months mean visual acuity improvement was 5.4 ETDRS
letters. Visual acuity at six months was stabilized or improved
in 89% of the eyes. Two (11%) of the 19 eyes had a
regression in visual acuity at six months compared with
preoperatively, although both eyes showed a visual im-
provement at three months. For all eyes, mean intraocular
pressure before injection was 15.6 (Ϯ 3.1) mm Hg, and at
six months postoperative 14.3 (Ϯ 2.9) mm Hg. We did not
observe intraocular pressures that exceeded 22 mm Hg in
any of the eyes during follow-up, and no antiglaucoma
medication was needed. Retreatment rate was 1.3 injec-
tions per eye after a mean period of 13.2 weeks. Macular
edema decreased in 13 eyes (69.4%) (Figure 2, Table). No
other adverse events, such as endophthalmitis, vitreous
hemorrhage, or retinal detachment occurred.
In summary, mean visual acuity improvement after intra-
vitreal prednisolone sodium succinate was statistically signif-
icant compared with preoperative visual acuity up to six
months postoperatively. Prednisolone sodium succinate
has glucocorticoid activity, but we encountered no signif-
icant increase in intraocular pressure and no other adverse
events in the small group of studied eyes during follow-up,
although no risk factors for glaucoma (i.e., family history,
myopia greater than 5 diopters, or a history of collagen
vascular disease) were present in any of the study patients.
Perhaps this may be attributable to the fact that, in
contrast with the crystalline cortisone of triamcinolone
acetonide, prednisolone sodium succinate is injected as a
transparent solution. Although the number of eyes in this
pilot study was limited, results suggest that intravitreal
injection of the transparent solution of prednisolone so-
dium succinate may be a safe and good alternative for
triamcinolone acetonide in eyes with macular edema.
Because the follow-up in this study was short, long-term
efﬁcacy of intravitreal prednisolone sodium succinate
needs further analysis.
1. Massin P, Audren F, Haouchine B, et al. Intravitreal triamcino-
lone acetonide for diabetic diffuse macular edema: preliminary
results of a prospective controlled trial. Ophthalmology 2004;
2. Jonas JB, Martus P, Degenring RF, et al. Predictive factors for
visual acuity after intravitreal triamcinolone treatment for dia-
betic macular edema. Arch Ophthalmol 2005;123:1338–1343.
3. Jonas JB, Degenring RF, Kreissig I, et al. Intraocular pressure
elevation after intravitreal triamcinolone acetonide injection.
4. Yu SY, Damico FM, Viola F, et al. Retinal toxicity of
intravitreal triamcinolone acetonide: a morphological study.
5. Sutter FK, Simpson JM, Gillies MC. Intravitreal triamcinolone
for diabetic macular edema that persists after laser treatment:
three-month efﬁcacy and safety results of a prospective, ran-
domized, double-masked, placebo-controlled clinical trial.
Ophthalmology 2004;111:2044 –2049.
A Comparison Between Cultivated
and Conventional Limbal Stem Cell
Transplantation for Stevens-Johnson
Leonard P. K. Ang, FRCS, MRCOphth,
Chie Sotozono, MD, PhD,
Noriko Koizumi, MD, PhD,
Tomo Suzuki, MD, PhD,
Tsutomu Inatomi, MD, PhD,
and Shigeru Kinoshita, MD, PhD
To compare the resolution of inﬂammation and
long-term results of cultivated and conventional limbal
stem cell transplantation (LSCT) in a patient with Stevens-
Johnson syndrome (SJS).
Interventional case report.
A 32-year-old man with SJS and bilateral total
limbal stem cell deﬁciency underwent cultivated LSCT in
the right eye, followed by conventional LSCT in the left
eye three weeks later. The postoperative medication
included dexamethasone 0.1% and oﬂoxacin 0.3% eye-
drops and a tapering dose of systemic corticosteroid,
cyclosporine, and cyclophosphamide. Tear samples were
collected and analyzed for interleukin (IL) 8 levels.
Complete corneal epithelialization was achieved
48 hours after cultivated LSCT, compared with three
Accepted for publication Jul 27, 2006.
From the Department of Ophthalmology, Kyoto Prefectural University
of Medicine, Kyoto, Japan (L.P.K.A., C.S., N.K., T.S., T.I., S.K.), and
Singapore National Eye Center, Singapore (L.P.K.A.).
Inquiries to Chie Sotozono, MD, PhD, Department of Ophthalmology,
Kyoto Prefectural University of Medicine, 465 kajii-cho, hirokoji-agaru,
kawaramachi-dori, kamigyo-ku, Kyoto, 602-0841, Japan; e-mail: csotozon@
TABLE. Intravitreal Prednisolone Sodium Succinate
Injections for Persistent Diabetic Macular Edema:
Qualitative (FAG) or Quantitative (OCT) Assessment of
CME at 3 Months, Whereupon the Decision to Re-treat
CME at 3 Months:
FAG or OCT
CME at 6 Months:
FAG or OCT
Worse 2 (10.5%) 3 (15.8%)
Stabile 3 (15.8%) 3 (15.8%)
Decreased 14 (73.7%) 13 (68.4%)
CME ϭ cystoid macular edema; FAG ϭ ﬂuorescein angiogra-
phy; OCT ϭ ocular coherence tomography.
Need for retreatment was based on ﬂuorescein angiographic
or OCT evidence of persisting (eg “worse or stabile”) macular
edema at 3-month follow-up. The pre- and posttreatment an-
giograms at 6 months were reviewed in a masked fashion.