Anterior Ischemic Optic Neuropathy Following Periocular Autologous Fat Injection

PURPOSE: To report an unusual case of anterior ischemic optic neuropathy and choroidal ischemia after injection of autologous fat into the periorbital region due to embolism of the short posterior ciliary artery without involving the retinal artery. CASE SUMMARY: A 39-year-old female presented with sudden blurred vision, diplopia and ptosis of her left eye immediately after receiving an autologous fat injection into the periorbital area. The first ophthalmologic examination revealed that the patient s left eye had decreased visual acuity, relative afferent pupillary defect, exotropia, and hypertropia. Fundus examination of the left eye showed disc edema. Fluorescein angiography showed multiple choroidal vascular filling defects at the early phase and wedge-shaped or geographic fluorescein staining at the superior, inferior, and temporal peripheral areas at late phase. Humphrey visual field test results disclosed an inferior visual field defect. On the follow-up visit after oral steroid therapy (prednisolone 30 mg) for 7 days, diplopia disappeared and visual acuity recovered to 1.0. The inferior visual field defect and relative afferent pupillary defect were still present.

Partial Fluid-Air-Exchange at the End of 23 Gauge Sutureless Vitrectomy to Prevent Postoperative Hypotony

PURPOSE: To evaluate the efficacy and safety of partial fluid air exchange at the end of 23-gauge transconjunctival sutureless vitrectomy to prevent postoperative hypotony. METHODS: Fifty-five eyes in 49 consecutive patients who underwent partial fluid air exchange at the end of 23-gauge sutureless vitrectomy by a single surgeon at Gil Hospital between August 2007 and February 2008 were recruited for this study. Intraocular pressure (IOP), visual acuity and post-operative complications were evaluated. RESULTS: Surgical indications included proliferative diabetic retinopathy (n=31), epiretinal membrane (n=9), nondiabetic vitreous hemorrhage (n=5), vitreous opacities (n=3), and others (n=7). Two eyes showed hypotony (<6 mmHg) on postoperative day 1 and resolved within a week without any supplemental procedures. Other complications included choroidal detachment in 1 eye, hyphema in 1 eye, and transient IIOP in 2 eyes. In 38 eyes in which combined cataract surgery was performed, air bubble-related complications including iris capture by the IOL in 3 eyes (7.9%) and opacification of the posterior capsule in 11 eyes (28.9%) occurred. No case of retinal detachment or endophthalmitis was observed. The final best corrected visual acuity was 20/40 or better in 14 eyes (25.5%). CONCLUSIONS: The partial fluid air exchange shows promise as an effective and safe procedure for prevention of postoperative hypotony after sutureless vitrectomy. Air bubble-related complications after combined cataract surgery can be avoided by several techniques.

Foveal Reattachment After Scleral Buckling vs Vitrectomy for Macula-Off Retinal Detachment

PURPOSE: To compare the time course of foveal reattachment after successful surgery for macula-off retinal detachments by scleral buckling or pars plana vitrectomy (PPV). METHODS: We retrospectively examined, using optical coherence tomography (OCT), the cross-sectional retinal images of 28 patients who underwent scleral buckling or PPV for macula-off retinal detachment and whose retinas reattached upon binocular stereoscopic indirect ophthalmoscopy within 4 weeks postoperatively. All eyes underwent clinical examination and OCT scan of the macula at 6 weeks after surgery. If subretinal fluid persisted, repeated OCT was obtained at every 1~2 months until no abnormality was seen on OCT. Demographic data, including detachment characteristics, was also analyzed. RESULTS: On postoperative OCT examination 6 weeks after surgery, complete foveal reattachments were detected in 14 patients (73.7%) in the PPV group (n=19), significantly higher than 3 (33.3%) patients in the buckling group (n=9). Foveal reattachment took a mean 8.31+/-5.25 weeks in the PPV group and a mean 20.89+/-11.37 weeks in the buckling group. CONCLUSIONS: Foveal reattachment after macula-off retinal detachment occurred faster after PPV than after buckle surgery.

