Risk Score for Prediction of Urgency in Carotid Cavernous Sinus Fistulas.

Purpose: To develop a clinical risk score for the prediction of urgency in patients with carotid cavernous sinus fistulas (CCFs) and test for the discriminative ability of the diagnostic prediction. Methods: The medical charts of 60 patients with CCFs were retrospectively reviewed. The clinical characteristics of direct and dural CCFs were analyzed by logistic regression. The clinical risk score was developed from the coefficient in the multivariable regression model and used to predict direct CCFs which were more urgent than the dural type. The score prediction was reported as an area under the receiver operating characteristic (AuROC) curve and 95% confidence interval (95% CI). Results: In a univariable analysis, the clinical characteristics which increased the risk of direct CCFs were age, gender, trauma, underlying diseases, visual acuity (VA) at presentation, bruit, chemosis, and dilated retinal vessels. However, in multivariable analysis, the significant predictors were limited to age, trauma, bruit, underlying diseases and logMAR VA. Regression coefficient of each predictor was converted to a risk score and summation of scores from these predictors for each patient was calculated. The total risk score predicted the urgent direct CCFs correctly with AuROC of 97.77% (95% CI; 93.57, 100). Conclusion: The clinical risk score for the prediction of urgent direct CCFs has been developed and used in the patients with CCFs in our setting. The discriminative ability of the score prediction is high. This simple clinical risk score may help clinicians suspect direct CCFs and urgently refer the patients to have prompt angiography and treatment.

Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics.

Purpose: To compare the clinical characteristics of patients with direct and dural carotid cavernous sinus fistulas (CCFs). Methods: The medical records of 60 patients diagnosed with CCFs were retrospectively reviewed. The collected data included demographic characteristics, clinical findings, and ocular manifestation. The clinical characteristics of the direct and the dural CCFs were compared on head-to-head basis. Logistic regression analysis was used to demonstrate the direction and magnitude of the difference and reported as odds ratio with its 95% confidence interval. Results: There were 28 patients (46.67%) with direct CCFs, and 32 patients (53.33%) with dural CCFs. Patients with direct CCF were mostly male (p=0.023), younger age (p<0.001), had history of trauma (p<0.001), and more visual impairment at presentation (p=0.025), when compared to those with dural CCFs. In addition, patients with direct CCF had significantly more chemosis (p=0.005), proptosis (p=0.042), bruit (p<0.001) and dilated retinal vessels (p=0.008) than those with dural CCF. Thirty patients (50%) had increased intraocular pressure (IOP). Mean IOP of the affected eyes was significantly higher than the unaffected eyes (p<0.0001). In patients with normal IOP, mean IOP of the affected eyes was also higher than the unaffected eyes (p=0.0027). Conclusion: Patients with direct CCF were younger age, associated with trauma, and more visual impairment at presentation. Chemosis, proptosis, bruit and dilated retinal vessels were detected more in the direct CCF than the dural CCF. Despite normal IOP, affected eyes had significantly higher IOP than the unaffected eyes. Information on these clinical characteristics may be helpful in discrimination of the direct type, which is more urgent for further investigation and treatment.

Botulinum Toxin Injection versus Extraocular Muscle Surgery for Acute Acquired Comitant Esotropia.

Purpose: To compare the success rate of extraocular muscle surgery and botulinum toxin injection for treatment in patients with acute acquired comitant esotropia (AACE). Patients and Methods: This is a retrospective cohort study in which we treated 34 patients of AACE with botulinum toxin compared with 80 patients who had been treated with surgery. The data included angle of deviation in prism diopter (PD) at baseline and one, three, and six months after treatment. The main outcome was the success rate in each treatment group. Results: In the surgery group, mean esodeviation angles at baseline and one, three, and six months after treatment were 50.8 ± 18.3 PD, 4.9 ± 8.3 PD, 4.6 ± 9.5 PD, and 5.5 ± 10.3 PD, whereas those in the botulinum toxin group were 51.2 ± 14.3 PD, 13.9 ± 17.4 PD, 22.0 ± 19.3, and 31.3 ± 23.8 PD, respectively. There was a statistically significant difference in the deviation angles between the two groups (p < 0.001). The success rate in the surgery group at one, three, and six months was 81%, 84%, and 79%, whereas that in the botulinum toxin group was 50%, 27%, and 27%. Conclusion: Botulinum toxin injection was not as effective as conventional extraocular muscle surgery in AACE patients. However, the treatment is safe, fast-acting, and improves both cosmetic appearance and quality of life. This may be considered as a chance for patients not preferring surgery.

