- Email: [email protected]
Photodynamic therapy for retinal angiomatous proliferations and pigment epithelium detachment
tures or as a cystic mass. A wound fistula with vascularization along the wound tract are factors that promote downgrowth.1 Epithelial downgrowth following glaucoma surgery has been reported to occur into the bleb cavity surrounding glaucoma drainage device (GDD) plates2,3 and into the anterior chamber,4 presumably as a result of epithelial cells carried by the GDD tube into the chamber. In the few reported cases of downgrowth following GDD surgery all patients had a history of previous ocular surgeries (cataract, scleral buckle, strabismus) that cannot be excluded as the source of downgrowth. Despite numerous manipulations of the Ahmed valve and its track in our patient, the epithelial inclusion cyst appears to have originated from the temporal clear-corneal stab incision, created for goniotomy, following removal of a limbal suture. The cyst’s apparent resolution after cryotherapy to the temporal limbus also supports this conclusion, although epithelial ingrowth associated with the Ahmed valve cannot be definitively excluded. This is the first reported case of an epithelial inclusion cyst following glaucoma surgery in a child, and this rare, potentially sight-threatening complication should be considered when discussing possible complications of surgery for glaucoma in children. REFERENCES
1. Vargas LG, Vroman DT, Solomon KD, et al. Epithelial downgrowth after clear cornea phacoemulsification: report of two cases and review of the literature. Ophthalmology 2002; 109:2331–2335. 2. Sidoti PA, Minckler DS, Baerveldt G, Lee PP, Heuer DK. Epithelial ingrowth and glaucoma drainage implants. Ophthalmology 1994;101:872– 875. 3. Rhee DJ, Casuso LA, Rosa RH, Budenz DL. Motility disturbance due to true tenon cyst in a child with a Baerveldt glaucoma drainage implant. Arch Ophthalmol 2001;119:440 – 442. 4. Jewelewicz DA, Rosenfeld SI, Litinsky SM. Epithelial downgrowth following insertion of an Ahmed glaucoma implant. Arch Ophthalmol 2003;121:285–286.
Photodynamic Therapy for Retinal Angiomatous Proliferations and Pigment Epithelium Detachment Francesco Boscia, MD, Claudio Furino, MD, Luigi Sborgia, MD, Michele Reibaldi, MD, and Carlo Sborgia, MD PURPOSE: To evaluate results of photodynamic therapy (PDT) with verteporfin for subfoveal neovascular ageAccepted for publication June 21, 2004. From the Dipartimento di Oftalmologia ed Otorinolaringoiatria, Università di Bari, Bari, Italy. Presented in part as a paper at the American Academy of Ophthalmology Annual Meeting, Anaheim, California, November 15 to 18, 2003. Inquiries to Francesco Boscia, MD, Dipartimento di Oftalmologia ed Otorinolaringoiatria, Università di Bari, Piazza Giulio Cesare, 11, Bari, Italy; fax: ⫹39-080-5478918; e-mail: [email protected]
VOL. 138, NO. 6
related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) and pigment epithelial detachment (PED). DESIGN: Interventional case series. METHODS: Thirteen eyes (11 stage 2 and 2 stage 3 RAP) underwent PDT. Best-corrected visual acuity (BCVA), fluorescein and indocyanine-green angiography were performed to evaluate the outcome. RESULTS: After 13.5 ⴞ 2.5 months and 1.7 ⴞ 0.4 treatments, mean BCVA decreased from 20/73 to 20/174 (P ⴝ .04). Occlusion of RAP and flattening of PED was observed in three eyes, and persistence of PED in six. Two eyes deteriorated to disciform lesions, one developed hemorrhagic PED, and one evolved toward stage 3 RAP. Three eyes, with PED exceeding 50% of the entire lesion, developed retinal pigment epithelium tear. CONCLUSIONS: PDT might prove effective for neovascular ARMD with RAP and small PED, whereas it might cause acute retinal pigment epithelium tear for RAP with PED exceeding 50% of the lesion. (Am J Ophthalmol 2004;138:1077–1079. © 2004 by Elsevier Inc. All rights reserved.)
