Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole

Purpose@#To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole. @*Methods@#The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months. @*Results@#Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade. @*Conclusions@#Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole

Purpose@#To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole. @*Methods@#The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months. @*Results@#Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade. @*Conclusions@#Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

The Effect of Adalimumab on Refractory Uveitis

Purpose@#To assess the efficacy and safety of Adalimumab (Humira®, AbbVie, Chicago, IL, USA) for repeated refractory uveitis during systemic steroid or immunosuppressive therapy. @*Methods@#We retrospectively reviewed clinical records on 30 eyes of 18 patients with non-infectious refractory uveitis who underwent Adalimumab injection therapy from December 2017 to July 2019. The therapeutic effect was assessed based on intraocular inflammation grade, central macular thickness, and best corrected visual acuity, and the efficacy was assessed based on control of inflammation and macular edema, as well as corticosteroid sparing effects. The safety was assessed based on adverse events. @*Results@#The mean duration of uveitis at baseline was 55.4 months (13-121 months) and the mean follow-up was 9.2 months (6-18 months). All 30 eyes of 18 patients stopped using systemic steroids and maintained clinical quiescence. Anterior chamber inflammation, vitreous inflammation, and best corrected visual acuity showed significant improvement, and there was no difference in central macular thickness. Uveitis recurred in 5 eyes, but 4 eyes showed controlled inflammation after single posterior sub-tenon steroid injection. One eye was controlled after methotrexate co-administration. Ulticaria (two patients) and injection- site reaction (one patient) were reported as adverse events. @*Conclusions@#Adalimumab is an effective treatment for decreasing inflammatory activity and reducing corticosteroid burden in refractory uveitis.

Effect of Amiloride to Retinal Toxicity Induced by Tissue Plasminogen Activator

PURPOSE: The effects of amiloride on cellular toxicity caused by tissue plasminogen activator (tPA) in mouse primary retinal cells were investigated. METHODS: Primary retinal cell cultures were maintained using glial conditioned medium. Commercial tPA and L-arginine were added, and the level of cyclic guanosine monophosphate (cyclic-GMP) in the culture supernatant was assessed using an ELISA assay. We measured the cell viability of cultured retinal cells pretreated with three different concentrations of amiloride (1, 10, and 100 microm) in addition to commercial tPA or L-arginine treatment. RESULTS: After exposing the cultured mouse retinal cells to tPA plus L-arginine or L-arginine alone, cyclic-GMP concentrations were 61.9 +/- 5.1 pmole/mL and 63.1 +/- 6.1 pmole/mL, respectively. However, the control group had a significantly lower concentration of cyclic-GMP (37.2 +/- 3.4 pmole/mL, p < 0.01). The cyclic GMP-dissolved solution did not cause retinal cell death. In the control group and the group treated with 1 microm amiloride and tPA containing L-arginine, the cell viability was 43.7% and 44.5%, respectively. However, cell viability increased to 70.6% with 10 microm amiloride and 78.4% with 100 microm amiloride (p = 0.015). CONCLUSIONS: L-arginine increases intracellular cyclic-GMP and may give rise to retinal cells through this mechanism. In addition, amiloride in concentrations greater than 10 microm protects against L-arginine-induced retinal cell death.

The Prevalence of Vitreoretinal Diseases in a Screened Korean Population 50 Years and Older

PURPOSE: To describe the prevalence of vitreoretinal diseases in the Korean population 50 years or older at a health screening center. METHODS: The participants of this study included 11,180 adults 50 years of age and older who visited the Health Promotion Center of Kangbuk Samsung Hospital from January to December 2006. Digital images of non-mydriatic fundus photographs were examined. We calculated the sex- and age-adjusted prevalence of vitreoretinal diseases using the direct standardized method based on the number of resident registrations. RESULTS: The age- and sex-adjusted prevalence of vitreoretinal diseases in Korean adults 50 years of age and older was 9.9%. The prevalence of vitreoretinal diseases significantly increased with age (P=0.000). There was no significant gender difference in the prevalence of vitreoretinal diseases (p=0.553). Age-related macular degeneration was the most common vitreoretinal disease, with an age- and sex-adjusted prevalence of 5.2%. Epiretinal membrane, retinal vein occlusion, and diabetic retinopathy were common vitreoretinal diseases in that order, and the age- and sex-adjusted prevalences were 1.5%, 1.1%, and 0.9%, respectively. CONCLUSIONS: The prevalence of vitreoretinal diseases in a screened Korean population 50 years and older was 9.9%. Vitreoretinal diseases are a major ophthalmic problem in Korea. As the Korean population continues to age and the prevalence of diabetes increases, further investigations about the epidemiology and prevention of vitreoretinal diseases are needed.

