Two Cases of Corneal Toxicity in Acanthamoeba Keratitis by Combined Topical Anti-Acanthamoeba Keratitis Eye Solution

PURPOSE: To present a case of corneal toxicity caused by therapeutic duplication during treatment of acanthamoeba keratitis as a complication of contact lens use. CASE SUMMARY: A 12-year-old girl with a history of wearing orthokeratology contact lenses and a 14-year-old girl with a history of wearing cosmetic contact lenses presented with ocular pain, injection, and decreased visual acuity. They were diagnosed as having acanthamoeba keratitis based on slit lamp examination, confocal microscopy and culture. After the patients were treated with polyhexamethylene biguanide (PHMB) and chlorhexidine, corneal epithelial defect and erosion occurred. Use of chlorhexidine was stopped, and PHMB was used to treat patients and recovery of the corneal epithelium with improvement in symptoms of acanthamoeba keratitis was found. CONCLUSIONS: Using PHMB and chlorhexidine together in treating acanthamoeba keratitis increases the risk of corneal toxicity. Therefore, these drugs should be avoided in combination.

Intravitreal Bevacizumab With or Without Photodynamic Therapy for the Treatment of Polypoidal Choroidal Vasculopathy

PURPOSE: To compare the efficacy of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab and bevacizumab monotherapy in polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-six eyes, diagnosed with PCV were reviewed retrospectively. They were divided into two groups: combined treatment (COMB) and bevacizumab monotherapy (BEV). Visual acuity, fluorescein angiography (FA) and indocyanine green angiography (ICG) results were reviewed to compare changes in the polypoidal vessels and the branching vascular networks. RESULTS: Among 26 eyes of 26 patients, there were 12 eyes in the COMB group and 14 eyes in the BEV group. Follow-up periods were about 42 weeks and 48 weeks for the respective groups. In the COMB group, visual acuity improved from log MAR 0.92 to 0.56, whereas visual acuity in the BEV group changed only minimally from log MAR 0.98 to 0.97. In the COMB group, the polypoidal vessel resolved in six eyes. In the BEV group, the polypoidal vessel resolved in one eye. In the COMB group, the vascular network resolved in one eye, improved in ten eyes, and did not change in one eye. In the BEV group, the vascular network did not change in any of the 14 eyes. CONCLUSIONS: Combined treatment with PDT and intravitreal bevacizumab resulted in a more prolonged effect, induced the resolution of polypoidal vessels more effectively than did bevacizumab monotherapy, and is expected to reduce recurrence and retreatment.

The Relationship Between Intraocular Pressure and Health Parameters

PURPOSE: This study analyzed the relationship between intraocular pressure (IOP) and health parameters, including waist circumference, in healthy Koreans. METHODS: A total of 6169 healthy participants underwent automated multi-phasic tests including tonometry, automated perimetry, and fundus photography. Parameters of these patients including height, weight, degree of obesity, body fat percentage, waist circumference, body mass index, and body muscle rate, were recorded. The subjects were divided into six age groups by decades ranging from 20~29 years to over 70 years. Multiple regression analysis was used to examine the relationship between IOP and the parameters mentioned above. RESULTS: The mean age of the participants was 47.87 years, and 3015 (51.1%) of the participants were men. The mean IOP was 13.58+/-3.1 mmHg, and was significantly higher in men than in women (p0.05). CONCLUSIONS: Because increased IOP is associated with several health parameters that can be modified by diet and exercise such as weight, body fat percentage, body mass index, and waist circumference, it is recommended that these be reduced.

Edema of the Photoreceptor Layer in Vogt-Koyanagi-Harada Disease Observed Using High-Resolution Optical Coherence Tomography

