Benign Concentric Annular Macular Dystrophy in a Young Woman

Purpose@#Here, we report a case of benign concentric annular macular dystrophy associated with a visual field defect.Case summary: A 34-year-old woman presented with a visual field defect that was not accompanied by a deterioration in visual acuity. The patient’s best-corrected visual acuity was 1.25 in both eyes. No signs of anterior chamber inflammation were observed, and fundoscopy showed annular hypopigmentation at the fovea in both eyes. Annular hyperfluorescence was observed on fluorescein angiography due to the window defect. Automated perimetry demonstrated an annular paracentral scotoma in both eyes. The standard electroretinogram was normal, whereas optical coherence tomography showed a loss at the inner and outer boundaries of the foveal photoreceptors. The patient had no history of chloroquine or hydroxychloroquine intake, which excluded Bull’s eye maculopathy. The patient was observed without treatment for 2 years and no change was observed in her visual acuity or the appearance of the fovea. @*Conclusions@#Benign concentric annular macular dystrophy should be considered in patients with annular hypopigmentation at the fovea without deterioration in the visual acuity of both eyes.

Combined Intravitreal Bevacizumab and Laser Photocoagulation to Treat Retinal Arterial Macroaneurysms

Purpose@#To investigate the effects of intravitreal bevacizumab injection combined with laser photocoagulation in patients with retinal microaneurysms. @*Methods@#We retrospectively reviewed the medical records of 21 eyes of 21 patients who underwent intravitreal bevacizumab injection and/or laser photocoagulation to treat retinal macroaneurysms. Eleven eyes received the combination therapy (CT) and 10 eyes monotherapy (MT) (either bevacizumab injection or laser photocoagulation). Changes in visual acuity, central macular thickness, macroaneurysm size and location, blood pressure, and the lipid level were compared between the two groups. @*Results@#The mean patient age was 74.0 ± 10.5 years and the mean study period 7.0 ± 5.3 months. The mean macroaneurysm diameter of the CT group was 480.00 ± 292.30 μm and that of the MT group 328.75 ± 87.09 μm. The diameter was significantly larger in the CT group (p = 0.002). The initial visual acuities were 0.91 ± 0.66 and 0.88 ± 0.83 in the CT and MT groups, respectively. At the 4-month follow-up, the visual acuities were 0.33 ± 0.26 and 0.17 ± 0.29 in the CT and MT groups, respectively, and had significantly improved only in the CT group (p = 0.042). The initial central macular thicknesses were 441.82 ± 226.81 and 541.63 ± 401.97 μm in the CT and MT groups, respectively. At the 4-month follow-up, the figures were 293.60 ± 46.10 and 269.00 ± 48.34 μm in the CT and MT groups, respectively, and had significantly decreased only in the CT group (p = 0.043). Compared to the initial findings, the proportion of patients whose final visual acuities improved by more than two lines were 73% and 40%, respectively, thus significantly higher in the CT group (p < 0.001). @*Conclusions@#Combined intravitreal bevacizumab injection and laser photocoagulation treatment of retinal macroaneurysms improve visual acuity and decrease macular thickness.

Combined Intravitreal Bevacizumab and Laser Photocoagulation to Treat Retinal Arterial Macroaneurysms

Purpose@#To investigate the effects of intravitreal bevacizumab injection combined with laser photocoagulation in patients with retinal microaneurysms. @*Methods@#We retrospectively reviewed the medical records of 21 eyes of 21 patients who underwent intravitreal bevacizumab injection and/or laser photocoagulation to treat retinal macroaneurysms. Eleven eyes received the combination therapy (CT) and 10 eyes monotherapy (MT) (either bevacizumab injection or laser photocoagulation). Changes in visual acuity, central macular thickness, macroaneurysm size and location, blood pressure, and the lipid level were compared between the two groups. @*Results@#The mean patient age was 74.0 ± 10.5 years and the mean study period 7.0 ± 5.3 months. The mean macroaneurysm diameter of the CT group was 480.00 ± 292.30 μm and that of the MT group 328.75 ± 87.09 μm. The diameter was significantly larger in the CT group (p = 0.002). The initial visual acuities were 0.91 ± 0.66 and 0.88 ± 0.83 in the CT and MT groups, respectively. At the 4-month follow-up, the visual acuities were 0.33 ± 0.26 and 0.17 ± 0.29 in the CT and MT groups, respectively, and had significantly improved only in the CT group (p = 0.042). The initial central macular thicknesses were 441.82 ± 226.81 and 541.63 ± 401.97 μm in the CT and MT groups, respectively. At the 4-month follow-up, the figures were 293.60 ± 46.10 and 269.00 ± 48.34 μm in the CT and MT groups, respectively, and had significantly decreased only in the CT group (p = 0.043). Compared to the initial findings, the proportion of patients whose final visual acuities improved by more than two lines were 73% and 40%, respectively, thus significantly higher in the CT group (p < 0.001). @*Conclusions@#Combined intravitreal bevacizumab injection and laser photocoagulation treatment of retinal macroaneurysms improve visual acuity and decrease macular thickness.

