Type III Usher Syndrome in the Republic of Korea

Purpose@#To report a case of type III Usher syndrome that has not been previously reported in the Republic of Korea.Case summary: A 39-year-old female visited the local eye clinic for ophthalmic evaluation and then visited our ophthalmologydepartment due to a need for further evaluation and proper management. She complained of night blindness after she becamean adult. She underwent a funduscopic examination, which revealed decolorization and atrophy of the retinal pigment epithelium,bony spicule pigmentation in the retina, and thinning of the retinal arteriole. Results of an electroretinogram and electrooculogramrevealed that responses were weak. She was diagnosed with the fourth grade of hearing impairment according to hermedical history. There was no mental retardation. According to her family history, her mother had hypermetropia, and her brotherhad astigmatism. There was no other medical history, including ophthalmic history. She was diagnosed with type III Usher syndromebased on ataxia and the dynamic visual acuity test. @*Conclusions@#It may be necessary to consider a genetic disease by assessing other systemic symptoms when a patient with retinitispigmentosa is diagnosed.

Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy

PURPOSE: To evaluate the effect of oral spironolactone for non-resolving chronic central serous chorioretinopathy after intravitreal bevacizumab injection.METHODS: Seventeen eyes of 17 patients with non-resolving chronic central serous chorioretinopathy after intravitreal bevacizumab injection from September 2017 to December 2018 were treated with oral spironolactone for 6 months, and changes in central macular thickness, subretinal fluid height, and best-corrected visual acuity (BCVA) were analyzed retrospectively.RESULTS: The central macular thickness decreased from 309.94 ± 105.20 µm at baseline to 259.76 ± 81.83 µm at 3 months, and 243.11 ± 61.98 µm at 6 months, which were both statistically significant (Wilcoxon signed-rank test, p = 0.016 and p = 0.001, respectively). The subretinal fluid height decreased from 138.05 ± 95.69 µm at baseline to 70.88 ± 83.13 µm at 3 months, and 54.00 ± 56.25 µm at 6 months, which were both statistically significant (Wilcoxon signed-rank test, p = 0.002 and p = 0.000, respectively). The BCVA (LogMAR) changed from 0.30 ± 0.38 at baseline to 0.35 ± 0.43 at 1 month, 0.29 ± 0.43 at 3 months, and 0.26 ± 0.40 at 6 months. The results at 6 months were statistically significant (Wilcoxon signed-rank test, p = 0.033). There were no side effects in patients treated with oral spironolactone.CONCLUSIONS: In chronic central serous chorioretinopathy, treatment with oral spironolactone significantly reduced the central macular thickness, subretinal fluid height, and the BCVA, without side effects.

The Prevalence and Clinical Characteristics of Charles Bonnet Syndrome in the Republic of Korea

PURPOSE@#To report the clinical characteristics and prevalence of Charles Bonnet syndrome (CBS) in patients with retinal diseases in the Republic of Korea.@*METHODS@#Patients with deterioration of visual acuity or visual field or episodes of complex visual hallucination (cVH) with retinal diseases between March 2019 and June 2019 at the retinal outpatient clinic of the Chonbuk National University Hospital were selected to answer standardized questions to determine whether they had symptoms of CBS.@*RESULTS@#The selected 303 patients from the total of 2,916 patients were comprised of 163 males (53.8%) and 140 females (46.2%). The mean age of the patients was 66.0 ± 15.1 years. six patients (2.4%) of 245 with no response to initial question in 301 with best-corrected visual acuity less than finger counting and two patients with experience of cVH were diagnosed with CBS. Most patients had seen a wide variety of hallucinations, including objects, people, and scenery, with negative emotions, for > 1 year. The hallucinations were experienced daily with the same frequency. Negative feelings such as fear and worry improved when they received appropriate patient education about the hallucinations.@*CONCLUSIONS@#The prevalence of CBS in the Republic of Korea is higher than previously reported. We found that relatively young patients with visual impairment could experience cVH from CBS. CBS patients experienced negative emotions for long periods due to the hallucinations which decreased their quality of life. CBS should be considered during the differential diagnosis of cVH in patients with visual impairment due to ophthalmic diseases. We should also provide appropriate patient education to assist them in understanding more fully the clinical characteristics of CBS.

