Machine Learning-based Auto-merge Program for Nine-directional Ocular Photography

Purpose@#This study introduces a new machine learning-based auto-merge program (HydraVersion) that automatically combines multiple ocular photographs into single nine-directional ocular photographs. We compared the accuracy and time required to generate ocular photographs between HydraVersion and PowerPoint. @*Methods@#This was a retrospective study of 2,524 sets of 250 nine-directional ocular photographs (134 patients) between March 2016 and June 2022. The test dataset comprised 74 sets of 728 photographs (38 patients). We measured the time taken to generate nine-directional ocular photographs using HydraVersion and PowerPoint, and compared their accuracy. @*Results@#HydraVersion correctly combined 71 (95.95%) of the 74 sets of nine-directional ocular photographs. The average working time for HydraVersion and PowerPoint was 2.40 ± 0.43 and 255.9 ± 26.7 seconds, respectively; HydraVersion was significantly faster than PowerPoint (p < 0.001). @*Conclusions@#Strabismus and neuro-ophthalmology centers are often unable to combine and store photographs, except those of clinically significant cases, because of a lack of time and manpower. This study demonstrated that HydraVersion may facilitate treatment and research because it can quickly and conveniently generate nine-directional ocular photographs.

Long-term Outcome of Anterior Chamber Parameters after Laser Iridotomy and Iridoplasty in Primary Angle Closure Glaucoma

Purpose@#To investigate the long-term outcomes of anterior chamber angle parameters in patients with primary angle closure glaucoma (PACG) after peripheral laser iridotomy (LI) combined with iridoplasty (PI) using a dual Scheimpflug analyzer. @*Methods@#This retrospective study included 32 eyes in 32 patients diagnosed with PACG who underwent LI plus PI. Patients with an acute angle closure crisis were excluded. Dual Scheimpflug analyzer images were acquired before and 1 week after LI plus PI, and yearly afterwards. Anterior chamber depth (ACD) and volume (ACV), mean anterior chamber angle (ACA), and intraocular pressure (IOP) were also measured. @*Results@#The mean follow-up was 32.28 ± 13.34 months. Baseline demographics were age 63 ± 7.9 years, 62.5% female, IOP 15.48 ± 4.79 mmHg, ACD 2.09 ± 0.19 mm, and visual field mean deviation -7.97 ± 8.49 dB. ACD increased from baseline to 2.15 ± 0.32 mm, but it was not significant (p = 0.136). ACV increased significantly from 78.32 ± 11.49 mm at baseline to 83.04 ± 11.16 mm at the last visit after LI (p = 0.011). The mean ACA increased significantly from 26.86 ± 2.53° at baseline to 28.82 ± 4.64° at the last visit (p = 0.022). IOP decreased significantly from baseline to 13.06 ± 2.21 mmHg at the last visit (p = 0.001). @*Conclusions@#The ACA parameters improved after LI combined with PI in patients with PACG and remained so on long-term follow-up. IOP was also significantly reduced for more than 2.5 years after LI plus PI.

Repeatability of Bruch’s Membrane Opening-minimum Rim Width in Age-related Macular Degeneration and Diabetic Macular Edema

Purpose@#To evaluate the repeatability of retinal nerve fiber layer (RNFL) thickness and Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements by spectral-domain optical coherence tomography (SD-OCT) in wet age-related macular degeneration (wAMD) and diabetic macular edema (DME). @*Methods@#This was a prospective study. The RNFL thickness and BMO-MRW parameters for each sector and global average were measured twice by SD-OCT. Repeatability was evaluated using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). If the optic disc membrane was confirmed, it was analyzed by dividing it into three groups based on severity. @*Results@#A total of 99 eyes (48 with wAMD, 51 with DME) were included in the analysis. The ICCs of the global RNFL thickness and global BMO-MRW measurements were 0.996 and 0.997, respectively, in wAMD and 0.994 and 0.996, respectively, in DME eyes. The CV values of global RNFL thickness and BMO-MRW were 0.60% and 0.73%, respectively, in wAMD eyes and 1.10% and 1.21%, respectively, in DME eyes. The disc membrane on the optic nerve head significantly affected global BMO-MRW repeatability (B = 0.814, p < 0.001). @*Conclusions@#Both RNFL thickness and BMO-MRW measurements showed good repeatability in eyes with wAMD and DME. The severity of the optic disc membrane significantly affected the repeatability of BMO-MRW measurements in eyes with wAMD and DME. Therefore, physicians should examine the BMO-MRW in eyes with severe optic disc membrane.