N
EOVASCULAR AGE-RELATED MACULAR DEGENERA-
tion (ARMD) with retinal angioumatous proliferation (RAP) has a poor natural history and the efficacy of any treatment has not yet been established. We undertook the present prospective interventional case series study to assess whether photodynamic therapy (PDT) might be effective for treating these patients. Patients data are summarized in Table 1. Thirteen eyes of 12 consecutive caucasian patients (age: 74.3 ⫾ 7.1 year) with ARMD and RAP stage 2 (11 eyes) or stage 3 (2 eyes) and best corrected visual acuity (BCVA) ⱖ20/200, with documented vision loss, underwent PDT with verteporfin. Best-corrected visual acuity, fluorescein angiography, and indocyanine green angiography (ICG-A) were performed pre and postoperatively to evaluate lesion size, results of PDT, need of retreatment, and complications. Any hypofluorescent area attributable to blood or serous pigment epithelium detachment (PED) contiguous with RAP was considered part of the greatest linear dimension (GLD) of the lesion. Mean GLD at baseline was 3784 ⫾ 1053. After 13.5 ⫾ 2.5 months, and 1.7 ⫾ 0.4 treatments (range:1 to 2), mean BCVA decreased (P ⫽ .04) from 20/73 to a final value of 20/174. In five eyes (38.5%) BCVA remained stable, whereas in eight eyes (61.5%) decreased. Occlusion of RAP and flattening of PED was observed in three eyes (23%) with smaller lesions, conversion to disciform lesion in two and reperfusion of RAP with persistence of PED in six (46.1%). Two eyes (15.4%) deteriorated to disciform lesions, one (7.7%) developed hemorrhagic PED, and one (7.7%) evolved toward stage 3 RAP. A tear of retinal pigment epithe-
BRIEF REPORTS
1077
1078 TABLE 1. Clinical Characteristics Of Patients Undergoing Photodynamic Therapy for Retinal Angiomatous Proliferation
Age/Gender/History
Eye
Preop BCVA†
Postop BCVA†
1
72/M/COAD-GC
OD
0,94
2
2*
79/M/DM-BP-CC
3
67/M/HT
OD OS OS
0,2 0,84 0,3
4
59/M
OS
5 6 7 8 9 10 11 12
77/F 67/F/BP 77/F/IHD 82/F/BP 81/M/DM 72/F/BP - HT 82/F/BP-CC 77/F/BP
OS OD OD OD OD OD OS OD
Case
Initial Status
Fellow Eye
Initial Lesion Size ()
AMERICAN JOURNAL OF
OPHTHALMOLOGY
RAP-PED
ARMD
3900
0,5 1,48 1
RAP-PED RAP-PED RAP-PED-CNV
RAP-PED RAP-PED ARMD
5300 5600 4600
0,4
1,4
RAP-PED-CNV
Disciform lesion
3300
0,3 0,5 1 0,6 1 0,2 0,14 0,92 0.56 ⫾ 0.3 20/73
0,3 0,5 1 0,6 1 0,2 0,8 1 0.94* ⫾ 0.5 20/174 (P ⫽ .04)
RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED
Disciform lesion RAP Enucleated G-RAP laser Disciform lesion RAP Disciform lesion ARMD Disciform lesion RAP ARMD
4200 3600 4200 2500 2000 2600 3400 4000 3784 ⫾ 1053
Anatomic—FA Outcome
Disciform lesion—moderate RPE tear—moderate RPE tear—moderate Hemorrhagic PED— progression RPE tear—disciform lesion—moderate RAP-PED—progression No leakage RAP-PED-CNV—progression No leakage No leakage RAP-PED—moderate RAP-PED—progression RAP-PED—progression
No of PDT
Follow Up (Months)
2
9
1 2 2
10 11 13
2
13
2 2 2 2 1 2 2 1 1.7 ⫾ 0.4
10 9 6 11 5 9 10 7 9.4 ⫾ 2.4
BCVA ⫽ best-corrected visual acuity; CF ⫽ counting fingers; HM ⫽ hand movements; OD ⫽ right eye; OS ⫽ left eye; DM ⫽ diabetes mellitus; BP ⫽ hypertension; HT ⫽ hypotyroidism; ARMD ⫽ age-related macular degeneration; IHD ⫽ ischemic hearth disease; FA ⫽ fluorescein angiography. *Both eyes treated. † Log MAR.
