Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months

PURPOSE: In this study we compared the effectiveness between half energy photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection for chronic central serous chorioretinopathy (CSC). METHODS: Forty-five eyes of 42 patients diagnosed as chronic CSC from March 2008 to April 2011 were treated with half energy PDT or IVB injection. The subjects were chosen for a retrospective study and analysis was performed on changes in best corrected visual acuity and existence of subretinal fluid, recurrence rate and changes in central macular thickness. RESULTS: Similar improvement of visual acuity was observed in both treatment groups 1 month after treatment and no meaningful difference was found in each stage for both groups (p = 0.001, p = 0.0012, respectively). However, 6 to 12 months after the treatment, the half energy PDT group showed more improvement in visual acuity compared to the IVB injection group (p = 0.019, p = 0.043, respectively). Nineteen out of 21 cases showed full recovery of subretinal fluid in the half energy PDT group with an average treatment period of 1.3 +/- 0.8 months and 7 out of 24 cases showed full recovery in the IVB injection group with an average treatment period of 3.2 +/- 2.8 months. There was a single case of recurrence in the half energy PDT group and 4 in the IVB injection group. The half energy PDT group showed a meaningful decline in central macular thickness at 1, 3, and 6 months after treatment (p = 0.001, p = 0.005, p = 0.007, respectively) compared to the IVB injection group and showed numerous cases with decline in central macular thickness below the 2 standard deviation from normal values (p = 0.002). CONCLUSIONS: Both half energy PDT and IVB injection were effective for the treatment of chronic central serous chorioretinopathy. However, the half energy PDT group comparatively showed better anatomical and functional outcomes. The thinning of central macular thickness below normal value was also observed, thus careful choice of treatment is necessary for patients with chronic central serous chorioretinopathy.

Preoperative Ocular Aberrations Measured by Zywave(R) II Aberrometer in Individuals Screened for Refractive Surgery

PURPOSE: To report the distribution of ocular higher-order aberrations in candidates for refractive surgery measured by Zywave(R) II aberrometer. METHODS: The present study included 232 eyes of 116 subjects. Ocular aberration data were obtained by measurements per eye using Zywave(R) II aberrometer. The mean Zywave spherical equivalent (SE) and higher order aberrations (HOAs) calculated in the central 6-mm zone and expressed as root mean square (RMS) values were analyzed. Correlation analysis was performed to assess the association between ocular HOAs and gender, age, SE refractive error, or central corneal thickness (CCT) and investigate the aberration symmetry between right and left eyes. RESULTS: The average SE was-4.67 +/- 1.83 diopters (D). The mean RMS values of total HOA, 3rd, 4th or 5th summated HOAs, coma, trefoil and spherical aberration (SA) were 0.421 +/- 0.201 microm, 0.346 +/-0.206 microm, 0.202 +/- 0.105 microm, 0.087 +/- 0.048 microm, 0.241 +/- 0.172 microm, 0.225 +/- 0.154 microm and 0.136 +/- 0.102 microm, respectively. There was no significant differences of the mean total HOA, summated HOAs, coma, trefoil and SA between genders, age and refractive errors, but the 3rd order trefoil was strongly related with myopia (r = -0.900, p = 0.008). There was symmetry of ocular aberrations between both eyes and the ocular aberrations were not correlated with CCT. CONCLUSIONS: Herein, we report the normative distribution of ocular aberrations in the myopic Korean population measured by Zywave(R) II aberrometer. The 3rd order trefoil and myopia were correlated and mirror symmetry was observed between right and left eyes.

