Angle-closure Attack after Retinal Pigment Epithelium Double-tear and Hemorrhagic Retinal Detachment in Exudative Macular Degeneration

Purpose@#To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED).Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient’s intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition. @*Conclusions@#It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.

Angle-closure Attack after Retinal Pigment Epithelium Double-tear and Hemorrhagic Retinal Detachment in Exudative Macular Degeneration

Purpose@#To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED).Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient’s intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition. @*Conclusions@#It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.

Disorganization of Retinal Inner Layers in Diabetic Macular Edema Treated with a Dexamethasone Implant

Purpose@#To evaluate the correlation between visual acuity (VA) and the disorganization of retinal inner layers (DRIL) after use of an intravitreal dexamethasone implant to treat diabetic macular edema (DME). @*Methods@#The clinical records of 25 patients with DME treated with an intravitreal dexamethasone implant were reviewed. Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography data were analyzed from each visit. @*Results@#The BCVAs at 1 month and 3 months after treatment were statistically significant with respect to the baseline BCVA of DME patients (p = 0.021, p < 0.001, respectively); however no statistically significant change was evident at the 6 months follow-up (p = 0.062). Also, the DRIL degree at 1 month and 3 months after treatment was statistically significant with respect to baseline DRIL (p = 0.034, p < 0.001); however, there was no statistically significant change at 6 months after treatment (p = 0.052). The BCVA at 6 months after treatment was positively and significantly correlated with the baseline BCVA (p < 0.001, R2 = 0.705), CRT (p = 0.032, R2 = 0.308), and DRIL extent (p = 0.024, R2 = 0.201). @*Conclusions@#The BCVA in patients after treatment with an intravitreal dexamethasone implant for DME was related to the change in the CRT after treatment. The baseline BCVA and change in the DRIL may be important indicators for predicting VA improvement in DME.

Bacterial Bacterial Culture and Clinical Characteristics of Infectious Endophthalmitis in Western Gyeongsangnam-do

Purpose@#To investigate the bacterial culture, clinical characteristics, and prognosis associated with infectious endophthalmitis in western Gyeongsangnam-do. @*Methods@#This study was a retrospective review of the medical records of 98 eyes that presented with infectious endophthalmitis from 2010 to 2019. All patients were analyzed for the type of causative bacteria, treatment method, and the visual prognosis. @*Results@#The bacterial cultures (n = 98 eyes) revealed bacterial growth in 67 eyes (68.4%). The most commonly isolated causative microorganism was Gram-positive Staphylococcus epidermidis (14.3%). As a result of analyzing the best corrected visual acuity (VA) based on 1.0 (logMAR), baseline VA was worse than counting fingers, and whether pars plana vitrectomy was undertaken showed a difference in the final visual acuity (p < 0.001, p = 0.021). @*Conclusions@#Exogenous endophthalmitis occurs frequently after cataract surgery, and S. epidermidis is the most common causative agent, but a good visual prognosis resulted. Liver abscess was a common extraocular source of endogenous endophthalmitis and Klebsiella pneumonia was the most common causative agent for a poor visual prognosis.

Disorganization of Retinal Inner Layers in Diabetic Macular Edema Treated with a Dexamethasone Implant

Purpose@#To evaluate the correlation between visual acuity (VA) and the disorganization of retinal inner layers (DRIL) after use of an intravitreal dexamethasone implant to treat diabetic macular edema (DME). @*Methods@#The clinical records of 25 patients with DME treated with an intravitreal dexamethasone implant were reviewed. Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography data were analyzed from each visit. @*Results@#The BCVAs at 1 month and 3 months after treatment were statistically significant with respect to the baseline BCVA of DME patients (p = 0.021, p < 0.001, respectively); however no statistically significant change was evident at the 6 months follow-up (p = 0.062). Also, the DRIL degree at 1 month and 3 months after treatment was statistically significant with respect to baseline DRIL (p = 0.034, p < 0.001); however, there was no statistically significant change at 6 months after treatment (p = 0.052). The BCVA at 6 months after treatment was positively and significantly correlated with the baseline BCVA (p < 0.001, R2 = 0.705), CRT (p = 0.032, R2 = 0.308), and DRIL extent (p = 0.024, R2 = 0.201). @*Conclusions@#The BCVA in patients after treatment with an intravitreal dexamethasone implant for DME was related to the change in the CRT after treatment. The baseline BCVA and change in the DRIL may be important indicators for predicting VA improvement in DME.