Single Nucleotide Polymorphisms in the 3'-Untranslated Region of Vascular Endothelial Growth Factor in Diabetic Retinopathy

PURPOSE: Recent studies suggest that increased expression of the vascular endothelial growth factor (VEGF) may play a role in the pathogenesis of diabetic complications. The aim of this study was to assess the potential association of VEGF gene polymorphisms with disease expression of retinopathy in patients with diabetes mellitus. METHODS: We studied 96 diabetic patients to determine whether there is an association between diabetic retinopathy in VEGF and VEGFR gene; all patients were unrelated Korean individuals (PDR, n=32; NPDR, n=25; no DMR, n=39). We analyzed VEGF and VEGFR SNP by restriction fragment mass polymorphism (RFMP). PCR was performed with primers designed to introduce a type IIS restriction endonuclease recognition sequence (FokI, BstF5I) ahead of the polymorphism site. The enzymatic cleavage of the products resulted to excision of two oligonucleotide fragments containing the variation site, and then masses of the resulting oligonucleotide fragments were examined by matrix assisted laser desorption time of flight mass spectrometry (MALDI-TOF MS). Difference are seen as the presence, absence, or mass change in peaks corresponding to the fragments affected by existence of polymorphism that have base substitution at the site of variation. RESULTS: We found that the genotype frequencies of two polymorphisms shown to be completely linked to each other (rs3025039; vf1, rs3025040; vf2) and one polymorphism (rs3812867; vfr1) within 3'-untranslated regions (3'-UTR) of the VEGF and VEGFR1 significantly differed between patients with and without retinopathy. The frequencies of the vf1, vf2 and vfr1 did not differ significantly between the NPDR and PDR group CONCLUSIONS: These data implicate the polymorphisms in the 3'-UTR of the VEGF and VEGFR1 genes as risk factors for diabetic retinopathy.

Photodynamic Therapy in Practice: A Review of Experiences with Myopic CNV in Korean Patients

PURPOSE: To evaluate the effects of photodynamic therapy with verteporfin on visual acuity and fluorescein angiography in choroidal neovascularization (CNV) associated with pathologic myopia and to determine if this treatment could reproduce the results achieved in the Verteporfin in Photodynamic Therapy (VIP) Trial in Korean patients. METHODS: Forty-two eyes of 39 patients with CNV secondary to pathologic myopia were included. A retrospective review of their clinical records and fluorescein angiography was done. The patients underwent photodynamic therapy with verteporfin and were followed up for more than 6 months after the therapy. The change in best corrected visual acuity (BCVA) and leakage in fluorescein angiography were evaluated. RESULTS: The mean age of the patients was 39.6 and mean follow-up period was 23.5 months. The BCVA of the patients improved in 22 (52.4%) eyes, was unchanged in 13 (30.9%), and worsened in 7 (16.7%). The leakage in fluorescein angiography decreased in 25 (59.5%) eyes. CONCLUSIONS: Photodynamic therapy with verteporfin for myopic CNV in Korean patients appeared to be effective in stabilization of the lesions and improvement of visual acuity.

Effect of Photodynamic Therapy and Intravitreal Triamcinolone Acetonide on Choroidal Neovascularization in Age-related Macular Degeneration

PURPOSE: To evaluate the safety and visual outcome of intravitreal triamcinolone acetonide combined with photodynamic therapy for subfoveal choroidal neovascularization in patients with age-related macular degeneration. METHODS: We evaluated 32 eyes of 32 patients with choroidal neovascularization due to age-related macular degeneration. The study group received photodynamic therapy and intravitreal triamcinolone acetonide (combined group), while the control group received photodynamic therapy only (PDT group). RESULTS: Three months after treatment, no difference was detected between the two groups in visual acuity changes (p>0.05), but the leakage in fluorescein angiography and macular edema in optical coherent tomography decreased (p<0.05) in the combined group. The retreatment rate in the combined group (6.0%) after 3 months was lower than that of the PDT group (53.3%). CONCLUSIONS: Photodynamic therapy with intravitreal triamcinolone acetonide to choroidal neovascularization reduced the retreatment rate at 3 months significantly. These results may have been be due to the short-term anti-inflammatory effect of steroids.

