Relationship between the Morphology of Diabetic Macular Edema and Renal Dysfunction in Diabetes

PURPOSE: To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes. METHODS: The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was 1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher's exact test. RESULTS: The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%). CONCLUSIONS: Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.

Relationship between the Morphology of Diabetic Macular Edema and Renal Dysfunction in Diabetes

PURPOSE: To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes. METHODS: The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was 1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher's exact test. RESULTS: The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%). CONCLUSIONS: Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.

A Giant Unruptured Aneurysm of Distal Internal Carotid Artery Presenting with Compressive Optic Neuropathy

PURPOSE: To report a case of compressive optic neuropathy due to a giant unruptured aneurysm of a distal internal carotid artery. CASE SUMMARY: A 68-year-old female presented with a one-week history of visual disturbance in her left eye. The patient had no underlying disease except hypertension. Best corrected visual acuity was 20/20 in the right eye and 8/20 in the left eye. The color perception test showed abnormal findings in the left eye. Slit lamp examination showed no abnormal finding except incipient cataract in both eyes. Additionally, fundus examination showed no abnormal finding. Brain MRI and MRA revealed a 2.4 x 2.2 x 3.0-cm-sized unruptured giant aneurysm on the left internal carotid artery. CONCLUSIONS: A giant aneurysm should be considered as a cause for acute or subacute optic neuropathy in a patient with hypertension.

A Case of Paclitaxel-induced Maculopathy Treated with Methazolamide

A 54-year-old female patient who had been undergoing anti-cancer chemotherapy and radiotherapy for seven years after surgery for left breast cancer visited our clinic for visual disturbance in the right eye at nine months after paclitaxel administration. The best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. The patient was diagnosed with maculopathy due to paclitaxel administration based on the finding of cystoid macular edema in the right eye on fundus examination and optical coherence tomography; however, no leakage was detected on fluorescein angiography. Thus, drug replacement was planned. On the other hand, no abnormal finding was observed in the left eye. However, as the anti-cancer effect of paclitaxel is significant, replacing paclitaxel with another agent was not warranted; therefore, maintenance therapy with methazolamide was performed before and after administering the anti-cancer agent. Aggravation of cystoid macular edema was prevented, and vision improvement was achieved by oral maintenance therapy with methazolamide. In addition, the same fundus findings as shown in the right eye were detected in the left eye at 16 months after paclitaxel administration. After administering methazolamide, macular thickness was reduced, and vision was improved in the left eye. Paclitaxel administration was discontinued due to cutaneous metastasis from the breast cancer, and another anti-cancer agent was then administered. No subsequent cystoid macular edema has occurred.

Resolution of Macular Edema after Systemic Treatment with Furosemide

We report two cases of macular edema treated with the oral administration of furosemide. The first case presented here was a 78-year-old male patient with visual disturbance of the left eye. He had been taking an oral agent for diabetes and had chronic renal failure for 7 years. From 10 days prior to the visit, he had visual disturbance of the left eye accompanied by systemic edema. There were no specific findings in the anterior segment, but sub-retinal fluid was observed in the left fundus. Macular edema was observed on fluorescein angiography and optical coherence tomography; therefore, the oral administration of furosemide was initiated. After seven days, the sub-retinal fluid disappeared. The second case was a 43-year-old female patient with visual disturbance of the left eye who had been taking hypoglycemic agents for diabetes for 13 years. There were no specific findings in the anterior segment, but flame-shaped retinal hemorrhages were scattered over both posterior poles, neovascularization was observed in the left eye, and, of particular note, sub-retinal fluid was detected in the macula of the left eye. Macular edema was also observed on fluorescein angiography and optical coherence tomography, and oral administration of furosemide was initiated. After 3 weeks, the macular edema had significantly decreased.

Spectral-Domain Optical Coherence Tomography Findings in Acute Central Retinal Artery Occlusion

PURPOSE: To evaluate spectral-domain optical coherence tomography (SD-OCT) images of acute central retinal artery occlusion (CRAO). METHODS: Six eyes of 6 patients who were diagnosed with acute CRAO were enrolled in the present study. The main SD-OCT measurements included macular thickness in the macular cube map and retinal thickness in the 5-line raster map. RESULTS: In acute CRAO, macular thickness increased more than that in the normal fellow eye in all cases. SD-OCT images demonstrated increased reflectivity and thickness in the inner retinal layer, especially in the nerve fiber layer and ganglion cell layer. However, in the outer retinal layer, SD-OCT images disclosed decreased reflectivity and increased thickness. The central subfield thickness area image showed normal reflectivity and thickness. The horizontal cross-sectional image showed relatively the same edema ratio between the inner retinal layer and outer retinal layer thickness. There was no cystoid or serous foveal detachment-type edema. CONCLUSIONS: SD-OCT images of CRAO showed increased outer retinal layer thickness and decreased reflectance as well as increased inner retinal layer thickness and reflectance. However, inner segment and outer segment junctions of the photoreceptor and retinal pigment epithelial signal were intact.