A Lacrimal Punctal Keratinizing Cyst of the Lower Lid

PURPOSE: We report an unusual case of a keratinizing cyst on the lacrimal punctum. CASE SUMMARY: A 49-year-old female presented with an outpouching punctal mass at the left lower lid that occurred a week prior to her visit. Histopathological examination revealed a cyst filled with keratin arranged in lamina and surrounding the bacterial colony. The epithelial wall was composed of multilaminar, keratinizing squamous epithelium without goblet cells. The features were consistent with a keratinizing cyst. There was no recurrence at 4 months after the excision, and the punctum was patent. CONCLUSIONS: Keratinizing cyst should be considered as a differential diagnosis of the cystic mass of the punctum. Because it has an excellent prognosis after surgical resection, complete resection should be performed if a keratinizing cyst is suspected.

Fundus Albipunctatus Diagnosed in a 9-year-old Female

PURPOSE: We report a case of fundus albipunctatus discovered in a young patient. CASE SUMMARY: A 7.6-year-old female showed numerous small whitish-yellow flecks in the perimacular area and retinal periphery. Dark adapted 0.01 electroretinography (ERG) and dark adapted 3.0 ERG were profoundly reduced. At 26 months after the first visit, the best-corrected visual acuities were 1.0 right eye and 0.9 left eye. There were no pigmented lesions, atrophic lesions, or vascular abnormalities in the retina. Humphrey and Goldmann visual field tests were performed, but neither of the tests revealed any scotomas or other visual field defect. The number and size of characteristic numerous small whitish-yellow retinal flecks seemed almost unchanged. In spectral domain-optical coherence tomography (SD-OCT), the subretinal hyper-reflective lesions spanned the retinal pigment epithelium and the external limiting membrane. ERG showed improved dark adapted responses (dark adapted 0.01 ERG and dark adapted 3.0 ERG) after prolonged dark adaptation (2.5 hours). No family member showed any abnormal findings. CONCLUSIONS: Fundus albipunctatus is a rare disease in Koreans. We report a case diagnosed using fundus photography, SD-OCT, visual field tests, and ERG after prolonged dark adaptation (2.5 hours).

Long-term Follow-up Results of Patients with Welding-arc Maculopathy Assessed Using Spectral Domain Optical Coherence Tomography

PURPOSE@#We present four cases of welding arc maculopathy as observed using spectral-domain optical coherence tomography (SD-OCT).CASE SUMMARY: Four patients, who performed welding without wearing protective eye gear, presented to the hospital due to poor visual acuity. The mean visual acuity of the patients was 0.6. Fundus photographs of the four patients revealed a yellowish retinal scar at the fovea. SD-OCT images of the four patients showed photoreceptor inner segment/outer segment junction (IS/OS junction) disruption and retinal pigment epithelium injury. We diagnosed the patients with welding arc maculopathy, and three of them were treated with oral steroids or antioxidants. The IS/OS junctions were restored in two patients, who had short welding arc exposures. The disrupted IS/OS junction recovered partially in one of the other two patients, who had a longer duration of exposure, and the IS/OS junction disruption remained in another patient.@*CONCLUSIONS@#We report four cases of welding arc maculopathy caused by welding light exposure evaluated using SD-OCT and treated with oral steroids and antioxidants.

