Clinical Manifestation and Result of Vitrectomy of Vitreomacular Traction Syndrome

PURPOSE: To investigate the clinical manifestation and the result of vitrectomy in patients with vitreomacular traction syndrome. METHODS: Optical coherent tomography (OCT) was used to evaluate the clinical manifestation and the results of vitrectomy for 26 eyes with vitreomacular traction syndrome. RESULTS: Spontaneous relief of vitreomacular traction was achieved in 3 of 8 eyes after a mean follow-up duration of 9 months. One eye recovered visual acuity, but the other 2 eyes could not attain better visual acuity because of persistent sponge-like macular edemas. Six of 13 eyes (46%) improved by two or more lines of visual acuity after vitrectomy. The presence of simple macular cysts without sponge-like macular edemas or tractional retinal detachment seemed to be related to good results after vitrectomy. CONCLUSIONS: Vitrectomy is a preferable way to treat vitreomacular traction syndrome. Preoperative OCT could predict the surgical prognosis.

Two Cases of Ocular Ischemia following Scleral Encircling

PURPOSE: To report two cases of ocular ischemia following scleral encircling. METHODS: A 21-year-old man with glaucoma and a 76-year-old woman without any medical problem were transferred to our department for surgery to treat retinal detachment. After retrobulbar anesthesia and limbal peritomy of conjunctiva, the 4-rectus muscles were isolated. Scleral encircling was performed with No. a 42 band (4.0 mm in width) after cryotherapy done completely around retinal tear. RESULTS: Following surgery, One patient experienced ophthalmic artery occlusion and while the other patient experienced central retinal artery occlusion. Vision was not restored in either cases despite IV injection of 250 ml of 15% mannitol solution and anterior chamber paracentesis. CONCLUSIONS: In the cases where patients are of old age or suffer from glaucoma, we strongly recommend that the surgeons perform the scleral encircling carefully.

The Spontaneous Resolution of Idiopathic Macular Hole Diagnosed with OCT

PURPOSE: To report two cases of spontaneous resolution of macular hole stage 1 and 2, that were objectively diagnosed with OCT(optical coherence tomography). METHODS: Case 1-A 64-year-old woman without systemic disease visited Kong Eye Center complaining of decreasing visual acuity for 1 month. We diagnosed her case as macular hole stage 1, checked her regularly and detected spontaneous resolution of the macular hole after 6 months. We examined her using OCT before and after spontaneous resolution. Case 2-A 66-year-old man without systemic disease visited Kong Eye Center complaining of decreasing visual acuity for several months. We diagnosed his case as macular hole stage 2 and decided to perform an operation 3 weeks later. On admission, we detected spontaneous resolution of the macular hole. We examined him using OCT before and after spontaneous resolution. RESULTS: We could confirm the spontaneous resolution of stage 1 and 2 macular hole using OCT objectively. CONCLUSIONS: OCT is a useful tool in the diagnosis of macular hole and in the evaluation of various natural course of macular hole.

The Clinical Manifestations and Treatments of Parafoveal Telangiectasis

PURPOSE: To investigate the clinical manifestations and treatments of parafoveal telangiectasis. METHODS: Twenty-two eyes of fifteen patients diagnosed as parafoveal telangiectasis were selected who had visited Kong Eye Center from September 1999 to August 2003 complaining of decreasing visual acuity. Visual acuity was checked and fluorescein angiography and optical coherence tomography were done. Authors treated six eyes of six patients experienced decreasing visual acuity due to macular edema with argon laser photocoagulation and one eye of one patient accompanying with choroidal neovascularization with photodynamic therapy. RESULTS: Among fifteen patients, group 1 cases were eight (1B eight) and group 2 cases were seven by classification of Gass and Blodi. Visual acuity improved in two eyes of six eyes and maintained in four eyes of six eyes and optical coherence tomography showed decrease of macular edema in six eyes of six patients all after argon laser photocoagulation. Visual acuity improved and optical coherence tomography showed decrease of macular edema in one eye of one patient after photodynamic therapy. CONCLUSIONS: Group 1 cases were more than group 2 cases. Argon laser photocoagulation can be effectively used to treat decreasing visual acuity due to macular edema in parafoveal telangiectasis patients. Photodynamic therapy seems to be effective in parafoveal telangiectasis accompanied with choroidal neovascularization but we think that additional studies with more cases are needed.

