Successful treatment of central retinal artery occlusion using hyperbaric oxygen therapy

Central retinal artery occlusion (CRAO) is considered an ophthalmologic emergency. The prognosis of this disease is very poor. Currently, there is no generally effective therapy available to treat CRAO. Hyperbaric oxygen therapy (HBOT) can increase the volume of oxygen delivered to the ischemic retinal tissue until spontaneous or assisted reperfusion occurs. We report the case of a patient who experienced sudden visual loss due to CRAO that was treated with HBOT. The patient was an 81-year-old woman who presented with CRAO in her right eye (OD). She exhibited “hand motion” visual acuity before treatment. She underwent three sessions of HBOT at a pressure of 2.8 atmospheres absolute, performed over 3 days. After 4 days in hospital, her visual acuity improved to 0.4 (OD) for far vision and 0.5 (OD) for near vision. Her vision was stable without the supply of oxygen; therefore, she was discharged.

Quality of Life and Visual Efficiency: fifth Korea National Health and Nutrition Examination Survey

PURPOSE: To analyze the association of visual efficiency and quality of life using data from the fifth Korea National Health and Nutrition Examination Survey (KNHANES V). METHODS: The present study included 5,244 glaucoma or glaucoma suspect subjects who completed a visual acuity test, visual field test and health-related questionnaire from the KNHANES V. Visual efficiency was calculated using best corrected visual acuity and visual field test. Quality of life was assessed with EuroQoL 5D (EQ-5D). Visual efficiency was compared with best corrected vision of the better eye to evaluate the relationship with quality of life. One-way analysis of variance (ANOVA) and partial correlations analysis were used to analyze the associations between factors. RESULTS: Both visual efficiency and best corrected visual acuity of the better eye were significantly different with all EQ-5D parameters (p < 0.005). After controlling for age, gender, income, education, spouse and house ownership, visual efficiency showed a positive correlation coefficient of +0.040 (p = 0.006) with the quality of life and the best corrected visual acuity of the better eye showed negative correlation coefficient of -0.044 (p = 0.002) with the quality of life. CONCLUSIONS: Visual efficiency was associated with the quality of life. Not only visual acuity but also visual efficiency would be a valuable parameter when considering the quality of life. Further studies are needed to evaluate non-glaucomatous populations.

A Case of Penetrating Fish Hook Ocular Injury

PURPOSE: To report a case study of a penetrating fish hook ocular injury. CASE SUMMARY: A 53-year-old male visited the emergency department complaining that he injured his eye with a fish hook. He had no specific ophthalmologic or medical history. A fish hook had penetrated the sclera 1.5 mm temporal to the limbus. The tip of the fish hook was visible at the posterior surface of the lens. His visual acuity was hand motion. The fish hook was removed through the entrance wound using the backout method. Anterior chamber irrigation and extracapsular cataract extraction with phacoemulsification were performed and intracameral antibiotic injection administered. Intraocular lens implantation was performed at a later date. Presently, the patient has a best correctional visual acuity of 0.7 with no signs of infections. CONCLUSIONS: In cases of ocular fish hook injury, determining a removal method is crucial for recovery. Herein, we report a case of successfully treated fish hook ocular perforation along with a literature review.

A Case of Recurrent Uveitis in Autoimmune Liver Disease

PURPOSE: To report a case of recurrent uveitis associated with autoimmune liver disease. CASE SUMMARY: A 50-year-old female with severe fatigue and arthritis visited the ophthalmology department due to decreased visual acuity and discomfort in her right eye for ten days. She had intermittent injection and blurred vision in both eyes for 30 years. Slit lamp examination of her right eye showed keratic precipitates, pigment deposits on the anterior capsule of the lens and anterior chamber cells; fundus examination was normal without any sign of chorioretinitis. Inflammatory reaction was improved after steroid and cycloplegic eye drop treatment. Two months later, her left eye developed anterior uveitis. Inflammation was well controlled with steroid and cycloplegic eye drop treatment. To evaluate the cause of uveitis and associated systemic disease, serological testing was performed, and abnormal elevation of liver enzymes was detected. The patient was referred to the Gastroenterology Department and diagnosed with autoimmune liver disease. Oral ursodeoxycholic acid was prescribed. Liver function profile improved to normal range, and the patient is currently under routine follow-up with no sign of recurrent uveitis. CONCLUSIONS: When a patient with recurrent uveitis presents symptoms such as nausea, fatigue, abdominal pain, jaundice or abnormal liver profile, association with autoimmune liver disease should be considered.