The Association Between Amblyopia and Anisometropia in Intermittent Exotropia

PURPOSE: To determine the frequency of amblyopia and anisometropia in intermittent exotropia and to evaluate the relationship between anisometropia and amblyopia. METHODS: The medical records of 471 intermittent extotropia patients, who were followed up over a period of 6 months and ranged from 3 to 15 years of age had been retrospectively reviewed. Anisometropia patients, who had either spherical or cylindrical anisometropia of more than 1.00D, were divided into 4 groups: spherical hyperopic anisometropia (SHA), spherical myopic anisometropia (SMA), cylindrical hyperopic anisometropia (CHA), and cylindrical myopic aniometropia (CMA). RESULTS: The frequency of amblyopia in the intermittent exotropia group was 41/471 (8.7%). Amblyopia results in a significant increase in the incidence of anisometropia and a decrease in binocular function when compared with non-amblyopic patients. In the amblyopia group, 14 patients had anisometropia (34.1%) consisting of 2 patients with spherical myopic anisometropia (SMA), 2 patients with spherical hyperopic anisometropia (SHA), 2 patients with cylindrical myopic anisometropia (CMA) and 8 patients with cylindrical hyperopic anisometropia (CHA). In the anisometropia group (n=56) 14 patients (25.0%) had amblyopia and in the non-anisometropia group (n=415) 27 patients (6.5%) had amblyopia. CONCLUSIONS: Intermittent exotropia is susceptible to amblyopia, especially when combined with anisometropia. Among the 4 types of anisometropia, cylindrical hyperopic anisometropia has a higher risk for developing amblyopia.

Sclerotomy-related Retinal Breaks in Vitrectomy for Proliferative Diabetic Retinopathy: 20- vs 23-Gauge Systems

PURPOSE: To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR). METHODS: Medical records of 62 consecutive eyes of 54 patients who underwent 20-gauge pars plana vitrectomy (PPV) and 63 consecutive eyes of 55 patients who received 23-gauge transconjunctival sutureless vitrectomy were retrospectively reviewed. RESULTS: Three (4.8%) out of 62 eyes in the 20-gauge group had SRRB and 1 (1.6%) eye developed retinal detachment at 4 months postoperatively, while 2 (3.2%) out of 63 eyes in the 23-gauge group had SRRB and 1 (1.6%) eye developed retinal detachment at 3 months postoperatively. CONCLUSIONS: There were no significant differences in the rates of sclerotomy-related retinal breaks and sclerotomy-related retinal detachments between 20-gauge PPV and 23-gauge PPV for PDR.

2006 Survey for KSCRS Members: Current Trends in Refractive Surgery in Korea

PURPOSE: To investigate the current situation and future trends in the field of refractive surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been annually surveyed on cataract and refractive surgery. The 2006 annual survey, consisting of 63 multiple-choice questions, was mailed in July 2007 to 298 KSCRS members. Forty-eight (16.1%) of the members responded to the survey. The current data were compared with those of previous annual surveys and with those of the USA. RESULTS: The society members in their forties accounted for the highest percentage (39%) of the respondents, and LASIK was the most common (50%) of the refractive surgeries. Among the possible complications that arise after refractive surgeries, the regression of corrected vision after PRK, and dry eye syndrome after LASIK accounted for the highest proportion. LASIK was preferred for patients with myopia less than -12 diopter, and phakic IOL was preferred for patients with myopia more than -12 diopter. Almost all of the respondents answered that the most promising refractive surgery is LASIK or phakic IOL. CONCLUSIONS: This survey summarized current trends and changes in cataract and refractive surgery in Korea.

Endogenous Candida Endophthalmitis with Bilateral Massive Submacular Abscess

PURPOSE: We present a case of endogenous endophthalmitis in which the patient presented with an overall clinical picture suggestive of bacterial endophthalmitis but was subsequently found to have Candida endophthalmitis. CASE SUMMARY: A 50-year-old man with hepatic encephalopathy and alcoholic liver cirrhosis who was treated in gastroenterology presented with reduced vision in both eyes. Indirect ophthalmoscopy showed bilateral massive submacular abscesses and surrounding retinal hemorrhage. In view of the initial fundal picture of a submacular abscess lesion, the subacute course of the disease, and a medical history of diabetes and liver cirrhosis, a provisional diagnosis of bacterial endophthalmitis was made. Treatment with topical and systemic empirical antibiotics was immediately initiated. CONCLUSIONS: Candida albicans should be considered in the differential diagnosis of endogenous endophthalmitis when massive submacular abscesses and hemorrhage are seen.