Bacterial Bacterial Culture and Clinical Characteristics of Infectious Endophthalmitis in Western Gyeongsangnam-do

Purpose@#To investigate the bacterial culture, clinical characteristics, and prognosis associated with infectious endophthalmitis in western Gyeongsangnam-do. @*Methods@#This study was a retrospective review of the medical records of 98 eyes that presented with infectious endophthalmitis from 2010 to 2019. All patients were analyzed for the type of causative bacteria, treatment method, and the visual prognosis. @*Results@#The bacterial cultures (n = 98 eyes) revealed bacterial growth in 67 eyes (68.4%). The most commonly isolated causative microorganism was Gram-positive Staphylococcus epidermidis (14.3%). As a result of analyzing the best corrected visual acuity (VA) based on 1.0 (logMAR), baseline VA was worse than counting fingers, and whether pars plana vitrectomy was undertaken showed a difference in the final visual acuity (p < 0.001, p = 0.021). @*Conclusions@#Exogenous endophthalmitis occurs frequently after cataract surgery, and S. epidermidis is the most common causative agent, but a good visual prognosis resulted. Liver abscess was a common extraocular source of endogenous endophthalmitis and Klebsiella pneumonia was the most common causative agent for a poor visual prognosis.

Changes of Anterior Chamber Depth and Refractive Error after Phacovitrectomy with and without Posterior Capsulotomy

Purpose@#To compare the effect on changes in anterior chamber depth (ACD) and refractive error between subjects after combined phacovitrectomy with posterior capsulotomy using a vitrectomy probe and control subjects after combined phacovitrectomy without posterior capsulotomy. @*Methods@#A total of 20 eyes of 20 subjects who underwent combined phacovitrectomy with posterior capsulotomy using a vitrectomy probe were compared with 20 eyes of 20 control subjects who underwent only phacovitrectomy without posterior capsulotomy. The ACD was measured with Scheimpflug imaging (Pentacam ® ; OCULUS Optikgeräte GmbH, Wetzlar, Germany) before and after surgery. Also the preoperative desired refraction and postoperative refraction were compared using an auto keratorefractometor. @*Results@#The preoperative ACD of subjects with posterior capsulotomy was 2.56 ± 0.233 mm. The ACD was 3.54 ± 0.366 mm and 3.71 ± 0.424 mm at one and three months after surgery in subjects with posterior capsulotomy. The preoperative ACD of subjects without posterior capsulotomy was 2.53 ± 0.204 mm. The ACD was 3.09 ± 0.197 mm and 2.95 ± 0.295 mm at one and three months after surgery in subjects without posterior capsulotomy. There was no significant difference between the two groups in preoperative ACD, but ACD at one and three months after surgery was significantly different between the two groups.The desired refractory error was -0.32 ± 0.124 D in subjects with posterior capsulotomy, and -0.33 ± 0.142 D in the control group.The postoperative refraction was -0.62 ± 0.132 D in patients who underwent phacovitrectomy with posterior capsulotomy, and -0.91 ± 0.292 D in the control group. There was a significant difference in refraction three months after the surgery. @*Conclusions@#Combined phacovitrectomy with posterior capsulotomy using a vitrectomy probe may be a useful way to prevent myopic change caused by anterior migration of an intraocular lens compared with control subjects, without posterior capsulotomy, for three months after surgery.

Comparison of Short-term Effects of Intravitreal Injection of Three Modalities on Central Retinal Vein Occlusion

PURPOSE: To report the short-term effects of intravitreal bevacizumab alone, low-dose bevacizumab combined with low-dose triamcinolone injection, and intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA, USA) injection in patients with macular edema following central retinal vein occlusion (CRVO). METHODS: The medical records of 70 patients (70 eyes) with macular edema secondary to CRVO were reviewed retrospectively. Of these, 25 eyes (IVB group) were injected with intravitreal bevacizumab, 23 eyes (intravitreal low-dose bevacizumab and triamcinolone injection [IVB+IVTA] group) were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL), and 20 eyes (intravitreal dexamethasone implant [IVD] group) were injected with an intravitreal dexamethasone implant. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) of treated eyes were measured before injection and at 1 month and 3 months after injection. RESULTS: Groups were similar in age and gender distribution. At 1 month, the CMT of all groups was significantly lower, and the BCVA of all groups had increased significantly in patients with CRVO; there were no significant differences among the three groups (p = 0.246, p = 0.974). At 3 months, the CMT and BCVA had improved significantly only in the IVD and IVB+IVTA groups; the short-term effect was comparable to the IVD group. IOP showed no significant change at 3 months after injection for all groups. CONCLUSIONS: Considering various clinical variables in the treatment of macular edema associated with CRVO, intravitreal injection of bevacizumab, low-dose bevacizumab combined with triamcinolone, and dexamethasone implants may be used selectively.