DECEMBER 2004
lium was observed in three eyes (23%) with PED exceeding 50% of the entire lesion, within the first week after treatment. We did not observe foveal phototoxic injury or other adverse event. In RAP stage 2 and 3, thermal laser photocoagulation showed a low success rate,1 and transpupillary thermotherapy induced a rapidly progressive scar formation,2 while surgical ablation achieved good outcome, in a small number of patients with short follow-up.3 Lesions with RAP often present with PED exceeding 50% of the entire lesion, and were not included in Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study groups.4 In our series, in cases with small PED, PDT determined a beneficial effect on vision. In cases with PED exceeding 50% of the entire lesion, PDT did not alter the course of the disease, with most of the eyes undergoing enlargement, disciform transformation or retinal pigment epithelium tear. Retinal pigment epithelial tears after PDT for choroidal neovascularization (CNV) seems related to the contractile forces of regressing CNV.5 The high rate of retinal pigment epithelium tear (3/13, 23%) we observed might be explained by fluid extravasation as a result of the simultaneous damage to choroidal and retinal vessels, secondary to PDT. The connection of retinal vessels with the retinal pigment epithelium in the subretinal space might direct a rapid influx of fluid inside the PED, determining its rupture. In large lesions, with PED exceeding 50% of the entire lesion, treating a smaller area, as the hot spot identified in late phases of ICG-A, or combining PDT with intravitreal triamcinolone may be a way to avoid complications and improve the outcome. However, further trials are required to address the efficacy and safety of PDT for RAP with PED. REFERENCES
1. Kuhn D, Meunier I, Soubrane G, Coscas G. Imaging of chorioretinal anastomoses in vascularized retinal pigment epithelium detachments. Arch Ophthalmol 1995;113:1392– 1398. 2. Kuroiwa S, Arai J, Gaun S, et al. Rapidly progressive scar formation after transpupillary thermotherapy in retinal angiomatous proliferation. Retina 2003;23:417– 420. 3. Borrillo JL, Sivalingam A, Martidis A, Federman J. Surgical ablation of retinal angiomatous proliferation. Arch Ophthalmol 2003;121:558 –561. 4. Yannuzzi LA, Negrao S, Iida T, Carlalho C, et al. Retinal angiomatous proliferation in age-related macular degeneration. Retina 2001;21:416 – 434. 5. Gelisken F, Inhoffen W, Partsch M, et al. Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. Am J Ophthalmol 2001;131: 518 –520.
VOL. 138, NO. 6
Multiple Components of Epiretinal Tissues Detected by Triamcinolone and Indocyanine Green in Macular Hole and Retinal Detachment as a Result of High Myopia Hirokazu Sakaguchi, MD, Yasushi Ikuno, MD, Jun-Sub Choi, PhD, Masahito Ohji, MD, and Tasuo Tano, MD PURPOSE: To examine three layers of membranes detected by triamcinolone acetonide (TA) and indocyanine green (ICG) during surgery for macular hole and retinal detachment (MHRD) as a result of high myopia. DESIGN: Histologic study. METHODS: We excised three layers of membranes visualized with TA and ICG that were tightly adhering to the retinal surface during vitrectomy and examined them by transmission electron microscopy. RESULTS: The first membrane was made of acellular collagen fibers, suggestive of vitreous, and the second was comprised of parts of fibroblast-like cells and collagen fibrils, suggesting a proliferative epiretinal membrane. The third membrane was an internal limiting membrane. CONCLUSIONS: Multiple components of epiretinal tissue could be delaminated with the assistance of TA and ICG during surgery for myopic MHRD. (Am J Ophthalmol 2004;138:1079 –1081. © 2004 by Elsevier Inc. All rights reserved.)