Surgery in a Patient with Sensory Exotropia with an Abnormally Attached Lateral Rectus Muscle

Purpose@#We report surgical repair of an abnormally attached lateral rectus muscle in a sensory exotropia patient.Case summary: A 21-year-old man visited our hospital with lateral deviation in the right eye. The patient had a history of trauma (11 years previously) to the right eye, which showed 30 prism diopters of exotropia. In accordance with a diagnosis of sensory exotropia, 7.5-mm lateral rectus muscle recession and 6-mm medial rectus muscle resection were planned in the right eye. During surgery, the lateral rectus muscle was inserted into the sclera at a distance of 12 mm from the corneal limbus. To compensate for this, the lateral rectus muscle was recessed with an adjustable suture. After surgery, the patient showed 8-10 prism diopters of exotropia. A 2-mm recession was achieved by suturing. After surgery, the patient did not show exotropia, while after 3 months of follow-up the patient showed about 4 prism diopters of esotropia. @*Conclusions@#Despite abnormal attachment of an extraocular muscle, it is possible to obtain a good cosmetic result if the surgery is performed according to the preoperative plan. Suturing can be helpful if the surgical field is difficult to secure during the surgery.

Relentless Placoid Chorioretinitis in a Young Man

Purpose@#To report a patient with relentless placoid chorioretinitis who showed recurrent multiple placoid lesions and retinal pigment epithelial atrophic changes in both eyes for more than 16 months.Case summary: A 21-year-old man visited our clinic because of visual disturbance in both eyes. The best-corrected visual acuities were 20/50 and 20/20 in the right and left eyes, respectively. The fundus showed multiple whitish placoid lesions from the posterior pole to the mid-periphery. There were no anterior chamber inflammation signs. To exclude systemic and infectious etiologies, laboratory workup was performed. All tests were negative except for the serological types HLAB13 and B51. Based on clinical estimation, we made a diagnosis of acute posterior multifocal placoid pigment epitheliopathy or posterior uveitis and prescribed oral methylprednisolone for the patient. However, multiple white dot lesions occurred repeatedly in both eyes for 7 months. With the oral methylprednisolone and immunosuppressive treatment, the best-corrected visual acuity of both eyes was maintained at 20/20 without further recurrence 16 months after the first visit. The lesions left atrophic findings in the retinal pigment epithelium. We diagnosed the patient with relentless placoid chorioretinitis, based on the prolonged clinical course and widespread lesion distribution. @*Conclusions@#Relentless placoid chorioretinitis should be considered in patients with chronically progressive multiple white dot lesions and retinal pigment epithelium atrophic changes between the central pole and the periphery. Aggressive immunosuppressive treatment should be performed to improve the patient's visual outcome.

Relentless Placoid Chorioretinitis in a Young Man

Purpose@#To report a patient with relentless placoid chorioretinitis who showed recurrent multiple placoid lesions and retinal pigment epithelial atrophic changes in both eyes for more than 16 months.Case summary: A 21-year-old man visited our clinic because of visual disturbance in both eyes. The best-corrected visual acuities were 20/50 and 20/20 in the right and left eyes, respectively. The fundus showed multiple whitish placoid lesions from the posterior pole to the mid-periphery. There were no anterior chamber inflammation signs. To exclude systemic and infectious etiologies, laboratory workup was performed. All tests were negative except for the serological types HLAB13 and B51. Based on clinical estimation, we made a diagnosis of acute posterior multifocal placoid pigment epitheliopathy or posterior uveitis and prescribed oral methylprednisolone for the patient. However, multiple white dot lesions occurred repeatedly in both eyes for 7 months. With the oral methylprednisolone and immunosuppressive treatment, the best-corrected visual acuity of both eyes was maintained at 20/20 without further recurrence 16 months after the first visit. The lesions left atrophic findings in the retinal pigment epithelium. We diagnosed the patient with relentless placoid chorioretinitis, based on the prolonged clinical course and widespread lesion distribution. @*Conclusions@#Relentless placoid chorioretinitis should be considered in patients with chronically progressive multiple white dot lesions and retinal pigment epithelium atrophic changes between the central pole and the periphery. Aggressive immunosuppressive treatment should be performed to improve the patient's visual outcome.