A Case of Acute Retinal Necrosis in Healthy Childhood

PURPOSE: To describe a case of acute retinal necrosis (ARN) in childhood. CASE SUMMARY: A 6-year-old child visited our clinic complaining of conjunctival injection and decreased visual acuity in the left eye. Slit-lamp examination showed conjunctival injection, inflammatory cells (4+) in the anterior chamber, and keratic precipitates. Fundus examination showed disc swelling. The patient was treated with 30 mg of oral prednisolone and 1% prednisolone acetate with the suspicion of uveitis. After 2 days, retinal examination showed a peripheral multifocal yellowish patch and retinal hemorrhage. Herpes simplex virus-2 was detected using polymerase chain reaction (PCR) analysis of the aqueous humor, which was obtained by anterior chamber paracentesis. In the present case, ARN in childhood was successfully treated with intravenous acyclovir. CONCLUSIONS: We report a case of ARN in childhood diagnosed using PCR. Intravenous acyclovir may be an effective therapy in children with ARN. Ophthalmologists should promptly perform PCR analysis in patients diagnosed with ARN.

A Case of Postpartum Macular Hole in a Young Woman

PURPOSE: To describe a case of macular hole (MH) in a 29-year-old non-myopic woman after uncomplicated delivery. CASE SUMMARY: A 29-year-old woman visited our clinic complaining of decreased visual acuity in her left eye after uncomplicated delivery. Fundoscopy and optical coherence tomography showed a full thickness macular hole in the left eye. However, we found not posterior vitreous detachment or vitreomacular traction in the posterior pole. The patient underwent pars plana vitrectomy, internal limiting membrane peeling, and SF6 gas tamponade. Three months after vitrectomy, the patient's visual acuity was improved and the macular hole was closed successfully. CONCLUSIONS: We experienced and treated a case of postpartum MH developed in a young woman without posterior vitreous detachment or vitreomacular traction in the posterior pole. This suggests another mechanism of MH formation. Postpartum MH was successfully treated by existing idiopathic macular hole surgery.

Long-term Results from Cyclocryotherapy Applied to the 3O'clock and 9O'clock Positions in Blind Refractory Glaucoma Patients

PURPOSE: To report the long-term follow-up results after cyclocryotherapy, applied to the 3-o'clock and 9-o'clock positions in blind refractory glaucoma patients. METHODS: We retrospectively reviewed the charts of 19 blind patients, and a total of 20 eyes with refractory glaucoma who were treated with cyclocryotherapy. Cyclocryotherapy treatments were performed using a retinal cryoprobe. The temperature of each cyclocryotherapy spot was -80degrees C and each spot was maintained in place for 60 seconds. Six cyclocryotherapy spots were placed in each quadrant, including the 3-o'clock and 9-o'clock positions. RESULTS: The mean baseline pretreatment intraocular pressure (IOP) in all eyes was 50.9 ± 12.5 mmHg, which significantly decreased to a mean IOP at last follow-up of 14.1 ± 7.1 mmHg (p < 0.001). The mean number of antiglaucoma medications that patients were still taking at last follow-up was 0.3 ± 0.6. Devastating post-procedure phthisis occurred in only one eye. CONCLUSIONS: Cyclocryotherapy, performed at each quadrant and at the 3-o'clock and 9-o'clock position, is an effective way to lower IOP and, thus, is a reasonable treatment option for refractory glaucoma patients who experience with ocular pain and headaches.

The Changes of Corneal High-Order Aberrations and Anterior Chamber Parameters after Trabeculectomy Using Pentacam(R)

PURPOSE: To evaluate changes in corneal keratometry, high-order aberrations (HOAs), and anterior chamber parameters after trabeculectomy using Pentacam(R) (Oculus Inc., Dutenhofen, Germany). METHODS: Forty eyes of 40 patients who underwent limbal-based trabeculectomy or fornix-based trabeculectomy between July 2011 and May 2012 were retrospectively reviewed. Intraocular pressure (IOP), corneal keratometry, central corneal thickness, anterior chamber depth, anterior chamber volume, and HOAs were measured using Pentacam(R) preoperatively and at 3 months postoperatively. RESULTS: The mean age of patients who underwent trabeculectomy was 58.26 +/- 16.28 years. IOP showed significant decrease after surgery in both groups compared to preoperative values (p 0.05). CONCLUSIONS: Postoperative corneal keratometry and anterior chamber parameters did not change significantly compared to preoperative values in glaucoma patients after performing trabeculectomy. Most HOAs that affected quality of vision were not changed in the limbal-based trabeculectomy or fornix-based trabeculectomy.

