Retinal Vascular Caliber Changes in Early Type 2 Diabetic Patients without Retinopathy

Purpose@#To evaluate the retinal vascular caliber in early type 2 diabetic patients without retinopathy. @*Methods@#This retrospective study reviewed the medical records of 85 patients who were diagnosed with type 2 diabetes (age, 10-48 years) and sex-matched healthy controls. Dilated fundus examinations were performed to confirm the absence of diabetic retinopathy. Fundus photographs were acquired and analyzed using software that semi-automatically measured retinal vascular caliber. Central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR) were determined using the revised Parr-Hubbard formula. Healthy controls were examined using the same approach. @*Results@#There were no significant differences between patients and controls in terms of CRAE (149.92 ± 21.29 µm and 144.85 ± 17.14 µm, respectively; p = 0.137) or CRVE (195.85 ± 22.94 µm and 196.69 ± 18.43 µm, respectively; p = 0.829). However, AVR was significantly higher in the patient group (0.768 ± 0.088 vs. 0.737 ± 0.061; p = 0.031). In the patient group, AVR was significantly correlated with hemoglobin A1c (r = 0.325, p = 0.006), but not with body mass index (p = 0.478). @*Conclusions@#An increase in peripapillary AVR may be an early feature of retinal vessels observed in patients with type 2 diabetes, which is closely related to elevated blood sugar.

Subfoveal Choroidal Thickness Changes after Intravitreal Bevacizumab in Macular Edema Secondary to Retinal Vein Occlusion

PURPOSE: To determine changes in subfoveal choroidal thickness (SCT) after intravitreal injection of bevacizumab in eyes with macular edema secondary to retinal vein occlusion (RVO). METHODS: Forty-four patients treated with intravitreal bevacizumab for unilateral macular edema due to RVO were retrospectively reviewed. Before injection, patients underwent best-corrected visual acuity (BCVA) assessment, dilated fundus examination, fluorescein angiography, and enhanced depth imaging optical coherence tomography. Changes in BCVA, SCT, and central macular thickness (CMT) of the RVO eyes were evaluated and compared with those of the normal contralateral eyes at baseline and at 1, 3, and 6 months after injection. RESULTS: The mean SCT in RVO eyes (265.41 ± 43.02 µm) was significantly thicker than that in the fellow eyes (244.77 ± 30.35 µm) at baseline (p < 0.001). The mean SCT was significantly reduced at 1, 3, and 6 months after intravitreal bevacizumab injection (all p < 0.001), and the change in SCT was significantly correlated with the change in CMT (r = 0.327, p = 0.030). While there was an improvement in BCVA together with a reduction in SCT (p < 0.001), no significant correlation was found (p = 0.126). CONCLUSIONS: Subfoveal choroidal thickness in RVO eyes with macular edema was greater than that in the normal fellow eyes, and decreased significantly after intravitreal bevacizumab injection. The SCT reduction was significantly correlated with CMT reduction.

The Effect of a Fixed Combination of 0.0015% Tafluprost-0.5% Timolol in Normal Tension Glaucoma Patients

PURPOSE: This study evaluated the effect of a fixed combination of 0.0015% tafluprost-0.5% timolol (Tapcom®, Santen, Osaka, Japan) in glaucoma patients. METHODS: This study included 23 patients who were diagnosed with normal tension glaucoma and treated with a fixed combination of 0.0015% tafluprost-0.5% timolol as the first therapy. Diurnal intraocular pressure (IOP) was measured every 2 and 0.5 hours between 9:00 am and 4:30 pm. The IOP change with respect to body position (positional IOP) was measured at baseline and at 6 months after eye-drop instillations. IOP fluctuation was defined as the standard deviation of IOP measurements. Throughout the study, all side effects were recorded and monitored by the investigators. RESULTS: The mean reduction in IOP in the 0.0015% tafluprost-0.5% timolol fixed combination-treated eyes was −3.37 ± 2.39 mmHg (−19.70 ± 13.97%) for the right eye and −3.22 ± 2.27 mmHg (-18.81 ± 13.28%) for the left eye (paired t-test, p < 0.001). The mean positional IOP measured at 4 pm at 6 months after 0.0015% tafluprost-0.5% timolol fixed combination instillation showed statistically significant reduction from the mean positional IOP at baseline. There was a significant difference in the number of patients with ≤3 mmHg IOP variation over four time points between baseline and at 6 months in the 0.0015% tafluprost-0.5% timolol fixed combination-treated eyes (McNemar test, p < 0.001). There was no serious adverse event causing ocular damage. CONCLUSIONS: Use of 0.0015% tafluprost-0.5% timolol fixed combination was effective and well tolerated in reducing IOP and in maintaining its effectiveness in glaucoma patients.