Factors Affecting Visual Recovery in Patients with Ethambutol-Induced Optic Neuropathy.

Purpose: To study visual recovery and identify the factors that may affect it in patients with ethambutol-induced optic neuropathy (EON). Patients and Methods: Medical charts of patients who developed optic neuropathy after ethambutol (EMB) treatment for tuberculosis infection were retrospectively reviewed. Demographic details and clinical data were examined to assess visual recovery after discontinuation of ethambutol treatment. The univariate and multivariate relationships between various factors and visual recovery were evaluated using regression analysis. Results: Of 5394 patients diagnosed with tuberculosis infection and treated with EMB, 23 patients (0.43%) were diagnosed with EON. Logistic regression analysis found that female sex was the categorical factor significantly associated with good visual recovery with an odds ratio of 12.0 (95% confidence interval 1.56, 92.29; p = 0.02), while linear regression analysis identified good initial visual acuity as the numerical factor significantly related with it (p < 0.001). After adjustment with multivariate analysis, initial visual acuity was found to be the only significant factor associated with visual recovery. All patients with initial visual acuity of better than 20/200 at first visit achieved good visual recovery. Conclusion: The incidence of EON in patients treated with EMB was 0.43% in this hospital-based study. Good visual recovery was noted in 39.13% of these patients, and initial visual acuity was the factor that affected visual recovery. It is recommended that patients on EMB have regular screening by an ophthalmologist for early detection of the disease, and if it is discovered, that the use of the drug be immediately discontinued in order to prevent potentially devastating visual loss.

Predictors for Dry Eye Diseases in Patients with Systemic Sclerosis.

Purpose: To evaluate the prevalence of dry eye disease (DED) in patients with both limited and diffuse subtypes of systemic sclerosis (SSc) and to determine the predictive factors associated with the occurrence of DED. Patients and Methods: This was a prospective consecutive cross-sectional study of patients with SSc. Each patient underwent a comprehensive ophthalmological evaluation. The Ocular Surface Disease Index (OSDI) was used to assess the symptoms of DED. Tear break up time (TBUT), Schirmer I and ocular surface staining (OSS) were used for objective tests. Patients were diagnosed DED using the DEW II diagnostic method which included both symptom and objective tests. The collected data of patients with and without DED were compared to find out possible associated factors. Logistic regression analysis was used to determine the effects of these factors. Results: Eighty-four SSc patients (25 limited and 59 diffuse subtypes) were studied. The prevalence of DED in SSc patients was 52.38%. The OSDI, tear break up time (TBUT), Schirmer I and ocular surface staining (OSS) were not significantly different between SSc subtypes. Among the 46 symptomatic patients, DED was noted in 44 (52.38%). Most patients (61.4%) were mixed aqueous deficiency-evaporative dry eye type (both TBUT and Schirmer I test positive). The mean age and the median of disease duration in DED patients were higher than those without DED with statistically significant difference (P = 0.004 and 0.019). Conclusion: DED was common in patients with SSc. The predictors for the occurrence of DED were older age and longer disease duration. Therefore, OSDI and objective tests for DED should be evaluated in all SSc patients, particularly those with older age and longer disease duration.

Predictors for Visual Outcome After Silicone Oil Removal in Eyes with Complicated Retinal Detachment.

