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.

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).

Effects of Emotional Stability on Insomnia through Anxiety in Patients with Cataracts

This study investigated the effect of emotional stability (ES) on insomnia through anxiety in preoperative patients with cataracts. Fifty-four subjects completed a self-questionnaire that included the Insomnia Severity Index (ISI), the International Personality Item Pool (IPIP) for ES, and the Hospital Anxiety and Depression scale (HADS). Pathway analysis was performed to analyze the mediating effects of ES, the anxiety subscale scores of the HADS, and the ISI scores. The low-ES group exhibited an insomnia severity that was significantly higher than that of the high-ES group (p=0.048). According to the pathway analysis, the significant indirect effect of ES on the ISI scores was mediated by the scores on the anxiety subscale of the HADS. Cataract patients with low ES waiting to undergo surgery have a high risk of experiencing insomnia due to anxiety. Before surgery, it is essential to identify patients’ personality characteristics and provide appropriate intervention.

Effect of Nd:YAG Laser Capsulotomy on Anterior Segment Parameters in Patients with Posterior Capsular Opacification after Phacovitrectomy

PURPOSE: To compare changes in anterior segment parameters after Nd:YAG laser capsulotomy in eyes that underwent either combined phacovitrectomy or cataract surgery. METHODS: This retrospective study enrolled 37 eyes of 35 patients with posterior capsular opacification treated with combined phacovitrectomy (group A), and 35 eyes of 32 patients with posterior capsular opacification treated with cataract surgery (group B). Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle, and anterior chamber volume, were measured by a Pentacam before Nd:YAG laser capsulotomy and 1 hour, 1 day, 1 week, 1 month, and 3 months after this treatment. RESULTS: In the cataract surgery group, the ACD was significantly lower 1 day (3.75 ± 0.74 mm), 1 week (3.73 ± 0.24 mm), and 3 months (3.74 ± 0.33 mm) after Nd:YAG laser capsulotomy compared with the pretreatment value (4.20 ± 0.62 mm, p = 0.002). By contrast, the ACD did not change significantly over time in the combined phacovitrectomy group. The ACD differed significantly between the two groups at 1 week, 1 month, and 3 months after capsulotomy. There were no significant changes in the anterior chamber volume, anterior chamber angle, central corneal thickness, or pupil size from before to after capsulotomy in either group. A non-significant trend toward myopic shift was observed in group A (p = 0.072) and B (p = 0.055). CONCLUSIONS: The results of the present study may help determine the power of the intraocular lens in patients who underwent combined surgery or cataract surgery and who will receive Nd:YAG laser capsulotomy.

Clinical Features of Herpes Simplex Keratitis in a Korean Tertiary Referral Center: Efficacy of Oral Antiviral and Ascorbic Acid on Recurrence

PURPOSE: To describe the clinical manifestations of herpes simplex keratitis (HSK) in a tertiary referral center in South Korea and to determine whether ascorbic acid treatment prevents recurrence of herpetic epithelial keratitis. METHODS: This retrospective cohort study included all consecutive patients with herpetic keratitis referred to our center from January 2010 to January 2015. Clinical features, ocular complications, and recurrences were recorded. RESULTS: In total, 149 eyes of the 133 patients (72 male and 61 female) were followed for an average of 24.6 ± 13.2 months. Sixteen (12.0%) patients had bilateral HSK. The most frequent HSK subtype was epithelial keratitis (49.7%), which was followed by stromal keratitis (23.5%). Epithelial keratitis was the most likely subtype to recur. Complications occurred in 122 (81.9%) eyes. The most common complication was corneal opacity. Recurrences were observed in 48 (32.2%) eyes. The recurrence rates were lower in the prophylactic oral antiviral agent group (16 / 48 eyes, 33.3% vs. 49 / 101 eyes, 48.5%) and the ascorbic acid treatment group (13 / 48 eyes, 27.1% vs. 81 / 101 eyes, 70.3%) compared with the groups without medications. Univariate logistic regression analysis revealed that both factors significantly reduced the risk of recurrence (acyclovir: odds ratio, 0.25; 95% confidence intervals, 0.12 to 0.51; ascorbic acid: odds ratio, 0.51; 95% confidence intervals, 0.20 to 0.91). CONCLUSIONS: This retrospective study described the clinical findings of HSK in a tertiary referral center in South Korea. Prophylactic oral antiviral agent treatment and oral ascorbic acid administration may lower the risk of recurrence.

