Combined Clear Corneal Phacoemulsification and Vitrectomy Versus Two-Step Surgery in Korean Patients With Idiopathic Epiretinal Membrane

PURPOSE: To evaluate the surgical outcomes on the combined procedures of phacoemulsification, intraocular lens (IOL) implantation, and vitrectomy, and to compare clinical results with sequential surgery results in Korean patients with idiopathic epiretinal membrane. METHODS: The present retrospective study included 20 eyes of 19 patients with idiopathic epiretinal membrane who underwent combined phacoemulsification, IOL implantation, and pars plana vitrectomy (combined surgery), and 18 eyes of 18 patients who underwent phacoemulsification and IOL implantation subsequent to vitrectomy (sequential surgery). Postoperative clinical results and intra- and postoperative complications were compared between the 2 groups. RESULTS: Postoperative best corrected visual acuity (BCVA) (logMAR) was 0.41 +/- 0.42 in the combined group, and 0.35 +/- 0.37 in the sequential group. There was no significant difference in BCVA between the 2 groups (p = 0.675). The mean refractive prediction error was -0.46 +/- 0.88 diopters (D) in the combined group, and -0.06 +/- 0.68 D in the sequential group, showing no statistically significant difference between the 2 groups (p = 0.147). The present study showed no major differences between the 2 groups in complications such as intraoperative mild corneal edema, postoperative ocular hypertension, and lens capsular opacity. CONCLUSIONS: Combined phacoemulsification, IOL implantation, and pars plana vitrectomy as well as the two-step procedure are safe and effective for treating patients with idiopathic epiretinal membrane.

Analysis of Postoperative Macular Edema in Cataract Patients with Diabetes using Optical Coherence Tomography

PURPOSE: To evaluate the incidence and progression of macular edema (ME) and associated risk factors in diabetic patients. METHODS: In a prospective study, 66 eyes were assessed by optical coherence tomography (OCT) and best-corrected visual acuity was checked before operation at one and three months after operation. ME was defined as an increase of central macular thickness (CMT) by 30% or more after surgery than before operation, as measured by OCT. RESULTS: The incidence of ME in diabetic patients was 8.8%. The increment of CMT at three months after cataract surgery was statistically significant in the patients of diabetic duration> or =10 years (p=0.049). But insulin treatment, the severity of diabetic retinopathy, diabetic nephropathy and hemoglobin A1C were not significant risk factors for ME. CONCLUSIONS: The OCT might be useful to assess the ME after cataract surgery in diabetic patients. In the patients who had long been suffered from diabetes, the incidence of ME could be higher, so cataract surgery should be carefully considered.

Short-term Efficacy of Intravitreal Ranibizumab for Myopic Choroidal Neovascularization

PURPOSE: To evaluate the effects of intravitreal ranibizumab in myopic choroidal neovascularization (CNV). METHODS: Patients who underwent intravitreal ranibizumab injection for myopic CNV, and were followed up more than 6 months, and their records were retrospectively investigated. The best corrected visual acuity, central macular thickness, and leak in fluorescein angiography were compared at baseline, and at 1, 3, and 6 months after injection. RESULTS: Twenty-one eyes of 18 patients were evaluated. The mean best corrected visual acuity (logMAR) was 1.23+/-0.65, 0.96+/- 0.40, 0.95+/-0.67, and 0.83+/-0.58 at baseline, 1, 3, and 6 months, respectively (p<0.001, p=0.006, p=0.001). The mean central macular thickness was 233.42+/-65.55 microm, 204.14+/-65.29 micrometer, and 157.76+/-71.45 microm at baseline, 3, and 6 months, respectively (p<0.001). In fluorescein angiography at 6 months after injection, regression was observed in 12 eyes, and fibrosis in 9 eyes. CONCLUSIONS: Intravitreal ranibizumab injection for myopic CNV in Korean patients appeared to be effective, resulting in regression of lesion and improvement of visual acuity.

