Clinical Features and Risk Factors for Uveitis in Patients with Ankylosing Spondylitis: A Survey-Based Study

Purpose@#We investigated the clinical features and risk factors associated with the onset of uveitis in patients with ankylosing spondylitis. @*Methods@#A survey was conducted targeting patients with ankylosing spondylitis who have experienced uveitis. The questionnaire collected information on demographic characteristics, clinical features, and lifestyle-related risk factors for uveitis including stress, sleep quality, rest periods, eating habits, and intake of caffeine, alcohol, and tobacco. Respondents were asked to recall their condition at the time of their most recent uveitis flare-up and rate it on a 5-point scale (1 = good to 5 = bad). @*Results@#The study included 47 patients with ankylosing spondylitis; the average age was 40.0 years, 68.1% were male, and 89.4% tested positive for human leukocyte antigen (HLA)-B27. The average treatment duration for uveitis was 5.2 weeks, with an average recurrence rate of 4.5 times. The most common symptom at the time of uveitis was eye redness (87.2%). The average scores for the surveyed risk factors were as follows: stress, 4.1 points; sleep, 3.1 points; rest, 3.4 points; eating habits, 2.9 points; caffeine intake, 3.3 points; alcohol intake, 2.4 points; and smoking, 2.5 points. No significant correlation was found between age, uveitis treatment duration, number of recurrences, and any of the surveyed scores. @*Conclusions@#Patients with ankylosing spondylitis appeared to experience higher levels of stress during episodes of uveitis; however, further investigation is needed.

An Overview of the Korean Intermittent Exotropia Multicenter Study by the Korean Association for Pediatric Ophthalmology and Strabismus

The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.

An Overview of the Korean Intermittent Exotropia Multicenter Study by the Korean Association for Pediatric Ophthalmology and Strabismus

The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.

Range of Eye Movement in a Normal Population and Its Relationship to Age

PURPOSE: The purpose of this study is to measure the range of normal eye movement and to evaluate the effect of age on the range of ocular movement in a normal population. METHODS: We conducted a prospective observational study of 85 subjects aged between 5 and 91 years. Photographs were taken of the cardinal position, and these images were analyzed using an image analysis software (Adobe Photoshop 6.0, Adobe, San Jose, CA, USA). To measure the range of eye movement, the preprocessed images were analyzed using the Image J program. The range of movement of the eyeball was quantitatively measured using corneal limbal analysis. Specifically, the ranges of ocular movement according to adduction, abduction, elevation, and depression were measured. RESULTS: The normal movement ranges were 44.4 ± 6.9° in adduction, 44.8 ± 5.5° in abduction, 27.7 ± 7.6° in elevation, and 46.7 ± 8.4° in depression. Adduction, abduction, and elevation were negatively correlated with age (R² = 0.220, R² = 0.126, and R² = 0.304, respectively, all p < 0.001). However, there was no significant correlation between age and depression (R² = 0.030, p = 0.113). CONCLUSIONS: For all ages, the range of normal ocular movement in the horizontal direction was symmetric, while the range of ocular movement in elevation was smaller than that of depression. As age increased, the range of ocular movement decreased in all directions except depression, but depression did not decrease with age. When assessing eye movement, it is necessary to consider the range of ocular movements relative to both the movement direction and changes in the ocular movement range according to age.

Ocular Manifestations of Pediatric Systemic Disease / 한양의대학술지

Pediatric diseases are important because diagnosis and care for these can be complex. Among them, specific diseases have been associated with ocular involvement. This review presents the ocular manifestations of various pediatric diseases relevant to the clinician. An array of ocular manifestations of hyperthyroidism, hypoparathyroidism, diabetes mellitus, porphyria, cystinosis, mucopolysaccharidosis, Wilson disease, juvenile idiopathic arthritis, systemic lupus erythematosus, Marfan syndrome, Weill-Marchesani syndrome are described. In this review we will review ocular manifestations of systemic pediatric diseases for comprehensive understanding of eye involvement. With this review, authors can recognize the ocular manifestations for diagnosis and management of pediatric systemic diseases.

Bilateral Simultaneous Central Retinal Vein Occlusion in a Patient with Waldenstrom's Macroglobulinemia

PURPOSE: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom's macroglobulinemia. CASE SUMMARY: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom's macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. CONCLUSIONS: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment.

