Comparison of Short-term Clinical Outcomes between Sutured Scleral Fixation and Modified Yamane Sutureless Scleral Fixation

Purpose@#To compare and investigate the short-term clinical outcomes between 10-0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state. @*Methods@#From August 2012 to May 2022, medical records were retrospectively analyzed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month, and 3 months after surgery. @*Results@#In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for one week after surgery and IOL astigmatism for one week and one month after surgery were significantly lower in sutureless fixation group. There was no significant difference in postoperative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group. @*Conclusions@#Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

Four-port Vitrectomy in Rhegmatogenous Retinal Detachment

Purpose@#The study investigated the results of direct surgical scleral depression using four ports and the chandelier lighting system in rhegmatogenous retinal detachment. @*Methods@#Anatomical and functional success rates and complications were analyzed in 179 eyes diagnosed with rhegmatogenous retinal detachment that underwent primary vitrectomy using four ports at our hospital between March 2012 and February 2022. @*Results@#A total of 168 (93.9%) eyes had anatomical success without reoperation while 11 (6.1%) developed recurrence. However, the final success rate was 100%. The best-corrected visual acuity improved significantly from logarithm of the minimum angle of resolution (logMAR) 1.03 ± 0.92 to logMAR 0.24 ± 0.39 after surgery (p < 0.001). Complications included a temporary increase in the intraocular pressure (n = 3, 1.7%), leakage through the scleral incision (n = 2, 1.1%), hyphema and vitreous hemorrhage (n = 10, 5.6%), and iatrogenic retinal break (n = 1, 0.6%), but these improved after treatment. @*Conclusions@#Four-port vitrectomy for rhegmatogenous retinal detachment in which scleral depression is directly performed using the chandelier lighting system is a useful surgical method. It allows effective visualization of the peripheral retina regardless of the assistant’s proficiency which results in a more meticulous surgery. The anatomical and functional results of this technique were similar to the conventional technique.

Two Cases of Flanged Intrascleral Fixation Performed with Vitrectomy and Air-fluid Exchange

Purpose@#We report two cases in which vitrectomy, air-fluid exchange, and flanged intrascleral fixation were employed to treat crystalline or intraocular lens dislocation associated with retinal detachment.Case summary: Two patients visited our clinic complaining of visual disturbance in the right and left eye respectively. At the initial visits, slit-lamp examination revealed subluxation of a crystalline lens (with zonulysis on the nasal side) in case 1 and dislocation of an intraocular lens (IOL) in case 2. Since retinal detachment was accompanied in both patients, they also underwent vitrectomy and air-liquid exchange during surgery. To fix the intraocular lens to the sclera, both ends of IOL haptics were cauterized using a low-temperature handheld device and flanged haptics had been deeply inserted into scleral tunnels. The intraocular pressure fell and vitreous hemorrhage developed immediately after surgery, but improved on additional treatment. At 18 and 6 months (cases 1 and 2) after surgery, the implanted IOLs were moved to the centers of the pupils without complications. @*Conclusion@#Flanged intrascleral fixation is stable and effective when treating a patient who requires vitrectomy and air-fluid exchange to deal with a retinal disease.

A Case of Traction Retinal Detachment Accompanied by Ocular Syphilis

Purpose@#We report a first case of traction retinal detachment accompanied by ocular syphilis in Korea.Case summary: A 20-year-old male visited with poor left-eye vision. His best-corrected visual acuity was 0.3; no inflammation was evident in the anterior chamber, but many inflammatory cells were found in the vitreous cavity. Fundus examination revealed inferior exudative and tractional retinal detachment. Optical coherence tomography revealed an epiretinal membrane; fluorescein angiography showed that the inferior (detached) retina did not fluoresce. Syphilis was serologically detected; ceftriaxone (2 g daily) was intravenously injected for 14 days. The vitreous cavity inflammation improved, but the tractional membrane proliferation triggered tractional retinal detachment. We performed vitrectomy to remove the tractional membrane and prescribed intravitreal antibiotics. The patient was discharged after intravenous injection of penicillin G (20 MU daily) for 14 days. Three months after surgery, the best-corrected left-eye visual acuity had improved to 0.8, and no recurrence of the retinal detachment was noted. @*Conclusions@#Patients with ocular syphilis may evidence retinal detachment despite initial prescription of systemic antibiotics. A possible need for surgery should be kept in mind; the prognosis is good if an operation is performed in a timely manner.