The Correlation between Preoperative En Face Optical Coherence Tomography and Postoperative Visual Prognoses in Idiopathic Epiretinal Membranes

PURPOSE: To investigate the correlation between en face optical coherence tomography and improvements in the postoperative prognoses of idiopathic epiretinal membranes. METHODS: The medical records of 59 epiretinal membrane patients who had epiretinal membrane peeling between January 2005 and January 2016, and were followed up for > 12 months, were retrospectively reviewed. The preoperative en face images were divided into four sections involving three circular areas (6,000 µm diameter circle, 3,000 µm diameter circle, and 1,000 µm diameter circle) and one square (6,000 × 6,000 µm). The surface area where no epiretinal adhesion was present was quantified by measuring the number of black pixels using image-editing software (Adobe Photoshop CS6, Adobe Systems, San Jose, CA, USA). Then the correlations among the value of black pixels, preoperative and postoperative visual acuities, and central retinal thickness were analyzed. RESULTS: The best-corrected visual acuity (BCVA) was significantly increased after epiretinal membrane peeling (p < 0.001), and the central retinal thickness was significantly decreased (p < 0.001). As the number of black pixels in the circles and the square in the en-face images increased, the postoperative BCVA significantly increased (r = 0.645, p < 0.001; r = 0.590, p < 0.001, respectively). CONCLUSIONS: As the nonadhesive surfaces of the epiretinal membrane and the retina in preoperative en face images became wider, the increments of the BCVA after surgery were greater. Therefore, en face optical coherence tomography can be used to predict prognosis after epiretinal membrane peeling.

The Clinical Manifestations and Differential Diagnosis of Tuberculosis Serpiginous-like Choroiditis and Serpiginous Choroiditis

PURPOSE: The purpose of this study is to make a distinction between tuberculous serpiginous-like choroiditis and serpiginous choroiditis, and compare their clinical manifestations. METHODS: We retrospectively reviewed thirty eight eyes of twenty-six patients who visited our institution and were diagnosed with serpiginous choroiditis from January 2005 to December 2014. The patients were divided into two groups, tuberculosis serpiginous- like choroiditis (Tb-SLC) and classic serpiginous choroiditis (classic SC), and were analyzed based on the treatment response, previous history of Bacillus Calmette–Guérin (BCG) vaccination, positive results of tuberculin skin test (TST), chest X-ray, anterior and fundus examination, and fluorescein angiography (FAG). RESULTS: Twenty seven eyes of eighteen patients were serpiginous choroiditis and eleven eyes of eight patients were tuberculosis serpiginous-like choroiditis. There were no significant differences in age, sex, or previous history of BCG vaccination between the two groups. The positive result of the tuberculin skin test and abnormality in the chest X-ray were shown to be significantly higher in the Tb-SLC group. Multi-focal lesions involving periphery observed in fundus examination and FAG were significantly higher in Tb-SLC. CONCLUSIONS: In tuberculosis endemic areas such as Korea, tuberculosis serpiginous-like choroiditis should be considered as a differential diagnosis when the patient is suspicious of serpiginous choroiditis. The understanding of various clinical manifestations of tuberculosis serpiginous-like choroiditis may derive accurate diagnosis and treatment, enhancing patient's prognosis.

The Effect of Mitomycin C Instillation after Silicone Intubation in Adult Partial Nasolacrimal Duct Obstruction

PURPOSE: To compare the result of mitomycin C (MMC) instillation after silicone intubation in partial nasolacrimal duct obstruction in adults according to duration of instillation. METHODS: An instillation of 0.04% MMC eyedrops was performed on 61 eyes of 38 patients diagnosed with partial nasolacrimal duct obstruction. The clinical result of patient groups, classified according to duration of MMC eyedrops instillation, was analyzed prospectively. The patients groups was as follows: no MMC eyedrop instillation (group A), 1 week of MMC instillation (group B), 2 weeks of MMC instillation (group C), and 3 weeks of MMC instillation (group D). RESULTS: Among all patients, 50 eyes (81.9%) showed improved symptoms. Fifteen eyes (71.4%) in group A, 8 eyes (72.7%) in group B, 13 eyes (86.7%) in group C and 14 eyes (100.0%) in group D had a successful outcome. The success rate was observed in groups D, C, B, and A, in descending order, which was statistically significant (p = 0.025). CONCLUSIONS: Silicone intubation is an effective treatment option for partial nasolacrimal duct obstruction in adults and MMC eyedrop instillation may improve silicone intubation results.

