Frosted Branch Angiitis as Ocular Manifestation of Behcet's Disease: Unusual Case Report and Literature Review

We report an unusual case of unilateral frosted branch angiitis associated with Behcet's disease, including a review of previously reported cases. A 39-year-old male with history of recurrent oral and genital ulcers presented with visual loss in his left eye. Fundus findings demonstrated occlusive retinal vasculitis resembling acute frosted branch angiitis. Laboratory examinations including viral markers revealed no abnormal findings except positive HLA-B51. The patient was treated with systemic steroid and cyclosporine. Six months after presentation, new oral ulcers and pseudofolliculitis appeared, and he was diagnosed with Behcet's disease following rheumatology consultation. During follow-up, there was no change in visual acuity of hand movement, and disc neovascularization developed even after complete panretinal photocoagulation. Ocular manifestations of Behcet's disease can present as unilateral frosted branch angiitis, and may consecutively involve in both eyes. Early immunosuppressive treatment is recommended.

Transient Hypotony after Silicone Oil Removal in Rhegmatogenous Retinal Detachment

PURPOSE: To determine the risk factors for transient hypotony after silicone oil removal in rhegmatogenous retinal detachment and to analyze changes in intraocular pressure and visual acuity after silicone oil removal. METHODS: The medical records of 54 eyes of 52 patients who underwent pars plana vitrectomy, silicone oil tamponade followed by silicone oil removal due to rhegmatogenous retinal detachment, were reviewed. RESULTS: The incidence of transient hypotony after silicone oil removal was 18.5%. Young age (p = 0.011) and axial length (p = 0.002) were risk factors for transient hypotony based on univariate analysis. In multivariate analysis, axial length longer than 26 mm was the only risk factor for transient hypotony (p = 0.005). Seven hypotony patients recovered to normal intraocular pressure spontaneously within 2 weeks. In 2 patients, intraocular pressure was normalized after intravitreal injection of C3F8 gas and 1 patient recovered after a balanced salt solution injection into the anterior chamber. Two weeks after silicone oil removal, there was no significant difference in intraocular pressure between the hypotony group and normal intraocular pressure group. Additionally, there was no statistically significant difference in best corrected visual acuity between the 2 groups after 2 weeks. CONCLUSIONS: Although transient hypotony after silicone oil removal in rhegmatogenous retinal detachment was frequently observed in the present study, the final best corrected visual acuity and intraocular pressure was not always affected. Ocular hypotony should be examined thoroughly in the early postoperative period.

Prevalence of School Bullying and Related Psychopathology in Children and Adolescents

OBJECTIVES: This study examined the current prevalence rate of school bullying and its related psychopathology. METHODS: A total of 3,550 elementary/middle school students and their parents were recruited for this study. A self-report questionnaire on perpetration and victimization in school bullying was used for collection of data regarding prevalence and the present state of school bullying. For evaluation of associated psychopathology, self report forms, including the Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), attention-deficit hyperactivity disorder Rating Scale (ARS), Korean-Child Behavior Checklist (K-CBCL), Korean-Youth Self Report (K-YSR), and the Korean Eppendorf Schizophrenia Inventory (K-ESI) were applied. Samples were classified according to four subtype groups (control, victim, perpetrator, and victim-perpetrator) and characteristics of each group were compared. RESULTS: Overall, the prevalence rate for bullying perpetration was 64.4% and the prevalence rate for bullying victimization was 63.4%, indicating involvement of more than half of students in school bullying. Bully-victims reported high social immaturity and depressive and suicidal tendency, whereas bully-perpetrators reported less social immaturity and more externalizing problems. Among the subtype groups, the victim-perpetrator group showed the most prominent depressive/anxiety tendency and behavioral problems. CONCLUSIONS: Both victimization and perpetration of bullying are common problems for child and adolescent groups and several psycho-social problems were found to be related. The results of this study will guide direction of future study and development of strategies for prevention of bullying.

Bilateral Retinal Detachment in a 15-Year-Old Child with Tourette Syndrome

PURPOSE: To report a case of bilateral retinal detachment in a 15-year-old child with Tourette syndrome. CASE SUMMARY: A 15-year-old child treated for Tourette syndrome for 4 years presented with decreased visual acuity of several days in duration. The fundus of the right eye was not observed due to lens opacity and posterior synechiae. The B-scan of the right eye showed funnel-shaped densely reflective echoes connected to the optic disc, suggesting a total retinal detachment. Fundus examination of the left eye revealed an inverted retinal flap, which covered the posterior pole. During vitrectomy of the left eye, a ciliary body detachment anterior to a giant retinal tear extending 360 degrees was observed. In addition, an inverted flap covering 2 superior retinal quadrants was observed. A perfluorocarbon liquid was injected to unfold the tear's inverted flap, and silicone oil tamponade was performed. CONCLUSIONS: Self-induced and repeated periocular trauma induced by motor tics of Tourette syndrome can result in bilateral retinal detachment. Regular ophthalmic examinations are helpful for early detection of ocular complications including periocular trauma induced by motor tics of Tourette syndrome.