A Case of Subconjunctival Foreign Body Migration after Collagen-Containing Filler Injection

PURPOSE: To report a case of subconjunctival foreign body migration in both eyes after collagen-containing filler injection. CASE SUMMARY: A 51-year-old female, who had been treated with collagen-containing filler in her eyelid, nose, and forehead for cosmetic complaints four months earlier, presented to our clinic with decreased visual acuity and foreign body sensation in both eyes. Slit lamp examination revealed moderate nucleosclerosis and subcapsular opacity in her crystalline lens, in addition to scattered subconjunctival foreign body infiltration in both eyes. Cataract extraction with posterior chamber lens implantation was performed, and the subconjunctival foreign body was also partially removed. Biopsy of the remaining foreign body was performed, and examination revealed foreign material and multivacuolated cells in the conjunctiva. CONCLUSIONS: Clinicians and patients should be aware of the risk of migration of collagen-containing filler inject at or near the eyelid, to the eyeball, including the conjunctiva.

A Case of Endophthalmitis Treated with Surgical Removal of the Inflammatory Plaque on Corneal Endothelium

PURPOSE: To report a case of endophthalmitis treated with surgical removal of the inflammatory endothelial plaque. CASE SUMMARY: A 61-year-old male was transferred to our clinic due to corneal laceration of the left eye. An emergency operation for the lacerated cornea was performed. After the operation, the patient had no specific symptoms for 8 months but then visited our clinic with sudden decreased visual acuity. On slit lamp examination, the patient had some chamber reactions. Anterior chamber reactions exacerbated after 2 months and the best corrected visual acuity was decreased from 1.0 to 0.08. An inflammatory corneal endothelial plaque and endothelial precipitates had developed. The posterior segment was not visualized due to the severe anterior chamber inflammatory reaction. No growth was observed on bacterial or fungal cultures. However, administration of eye drops and oral voriconazole were initiated based on a clinical impression suspicious of fungal infection. Despite the treatment, the infection did not respond. Voriconazole was then directly injected into the vitreous and anterior chamber. Although the patient's best corrected visual acuity slightly improved, the inflammatory reactions of the anterior chamber and vitreous did not. The inflammatory endothelial plaque on the patient's cornea was then surgically removed and the best corrected visual acuity improved to 1.0. Mycelium was detected on the KOH smear of the endothelial plaque. There were no further inflammatory reactions in the anterior chamber or vitreous after surgical removal of the endothelial plaque.

Clinical Study for the Undercorrection Factor in Intermittent Exotropia

PURPOSE: The surgical technique for intermittent exotropia ?X(T)? is quite simple. However, in many cases, the condition recurs due to any one of a number of causes, including undercorrection. This study examined the factors associated with undercorrection on X(T) patients. METHODS: The study examined 199 X(T) patients who underwent bilateral recession of the lateral rectus muscle or unilateral recession of the lateral rectus muscle and resection of the medial rectus muscle, and who were followed-up for more than a year. Patients whose near and far distance angles of deviation were 9 prism diopters (PD) or more at one year after surgery were designated as group 1. Those whose PD was 8 or below or who had orthophoria were assigned to group 2. Various factors were compared and analyzed. RESULTS: One day after surgery, group 1 showed an average overcorrection of 1.9 and 4.1 PD at near and far, respectively, and group 2 showed an average overcorrection of 6.3 and 7.6 PD at near and far, respectively. A statistically significant difference was observed between the two groups (p0.05). CONCLUSIONS: Of the many factors that might influence the surgical results of X(T) patients, the angle of deviation during the initial postoperative period is the most important factor.

A Case of Bilateral Cavernous Sinus Thrombosis with Intraorbital Abscess

PURPOSE: We report a case of bilateral cavernous sinus thrombosis and unilateral intraorbital abscess in a patient suffering proptosis, a limitation of ocular movement, and visual disturbance. METHODS: After several days of febrile and chilling sensation, a 49-year-old man suffered from vision loss, a limitation of ocular movement in all directions, proptosis in the right eye and mild abduction limitation in the left eye. Brain MRI, indicated inflammation in the bilateral cavernous sinuses and intraorbital abscess in the right eye, leading to a diagnosis of cavernous sinus thrombosis. Systemically, the patient was treated with antibiotics and steroid injection. For intraorbital abscess, aspiration and antibiotics injection were administered locally. The patient improved overall and the abscess size decreased. Blood culture showed alpha-hemolytic Streptococcus. The Gram stain of the specimen from the intraorbital abscess revealed Gram-positive cocci but no specific strain was cultured. RESULTS: We believe that proptosis in the right eye, intraorbital abscess, limitation of ocular movement, retinal hemorrhage, and optic atrophy were due to alpha-hemolytic Streptococcus, which had spread to the cavernous sinus and right orbit through the vascular system. CONCLUSIONS: We report a case of bilateral cavernous sinus thrombosis and intraorbital abscess in the right eye in a patient who suffered from sepsis caused by alpha-hemolytic Streptococcus.

Change of Stereoacuity with Aging in Normal Eyes

PURPOSE: Stereopsis in normal subjects aged between 7 and 76 years was compared to examine changes in stereopsis with age. METHODS: Eighty subjects with no ocular disease were divided into 8 groups by age. Near stereopsis was evaluated with the TNO, Titmus, and Randot tests; distance stereopsis with the Mentor B-VAT II video acuity tester. RESULTS: The results of all 4 tests showed decreased stereopsis with increasing age (p< 0.05). Compared to the stereoacuity of 7 to 10-year-old group, both the TNO and distance stereopsis test results were significantly decreased for the 6th, 7th, and 8th decade groups, while both the Titmus and Randot test results were significantly decreased for the 8th decade group (p< 0.05). CONCLUSIONS: Overall, both near and distance stereopsis decreased with increasing age. Thus, decreased stereopsis should be taken into account when performing the stereopsis test.