Retinal Nerve Fiber Layer Volume Measurements in Normal Children Using Spectral Domain Optical Coherence Tomography

PURPOSE: To measure retinal nerve fiber layer (RNFL) volume in normal children using spectral domain optical coherence tomography (SD-OCT). METHODS: This study included 79 eyes of 54 normal children between 4 and 15 years of age evaluated from February 2012 to November 2012. All participants underwent ocular examination and 3D-disc scanning using SD-OCT. RNFL volume was calculated between 2.5 and 5 mm diameter circles using the length, width, and height of each pixel derived from the RNFL thickness map with Matlab software. The relationship between RNFL volume and thickness was analyzed. RESULTS: The RNFL volumes of the mean total, superior, nasal, inferior, and temporal areas were 1.48 ± 0.09 mm3, 0.45 ± 0.04 mm3, 0.29 ± 0.04 mm3, 0.46 ± 0.03 mm3, and 0.29 ± 0.04 mm3, respectively. Comparing RNFL volume and conventional circumpapillary RNFL thickness measured using built-in software, a strong correlation between mean total, superior, and inferior areas (R = 0.980, 0.953 and 0.932, respectively) and a moderate correlation between the nasal and temporal areas were observed (R = 0.545 and 0.514, respectively). The negative correlations between RNFL thickness and RNFL volumes of the mean total, superior, nasal, inferior, and temporal areas and age were not significant (p > 0.05). CONCLUSIONS: This study reports RNFL volume measured from RNFL thickness map analysis in normal children. These data regarding RNFL volume of normal children may provide useful information for diagnosis and monitoring of pediatric glaucoma.

Effects of Continuous Curvilinear Capsulorhexis, Intraocular Lens Decentration and Tilt on Clinical Outcomes

PURPOSE: To evaluate the effects of continuous curvilinear capsulorhexis, intraocular lens (IOL) decentration and tilt on postoperative clinical outcomes after cataract surgery. METHODS: We reviewed 62 eyes of 52 patients who underwent cataract surgery and measured the uncorrected visual acuity, best corrected visual acuity and manifest refraction preoperatively and 3 months postoperatively. IOL decentration on anterior segment photography and IOL tilt on anterior optical coherent tomography were analyzed and correlations of postoperative uncorrected visual acuity, best corrected visual acuity, and higher order aberrations were evaluated. In addition, we inspected the relationship of size and decentration of continuous curvilinear capsulorhexis (CCC) intraoperatively with the change in IOL position postoperatively. RESULTS: The average size of CCC was 5.40 ± 0.51 mm (4.12-6.24 mm) and the average decentration of CCC was 0.30 ± 0.19 mm (0.09-1.21 mm) intraoperatively. The average decentration of IOL was 0.23 ± 0.15 mm (0.00-0.71 mm) and the average IOL tilt was 1.43 ± 0.73° (0.00-4.22°) postoperatively. Intraoperative CCC size and decentration were associated with postoperative IOL decentration (p = 0.01, p < 0.001), but not with IOL tilt (p = 0.69, p = 0.52). There were no significant correlations between IOL decentration and tilt with postoperative visual outcomes and higher order aberrations. CONCLUSIONS: The CCC size and decentration can affect the IOL decentration, but IOL decentration and tilt do not have a significant impact on clinical outcomes after cataract surgery.

Effects of Continuous Curvilinear Capsulorhexis, Intraocular Lens Decentration and Tilt on Clinical Outcomes

PURPOSE: To evaluate the effects of continuous curvilinear capsulorhexis, intraocular lens (IOL) decentration and tilt on postoperative clinical outcomes after cataract surgery. METHODS: We reviewed 62 eyes of 52 patients who underwent cataract surgery and measured the uncorrected visual acuity, best corrected visual acuity and manifest refraction preoperatively and 3 months postoperatively. IOL decentration on anterior segment photography and IOL tilt on anterior optical coherent tomography were analyzed and correlations of postoperative uncorrected visual acuity, best corrected visual acuity, and higher order aberrations were evaluated. In addition, we inspected the relationship of size and decentration of continuous curvilinear capsulorhexis (CCC) intraoperatively with the change in IOL position postoperatively. RESULTS: The average size of CCC was 5.40 ± 0.51 mm (4.12-6.24 mm) and the average decentration of CCC was 0.30 ± 0.19 mm (0.09-1.21 mm) intraoperatively. The average decentration of IOL was 0.23 ± 0.15 mm (0.00-0.71 mm) and the average IOL tilt was 1.43 ± 0.73° (0.00-4.22°) postoperatively. Intraoperative CCC size and decentration were associated with postoperative IOL decentration (p = 0.01, p < 0.001), but not with IOL tilt (p = 0.69, p = 0.52). There were no significant correlations between IOL decentration and tilt with postoperative visual outcomes and higher order aberrations. CONCLUSIONS: The CCC size and decentration can affect the IOL decentration, but IOL decentration and tilt do not have a significant impact on clinical outcomes after cataract surgery.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