Acute Visual Loss after Intravitreal Bevacizumab Injection in a Patient with Ocular Ischemic Syndrome

PURPOSE: To report a patient with ocular ischemic syndrome who suffered from sudden decrease in visual acuity after bevacizumab injection. CASE SUMMARY: A 70-year-old patient visited the Department of Ophthalmology due to progressively decreasing visual acuity in the right eye. Corrected visual acuity in his right eye was 0.1 on the first visit; ocular ischemic syndrome was suspected. Despite panretinal photocoagulation, severe iris neovascularization was still present in the right eye. Intravitreal bevacizumab injection was performed to regress the iris neovascularization. One day after injection, iris neovascularization regressed significantly, however, visual acuity was decreased to finger counting. CONCLUSIONS: In ocular ischemic syndrome, bevacizumab injection for reduction of iris neovascularization should be carefully considered due to possibility of acute visual loss.

Acute Visual Loss after Intravitreal Bevacizumab Injection in a Patient with Ocular Ischemic Syndrome

PURPOSE: To report a patient with ocular ischemic syndrome who suffered from sudden decrease in visual acuity after bevacizumab injection. CASE SUMMARY: A 70-year-old patient visited the Department of Ophthalmology due to progressively decreasing visual acuity in the right eye. Corrected visual acuity in his right eye was 0.1 on the first visit; ocular ischemic syndrome was suspected. Despite panretinal photocoagulation, severe iris neovascularization was still present in the right eye. Intravitreal bevacizumab injection was performed to regress the iris neovascularization. One day after injection, iris neovascularization regressed significantly, however, visual acuity was decreased to finger counting. CONCLUSIONS: In ocular ischemic syndrome, bevacizumab injection for reduction of iris neovascularization should be carefully considered due to possibility of acute visual loss.

A Case Report of Bilateral Retinal Racemose Hemangioma Restricted to Peripapillary Area

PURPOSE: The authors of the present case report observed a bilateral retinal racemose hemangioma which was located within the peripapillary area. CASE SUMMARY: A 17-year-old man presented with floaters in both eyes. Fundus revealed tortuous and anastomosed retinal vasculature around the optic disc. In addition, fluorescein angiography showed a non-leaking retinal arteriovenous anastomosis. Seven years after the initial visit, vitreous hemorrhage occurred in the patient's left eye, and then 1 year later, subretinal hemorrhage was found in his left eye. CONCLUSIONS: Because retinal racemose hemangioma can accompany vitreous hemorrhage and subretinal hemorrhage regardless of size, a routine periodic ophthalmic examination is recommended.

Comparison of Damage Degrees After Corneal Epithelial Debridement Using Different Instruments in Rabbit Eyes

PURPOSE: A corneal epithelial debridement using three different instruments was performed in rabbits, and the rates of corneal epithelium recovery were compared. Additionally, the extent of corneal damage as determined by the scanning electron microscopy was evaluated in each group. METHODS: Nineteen eyes of ten rabbits were classified into three groups according to the instruments used. The corneal epithelial debridement was performed using three different instruments: a Beaver blade (group A), a Bard-Parker blade No.15 (group B) and a dry cotton-tipped ap plicator (group C). After epithelial debridement, each cornea was observed every 24 hours for three days. After completion of the corneal recovery, each cornea was severed along the limbus and observed under the scanning electron microscope. RESULTS: The rate of corneal epithelial healing of the group C (dry cotton-tipped applicator) showed no statistical significance from those of the other groups. However, according to the corneal status observed under scanning electron microscope after debridement, cracks in the corneal surface in portions of group A and B were observed in contrast with no creaks in group C. CONCLUSIONS: Based on these results, corneal epithelial debridement using a cotton-tipped applicator is expected to reduce the occurrence of postoperative corneal complications. Use of a dry cotton-tipped applicator for corneal epithelial debridement in vitreoretinal surgery is suggested.

