Silicone Oil with Short-Term Prone Position in Macular Hole Retinal Detachment Surgery in High Myopia

PURPOSE: To evaluate the result of vitrectomy with internal limiting membrane peeling and silicone oil tamponade with short term face-down positioning in highly myopic patients with retinal detachment due to macular hole. METHODS: Eleven eyes of highly myopic patients with retinal detachment caused by macular hole were retrospectively reviewed. All patients underwent pars plana vitrectomy, internal limiting membrane peeling, and silicone oil tamponade with short term (1-3 days) face-down positioning. Silicone oil was removed between 6 and 12 months postoperatively. Outcomes included best-corrected visual acuity, retinal reattachment rate, macular hole closure, and complications. RESULTS: The mean age of patients was 63.3 +/- 8.3 years. During the silicone oil period, all 11 eyes (100%) had complete retinal attachment. After silicone oil removal, retinal detachment recurred in 2 eyes (18.2%). Macular hole closure was observed in 8 eyes (72.7%). The best corrected visual acuity (log MAR) improved from 1.99 +/- 0.94 before surgery to 1.33 +/- 0.62 at final visit. CONCLUSIONS: Pars plana vitrectomy, internal limiting membrane peeling and silicone oil tamponade with short term face-down positioning was effective in treating retinal detachment caused by macular hole in highly myopic eyes.

Comparison of the Postoperative Refractive Errors Measured by Ultrasound and Partial Coherence Interferometers after Phacovitrectomy

PURPOSE: To compare the accuracy of refractive outcome measured by Ultrascan(R) (Alcon, Fort Worth, TX, USA) and partial coherence interferometers after phacovitrectomy. METHODS: We performed a retrospective study in 74 eyes of 74 patients who underwent phacovitrectomy. SRK-T formula was used to predict intraocular lens (IOL) power. The difference between the predicted and postoperative refractive outcomes for the 2 methodologies (Ultrascan(R) and IOL Master(R) [Zeiss, Carl Zeiss, Jena, Germany]) were compared. The predicted refractive outcome was defined as the estimated refractive error when the selected IOL was inserted. RESULTS: The axial length measured using IOL Master(R) was statistically longer than when measured using Ultrascan(R) (23.85 +/- 0.15 mm, 23.56 +/- 0.15 mm, p < 0.001). Based on keratometry, statistically significant difference between the 2 groups was not observed. The postoperative refractive error was more accurate when using the IOL Master(R) than Ultrascan(R) (0.08 +/- 0.74, 0.47 +/- 0.69, p < 0.001). However, in cases of vitreous hemorrhage, the postoperative refractive error was 0.42 +/- 0.49 with the IOL Master(R) and 0.07 +/- 0.54 with the Ultrascan(R). CONCLUSIONS: Generally, IOL Master(R) is a more accurate method for calculating the IOL power prior to phacovitrectomy. However, in cases of vitreous hemorrhage, Ultrascan(R) appears superior to IOL Master(R) when calculating the IOL power.

Comparison of the Postoperative Refractive Errors Measured by Ultrasound and Partial Coherence Interferometers after Phacovitrectomy

PURPOSE: To compare the accuracy of refractive outcome measured by Ultrascan(R) (Alcon, Fort Worth, TX, USA) and partial coherence interferometers after phacovitrectomy. METHODS: We performed a retrospective study in 74 eyes of 74 patients who underwent phacovitrectomy. SRK-T formula was used to predict intraocular lens (IOL) power. The difference between the predicted and postoperative refractive outcomes for the 2 methodologies (Ultrascan(R) and IOL Master(R) [Zeiss, Carl Zeiss, Jena, Germany]) were compared. The predicted refractive outcome was defined as the estimated refractive error when the selected IOL was inserted. RESULTS: The axial length measured using IOL Master(R) was statistically longer than when measured using Ultrascan(R) (23.85 +/- 0.15 mm, 23.56 +/- 0.15 mm, p < 0.001). Based on keratometry, statistically significant difference between the 2 groups was not observed. The postoperative refractive error was more accurate when using the IOL Master(R) than Ultrascan(R) (0.08 +/- 0.74, 0.47 +/- 0.69, p < 0.001). However, in cases of vitreous hemorrhage, the postoperative refractive error was 0.42 +/- 0.49 with the IOL Master(R) and 0.07 +/- 0.54 with the Ultrascan(R). CONCLUSIONS: Generally, IOL Master(R) is a more accurate method for calculating the IOL power prior to phacovitrectomy. However, in cases of vitreous hemorrhage, Ultrascan(R) appears superior to IOL Master(R) when calculating the IOL power.