The Effects of Long-term Hemodialysis on Visual Acuity and Central Macular Thickness in Diabetic Retinopathy Patients

PURPOSE: To investigate the changes of visual acuity and central macular thickness (CMT) in patients with diabetic retinopathy (DR) receiving long-term hemodialysis (HD). METHODS: From January 1, 2008, to December 31, 2018, the medical records of patients who were diagnosed with DR receiving HD three times a week for ≥18 months due to chronic kidney disease (CKD) were analyzed. Among them, patients diagnosed with DR 6 months before the start of HD were included. Patients with vitreous hemorrhage (VH) affecting visual acuity (VA), other retinal diseases, and cataract surgery after HD were excluded. The VA and CMT before HD and at 1, 3, 6, 12, and 18 months after HD were analyzed. RESULTS: Of the 222 eyes of 111 patients who were diagnosed with DR and received HD for CKD due to diabetes, 174 eyes with DR diagnosed after starting HD were excluded. Ten eyes with VH before starting HD, two eyes with epiretinal membrane, and four eyes with cataract surgery after starting HD were also excluded. Thirty-two eyes of 18 patients were included. The mean age of the patients was 53.71 ± 9.25 years. Twenty-four males and eight female patients were included in the study. The mean logMAR VA improved significantly from 0.36 ± 0.28 before starting HD to 0.26 ± 0.27 at 18 months after starting HD (p = 0.002). The mean CMT was significantly decreased from 307.12 ± 89.52 µm before starting HD to 279.71 ± 61.75 µm at 12 months after starting HD (p = 0.02). CONCLUSIONS: In patients with DR who underwent long-term HD, CMT decreased and VA improved, when compared with these parameters before HD.

Changes in Angular Deviations under General Anesthesia for Strabismus Surgery with Objective Anesthetic Depth Control

PURPOSE: Changes in angular deviation before and after general anesthesia and strabismus surgery were examined. METHODS: Twenty patients with intermittent exotropia who were operated on by the same surgeon from January 2014 to October 2017 were included. The basic angle of deviation (preoperative angle of deviation, PreAn) was measured at an outpatient clinic. While lying on a surgical bed under general anesthesia, the bispectral index was referenced, and it was confirmed that there was a sufficient degree of sedation. Photographs were then taken at a height of 40 cm (angle of deviation under general anesthesia, PostAn); while still under general anesthesia, the same procedure was followed immediately after the end of surgery. At 6 months after surgery, the angle of deviation was measured. RESULTS: There were 10 males and 10 females, and the mean age was 7.31 ± 3.59 years. The preoperative angle of deviation was 30.0 ± 13.87 prism diopters (PD) at far fixation; under general anesthesia, 26.46 ± 5.39 PD. There was a significantly positive correlation between the PreAn and angle of deviation under general anesthesia (PostAn - PreAn = −7.67 × PreAn + 19.57; R2 = 0.872; p < 0.00). The angle of deviation changes between pre- and post-anesthesia (PostAn-PreAn) and at the end point of surgery (OP end) and at 6 months after surgery (6mon) also showed a significantly positive correlation (6mon-OP end = 0.317 × [PostAn - PreAn] + 13.098; R2 = 0.334; p = 0.01). CONCLUSIONS: There was a significant positive correlation between the measured angle of deviation pre- and post-anesthesia. We could estimate the degree of change between the angle of deviation immediately after surgery and the stable angle according to the degree of deviation before and after general anesthesia.