R
EMOVING THE EPIRETINAL MEMBRANE (ERM) TO
treat macular hole and retinal detachment (MHRD) in high myopia is beneficial.1 Triamcinolone acetonide (TA) can help visualize the vitreous during vitrectomy, and we often encounter multiple membranes of unknown origin adhering to the retinal surface in MHRD. We excised three layers of membranes intraoperatively from the macular area in myopic MHRD and examined them under transmission electron microscopy (TEM). A 73-year-old woman had MHRD OS with high myopia (Figure 1A). The best-corrected visual acuity (BCVA) was 6/200. She had a history of bilateral cataract surgeries. She underwent a three-port vitrectomy OS. After core vitrectomy, we injected 0.4 mg of TA (Kenacort-A, Bristol-Myers Squibb, New York, New York) above the macular area after preparation.2 After flushing the excess TA, we identified a thin membrane Accepted for publication June 22, 2004. From the Osaka University Medical School, Department of Ophthalmology, Osaka, Japan. Inquiries to Hirokazu Sakaguchi, MD, Osaka University Medical School, Department of Ophthalmology, 2-2, E-7 Yamadaoka, Suita, Osaka 565-0871, Japan; fax: 81-6-6879-3458; e-mail: sakaguh@ ophthal.med.osaka-u.ac.jp
BRIEF REPORTS
1079
1. Vargas LG, Vroman DT, Solomon KD, et al. Epithelial downgrowth after clear cornea phacoemulsification: report of two cases and review of the literature. Ophthalmology 2002; 109:2331–2335. 2. Sidoti PA, Minckler DS, Baerveldt G, Lee PP, Heuer DK. Epithelial ingrowth and glaucoma drainage implants. Ophthalmology 1994;101:872– 875. 3. Rhee DJ, Casuso LA, Rosa RH, Budenz DL. Motility disturbance due to true tenon cyst in a child with a Baerveldt glaucoma drainage implant. Arch Ophthalmol 2001;119:440 – 442. 4. Jewelewicz DA, Rosenfeld SI, Litinsky SM. Epithelial downgrowth following insertion of an Ahmed glaucoma implant. Arch Ophthalmol 2003;121:285–286.
Photodynamic Therapy for Retinal Angiomatous Proliferations and Pigment Epithelium Detachment Francesco Boscia, MD, Claudio Furino, MD, Luigi Sborgia, MD, Michele Reibaldi, MD, and Carlo Sborgia, MD PURPOSE: To evaluate results of photodynamic therapy (PDT) with verteporfin for subfoveal neovascular ageAccepted for publication June 21, 2004. From the Dipartimento di Oftalmologia ed Otorinolaringoiatria, Università di Bari, Bari, Italy. Presented in part as a paper at the American Academy of Ophthalmology Annual Meeting, Anaheim, California, November 15 to 18, 2003. Inquiries to Francesco Boscia, MD, Dipartimento di Oftalmologia ed Otorinolaringoiatria, Università di Bari, Piazza Giulio Cesare, 11, Bari, Italy; fax: ⫹39-080-5478918; e-mail: [email protected]
VOL. 138, NO. 6
related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) and pigment epithelial detachment (PED). DESIGN: Interventional case series. METHODS: Thirteen eyes (11 stage 2 and 2 stage 3 RAP) underwent PDT. Best-corrected visual acuity (BCVA), fluorescein and indocyanine-green angiography were performed to evaluate the outcome. RESULTS: After 13.5 ⴞ 2.5 months and 1.7 ⴞ 0.4 treatments, mean BCVA decreased from 20/73 to 20/174 (P ⴝ .04). Occlusion of RAP and flattening of PED was observed in three eyes, and persistence of PED in six. Two eyes deteriorated to disciform lesions, one developed hemorrhagic PED, and one evolved toward stage 3 RAP. Three eyes, with PED exceeding 50% of the entire lesion, developed retinal pigment epithelium tear. CONCLUSIONS: PDT might prove effective for neovascular ARMD with RAP and small PED, whereas it might cause acute retinal pigment epithelium tear for RAP with PED exceeding 50% of the lesion. (Am J Ophthalmol 2004;138:1077–1079. © 2004 by Elsevier Inc. All rights reserved.)
