Neovascular Glaucoma as the Initial Presentation of Ocular Tuberculosis

Purpose@#To report a case of ocular tuberculosis that first manifested as neovascular glaucoma.Case summary: A 76-year-old male visited our hospital complaining of decreased visual acuity in the left eye. He had undergone tuberculosis treatment 1 year prior, and had been cured. At the time of his visit, decreased visual acuity, increased intraocular pressure, and iris neovascularization were observed in the left eye. He was diagnosed with neovascular glaucoma and was started on treatment to lower the intraocular pressure. At the time of the visit, we also noticed vitreous opacity in both eyes. The patient did not attend his scheduled follow-up visit, but returned 2 months later complaining of decreased visual acuity in both eyes. The vitreous opacity in the retinae of both eyes had become aggravated. Diagnostic vitrectomy was performed on both eyes, and multiple yellowish-white circular lesions were observed throughout the retinae. Systemic abnormalities were suspected, and thus additional tests were performed. Bronchoalveolar lavage fluid analysis revealed recurrence of pulmonary tuberculosis, and tuberculosis treatment was recommenced. Temporary increases in ocular inflammation and deterioration were observed but improved after the addition of systemic steroids. The patient has been under observation without recurrence for about 1 year. @*Conclusions@#Ocular tuberculosis can be expressed in the form of neovascular glaucoma, so ocular tuberculosis should be suspected if there is a history of tuberculosis and abnormal retinal findings.

Clinical Manifestations and Prognosis in Patients with Infectious Endophthalmitis after Ahmed Glaucoma Valve Implant Surgery

Purpose@#We studied the clinical features and assessed the treatment outcomes of infectious endophthalmitis subsequent to Ahmed glaucoma valve (AGV) implant surgery. @*Methods@#We performed a retrospective review of the medical records of patients who underwent AGV implant surgery between January 1, 2010 and May 31, 2022. Clinical course, microbiological lab results, and the treatment data of patients who developed infectious endophthalmitis were analyzed. @*Results@#Of 310 eyes that underwent AGV implant surgery, 9 (2.90%) developed endophthalmitis. The average time interval between AGV implant surgery and the diagnosis of endophthalmitis was 3.59 years. As initial treatment, all affected eyes received injections of intravitreal antibiotics, while four underwent primary pars plana vitrectomy. The implanted valve was removed in seven instances. Microorganisms were found in cultures from four cases. Two patients achieved a final best-corrected visual acuity (BCVA) above 20/200, while the other five had a final BCVA of hand motion or worse. @*Conclusions@#AGV implant-related endophthalmitis is uncommon and often results in poor visual outcomes, with unpredictable onset. Consequently, it is crucial to educate patients undergoing AGV implant surgery during regular follow-ups. Immediate evaluation and treatment are necessary for patients exhibiting symptoms after surgery.

Syphilis Presenting as a Unilateral Incipient Papillitis

Purpose@#To report a case of unilateral incipient syphilitic papillitis.Case summary: A 53-year-old female visited for a routine ocular examination. Best-corrected visual acuities were 20/20 in both eyes and there was no abnormality in the anterior segment, pupillary response, ocular motility examination, color vision test, and there were no inflammatory cells in the anterior chamber and vitreous cavity of both eyes. However, optic disc edema and corresponding retinal nerve fiber layer (RNFL) thickening in her left eye were observed in a fundoscopic examination and by optical coherence tomography. In orbital magnetic resonance imaging, there was no abnormal enhancement of the optic nerve or optic nerve sheath in both eyes. Serological tests were positive for fluorescent treponemal antibody absorbance (FTA-ABS) immunoglobulin M (IgM) and IgG, the treponema pallidum hemagglutination test, venereal disease research laboratory (VDRL) testing, and a rapid plasma reagin test, but there was no abnormal finding in cerebrospinal fluid analyses including the VDRL and FTA-ABS tests. With the diagnosis of unilateral incipient syphilitic papillitis in her left eye, she was treated with intravenous penicillin for 14 days and high dose systemic steroids for 3 days with complete resolution of the optic disc edema and RNFL thickening. @*Conclusions@#Syphilis can present as a unilateral incipient papillitis. Therefore, in case with unilateral papillitis, serological test for syphilis, appropriate antibiotics and steroid treatment should be considered.

