A Novel Method for Hyperacuity Measurement

PURPOSE: We developed a novel method for measurement of hyperacuity and verified the utility thereof.METHODS: We developed a three-dimensional (3D) hyperacuity test using a 3D liquid crystal flat screen, a left- and right-image polarized display, and liquid crystal shutter glasses. We tested the technique in three groups: normal (n = 48), with cataracts (n = 14), and with macular disease (n = 35). We used a chart consisting of five dots and a reference line. Of the five dots, one was variably shifted from the other dots. A chart was presented to one eye and the reference line or blank image to the other eye; a subject scored positive when the dot in the unusual position was recognized.RESULTS: Hyperacuity was measured in terms of the reference line seen by the reference eye (RR), a blank image seen by the reference eye (RB), the reference line seen by the contralateral eye (CR), and a blank image seen by the contralateral eye (CB). All test scores were significantly lower when the reference line was seen than not (RR vs. RB and CR vs. CB; p < 0.01, respectively). For the RR and CR tests, no significant difference was apparent between the normal and cataracts group (p = 0.553, p = 0.494) but such differences were evident between the normal and macular disease groups (p = 0.028, p = 0.002). Also, visualization of the reference line by the reference and contralateral eyes did not differ (p > 0.05).CONCLUSIONS: Measurement of hyperacuity using our new method was not affected by media opacity but was significantly affected by macular disease. Presentation of a reference line facilitated hyperacuity assessment.

Change in Subfoveal Choroidal Thickness after Argon Laser Panretinal Photocoagulation / 이화의대지

OBJECTIVES: To evaluate changes in subfoveal choroidal thickness (SFCT) and macular thickness as measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) after argon laser panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy. METHODS: This prospective, comparative case series included 21 patients (28 eyes) with severe diabetic retinopathy. All patients underwent three sessions of PRP. The SFCT and macular thickness were measured using EDI-OCT at baseline and one week after completion of 3 sessions of PRP. RESULTS: SFCT before PRP was 318.1±96.5 µm and increased to 349.9±108.3 µm; P=0.001 after PRP. Macular thickness significantly increased at one week after PRP from 273.1±23.9 µm at baseline 295.8±25.3 µm at one week; (P<0.001). No significant relationship between the changes in macular thickness and SFCT was observed (r=−0.13, P=0.52). CONCLUSION: PRP induced increases in both SFCT and macular thickness. Changes in SFCT did not correlate with changes in macular thickness.

Ocular Manifestations of Sarcoidosis: An Ophthalmologist's View / 한양의대학술지

Sarcoidosis is a granulomatous disease which frequently involves eyes and adnexal tissues. Its prevalence of ocular involvement is reported as about 20%, although it varies widely according to authors, from 12% to 73%. Ocular sarcoidosis is present as various forms - uveitis, conjunctival involvement, optic nerve involvement, and orbital involvement. All the forms of uveitis - anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis - can be shown in sarcoidosis. Because clinical manifestation, prognosis and treatment are determined by the location of uveitis, it is important to classify uveitis. Conjunctival involvement is not a sight-threatening condition in general, its diagnostic value may be of use. Optic nerve is the most commonly involved cranial nerve, which can impair vision. Subjects with visual impairment without any evidence of uveitis, optic nerve involvement should be suspected. Orbital involvement, especially lacrimal gland involvement is common, and it may cause mass-effect. Besides systemic administration of drugs, there are several localized treatments for ocular sarcoidosis - topical eye drops, intra/peri-ocular injection of agents.

Celebrating the 70th anniversary of Ewha Womans University School of Medicine; Interview with Dean / 이화의대지

No abstract available.

Internal Jugular Vein Thrombosis Presenting with Elevated Intraocular Pressure

PURPOSE: To report a case of elevated intraocular pressure (IOP) caused by internal jugular vein thrombosis. CASE SUMMARY: A 58-year-old male diagnosed with diabetic retinopathy visited our clinic for a regular checkup. On ophthalmic examination, IOP was 30 mm Hg in the right eye and 28 mm Hg in the left eye. Slit lamp examination showed chemosis, conjunctival injection and slight corneal edema in both eyes. Additionally, gonioscopic examination showed open angle. We observed face edema that started 1 month prior and he was diagnosed with internal jugular vein thrombosis on the right side, internal jugular vein and innominate vein stenosis on the left side approximately 2 months ago. The patient underwent percutanoeus transluminal angioplasty for dilating stenosed vessel. Four days after the procedure, his IOP was 15 mm Hg in the right eye and 12 mm Hg in the left eye based on Goldman applanation tonometer and was well maintained. CONCLUSIONS: Internal jugular vein thrombosis on both sides can cause an increase in IOP.