Clinical Effectiveness of a Brinzolamide 1%-Brimonidine 0.2% Fixed Combination for Normal Tension Glaucoma in South Koreans

PURPOSE: This study evaluated the efficacy and safety of a brinzolamide 1%-brimonidine 0.2% fixed combination (BBFC) for normal tension glaucoma (NTG) in a South Korean population. METHODS: This study included 45 patients who were newly diagnosed with NTG and treated with BBFC as the first therapy from January 2016 through December 2016. The unilateral eye of NTG eyes of all patients were enrolled. If both eyes were eligible, the eye with the more severe glaucomatous change was selected. If the glaucomatous change was similar in both eyes, the right eye was selected. The patients received the BBFC twice a day. Diurnal intraocular pressure (IOP) was measured every 2 and 1/2 hours between 09:00 am and 04:30 pm. The IOP change with respect to body position (positional IOP) was measured at baseline and at 6 months after eyedrop instillation. Throughout the study, all side effects were recorded and monitored by the investigators. RESULTS: Ten patients were excluded due to an allergic reaction or follow-up loss. A total of 35 patients were enrolled in this study. The mean IOP was 15.32 ± 4.00 mmHg at baseline and 13.38 ± 3.30 mmHg at 6 months after BBFC instillation (p < 0.001). The IOP fluctuation decreased from 3.33 ± 3.10 to 2.35 ± 1.40 mmHg after BBFC instillation; however, the difference was not statistically significant (p = 0.150). The mean change in positional IOP showed a statistically significant reduction from 16.94 ± 3.18 to 14.80 ± 3.27 mmHg (p = 0.025). There was no serious adverse drug reaction except in three cases of allergic reaction. CONCLUSIONS: BBFC is effective for the reduction of mean IOP and positional IOP in NTG patients.

Positional Intraocular Pressure of Vitrectomized and Normal Fellow Eyes

PURPOSE: To compare posture-induced intraocular pressure (IOP) changes in vitrectomized eyes and normal eyes of patients who had vitrectomy in one eye. METHODS: A total of 31 patients older than 20 years of age who underwent vitrectomy were enrolled in the study. At least six months after vitrectomy, we measured IOP in both eyes using a rebound tonometer 10 minutes after the patient assumed sitting, supine, right lateral decubitus, and left lateral decubitus positions. Patients with a history of ocular surgery (not including vitrectomy) or recent medication use associated with IOP were excluded. IOP and ocular parameters of vitrectomized and normal fellow eyes were compared. For the decubitus position, IOP values of dependent and nondependent eyes were compared. RESULTS: No significant difference was observed in IOP between vitrectomized and normal eyes in the sitting and supine positions. The IOP for dependent eyes (on the lower side in the lateral decubitus position) was significantly higher than the IOP for nondependent eyes in both right lateral decubitus (right vitrectomized eye 19.31 ± 4.20 vs. 16.71 ± 4.02 mmHg, p < 0.001; left vitrectomized eye 18.35 ± 1.75 vs. 16.04 ± 3.02 mmHg, p = 0.003) and left lateral decubitus (right vitrectomized eye 17.32 ± 4.63 vs. 19.15 ± 3.83 mmHg, p = 0.004; left vitrectomized eye 16.19 ± 1.81 vs. 18.12 ± 2.29 mmHg, p < 0.001) positions. CONCLUSIONS: IOP was higher in the dependent than the nondependent eye in the lateral decubitus position, for both vitrectomized and nonoperated eyes.