A Case of Purtscher's Retinopathy with Diffuse Serous Macular Detachment

PURPOSE: To report a case of Purtscher's retinopathy with diffuse serous macular detachment. CASE SUMMARY: A 63-year-old male patient presented to the hospital with decreased visual acuity. Three days prior to visiting the hospital, he had an blunt injury to the thoracic region caused by a steel beam, and his best corrected visual acuity was 20/50 in the right eye and 20/160 in the left eye. On slit lamp examination nothing unusual was observed in either eye, but fundus examinations showed retinal hemorrhages and a cotton wool spots on the posterior pole of the left eye and nothing unusual in the right eye. On fluorescein angiography, severe nonperfusion was observed at the posterior pole of the left eye. On optical coherence tomography, there was diffuse serous retinal detachment at the posterior pole and inferior retina of the left eye while mild subretinal fluid was observed at the posterior pole of the right eye. Under the suspicion of Purtscher's retinopathy in both eyes, oral prednisolone (40 mg) was prescribed and the dosage was gradually reduced. Six weeks after the treatment, best corrected visual acuity improved to 20/20 in the right eye, and 20/30 in the left eye. Additionally, subretinal fluid in the right eye completely disappeared. CONCLUSIONS: Purtscher's retinopathy is known as an ocular disease occurring after traumatic events. However, serous detachment of the macula has rarely been observed in Purtscher's retinopathy, and herein we report a case with diffuse serous macular detachment which responded to oral steroid treatment.

A Case of Orbital Abscess with Central Retinal Artery Occlusion

PURPOSE: To report a case of rapidly progressed orbital abscess after central retinal artery occlusion. CASE SUMMARY: A 60-year-old man with right periorbital pain and edema starting 3 days earlier visited the hospital. His first visual acuity was 1.0 for the right eye with peripheral edema and tenderness; severe hemorrhagic chemosis, proptosis (approximately 3 mm) and extraocular motility limitation were also observed. According to the CT findings, a 2.5 x 1 cm-sized encapsulated cystic mass was found in the right orbital cavity, along the medial orbital wall; with a diagnosis of orbital abscess, he was hospitalized with systemic antibiotic treatment and abscess drainage. On the second day of hospitalization, the best corrected visual acuity was reduced to light perception, and relative afferent pupillary defect, pale retina and cherry red spot were found. Therefore, emergent incisional drainage, optic massage, and antibiotics were given to the patient. Immediately after the surgery, the peripheral edema and proptosis improved; nevertheless, central retinal artery occlusion did not resolve and vision did not improve. Two months later, best corrected visual acuity for the right eye was counting fingers and central retinal artery occlusion showed no further improvement. CONCLUSIONS: No case report on rapidly progressing orbital abscess has been proposed in Korea to date. In the case of rapidly progressed orbital abscess, incisional drainage and antibiotics should be administered promptly.

A Case of Cardiac Tamponade due to Primary Hypothyroidism

Pericardial effusions occur in approximately 30% of patients with untreated hypothyroidism. The effusions are more common in patients with longstanding, severe disease. But, cardiac tamponade is a very rare complication, because of the elasticity of pericardium and slow progression. We experienced a 61 year old female patient with cardiac tamponade due to primary hypothyroidism. She was treated with pericardiocentensis and thyroid hormone replacement, confirmed by echocardiography,thyroid function test and TRH stimulation test.

Persistent Truncus Arteriosus with Survival to the Age of 29 Years

The Truncus arteriosus is a congenital malformation in which only one great artery arises from the base of the heart and gives origin to the systemic, pulmonary and coronary arteries proximal to the aortic arch. Pulmonary blood flow is governed by the size of the pulmonary arteries and the pulmonary vascular resistance. In infancy, pulmonary blood flow is usually excessive because pulmonary vascular resistance is not greatly increased. Thus, despite an obligatory admixture of systemic and pulmonary venous blood in the common trunk, only minimal cyanosis is present. Rarely pulmonary blood blood flow is restricted by hypoplastic or stenotic pulmonary arteries arising from the truncus. The prognosis in persistent truncus arteriosus is very poor. the median age of survival of the 94 patients with the disease reported up to 1962 was only five weeks. The longest survival reported is the case of the man described by Carr et al who lived to the age of 36 years and 2 months. We report the case of a man with persistent truncus arteriosus who lives to the age of 29 years.

A Case of Isolated ACTH Deficiency Accompanied by hyperprolactinemia / 대한내분비학회지

Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.