Exophiala Endophthalmitis after Cataract Surgery

Purpose@#To report a case of Exophiala endophthalmitis after cataract surgery, which has not been reported previously in Korea.Case summary: A 70-year-old woman visited the hospital 7 days after cataract surgery in her right eye with unilateral vision impairment. At the time of the visit, visual acuity of the right eye was hand motion, and the fundus was not clearly observed due to numerous inflammatory cells with hypopyon in the anterior chamber. With an initial diagnosis of suspected bacterial endophthalmitis, vitrectomy was performed immediately with intravitreal injection of antibiotics and steroid. On day 14 after vitrectomy, inflammation in the anterior chamber and vitreous opacity worsened, and complete vitrectomy, including of the vitreous base, and removal of the intraocular lens and capsule was performed. Exophiala was detected in the biopsy specimen on day 6 after the second surgery, and the patient was discharged with a prescription for voriconazole eye drops. On day 23 after the second surgery, the best-corrected visual acuity in the right eye had improved to 1.0, and there was no evidence of endophthalmitis recurrence and no observed additional abnormal findings of the fundus until 6 months after second surgery. @*Conclusions@#In a case of fungal endophthalmitis that occurred after cataract surgery, good results were obtained by vitrectomy involving complete removal of the peripheral vitreous body, including the intraocular lens and lens capsule, which was the basis for growth of the fungus in the early stage of endophthalmitis.

Quantification of Vascular Tortuosity by Analyzing Smartphone Fundus Photographs in Patients with Retinopathy of Prematurity

Purpose@#To determine the usefulness of measuring the tortuosity of retinal arteries using smartphone fundus photographs to quantify plus disease in retinopathy of prematurity (ROP) patients. @*Methods@#Digital fundus photographs were taken with a smartphone of 116 eyes involving 58 premature infants. The tortuosity of retinal arteries named as the tortuosity index (TI) was measured with Image J software. Patients were classified into the treated and control groups and the TIs of the two groups were compared. A receiver operating characteristic curve was constructed and areas under the curve (AUC) were calculated to quantify the diagnostic utility of TI. @*Results@#Fundus photographs of 98 eyes of 50 premature infants were analyzed; 38 eyes of 20 infants were the treated group and 60 eyes of 30 infants were the control group. The TI was 1.231 ± 0.156 in the treated group before treatment, which was significantly larger than 1.062 ± 0.019 in the control group. After treatment of the treated group, the TI was 1.100 ± 0.093, which was significantly smaller than before treatment. The AUC was 0.926, and using a cut-off value of 1.095, the sensitivity and specificity of TIs for requiring treatment were 85.1% and 95.5%, respectively. @*Conclusions@#The tortuosity of retinal arteries was measured by analyzing smartphone fundus photographs to quantify plus disease in ROP patients. This method may be helpful for screening, follow-up, and treatment decisions for ROP patients.

Characters of Floaters and Flash Associated with Retinal Breaks and Peripheral Retinal Degeneration

PURPOSE@#To investigate the relationship between peripheral retinal degeneration including retinal tear and character of floater and flash in patients with symptoms.@*METHODS@#A retrospective review of 56 patients who visited Dong-A University Hospital with the symptoms of vitreous floaters and flash between July 2017 and March 2018 was performed using medical records. All patients completed a questionnaire detailing their symptoms include duration of symptoms, characters, floaters with flash and associated another visual symptom (e.g., headache, whiteout) had been performed full ophthalmic examination.@*RESULTS@#A total of 56 eyes were included in this study, including 22 eyes (39.3%) of retinal breaks and peripheral retinal degeneration and 34 eyes (60.7%) of no peripheral retinal degeneration. Univariated analysis showed that the onset of symptoms within 1 week, multiple floaters particularly for the number from 2 to 5, and existence of posterior vitreous detachment are meaningful factor. Laser photocoagulation was performed in patients with peripheral retinal degeneration including retinal tears requiring treatment. No additional breaks were observed in all patients during the 6-month follow-up.@*CONCLUSIONS@#Patients with floaters and flash should be thoroughly asked with regard to the onset and number of floaters, and if the onset of symptom is within one week or patients feel multiple floaters, thorough peripheral fundus examination to find peripheral retinal degeneration including retinal tears should be needed.