A Case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following Human Papilloma Virus Vaccination

PURPOSE: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) that developed after human papilloma virus (HPV) vaccination. CASE SUMMARY: A 31-year-old woman experienced sudden bilateral blurred vision and paracentral scotomas four days before visiting the hospital. The symptoms occurred two weeks after the second vaccination with quadrivalent HPV vaccine (Gardasil®, MSD Korea, Seoul, Korea), and she had no pain or cold symptoms. At initial visit, the anterior chamber cells were observed, and the anterior vitreous was found to be clear. On fundus examination, multiple placoid yellow-whitish lesions were observed at the posterior pole, and fluorescein angiography showed early hypofluorescence and late hyperfluorescence with staining. Under a diagnosis of bilateral APMPPE, oral corticosteroid was used as treatment for two weeks, after which symptoms were resolved, anterior chamber cells disappeared, and lesions at the posterior pole markedly decreased. After five weeks, multiple hyperreflective areas on the outer retinal layers as well as missing photoreceptor and retinal pigment epithelial layers were almost recovered upon optical coherence tomography. CONCLUSIONS: Non-infectious uveitis such as APMPPE can rarely present after HPV vaccination. Further studies are necessary to understand whether HPV vaccine is a direct cause of uveitis.

Comparison of Reliability in Diabetic Macular Edema Estimates between Two Image Analysis Algorithms

PURPOSE: To evaluate segmentation reliability in diabetic macular edema (DME) estimates between a Cirrus™ HD-OCT image analysis algorithm and an Iowa reference algorithm, which are an automatic segmentation software. METHODS: Thirty eyes from 23 patients diagnosed with DME were included and underwent spectral-domain optical coherence scans (Cirrus™ HD-OCT). Central foveal thickness (CFT) and ganglion cell layer-inner plexiform layer segmentation data were compared with those produced by the Cirrus™ HD-OCT segmentation algorithm and Iowa reference algorithm. Measurement agreement was assessed using intraclass correlation (ICC) and segmentation errors were confirmed by 2 ophthalmologists. RESULTS: The mean CFT in the 1-mm central area determined by the manufacturer-supplied Cirrus software and Iowa reference algorithm was 512.07 ± 182.35 µm and 476.53 ± 32.36 µm, respectively (p < 0.05). The mean paired difference was 35.53 ± 92.46 µm (ICC, 0.929). Segmentation errors were demonstrated in eyes with a CFT less than 400 µm, specifically for 45% of scans obtained by the Cirrus algorithm and 9% from the Iowa algorithm; in eyes with a CFT equal to or higher than 400 µm, the error rates were 95% and 42%, respectively. CONCLUSIONS: CFT measurement in eyes with diabetic macular edema using the Cirrus algorithm and Iowa algorithm showed relatively high degrees of agreement and significant correlation. In eyes with a CFT equal to or higher than 400 µm, the Iowa algorithm showed higher reliability in retinal segmentation than the Cirrus algorithm.

The Association between Diabetic Retinopathy and Framingham Risk Score in Koreans with Type II Diabetes

