Background/Purpose: To report the effects of ranibizumab on very low birth weight (VLBW) infants with retinopathy of prematurity (ROP). Methods: A retrospective, noncomparative, consecutive, interventional case series was conducted. Patients with stage 3 ROP were identified and evaluated from August 2011 to February 2012. All patients with ROP received one intravitreal ranibizumab injection (0.25 mg/0.025 mL) under topical anesthesia as the initial treatment. Main outcome measures: Regression of ROP and the complications associated with the intravitreal ranibizumab injection. Results: A total of 23 eyes of 12 patients (four boys and eight girls) were included in this study. All of the patients had a history of supplemental oxygen and mechanical ventilation use. The mean gestational age was 26.33 ± 2.06 weeks (range: 24–30 weeks), and the mean birth weight was 821.58 ± 297.63 g (range: 507–1480 g). The mean postmenstrual age during the intravitreal administration of ranibizumab injection was 35.08 ± 2.07 weeks (range: 32–39 weeks), and the mean follow-up period was 5.83 ± 1.64 months (range: 3–8 months). All eyes received one intravitreal ranibizumab injection (0.25 mg/ 0.025 mL) as the primary therapy. None of the eyes needed conventional laser photocoagulation or cryotherapy as adjuvant therapy and no systemic complications were noted. No cataracts, endophthalmitis, or retinal detachment occurred postoperatively. Preretinal hemorrhages were found in four eyes of three patients (17.39%), but all were absorbed without sequelae. Conclusion: Intravitreal ranibizumab injections seem to be effective and well tolerated in VLBW infants with stage 3 ROP. Only self-limited preretinal hemorrhages were noted, and no short-term systemic or major ocular side effects were identified.

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Purpose: Today, many patients who have undergone cataract surgery want to enjoy good non-spectacle corrected distant vision and nonspectacle corrected near vision with glasses independence. According to the literature, the implantation of an accommodative intraocular lens (AIOLs) can achieve the level of vision after cataract surgery. However, there is a debate regarding the true accommodative capability of the AIOLs (i.e., whether the IOLs can move forward when attempting to accommodate like the natural crystalline lens of a phakic eye). This review aims to answer the following questions: (1) Can pseudo-phakic eye accommodate? (2) If pseudophakic eyes can accommodate, how long does this accommodation last? (3) Is there pseudoaccommodation? Methods: This is a systematic review of randomized and nonrandomized controlled trials that have compared different IOLs in accommodation using subjective and objective methods of testing accommodation. All peer reviewed randomized and nonrandomized controlled trials that compared different IOLs in accommodation were included. Results: There was evidence of pseudophakic accommodation up to 12 months postoperatively for AIOLs (mostly 1CU): subjective accommodation [95% confidence interval (CI), 0.36–0.98], objective optic shift (95% CI, 0.12–0.76). However, accommodation decreased at 12 months postoperatively (95% CI, 0.55–1.00). In addition, several papers have reported evidence of pseudoaccommodation. Conclusion: There is pseudophakic accommodation up to 1 year post cataract surgery, mostly 1CU AIOL. Pseudoaccommodation may coexist.

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Purpose: To study the anatomical and visual outcomes of surgery for retinal detachment (RD) in patients with choroidal coloboma. Methods: Forty-six eyes of 46 patients underwent surgery for RD with choroidal coloboma. Patients were divided into three groups, according to the extent of choroidal coloboma: Coloboma not involving the disc and macula (Group A), coloboma involving the disc (Group B), and coloboma involving the disc and macula (Group C). Thirty-eight eyes underwent pars plana vitrectomy with silicone oil (SO) (Group 1) and eight eyes underwent scleral buckling surgery (Group 2). SO removal was carried out in 18 eyes at final follow up. Results: After a mean follow-up of 16.2 months, 40 eyes (86.9%) had an attached retina and the best corrected visual acuity (VA) improved from a preoperative median of 20/800 to 20/250 (p = 0.001). Thirty-four eyes (74%) recovered ≥20/400 VA. The final median VA in Group A (20/200) was better than in Group B (20/800) and Group C (light perception and hand movement) which was statistically significant (p = 0.01). Redetachment occurred in 10 eyes (21.8%), of which 7 eyes (18.91%) belonged to Group 1 and 3 eyes (37.5%) belonged to Group 2, and all of these eyes underwent resurgery. Of these 10 eyes, 9 had an attached retina at final follow up. Conclusion: Postoperative visual recovery in RD with choroidal coloboma is dependent upon the involvement of the disc and macula with the colobomatous area. Resurgery following redetachment improves the final anatomical outcomes.

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Two young male patients experienced acute visual disturbance in one eye, with central scotoma showing central retinal vein occlusion with cilioretinal artery occlusion (CLRAO). Optical coherent tomography (OCT) revealed inner retinal edema at areas of retinal infarction. An intravitreal injection of Avastin was administered to these two patients with improvement of symptoms within 4–8 weeks. These two cases suggested that OCT may help detect CLRAO by showing inner retinal edema, and demonstrated that intravitreal injection of Avastin may improve venous engorgement and retinal hemorrhage, as well as circulation of cilioretinal artery, thus shortening the disease course.