Clinical Progress in Impending Central Retinal Vein Occlusion

PURPOSE: Impending central retinal vein occlusion is associated with mild or no loss of vision; however, its progress and vision prognosis have not been clearly defined until now. Therefore, we studied the progress and prognoses in patients with impending central retinal vein occlusion. METHODS: For this study, we selected ten subjects who had been diagnosed with impending central retinal vein occlusion, and we retrospectively reviewed their progress and prognoses. RESULTS: The average age of the subjects was 31.0 years (18 to 48 years). Eight patients were male and two were female. The average observational period was 5.5 months. Six out of ten subjects were found to have no underlying systemic disease, four subjects had underlying disease. All ten patients were affected unilaterally. When initially tested, the affected eyes showed an average vision of LogMar 0.30. The final vision test revealed an average of LogMar 0.04, which indicates good progress and prognosis. In one patient, retinal hemorrhage and macular edema progressively worsened after the diagnosis, and the patient was treated with radial optic neurotomy. CONCLUSIONS: The cases of impending central retinal vein occlusion that we observed seemed to primarily affect young patients with generally good prognoses. However, in some cases, the degrees of obstruction and hemorrhage increased as time progressed. This suggests that impending central retinal vein occlusion could develop into the prodromal phase of an acute attack.

Electron Microscopy of Needle Tips Following Intravitreal Injections Using 30-Gauge Needles

PURPOSE: To observe the degree of damage in a 30-gauge injection needle by observing the changes in needle tip following an intravitreal injection with the use of a scanning electron microscope. METHODS: The present study evaluated 11 injection needles collected following the use of an intravitreal injection of bevacizumab. Ten unused injection needles were selected as the control group. Needle examination was performed using a scanning electron microscope. RESULTS: Following 11 intravitreal injections, seven bent needle tips, two stubbed needle tips and two almost normal needle tips were observed following intravitreal injections. In the control group, a single damaged needle tip was observed. CONCLUSIONS: Significant damage to the needle tip was observed following intravitreal injection using a 30-gauge injection needle. The results indicate that needles should be manipulated carefully during an intravitreal injection. Additionally, in the control group where no procedures were performed, a single injection needle with damaged status was found. These results indicate that needles should be replaced in cases in which resistance is perceived during the procedure.

Macular Infarction Associated with Reactive Arthritis

A 53-year-old woman visited the Department of Rheumatology with a chief complaint of a 3-day history of fever and chills and also presented with pain occuring in both knees at the time of outpatient visit. Based on rheumatologic and hematological lab studies, ultrasonography, and a needle aspiration biopsy of the articular cavity, the patient was diagnosed with reactive arthritis. On hospitalization day 3, consultation with the Department of Ophthalmology was requested regarding decreased visual acuity lasting for 3 days. Upon ophthalmologic examination, the corrected visual acuity was 0.1 in the right eye and 0.05 in the left eye. Upon slit lamp microscopy, there were no abnormal findings in the anterior segment. Upon fundus examination, however, there were yellow-white lesions in the macular area of both eyes. Fluorescein angiographywas performed to assess the macular lesions, and the findings were suggestive of macular infarction in both eyes. Due to a lack of other underlying disease, a past surgical history, and a past history of drug administration, the patient was diagnosed with macular infarction in both eyes associated with reactive arthritis. To date, there have been no other such cases reported. In a patient with reactive arthritis, we experienced a case of macular infarction in both eyes, which occurred without association with a past history of specific drug use or underlying disease. Herein, we report our case, with a review of the literature.

Refractive Change Caused Silicone Oil Adhesion to the Intraocular Lens Following Nd:YAG Posterior Capsulotomy

A 32-year-old female who had undergone the silicone oil removal procedure presented with visual disturbance in her left eye. Several months previous, she had cataract surgery in a private clinic, and a month later she had a Nd:YAG laser procedure for posterior capsulotomy. The slit-lamp examination revealed silicone oil droplets that had adhered to the intraocular lens where the posterior capsulotomy was performed. She had experienced high myopia as a manifestation of the resulting refractive changes. We replaced the previous intraocular lens with a new acrylic intraocular lens with resulting improvement to her vision. Here we report the case of a female patient with a history of silicone oil removal surgery where the resulting silicone bubbles had not been removed thoroughly and remained in the vitreous cavity. These bubbles subsequently adhered to the intraocular lens following YAG laser posterior capsulotomy, resulting in refractive changes. We recommend that implanting a silicone intraocular lens in anyone with a history of the silicone oil removal procedure or who has a possible history of silicone oil use should be avoided.