Changes in Subfoveal Choroidal Thickness in Malignant Hypertension Patients

PURPOSE: To evaluate changes in subfoveal choroidal thickness in patients with malignant hypertension. METHODS: A total of 12 eyes of six malignant hypertension patients were included in the present study. Intraocular pressure, blood pressure (systolic and diastolic), and choroidal thickness were measured before and after blood pressure control. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). The changes in choroidal extravascular density of the EDI-OCT image after blood pressure control were evaluated by comparing brightness values obtained with Adobe Photoshop software. RESULTS: The subfoveal choroidal thickness (SFCT) of malignant hypertension patients was 412.63 +/- 66.55 microm (mean +/- SD), which was thicker than in normal patients. After blood pressure control, SFCT decreased significantly to 356.96 +/- 59.08 microm (mean +/- SD) (p = 0.002). The choroidal extravascular density of the EDI-OCT image decreased after blood pressure control (p = 0.002), and the mean change was 17.21 +/- 7.56. CONCLUSIONS: The choroid is thickened in patients with malignant hypertension, and its thickness decreases after blood pressure control. This suggests that changes in blood pressure may affect choroidal thickness.

A Three-year Follow-up of Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Diffuse Diabetic Macular Edema

PURPOSE: To report the three-year outcomes of macular laser photocoagulation following intravitreal injection of triamcinolone acetonide (IVTA) for diffuse diabetic macular edema (DME). METHODS: A prospective, randomized controlled study was completed. Eighty-six eyes of 74 patients with diffuse DME were randomized into two groups. Eyes assigned to the combination group (n = 48) were subjected to macular laser photocoagulation three weeks after IVTA. Eyes in the IVTA group (n = 38) underwent IVTA alone. Central macular thickness was measured by optical coherence tomography, and the number of additional treatments and mean time to recurrence were assessed. RESULTS: Thirty-seven eyes in the combination group and 26 eyes in the IVTA group completed the three-year follow-up. Recurrence of DME after initial treatment was not observed for nine of the 37 (24.3%) eyes in the combination group or for one of the 26 (3.9$) eyes in the IVTA group (p = 0.028). DME was absent for 19.9 months after treatment in the combination group compared to 10.3 months in the IVTA group (p = 0.027). The mean number of additional treatments was 0.92 in the combination group and 1.88 in the IVTA group (p = 0.001). CONCLUSIONS: Results in the subset of subjects who completed the three-year follow-up demonstrated that laser photocoagulation following IVTA is more effective than IVTA monotherapy for diffuse DME. Combination therapy required fewer additional treatments and resulted in a lower recurrence rate than IVTA monotherapy.

Clinical Features of Idiopathic Juxtafoveal Telangiectasis in Koreans

PURPOSE: To describe the clinical characteristics of idiopathic juxtafoveal telangiectasis (IJT) in Koreans. METHODS: Medical records of 16 patients with IJT were analyzed during the period from 1997 to 2009. Diagnosis was based on biomicrosopic and fluorescein angiographic findings and the group was determined according to the Gass and Blodi classification. RESULTS: We analyzed eight patients in group 1A (50%), two in group 1B (12.5%), and six in group 2A (37.5%). Diverse treatment modalities, such as macular laser photocoagulation, photodynamic therapy, intravitreal antiangiogenic agent, and steroid injection, were applied for macular edema in nine eyes; however, only two eyes showed visual improvement. CONCLUSIONS: In this case series, group 1A was the most common. For macular edema related to IJT, current treatment strategies had no consistent effect.

Laser Photocoagulation as Adjuvant Therapy to Surgery for Large Macular Holes

PURPOSE: To evaluate the effectiveness of laser photocoagulation as adjuvant therapy in the treatment of large macular holes. METHODS: A randomized clinical trial. Thirty-one eyes from 29 subjects with idiopathic macular holes of diameters larger than 400 micrometer were randomized into a laser group and a control group. All eyes underwent vitrectomy with peeling of the internal limiting membrane. Contrary to the control group eyes, the laser group eyes underwent laser photocoagulation at the center of the macular hole before vitrectomy. Visual acuity and anatomic outcomes assessed by optical coherence tomography (OCT) were analyzed 3 months after surgery. RESULTS: On postoperative OCT, closure of the macular hole was noted in 17 of the 18 (94.4%) laser group eyes and 10 of the 13 (76.9%) control group eyes. Hole closure without bare retinal pigment epithelium was observed in 16 eyes in the laser group and 6 eyes in the control group (P<0.05). The amount of improvement in logMAR visual acuity 3 months after surgery was 0.40+/-0.29 in the laser group, and 0.19+/-0.23 in the control group (P<0.05). CONCLUSIONS: Laser photocoagulation constitutes a potent adjuvant therapy that may improve anatomical and visual outcomes of surgery for macular holes larger than 400 micrometer.