Diplopia and Periorbital Mass Associated with Miragel Buckling Explant

A 28-year-old female presented with a palpable mass lesion on the superonasal aspect of her right globe and she had a progressive diplopia. She had a scleral encircling surgery with a Miragel explant (MIRA, Waltham, Mass, USA) for the tractional retinal detachment associated with pars planitis 9 years previously. On examination, she revealed restricted eye movements of her right eye. The magnetic resonance imaging documented a swelling of the Miragel explant that mimicked a periorbital mass lesion. The Miragel explant was removed and fragmentation of the explant was found intraoperatively. The removed Miragel explant was examined by a scanning electron microscopy, and this demonstrated a disintergrated and swollen structural composition of the Miragel explant. Postoperatively, her extraocular movement was almost restored and the retina remained well attached. Alterations in the structural composition of the Miragel explant results in an excessive swelling that causes a restriction of the extraocular movement, and this can mimick a periorbital mass lesion.

Phacoemulsification Using Microhook Iris Retractor for the Management of Ectopia Lentis in Marfan Syndrome

PURPOSE: We evaluated the clinical results of phacoemulsifacation using microhook iris retractor for the management of ectopia lentis in Marfan syndrome. METHODS: Seventeen eyes of 9 patients with Marfan syndrome were included. All the patients had undergone phacoemulsifacation with microhook iris retractor capsule stabilization between May 1997 and January 2000. RESULTS: Mean patient age was 11.6 +/-8.2 years old. Superior nasal(38%) and superior temporal(38%) were the most common direction of lens dislocation. Fifteen eyes demonstrated improvement in best corrected visual acuity by 2 lines or more following average follow-up period of 22.9 +/-9.2 months. As postoperative complications retinal detachment developed in 3 eyes. CONCLUSIONS: Phacoemulsifacation using microhook iris retractor for capsule stabilization appears to be a good technique for the management of ectopia lentis in Marfan syndrome.

Strabismus Surgery for Thyroid Ophthalmopathy

PURPOSE: To investigate the result of strabismus surgery for thyroid ophthalmopathy. METHODS: This retrospective study included 13 patients with strabismus due to thyroid ophthalmopathy.These patients underwent strabismus surgery with intraoperative adjustable suture technique under topical anesthesia in the period between January 1997 and December 2000. Mean postoperative follow-up examination period was 13.2+/-9.9 months. RESULTS: Eleven of thirteen patients (84.6%) had heterotropia less than 8 prism diopter at last postoperative follow up examination. CONCLUSIONS: With relatively short period of preoperative examination, we achieved satisfactory surgical outcome for the treatment of strabismus due to thyroid ophthalmopathy.

A Case of Mycobacterium Fortuitum Keratitis at the Interface of the Cornea after LASIK

PURPOSE: To report a case of Mycobacterium fortuitum keratitis which occurred in the interface between the corneal stromal bed and flap after laser in situ keratomileusis (LASIK). RESULTS: Forty five year old female patient presented with clinical picture of keratitis 20 days after LASIK. The keratitis started with one soft round colony in the interface between the corneal stromal bed and the flap and, then progressed slowly with crystal shaped colonies. The keratitis worsened after removal of colonies showing partially method flap. Inflammation was controlled only after removal of the partially melted flap and with intensive medical treatment. Mycobacterium fortuitum keratitis was confirmed 2 months later by culture of the excised flap tissue. The patient's corrected visual acuity improved to 20/400 at 6 months after treatment. CONCLUSIONS: Mycobacterium fortuitum should be considered as one of the causes of keratitis manifesting white colonies after LASIK. The characteristics of the colonies may change during the course of the disease. Vigorous work-up should be considered for early identification of the organism.