Pars Plana Vitrectomy for Cystoid Macular Edema in a Retinitis Pigmentosa Patient

PURPOSE: To report the first case of cystoid macular edema in a retinitis pigmentosa patient with pars plana vitrectomy. CASE SUMMARY: A 43-year-old female visited our hospital with visual disturbances of both eyes. Corrected visual acuity was 20/22 in the right eye and 20/25 in the left eye. Peripheral depigmentation and atrophy of the retinal pigment epithelium, pigmentary retinal degeneration, and attenuated arterioles were observed in both eyes. Cystoid macular edema was observed on optical coherence tomography which showed that the central macular thickness was 308 µm in the right eye and 422 µm in left eye. Intravitreal aflibercept was injected into the left eye. One month after injection, the central macular thickness showed no response with a thickness of 449 µm. An intravitreal dexamethasone implant was then injected, 1 month after injection, the central macular thickness was 367 µm. Six months after injection, the patient again complained of visual disturbance of the left eye with a corrected visual acuity of 20/70. Vitreous opacity was observed and the central macular thickness was 501 µm. The patient underwent pars plana vitrectomy. Three days after surgery, the central macular thickness was 320 µm. One year after surgery, the corrected visual acuity was 20/33 and the central macular thickness was 311 µm. CONCLUSIONS: Pars plana vitrectomy due to cystoid macular edema in a retinitis pigmentosa patient has not been previously reported in the Republic of Korea. Pars plana vitrectomy can therefore be an effective treatment for cystoid macular edema in retinitis pigmentosa patients.

Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

PURPOSE: To investigate the outcomes of quantitative lens nuclear opalescence change after pars plana vitrectomy and intravitreal gas injection in patients with idiopathic epiretinal membrane and macular hole. METHODS: All patients were divided into two group according to the kinds of injected gases, either Group 1 (fluid/air exchange) or Group 2 (20% SF₆ gas injection). Lens nuclear opalescence according to the classification of Lens Opacities Classification System (LOCS) III, mean nuclear density and maximal nuclear density of Pentacam® scheimpflug image changed by image J, besides refractive errors were evaluated before surgery and 1, 2, 4, 6, and 12 months after surgery. RESULTS: Out of 40 eyes of 40 patients included in the analysis, 21 received only fluid/air exchange (Group 1) and 19 received 20% SF₆ gas injection (Group 2). There were significant changes in lens nuclear opalescence between the study and control (unaffected) eyes. In both groups, the study eyes experienced significant progression of cataract compared with the control eyes, in terms of mean nuclear density, maximal nuclear density and LOCS III. In comparison according to the kinds of injected gases, there was a significant difference in mean nuclear density after 4 months, maximal nuclear density after 2 months and 4 months, LOCS after 2 months and 4 months, and refractive error after 1, 2, 4, and 6 months between both groups (p = 0.003). CONCLUSIONS: After vitrectomy and intravitreal gas injection, changes in postoperative lens nuclear opalescence of the study eyes progressed more rapidly compared with the control eyes. This study identified that lens nuclear opalescence of Group 2 progressed rapidly, but after 12 months there was no significant difference of lens opacity between the kinds of injected gases.