Clinical Result of Wavefront-guided Corneal Ablation: LASIK vs. LASEK

PURPOSE: To evaluate the 6-month refractive outcomes of wavefront-guided myopic laser in situ keratomileusis (LASIK) versus laser subepithelial keratomileusis (LASEK). METHODS: This observational case study comprised 35 eyes of 18 patients in the wavefront-guided LASIK group and 27 eyes of 14 patients in the LASEK group. Preoperative and postoperative wavefront analysis was performed with the Hartmann-Shack based Wavescan(R) aberrometer (VISX, Santa Clara, CA) and corneal ablation was performed using STAR S4 excimer laser ablation. The efficacy, predictability and higher-order aberrations (HOAs) were evaluated. RESULTS: Six months after surgery, the mean logMAR UCVA was -0.16 and -0.15. The mean postoperative spherical equivalent was -0.00+/-0.18D and -0.01+/-0.14D. The predictability was 97% and 100%. The efficacy index was 1.40 and 1.39 in the LASIK and LASEK groups, respectively. In comparison of HOA, there was no significant difference between the 2 groups except for the trefoil aberration. Vector analysis showed no difference of the coma aberration in the 2 groups. There was no significant difference in subjective satisfaction. CONCLUSIONS: Both wavefront-guided LASIK and LASEK are effective and predictable for correction of myopic astigmatism. Comparing LASIK and LASEK, there were no significant differences in the change of HOAs except for trefoil.

Primary Localized Amyloidosis of the Lacrimal Gland

PURPOSE: Primary localized amyloidosis of the lacrimal gland is rarely encountered in the lacrimal gland. The authors report a patient with orbital amyloidosis isolated to the lacrimal gland. METHODS: A 52-year-old woman presented with the superotemporal orbital mass for one year. The patient underwent surgical biopsy. RESULTS: A representative tissue section, stained with hematoxylin and eosin, showed pink amorphous hyaline deposits diffusely infiltrating tissue. The hyaline deposits stained positively with Congo red and demonstrated birefringence under polarized light. Immunohistochemical stains against immunoglobulin light chain were positive against kappa and lambda chain. No systemic involvement was noted from systemic work-up. Primary localized amyloidosis of the lacrimal gland was diagnosed. CONCLUSIONS: As far as we know this is the first case of primary localized amyloidosis of the lacrimal gland in Korea. Amyloidosis should be considered in differential diagnosis of a mass in the lacrimal gland.

Comparison of Optic Nerve Head Measurements by Optical Coherence Tomography and Confocal Scanning Laser Ophthalmoscopy

PURPOSE: To evaluate the relationship between the optic disc measurements generated by TopSS(TM) and by OCT. METHODS: Sixty-two eyes of 34 patients, 52 non-glaucomatous and 10 glaucomatous eyes, were scanned with TopSS(TM) and OCT 3000(TM). The margin of optic disc were defined automatically in OCT 3000(TM). The relationship between the optic disc variables- disc area (DA), cup area (CA), neuroretinal rim area (NRRA), and cup-disc area ratio (CDAR)- from TopSS(TM) and OCT was evaluated and the relationship between these and the tilt of disc was assessed. The horizontal (HD) and vertical diameter (VD) of the disc were measured from TopSS(TM) and OCT , then the ratio (HD/VD) were compared. RESULTS: In non-glaucomatous eyes with tilt more than 4 degrees, OCT measured DA and NRRA larger, and CDAR smaller than those measured by TopSS(TM), but the CA showed no difference. In non-glaucomatous eyes with tilt less than 4 degrees, there were no significant differences between OCT and TopSS(TM). In glaucomatous eyes, the CA measured by OCT was greater than that measured by TopSS(TM) (p=0.013). The HD/VD measured by TopSS(TM) showed no difference from HD/VD measured by OCT (p=0.849), and significant difference from HD/VD measured by OCT in eyes with tilted more than 4 degrees (p=0.003). In glaucomatous eyes, HD/VD measured by TopSS(TM) showed difference from HD/VD measured by OCT (p=0.022). CONCLUSIONS: Although measurement of disc in TopSS(TM) and OCT are correlated, the discrepancy becomes prominent in eyes with tilted disc or in glaucomatous eyes. Therefore optic disc analysis by OCT needs to be interpreted cautiously in tilted disc and in glaucomatous eyes.