A Case of Bilateral Central Serous Chorioretinopathy after Blunt Trauma

PURPOSE: To report a case of bilateral central serous chorioretinopathy (CSC) after blunt trauma with rapid remission. CASE SUMMARY: A 44-year-old man visited our clinic after blunt trauma around the right eye. At the first examination, no ocular problem was detected except a periorbital contusion. After one week, the patient complained of visual disturbance in his right eye. Fundus examination showed subretinal fluid in his right eye, and fluorescein angiography (FAG) showed typical smoke-stack pattern leakage, which lead to a diagnosis of CSC. Three days later, the patient complained of visual disturbance in his left eye, which was then also diagnosed as CSC. After 2 more weeks, the subretinal fluid in the right and left eyes had decreased. After 3 weeks, the subretinal fluid was almost completely absorbed in both eyes. CONCLUSIONS: Central serous chorioretinopathy can develop after blunt trauma, especially with a rapid clinical course. Thus, periodic ophthalmologic examination is needed after the first examination for blunt trauma of the eye.

Central Corneal Thickness and Corneal Endothelial Cells in Pseudoexfoliation Syndrome

PURPOSE: To evaluate the central corneal thickness (CCT) and corneal endothelial cell density (ENDO) in pseudoexfoliation syndrome. METHODS: Medical records of patients who underwent a preoperative examination for cataract surgery and an examination for glaucoma were retrospectively reviewed. The present study included 44 patients (59 eyes) and age- and sex-matched controls. The total pseudoexfoliation patients divided into 2 groups, such as pseudoexfoliation syndrome (28 eyes) and pseudoexfoliative glaucoma (21 eyes) .The intraocular pressure (IOP), CCT, ENDO, corneal curvature (CC) and axial length (AL) were measured. RESULTS: The total pseudoexfoliation group showed significantly higher IOP (p = 0.001), thinner CCT (p = 0.003) and lower ENDO (p = 0.037). The pseudoexfoliation syndrome group showed significantly thinner CCT (p = 0.010) and lower EDNO (p = 0.041), but no significant difference in IOP (p = 0.941). There was no significant difference in CCT (p = 0.060) and ENDO (p = 0.171) between the pseudoexfoliative glaucoma group and controls, but the pseudoexfolliative glaucoma group showed significantly higher IOP (p < 0.001). CONCLUSIONS: The pseudoexfoliation group showed thinner CCT which should be taken into consideration when evaluating IOP with the applanation tonometer and diagnosing glaucoma, especially in pseudoexfoliation syndrome patients.

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema

PURPOSE: To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both. RESULTS: The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 +/- 0.15, 0.36 +/- 0.18, 0.31 +/- 0.14, and 0.34 +/- 0.22, respectively. The mean CSTs were 433.3 +/- 77.9, 329.9 +/- 59.4, 307.2 +/- 60.2, and 310.1 +/- 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012). CONCLUSIONS: Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.

The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia

PURPOSE: To evaluate the long-term anatomical and functional results of macular buckling for retinal detachment associated with a macular hole in high myopia. METHODS: Eleven consecutive highly myopic eyes with retinal detachment and macular holes were retrospectively studied between January 2002 and September 2010. All cases developed after pars plana vitrectomy for internal limiting membrane removal, for the treatment of retinal detachment associated with a macular hole, or vitreomacular traction with a macular hole. Macular buckling with an episcleral sponge was performed for all cases. The mean follow-up period after macular buckling was 45.1 months (range from 12 to 102 months). Retinal reattachment and macular hole closure after the surgery and best-corrected visual acuity before and after the surgery were evaluated. RESULTS: Nine out of 11 eyes were successfully treated with the macular buckling procedure. In the remaining 2 eyes, retinal re-detachment occurred with anterior proliferative vitreoretinopathy. In these eyes, successful retinal attachment occurred after reoperation with silicone oil tamponade. Optical coherence tomography (OCT) was performed after the surgery in 10 out of 11 eyes and the macular hole closure rate was 30%. The mean best corrected visual acuity went from counting fingers preoperatively to 0.06 postoperatively. CONCLUSIONS: The macular buckling procedure is effective for retinal detachment associated with a macular hole in high myopia, especially following an unsuccessful pars plana vitrectomy with removal of inner retinal traction.