Purpose: To determine the predictors for visual outcome after silicone oil removal (SOR) in eyes with complicated retinal detachment. Patients and Methods: A total of 182 eyes with complicated retinal detachment that had undergone SOR were retrospectively reviewed. Snellen best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications were recorded at baseline, 1 day, 1 month and 3 months postoperatively. Good visual outcome was defined as best-corrected visual acuity of ≥20/200 at 3 months visit. Factors predicting visual outcome were evaluated using univariate and multivariate analysis. Results: After SOR, anatomical retinal reattachment was noted in 165 eyes (90.66%). Good visual outcome (VA ≥ 20/200) was achieved in 104 eyes (57.14%) at 3 months after SOR. For the eyes that remained attached after SOR, the percentage of good visual outcome was 63.03%. With univariate and multivariate analysis, visual acuity before SOR (p<0.001), circumferential peripheral retinopexy (p=0.037), additional endolaser during SOR (p=0.004), and pseudophakia status at the last follow up (p=0.021) were associated with visual outcome. Complications after SOR included redetachment (9.4%), hypotony (6.6%) and bullous keratopathy (1.7%). Conclusion: While anatomically attached retina was achieved in most of the patients, the functional outcomes were still much lower. Good BCVA before SOR and pseudophakia status at the last follow up were predictors for good visual outcomes, whereas circumferential peripheral retinopexy and additional endolaser during SOR were predictors for poor visual outcomes after SOR in eyes with complicated retinal detachment.

Efficacy of Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Treatment of Large Idiopathic Full-Thickness Macular Holes.

PURPOSE: To evaluate anatomical and visual outcomes of pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) in large idiopathic full-thickness macular holes (FTMH). Predictive factors also formed part of the study. PATIENTS AND METHODS: A retrospective review of medical charts and optical coherence tomography images of patients with large idiopathic FTMH (≥400 µm) was conducted. RESULTS: One hundred and fifty-eight eyes of 155 patients with a mean age of 62.94±7.50 years were included in the study. Mean preoperative visual acuity (VA) was 1.26±0.36 logMAR. Mean preoperative minimum linear diameter (MLD) and basal linear diameter (BLD) were 644.89±136.85 µm and 1208.11±307.14 µm, respectively. At 12 weeks postoperative follow-up, FTMH closure rate was 61.39% and mean postoperative BCVA was 0.92±0.36 logMAR. Multivariate logistic regression analyses showed the anatomical outcome was significantly associated with BLD ≤1200 µm, preoperative vitreomacular interface (VMI) disorder and extended ILMP (a radius of 2 disc diameters), whereas only postoperative ellipsoid loss ≤500 µm was significantly associated with visual outcome. In subgroup analyses, the large FTMH group (400-600 µm) had significantly better results in closure rate (70.97% vs 55.21%, P = 0.047) and visual results (P = 0.031) than the extra-large FTMH group (>600 µm). CONCLUSION: PPV with conventional ILMP provided relatively low closure rate in large FTMH. Surgical success was significantly associated with BLD ≤1200 µm, no preoperative VMI abnormality, extended ILMP and postoperative ellipsoid defect ≤500 µm. Therefore, we suggest the extended ILMP if conventional ILMP technique is used. The large FTMH group had significantly better surgical outcomes than the extra-large group, so there is a need for reclassification of large FTMH.

Comparative study of 1 DD and 2 DD radius conventional internal limiting membrane peeling in large idiopathic full-thickness macular holes: a randomized controlled trial.