The Statistical Observation of Ocular Injury

PURPOSE: To investigate the regional characteristics and changing history in the era of ocular injuries, in order to use the results for the treatment and prevention of ocular injuries. METHODS: A retrospective survey was performed with 372 patients, who were hospitalized due to ocular injuries from January 1, 1996 to December 31, 2005, using the year 2000 as the divider for establishing the 2 groups. The change of incidence in industrial ocular injuries, sex, age, distribution of season, side, mode, cause, nature, primary ocular surgery, complications, secondary operation, and change in visual acuity were reviewed statistically. RESULTS: The number of patients in group one was 223 and 149 in group two with a greater incidence in males (87.9%). The incidence peaked at the third decade of age in group 1, and at the fifth decade in group 2. The incidence was highest in the autumn in group 1, and in the spring in group 2. Regarding the mode of ocular injury, industrial injury was the most common, and ocular injuries from violence, traffic accidents and sports increased. Within the two groups, the most common cause of injury involved a piece of iron, and the most common surgery was primary corneal closure. The most common complication was corneal opacity. There was no statistical difference in the improvement of visual acuity between the two groups (p=0.251). CONCLUSIONS: This survey gathered the characteristics and changing history in the era of ocular injuries in order to use the results for the treatment and prevention of ocular injuries.

The Relationship of Hypertropia, Inferior Oblique Overaction and Extorsion in Congenital Superior Oblique Palsy

PURPOSE: To evaluate the correlation among hypertropia, inferior oblique overaction (IOOA), and extorsion. METHODS: Thirty-one patients with congenital unilateral superior oblique palsy were evaluated. Visual acuity tests, refraction tests, ocular movement tests, prism cover tests, and fundus photography were performed. The correlations of vertical deviation, IOOA, and extorsion were analyzed. The operation method involved weakening the inferior oblique muscle, and then a comparison was made between measurements 1 month preoperative and 1 month postoperative for vertical deviation, inferior oblique overaction, and extorsion. RESULTS: On average, preoperative hypertropia was 8.84+/-6.88 prism diopters (PD), IOOA was 2.20+/-0.69, and extorsion was 18.06+/-5.83 degrees. The Pearson's correlation of IOOA and extorsion, hypertropia and IOOA, and extorsion and hypertropia were r=0.620, r=0.327, and r=0.126, respectively. Postoperative hypertropia, IOOA, and extorsion were reduced to 1.42+/-3.11PD, 0.42+/-1.11, and 8.63+/-5.09, respectively. CONCLUSIONS: Both extorsion and hypertropia showed significant positive correlations with IOOA, whereas hypertropia and extorsion revealed somewhat weaker positive correlations in congenital monocular superior oblique palsy. In addition, the amount of hypertropia was reduced, and extorsion and IOOA improved after recession of the inferior oblique muscle.

The Effect of Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

PURPOSE: To determine whether photodynamic therapy (PDT) is effective and safe for the treatment of chronic central serous chorioretinopathy (CSC) in Korean patients. METHODS: Eleven eyes of 11 patients with chronic CSC underwent PDT. The laser spot size was chosen to cover the hyperfluorescent area on indocyanine green (ICG) angiography principally and to cover wide area including leaking point or detachment of retinal pigment epithelium on fluorescein angiography. We analyzed the medical records retrospectively to know the changes in visual acuity and serous detachment. RESULTS: The mean follow-up was 14.2+/-6 months and exudative macular detachments resolved completely in 11 eyes within 1 month. In addition, eight weeks after treatment, the visual acuity improved in 3 eyes, and remained unchanged in 7 eyes and decreased in one eye. However, in 2 eyes, visual acuity decreased immediately after PDT due to choroidal hypoperfusion, and in one of them, the final visual acuity did not recover to the pre-treatment level. CONCLUSIONS: In Korean patients, PDT seems to be effective for treatment of chronic CSC in the short term, but the long-term efficacy still must be determined. In addition, in PDT used for treatment of choroidal neovascularization (CNV), there was a possibility of irreversible occlusion in normal choroidal capillaries. Further studies are needed to determine the treatment parameters of PDT.