Four-flanged Technique for Scleral Fixation of a Dislocated Four-eyelet Intraocular Lens

Purpose@#To define and evaluate the short-term clinical outcomes of the four-flanged technique for scleral fixation of a dislocated four-eyelet intraocular lens (IOL). @*Methods@#Eleven eyes of 11 patients who underwent scleral fixation of dislocated four-eyelet intraocular lenses using a four-flanged technique were studied retrospectively. We measured the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, astigmatism, IOL tilt and decentration, and postoperative complications. @*Results@#The BCVA was 0.25 ± 0.11 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.14 ± 0.12 logMAR 6 months later (p < 0.001). The corneal endothelial cell count was 2,427 ± 384 and 2,367 ± 298/mm2 before and after surgery, respectively (p = 0.285). The spherical equivalent was 6.02 ± 4.90 and 0.11 ± 0.36 before and after surgery, respectively. There was no significant difference in astigmatism before and after surgery. The mean IOL tilt and decentration were 2.44 ± 1.68° and 0.23 ± 0.09 mm, respectively. The refractive difference was 0.11 ± 0.24 diopters (D). Postoperative complications occurred in one eye; one flange lay outside the scleral tunnel, triggering hyperemia and conjunctival inflammation. @*Conclusions@#The four-flanged scleral fixation technique for a dislocated four-eyelet IOL improved the BCVA but did not significantly affect corneal endothelial cell loss. The procedure significantly reduced postoperative IOL tilt, decentration, and astigmatism, and may be a useful alternative to scleral fixation of a dislocated four-eyelet IOL.

Cytomegalovirus Retinitis in Immunocompetent Patients with Diabetes Mellitus

Purpose@#We report five cases of cytomegalovirus (CMV) retinitis in immunocompetent patients with diabetes mellitus (DM). @*Methods@#This was a retrospective observational case series of five immunocompetent patients with CMV retinitis. All patients had DM and variable degrees of DM retinopathy. After discovery of the retinitis, we assessed the patients in terms of ophthalmologic history, systemic conditions, underlying disease, and the medications used for treatment, such as immunosuppressants. This was followed by blood and immunology tests. None of the five patients were immunocompromised. We confirmed the diagnosis of CMV retinitis by polymerase chain reaction (PCR) analysis; samples were collected by anterior chamber paracentesis. All patients were treated with intravitreal antiviral injection until negative results were obtained for the anterior chamber PCR. @*Results@#All five immunocompetent patients who had developed CMV retinitis, had a history of diabetes of at least 15 years. The average duration of diabetes was 17.4 ± 2.4 (15-20) years, the average HbA1c was 7.3 ± 0.5% (6.8-8.0%), and the average duration and numbers of Intravitreal antiviral injections were 23.8 ± 8.5 months (14-36 months) and 14.8 ± 3.2 times (10-18 times), respectively. @*Conclusions@#We report this case series because CMV retinitis can be complicated even in diabetic patients shown to be immunocompetent.

Central Serous Chorioretinopathy Following High G-force Exposure in a Fighter Pilot

Purpose@#To report a case of central serous chorioretinopathy (CSC) after high G-force exposure in a fighter pilot with rapid remission.Case summary: A 28-year-old male patient was transferred from a local clinic with metamorphopsia in the left eye. His visual acuity was 20/20 in both eyes. Fundus examination of his left eye showed serous retinal detachment. Fluorescein angiography revealed leakage, which led to a diagnosis of CSC. As a fighter pilot, he had been exposed repeatedly to high g-forces before symptoms occurred. His flying was then stopped, and a follow-up examination was scheduled. After two weeks, a fundus examination showed resolution of the subretinal fluid. @*Conclusions@#CSC can develop after high g-force exposure, with a rapid clinical course. When making a CSC diagnosis, the physician should confirm potential causative environments by performing a thorough review of the patient’s occupational history and promptly terminate the likely causes.

The Effect of a 0.1% Bromfenac Solution on Diabetic Macular Edema

Purpose@#The short-term outcomes of patients with diabetic macular edema (DME) treated with 0.1% Bromfenac eyedrops were evaluated. @*Methods@#We included 14 eyes of 14 patients diagnosed with persistent macular edema after intravitreal bevacizumab injection to treat DME. Bromfenac sodium hydrate 0.9 mg/mL eyedrops were administered to the affected eye twice daily for 3 months. The best corrected visual acuity (BVCA) and central macular thickness (CMT) were measured before treatment and at 1, 2, and 3 months after treatment. We noted no adverse drug reaction such as corneal toxicity. @*Results@#After 2 months of intravitreal bevacizumab and before Bromfenac eyedrops treatment, the logarithm of the minimal angle of resolution (logMAR) BCVA and the CMT were 0.40 ± 0.29 and 337 ± 97.3 μm, respectively. The logMAR BCVA decreased from 0.40 ± 0.29 to 0.39 ± 0.29 after 1 month, to 0.38 ± 0.24 after 2 months, and to 0.34 ± 0.21 after 3 months of Bromfenac treatment, but statistical significance was not attained (p = 0.93, p = 0.62, and p = 0.36 respectively). The CMT improved significantly from 337 ± 97.3 μm to 331 ± 67.9 μm after 1 month, 311 ± 89.1 μm after 2 months, and 282.9 ± 76.7 μm after 3 months (p = 0.47, p = 0.08, and p = 0.04, respectively). Treatment was well-tolerated; we noted no topical or systemic side-effect. @*Conclusions@#Topical bromfenac may play a useful role in terms of reducing DME.

