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Objective To compare baseline characteristics and treatment response of participants with hemiretinal vein occlusion (HRVO) with those of participants with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the Standard Care vs COrticosteroid for REtinal Vein Occlusion (SCORE) Study. Methods Eyes were randomized to standard care, 1 mg intravitreal triamcinolone acetonide, or 4 mg intravitreal triamcinolone acetonide. Standard care was observation in the SCORE-CRVO trial and grid photocoagulation in the SCORE-BRVO trial. The HRVO eyes were enrolled in the SCORE-BRVO trial. Baseline characteristics, changes in visual acuity and center point thickness, safety outcomes, and number of treatments were compared among HRVO, BRVO, and CRVO participants. Results At baseline, HRVO eyes were intermediate between BRVO and CRVO eyes in area of retinal thickening, area of fluorescein leakage, visual acuity, and center point thickness. No differences in visual acuity change from baseline to 1 year were noted between standard care groups for HRVO and BRVO. Within triamcinolone-treated eyes, HRVO eyes did not differ from BRVO eyes in visual acuity change, but HRVO eyes fared better than CRVO eyes. There were no differences in center point thickness change between standard care groups for HRVO and BRVO, nor were there differences across the 3 disease entities for triamcinolone-treated eyes. There were no differences in frequency of protocol treatments and adverse events. Conclusions The HRVO participants were similar to BRVO and CRVO participants regarding most demographic characteristics, with fundus findings intermediate between BRVO and CRVO. In the SCORE Study, HRVO was treated as BRVO; HRVO eyes responded to treatment similarly to BRVO eyes, and there was no difference among the 3 disease entities in frequency of protocol treatments and adverse events. Trial Registration clinicaltrials.gov Identifier: NCT00105027

Objectives To determine whether there was a different response to vitrectomy and tap/biopsy with or without systemic antibiotic treatment in the Endophthalmitis Vitrectomy Study and whether the signs and symptoms of endophthalmitis differ between diabetic and nondiabetic patients. Design A multicenter clinical trial in which patients with acute post–cataract extraction endophthalmitis were randomly assigned in a 2 × 2 factorial design to vitrectomy or tap/biopsy, in each case with or without intravenous antibiotics, and followed up for 9 months. Outcome measures included visual acuity assessed in standardized fashion. Results Fifty-eight of 420 study patients had diabetes. Diabetic patients had slightly worse vision and ocular media at the baseline assessment. Only 39% of diabetic patients compared with 55% of nondiabetic patients achieved 20/40 final vision. Both diabetic and nondiabetic patients with initial light perception(LP)-only vision had better visual results with immediate vitrectomy. For those with better than LP baseline vision, patients with diabetes achieved visual acuity of 20/40 more often with vitrectomy (57%) than with tap/biopsy(40%), but this difference was not statistically significant. Patients without diabetes did equally well with vitrectomy or tap/biopsy. Conclusions For patients with better than LP vision, tap/biopsy is appropriate for those without diabetes. A clinical trial of a sufficient number of diabetic patients with better than LP vision is necessary to determine the best management for this group. At present, initial vitrectomy or tap/biopsy are reasonable approaches for diabetic patients with better than LP vision.

In Reply. —We thank Drs Haimann, Weiss, and Miller for their interest in the reasons for specific antibiotic choices in the Endophthalmitis Vitrectomy Study (EVS). Several considerations are important in choosing antimicrobial agents for endophthalmitis. To select the drugs for intravitreal administration, one must weigh the toxicity of the drug in the eye, the ability to achieve bactericidal levels, the antibacterial spectrum, and the drug's half-life. However, for systemically administered antibiotics, one must also consider the systemic toxicity of the drug and the degree to which it penetrates into the vitreous cavity. Even when the antibacterial spectrum is excellent, if a drug administered systemically does not penetrate the vitreous cavity it will be of little benefit in treating endophthalmitis. There is currently broad consensus that the intravitreal drugs of choice in the initial treatment of postsurgical endophthalmitis should be amikacin and vancomycin. Amikacin provides a broad spectrum extending to gram-negative

Recently, concern has been expressed regarding the choice of amikacin sulfate as the companion drug to vancomycin hydrochloride for intravitreal injection in the initial treatment of patients with postoperative endophthalmitis. 1 The concern arises because of reports suggesting that amikacin may cause macular infarction. It has been recommended that ceftazidime be used in its place. Because of these reports, investigators and consultants of the Endophthalmitis Vitrectomy Study (EVS), sponsored by the National Eye Institute, reviewed their choice of antibiotics for intravitreous injection in the treatment of postoperative endophthalmitis. In vitro, both amikacin and ceftazidime are highly active against gram-negative bacilli, and few strains are resistant. Data from a retrospective series of cases of endophthalmitis caused by gram-negative bacilli showed one of 35 strains resistant to amikacin and none to ceftazidime. 2 So far, in the EVS, three of 21 isolates were resistant to ceftazidime and two to amikacin. Based on

• This study compares the efficacy of cyclosporine and corticosteroids in the treatment of retina S antigen-induced uveitis (experimental autoimmune uveitis). Forty guinea pigs were immunized with retina S antigen in complete Freund's adjuvant to induce uveitis. After 16 days, animals were divided into groups that received a two-week course of daily intramuscular injections of cyclosporine, corticosteroids, both drugs, or saline. Eyes were graded by a masked retinal specialist for amount of vitreous cells by biomicroscopy, and after enucleation by a masked ocular pathologist for histologic evidence of inflammation. Clinically and histopathologically, animals treated with cyclosporine, or cyclosporine and corticosteroids, had statistically significant reduction of intraocular inflammation compared with controls. Corticosteroids alone had a less beneficial effect. The combined use of cyclosporine and corticosteroids, at the single dose tested, did not demonstrate synergism.