Comparison of Dacryocystographic Results Before and After Silicone Intubation in Incomplete Nasolacrimal Duct Obstruction

PURPOSE: To compare the dacryocystographic results before and after silicone tube intubation in partial nasolacrimal duct obstruction. METHODS: Dacryocystography was performed on 33 eyes of 17 patients diagnosed with partial nasolacrimal duct obstruction. The anteroposterior (AP) diameters and the mediolateral diameters of the nasolacrimal ducts intubated at the operation were measured by dacryocystography, before the operation and after silicone tube removal. RESULTS: The mean AP, mediolateral diameter and length of nasolacrimal duct in the group who demonstrated improvement after the operation was 2.32 mm, 1.39 mm, and 17.14 mm before the operation, and 2.40 mm, 1.77 mm, and 17.38 mm after the operation, respectively. The mean AP, mediolateral diameter and length of nasolacrimal duct in the group who demonstrated no symptomatic improvement was 2.06 mm, 1.28 mm, and 17.42 mm before the operation, and 2.75 mm, 1.99 mm, and 18.03 mm after the operation, respectively. The alteration of the nasolacrimal duct size in the group with successful postoperative results compared with unsuccessful postoperative results showed no significant difference. CONCLUSIONS: The nasolacrimal duct showed expansion in size based on dacryocystographic results after silicone tube intubation in partial nasolacrimal duct obstruction. However, the operation results and the alteration of the nasolacrimal duct size based on dacryocystographic results demonstrated no accordance.

Comparison of Methicillin-Sensitive Staphylococcus Epidermidis (MSSE) Keratits and Methicillin-Resistant Staphylococcus Epidermidis (MRSE) Keratitis

PURPOSE: To investigate the clinical features and treatment outcomes between methicillin-sensitive Staphylococcus epidermidis (MSSE) and methicillin-resistant Staphylococcus epidermidis (MRSE) keratitis groups. METHODS: A retrospective analysis of case series was conducted of all patients with keratitis caused only by Staphylococcus epidermidis from January 1997 through December 2008. Sex, age, history of trauma, systemic disease, previous ocular history, antibiotic sensitivity test results, and treatment outcomes were evaluated. Patients were categorized into two groups as MSSE and MRSE according to methicillin-sensitivity result, and a comparative analysis was performed. RESULTS: There were no significant differences in clinical features, such as risk factors or size or location of keratitis between the two groups. All MSSE and MRSE isolates were sensitive to vancomycin, moxifloxacin, and levofloxacin. All MSSE and 17%, 50%, 52%, and 57% of MRSE isolates were sensitive to cephalothin, norfloxacin, ciprofloxacin, and erythromycin, respectively (p < 0.05). There was no significant difference in visual acuity between the two groups. CONCLUSIONS: All MSSE and MRSE isolates were sensitive to vancomycin and to third- or fourth-generation fluoroquinolones In addition, approximately 50% of MRSE isolates were sensitive to norfloxacin and ciprofloxacin. There were no significant differences in clinical features of keratitis caused by MSSE versus those of MRSE isolates. Both keratitis groups had relatively good visual prognoses.

Effect of Simultaneous Intravitreal Bevacizumab and Retrobulbar Triamcinolone Injection in Refractory Neovascular Glaucoma

PURPOSE: To identify the regression of neovascularization and relief of other symptoms after intravitreal bevacizumab and retrobulbar triamcinolone injection in neovascular glaucoma patients with no possibility of visual acuity recovery. METHODS: A total of 15 eyes in 15 patients with neovascular glaucoma, who had no possibility of visual acuity recovery and could not be treated with surgical intervention despite pain from October 2008 to May 2009, were reviewed retrospectively. Changes in degree of pain, conjunctival injection, revascularization, and visual acuity were evaluated after injection. RESULTS: Ten of the 15 (67%) neovascular glaucoma patients were male, with a mean age of 62.50+/-12.79 years. The most common prediposing ocular disease was diabetic retinopathy (9; 60%), and the others were central retinal vein occlusion (4: 26%), central retinal artery occlusion (1; 7%), and uveitis (1; 7%). Change in intraocular pressure was significant (p<0.001), as were decreases in the degrees of pain and conjunctival injection (p<0.001, <0.001) after the injections. Regression of neovascularization continued in 13 patients (87%) after two months. CONCLUSIONS: Intravitreal bevacizumab and retrobulbar triamcinolone injection is a safe intervention that can substantially relieve pain experienced by neovascular glaucoma patients.