A Case of Acute Retinal Necrosis in Healthy Childhood

PURPOSE: To describe a case of acute retinal necrosis (ARN) in childhood. CASE SUMMARY: A 6-year-old child visited our clinic complaining of conjunctival injection and decreased visual acuity in the left eye. Slit-lamp examination showed conjunctival injection, inflammatory cells (4+) in the anterior chamber, and keratic precipitates. Fundus examination showed disc swelling. The patient was treated with 30 mg of oral prednisolone and 1% prednisolone acetate with the suspicion of uveitis. After 2 days, retinal examination showed a peripheral multifocal yellowish patch and retinal hemorrhage. Herpes simplex virus-2 was detected using polymerase chain reaction (PCR) analysis of the aqueous humor, which was obtained by anterior chamber paracentesis. In the present case, ARN in childhood was successfully treated with intravenous acyclovir. CONCLUSIONS: We report a case of ARN in childhood diagnosed using PCR. Intravenous acyclovir may be an effective therapy in children with ARN. Ophthalmologists should promptly perform PCR analysis in patients diagnosed with ARN.

A Case of Bilateral Maculopathy Caused by High-Voltage-Induced Spark Injury

PURPOSE: To report a case of maculopathy after exposure to a high-voltage spark. CASE SUMMARY: A 40-year-old male patient visited our clinic complaining of visual disturbance in both eyes 1 day after exposure to a high voltage arc discharge. His best corrected visual acuity was 4/20 in both eyes. On fundus examination, a yellowish retinal scar was observed at the foveal area. The spectral domain optical coherence tomography (SD-OCT) showed inner segment/outer segment line disruption. The best corrected visual acuity was 4/20 in both eyes and SD-OCT showed a remaining inner segment/outer segment line disruption after 3 years. CONCLUSIONS: Maculopathy can result from exposure to a high voltage arc discharge exposure.

A Case of Phacoanaphylactic Uveitis Presenting as Endophthalmitis

PURPOSE: To report a case of phacoanaphylactic uveitis presenting as endophthalmitis. CASE SUMMARY: A 77-year-old woman presented with sudden visual disturbance and painful red right eye. She did not have a history of trauma or surgery in her right eye. Her best corrected visual acuity was hand movement in the right eye and log MAR 0.22 in the left eye; intraocular pressure was 27 mm Hg in the right eye and 15 mm Hg in the left eye. Slit-lamp examination revealed corneal edema and prominent inflammation with hypopyon in the anterior chamber. B-scan showed vitreous opacity behind the lens. Based on the diagnosis of endophthalmitis, anterior chamber paracentesis and irrigation were performed. After irrigation, a hypermature cataract with intact anterior capsule was observed. Therefore, we performed extracapsular cataract extraction and intravitreal antibiotics injection. Gram staining of the aqueous humor revealed numerous macrophages filled with lens protein but no organisms. She was treated with hourly topical corticosteroid and an antibiotic agent. One month later, the anterior chamber is clear, and the cultures remained negative. CONCLUSIONS: We report a case of spontaneous phacoanaphylactic uveitis presenting as endophthalmitis in a patient with no history of eye trauma or surgery.

A Case of Anterior Migration of Fragmented Dexamethasone Intravitreal Implant

PURPOSE: To report a case of fragmentation and anterior migration occurred after dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA) injection in a branch retinal vein occlusion patient. CASE SUMMARY: A 66-year-old male was referred for blurred vision. He received cataract surgery in 1986 and was diagnosed with central retinal vein obstruction in 2011 in the right eye. For treatment of macular edema, dexamethasone intravitreal implant was performed in the right eye. One week after implantation, a fragment of the dexamethasone implant migrated to the anterior chamber with corneal edema and surgical removal was performed immediately. One day after removal, the remaining fragmented implant migrated to the anterior chamber and corneal edema still existed. The fragmented implant was removed with anterior chamber irrigation. After removal, corneal edema improved and visual acuity was recovered. CONCLUSIONS: Anterior migrated dexamethasone implant could induce corneal complications, such as corneal edema and corneal decompensation and might lower the corneal endothelial cell even if immediately removed. We report a case of corneal edema, which was induced by anterior migration of a fragmented dexamethasone implant and recovered with immediate surgical removal.