PURPOSE: In this study, we compared the risk of cardiovascular complications between diabetic retinopathy (DR) groups based on the Framingham Risk Score. METHODS: Subjects 40 years of age or older were enrolled in the present study from September 2008 to September 2009. Five scales were used to evaluate the severity of DR for the most severely affected eye in each patient: no DR, mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). The first group included no DR patients and the second group included mild NPDR patients. The third group included moderate NPDR, severe NPDR and PDR patients. The Framingham Risk Score was analyzed among the groups to determine whether a difference in score existed. RESULTS: DR was found in 126 subjects. The first group included 403 subjects, the second group 22 subjects and the third group 104 subjects. The average Framingham Risk Score that appeared with increasing severity of DR was 10.89 ± 7.98 in the first group, 12.25 ± 10.84 in the second group and 13.25 ± 10.66 in the third group. The average difference between the first and third groups was statistically significant (p = 0.014). CONCLUSIONS: In our study, the Framingham Risk Score increased significantly with more severe DR (p = 0.042). Our results are useful when considering the easily accessible identification of DR and that cardiovascular disease is one of the main causes of death worldwide. However, confirming the exact causal relationship based on our results is difficult because the study design was cross-sectional and additional studies are necessary.

Associations between Optic Cup-to-disc Ratio and Systemic Factors in the Healthy Korean Population

PURPOSE: To assess the relationships between optic cup-to-disc ratio (CDR) and age, sex, and other demographic and health characteristics in the healthy Korean population. METHODS: The study design was retrospective and population-based. A total of 28,377 subjects who participated in the Korea National Health and Nutrition Examination Survey between 2008 and 2011 were enrolled in this study. Participants underwent structured interviews as well as systemic and ophthalmic examinations. Patients with glaucoma who were diagnosed using the International Society of Geographical and Epidemiological Ophthalmology classification were excluded. Changes in vertical CDR were examined by age in relation to systemic variables on multiple regression analysis. RESULTS: The mean vertical CDR was 0.34 +/- 0.12. The vertical CDR increased with age from subjects in their 20s to those in their 80s (p < 0.001). The mean CDR in males was significantly higher than that of females (p < 0.001). On multiple regression analysis, the vertical CDR was positively associated with age (p < 0.001), male sex (p < 0.001), diastolic blood pressure (p = 0.009), and intraocular pressure (p < 0.001) but was negatively associated with body mass index (p < 0.001). CONCLUSIONS: Greater vertical CDR was related to age, male sex, higher diastolic blood pressure, higher intraocular pressure, and lower body mass index in healthy Koreans.

Intravitreal Ranibizumab for Subfoveal Choroidal Neovascularization from Age-Related Macular Degeneration with Combined Severe Diabetic Retinopathy

BACKGROUND: To evaluate the efficacy of intravitreal ranibizumab for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) with combined severe diabetic retinopathy (DR). METHODS: This retrospective, interventional case series included eleven patients (mean age, 70.09 years; range, 54 to 83 years) with at least severe non-proliferative DR and subfoveal CNV secondary to AMD. Each subject was treated with intravitreal injections of 0.5 mg ranibizumab. The primary outcomes included change in best-corrected visual acuity and central subfield thickness (CST) on optical coherence tomography (OCT). RESULTS: The mean follow-up time was 16.7+/-14 months (range, 6 to 31 months). Mean visual acuity improved from 1.21+/-0.80 logarithm of the minimum angle of resolution (logMAR) to 1.0+/-0.6 logMAR (P=0.107), 0.95+/-0.62 logMAR (P=0.044), 1.10+/-0.68 logMAR (P=0.296), and 1.13+/-0.66 logMAR (P=0.838) at 1, 3, 6, and 12 months after injection, respectively. Eight patients (72.7%) gained or maintained vision (mean 0.32 logMAR), whereas three patients (27.3%) lost more than one line of vision (mean 0.51 logMAR). The mean OCT CST was 343.9+/-134.6 microm at baseline, and the mean CST at 1, 3, 6, 12 months after the injection was 367.8+/-172.1 (P=0.864), 346.2+/-246.2 (P=0.857), 342+/-194.1 (P=0.551), and 294.2+/-108.3 microm (P=0.621), respectively. CONCLUSION: Intravitreal ranibizumab injection can be considered to be a therapy for the stabilization of subfoveal CNV secondary to AMD with combined severe DR. However, these patients might exhibit limited visual improvement after treatment.