RNFL and Ganglion Cell Complex Thickness in Normal Hemifield According to the Severity of Glaucoma

PURPOSE: To analyze the thickness of the circumpapillary retinal nerve fiber layer (cRNFL) and macular ganglion cell complex (mGCC) in apparently normal hemifield areas of glaucomatous eyes with superior or inferior visual hemifield defects according to their severity compared with the same hemifield of normal eyes using Topcon 3D spectral-domain optical coherence tomography (SD-OCT). METHODS: The present study included 90 normal eyes and 90 glaucomatous eyes with superior or inferior visual hemifield defects that underwent cRNFL and mGCC imaging using 3D SD-OCT. The cRNFL and mGCC parameters were compared between normal hemifield in glaucomatous eyes and the same hemifield in normal eyes. The mean deviation (MD) parameters (Mild: MD > -6 dB, 54 eyes; Moderate: -6 dB ≥ MD ≥ -12 dB, 60 eyes; Severe: MD < -12 dB, 30 eyes) in glaucomatous eyes were also compared between the 3 severity groups. RESULTS: The average hemifield cRNFL thickness was 93.6 ± 24.2 µm and 118.1 ± 14.1 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 107.8 ± 19.1 µm and 124.9 ± 17.1 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively. mGCC thickness was 95.8 ± 5.9 µm and 103.5 ± 7.7 µm in superior normal hemifield of glaucomatous eyes and controls, respectively, and 93.4 ± 8.2 µm and 104.5 ± 8.2 µm in inferior normal hemifield of glaucomatous eyes and controls, respectively (all p < 0.05). The thickness parameters were decreased in normal hemifield of glaucomatous eyes, which significantly decreased according to the severity (MD) of visual field defect (all p < 0.01). CONCLUSIONS: The measurement of cRNFL and mGCC thickness in normal hemifield of glaucomatous eyes using SD-OCT is useful in detecting structural glaucomatous changes before visual field defects appear.

Macular Choroidal Thickness and Volume Measured by Swept-source Optical Coherence Tomography in Healthy Korean Children

PURPOSE: To evaluate the thickness and volume of the choroid in healthy Korean children using swept-source optical coherence tomography. METHODS: We examined 80 eyes of 40 healthy children and teenagers ( or =18 years) and compared adult measurements with the findings in children. RESULTS: The mean age of the children and teenagers was 9.47 +/- 3.80 (4 to 17) vs. 55.04 +/- 12.63 years (36 to 70 years) in the adult group (p < 0.001, Student's t-test). Regarding the Early Treatment Diabetic Retinopathy Study subfields, the inner temporal subfield was the thickest (247.96 microm). The inner and outer nasal choroid were thinner (p = 0.004, p = 0.002, respectively) than the surrounding areas. The mean choroidal volumes of the inner and outer nasal areas were smaller (p = 0.004, p = 0.003, respectively) than those of all the other areas in each circle. Among the nine subfields, all areas in the children, except the outer nasal subfield, were thicker than those in adults (p < 0.05). Regression analysis showed that age, axial length, and refractive error correlated with subfoveal choroidal thickness (p < 0.05). CONCLUSIONS: Overall macular choroidal thickness and volume in children and teenagers were significantly greater than in adults. The nasal choroid was significantly thinner than the surrounding areas. The pediatric subfoveal choroid is prone to thinning with increasing age, axial length, and refractive error. These differences should be considered when choroidal thickness is evaluated in children with chorioretinal diseases.