Classification of Lacrimal Punctal Stenosis and Its Related Histopathological Feature in Patients with Epiphora

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.

Ruptured Retinal Arterial Macroaneurysm after Panretinal Photocoagulation for Diabetic Retinopathy

PURPOSE: To report a case of deterioration of a retinal arterial macroaneurysm after panretinal photocoagulation (PRP) for diabetic retinopathy. CASE SUMMARY: A 70-year-old woman visited our clinic for evaluation of diabetic retinopathy. Fundus examination and fluorescein angiography showed severe non-proliferative diabetic retinopathy and PRP was planned for the patient. In addition, the patient was found to have a retinal arterial macroaneurysm on the superotemporal area of the retina on her right eye. However, the lesion was small and was located far from the macula, causing no symptoms; thus we decided to observe the patient over a period of time. Two months after PRP, the patient revisited the clinic complaining of acute visual loss. Fundus examination showed vitreous and retinal hemorrhage and optical coherence tomography revealed subretinal fluid in the corresponding area. This was considered to be due to aggravation of the pre-existing macroaneurysm. Intravitreal Bevacizumab injection, C₃F₈ gas injection, and pars plana vitrectomy were performed. After absorption of the hemorrhage, barrier photocoagulation was performed around the retinal macroanerysm. The visual acuity improved and the retina remained stable through the most recent follow-up. CONCLUSIONS: We experienced the rupture of a preexisting retinal arterial macroaneurysm in an asymptomatic patient after panretinal photocoagulation. PRP in diabetic patients could aggravate retinal arterial macroaneurysms. Therefore, it is necessary to carefully examine the patient for retinal macroaneurysms when planning a PRP for diabetic retinopathy.

Clinical Outcomes of Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane in Epiretinal Membrane Surgery

PURPOSE: In this study we compared the clinical outcomes of idiopathic epiretinal membrane (ERM) surgery according to the use of indocyanine green (ICG) and ICG exposure time. METHODS: The medical records of 76 patients with an idiopathic ERM that underwent vitrectomy and ERM and internal limiting membrane (ILM) removal were reviewed. We compared the results (best corrected visual acuity [BCVA, log MAR] and central macular thickness [CMT, µm]) of idiopathic ERM surgeries using ILM peeling with (group I, 39 eyes) and without ICG (group II, 37 eyes). Additionally, the correlation of ICG exposure time and clinical outcomes in group I was analyzed. RESULTS: Gender, age, lens state, preoperative BCVA, and preoperative CMT were not significantly different between the two groups. The postoperative BCVA was significantly improved in both groups but the difference was not statistically significant. The postoperative CMT was significantly improved in both groups and the change amount of group I was more larger than group II. Additionally, ICG exposure time was not significantly correlated with changes of BCVA and CMT. CONCLUSIONS: Intravitreal ICG-assisted ILM peeling did not significantly affect the recovery of BCVA, however that impaired the recovery of CMT. ICG exposure time did not affect the postoperative visual outcome.

Scleral Perforation During Inferior Rectus Muscle Recession in Congenital Fibrosis of the Extraocular Muscles