OBJECTIVE: To compare the surgical outcomes of 1-disc diameter (DD) and 2-DD conventional internal limiting membrane peeling (C-ILMP) in large full-thickness macular holes (FTMHs). MATERIALS AND METHODS: A prospective randomized controlled trial. One hundred patients with large idiopathic full-thickness macular hole (FTMH) were randomized into C-ILMP and extended C-ILMP (EC-ILMP) groups. The primary outcome was closure rate at 6 months after surgery. Secondary outcomes were visual acuity (VA), closure type, consequence of ILMP and complications. RESULTS: The mean symptom duration was 12.19 ± 9.64 months. Mean preoperative VA was 1.25 ± 0.37 logMAR. The average minimum linear diameter was 633.05 ± 129.82 µm and basal linear dimension was 1158.49 ± 249.07 µm. The two groups did not differ in term of demographic data. Closure rate was significantly higher in the EC-ILMP group (76.47% vs. 51.02%, 95% CI 7.24-43.66; p = 0.008). There were also no significant differences in closure type, central foveal thickness, dissociated optic nerve fibre layer detection, or change in fovea-to-disc distance. There were also no significant differences in postoperative VA (p = 0.069) or visual improvement (mean 0.39 ± 0.43 logMAR; p = 0.286). According to subgroup analysis, EC-ILMP resulted in a higher closure rate in patients with chronic FTMH for >6 months, (p = 0.008). Furthermore, EC-ILMP resulted in better anatomical closure and visual result in patients with FTMH with macular hole closure index ≤0.5, p = 0.003 and p = 0.010, respectively. CONCLUSION: Extended C-ILMP yielded a significantly higher closure rate in large FTMHs, but visual outcome did not differ significantly. According to subgroup analysis, extended C-ILMP was more effective in chronic large FTMH with MHCI ≤ 0.5.

Oral Spironolactone versus Conservative Treatment for Non-Resolving Central Serous Chorioretinopathy in Real-Life Practice.

OBJECTIVE: To compare the efficacy of oral spironolactone treatment versus conservative treatment for patients with persistent central serous chorioretinopathy (CSC) in real-life practice. DESIGN: Retrospective comparative study. PATIENTS AND METHODS: Medical records and retinal images of 62 patients with non-resolving CSC were reviewed. Twenty-one patients received oral spironolactone (50 mg/day) while 41 patients received conservative treatment. Primary outcome was proportion of eyes with complete resolution of subretinal fluid (SRF) within 6 months. Secondary outcome measures included changes in SRF height, central macular thickness (CMT), lesion size and best-corrected visual acuity (BCVA). The occurrence of drug side effect was also assessed. RESULTS: There was no significant difference in demographic data, clinical characteristics, optical coherence tomography parameters and leaking patterns in fluorescein fundus angiography between two groups. Complete resolution of SRF was significantly higher and faster in the spironolactone group than the conservative treatment group (p=0.03). Although significant anatomical improvement in SRF height, CMT and lesion size were observed in both groups (p < 0.001), final BCVA was improved significantly in only the spironolactone group (p < 0.05). The recurrence of SRF after complete resolution was observed in 4/12 eyes (33.33%) in the treatment group. None of the patients experienced any side effects of spironolactone. CONCLUSION: Oral spironolactone (50 mg/day) could achieve both significant anatomical and visual improvement, while the significant visual gain could not be provided with the conservative treatment. Spironolactone should be considered as an alternative treatment option in non-resolving CSC patients who cannot afford the PDT treatment.

Emulsification of Different Viscosity Silicone Oil in Complicated Retinal Detachment Surgery: A Randomized Double-Blinded Clinical Trial.

OBJECTIVE: To study silicone oil (SO) emulsification, anatomic and visual outcome after complicated retinal detachment surgery by pars plana vitrectomy (PPV) with intraocular SO tamponade, comparing between low and high viscosity SO. DESIGN: Randomized, double-blinded, controlled trial. PATIENTS AND METHODS: Patients with complicated retinal detachment who had been surgically treated by PPV and intraocular SO tamponade were randomly divided into low viscosity (Group 1) or high viscosity (Group 2). Main Outcome Measures were rate of silicone oil emulsification, anatomic retinal reattachment and visual outcome, assessed at 1,3,6,9 and 12 months. RESULTS: One hundred patients were divided into 50 patients in each group. The rate of silicone oil emulsification in Group 1 (63.64%) was higher than Group 2 (40%), but the difference was not statistically significant (p = 0.08). Rates of anatomic retinal reattachment were 88% in Group 1 and 90% in Group 2 (p = 0.76). For functional visual outcome, final best-corrected visual acuity (BCVA) at Month 12 compared with the baseline BCVA was improved vision 52% in Group 1 and 58% in Group 2 (p = 0.82). CONCLUSION: SO emulsification rate in low viscosity group is non-significantly higher than high viscosity group, but results in a comparable reattachment rate and final visual recovery. Emulsification in both groups is detected at as early as 1 month and mostly within 3 months. We recommend using either low or high viscosity SO in complicated retinal detachment surgery and removing it as early as possible to prevent the consequent serious complications. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02988583.