The Effect of a 0.1% Bromfenac Solution on Diabetic Macular Edema

Purpose@#The short-term outcomes of patients with diabetic macular edema (DME) treated with 0.1% Bromfenac eyedrops were evaluated. @*Methods@#We included 14 eyes of 14 patients diagnosed with persistent macular edema after intravitreal bevacizumab injection to treat DME. Bromfenac sodium hydrate 0.9 mg/mL eyedrops were administered to the affected eye twice daily for 3 months. The best corrected visual acuity (BVCA) and central macular thickness (CMT) were measured before treatment and at 1, 2, and 3 months after treatment. We noted no adverse drug reaction such as corneal toxicity. @*Results@#After 2 months of intravitreal bevacizumab and before Bromfenac eyedrops treatment, the logarithm of the minimal angle of resolution (logMAR) BCVA and the CMT were 0.40 ± 0.29 and 337 ± 97.3 μm, respectively. The logMAR BCVA decreased from 0.40 ± 0.29 to 0.39 ± 0.29 after 1 month, to 0.38 ± 0.24 after 2 months, and to 0.34 ± 0.21 after 3 months of Bromfenac treatment, but statistical significance was not attained (p = 0.93, p = 0.62, and p = 0.36 respectively). The CMT improved significantly from 337 ± 97.3 μm to 331 ± 67.9 μm after 1 month, 311 ± 89.1 μm after 2 months, and 282.9 ± 76.7 μm after 3 months (p = 0.47, p = 0.08, and p = 0.04, respectively). Treatment was well-tolerated; we noted no topical or systemic side-effect. @*Conclusions@#Topical bromfenac may play a useful role in terms of reducing DME.

A Case of Fungal Keratitis Caused by Paecilomyces lilacinus after Penetrating Keratoplasty

PURPOSE: To report a case of corneal ulcer caused by Paecilomyces lilacinus after penetrating keratoplasty. CASE SUMMARY: A 67-year-old male with a history of penetrating keratoplasty in the left eye 7 years prior and re-penetrating keratoplasty in the left eye due to graft failure in June 2013, visited our clinic for ocular pain and conjunctival injection in the left eye 3 days in duration. Corneal scrapings were performed for Gram and fungal stains and cultures. The patient was admitted to the hospital for hourly topical fortified ceftazidime and amphotericin B. Despite intensive topical therapy, no improvement was observed. Three days later, fungal culture confirmed Paecilomyces lilacinus and topical voriconazole was prepared from the intravenous formulation and was administered topically and intravenously. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty. CONCLUSIONS: Keratitis caused by Paecilomyces lilacinus is difficult to eradicate and refractory to amphotericin B. We suggest early use of topical eyedrops, intracameral, and intravitreal injections of voriconazole may be an appropriate treatment for patients with Paecilomyces lilacinus keratitis.

Clinical Analysis of Epithelial Tumors of the Lacrimal Gland

PURPOSE: To analyze the clinical and radiologic findings and to evaluate the treatment and prognosis of epithelial tumor patients. METHODS: We retrospectively reviewed clinical and radiologic findings of 36 patients who had been histopathologically diagnosed with epithelial tumors of the lacrimal gland after biopsy and surgery at Seoul St. Mary's Hospital from May 2005 to October 2012. RESULTS: Among the patients with epithelial tumors of the lacrimal gland based on histopathological findings, there were 21 cases of pleomorphic adenoma, seven cases of dacryops, four cases of adenoid cystic carcinoma, two cases of adenocarcinoma, one case of benign oncocytoma, and one case of mucoepidermoid carcinoma. The characteristic clinical finding of epithelial tumors of the lacrimal gland was proptosis (52.7%). In contrast with benign epithelial tumors of the lacrimal gland, the characteristic clinical findings of malignant epithelial tumors of the lacrimal gland were limitation of motion (57.1%), diplopia (57.1%), ocular pain (42.9%), and decreased visual acuity (42.9%). The mean duration of the symptoms of malignant epithelial tumors (5.0 +/- 4.2 months) was shorter than that of benign epithelial tumors (11.2 +/- 11.1 months) (t-test, p = 0.034). In radiologic CT and MRI findings, there was minimal bony destruction in two cases of pleomorphic adenoma and calcification in one case of pleomorphic adenoma. Malignant epithelial tumors of the lacrimal gland, in contrast to benign tumors, showed characteristic bony destruction (57.1%), poorly marginated tumor outline (42.9%) and calcification (14.3%). The 57.1% of patients in this study with malignant tumors were treated with chemotherapy and radiotherapy after surgical treatment, and there was one case (14.3%) of recurrence after treatment. CONCLUSIONS: Careful analysis of clinical and radiologic findings can lead to early diagnosis of malignant tumors.