Changes in Retinal Circulation Time after Panretinal Photocoagulation in Patients with Nonproliferative and Proliferative Diabetic Retinopathy

Purpose@#To explore whether panretinal photocoagulation (PRP) improved retinal blood circulation in patients with diabetic retinopathy of various levels of severity based on changes in the retinal circulation time as measured by video fluorescein fundus angiography. @*Methods@#We recruited patients with severe diabetic retinopathy indicated for PRP; we performed video fluorescein fundus angiography before and after PRP. We measured changes in the arterial circulation time (ACT), arteriovenous passage time (APT), and venous filling time (VFT) in patients with diabetic retinopathy of varying severity, and compared the findings. We recorded HbA1c levels and hypertension status. @*Results@#We enrolled 33 patients, 17 with severe nonproliferative diabetic retinopathy (NPDR) and 16 with early proliferative diabetic retinopathy (PDR). After PRP, neither the ACT nor the APT changed significantly in patients with severe NPDR (p = 0.927, p = 0.138) or early PDR (p = 0.137, p = 0.268). After PRP, the VFT was significantly reduced in patients with both severe NPDR (p = 0.000) and early PDR (p = 0.022). The VFT reductions were similar in both groups (p = 0.217). @*Conclusions@#In patients with severe NPDR and early PDR, improvements in retinal blood circulation after PRP are reflected by reductions in the VFT evident on video fluorescein fundus angiography. We speculate that the improvements are similar in patients with severe NPDR and early PDR.

Changes in Retinal Circulation Time after Panretinal Photocoagulation in Patients with Nonproliferative and Proliferative Diabetic Retinopathy

Purpose@#To explore whether panretinal photocoagulation (PRP) improved retinal blood circulation in patients with diabetic retinopathy of various levels of severity based on changes in the retinal circulation time as measured by video fluorescein fundus angiography. @*Methods@#We recruited patients with severe diabetic retinopathy indicated for PRP; we performed video fluorescein fundus angiography before and after PRP. We measured changes in the arterial circulation time (ACT), arteriovenous passage time (APT), and venous filling time (VFT) in patients with diabetic retinopathy of varying severity, and compared the findings. We recorded HbA1c levels and hypertension status. @*Results@#We enrolled 33 patients, 17 with severe nonproliferative diabetic retinopathy (NPDR) and 16 with early proliferative diabetic retinopathy (PDR). After PRP, neither the ACT nor the APT changed significantly in patients with severe NPDR (p = 0.927, p = 0.138) or early PDR (p = 0.137, p = 0.268). After PRP, the VFT was significantly reduced in patients with both severe NPDR (p = 0.000) and early PDR (p = 0.022). The VFT reductions were similar in both groups (p = 0.217). @*Conclusions@#In patients with severe NPDR and early PDR, improvements in retinal blood circulation after PRP are reflected by reductions in the VFT evident on video fluorescein fundus angiography. We speculate that the improvements are similar in patients with severe NPDR and early PDR.

Clinical Efficacy of the Spot Vision Screener for Measuring Refraction andDetecting Strabismus in Children

Purpose@#To investigate the clinical efficacy of the Spot Vision Screener in measuring refractive power and detecting strabismusin pediatric patients. @*Methods@#We retrospectively analyzed the spherical equivalent, cylinder, and strabismus using the Spot Vision Screener beforecycloplegic refraction for pediatric patients <10 years of age. We compared the spherical equivalent and cylinder using the SpotVision Screener with the results of cycloplegic refraction, and we measured the accuracy of the Spot Vision Screener in detectingstrabismus compared with the alternate prism cover test. @*Results@#A total of 38 eyes of 19 patients were included in this study. There was no significant difference in spherical equivalentbetween the Spot Vision Screener before cycloplegic refraction and cycloplegic refraction (paired t-test: -0.25 ± 1.12 diopters [D]vs. 0.04 ± 1.86 D; p = 0.12). There was a significant difference in cylinder between the Spot Vision Screener before cycloplegicrefraction and cycloplegic refraction, but the difference was only -0.25 D (paired t-test: -1.41 ± 1.16 D vs. -1.16 ± 1.25 D; p = 0.01).The sensitivity of the Spot Vision Screener was 42.86%, and the specificity was 66.67% for detecting strabismus. @*Conclusions@#The Spot Vision Screener was a useful instrument to measure the refractive power in pediatric patients before cycloplegicrefraction, but it had poor sensitivity and specificity for detecting strabismus.