Predictors for Visual Outcomes in Eye Injuries with Intraocular Foreign Body.

OBJECTIVE: To study the visual outcomes and identify the predictive factors for visual outcomes in patients with eye injuries and retained intraocular foreign bodies (IOFBs). PATIENTS AND METHODS: The medical records of 359 consecutive patients with eye injuries and retained IOFBs were retrospectively reviewed during 2009-2018. Demographic data, clinical findings, treatment and visual outcomes were studied. Univariate and multivariate analyses were used to identify the predictive factors. RESULTS: Most of the patients were male and the average age was 36.4 years old. The three most common causes of eye injuries were grass trimming (25.07%), chiseling (23.12%) and hammering (13.93%). Most of the patients (79.39%) presented with poor initial best-corrected visual acuity (BCVA) (<3/60). Pars plana vitrectomy with IOFB removal was done in 273 eyes (76.04%). After treatment, eyes with poor BCVA (<3/60) decreased from 79.39% to 62.95% and eyes with good BCVA (≥3/60) increased from 20.61% to 37.05%. Poor initial best-corrected visual acuity (odds ratio 23.39, P<0.001), rhegmatogenous retinal detachment (odds ratio 9.91, P<0.001) and the presence of infectious endophthalmitis (odds ratio 2.06, P=0.02) were statistically significant predictive factors for poor visual outcome. CONCLUSION: Most patients with eye injuries and IOFBs usually have poor final BCVA. Poor presenting BCVA, retinal detachment and endophthalmitis are significant predictive factors for poor visual outcomes. These factors can be used to inform the visual prognosis and plan prompt surgical intervention for the patients. Causes of IOFBs were mostly work-related and could be preventable. Education and activation of using appropriate protective safety glasses during work are necessary to avoid serious eye injuries and blindness.

Ocular angiostrongyliasis in Thailand: a retrospective analysis over two decades.

PURPOSE: To elucidate the clinical manifestations, management, and visual outcomes of patients with ocular angiostrongyliasis. METHODS: This was a single-center retrospective study of patients with ocular angiostrongyliasis presenting between 1995 and 2017 at Srinagarind Hospital, Khon Kaen, Thailand. Cases were found based on a search of diagnostic codes. A total of 18 patients were diagnosed through identification of the Angiostrongylus cantonensis parasite within the eye. Medical records and ocular photography were reviewed. RESULTS: There were 18 cases, with a mean age of 40.7±14.2 years. All patients had a history of raw food ingestion, such as snails. Most of the patients presented with blurred vision: 13 cases (72.22%) had best-corrected visual acuity of 2/60 or worse. Only one living larva was detected in each case. The size of larvae varied widely from 2.6-12.6 mm in length. Larvae were commonly detected in the vitreous cavity. Although multiple treatment modalities were used, including focal laser, surgery, antihelminthic drugs, and steroid treatment, the majority of cases (70.6%) did not have visual improvement. CONCLUSION: Focal laser is recommended to eradicate subretinal angiostrongyliasis, while laser treatment prior to surgical removal is recommended to eliminate intracameral and intravitreal angiostrongyliasis. Pulse methylprednisolone therapy may be beneficial in cases of acute optic neuritis. The visual prognosis mainly depends on ocular pathology and parasitic migration pathway.

Digital image processing software for diagnosing diabetic retinopathy from fundus photograph.

