Iris-trabecular Contact Index Change after Cataract Surgery in Acute Angle Closure Glaucoma

PURPOSE: To evaluate the change of iris-trabecular contact index (ITC index) after cataract surgery in acute angle closure glaucoma. METHODS: Twelve patients (17 eyes) who had a history of acute angle closure glaucoma underwent swept source optical coherence tomography before and after cataract surgery. Correlations between lens vault (LV), ITC index and intraocular pressure (IOP), anterior chamber depth (ACD), anterior chamber volume (ACV), and angle parameters were analyzed before and after cataract surgery. RESULTS: IOP (p = 0.007), ACD (p < 0.001), ACV (p < 0.001), angle parameters (p = 0.001), and ITC index (p = 0.012) were improved after cataract surgery. ITC index decreased from 88.42 ± 23.59% to 48.91 ± 35.13% after cataract surgery (p = 0.012). There was no correlation between LV and ACD (p = 0.075), ACV (p = 0.864), angle parameter (p = 0.112-0.707), or ITC index (p = 0.288) before cataract surgery. The correlations between ITC index and IOP (p = 0.021), ACD (p = 0.002), ACV (p < 0.001), and angle parameter (p = 0.001-0.030) were statistically significant before surgery but not statistically significant (p = 0.223/0.206/0.761/ 0.096-0.819) after surgery. CONCLUSIONS: ITC index significantly improved after cataract surgery, but part of angle closure was not resolved in some cases of acute angle closure glaucoma.

Intravitreal Bevacizumab for Macular Edema Secondary to Ruptured Retinal Arterial Macroaneurysm

PURPOSE: To study the short-term effect of intravitreal injection of bevacizumab in the treatment of macular edema secondary to retinal macroaneurysm. METHODS: Eight eyes of 9 patients who underwent consecutive intravitreal bevacizumab injections for macular edema secondary to retinal macroaneurysm were prospectively evaluated. Complete eye examination including the best corrected visual acuity (BCVA), fundus examination and optical coherence tomography (OCT) were performed at baseline and follow-up visits at 2, 4 and 6 months. RESULTS: The mean age was 73.6 +/- 6.9 years, and the mean study period was 7.3 +/- 2.6 months. At the final visit, BCVA improved from log MAR 1.92 +/- 0.67 to log MAR 0.87 +/- 0.57. The mean central macular thickness on OCT image decreased from 388 +/- 168 microm at the initial visit to 200 +/- 39 microm at the final visit. Three eyes without subretinal hemorrhage presented better visual outcome than eyes with subretinal hemorrhage. All eyes showed some decrease in angiographic leakage. No adverse side effects were observed following the injections. CONCLUSIONS: Intravitreal bevacizumab injection can be used as a selective alternative treatment modality for macular edema secondary to retinal macroaneurysm.

Case of Tsutsugamushi Disease With Anterior Uveitis

PURPOSE: To report a single case of tsutsugamushi disease with anterior uveitis and eschars on the upper eyelid. CASE SUMMARY: A 56-year-old female patient complained of ocular pain and gradually decreasing visual acuity in her right eye. On physical examination, lymphadenopathy was palpable on the right side of the neck, and eschars were observed on the forehead and upper eyelid. On slit lamp examination, conjunctival injection, episcleral vessel dilations and severe intraocular inflammatory reaction were observed. Fundus examination showed no abnormal findings. A blood test was submitted for analysis, and tsutsugamushi disease was diagnosed. The patient's ocular manifestations responded well to treatment with steroids. After three weeks, the patient showed improvement on ocular examination, and no problems were observed at the six-month follow-up. CONCLUSIONS: Although ocular manifestation of tsutusgamushi disease with conjunctivitis and limbitis has previously been reported, ocular manifestation of tsutusgamushi disease with anterior uveitis has not been reported. Anterior uveitis may respond satisfactorily to steroid treatment, along with improvement in systemic conditions.