Epstein-Barr Virus-related Corneal Endotheliitis Accompanied with Secondary Glaucoma

PURPOSE: To report a case of Epstein-Barr virus-related corneal endotheliitis accompanied by secondary glaucoma.CASE SUMMARY: A 73-year-old male presented with blurred vision in his right eye. In the ophthalmic evaluation, there were dispersed keratic precipitates overlying corneal edema. The anterior chamber showed trace ~1+ graded inflammation and an endothelial density decrease. His best-corrected visual acuity and intraocular pressure in the right eye were 0.2 and 34 mmHg, respectively. Paracentesis was performed on the anterior chamber of the right eye to confirm the diagnosis under the suspicion of corneal endotheliitis with trabeculectomy for the intraocular pressure control. Epstein-Barr virus was confirmed using a multiplex polymerase chain reaction (PCR), and oral and eye drops of Acyclovir were used to treat the patient. There was no evidence of a recurrence over 2 years and his intraocular pressure was 12 mmHg and best-corrected visual acuity was maintained at 0.5.CONCLUSIONS: A case of Epstein-Barr virus-related corneal endotheliitis was diagnosed using PCR of the aqueous humor. The patient was treated with an oral antiviral agent and eyedrops without a recurrence.

Clinical Manifestations and Outcomes of Varicella-zoster Virus Endotheliitis

PURPOSE@#We evaluated the clinical manifestations of varicella-zoster virus (VZV)-induced endotheliitis and treatment outcomes.@*METHODS@#We retrospectively reviewed the medical records of patients exhibiting clinical manifestations of endotheliitis diagnosed as VZV endotheliitis via polymerase chain reaction (PCR) of anterior chamber puncture fluid from January 2013 to December 2018. Their clinical characteristics, treatments, and outcomes were analyzed.@*RESULTS@#Seven eyes of seven patients were diagnosed as VZV-affected via PCR of the aqueous humor. Mean patient age was 70.4 ± 10.4 years and the average follow-up time 24.7 ± 3.8 months. All eyes exhibited mild anterior chamber inflammation (trace to 1+). Four eyes were disciform in shape and three exhibited diffuse endotheliitis. Six patients evidenced intraocular pressures >21 mmHg. All patients were treated with oral antiviral agents; they were cured and no recurrence was noted. The mean best-corrected visual acuity (logMAR) increased significantly from 0.73 ± 0.19 to 0.09 ± 0.07 and the mean ocular pressure decreased significantly from 26.1 ± 7.3 to 13.2 ± 2.1 mmHg.@*CONCLUSIONS@#VZV endotheliitis may present as mild inflammation of the anterior chamber with a disciform eye or diffuse corneal edema. Diagnosis is aided by VZV-specific PCR of anterior chamber fluid; oral antiviral agents are useful. Be diagnosed with PCR of anterior chamber, and be treated with oral antiviral agents.

Clinical Aspects of Infectious Keratitis in Western Gyeongsangnamdo, Republic of Korea

PURPOSE: We investigated the regional characteristics and trends in causative agents, clinical features, and antibiotic susceptibility in infectious keratitis in western Gyeongnam province. METHODS: This retrospective chart review included 551 eyes of 551 patients with infectious keratitis, who were referred to our center from January 2004 to December 2017. The period of this study was divided into two terms of 7 years before and after 2011 to analyze the changes in causative organisms and antibiotic susceptibilities and to investigate the clinical features and regional characteristics in western Gyeongnam province. RESULTS: The most common occupation among patients was farming; the mean time taken for initial treatment was 8.6 days. The culture positivity rate was 35.8%, the most commonly isolated microorganisms were Staphylococcus epidermidis (14.5%) for Gram-positive bacteria and Pseudomona aeruginosa (13.5%) for Gram-negative bacteria. The distribution of culture-positive organisms before and after 2011 did not show any significant difference, but the increase in resistance to second and third generation quinolones was significantly greater in Gram-positive bacteria after 2011. There was no significant difference in clinical characteristics before and after 2011, but the hospital stay duration and treatment needs were significantly reduced. CONCLUSIONS: This was a large-scale study analyzing the clinical features of infectious keratitis in western Gyeognam province over a 14-year period. The results will help us understand the characteristics, microbiology, and community in infectious keratitis by analyzing patients referred to tertiary centers.