Diagnosis and Treatment of Vitreomacular Traction Syndrome Using Optical Coherence Tomography

PURPOSE: To determine the benefit of optical coherence tomography (OCT) in the diagnosis of vitreomacular traction syndrome and evaluate the vitreoretinal interface before and after vitreous surgery. METHODS: Medical records of five patients with vitreomacular traction syndrome who had undergone vitrectomy were reviewed. Preoperative and postoperative visual acuity and preoperative and postoperative OCT were reviewed. In all patients OCT demonstrated posterior vitreous detachment and a focal adhesion of hyaloid membrane to macula with traction on the foveal retinal tissue. All of them underwent pars plana vitrectomy with peeling of poterior hyaloid face. RESULTS: Visual acuity improved in 4 eyes after the first vitrectomy. One eye developed postoperatively a macular hole, which was treated with the second vitrectomy and intravitreal gas tamponade with subsequent improvement in vision. In 4 eyes, OCT showed elimination of vitreous strand, relief of vitreous traction and restoration of normal foveal contour after vitrectomy. CONCLUSION: Optical coherence tomography is a useful tool in the diagnosis of vitreomacular traction syndrome and in the evaluation of status of vitreoretinal interface before and after vitrectomy. Following pars plana vitrectomy, vision improved and normal foveal contour was restored.

A Prospective Study of Intraocular Candidiasis

Intraocular fungal infection, especially due to candida infection, has become an increasingly important cause of nosocomial infectio. Despite increasing awareness of this complication of candidemia, serious visual impairment due to candida infection remains as a problem. For the determine the frequency of intraocular candidasis and evaluation of risk factor, patients with candidemia were evaluated with indirect ophthalmoscopic examination within ninety six hours ater blood culture. Intraocular candidiasis were found in thirty three Percent of patient with candidemia. Candida chorioretiritis were found in five (27%) patients, candida endophthalmitis was found in one (5%) patients. The candida chorioretinitis was not progressed to candida endophthalmitis in one patients. That patient with candida endophthalmitis was treated with intravitreal amphotericin B injection, pars plana vitrectomy. Among the six intraocular candidiasis patients, five patients got cnadidiasis after long term antibiotics therapy for flame burn injury and one after anticancer therapy combined with intravenous hyperalimentation. The risk factors for the development of intraocular candidiasis can be long-term antibiotic therapy, parenteral hyperalimentation, use of indwelling catheter, or use of immunosupressive drugs in our cases.

Photic Retinal Injury Induced by Endoillumination during Vitrectomy

Photic retinal injuries following operating microscopic light exposure or endoillumination are produced by mechanical, thermal or photochemical mechanism. The authors experienced a case of a patient who developed a round macular lesion which seemed to be a light-induced retinal damage during pars plana vitrectomy and removal of intraretinal foreign body.

A Case of Aicardi Syndrome

Aicardi syndrome is a congenital multiorgan disorder which is characterized by agenesis of the corpus callosum, chorioretinal ""lacunae"" (often associated with retinal colobomas and microphthalmia), vertebral anomalies, a characteristic seizure disorder, and mental retardation. We present a case of Aicardi syndrome with cleft lip and palate.

The Experimental study of Injections of Cultured Fibroblasts into the Rabbit Vitreous

The major cause of failure of retinal detachment surgery is proliferative vitreoretinopathy(PVR). This disorder is characterized by the formation of the contractile cellular membrane on both surfaces of retina and within the vitreous cavity. These cellular membranes contract and thereby cause traction retinal detachment. The pathogenesis of this disorder is not fully understood. The authors developed a consistent model of proliferative vitreoretinopathy in the rabbit by partially digesting the post. Vitreous with repeated injection and aspiration of 1 IU of hyaluronidase before injection of 250,000 homologous dermal fibroblasts. All experimental rabbit eyes had vitreous opacity and hyperemia of the optic disc head. The progression of PVR was rapid and moderately severe. On day 1, 13 of 15 eyes(87%) had vitreous strand formation alone(Grade 1 PVR). One day 3, all 15 eyes(100%) had vitreous strand formation. We have developed a model of proliferative vitreoretinopathy in the rabbit. After intravitreal autotransplantation of tissue cultured homologous skin fibroblasts, we observed high rate of vitreous strand formation in the vitreous cavity. This experimental model will be useful for studying the pathogenesis of proliferative vitreoretinopathy and evaluating potential treatment for its prevention.

A Case of Candida Endophthalmitis

Candida chorioretinitis is the most common fungal infection of the retina and choroid, and is one of the most common of all endogenous infections of the eye. The typical lesion of candida chorioretinitis is a white, circumscribed lesion, less than 1 mm in diameter, with an overlying haze of vitreous inflammatory cells. There may be vascular sheathing of retinal vessels in the area surrounding the lesions. Candida Endophthalmitia is defined as chorioretinitis with extension into vitreous or with intravitreal "puff balls". It has become an increasingly important cause of nosocomial infection, and has been documented in 9.9 % to 37% of adult patients with candidemia. We successfully treated one case of candida endophthalmitis with systemic administration of amphotericin B, itraconazole and intravitreal injection of amphotericin B in 18-year-old male after flame burn injury. We also performed pars plana vitrectomy with membrane peeling for the purpose of relieving preretinal traction membrane which had occurred after resolution of candida chorioretinitis.