An Epidemiologic Survey of Strabismus and Nystagmus in South Korea: KNHANES V

PURPOSE: Strabismus affects any age and represents various functional or non-functional eye problems. This population-based study was conducted to determine the prevalence of strabismus and nystagmus in South Korea according to various sociodemographic factors. METHODS: We acquired data from the Korea National Health and Nutrition Examination Survey, a nation-wide cross-sectional survey and examinations of the non-institutionalized civilian population in South Korea (n = 30,538), conducted from July 2008 to December 2011. The prevalence of strabismus and nystagmus were verified, and associated sociodemographic factors was evaluated. RESULTS: The overall prevalence of strabismic disorder in participants over 3 years of age was 1.4 ± 0.1% (95% confidence interval [CI] 1.3–1.6%; 1.5 ± 0.1% in males, 1.3 ± 0.1% in females). The prevalence of exodeviation (15 or more prism diopters), esodeviation (10 or more prism diopters), vertical deviation, and other complicated strabismus and nystagmus was 1.0%, 0.2%, 0.2%, 0.1% and 0.1% respectively. The prevalence was highest in the 6 to 15-year age group (1.9 ± 0.3%), and lowest in the 40 to 49 years age group (0.8 ± 0.1%) (p = 0.005). There were no statistically significant differences for gender, region, residential area, household income, educational level and occupation. CONCLUSIONS: This nation-wide epidemiologic study demonstrated that the prevalence of strabismus and nystagmus according to various sociodemographic factors in South Korea was not statistically significant except for age group. Further investigations are required based on more surveys to better recognize the etiologic or risk factors that may be related to strabismus and nystagmus.

The Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation in Patients with Clinically Significant Macular Edema

PURPOSE: To determine the effect of intravitreal bevacizumab injection before panretinal photocoagulation (PRP) in clinically significant macular edema (CSME) patients. METHODS: A total of 91 eyes (70 patients) having severe nonproliferative diabetic retinopathy with CSME requiring PRP were enrolled in the present study; the medical records were retrospectively reviewed and analyzed. The eyes were divided into the regular PRP group (51 eyes) and PRP with preinjection of bevacizumab (1.25 mg) group (combination group, 40 eyes) and compared. Best corrected visual acuity (BCVA) and central macular thickness (CMT) at pretreatment and 1, 3, 6, and 12 months after PRP was evaluated. RESULTS: BCVA (logarithm of the minimum angle of resolution, Snellen visual acuity in parentheses) at pretreatment and 1, 3, 6, and 12 months after PRP was 0.24 (0.575), 0.27 (0.537), 0.28 (0.525), 0.28 (0.525), and 0.30 (0.501) (p = 0.13, 0.15, 0.56 and 0.79) in the regular PRP group and 0.32 (0.479), 0.25 (0.562), 0.26 (0.549), 0.27 (0.537), and 0.36 (0.436) (p = 0.02, 0.04, 0.02 and 0.13) in the combination group, respectively. CMT (microm) at pretreatment and 1, 3, 6, and 12 months after PRP was 257.66, 285.16, 282.21, 289.65, and 309.85 (p = 0.00, 0.00, 0.00 and 0.00) in the regular PRP group and 349.39, 312.17, 331.15. 353.30, and 333.55 (p = 0.04, 0.94, 0.79 and 0.06) in the combination group, respectively. CONCLUSIONS: Pretreatment of anti-vascular endothelial growth factor injection before PRP affected the decrease of macular thickness for 3 months after PRP and improved visual acuity for 6 months after PRP when compared with PRP alone in patients with CSME.

A Case of Polyarteritis Nodosa with Decreased Vision as a First Symptom

PURPOSE: Polyarteritis nodosa (PAN) is the necrotic vasculitis affecting middle and small-sized arteries throughout the body including ocular tissue. We report an atypical PAN case of unilateral central retinal artery occlusion in which the ocular involvement occurred before systemic symptoms. CASE SUMMARY: A 58-year-old male visited the ophthalmology department due to abruptly decreased visual acuity. Best corrected visual acuity (BCVA) was 0.05 (in the right eye) and 1.0 (in the left eye) basedon the Snellen chart. He complained of acute decreased vision occurring ten days prior and intermittent migraine on the right side with no underlying diseases, such as hypertension or diabetes mellitus. Relative afferent pupillary defect was observed in the right eye. Generalized edema was found around the optic disc and fovea on fundus examination and optical coherence tomography. The patient was diagnosed with central retinal artery occlusion (CRAO) based on a fluorescein angiography. Subsequently, PAN was diagnosed based on clinical features, laboratory test results and imaging studies. The treatment was started with an immunosuppressive agent. One month later, the BCVA was 0.05 based on the Snellen chart. CONCLUSIONS: In PAN patients, decreased vision can occur as a first symptom due to CRAO. If the patient visits the ophthalmology clinic, history taking and laboratory tests for PAN can aid in early diagnosis and treatment, as well as preventing additional complications of PAN.