Comparison of Bevacizumab and Combined Low-dose Bevacizumab and Triamcinolone in Central Retinal Vein Occlusion

PURPOSE: To report the effects and intraocular pressure (IOP) results of intravitreal injection of bevacizumab alone compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with central retinal vein occlusion. METHODS: In total, 40 eyes of 40 patients diagnosed with central retinal vein occlusion were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL), and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness (CMT), and IOP of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. RESULTS: In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, CMT decreased significantly at 1 month, 2 months, and 3 months after injection (p 0.05). The BCVA, IOP, and CMT at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (p > 0.05). CONCLUSIONS: The CMT of both groups decreased significantly, and BCVA of both groups increased significantly in patients with central retinal vein occlusion. Injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of central retinal vein occlusion.

Clinical Manifestations and Outcomes of Treatment in Cytomegalovirus Endotheliitis

PURPOSE: To elucidate the clinical manifestations of cytomegalovirus (CMV) endotheliitis, and evaluate the outcomes of treatment in CMV endotheliitis. METHODS: We reviewed the medical records of 7 patients (8 eyes) who were diagnosed with CMV endotheliitis via a polymerase chain reaction (PCR) of aqueous humor and were treated with ganciclovir. RESULTS: Eight eyes of 7 patients were followed for a mean of 17.8 months. One patient had bilateral corneal endotheliitis. All eyes had coin-shaped keratoprecipitates and mild anterior chamber inflammation (1+~2+). All eyes had an absence of anterior segment inflammation 3 weeks after ganciclovir treatment. Following treatment, the mean visual acuity improved significantly from 0.60 ± 0.40 (log MAR) at baseline to 0.18 ± 0.18 (log MAR) at last follow-up. The mean intraocular pressure (IOP) decreased significantly from 30 mm Hg at baseline to 12 mm Hg at last visit. Two eyes had a recurrence of corneal endotheliitis, where one underwent penetrating keratoplasty and the other was treated with intravitreal ganciclovir injection. CONCLUSIONS: Patients with increased IOP and coin-shaped keratoprecipitates are suspected to have CMV endotheliitis, and PCR of aqueous humor is needed to diagnose CMV endotheliitis. More than 6 weeks of ganciclovir treatment might be effective for CMV endotheliitis and may help prevent recurrence.

Clinical Manifestations and Outcomes of Treatment in Cytomegalovirus Endotheliitis

PURPOSE: To elucidate the clinical manifestations of cytomegalovirus (CMV) endotheliitis, and evaluate the outcomes of treatment in CMV endotheliitis. METHODS: We reviewed the medical records of 7 patients (8 eyes) who were diagnosed with CMV endotheliitis via a polymerase chain reaction (PCR) of aqueous humor and were treated with ganciclovir. RESULTS: Eight eyes of 7 patients were followed for a mean of 17.8 months. One patient had bilateral corneal endotheliitis. All eyes had coin-shaped keratoprecipitates and mild anterior chamber inflammation (1+~2+). All eyes had an absence of anterior segment inflammation 3 weeks after ganciclovir treatment. Following treatment, the mean visual acuity improved significantly from 0.60 ± 0.40 (log MAR) at baseline to 0.18 ± 0.18 (log MAR) at last follow-up. The mean intraocular pressure (IOP) decreased significantly from 30 mm Hg at baseline to 12 mm Hg at last visit. Two eyes had a recurrence of corneal endotheliitis, where one underwent penetrating keratoplasty and the other was treated with intravitreal ganciclovir injection. CONCLUSIONS: Patients with increased IOP and coin-shaped keratoprecipitates are suspected to have CMV endotheliitis, and PCR of aqueous humor is needed to diagnose CMV endotheliitis. More than 6 weeks of ganciclovir treatment might be effective for CMV endotheliitis and may help prevent recurrence.