The Changes of Corneal High-Order Aberrations and Anterior Chamber Parameters after Trabeculectomy Using Pentacam(R)

PURPOSE: To evaluate changes in corneal keratometry, high-order aberrations (HOAs), and anterior chamber parameters after trabeculectomy using Pentacam(R) (Oculus Inc., Dutenhofen, Germany). METHODS: Forty eyes of 40 patients who underwent limbal-based trabeculectomy or fornix-based trabeculectomy between July 2011 and May 2012 were retrospectively reviewed. Intraocular pressure (IOP), corneal keratometry, central corneal thickness, anterior chamber depth, anterior chamber volume, and HOAs were measured using Pentacam(R) preoperatively and at 3 months postoperatively. RESULTS: The mean age of patients who underwent trabeculectomy was 58.26 +/- 16.28 years. IOP showed significant decrease after surgery in both groups compared to preoperative values (p 0.05). CONCLUSIONS: Postoperative corneal keratometry and anterior chamber parameters did not change significantly compared to preoperative values in glaucoma patients after performing trabeculectomy. Most HOAs that affected quality of vision were not changed in the limbal-based trabeculectomy or fornix-based trabeculectomy.

A Case of Serratia Marcescens Keratitis Presenting as Radial Keratoneuritis

PURPOSE: To report a case of Serratia marcescens keratitis presenting as radial keratoneuritis. CASE SUMMARY: A 15-year-old female who wore cosmetic and orthokeratology contact lenses but performed inadequate lens care visited our clinic with severe pain and visual disturbance in her left eye. On slit lamp examination, central corneal epithelial defect and stromal infiltration with radial keratoneuritis were observed. Based on clinical findings and past history, Acanthamoeba keratitis was highly suspected. The patient was treated with topical chlorhexidine 0.02% (Sigma-Aldrich Co., MO, USA) and moxifloxacin 0.5% (Vigamox(R), Alcon, TX, USA) per hour with 200 mg of oral itraconazol (Sporaone(R), LG, Seoul, Korea) once a day. Symptoms and corneal lesions did not improve after three days. After Serratia marsenscens was isolated from her contact lenses and solution, topical chlorhexidine 0.02% was discontinued, and intravenous ceftazidime (Tazime(R), Hanmi, Seoul, Korea) and fortified ceftazidime (50 mg/mL) eye drop was added. The corneal lesion dramatically improved, and after six months of follow-up, best-corrected visual acuity was 20/20 in the affected eye. CONCLUSIONS: Radial keratoneuritis can present not only in Acanthamoeba keratitis, but also in Serratia marsenscens keratitis. Confirmation of the isolated organism is useful when treating radial keratoneuritis.

Comparison of Intravitreal Bevacizumab Alone Injection and Intravitreal Combination Low-Dose Bevacizumab-Triamcinolone Injection or Diabetic Macular Edema

PURPOSE: To report the effects and intraocular pressure results of intravitreal bevacizumab alone injection compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with diabetic macular edema. METHODS: In total, 40 eyes of 40 patients diagnosed with diabetic macular edema were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL) and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness, and intraocular pressure of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. RESULTS: In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, BCVA increased significantly at 1 month, 2 months, and 3 months after injection (p 0.05). The BCVA, IOP, and central macular thickness (CMT) at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (p > 0.05). CONCLUSIONS: The BCVA of both groups increased significantly, and the CMT of both groups decreased significantly in patients with diabetic macular edema. The injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of diabetic macular edema.

The Change of Anterior Chamber Parameters with Pentacam(R) after Intravitreal Injection

PURPOSE: To evaluate the changes of anterior chamber parameters and intraocular pressure (IOP) with Pentacam(R) after intravitreal injection. METHODS: A total of 76 eyes of 76 patients received an intravitreal injection of either triamcinolone acetonide (TA) or bevacizumab. Twelve patients were treated with an intravitreal injection of TA 0.1 ml, 16 patients were treated with an intravitreal injection of TA 0.05 ml, while the remaining 48 patients received a bevacizumab 0.05 ml injection. All patients underwent anterior chamber depth, anterior chamber angle, and anterior chamber volume evaluation with Pentacam(R) before and 5 minutes after injection. Additionally, IOP measurements were taken 5 minutes before and 5 minutes, 30 minutes, 1 hour and 1 day after injection. RESULTS: Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving TA 0.1 ml were 0.4 +/- 0.11 mm, 10.2 +/- 4.1degrees, 33.7 +/- 5.9 mm3 and 18.8 +/- 12.1 mm Hg, respectively. Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving TA 0.05 ml were -0.01 +/- 0.05 mm, 2.4 +/- 3.2degrees, 5.8 +/- 9.5 mm3 and 4.8 +/- 7.4 mm Hg, respectively. Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving bevacizumab were 0.28 +/- 0.99 mm, 0.8 +/- 4.0degrees, 7.1 +/- 9.6 mm3 and 5.4 +/- 6.3 mm Hg, respectively. There was a significant difference between TA 0.1 ml and 0.05 ml. However, there was no significant difference between TA 0.05 ml and bevacizumab 0.05 ml. CONCLUSIONS: Because of similar anterior chamber parameters changes after 0.05 ml intravitreal injection with TA or bevacizumab, early period IOP increases due to intravitreal volume expansion. Intravitreal 0.05 ml injections do not require any other procedures for controlling IOP 30 minutes after injection.