The Effect of Anthocyanoside and Ginkgo Biloba Extract on Normal-Tension Glaucoma According to Presence of Diabetes

PURPOSE: This study was performed to evaluate the effect of anthocyanoside and ginkgo biloba extract (GBE) in patients with normal tension glaucoma (NTG), according to the presence of diabetes mellitus (DM). METHODS: A chart review of patients with normal tension glaucoma was retrospectively analyzed. All patients underwent a Humphrey visual field (HVF) test and logarithm of the minimal angle of resolution best-corrected visual acuity (log MAR BCVA) was measured over a 6 months period. Changes in mean deviation (MD), pattern standard deviation (PSD) of visual field and log MAR BCVA were compared among anthocyanoside, GBE and no medication (control) groups. Patients were divided according to the presence of DM. RESULTS: A total of 406 NTG patients, including 151 DM patients, were included in the present study. MD was improved in the anthocyanoside and GBE groups, but not in the control group. PSD was not significantly different in all groups. BCVA was improved in the anthocyanoside group, but deteriorated in the control group. The results were similar in patients with or without DM. The generalized linear model demonstrated that systemic medication affected changes in visual indices. CONCLUSIONS: The results from the present study suggest that anthocyanoside and GBE may be helpful for improving visual function in some patients with NTG regardless of their DM status.

The Effect of Fixed Combination of Brinzolamide 1% and Timolol 0.5% in Normal-Tension Glaucoma

PURPOSE: We conducted a study to evaluate the effects of brinzolamide/timolol fixed combination (BTFC) in normal-tension glaucoma (NTG) patients. METHODS: We reviewed the records of 33 normal-tension glaucoma patients treated with BTFC in the unilateral eye. We measured intraocular pressure (IOP) every 2 and 1/2 hours between 09:00 am and 04:30 pm. After using BTFC at 8:00 am and 8:00 pm for 6 months, we measured the IOP at the same time period. We analyzed and compared the IOP of eyes treated with BTFC and contralateral eyes. RESULTS: The mean reduction in IOP was -2.85 +/- 1.43 mm Hg (-18.36 +/- 8.58%) in the eyes treated with BTFC and -2.21 +/- 1.73 mm Hg (-13.90 +/- 10.66%) in the contralateral eyes. The IOP lowering effect was greater in the eyes treated with BTFC than in the contralateral eyes. After 6 months of BTFC instillation, the changes in IOP measurements were the lowest at 11:30 am and increased at each time point afterwards. The greatest reduction in IOP was observed at 1 month; however, significant IOP reduction was observed at 3 and 6 months in both BTFC and contralateral eyes. There was no serious adverse event causing ocular damage. CONCLUSIONS: BTFC provided a significant IOP reduction in both BTFC and contralateral eyes in NTG patients.

A Case of Oxaliplatin-Related Ocular Toxicity

PURPOSE: To report a case of oxaliplatin (Eloxatin(R))-related ocular toxicity in a patient with advanced stomach cancer. CASE SUMMARY: A 43-year-old female with advanced stomach cancer experienced visual symptoms during the treatment with oxaliplatin on a XELOX schedule (a combination of oxaliplatin and capecitabine). After 1 cycle of chemotherapy, she complained of blurred vision and visual field defects in both eyes. Visual field tests showed a bilateral concentric field defect and the electroretinogram revealed a marked reduction of responses in both eyes. On the second cycle of chemotherapy, oxaliplatin was discontinued due to suspicious ocular toxicity. Her visual symptoms improved and visual field test showed normal results 1 month after oxaliplatin discontinuation. However, 3 months after oxaliplatin discontinuation, electroretinogram remained abnormal despite the progressive improvement. CONCLUSIONS: Platinum-based antineoplastic agents such as oxaliplatin should be administered with caution because oxaliplatin can cause damage to the retinal photoreceptors and the optic nerve. Early detection of ocular toxicity and discontinuation of oxaliplatin therapy could prevent severe and irreversible visual loss.