Palpebral Conjunctival and Tarsal Stromal Tumor

No abstract available.

Relationship between Pain and Injection Site during Intravitreal Injection

PURPOSE: Using a visual analogue scale, patients pain was compared according to injection site during intravitreal injection. METHODS: A prospective, clinical trial was conducted on 171 eyes of patients experiencing age-related macular degeneration, diabetic retinopathy, retinal vein occlusion, or central serous chorioretinopathy. After determining the anatomic quadrant of the injection site, patients were randomized to receive intravitreal bevacizumab, aflibercept, ranibizumab, or dexamethasone injection. Fifteen minutes after the injection, patients completed a survey about pain using a visual analogue scale from 0 (no pain) to 10 (unbearable pain). RESULTS: According to the visual analogue scale, pain score was 3.20 at the superotemporal site, 3.03 at the superonasal site, and 2.35 at the inferonasal site. Pain was lowest when injected in an inferotemporal site (p = 0.012). CONCLUSIONS: Intravitreal injection at an inferotemporal site can help reduce patient pain.

Clinical Outcomes of M-Plus Intraocular Lenses

PURPOSE: To evaluate the clinical outcomes of eyes implanted with a zonal refractive multifocal intraocular lens (IOL) with an inferior segmental near add (M-plus), and to compare the outcomes between M-plus and a diffractive-type multifocal IOL, AT LISA (366D, bifocal). METHODS: We reviewed 19 eyes from 10 patients who were implanted with M-plus and 52 eyes of 26 patients who were implanted with AT LISA. The clinical outcomes of these 2 intraocular lenses were evaluated at 1 day and 2 months postoperatively, and consisted of distant, intermediate, and near visual acuity, contrast sensitivity, degree of tilt, and decentration using anterior segment photography, depth of focus, and patient satisfaction. RESULTS: There were no statistical differences between the 2 groups with respect to distant vision, near vision, refractive error, contrast sensitivity, degree of tilt, decentration, or satisfaction score. The M-plus group demonstrated significantly better intermediate visual acuity. In the defocus curve, the M-plus group also demonstrated significantly better visual acuities for intermediate unfocused vision levels. CONCLUSIONS: The M-plus multifocal IOLs are able to provide satisfactory distant and near visual acuity and visual function. The M-plus multifocal IOLs provide better intermediate vision than the AT LISA.

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.

Introduction of Lens-angle Reconstruction Surgery in Rabbit Eyes

PURPOSE: In this study, we examined the stability of the lens-angle supporter (LAS) for accommodation restoration by comparing intraocular lens (IOL) location, after-cataract and ciliary body damage after cataract surgery in rabbits. METHODS: Eight rabbits were divided into experimental and control groups of four rabbits each. Phacoemulsification and irrigation and aspiration were performed in all rabbits. This was followed by an LAS and IOL insertion in the four experimental rabbits. In the four control rabbits, only an IOL insertion was performed. Six months after the surgery, the location of the IOL, the conditions of the lens capsule and ciliary body were evaluated using a slitl-amp examination and Miyake-Apple view. RESULTS: For the experimental group, the ultrasound biomicroscope results showed normal LAS and IOL positioning in all four cases. According to the slitlamp examination and Miyake-Apple view, the IOL was positioned at the center, with less after-cataract and damage to the ciliary body. For the control group, ultrasound biomicroscope results indicated a higher IOL position than normal, as well as a single case of IOL decentering. According to the slit-lamp examination and Miyake-Apple view, the IOL was decentered with more severe after-cataract and ciliary body damage. CONCLUSIONS: The LAS has the potential to maintain a stable IOL position while producing less after-cataract when used in lens-angle reconstruction for correction of presbyopia. Moreover, LAS implantation incurs less damage to the ciliary body.