Arteriovenous Crossing Patterns in Branch Retinal Vein Occlusion

The study was designed to evaluate the relative anatomic position of the crossing vessels at the site of occlusion in eyes with branch retinal vein occlusion(BRVO). Fluorescein angiography and fundus photography of 33 eyes(33 patients) with BRVO were used to examine the relative position of artery and vein at occluded crossings. Three separate comparison groups were formed by identifying corresponding arteriovenous crossings for each occluded crossing in: (1) the ipsilateral but opposite vessel arcade within eyes affected by BRVO patients; (2) the same quadrant in unaffected eyes of BRVO patients; and (3) the same quadrant in eyes of patients without BRVO, matched by age and sex with the BRVO patients. The site of obstruction of the branch vein was an arteriovenous crossing in all affected eyes. In 97% of eyes with BRVO, the artery was located anterior to the vein at the obstructed site. In the three comparison groups the artery was anterior to the vein in 73%, 68%, 59% of the crossings, respectively, yielding statistically significant differances for first group(P<0.02), second graup(P<0.01) and third group(P<0.001) of control crossings compared with BRVO crossings.

A Case of Post. Scleritis Associated with Ciliochoroidal Detachment and Ant. Uveitis in Background Diabetic Retinopathy Patient

Posterior scleritis is an uncommon disease. Its clinical manifestations may include pain. reduced visual acuity, cellular infiltration in the aqueous and vitreous humor, serous retinal detachment, chorioretinal lesions, and disc or macular edema. The diagnosis of posterior scleritis is often difficult due to its rarity and the diversity of symptoms. However, ultrasography and computed tomography are noninvasive methods for diagnosis of posterior scleritis. We treated posterior scleritis associated with ciliochoroidal detachment and anterior uveitis with sclerotomy, drainage of ciliochoroidal fluid in a background diabetic retinopathy patient.

A Case of Ocular Ischemic Syndrome Associated with Multiple Branch Retinal Artery Occlusion and Neovascular Glaucoma

The ocular ischemic syndrome includes the ocular symptoms and signs secondary to severe carotid artery obstruction. Recently, authors have experienced a case of ocular ischemic syndrome in a 55 years old man, who has multipl cilioretinal artery occlusions and neovascular glaucoma associated with ipsilateral internal carotid artery obstruction.

Two Cases of Electric Cataract with Maculopathy

Catatracts are an infrequent but well-known complication of electrical injury, remains poorly understood. We report two cases of electric cataract with maculopathy experienced recently. The first case was a 58-year-old man who had exposed to 22000 voltage current and sustained third degree, 15% burn. 54th day after burn, the lenticular changes showed total opacity of both eyes and the intraocular pressure of left eye was 28 mmHg. 65th day after burn, extracapsular cataract extraction with posterior chamber lens implantation on left eye was performed. After the operation, naked vision was 1.0, but hard exudates were showed in macular area. The second case was a 23-year-old man who had exposed to 54000 voltage current and sustained third degree, 20% burn. 82th day after burn, the lenticular changes showed moderate opacities in the anterior and posterior subcapsular area of both eyes. 137th day after burn, extracapsular cataract extraction with posterior chamber lens implantation on right eye was performed. The final corrected visual acuity was 0.5 on 7th week after the operation due to lamellar macular hole.

Correction of the Trichiasis and the Cicatricial Entropion by Transposition of Skin Flaps

Trichiasis is usually associated with congenital entropion or conjunctival destruction from disease or injuries. Cicatricial entropion follows scarring of the palpebral conjunctiva, which may be caused by chemical injuries, surgical procedures, trauma and infections. Numerous surgical procedures have been described for correction of trichiasis and cicatricial entropion in accordance with the severity and location of the condition. We have treated partial trichiasis in 2 cases(4 lids),(one involving nasal one forth of the upper lid with corrected congenital ptosis and the other in temporal one forth of the upper lid with narrow palpebral fissure) and cicatricial entropion on the middle one forth of the upper lid in 3 cases(3 lids) with transposition of skin flaps. The resuits were satisfactory.

Clinical Study on The Vitreous Hemorrhage

Vitreous hemorrhage acounted for 64 patients(67 eyes) seen during a eighteenmonth period from March 1, 1987, to August 31, 1988. In order of decreasing frequency, the major causes were diabetic retinopathy(19.4%), trauma(l1.9%), silent retinal tear(10.4%). retinal branch vein occlusion(7.5%), acute posterior vitreous detachment(7.5%), Eales' disease(6%), Hypertension(6%), central retinal vein occlusion(4.4%). And the minor causes were rhegmatogenous retinal detachment(3%), retinal angioma(3%), chronic renal failure(3%), subretinal neovascularization(1.5%), disc neovascularization with undetermined cause(1.5%). No cause could be determined in 14.9% of the cases.

A Case of Orbital Hematoma Caused by Traumatic Parietal Subperiosteal Hemorrhage

Orbital hematoma is a condition not often encountered by the ophthalmologist. Trauma is the most common cause among the conditions caused to orbital hematoma. We have experienced a case of traumatic orbital hematoma with severe proptosis, visual deterioration, and limitation of EOM which was spread from parietal subperiosteal hemorrhage. It was managed efficiently by Hemo-vac application through transparietal route. We report this case with the review of the literatures.