Transscleral Fixation of Intraocular Lenses Using Modified Injector

PURPOSE: To evaluate the clinical stability and outcomes of 3-piece intraocular lens (IOL) transscleral fixation surgery using a modified injector. METHODS: We have modified and used the Sapphire unfolder injector system (Allergan(R), USA). This involved, cutting a slit longitudinally at the terminal part of the injector so that a thread could pass through it freely. After a conjunctival peritomy created at 2 and 8 o'clock, a long curved needle with double-armed 10-0 polypropylene is passed through the exposed sclera. Two pieces of suture are withdrawn through the 2.8 mm corneal incision and 1 suture (from 8 o'clock) is passed through the opening of the cartridge and then tied to the leading haptic. Next, the IOL was implanted with the cartridge and then inserted through the corneal incision site. The other suture (from 2 o'clock) is tied to the haptic on the opposite side and inserted. RESULTS: The study included 20 eyes of 20 patients with a mean age of 62.8 years at the initial visit. There were no complications, such as vitreous hemorrhage, retinal detachment, glaucoma, corneal edema, or iris injury. While the knot fixed to the leading haptic of IOL passed by the cartridge, there was no change of position. During the follow-up period, IOL dislocation did not occur and the corrected visual acuity and corneal astigmatism improved significantly. CONCLUSIONS: This technique is an effective procedure for minimizing entangled thread and corneal astigmatism.

Central Corneal Thickness Measured by Noncontact Specular Microscopy, Dual Rotating Scheimpflug Camera and Ultrasound Pachymetry

PURPOSE: To compare central corneal thickness (CCT) as measured using noncontact specular microscopy (NCSM), dual rotating Scheimpflug camera (Galilei(R)), and ultrasound pachymetry (USP). METHODS: The measurements of CCT using NCSM, dual rotating Scheimpflug camera and USP in 70 eyes of 70 healthy subjects were compared. RESULTS: The average measurements of CCT using NCSM, dual rotating Scheimpflug camera, and USP were 567.70 +/- 31.21 microm, 557.84 +/- 26.29 microm, and 553.31 +/- 29.69 microm, respectively. The CCT measurement using NCSM was statistically significantly thicker than when measured using USP (p 0.900, p < 0.001). CONCLUSIONS: The results of the 3 methods were significantly correlated but the measurement using NCSM was significantly thicker than when using USP. CCT measurements of healthy eyes using dual rotating Scheimpflug camera were more correlated with USP than NCSM. The CCT measurements using dual rotating Scheimpflug camera is a better alternative for USP than NCSM.

The Effect of Pattern Scan Laser Photocoagulation on Peripapillary Retinal Nerve Fiber Layer Thickness and Optic Nerve Morphology in Diabetic Retinopathy

PURPOSE: To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy. METHODS: Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups. RESULTS: The average RNFL thickness had increased by 0.84 microm two months after and decreased by 0.4 microm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 microm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 microm (p = 0.11) at six months in the PASCAL group. CONCLUSIONS: PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.

Morphologic and Functional Evaluation before and after Vitrectomy in Idiopathic Epiretinal Membrane Patients Using Microperimetry

PURPOSE: To investigate the relationship between photoreceptor inner/outer segment (IS/OS) integrity and macular sensitivity after epiretinal membrane (ERM) surgery using spectral-domain optical coherence tomography combined with microperimetry. METHODS: 20 eyes of 20 patients with idiopathic ERM who underwent pars plana vitrectomy for ERM removal were prospectively reviewed. The IS/OS defect diameter, BCVA, macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry. The correlation of these factors was analyzed. RESULTS: The macular sensitivity improved after successful ERM surgery (p < 0.001), but the IS/OS defect diameter has not improved. The preoperative and postoperative macular sensitivity were negatively correlated with preoperative IS/OS defect diameter (p = 0.035, p = 0.006). The fixation stability was not correlated with preoperative IS/OS defect diameter. CONCLUSIONS: Macular sensitivity showed significant correlation with IS/OS defect diameter. Macular sensitivity is vital functional parameter allows subjective quantification of the retinal function and reflects morphologic changes.

A Prospective Study of Blepharoptosis after Panretinal Photocoagulation Using Ophthalmoscopic Contact Lens

PURPOSE: To investigate the possibility of blepharoptosis as a complication after panretinal photocoagulation using ophthalmoscopic contact lens. METHODS: We prospectively evaluated patients who were diagnosed with diabetic retinopathy and scheduled to be treated with panretinal photocoagulation. Margin reflex distance 1 (MRD1), levator function, palpebral fissure height and width, and tarsal plate height were measured at the day of photocoagulation and 3 months after treatment. RESULTS: MRD1 was decreased in 8 eyes (25.8%), levator function was decreased in 5 eyes (16.1%), and palpebral fissure height was decreased in 6 eyes (19.4%). The decrement of MRD1 and palpebral fissure height after photocoagulation were significant (p = 0.008, p = 0.031, respectively). There was a significant negative correlation between MRD1 decrement and tarsal plate height (p = 0.045). CONCLUSIONS: We identified blepharoptosis after panretinal photocoagulation using contact ophthalmoscopic lens, which was related with low tarsal plate height.