Clinical Features of Herpes Simplex Keratitis in a Korean Tertiary Referral Center: Efficacy of Oral Antiviral and Ascorbic Acid on Recurrence

PURPOSE: To describe the clinical manifestations of herpes simplex keratitis (HSK) in a tertiary referral center in South Korea and to determine whether ascorbic acid treatment prevents recurrence of herpetic epithelial keratitis. METHODS: This retrospective cohort study included all consecutive patients with herpetic keratitis referred to our center from January 2010 to January 2015. Clinical features, ocular complications, and recurrences were recorded. RESULTS: In total, 149 eyes of the 133 patients (72 male and 61 female) were followed for an average of 24.6 ± 13.2 months. Sixteen (12.0%) patients had bilateral HSK. The most frequent HSK subtype was epithelial keratitis (49.7%), which was followed by stromal keratitis (23.5%). Epithelial keratitis was the most likely subtype to recur. Complications occurred in 122 (81.9%) eyes. The most common complication was corneal opacity. Recurrences were observed in 48 (32.2%) eyes. The recurrence rates were lower in the prophylactic oral antiviral agent group (16 / 48 eyes, 33.3% vs. 49 / 101 eyes, 48.5%) and the ascorbic acid treatment group (13 / 48 eyes, 27.1% vs. 81 / 101 eyes, 70.3%) compared with the groups without medications. Univariate logistic regression analysis revealed that both factors significantly reduced the risk of recurrence (acyclovir: odds ratio, 0.25; 95% confidence intervals, 0.12 to 0.51; ascorbic acid: odds ratio, 0.51; 95% confidence intervals, 0.20 to 0.91). CONCLUSIONS: This retrospective study described the clinical findings of HSK in a tertiary referral center in South Korea. Prophylactic oral antiviral agent treatment and oral ascorbic acid administration may lower the risk of recurrence.

Case of Anterior Segment Ischemia after Two Vertical Rectus Muscles Surgery

PURPOSE: To report a case of anterior segment ischemia after superior and inferior rectus muscle surgery in a patient with superior rectus muscle enlargement. This is the first report in the Republic of Korea of anterior segment ischemia after two rectus muscles surgery. CASE SUMMARY: An 80-year-old male was referred to our clinic with a 3 years history of diplopia. The patient had 30 prism diopters right eye hypertropia in the primary position and downgaze limitation. The orbital computed tomography scan revealed enlargement of the right superior rectus muscle. He underwent right superior rectus recession and inferior rectus resection. On postoperative day 2, slit lamp examination revealed diffuse corneal edema, Descemet's membrane folding, an aqueous flare and a dilated pupil. Treatment with 45 mg oral steroid was initiated, and 1% prednisolone acetate and 0.5% Levofloxacin eye drops were administered. At postoperative 1 month, the patient was orthophoric in the primary position, and there was no corneal edema, pupil abnormality or aqueous flare. CONCLUSIONS: Base on the present case, the possibility of anterior segment ischemia should be considered after even two muscles surgery, and older patients with vertical muscle surgery should be considered more carefully.

The Effect of 0.02% Mitomycin C Injection into the Hair Follicle with Radiofrequency Ablation in Trichiasis Patients

PURPOSE: To investigate the inhibitory effect of 0.02% mitomycin C on eyelash regrowth when injected to the eyelash hair follicle immediately after radiofrequency ablation. METHODS: We prospectively included 21 trichiasis patients from June 2011 to October 2012. Twenty eyes of 14 patients were treated with 0.02% mitomycin C to the hair follicle immediately after radiofrequency ablation in group 1, while radiofrequency ablation only was conducted in ten eyes of seven patients in group 2. Recurrences and complications were evaluated until six months after treatment. RESULTS: One hundred sixteen eyelashes of 20 eyes in group 1 underwent treatment, and 19 (16.4%) eyelashes recurred. Eighty-four eyelashes of ten eyes in group 2 underwent treatment, and 51 (60.7%) eyelashes recurred. No patients developed any complications related to mitomycin C. CONCLUSIONS: Application of 0.02% mitomycin C in conjunction with radiofrequency ablation may help to improve the success rate of radiofrequency ablation treatment in trichiasis patients.