OBJECTIVE: The aim of this study was to develop automated software for screening and diagnosing diabetic retinopathy (DR) from fundus photograph of patients with diabetes mellitus. METHODS: The extraction of clinically significant features to detect pathologies of DR and the severity classification were performed by using MATLAB R2015a with MATLAB Image Processing Toolbox. In addition, the graphic user interface was developed using the MATLAB GUI Toolbox. The accuracy of software was measured by comparing the obtained results to those of the diagnosis by the ophthalmologist. RESULTS: A set of 400 fundus images, containing 21 normal fundus images and 379 DR fundus images (162 non-proliferative DR and 217 proliferative DR), was interpreted by the ophthalmologist as a reference standard. The initial result showed that the sensitivity, specificity and accuracy of this software in detection of DR were 98%, 67% and 96.25%, respectively. However, the accuracy of this software in classifying non-proliferative and proliferative diabetic retinopathy was 66.58%. The average time for processing is 7 seconds for one fundus image. CONCLUSION: The automated DR screening software was developed by using MATLAB programming and yielded 96.25% accuracy for the detection of DR when compared to that of the diagnosis by the ophthalmologist. It may be a helpful tool for DR screening in the distant rural area where ophthalmologist is not available.

Factors affecting visual outcomes after treatment of infectious endophthalmitis in northeastern Thailand.

OBJECTIVE: To determine factors affecting visual outcomes after treatment of infectious endophthalmitis during 2012-2016 at a large referral eye center in northeastern Thailand. PATIENTS AND METHODS: Medical charts of patients with a diagnosis of infectious endophthalmitis including demographic data, types of endophthalmitis, causative organisms, methods of treatment, anatomical, and functional outcomes were retrospectively reviewed. Factors associated with improved visual outcomes were analyzed. RESULTS: Four hundred and eleven patients (417 eyes) were recruited for the study. The three most common types were post-traumatic (44.53%), post-operative (31.87%), and endogenous endophthalmitis (17.52%). Vitreous cultures revealed causative organisms in 41.25%. Most common Gram-positive organisms were coagulase-negative Staphylococcus 30% (36/120), Bacillus spp. 20% (24/120), and Streptococcus pneumoniae 18.33% (20/120). Most common Gram-negatives were Pseudomonas spp. 24.32% (9/37), Klebsiella spp. 24.32% (9/37), and Enterobacter spp. 16.21% (6/37). Methods of treatment were medical treatment (18.71%) and surgical treatment (81.29%), including pars plana vitrectomy with or without silicone oil tamponade (62.59%) and destructive surgery (18.71%). After treatment, visual improvement was noted in 44.6%, stable vision in 18.47%, and worse vision in 36.93%. Factors associated with improved visual outcomes were post-operative endophthalmitis (P<0.001), coagulase-negative Staphylococcus (P=0.003), and initial visual acuity before treatment of hand motion or better (P=0.017). CONCLUSION: Most infectious endophthalmitis patients were post-traumatic, post-operative, and endogenous. The most common method of treatment was pars plana vitrectomy. Treatment could improve visual outcomes and at least stabilize the vision in 63.07%. Factors associated with improved visual outcomes were types of endophthalmitis, causative organisms, and initial visual acuity before treatment.

Predictive factors in the treatment of streptococcal endophthalmitis.

OBJECTIVE: To evaluate visual outcomes and possible predictive factors in the treatment of infectious endophthalmitis caused by Streptococcus species during 2012-2016 at a large referral eye center in northeastern Thailand. METHODS: A retrospective medical record chart review of patients with culture-positive endophthalmitis caused by Streptococcus species was conducted. Demographic data including age, gender, occupation, duration of symptoms, time to surgery, surgical procedures, initial visual acuity at presentation, and final visual acuity after treatment were collected and analyzed. Possible predictive factors associated with improved visual outcomes were also studied. RESULTS: Forty-five eyes of 45 patients were recruited for the study. The 3 most common types of endophthalmitis were postoperative (35.56%), posttraumatic (20%), and endogenous (15.56%). At presentation, most patients (95.56%) had visual acuity of hand motion (55.56%), light perception (28.89%), or no light perception (11.11%). The 3 most common isolates were Streptococcus pneumoniae (44.44%), Group B ß-hemolytic Streptococcus (26.68%), and Streptococcus viridans (20%). Most patients (62.22%) were treated with surgical interventions, either pars plana vitrectomy with intravitreal antibiotics or pars plana vitrectomy with intravitreal antibiotics and silicone oil tamponade. After treatment, improved visual outcome was noted in only 9 patients (20%), and no visual improvement was seen in 36 patients (80%). Evisceration and enucleation were performed in 15 patients (33.33%). The only possible predictive factor associated with improved visual outcomes was early vitrectomy, performed within 3 days. CONCLUSION: Streptococcal endophthalmitis is often associated with poor visual prognosis. Only 9 patients (20%) had improved vision after treatment. The only possible predictive factor associated with improved visual outcomes was vitrectomy within 3 days. Early diagnosis and early vitrectomy are therefore recommended.