Intraindividual Comparison of ICL and Toric ICL Implantation in the Correction of High Myopia With Astigmatism

PURPOSE: We compared intra-individual visual outcomes and patient satisfaction after implantable contact lens (ICL) and Toric ICL implantation. METHODS: Twenty-eight eyes of 14 patients were enrolled in this retrospective study. One eye of each patient was assigned to ICL (ICL Group), and the contralateral eye was allocated to Toric ICL (Toric ICL Group). All patients were examined for visual acuity, refraction, intraocular pressure, slit lamp measurements, and satisfaction one week, one month, two months, and six months postoperatively. RESULTS: Mean spherical equivalents of the two groups were corrected from -7.83D (ICL Group) and -5.55D (Toric ICL Group) to 0.13D and 0.20D, respectively, and the mean refractive cylinders were corrected from 0.92D and 2.60D to 0.42D and 0.27D, respectively, at six months postoperatively. The myopias of these two groups and the astigmatism of the Toric ICL group were effectively corrected. The uncorrected visual acuity (UCVA) of the two groups were 1.02 and 1.05, respectively, at six months postoperatively. The safety index, efficacy index, predictability, and stability were favorable. There were no significant differences between the two groups in terms of postoperative UCVA, intraocular pressure(IOP), vaulting, noticeable complications, or patient satisfaction. CONCLUSIONS: The results show ICL implantation is effective treatment for high myopia, and Toric ICL implantation is a viable surgical option for the treatment of compound myopia astigmatism. Selection of proper phakic intraocular lens(IOL) is recommended for correcting astigmatism.

Intracorneal Ring Segment Implantation for the Management of Keratoconus: Short-Term Safety and Efficacy

PURPOSE: To assess the safety and efficacy of intracorneal ring segment (Intacs ring) implantation in managing keratoconus. METHODS: This retrospective case series comprised of 11 keratoconic eyes (11 patients) had Intacs ring (Addition Technology, Inc, California, USA) implantation. The main outcome measures were best corrected visual acuity, refraction, keratometry, topography, and pachymetry. Patients were examined before Intacs ring implantation as well as one week, one, three, and six months postoperatively. RESULTS: The mean best corrected visual acuity improved from 0.60+/-0.33 logMAR preoperatively to 0.39+/-0.23 logMAR six months postoperatively (p>0.05) and the mean corneal thickness, from 432.82+/-41.17 micrometer preoperatively to 448.00+/-62.27 micrometer at six months (p>0.05). The mean cylinder improved from -5.36+/-2.70D preoperatively to -2.50+/-1.66D six months postoperatively (p<0.05) and the mean keratometry, from 47.99+/-2.38D to 42.83+/-1.72D at six months (p<0.05). In addition, the mean spherical equivalent improved from -6.64+/-3.49D preoperatively to -3.66+/-3.37D six months postoperatively (p<0.05). One eye had a risk of ring exposure, but the others had no significant complications. CONCLUSIONS: Intacs ring implantation appears to be effective in improving cylinder, spherical equivalent, and keratometry in patients with keratoconus.

Subretinal Hemorrhage After Photodynamic Therapy for Age-Related Macular Degeneration

PURPOSE: To evaluate the clinical features of subretinal hemorrhage after photodynamic therapy in eyes with exudative age-related macular degeneration. METHODS: We retrospectively reviewed data for 267 eyes of 243 patients who had undergone PDT for the treatment of ARMD between January 2005 and December 2006. Best corrected visual acuity, fundus photography, fluorescein angiography, and ICG angiography were performed before and after treatment. We followed up the patients at 1 week, 1 month, and 3 months after treatment and at 3-month intervals thereafter. RESULTS: Postoperative subretinal hemorrhage was seen in 36 (13.4%) of 267 eyes. The pretreatment and post-treatment mean visual acuities were logMAR 0.80 and logMAR 1.05 respectively, representing a decrease of 2.05 lines. On FAG, two eyes were predominantly classic, four eyes were minimally classic, and 30 eyes were occult. The laser irradiation spot size was under 3,000 micrometer in one case and from 3,000 micrometer to 5,000 micrometer in 19 cases and over 5,000 micrometer in 16 eyes. CONCLUSIONS: Subretinal hemorrhage after PDT for ARMD can be a common complication in patients who have been treated for larger irradiation spot sizes and for pigment epithelial detachment (PED), so doctors should be aware of the risk of serious hemorrhagic complications in such situations.