Optic Neuritis of Korean Adult

PURPOSE: The aim of the study was to describe the clinical features and characteristics of optic neuritis patients compared with those of patients enrolled in the Optic Neuritis Treatment Trial (ONTT). METHODS: We retrospectively included consecutive patients diagnosed with optic neuritis between 2006 and 2015. The inclusion criteria were the same as those of the ONTT; an acute or subacute unilateral visual symptom ≤8 days in duration, a relative afferent pupillary defect, and a visual field defect in the affected eye. RESULTS: The 41 patients (14 females, 27 males) were of mean age 32.7 years. The incidence of papilledema was 58.5%, thus higher than that of ONTT patients (p = 0.004), and the incidence of ocular pain was 75.6%, lower than that of ONTT patients (p = 0.002). Six months after intravenous methylprednisolone therapy, 29 of 32 eyes (90.6%) recovered visual acuity of ≥1.0 or better, and only one eye exhibited poor visual acuity (≤0.5). Orbital magnetic resonance imaging (MRI) was performed on 34 patients, and most (91.2%) exhibited optic nerve enhancement. The three patients who did not exhibit enhancement reported no pain. CONCLUSIONS: The clinical features of Korean optic neuritis patients differed from those of patients of the ONTT. Most patients exhibited optic nerve MRI enhancement associated with ocular pain. If enhancement of the optic nerve is lacking, diseases other than optic neuritis should be suspected because most optic nerves with neuritis exhibit enhancement on MRI.

Spontaneous Resolution of Deposits on the Surface of an Intraocular Lens after Ahmed Valve Implantation

No abstract available.

Corneal Iron Lines Observed in the Clinical Practice

PURPOSE: To unveil the etiology, pathogenic mechanism and the clinical significance of the corneal iron line through various clinical aspects of the corneal iron line. METHODS: This study included 45 eyes of 39 patients who visited the Department of Ophthalmology in Chungnam National University Hospital between April 2011 and March 2014. Anterior segment of the eye was photographed during the diagnostic process. The medical history of the patient was investigated and corneal topography was performed to discover the relationship between the position of the corneal iron line and the curvature of the corneal surface. RESULTS: The corneal iron line was identified in various corneal diseases such as herpetic stromal keratitis and; corneal ulcer. The average age of patients was 57.8 years. Corneal topography was performed in 12 patients and a connection was found between the curvature of the corneal surface and the position of corneal iron line at 75%. During the research period, corneal disease progressed and associated corneal iron line became clearer in 2 eyes. However, there was no repositioning or new appearance in different areas. The corneal iron line was not associated with visual acuity and the shape varied in accordance with the accompanying corneal disorder. The location where the tears repeatedly accumulate was associated with corneal surface. CONCLUSIONS: Based on the occurrence location and the shape of the corneal iron line, we could understand that the occurrence of corneal iron line is associated with the past and current corneal surface irregularities, which verified the validity of the tear pooling hypothesis. Therefore, this result can aid in establishing the diagnosis and treatment plan when the corneal iron line is discovered during clinical practice.

Corneal Iron Lines Observed in the Clinical Practice

PURPOSE: To unveil the etiology, pathogenic mechanism and the clinical significance of the corneal iron line through various clinical aspects of the corneal iron line. METHODS: This study included 45 eyes of 39 patients who visited the Department of Ophthalmology in Chungnam National University Hospital between April 2011 and March 2014. Anterior segment of the eye was photographed during the diagnostic process. The medical history of the patient was investigated and corneal topography was performed to discover the relationship between the position of the corneal iron line and the curvature of the corneal surface. RESULTS: The corneal iron line was identified in various corneal diseases such as herpetic stromal keratitis and; corneal ulcer. The average age of patients was 57.8 years. Corneal topography was performed in 12 patients and a connection was found between the curvature of the corneal surface and the position of corneal iron line at 75%. During the research period, corneal disease progressed and associated corneal iron line became clearer in 2 eyes. However, there was no repositioning or new appearance in different areas. The corneal iron line was not associated with visual acuity and the shape varied in accordance with the accompanying corneal disorder. The location where the tears repeatedly accumulate was associated with corneal surface. CONCLUSIONS: Based on the occurrence location and the shape of the corneal iron line, we could understand that the occurrence of corneal iron line is associated with the past and current corneal surface irregularities, which verified the validity of the tear pooling hypothesis. Therefore, this result can aid in establishing the diagnosis and treatment plan when the corneal iron line is discovered during clinical practice.