Objective Clinical Evaluation of Ocular Optical Instrument According to the Type of Lens Opacity

PURPOSE: To investigate the results using the OQAS and the Pentacam in cataract patients classified according to the type of lens opacity. METHODS: The present study included 124 eyes of 92 patients who had cataract surgery at Seoul St. Mary's Hospital from December 2011 to January 2012 and were classified into nuclear, cortical, and posterior subcapsular cataract patients. The lens opacity was determined with OSI, MTF, Strehl ratio, width 10%, width 50% and the opacity of Scheimpflug image by the OQAS and the Pentacam. Additionally, the correlation between subjective cataract classification and objective opacity value was analyzed. RESULTS: The nuclear cataract group showed a 6.40 +/- 2.41 OSI value and had high opacity. The cortical cataract group showed the highest MTF cut-off value (12.02 +/- 6.19 C/deg). When evaluating Pentacam results, the posterior subcapsular cataract group had the lowest average level of lens opacity (9.12 +/- 1.08) followed by in increasing order, the cortical cataract group (9.79 +/- 1.67) and the nuclear cataract group (11.08 +/- 1.84). The results were statistically significant (p < 0.001). The OSI value of the OQAS was significantly correlated with nuclear and posterior opacity (p = 0.049, p = 0.039, respectively) except cortical opacity (p = 0.781). MTF and nuclear opacity showed statistically significant correlation and the lens opacity of Pentacam was correlated with nuclear and posterior opacities. In cortical cataract with severe peripheral opacity, the cortical opacity showed significant correlation with Maximum. CONCLUSIONS: The OQAS and Pentacam results showed high correlation with the nuclear and posterior opacities which can be useful for cataract surgery.

Correlation Between Central Corneal Thickness and Retinal Nerve Fiber Layer Thickness in Normal Tension Glaucoma

PURPOSE: To investigate the correlation between central corneal thickness (CCT) and peripapillary retinal nerve fiber layer (RNFL) thickness in the eyes of patients with normal tension glaucoma (NTG) at the initial examination and to examine the difference in the degrees of damage of RNFL thickness depending on the CCT. METHODS: Fifty-one eyes of 36 patients with NTG were included in the study, and 51 eyes of 30 people without the disease were used as a control group. CCT and peripapillary RNFL thickness were measured in each eye by ultrasonic pachymetry and optical coherence tomography(OCT), respectively. Patients from the normal NTG group who underwent OCT more than three times inthree years were identically assigned to two groups based on CCT: thin ( or = 553.6 micrometer). Thus, a comparison of the changes in the thickness of retinal nerve fiber layer was performed between the two groups. RESULTS: Patients with NTG showed a significant positive correlation between CCT and the mean peripapillary RNFL thickness at the initial examination (R=0.68, p0.05) CONCLUSIONS: At the time of initial diagnosis of NTG, there was a significant correlation between the thickness of CCT and RNFL. Howeverthere was no significant correlation between the thickness of CCT and the progression of the damage of RNFL.

A Case of Acute Angle-Closure Glaucoma in a Nanophthalmos Patient

PURPOSE: To present a case of acute angle-closure glaucoma in a nanophthalmos patient. CASE SUMMARY: A 28-year-old woman visited the hospital for a sudden pain in the left eye, she had a small orbital bone and narrow palpebral fissurea in both eyes. Her intraocular pressure (IOP) was 58 mmHg in the left eye. The slit lamp examination showed shallow anterior chambers in both eyes, and the gonioscopic examination showed a closed angle in the left eye. The diameters of the corneas were 11 mm , and the axial lengths were 19.7 mm in the right eye and 19.6 mm in the left eye. The depths of the anterior chambers were 1.51 mm in the right eye and 1.82 mm in the left eye. The disease was diagnosed as acute angle-closure glaucoma in the left eye of the patient with nanophthalmos, and thus the IOP of the left eye was lowered using ophthalmic drugs and medications. Laser iridotomy was performed on both eyes. CONCLUSIONS: For around a year of follow-up after laser iridotomy, complications such as the rise of intraocular pressure and choroidal effusion were not observed. This suggests that laser iridotomy can be an effective treatment for acute angle-closure glaucoma accompanying nanophthalmos.