Relationship Between the Ocular Surface Temperature and the Nasal Predominance in Pterygium

PURPOSE: To study the relationship between the distribution of the ocular surface temperature and the nasal predominance in pterygium. METHODS: In order to identify the distribution of the ocular surface, the surface temperature was measured at four points on the eyelids and on the bulbar conjunctiva with a non-contact thermometer. The ocular surface temperature in the pterygium patient group was compared with that in a normal control group. The temperature difference at each point on the ocular surface was also examined. RESULTS: In both of the patient and the normal groups, the surface temperature on the eyelid was at its lowest on the temporal lower eyelid, and highest on the nasal upper eyelid. On the bulbar conjunctiva, the surface temperature of the nasal conjunctiva was at its lowest, and at its highest on the upper conjunctiva. The most distinctive temperature difference between the patient and control groups was shown on the nasal and temporal bulbar conjunctivas, and statistically significant (p<0.05). CONCLUSIONS: Considering the temperature distribution over the ocular surface, we propose that an intrinsic factor that causes the nasal predominance of pterygium could be the comparatively low local temperature of the nasal bulbar conjunctiva.

Ischemic Factors Affecting the Pathogenesis of Pterygium

PURPOSE: Ultraviolet rays, dust, and the human papilloma virus are well known as extrinsic risk factors in pterygium pathogenesis, but the intrinsic factors and nasal predominance related to the development of pterygium have not been fully ulucidated. Herein, we sought to determine whether the relative ischemic state of nasal bulbar conjunctiva affects the development of nasal predominance in pterygium pathogenesis. METHODS: Anterior segment fluorescein angiography was performed and the anterior bulbar conjunctival temperature was obtained to identify the presence of nasal ischemia. Tear samples were collected from both a normal and a patient group. The difference in SDF-1 (stromal cell-derived factor-1) was determined through ELISA and Western blot anyalyses. The excised pterygium tissues were immunohistochemically stained by antibodies for HIF-1 (hypoxia-inducible factor-1), SDF-1, and CXCR4. RESULTS: Results of the anterior segment fluorescein angiography showed that, the vascularity of the nasal limbus was lowest among each groups and the nasal filling time was significantly delayed in the patient group. The temperature of the nasal bulbar conjunctiva was lower than that of the temporal bulbar conjunctiva. The concentration of SDF-1 in tears was significantly higher in the patient group. In the immunohistochemical stain, HIF-1, SDF-1, and CXCR4 were revealed at epithelial basal cells or vascular endothelia in the stroma and the stained areas corresponded to each other. CONCLUSIONS: From the above results, we assumed that low nasal vascularity and temperature resulted in relative ischemic state and this hypoxic injury may be a major risk factor in pterygium development through the mobilization of endothelial progenitor cells by HIF-1 induced SDF-1 overexpression.

Ultrastructural Analysis of in vivo Expanded Corneal Epithelium on Amniotic Membrane

The purpose of this study is to characterize and compare the ultrastructural changes occurring during the in vivo cultivation of corneal epithelium on amniotic membrane (AM) at several different time points. Corneal burn patients (n=7) with a corneal epithelial defect and severe limbal damage were selected. Initially, AM transplantation with limbal autograft was performed at the acute stage of corneal burn to reconstruct the damaged ocular surface. One to six (mean interval; 3.3+/-1.2) months later, the central part of AM containing an in vivo expanded corneal epithelium was excised and retransplanted in adjacent lesions. The excised epithelium with AM was examined by electron microscopy and immunohistochemical study. By electron microscopy, one and two months after expansion, cultivated epithelium on AM showed an undifferentiated epithelium and an incomplete basement membrane (BM). But, after three months, the cultivated epithelium began to differentiate into a multilayered epithelium with a continuous BM with increased hemidesmosomes. These findings were further confirmed by immunohistochemical study, that cytokeratin K3 was expressed in the cultivated corneal epithelium and newly formed BM was partially positive of collagen IV at three months. At least 3 months may be needed for the proliferation and differentiation of in vivo cultivated corneal epithelium on AM.

