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Purpose: To examine retinal nerve fiber layer (RNFL) changes after intravitreal injection of bevacizumab in patients with or without underlying glaucoma. Methods: A total of 104 eyes of 104 patients with retinal disease undergoing intravitreal injection of bevacizumab were prospectively investigated. Bevacizumab injections (1.25/0.05 mg/mL) were performed using a standardized technique. In the patient who had pretreatment with intraocular pressure (IOP)-lowering medication, 1 drop of brimonidine was instilled 30 minutes before the injection. Before and after the intravitreal injections, the patients were monitored for IOP and evaluated with optical coherence tomography using Stratus at least 3 months after the injection. Results: Thirty minutes after injection, 6.4% of patients had an IOP over 30 mm Hg in the non-pretreatment group while no patient had an IOP over 30 mm Hg in the pretreatment group. In eyes with only retinal diseases, the RNFL thickness did not change significantly after the injection regardless of pretreatment, whereas in eyes with underlying glaucomatous damage and no pretreatment, significant decrease in RNFL thickness was observed at the superior (p = 0.036) and temporal (p = 0.048) sectors of the optic nerve head without pretreatment. Conclusions: Intravitreal injection of bevacizumab did not typically cause significant changes in RNFL thickness; however, in eyes with underlying glaucoma without pretreatment, a significant decrease in RNFL thickness was observed in the superior and temporal sectors of the optic nerve head. Therefore, applying IOP-lowering pretreatment medication before intravitreal injection of bevacizumab is required for protection of RNFL in glaucoma patients. J Korean Ophthalmol Soc 2014;55(5):693-701

Purpose: The effect of suture presence or position of intraocular lens was evaluated on the astigmatic changes in cataract patients suffering from with-the-rule astigmatism who underwent temporal clear corneal incision cataract surgeries. Methods: According to the presence or absence of suture and the lens position (either 180˚ or 90˚), 49 eyes of 47 patients were divided into four groups. Astigmatism was determined using an autorefractor and by topography before surgery, and at one day, one week, one month, and two months after surgery. Results: The suture group showed significant reduction in astigmatism at postoperative day 1 and week 1 by autorefractor and topography compared with the non-suture group. The group with intraocular lens insertion axis at 180˚ did not show significant reduction of astigmatism by autorefractor evaluation. Astigmatism determination by topography in this group was 1.00±0.73D, 1.01±0.77D and 1.01±0.81D at postoperative week 1, month 1, and month 2, respectively, and this showed significant reduction of astigmatism compared with preoperative astigmatism (1.32±1.17D) and group with intraocular lens insertion axis at 90˚. In particular, the group with the sutured temporal incision and with an inserted intraocular lens axis at 180˚ showed significant reduction of astigmatism by autorefraction. Conclusions: When performing cataract surgery in with-the-rule astigmatism patients, suturing the temporal incision and inserting the intraocular lens axis at 180˚ can reduce astigmatism and minimize the effect of surgically-induced astigmatism.

Purpose: To report a case of bilateral adrenal gland lymphoma mimicking symptoms of Vogt-Koyanagi- Harada syndrome. Case summary: A 57-year-old woman complained of decreased visual acuity and metamorphopsia in both eyes. She had no prior medical history, but had experienced headaches in the past week. Fundus examination revealed multiple serous retinal detachment. Fluorescein angiography of the fundus revealed multiple pinpoint leaks in early stages and subretinal dye pooling in the retinal detachment area in late stages. The most likely diagnosis was therefore Vogt-Koyanagi-Harada syndrome. Two days later, mild fever developed and a systemic evaluation was performed. Computed tomography of chest and abdomen showed bilateral adrenal gland T-cell lymphoma. Through prompt combination chemotherapy, the patient’s systemic condition recovered, and her fundus recovered with improved visual acuity. Conclusions: We experienced a rare case of bilateral adrenal lymphoma which masqueraded as Vogt-Koyanagi- Harada syndrome. When there are systemic symptoms such as mild fever and headaches, systemic evaluation should be done so as not to miss more serious systemic pathology.