N
EOVASCULAR AGE-RELATED MACULAR DEGENERA-
tion (ARMD) with retinal angioumatous proliferation (RAP) has a poor natural history and the efficacy of any treatment has not yet been established. We undertook the present prospective interventional case series study to assess whether photodynamic therapy (PDT) might be effective for treating these patients. Patients data are summarized in Table 1. Thirteen eyes of 12 consecutive caucasian patients (age: 74.3 ⫾ 7.1 year) with ARMD and RAP stage 2 (11 eyes) or stage 3 (2 eyes) and best corrected visual acuity (BCVA) ⱖ20/200, with documented vision loss, underwent PDT with verteporfin. Best-corrected visual acuity, fluorescein angiography, and indocyanine green angiography (ICG-A) were performed pre and postoperatively to evaluate lesion size, results of PDT, need of retreatment, and complications. Any hypofluorescent area attributable to blood or serous pigment epithelium detachment (PED) contiguous with RAP was considered part of the greatest linear dimension (GLD) of the lesion. Mean GLD at baseline was 3784 ⫾ 1053. After 13.5 ⫾ 2.5 months, and 1.7 ⫾ 0.4 treatments (range:1 to 2), mean BCVA decreased (P ⫽ .04) from 20/73 to a final value of 20/174. In five eyes (38.5%) BCVA remained stable, whereas in eight eyes (61.5%) decreased. Occlusion of RAP and flattening of PED was observed in three eyes (23%) with smaller lesions, conversion to disciform lesion in two and reperfusion of RAP with persistence of PED in six (46.1%). Two eyes (15.4%) deteriorated to disciform lesions, one (7.7%) developed hemorrhagic PED, and one (7.7%) evolved toward stage 3 RAP. A tear of retinal pigment epithe-
BRIEF REPORTS
1077
1078 TABLE 1. Clinical Characteristics Of Patients Undergoing Photodynamic Therapy for Retinal Angiomatous Proliferation
Age/Gender/History
Eye
Preop BCVA†
Postop BCVA†
1
72/M/COAD-GC
OD
0,94
2
2*
79/M/DM-BP-CC
3
67/M/HT
OD OS OS
0,2 0,84 0,3
4
59/M
OS
5 6 7 8 9 10 11 12
77/F 67/F/BP 77/F/IHD 82/F/BP 81/M/DM 72/F/BP - HT 82/F/BP-CC 77/F/BP
OS OD OD OD OD OD OS OD
Case
Initial Status
Fellow Eye
Initial Lesion Size ()
AMERICAN JOURNAL OF
OPHTHALMOLOGY
RAP-PED
ARMD
3900
0,5 1,48 1
RAP-PED RAP-PED RAP-PED-CNV
RAP-PED RAP-PED ARMD
5300 5600 4600
0,4
1,4
RAP-PED-CNV
Disciform lesion
3300
0,3 0,5 1 0,6 1 0,2 0,14 0,92 0.56 ⫾ 0.3 20/73
0,3 0,5 1 0,6 1 0,2 0,8 1 0.94* ⫾ 0.5 20/174 (P ⫽ .04)
RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED RAP-PED
Disciform lesion RAP Enucleated G-RAP laser Disciform lesion RAP Disciform lesion ARMD Disciform lesion RAP ARMD
4200 3600 4200 2500 2000 2600 3400 4000 3784 ⫾ 1053
Anatomic—FA Outcome
Disciform lesion—moderate RPE tear—moderate RPE tear—moderate Hemorrhagic PED— progression RPE tear—disciform lesion—moderate RAP-PED—progression No leakage RAP-PED-CNV—progression No leakage No leakage RAP-PED—moderate RAP-PED—progression RAP-PED—progression
No of PDT
Follow Up (Months)
2
9
1 2 2
10 11 13
2
13
2 2 2 2 1 2 2 1 1.7 ⫾ 0.4
10 9 6 11 5 9 10 7 9.4 ⫾ 2.4
BCVA ⫽ best-corrected visual acuity; CF ⫽ counting fingers; HM ⫽ hand movements; OD ⫽ right eye; OS ⫽ left eye; DM ⫽ diabetes mellitus; BP ⫽ hypertension; HT ⫽ hypotyroidism; ARMD ⫽ age-related macular degeneration; IHD ⫽ ischemic hearth disease; FA ⫽ fluorescein angiography. *Both eyes treated. † Log MAR.