A Case of Raoultella planticola Endophthalmitis after Cataract Surgery

PURPOSE: To report the first case of the Raoultella planticola endophthalmitis after the phacoemulsification and posterior chamber multi-focused intraocular lens (IOL) implantation. CASE SUMMARY: A healthy 49-year-old male visited our clinic with a sudden visual disturbance and ocular pain 2 days after phacoemulsification and multi-focused IOL implantation in his right eye. On initial ophthalmic examination, severe corneal edema and hypopyon were observed. The retina could not be visualized due to vitreous opacity and anterior chamber inflammation. Therefore, the patient immediately underwent pars plana vitrectomy. Vancomycin hydrogen chloride (HCl) 0.3 mg/0.1 mL was injected into the anterior part and vancomycin HCl 1.0 mg/0.1 mL and ceftazidime 2.0 mg/0.1 mL were injected into the intravitreal part. The culture test of aqueous humor and vitreous body fluid revealed Raoultella planticola, thus, systemic antibiotic (ceftazidime) and antibiotic eye drops (vancomycin and ceftazidime) were administered. After 4 months of follow-up, best-corrected visual acuity improved to 20/20 in the affected eye after surgery. CONCLUSIONS: In the present case, we found that endophthalmitis due to Raoultella planticola can be successfully treated. We suggest that atypical bacteria should be considered in the differential diagnosis of endophthalmitis after cataract surgery.

Two Cases of WIOL-CF(R) IOL Dislocation after Nd:YAG Laser Capsulotomy

PURPOSE: To report 2 cases of WIOL-CF(R) intraocular lens (IOL) (Gelmed International, Kamenne Zehrovice, Czech Republic) dislocation after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. CASE SUMMARY: A 78-year-old female was referred for IOL dislocation. She was implanted with WIOL-CF(R) IOL 18 months prior. Two months after WIOL-CF(R) implantation, she received Nd:YAG laser capsulotomy at a local clinic. Pars plana vitrectomy and transscleral fixation of IOL were performed. CONCLUSIONS: This is the first report of WIOL-CF(R) IOL dislocation after Nd:YAG laser capsulotomy in unvitrectomized eyes. When Nd:YAG laser capsulotomy is performed after WIOL-CF(R) IOL implantation, IOL dislocation should be considered even in unvitrectomized eyes.

A Case of Maculopathy from Handheld Green Laser Pointer

PURPOSE: To report a case of successfully treated maculopathy after exposure to a handheld green laser pointer beam. CASE SUMMARY: A-15-year-old patient visited our clinic complaining of visual disturbance in the left eye 5 days earlier after exposure to a handheld laser pointer with 532 nm wavelength green beam for 5 seconds. His best corrected visual acuity was 20/50 in the left eye. On fundus examination, a yellowish retinal scar was observed at the foveal area. The spectral domain optical coherence tomography (SD-OCT) showed cone outer segment tip line and inner segment/outer segment line disruption, external limiting membrane line and retinal pigment epithelial complex injury related to laser pointer exposure. We started occlusion therapy, oral prednisolone and, antioxidant treatment on his left eye for 2 weeks. The best corrected visual acuity was 20/20 in the left eye at 1 month after treatment. However, spectral domain optical coherence tomography showed a scar remained in the retinal pigment epithelial complex of the macular region of his left eye while the external limiting membrane line was restored and inner segment/outer segment line was partially restored. CONCLUSIONS: Maculopathy can result from exposure to a handheld green laser pointer. Occlusion therapy, oral prednisolone and, antioxidant treatment might be helpful for recovery of visual acuity and restoration of external limiting membrane line.

A Case of Postpartum Macular Hole in a Young Woman

PURPOSE: To describe a case of macular hole (MH) in a 29-year-old non-myopic woman after uncomplicated delivery. CASE SUMMARY: A 29-year-old woman visited our clinic complaining of decreased visual acuity in her left eye after uncomplicated delivery. Fundoscopy and optical coherence tomography showed a full thickness macular hole in the left eye. However, we found not posterior vitreous detachment or vitreomacular traction in the posterior pole. The patient underwent pars plana vitrectomy, internal limiting membrane peeling, and SF6 gas tamponade. Three months after vitrectomy, the patient's visual acuity was improved and the macular hole was closed successfully. CONCLUSIONS: We experienced and treated a case of postpartum MH developed in a young woman without posterior vitreous detachment or vitreomacular traction in the posterior pole. This suggests another mechanism of MH formation. Postpartum MH was successfully treated by existing idiopathic macular hole surgery.