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Presumed ocular histoplasmosis syndrome (POHS) is rare in Taiwan. We report on a patient with a clinical picture resembling POHS who was successfully treated with intravitreal bevacizumab. A 42-year-old woman had blurred vision of her right eye. Ophthalmological examination revealed multiple juxtapapillary and peripheral punched-out chorioretinal scars. Fluorescein angiography and optic coherence tomography showed subfoveal choroidal neovascularization (CNV). She received three injections of intravitreal bevacizumab. The CNV regressed after treatment. Her visual acuity maintained 20/20 at 1 year follow-up. Taiwan is not an endemic area for histoplasmosis. Clinicians should be cautious in differential diagnosis of the clinical presentation of POHS or similar disease entities. Early identification and timely treatment with intravitreal bevacizumab may rescue the patient from vision loss.

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Purpose: To describe the clinical features of exudative AMD of patients in Taiwan. Methods: A retrospective case series consisting of 235 eyes in 211 patients, with a male/female ratio of 7:3, mean age 70.36 ± 8.98 years (range 50–86), with exudative AMD, was reviewed at Changhua Christian Hospital, Taiwan. Results: Among the 211 patients, 77 (36.5%) had bilateral involvement of exudative AMD; and of the 235 eyes, 117 (49.7%) were diagnosed with idiopathic PCV, 111 (47.2%) with typical AMD, and seven eyes (2.9%) with retinal angiomatous proliferation. PCV is predominant in patients younger than 70 years (71.8%), whereas typical AMD is prevalent in patients 70 years or older (59.4%). After treatment, mean visual acuity improved in 154 eyes, as reflected in the decreasing logarithm of minimal angle of resolution (log Mar VA)–from 0.95 ± 0.60 to 0.84 ± 0.55, whereas in the other 81 eyes without treatment visual acuity deteriorated–log Mar VA increased from 0.85 ± 0.60 to 1.22 ± 0.53. Conclusion: Male predominance, higher ratio of PCV, and lower ratio of retinal angiomatous proliferation are common features of exudative AMD in Taiwan.

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Purpose: To evaluate the efficacy of sequential posterior subtenon triamcinolone acetonide (PSTA) injection with macular grid/focal laser photocoagulation for clinically significant diabetic macular edema (CSME). Methods: Prospective, interventional clinical trial. Between July 2007 and March 2008, 41 eyes of 32 patients (17 males and 15 females) with Type II diabetes mellitus and diffuse clinically significant macular edema according to the Early Treatment Diabetic Retinopathy Study criteria were recruited. PSTA was used as the first line of treatment, followed by macular focal/grid photocoagulation 2 weeks later. In patients with persistent macular edema, a second dose of PSTA followed by additional focal laser treatment was administered 8–10 weeks later. 6 months (342.2 ± 127.2 μm, p = 0.001) in comparison with the baseline values 437.1 ± 186.5 μm. Total macular volume (TMV) was also significantly reduced both after 3 weeks (10.2 ± 1.8 mm³, p < 0.05) and after 6 months (10.3 ± 2.0 mm³, p < 0.05) in comparison with the baseline values 11.9 ± 2.1 mm³. There were no significant differences in BCVA, CMT, and TMV between 3 weeks and 6 months posttreatment. Conclusion: One or two sessions of sequential PSTA injection and macular grid/focal photocoagulation

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Purpose: The objective of this study was to investigate the effectiveness of botulinum toxin A (BTX-A) injections in the treatment of acute esotropia resulting from complete acute abducens nerve palsy. Methods: Fifteen patients treated for complete acute abducens nerve palsy in our clinic were retrospectively reviewed. All patients who experienced an onset within 3 months and who were treated with early subtenon BTX-A injections at the ipsilateral medial rectus muscle without electromyography (EMG) guidance were included in this study. Responses and complications were recorded during a follow-up of at least 6 months. Results: Thirteen patients who had trauma and two patients who had brain tumor that caused their abducens nerve palsy were enrolled. Overall, six patients (40%) had full recovery and two patients (13%) had partial recovery, but the residual esotropia could be tolerated with prism correction in an average of 14.6 weeks. Seven patients (47%) received strabismus surgery afterward. Patients who did not respond well to early BTX-A injections at the 1-week interval were prone to subsequent surgical intervention (p = 0.026). Three eyes (20%) had transient subconjunctival hemorrhage following the subtenon space injection; no other complications were found after the treatment. Conclusion: BTX-A offers patients with complete abducens palsy a possible better chance to regain binocular vision and indicates whether additional surgical interventions are needed for these patients. We also discovered that the subtenon space injection of BTX-A without EMG guidance was a safe, time-saving, and simple technique.

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A 59-year-old Chinese female had been diagnosed with choroidal osteoma of the right eye when she was 36. At that time, the best corrected visual acuity was 6/6 but this decreased to 6/12 due to the rapid growth of choroidal osteoma within 10 months. She returned to our clinic 23 years later due to gradual decreased vision (2/60). Ocular examination disclosed spontaneous decalcification of the tumor leaving an area of depigmentation and atrophy of choriocapillaris in the previous osteoma. Time-domain optical coherence tomography showed marked thinning and absence of the inner segment/outer segment photoreceptor junction with irregular elevated retinal pigment epithelium. To sum up, choroidal osteoma is a benign intraocular tumor that can cause visual acuity loss due to retinal pigment epithelium atrophy and photoreceptor degeneration over the years.

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