The Effect of Axial Length on the Variability of Stratus Optical Coherence Tomography

PURPOSE: To evaluate the effect of axial length on the variability of retinal nerve fiber layer (RNFL) thickness measurements using the Stratus optical coherence tomography (OCT) in normal and glaucomatous eyes. METHODS: We measured the RNFL thickness in 474 subjects using the Stratus OCT twice during the same day. Axial length was measured with the IOLMaster, and refractive error was the absolute value of the spherical equivalent measured with an auto ref-keratometer. Standard deviation in overall mean RNFL thickness was used as the dependent variable to identify significant correlations. RESULTS: Long axial length affected the variability in the RNFL thickness value by stratus OCT at the temporal quadrant (p = 0.006) and clock-hour sector 9 (p = 0.001). Refractive error also affected the variability of the RNFL thickness value by stratus OCT at the temporal quadrant (p = 0.025) and clock-hour sector 9 (p = 0.024). CONCLUSIONS: It is clinically significant that longer axial length demonstrates greater variability in temporal area as detected by OCT, a measurement which correlates with the preferably damaged position in the myopic glaucoma eye.

A Case of Endogenous Streptococcus Mitis Endophthalmitis in a Patient with Staphylococcus Aureus Sepsis

PURPOSE: To report a case of endogenous endophthalmitis due to Streptococcus mitis in a patient with Staphylococcus aureus sepsis. CASE SUMMARY: A 77-year-old male complained of sudden visual loss and ocular pain in his right eye and was treated with intravenous antibiotics for Staphylococcus aureus sepsis. With a diagnosis of endogenous endophthalmitis, the patient received pars plana vitrectomy and intravitreal injection of antibiotics. Vitreous fluid was obtained before surgery, and the organism was identified as Streptococcus mitis. Twenty-one days after the surgery, intraocular inflammation was stabilized, and visual acuity was improved from light perception to 20/60. CONCLUSIONS: Appropriate sampling and culture of vitreous fluid are important for the diagnosis of endogenous endophthalmitis. The possibility that the causative organism of endogenous endophthalmitis may be different from the result of blood culture should be considered.

Anatomical Non-Responder to Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration

PURPOSE: To analyze the characteristics of anatomical non-response to intravitreal bevacizumab (IVB) in patients with neovascular age-related macular degeneration (AMD). METHODS: Neovascular AMD patients who were treated with IVB were studied. A non-responder was defined as a patient whose eyes had no change in choroidal neovascularization (CNV) lesion size or fluorescein leakage and no change in foveal thickness (FT) after at least two administrations of IVB. Demographic findings and efficacy outcomes were compared between responders and non-responders based on patient gender, age, visual acuity (VA), FT, CNV lesion type, CNV lesion size, presence of serous retinal detachment (SRD), presence of pigment epithelial detachment (PED), PED size, and presence of sub-macular hemorrhage (SMH). RESULTS: Five patients (six eyes; 13.6%) were identified as non-responders to treatment with IVB. The mean age of the non-responder group (75.17 +/- 3.66 yers) was greater (p = 0.237) than that of the responder group (71.89 +/- 8.06 years), and the proportion of occult CNV (85.7% versus 55.3%, p = 0.375) was higher in the non-responder group, although there was no significant difference compared with that of the responder group. The PED size of the non-responder group (4.42 +/- 1.56 mm2) was significantly larger than that of the responder group (1.51 +/- 2.33 mm2, p = 0.001). CONCLUSIONS: The authors report a group of patients in AMD with poor treatment response to IVB. The PED size of the non-responder group was confirmed to be significantly larger than that of the responder group.