The Effect of 0.02% Mitomycin C Injection into the Hair Follicle with Radiofrequency Ablation in Trichiasis Patients

PURPOSE: To investigate the inhibitory effect of 0.02% mitomycin C on eyelash regrowth when injected to the eyelash hair follicle immediately after radiofrequency ablation. METHODS: We prospectively included 21 trichiasis patients from June 2011 to October 2012. Twenty eyes of 14 patients were treated with 0.02% mitomycin C to the hair follicle immediately after radiofrequency ablation in group 1, while radiofrequency ablation only was conducted in ten eyes of seven patients in group 2. Recurrences and complications were evaluated until six months after treatment. RESULTS: One hundred sixteen eyelashes of 20 eyes in group 1 underwent treatment, and 19 (16.4%) eyelashes recurred. Eighty-four eyelashes of ten eyes in group 2 underwent treatment, and 51 (60.7%) eyelashes recurred. No patients developed any complications related to mitomycin C. CONCLUSIONS: Application of 0.02% mitomycin C in conjunction with radiofrequency ablation may help to improve the success rate of radiofrequency ablation treatment in trichiasis patients.

Decorin and TGF-beta Expression after Partial Myotomy of the Extraocular Muscle in Rat

PURPOSE: To report the expression of decorin and TGF-beta in partial myotomy of the extraocular muscle in rats. METHODS: Partial myotomy of the superior rectus muscle was performed on the right eye of 10 Sprague-Dawley rats followed by exposure of the left superior rectus muscle and a simple suture of the conjunctiva. The bilateral superior rectus muscle was obtained from all rats at 2 weeks postoperatively. The tissues were observed under light microscopy with hematoxylin-eosin, Masson's trichrome staining and immunohistochemistry. RESULTS: Histological examinations of the surgical area at 2 weeks after postoperatively showed irregularly concentrated fibrosis on light microscopy with hematoxylin-eosin and Masson's trichrome staining of the experimental eyes. Immnohistochemistry showed that expression of decorin was in the same location as TGF-beta in the experimental group. CONCLUSIONS: The expression of decorin was found in the healing process after partial myotomy of the extraocular muscle in rats. Immunohistochemistry showed that expression of decorin was in the same location as with TGF-beta.

An Atypical Case of Lacrimal Sac Fistula Located on the Temporal Side of the Lateral Canthus

We report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus. A systemically healthy 1-year-old girl came to the outpatient clinic with a complaint of tearing on the temporal side of the right lateral canthus since birth. On examination, a small orifice was found in the skin on the temporal side of the lateral canthus. There was no evidence of inflammation or swelling within the opening. Surgeons carried out an operation under general anesthesia. They passed a probe through the lacrimal orifice and advanced it toward the lacrimal sac. Next, they introduced saline to the inferior punctum and found that it drained to the lateral fistula. The lower lid stretched as the dissected fistula was pulled. After the operation, the patient was free of the symptom. This paper is to report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus.

Scleral Window Surgery with Mitomycin C for Nanophthalmic Uveal Effusion: Case Report

PURPOSE: To report the case of a 36-year-old patient with nanophthalmic uveal effusion was treated with scleral window surgery and topical administration of mitomycin C (MMC). CASE SUMMARY: A 36-year-old woman presented with decreased visual acuity and blurred vision in the both eyes during 3 months. Fundus examination revealed choroidal effusion and retinal detachment with thickend sclera wall and short axial lengh. Partial-thickness sclera flap with deep sclerostomy was performed and topical MMC was administered to one quadrant of the equatorial sclera. The subretinal fluid resorbed gradually and visual acuity improved. CONCLUSIONS: Scleral window surgery and topical mitomycin C might relieve the blocked transscleral outflow of intraocular fluid in the small area of a sclerostomy in young patient with nanophthlamos.

A Case of Chronic Dacryocystitis Caused by Achromobacter Xylosoxidans

PURPOSE: To report a case of chronic dacryocystitis caused by Achromobacter xylosoxidans. CASE SUMMARY: A 73-year-old female was referred to our clinic for management of chronic dacryosyctitis from which she did not to recover despite empirical therapy. A. xylosoxidans was isolated from purulent discharge. Based on the results of susceptibility testing, therapy was changed to fortified ceftazidime eye-drop 6 times a day and intravenous tazocin 4.5 g/20 ml (piperacillin 2 g/tazobactam 0.25 g) 3 times a day. All symptoms were resolved after treatment with sensitive antibiotics and external dacryocystorhinostomy. CONCLUSIONS: To our knowledge, this is the first report of A. xylosoxidans dacryocystitis. A. xylosoxidans are rare but potential pathogens which cause dacryocystitis. The cultures and sensitivity test were collected and processed to detect the presence of unusual pathogens in a case with persistent infection despite conventional treatment.