Laser-Induced Choroidal Neovascularizations: Clinical Study of 3 Cases.

BACKGROUND: We report 3 patients with laser-induced choroidal neovascularization (CNV). METHOD: Retrospective, observational case series. Medical charts and photographs were reviewed. RESULTS: Two patients with central serous chorioretinopathy who developed iatrogenic CNV after focal laser photocoagulation were treated with intravitreal ranibizumab injections. One patient with CNV secondary to thermal laser photocoagulation for diabetic macular edema was treated with photodynamic therapy (PDT). Visual improvement has been demonstrated in the patients treated with intravitreal ranibizumab injections, and their successful visual outcome was stable for more than 2 years. Stable visual acuity was also observed in the patient treated with PDT, no visual improvement was observed possibly due to the macular scar and macular ischemia. No systemic or ocular complications were detected among the 3 cases. CONCLUSION: To prevent a laser-induced CNV, it is critical to avoid heavy small-spot laser burns and repeated application. Patients should be monitored carefully for CNV after laser treatment. In our cases, PDT and intravitreal ranibizumab injections were effective for the treatment of laser-induced CNV.

Successful treatment of Chrysosporium keratitis with voriconazole.

OBJECTIVE: To report a patient with severe Chrysosporium keratitis successfully treated by voriconazole. METHOD: Case report. RESULTS: A 37-year-old healthy male presented with irritation, pain and reduced vision in his left eye after mud contamination. Examination demonstrated corneal stromal infiltration, endothelial plaque and hypopyon. Corneal scrapings demonstrated numerous septate hyphae, and specimen cultures were positive for Chrysosporium sp. The lesion did not respond to aggressive topical 5% natamycin, 0.15% topical amphotericin B and oral itraconazole. The patient was then treated by topical 1% voriconazole every hour. Intracameral and intrastromal voriconazole injections (50 µg/0.1 mL) were also undertaken. The keratitis was significantly improved after voriconazole. CONCLUSION: To the best of the authors' knowledge, this is the first report on the use of voriconazole for Chrysosporium keratitis. Voriconazole may be an effective alternative to conventional antifungal agents in some cases of fungal keratitis. It should be considered before shifting to therapeutic keratoplasty.

Systemic abnormalities associated with retinal vein occlusion in young patients.

OBJECTIVES: To study the systemic abnormalities associated with retinal vein occlusion in patients aged ≤50 years with a particular emphasis on atherosclerotic diseases and thrombophilic disorders. METHODS: Medical charts of patients, aged ≤50 years whose diagnoses were retinal vein occlusions during the period 1995-2015 were retrospectively reviewed. The primary outcome was the number of systemic abnormalities associated with these patients. Secondary outcomes included types of retinal vein occlusion and sites of occlusion. RESULTS: Atherosclerotic diseases were the most common systemic abnormalities associated with retinal vein occlusion and accounted for 55.1% of the patients in the study. Hypertension in 27.55%, diabetes mellitus in 16.33%, and 5.1% with dyslipidemia were noted. The number of thrombophilic disorders seemed to be less than expected and were noted in only 5.1%. Other systemic abnormalities included viral hepatitis infection, systemic lupus erythematosus, and acquired immunodeficiency syndrome. Oral contraceptives were used by some patients. CONCLUSION: Atherosclerotic diseases remained the most commonly associated systemic diseases in the majority of these patients. Approach to these patients should include a screening for hypertension, diabetes mellitus, and lipid abnormalities. Thrombophilia should also be considered where no obvious atherosclerotic diseases are found or if the patient is <40 years old, a history of thrombosis or a family history of thrombosis is possible.