Valsalva Retinopathy Associated With an Oratorical Contest

A 17-year-old man presented to us with a chief complaint of decreased visual acuity accompanied by central scotoma. There was nothing unusual in his medical history other than a recent oratorical contest. At the time of initial diagnosis, the corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye. No significant findings were apparent on ophthalmic evaluation. On fundoscopy, there was a dumbbell-shaped macular bleed with a well-defined margin in the left eye. The clinical course was closely monitored along with drug therapy. Four weeks post presentation, the pre-retinal hemorrhage had nearly resolved. On fluorescein angiography, no significant findings were observed. In the left eye, the corrected visual acuity had improved to 20/25. Valsalva retinopathy is a pathology that occurs when a sudden increase in intra-thoracic pressure or abdominal pressure occurs in an otherwise healthy person. Here we report a case of Valsalva retinopathy occurring following an oratorical contest along with a review of the relevant literature.

Intraocular Pressure Change in Rabbits with Intraocular Gas During Ascending Car Travel

PURPOSE: The authors studied the change according to altitude in the intraocular pressure (IOP) of rabbit models after intravitreal gas injection. METHODS: We injected C3F8 gas (pure gas, 0.4 cc) into the vitreous cavity in six pairs of rabbits. The six rabbits were divided into the Fast group and the Slow group. After 3 days, we measured the rabbits' IOPs at five different check points along the Young-Dong Expressway while traveling in a car. RESULTS: The IOPs of the Fast and the Slow groups at each check point, respectively, were 11.83+/-2.14, 13.00+/-3.69 (p=0.518) in Won-ju (130 m), 20.00+/-2.28, 21.17+/-2.14 (p=0.382) in Hoeng-seong (560 m), 28.00+/-2.60, 24.83+/-1.94 (p=0.038) in Pyeong-chang (580 m), 30.83+/-3.60, 26.67+/-1.63 (p=0.027) in Dae-gwall-yeong (805 m) and 9.83+/-1.17, 10.83+/-2.14 (p=0.338) in Kang-neung (70 m). We found that IOP increased with increased altitude in both groups. The IOP of the Fast group was significantly higher than that of the Slow group at the Pyeong-chang and Dae-gwall-yeong check points. CONCLUSIONS: We observed that IOP increased during car travel as altitude increased. In addition, we found that the rate of ascent was a risk factor for increased IOP. Therefore, it is important to inform patients with intraocular gas to avoid fast ascents during car travel and to ascend slowly after IOP has stabilized.

Conjunctival Expansion Using a Subtenon's Silicone Implant in New Zealand White Rabbits

PURPOSE: In the field of ophthalmology, the conjunctival autograft is a useful therapeutic material in many cases, but the small size of the autograft is a disadvantage. Therefore, we evaluated the feasibility of taking an expanded sample of conjunctival tissue using a subtenon's silicone implant. MATERIALS AND METHODS: We included a total of nine rabbits; eight rabbits were operative cases, and one was a control. A portion of conjunctival tissue from the control rabbit, which did not undergo surgery, was dissected and examined to determine whether it was histologically different from the experimental group. The surgical procedure was performed on eight rabbits via a subtenon's insertion of a silicone sponge in the left superior-temporal portion; after surgery, we dropped antibiotics into the eyes. We sacrificed a pair of rabbits every three days (on days 3, 6, 9, and 12) after surgery, removed the expanded conjunctival tissues with the silicone sponge implants, and measured their sizes. RESULTS: The mean size of the expanded conjunctival tissues was 194.4mm(2). On the third day, we were able to harvest a 223.56mm(2) section of conjunctival tissue, which was the most expanded sample of tissue in the study. On the twelfth day, we removed a 160.38mm(2) section of conjunctival tissue, which was the least expanded sample of tissue. Statistically, there were no significant differences in the mean dimensions of the expanded conjunctival tissues for each time period. Microscopic examinations showed no histological differences between the expanded conjunctival tissues and the normal conjunctival tissues. CONCLUSION: The results reveal that this procedure is a useful method to expand the conjunctiva for grafting and transplantation.