Surgical Outcomes of Transconjunctival 25-Gauge Plus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

PURPOSE: To evaluate anatomical and visual results of transconjunctival 25-gauge plus pars plana vitrectomy (PPV) in the management of primary rhegmatogenous retinal detachment (RRD). METHODS: A retrospective analysis of 46 eyes of 46 patients who underwent transconjunctival 25-gauge plus PPV for primary RRD repair between January 2013 and May 2013 with a minimum of 3-month follow-up was performed. Data collected for the study included patient demographics, lens status, preoperative visual acuity, macular status, and location and number of primary breaks. Main outcome measures were anatomical reattachment rate, postoperative visual acuity, operation time, and postoperative complications. RESULTS: The study included 30 men and 16 women. The mean age of the patients was 54.3 years. The locations of retinal breaks were 24 (52.2%) eyes in the superior half, 15 (32.6%) eyes in the inferior half, and 7 (15.2%) eyes on both sides. The macula-on RRD was present preoperatively in 21 (45.7%) of 46 eyes. Of the 33 (71.7%) phakic eyes, 18 (39.1%) underwent combined phacoemulsification, intraocular lens implantation, and PPV. Two different tamponades, C3F8 gas and silicone oil were used in this study. C3F8 gas was injected in the 33 (71.7%) eyes, and the remaining eyes were filled with silicone oil (1,300 centistokes for 11 eyes, 5,700 centistokes for 2 eyes). Mean operation time was 48.8 +/- 13.2 minutes. Retinal reattachment was achieved in 45 (97.8%) of 46 eyes at 3 months. Mean best-corrected visual acuity improved from 1.33 +/- 1.20 log MAR preoperatively to 0.68 +/- 0.94 log MAR postoperatively (p < 0.001). Postoperative complications included transient intraocular pressure elevation in 6 (13.1%) eyes and posterior capsular opacity in 3 (6.5%) eyes. CONCLUSIONS: It seems that transconjunctival 25-gauge plus PPV can be a safe and effective option for surgical management of RRD.

Effect of Solvent in Indocyanine Green-Assisted Internal Limiting Membrane Peeling During Idiopathic Epiretinal Membrane Surgery

PURPOSE: This study was designed to compare the outcomes in idiopathic epiretinal membrane (ERM) surgery according to solvents of indocyanine green (ICG) for internal limiting membrane (ILM) peeling. METHODS: The medical records of 27 patients (27 eyes) with idiopathic ERM who had undergone pars plana vitrectomy with ICG staining for ILM peeling were retrospectively reviewed. The patients were divided into two groups according to solvents of 0.25% ICG solutions. Solvents used were balanced salt solution (BSS) in group I (15 eyes) and 5% glucose in group II (12 eyes). The severity of ERM, the duration of symptoms, the preoperative and postoperative best corrected visual acuity (BCVA) values, the visibility of the stained ILM (Good, Fair, Poor), and the postoperative complications were compared in the two groups. RESULTS: There was no statistically significant difference in the severity of ERM, the duration of symptoms and the preoperative BCVA in the two groups. The postoperative BCVA was significantly improved in both groups, and the difference was not statistically significant (p = 0.675). There was a significantly smaller number of eyes with poor ILM staining in group II than in group I (p = 0.014). No complications such as recurrence of ERM, atrophy of the retinal pigment epithelium (RPE) or retinal detachment were observed in the two groups. CONCLUSIONS: The higher specific gravity of 5% glucose compared with that of BSS as ICG solvents allows for improved ILM visualization. Therefore using the 5% glucose-ICG solution for staining ILM improved the visibility of ILM compared BSS-ICG solution and led to comparable visual recovery.

Three Cases of Focal Choroidal Excavation in the Macula Detected by Spectral-Domain Optical Coherence Tomography

PURPOSE: To report the clinical finding of 3 patients with focal choroidal excavation in the macula detected by spectral-domain optical coherence tomography (SD-OCT). CASE SUMMARY: Five eyes of 3 patients with focal choroidal excavation detected by SD-OCT were enrolled in the present study. All patients had myopia (average refractive power -5.60 diopter). Two of the 3 patients had focal choroidal excavation in both eyes. All 5 eyes revealed foveal pigmentary changes on fundus examination. The excavation area in the autofluorescence image was hypofluorescent. Fluorescein angiographic finding was normal to various degrees of hyperfluoresence. Indocyanine green angiography revealed hypofluoresence at the excavation area. The excavation involoved from the retinal pigment epithelium layer to the external limiting membrane or outer nuclear layer and average choroidal thickness at excavation were statistically thinner than the uninvolved area based on SD-OCT (p = 0.002). Retinoschisis, serous pigment epithelial detachment and choroidal neovascularziation (CNV) were detected individually in 3 eyes. The other 2 eyes had no specific abnormalities. CONCLUSIONS: During the follow-up period, the choroidal excavation remained relatively stable in 4 of 5 eyes, but CNV developed in 1 eye. Therefore, intravitreal bevacizumab injection was performed. Longer follow-up periods are necessary to determine the etiology, clinical course and visual prognosis of eyes with focal choroidal excavation.