The Changes of Anterior Chamber Depth, Axial Length, Refractive Errors after Combined Vitrectomy

PURPOSE: To evaluate the changes of anterior chamber depth (ACD), Axial length (AXL) after combined vitrectomy and cataract surgery and to analyze the association with refractive errors. METHODS: In 22 eyes who underwent combined vitrectomy and cataract surgery (PPV-Phaco group), 20 eyes who underwent vitrectomy-only (PPV-only group) and 28 eyes who underwent uncomplicated cataract surgery (Phaco-only group), ACD and AXL were measured with IOL master (Carl Zeiss Jena, Germany) preoperatively and 3 months postoperatively. We compared the preoperative desired refraction and postoperative 3 months refraction. RESULTS: ACD were increased in PPV-Phaco group and Phaco-only group (all, p < 0.001) and this change was more prominent in PPV-Phaco group (p = 0.030). In PPV only group, ACD was decreased (p < 0.001). The AXL after surgery was not significant different from the preoperative AXL in PPV-Phaco and PPV only groups (p = 0.612, p = 0.090). But the AXL was decreased in Phaco-only group (p = 0.022). Hyperopic shifting were noticed in PPV-Phaco and phaco-only groups, but myopic shifting was noticed in PPV-only group. However, these changes were not statistically significant (p = 0.292, p = 0.251, p = 0.068). CONCLUSIONS: ACD was increased after combined vitrectomy and cataract surgery. AXL was not changed. The hyperopic shifting was noticed after combined vitrectomy and cataract surgery, but was not statistically significant.

Intravitreal Bevacizumab Injection in Adult Coats' Disease

PURPOSE: To report the efficacy of intravitreal bevacizumab injection in adult patients with Coats' disease. CASE SUMMARY: Vascular telangiectasia, microaneurysms, circinate hard exudates, and macular edema were shown in the macula of two patients. Vascular abnormality was limited to < or =6 clock hours in both cases. In case 1, the temporal retina demonstrates filigree-like vessels and capillary nonperfusion. In case 2, the nasal retina demonstrates aneurysmal dilatation and multiple microaneurysms. Intravitreal bevacizumab injection was administered in both cases. After 1 month, macular edema decreased. Laser photocoagulation was performed for vascular telangiectasia, microaneurysms, and capillary nonperfusion area. Then an additional decrease of macular edema was observed. Fluorescein leakage decreased, as well. After 1 month (case 1) and 2 months (case 2), macular edema increased. The second and third intravitreal reinjections were administered to each patient. Macular edema decreased. CONCLUSIONS: We report two rare cases of Coats' disease in adult patients. Intravitreal bevacizumab injection in patients with Coats' disease can result in a rapid decrease of macular edema, which will then lead to rapid visual recovery and an opportunity for effective laser photocoagulation. We recommend that intraviteal bevacizumab injection be used in combination with laser photocoagulation for the treatment of Coats' disease.

A Cadaveric Anatomical Study of the Levator Aponeurosis and Whitnall's Ligament

PURPOSE: To identify the anatomy of the levator aponeurosis (LA) and Whitnall's ligament (WL) in Korean subjects using cadavers. METHODS: Orbital exenteration was performed in ten cadavers (20 eyeballs) that had no history of trauma near the eyeball. We observed characteristics of WL (tension, density, and shape) and the relationship between the superior rectus muscle (SR) and the levator palpebrae superioris. We measured the distance from both the eyelid margin and the upper border of the tarsal plate to the insertion of the LA medially, centrally, and laterally. RESULTS: The WLs we observed showed several shapes. In 12 eyes, we saw clear, white fibrotic bands, while in four others, we found thin, less taut bands. In four eyes, we were unable to identify the precise shape of the band. The insertions of the LA showed nasal dehiscence in 13 eyes and parallel attachment in seven eyes. The distances from the eyelid margin to the insertion of the LA medially, centrally, and laterally were 8.31 mm, 5.57 mm, and 5.15 mm, respectively. The distances from the upper border of the tarsal plate to the insertion of the LA medially, centrally, and laterally were 2.75 mm, 4.82 mm, and 4.29 mm, respectively. CONCLUSIONS: This study examined the anatomy of WL and the LA in Korean subjects and may be helpful as a reference in levator muscle surgery.