PURPOSE: To evaluate the characteristics of fluid accumulation in the uveitic stage of Vogt-Koyanagi-Harada (VKH) disease using high resolution optical coherence tomography (OCT3). METHODS: Twenty-eight eyes in 14 patients with VKH disease were reviewed retrospectively. These 28 eyes were divided into 19 eyes with intraretinal fluid (C group) and 9 eyes without intraretinal fluid (N group). Changes in visual acuity and fluid accumulation observed using OCT were compared between the two groups. RESULTS: Visual acuity at the time of presentation was significantly worse in the C group than in the N group (p=0.005). The photoreceptor layer appeared to be double-layered due to a cystoid space in the C group. Layered structures and strands found in the cystoid space. Expanding sponge-form edema led to the development of a cystoid space in the photoreceptor layer. Intraretinal fluid resolved earlier than subretinal fluid. There were no observed differences in visual acuity between the two groups after four days of treatment. CONCLUSIONS: Accumulation of intraretinal fluid was related to poor initial visual acuity, but not to final visual acuity. High resolution OCT findings indicate that edema of the photoreceptor layer participates in the development of a cystoid space.

The Relationship Between Intraocular Pressure and Age, Hypertension and Obesity Index in Ocular Hypertensive Patients

PURPOSE: To evaluate the relationship between intraocular pressure (IOP) and age, blood pressure and obesity index inocular hypertensive patients. METHODS: A total of 2684 ocular hypertensive patients underwent automated multi-phasic testing, including fundus photography, blood pressure and assessment of obesity. The subjects were divided into six age groups by decades ranging from 20~29 years to over 70 years of age. The relationships between factors were examined using multiple regression analysis. RESULTS: The mean participant age was 48.0+/-11.0 years, and 1,777 (66.3%) participants were male and 907 (33.7%) were female. The mean intraocular pressure (IOP) was 22.04+/-2.2 mmHg and was significantly higher in males than in females (p=0.023). The IOP was associated with mean blood pressure, gender and obesity index. After adjustment for mean blood pressure and obesity index, the relationship between IOP and age showed a significantly negative tendency (p<0.001). The relationship between IOP and obesity index adjusted for age and mean blood pressure had a significantly positive tendency (p<0.001), regardless of gender. The relationship between IOP and mean blood pressure adjusted for age and obesity index showed a significantly positive tendency (p=0.00014). CONCLUSIONS: IOP was associated with the mean blood pressure and obesity index. Regardless of gender, IOP decreased with age but increased with hypertension. It is necessary to check IOP regularly, especially in ocular hypertensive patients with systemic hypertension.

A Case of Retinal Contusion Combined Exudative Retinal Detachment Causing Delayed Visual Disturbance

PURPOSE: To report a case of retinal contusion with the complication of exudative retinal detachment causing delayed visual disturbance. CASE SUMMARY: A 28-year-old man presented with visual disturbance of the left eye. Three days prior, a soccer ball hit him on his left eye, and he visited a local clinic. His visual acuity was 0.9. Fundus examination revealed a lesion of the macula, which was diagnosedas retinal contusion. Two days later, visual acuity decreased to 0.3 and he was referred to us. At presentation, his visual acuity was 0.125. A gray to white lesion around the superotemporal vascular arcade, and exudative retinal detachment involving the fovea associated with the lesion were found. Subretinal fluid collection was confirmed with optical coherence tomography (OCT). Fluorescein angiography showed diffuse leakage over the contusion, and fluorescein was pooled in the detached area. At 15 days, subretinal fluid was resolved on OCT and vision was improved to 0.8. CONCLUSIONS: We suggest that leakage from the contusion caused delayed exudative retinal detachment and decrease of visual acuity. Visual acuity improved with resolution of the subretinal fluid. Though the visual acuity was good in spite of a severe retinal contusion on the perifoveal area, the possibility of exudative retinal detachment and delayed visual disturbance shoud be considered.

A Case of Fungal Keratitis as a Complication of Orthokeratology Contact Lens

PURPOSE: To present a case report of fungal keratitis related to prolonged overnight use of orthokeratology contact lenses. METHODS: A 13 year-old girl presented with a corneal ulcer in her left eye refractory to antibacterial medication. She had a history of wearing orthokeratology contact lenses overnight for seven months. RESULTS: The organism Aspergillus was isolated by corneal scraping, the contact lens itself, and from the storage case. The patient was treated with topical fluconazole and Natamycin pimaricin in addition to oral itraconazole, resulting in a resolution of the ocular lesion. CONCLUSIONS: The risk of fungal infection as a potential complication of the use of overnight orthkeratology contact lenses should be considered when using these lenses.