DECEMBER 2004
lium was observed in three eyes (23%) with PED exceeding 50% of the entire lesion, within the first week after treatment. We did not observe foveal phototoxic injury or other adverse event. In RAP stage 2 and 3, thermal laser photocoagulation showed a low success rate,1 and transpupillary thermotherapy induced a rapidly progressive scar formation,2 while surgical ablation achieved good outcome, in a small number of patients with short follow-up.3 Lesions with RAP often present with PED exceeding 50% of the entire lesion, and were not included in Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) and Verteporfin in Photodynamic Therapy (VIP) study groups.4 In our series, in cases with small PED, PDT determined a beneficial effect on vision. In cases with PED exceeding 50% of the entire lesion, PDT did not alter the course of the disease, with most of the eyes undergoing enlargement, disciform transformation or retinal pigment epithelium tear. Retinal pigment epithelial tears after PDT for choroidal neovascularization (CNV) seems related to the contractile forces of regressing CNV.5 The high rate of retinal pigment epithelium tear (3/13, 23%) we observed might be explained by fluid extravasation as a result of the simultaneous damage to choroidal and retinal vessels, secondary to PDT. The connection of retinal vessels with the retinal pigment epithelium in the subretinal space might direct a rapid influx of fluid inside the PED, determining its rupture. In large lesions, with PED exceeding 50% of the entire lesion, treating a smaller area, as the hot spot identified in late phases of ICG-A, or combining PDT with intravitreal triamcinolone may be a way to avoid complications and improve the outcome. However, further trials are required to address the efficacy and safety of PDT for RAP with PED. REFERENCES
1. Kuhn D, Meunier I, Soubrane G, Coscas G. Imaging of chorioretinal anastomoses in vascularized retinal pigment epithelium detachments. Arch Ophthalmol 1995;113:1392– 1398. 2. Kuroiwa S, Arai J, Gaun S, et al. Rapidly progressive scar formation after transpupillary thermotherapy in retinal angiomatous proliferation. Retina 2003;23:417– 420. 3. Borrillo JL, Sivalingam A, Martidis A, Federman J. Surgical ablation of retinal angiomatous proliferation. Arch Ophthalmol 2003;121:558 –561. 4. Yannuzzi LA, Negrao S, Iida T, Carlalho C, et al. Retinal angiomatous proliferation in age-related macular degeneration. Retina 2001;21:416 – 434. 5. Gelisken F, Inhoffen W, Partsch M, et al. Retinal pigment epithelial tear after photodynamic therapy for choroidal neovascularization. Am J Ophthalmol 2001;131: 518 –520.
VOL. 138, NO. 6
Multiple Components of Epiretinal Tissues Detected by Triamcinolone and Indocyanine Green in Macular Hole and Retinal Detachment as a Result of High Myopia Hirokazu Sakaguchi, MD, Yasushi Ikuno, MD, Jun-Sub Choi, PhD, Masahito Ohji, MD, and Tasuo Tano, MD PURPOSE: To examine three layers of membranes detected by triamcinolone acetonide (TA) and indocyanine green (ICG) during surgery for macular hole and retinal detachment (MHRD) as a result of high myopia. DESIGN: Histologic study. METHODS: We excised three layers of membranes visualized with TA and ICG that were tightly adhering to the retinal surface during vitrectomy and examined them by transmission electron microscopy. RESULTS: The first membrane was made of acellular collagen fibers, suggestive of vitreous, and the second was comprised of parts of fibroblast-like cells and collagen fibrils, suggesting a proliferative epiretinal membrane. The third membrane was an internal limiting membrane. CONCLUSIONS: Multiple components of epiretinal tissue could be delaminated with the assistance of TA and ICG during surgery for myopic MHRD. (Am J Ophthalmol 2004;138:1079 –1081. © 2004 by Elsevier Inc. All rights reserved.)
R
EMOVING THE EPIRETINAL MEMBRANE (ERM) TO
treat macular hole and retinal detachment (MHRD) in high myopia is beneficial.1 Triamcinolone acetonide (TA) can help visualize the vitreous during vitrectomy, and we often encounter multiple membranes of unknown origin adhering to the retinal surface in MHRD. We excised three layers of membranes intraoperatively from the macular area in myopic MHRD and examined them under transmission electron microscopy (TEM). A 73-year-old woman had MHRD OS with high myopia (Figure 1A). The best-corrected visual acuity (BCVA) was 6/200. She had a history of bilateral cataract surgeries. She underwent a three-port vitrectomy OS. After core vitrectomy, we injected 0.4 mg of TA (Kenacort-A, Bristol-Myers Squibb, New York, New York) above the macular area after preparation.2 After flushing the excess TA, we identified a thin membrane Accepted for publication June 22, 2004. From the Osaka University Medical School, Department of Ophthalmology, Osaka, Japan. Inquiries to Hirokazu Sakaguchi, MD, Osaka University Medical School, Department of Ophthalmology, 2-2, E-7 Yamadaoka, Suita, Osaka 565-0871, Japan; fax: 81-6-6879-3458; e-mail: sakaguh@ ophthal.med.osaka-u.ac.jp
BRIEF REPORTS
1079