A Case of Nonspecific Orbital Inflammation in Anophthalmia

PURPOSE: We report a case of orbital pseudotumor developed in an anophthalmic socket, presenting no typical symptoms or signs. METHODS: A 67-year-old woman was referred for treatment of necrotizing scleritis of her left eye and painful orbital pseudotumor of her right eye. The right eye had been removed 10 years previously. There was an irregular mass in superomedial portion of anterior orbit. Orbital MRI showed poorly defined T1 iso and low T2 signal intensity of a lesion in the medial anterior portion of the right orbit. Because systemic steroid administration was limited, 2 mg of betamethasone was injected locally, after which the size of the lesion was decreased and the orbital pain improved. CONCLUSIONS: The diagnosis of an orbital pseudotumor developed in an anophthalmic socket may be difficult because of the lack of typical eyeball-related signs or symptoms such as proptosis, red eye, or decreased vision. But, the easy access to the lesion can provide early and effective treatment through direct injection of glucocorticoid.

Application of Amniotic Membrane Graft for the Treatment of Bullous Keratopathy Combined with Intractable Glaucoma

PURPOSE: To evaluate the clinical effect of amniotic membrane (AM) graft and drainage valve implantation for the treatment of bullous keratopathy combined with intractable glaucoma. METHODS: Total 15 patients (15 eyes) were analyzed who underwent the operation for bullous keratopathy combined with intractable glaucoma, from Feb. 2002 to Aug. 2003. Under retrobulbar anesthesia, Ahmed valve was implanted under the supratemporal conjunctiva and exposed valve was covered with AM. And then, AM graft was performed after lamellar keratectomy for treatment of keratopathy. Serial check of IOP, corneal status and complications were performed after operation and during follow up. RESULTS: Mean IOP at last follow up was 11 mmHg. Corneal epithelium was stabilized within 10days. No serious complication was found and the drainage tube was well positioned. Especially, there is no pain in all cases. CONCLUSIONS: AM graft and valve implantation was clinically effective method for treatment of bullous keratopathy, combined with intractable glaucoma.

A Case of Mycobacterium Tuberculosis Keratitis

PURPOSE: Mycobacterium tuberculosis usually affects the lungs, although it may involve various segments of the eye and cause severe visual loss if not treated properly. We report the case of Mycobacterium tuberculosis keratitis treated successfully with antituberculous medication and amniotic membrane transplantation. METHODS: A 48-year-old male patient diagnosed as cervical tuberculous lymphadenitis about 20 years ago was referred from other hospital. He complained about painless corneal opacity on right eye. And other systemic evaluation other than cervical lymphadenitis was not remarkable. On biomicrosopy, peripheral multiple corneal opacity and neovascularization were observed. Fortified tobramycin eyedrops and oral antituberculous medication were used preoperatively. Under local anesthesia, the lesion was removed, and lamellar keratoplasty with lyophilized cornea and amniotic membrane transplantation was performed. Amikacin eyedrops was used postoperatively. RESULTS: From postoperative day 15, corneal opacity was decreased gradually. CONCLUSIONS: Mycobacterium tuberculosis should be considered as one of the causes of keratitis manifesting painless corneal opacity concomitant with cervical tuberculous lymphadenitis. Proper examination and management are necessary.

Assessment of Tear Lipid Layer after Treatment by an Infrared Instrument

PURPOSE: We performed this study to evaluate the influence on tear film of infrared instrument by observing the morphologic change of the tear lipid layer and tear break-up time by Tearscope(R). METHODS: The subjects were 52 eyes from 26 people. After infrared hyperthermic therapy, we analyzed the change of the tear lipid layer by Tearscope(R) at 10 minutes, 6 hours, and 12 hours. We also observed the subjective symptoms of change related to dry eye syndrome and tear break-up time. RESULTS: Of the 26 normal cases, 20 were men and 6 were women. The mean age was 26.4 +/- 1.9 years. The subjective symptoms improved and the tear lipid layer showed a decrease of color fringe yellow-brown and color fringe multiple colors type, and an increase of waves and closed meshwork type 10 minutes and 6 hours following infrared treatment. Tear break-up time was also prolonged from preoperative value of 10.0 +/- 2.4 seconds to 11.0 +/- 2.7 and 11.1 +/- 2.9 seconds at 10 minutes and 6 hours, respectively, after infrared treatment, but this effect did not persist after 12 hours. Schirmer test value did not show significant change. No complication related to infrared treatment was noted. CONCLUSIONS: Infrared treatment may be considered a possible method of treating dry eye syndrome by increasing the stability of the tear lipid layer.