The Effect of Stellate Ganglion Block in Various Types of Glaucoma

PURPOSE: To examine the effect of stellate ganglion block (SGB) in various types of glaucoma and ocular hypertension. METHODS: The subjects were chosen from patients who visited our hospital for glaucoma and postoperative ocular hypertension in the 6-month period from A to B (Ed-give the dates). SGB was performed one or four times with 15 eyes from four types of glaucoma and postoperative ocular hypertension patients. The intraocular pressure (IOP) of eyes that had undergone SGB was checked after 1 hour following SGB. We investigated the efficacy of SGB on the 15 patients. RESULTS: In primary open-angle glaucoma (POAG), early secondary glaucoma and post-operative ocular hypertension, the mean IOP of eyes that had undergone SGB decreased after 1 hour following SGB. However, in primary angle-closure glaucoma (PACG) and advanced secondary glaucoma, there was a rise in mean IOP after 1 hour following SGB. CONCLUSIONS: In the present study, SGB may be effective in treating POAG, early secondary glaucoma and postoperative ocular hypertension. However, in PACG and advanced secondary glaucoma, SGB may be considered to be harmful treatment modality.

The Effect of 9 mm, 7 mm Bilateral Superior Rectus Recession for Bilateral Dissociated Vertical Deviation

PURPOSE: To evaluate the effect of 9 mm and 7 mm bilateral recession of the superior rectus muscle in patients with bilateral dissociated vertical deviation (DVD) who had a deviation difference between the non-fixing and fixing eyes of less than 8PD. METHODS: The subjects were chosen from the patients who visited our hospital for DVD between January 2001 and November 2003. We reviewed the surgical records of 19 patients who had undergone 9 mm recession of superior rectus muscle in the non-fixing eye and 7 mm in fixing eye, and who had been followed up for at least 6 months. RESULTS: A residual DVD less than 8PD was regarded as successful. The overall success rate was 73.7%. The success rate of 10~14PD preoperative deviation of the non-fixing eye was 80.0%, and that of 15~19PD preoperative deviation of the non-fixing eye was 75.0%. However, the success rate was 66.7% in recession for the deviation over 20PD. CONCLUSIONS: Bilateral recession of 9 mm and 7 mm of the superior rectus muscle was effective for bilateral DVD in which the deviation difference of the non-fixing eye and fixing eyes was less than 8PD.

The Effect of Atropinization of Refractive Accommodative Esotropia Patients with Amblyopia

PURPOSE: The present study examined the effect of amblyopia treatment by applying atropine to patients with refractive accommodative esotropia and amblyopia. METHODS: The subjects were chosen from patients who visited the Wonju Christian Hospital for esotropia between July 2000 and July 2002. The subjects of this study included 15 patients who had refractive accommodative esotropia and amblyopia, 7 patients who could not receive visual acuity tests and showed monocular fixation. Atropine was applied to the 22 subjects, and its effect in treating amblyopia was examined. RESULTS: The fixation changed from monocular esotropia to alternating strabismus, or from healthy eye to amblyopia in 20 subjects (90.9%). Alternating strabismus continued since the dropping of atropine was stopped after the treatment of 17 subjects (77.3%), and fixating eyes changed to sound eyes in 5 subjects (22.7%). For patients who could receive visual acuity tests, 2 patients (13.4%) showed that those visual acuity did not improve by one line on the Snellen chart, and 13 patients (86.7%) showed improvement by two or more lines. CONCLUSIONS: In the present study, the effect of atropine applied to patients with refractive accommodative esotropia and amblyopia was not perfect in treating the amblyopia. However, 86.6% of them who could receive visual acuity tests showed improvement by two or more lines on the Snellen Chart, and 40.0% of them showed same visual acuity with sound eyes. In addition, in 77.3% of the subjects, the type of esotropia changed from monocular esotropia to alternating strabismus.