Effectiveness for Intralesional Triamcinolne Acetonide Injections for Chalazia in Pediatric Patients

PURPOSE: To evaluate the effectiveness of intralesional triamcinolone acetonide injection for chalazia in pediatric patients. METHODS: We performed a retrospective chart review of 58 patients (70 lesions) under fifteen years of age and 40 patients (50 lesions) aged fifteen and over, who underwent intralesional triamcinolone acetonide injections and performed follow-ups for at least three months between January 2007 and October 2008. Data regarding age, sex, lesion size, location, number of injections, treatment success, surgery, and complications were evaluated. RESULTS: Cumulative treatment success of TA was 64.3% with the first injection, 82.9% with a second injection, and 88.6% with a third injection in patients under fifteen years of age. The average number of TA injections was 1.67+/-1.03 in primary chalazia and 1.48+/-0.87 in recurrent chalazia, while the cumulative treatment success until third TA injection was 89.8% in primary chalazia and 85.7% in recurrent chalazia inpatients under fifteen years old. The average number of TA injections was 1.95+/-1.18 in primary chalazia and 1.80+/-1.14 in recurrent chalazia, while the cumulative treatment success until the third TA injection was 82.5% in primary chalazia and 70.0% in recurrent chalazia in patients aged fifteen and over. No complications were noted with TA injections. CONCLUSIONS: Intralesional triamcinolone acetonide injection in chalazia is an effective and safe treatment in pediatric patients.

Analysis on Inpatients With Infectious Keratitis: Causative Organisms, Clinical Aspects and Risk Factors

PURPOSE: To investigate the epidemiological, microbiological, and clinical characteristics of inpatients with infectious keratitis and also to elucidate risk factors for unimproved visual outcomes. METHODS: We performed a retrospective chart review of 167 eyes in 167 patients with infectious keratitis hospitalized between January 2005 and December 2007 at Yeungnam University Hospital. RESULTS: Keratitis cases were classified into four groups according to etiology: 92 bacterial, 43 herpes virus, 31 fungal, and 1 acanthamoeba. Culture positivity was 44.6% in bacterial keratitis and 22.6% in fungal keratitis, and KOH positivity of fungus was 48.4%. Of all the 55 isolated pathogens, the most commonly isolated microorganisms were S. epidermidis in Gram-positive bacteria, P. aeruginosa in Gram-negative bacteria, and Candida species in fungus. Epidemiologic characteristics such as male gender (59.9%), an age in the seventh decade (24.6%), farming occupation (40.1%), and trauma with vegetable matter (42.5%) were noted. Many fungal and bacterial keratitis cases were characterized by inadequate use of topical steroid when patients initially presented to our clinic. Visual outcomes were poorer in fungal keratitis than they were in other forms of keratitis. CONCLUSIONS: Risk factors for unimproved visual outcomes included an ulcer exceeding 3 mm in size and a fungal source. Therefore, a strong effort should be made to discern a differential diagnosis in infectious keratitis and to determine the appropriate early treatment for a successful treatment outcome.

Analysis on Inpatients With Infectious Keratitis: Causative Organisms, Clinical Aspects and Risk Factors

PURPOSE: To investigate the epidemiological, microbiological, and clinical characteristics of inpatients with infectious keratitis and also to elucidate risk factors for unimproved visual outcomes. METHODS: We performed a retrospective chart review of 167 eyes in 167 patients with infectious keratitis hospitalized between January 2005 and December 2007 at Yeungnam University Hospital. RESULTS: Keratitis cases were classified into four groups according to etiology: 92 bacterial, 43 herpes virus, 31 fungal, and 1 acanthamoeba. Culture positivity was 44.6% in bacterial keratitis and 22.6% in fungal keratitis, and KOH positivity of fungus was 48.4%. Of all the 55 isolated pathogens, the most commonly isolated microorganisms were S. epidermidis in Gram-positive bacteria, P. aeruginosa in Gram-negative bacteria, and Candida species in fungus. Epidemiologic characteristics such as male gender (59.9%), an age in the seventh decade (24.6%), farming occupation (40.1%), and trauma with vegetable matter (42.5%) were noted. Many fungal and bacterial keratitis cases were characterized by inadequate use of topical steroid when patients initially presented to our clinic. Visual outcomes were poorer in fungal keratitis than they were in other forms of keratitis. CONCLUSIONS: Risk factors for unimproved visual outcomes included an ulcer exceeding 3 mm in size and a fungal source. Therefore, a strong effort should be made to discern a differential diagnosis in infectious keratitis and to determine the appropriate early treatment for a successful treatment outcome.