Clinical Evaluation of Patients with Nonproliferative Diabetic Retinopathy Following Medication of Anthocyanoside: Multicenter Study

PURPOSE: To prospectively investigate the change of clinical manifestations after 1 year of administration of anthocyanoside (Tagen-F(R)) to patients with NPDR-associated macular edema. METHODS: One hundred seventy-five eyes in 88 patients were enrolled in this study, at 5 centers, from March, 2005 to October, 2005. Patients took 3 capsules of Vaccinium myrtillus extract (170 mg/capsule, Tagen-F(R), Kukje pharmaceutical) per day. The primary endpoints were corrected visual acuity and contrast sensitivity which were checked at 2 months following the beginning of treatment [East 1]. The secondary endpoints were the number of hard exudates, microaneurysms, leaking points and the changes of foveal thickness. These were examined at the beginning of, 6 months after, and 12 months after treatment. RESULTS: Corrected visual acuity showed no significant changes during 12 months. Contrast sensitivity improved gradually, especially in 12, 16 cycles per degree [East 2]. There was no statistically significant changes in the numbers of hard exudates, microaneurysms, and leaking points. Foveal thickness measured by OCT was maintained and there was no aggravation of macular edema. CONCLUSIONS: There was marked improvement of contrast sensitivity in patients with NPDR after 1 year of administration of anthocyanoside (Tagen-F(R)), and it might contribute to the quality of vision and the satisfaction of patients. Visual acuity and macular edema were maintained without aggravation.

Intravitreal Versus Subtenon Injections of Triamcinolone Acetonide for Diabetic Macular Edema

PURPOSE: To retrospectively evaluate the clinical effect of intravitreal (IVT) and posterior subtenon (PSTT) triamcinolone acetonide (TA) injection in diabetic macular edema. METHODS: Fifty eyes of 43 patients with diabetic macular edema (DME) were included. Twenty-two eyes in the IVT group received 4 mg/0.1 ml intravitreal TA injections and 26 eyes in the PSTT group received 40 mg/1.0 ml subtenon TA injections. LogMAR visual acuity and intraocular pressure (IOP) were measured and, using OCT, central macular thickness (CMT) and total macular volume (TMV) were also measured before and 1, 3, and 6 months postoperatively. RESULTS: Both groups showed significant decreases in the mean CMT and TMV. The mean CMT in the IVT group was significantly thinner than that of the PSTT group 1 month postoperatively. The percentage reduction in CMT and TMV were also greater in the IVT group than the PSTT group 1 month postoperatively. Both groups showed significant improvements in mean visual acuity, with no significant difference between the two groups. However, at 1-month postoperative improvement in visual acuity was significantly greater in the IVT group than the PSTT group. The mean IOP in the IVT group was also greater than that in the PSTT 1 month postoperatively. CONCLUSIONS: Both injections caused a significant increase in visual acuity and a decrease in CMT and TMV. The effect was more pronounced in the IVT group. However, the PSTT injection also appeared to be a safe and effective technique for the treatment of DME.

Reduction of Deviation Angle During Occlusion Therapy: In Partially Accommodative Esotropia with Moderate Amblyopia

PURPOSE: To evaluate changes in ocular alignment in partially accommodative esotropic children age ranged from 3 to 8 years during occlusion therapy for amblyopia. METHODS: Angle measurements of twenty-two partially accommodative esotropic patients with moderate amblyopia were evaluated before and at 2 years after occlusion therapy. RESULTS: Mean deviation angle with glasses at the start of occlusion treatment was 19.45+/-5.97 PD and decreased to 12.14+/-12.96 PD at 2 years after occlusion therapy (p<0.01). After occlusion therapy, 9 (41%) cases were indications of surgery for residual deviation but if we had planned surgery before occlusion treatment, 18 (82%) of patients would have had surgery. There was a statistical relationship between increase of visual acuity ratio and decrease of deviation angle (r=-0.479, p=0.024). CONCLUSIONS: There was a significant reduction of deviation angle of partially accommodative esotropic patients at 2 years after occlusion therapy. Our results suggest that occlusion therapy has an influence on ocular alignment in partially accommodative esotropic patients with amblyopia.

Neovascular Glaucoma after Vitrectomy for Proliferative Diabetic Retinopathy and the Ahmed Valve Implantation

PURPOSE: To evaluate the clinical features of neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy and the effect of Ahmed valve implantation. METHODS: The medical records of 217 eyes of 178 patients who had undergone pars plana vitrectomy for proliferative diabetic retinopathy were reviewed. The clinical data on preoperative, intraoperative, and postoperative factors of these patients were compared with that of those who developed neovascular glaucoma (20 eyes of 18 patients) after vitrectomy. The effect and complications of Ahmed valve implantation were also reviewed. RESULTS: The type 1 diabetes, the presence of NVD, grade of NVE, grade of preoperative PRP, presence of postoperative vitreous hemorrhage, and postoperative tractional retinal detachment were significantly correlated with the development of neovascular glaucoma. Ahmed valve implantation in these patients was effective in controlling intraocular pressure and improving visual acuity. Complications of the Ahmed valve implantation were hyphema, tube exposure, recurrent vitreous hemorrhage, hypotony, and choroidal effusion. CONCLUSIONS: The risk factors for the development of neovascular glaucoma after vitrectomy for proliferative diabetic retinopathy were evaluated. Ahmed valve implantation in these patients is considered an effective treatment for controlling intraocular pressure.