Efficacy of Intravitreal Triamcinolone Acetonide Injections at the End of Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of intravitreal injections of triamcinolone acetonide (TA) at the end of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: We analyzed 50 patients (52 eyes) who underwent PPV for treatment of PDR and received an intravitreal injection of 4 mg TA at the end of surgery. The study group (Group 1) was compared with a control group (Group 2, 46 patients, 51 eyes) (matched with the study group for preoperative parameters) who underwent PPV without intravitreal injection of TA. RESULTS: In Group 1, the grade of anterior chamber cells at postoperative days 1 and 7 was significantly lower than that of Group 2. There was slight mean IOP elevation in Group 1 at postoperative weeks 2, 3, 4, and 8, but it was not statistically significant. Forty-four eyes (84.6%) from Group 1 showed better visual acuity at the last follow-up than at the preoperative visit (Group 1). Thirty-two eyes (62.8%) from Group 2 showed better visual acuity at the last follow-up than at the preoperative visit. The degree of visual improvement was 0.75 logMAR in Group 1 and 0.59 logMAR in Group 2. Vitreous hemorrhage occurred in 9 eyes (17.3%) from Group 1 and in 19 eyes (37.3%) from Group 2. However, the differences in the occurrence of neovascularization in iris and neovascular glaucoma between two groups were not statistically significant. CONCLUSIONS: Intravitreal TA injection at the end of PPV seems to be effective in improving visual acuity and decreasing early postoperative inflammation and the frequency of vitreous hemorrhage.

Effect of Experimental Scleral Shortening on Axial Length of the Rabbit Eye

PURPOSE: To evaluate the change of axial length (AL), intraocular pressure (IOP), and corneal astigmatism after scleral shortening with scleral invagination in the rabbit eye. METHODS: The authors performed scleral shortening (3 mm) with scleral invagination in two groups of 6 eyes each: 180 degrees (group 1) and 360 degrees (group 2). RESULTS: Average AL shortening was more prominent in group 2 (0.5 +/- 0.17 mm) than in group 1 (0.37 +/- 0.29 mm), but the difference was not statistically significant. IOP increased immediately after the procedure and was maintained at a high level through 2 months postoperatively. Induced corneal astigmatism was more prominent in group 1 than in group 2. The difference was statistically significant in group 1 (p< 0.05) but not in group 2. CONCLUSIONS: In the scleral shortening with scleral invagination procedure, a large amount of scleral invagination resulted in more shortening of axial length, but there was more corneal astigmatism in 180-degree invagination of the sclera than in 360-degree. Further research is required to determine the effect of the extent of scleral invagination on the change of these values.

The Effect of Unilateral Lateral Rectus Recession for the Treatment of Moderate-Angle Exotropia

PURPOSE: To evaluate the surgical results and the amount of correction per millimeter after unilateral lateral rectus recession for moderate-angle exotropia in a pediatric population. METHODS: This study included 30 subjects who underwent 9-mm unilateral lateral rectus recession for basic type intermittent exotropia with deviation of 23 to 28 prism diopters (PD) and were followed-up for 6 months or more after surgery. RESULTS: Seventeen subjects were male and 13 were female. The mean age of subjects was 9.7 years. Defining satisfactory postoperative ocular alignment as 8PD or less, 25 of 30 subjects (83.3%) were satisfactorily aligned at 2 months postoperatively. The success rates at 4, and 6 months postoperatively were 76.7% respectively. No overcorrected subjects were found after 2 months postoperatively. A postoperative limitation of abduction was not found in all subjects after 2 months postoperatively. The average amount of correction per millimeter of recession at 2, 4, and 6 months was 2.83+/-0.26PD, 2.75+/-0.37PD, and 2.72+/-0.44PD respectively (range, 1.56 to 3.18PD). There was no statistically significant difference in the amount of correction per millimeter throughout the follow-up period (ANOVA, p=0.05). CONCLUSIONS: Unilateral lateral rectus recession appears to be an effective surgical procedure for the treatment of moderate-angle exotropia. However to reduce the rate of undercorrection, which is one of disadvantages of this procedure, proper patient selection is required.

Angiographic Findings in Patients with Vitelliform Macular Dystrophy

PURPOSE: To evaluated the fluorescein and indocyanine green angiographic findings (FAG and ICGA) of each stage in vitelliform macular dystrophy. METHODS: In this study (3 patients, 6 eyes), the stage of macula lesion was classified as follows: stage A (vitelliform), stage B (pseudohypopyon), stage C (scrambled egg), stage D (early cicatricial), and stage E (advanced cicatricial). RESULTS: At stage A, the lesion was hypofluorescent in the early phase and was hyperfluorescent in the late phase of both FAG and ICGA. At stage B, FAG showed hyperfluorescent in the upper portion and hypofluorescent in the lower portion of the lesion. ICGA showed hypofluorescent in the upper portion. However, ICGA showed hypofluorescent in the early and hyperfluorescent in the late phase in the lower portion. At stage C, the lesion was hypofluorescent in the early phase and hyperfluorescent in the late phase of both FAG and ICGA. At stage D, FAG showed hyperfluorescent and ICGA showed hypofluorescent. At stage E, FAG showed central hypofluorescent lesions and a hyperfluorescent ring. While ICGA showed typically hypofluorescent. CONCLUSIONS: The FAG and ICGA findings showed variable patterns according to the evolution of the lesion.

Comparison of Clinical Features in Three Types of Primary Glaucoma

PURPOSE: To compare the clinical characteristics of primary open-angle glaucoma (HTG), normal-tension glaucoma (NTG) and primary angle-closure glaucoma (ACG) patients. METHODS: We investigated the clinical characteristics of HTG (n=75), NTG (n=58), and ACG (n=150) patients from March 2000 to November 2002. We compared the age at initial glaucoma diagnosis, sex, family history, systemic diseases, refractive errors, and corneal curvature among the three groups. RESULTS: HTG was younger than the others at initial glaucoma diagnosis. In ACG, the incidence rate was higher in women, but it was in HTG, higher in men. Family history of glaucoma was significantly more prevalent in HTG than in the others. NTG showed higher prevalence of cardiovascular disease and hypotension than the others. In refractive errors, there was statistically significant difference among the three groups and HTG had more severe myopia than the others. ACG had the steepest cornea curvature. CONCLUSIONS: Three types of primary glaucoma (HTG, NTG and ACG) differed somewhat in clinical feature. This finding will be helpful in the early diagnosis and treatment of glaucoma.

A Case of Cryptococcal Chorioretinitis in a Renal Transplant Patient

PURPOSE: To report a case of cryptococcal chorioretinitis in the renal transplant patient. MATERIALS AND METHODS: A 31-year old male patient was admitted with visual disturbance, high fever and general weakness. On initial evaluation, visual acuity was 0.9 in the right eye and 0.3 in the left. On fundus exam, right eye showed the lesions which were expanded into posterior pole and equator and left eye showed several yellow white lesions which were larger than optic disc, and some of them were near the fovea. RESULT: Cryptococcus grew in CSF. The ocular diagnosis was cryptococcal chorioretinitis and intra-venous amphotericin B and oral flucytosine were given. In spite of 2-month treatment, the visual acuity of left eye was 0.04 due to the expansion of the lesion toward fovea. The patient refused the treatment after 4 months of treament, and he expired 1 month later.