Epidemiologic and Clinical Features of Uveal Melanoma in Korean Patients

PURPOSE: To investigate the epidemiologic and clinical features of uveal melanomas in Korean patients. METHODS: The medical records of 35 patients (35 eyes) with the diagnosis of uveal melanoma between September 2004 and December 2006 were reviewed retrospectively. RESULTS: Of the 35 patients, 22 were males (62.9%) and 13 were females (37.1%), with a mean age at diagnosis of 48.2+/-14.1 years (range, 24-82 years). Decreased visual acuity was the most common symptom in 23 patients (65.7%), while 6 patients (17.1%) were detected without prior symptoms. The shape of the uveal melanoma was dome-shaped in 27 eyes (77.1%) and mushroom-shaped in 8 eyes (22.9%). The mean largest basal diameter of the tumors was 9.0+/-3.3 mm (2.4-19.0 mm), and the mean apical height was 6.2+/-2.6 mm (1.1-13.0 mm). The tumors were classified according to their size; a small melanoma was found in 4 eyes (11.4%), a medium melanoma in 29 eyes (82.9%), and a large melanoma in 2 eyes (5.7%). CONCLUSIONS: Uveal melanomas manifest earlier in Korean patients than in Caucasian patients. At the time of diagnosis, 33 eyes (94.3%) had small or medium melanomas that could be treated.

Imaging Techniques for the Diagnosis of Primary Uveal Melanoma

PURPOSE: To investigate various imaging techniques for the diagnosis of primary uveal melanomas in Korean patients. METHODS: We retrospectively reviewed the medical records of 35 eyes in 35 patients (22 males, 13 females) diagnosed with uveal melanomas between September 2004 and December 2006. The findings of fundus photographs, ultrasonography, CT scan, MRI, and PET scan were documented. RESULTS: A/B scan ultrasonography showed typical findings of uveal melanomas in 74.3% (26 eyes) of the patients. On CT scan, the mass appeared as a homogenous hyperdense lesion, and on MRI, the typical signal of hyperintensity on the T1-weighted image and hypointensity on the T2-weighted image was seen in 89.3% (25 eyes), with contrast enhancement in only 46.4% (13 eyes) of the patients. A PET scan revealed positive tumor uptake in 22.7% (5 eyes) of the patients. CONCLUSIONS: Although ultrasonography is the most useful and accurate method for the diagnosis of uveal melanoma, it provides more atypical cases in Korean patients than Caucasian patients. CT scans and MRI can be used for a differential diagnosis, but the diagnostic efficacy of PET scans is low.

Photodynamic Therapy for Subretinal New Vessels

Photodynamic therapy (PDT) involves the induction of endothelial cell death or occlusion of blood vessels. On the basis of this mechanism of action, PDT is used in the treatment of predominant classic choroidal neovascularization (CNV), if the classic component is over 50%, and in myopic CNV. This study describes 2 cases of distinctive, abnormal, large, subretinal new vessels that are thought to have originated from the choroids. Diminishment of the new vessels was observed following treatment with PDT.

Surgery for Vertical Abnormal Head Posture in Infantile Nystagmus

PURPOSE: The purpose of this study is to assess the effect of surgical management for infantile nystagmus with vertical abnormal head posture. METHODS: We performed surgical procedures to correct the vertical abnormal head posture of more than 10degrees in 6 patients with infantile nystagmus. One patient with the chin-up head posture was treated with recession of bilateral inferior rectus muscles and resection of bilateral superior rectus muscles, and 5 patients with the chin-down head posture were treated with recession of bilateral superior rectus muscles and resection of bilateral inferior rectus muscles. The pre- and post-operative measurements of the head posture were evaluated and compared with each other. RESULTS: Preoperatively, the degree of vertical head posture ranged from 10 to 30degrees, and 4 patients were with the 20~30degrees abnormal head posture. In the average follow-up period of 35.8 months, 5 patients (83.3%) showed less than 5degrees of chin-up or chin-down head posture. In one case, 20degrees left face turn was noted postoperatively. However, duction was full in all cases. CONCLUSIONS: These results suggest that the surgical management with bilateral vertical rectus muscles was effective for the correction of vertical abnormal head posture in infantile nystagmus.