PURPOSE: We report a case of a scleral perforation during inferior rectus recession in congenital fibrosis of extraocular muscles and the management of this perforation with a scleral patch graft. CASE SUMMARY: A 20-month-old female with bilateral ptosis, absence of elevation and a chin-up position was diagnosed with congenital fibrosis of extraocular muscles. Because severe esotropia in the downward gaze was observed, we first performed esotropia surgery. After 1 year, she underwent a bilateral ptosis correction. We decided to perform bilateral inferior rectus recession due to an abnormal head posture and the absence of elevation. Because the inferior rectus muscles were extremely tight and adhered to the sclera, hooking and isolating these muscles during surgery was difficult. After muscle suture placement, a portion of the sclera that contacted the left inferior rectus was chipped off as this muscle was disinserted with blunt Westcott scissors. A scleral perforation was observed, thus, we placed a scleral patch graft using the donor sclera and finished the bilateral inferior rectus recession. No abnormal findings for the vitreous or retina were detected. At 8 months after surgery, the patient exhibited exotropia of 12 prism diopters in her primary gaze. Her abnormal head posture nearly disappeared. CONCLUSIONS: Careful isolation and disinsertion of the muscle from the globe is necessary in the treatment of patients who are expected to exhibit severe adhesions between the muscle and sclera, such as patients with congenital fibrosis of extraocular muscles.

Preoperative Factors Affecting the Visual Outcome after Vitrectomy in Rhegmatogenous Retinal Detachment

PURPOSE: To investigate the preoperative factors affecting the visual outcome after a vitrectomy in a rhegmatogenous retinal detachment (RRD). METHODS: A retrospective study of 79 eyes was carried out. The 41 eyes were macula-off RRD (group I), the 38 eyes were macula-on RRD (group II). The preoperative factors examined in this study included the preoperative best corrected visual acuity (BCVA), age, the duration of macular detachment, the extent of the detached retina, the delay of operation. The correlation between these factors and the postoperative 6 months BCVA were investigated. RESULTS: In group I, preoperative BCVA (r = 0.313, p = 0.037) and preoperative retinal detachment (RD) extent (r = 0.483, p = 0.001) were significantly correlated with postoperative 6 months BCVA. In group II, preoperative BCVA and preoperative RD extent were not significantly correlated with postoperative 6 months BCVA. Regardless of including macula, the patient's age, duration of symptom and delay of operation after clinic visit were not affected to the visual outcome. Patients with symptom duration of 7 days or less achieved better final BCVA (0.36 ± 0.45 log MAR, n = 29) than patients with longer symptom duration (0.79 ± 0.55 log MAR, n = 16) (p = 0.008). CONCLUSIONS: After vitrectomy for macula-off RRD, the factors related to favorable visual outcome were the better preoperative BCVA, the less extent of the detached retina. And surgical repair within 7 days of the symptom onset yielded better visual outcomes. Otherwise, in macula-on RRD, preoperative BCVA, age, the duration of retinal detachment, the extent of the detached retina, the delay of operation did not impact on visual outcome.

Comparison between Aflibercept, Ranibizumab Intravitreal Injection on Neovascular Age-related Macular Degeneration Patients

PURPOSE: To investigate the difference of optical coherence tomography (OCT) findings between the aflibercept treatment group and the ranibizumab treatment group. METHODS: This study includes patients diagnosed with treatment-naïve neovascular age-related macular degeneration (AMD), and they were treated with aflibercept (n = 23, 23 eyes) or ranibizumab (n = 26, 26 eyes) monthly for 3 months. In this study, the aflibercept treatment group patients were treated from March 2014 to April 2015, and the ranibizumab treatment group patients were treated from December 2008 to April 2015. After three initial injections, they were followed up monthly for an additional 3 months, and additional treatments were performed if necessary. We compared the changes of the two groups before the treatment and after 6 months of treatment, beginning with the OCT findings, such as serous pigment epithelium detachment, fibrovascular pigment epithelium detachment, subretinal fluid, intraretinal fluid, dense zone of outer retina, classic neovascularization, and hyper- reflective dots. We also compared the changes of best corrected visual acuity (BCVA) and inner segment/outer segment (IS/OS) length, external limiting membrane length, and central foveal thickness with optical OCT between the two groups. RESULTS: In the aflibercept group, 46% of serous epithelial detachments disappeared, while 33% disappeared in the ranibizumab group, and there was significant difference between the two groups (p = 0.01). There was no significant difference in BCVA change or OCT findings between the two groups, but there was a significant difference in serous pigment epithelium detachment. CONCLUSIONS: For treatment of neovascular AMD patients, aflibercept might be more effective in serous pigment epithelium detachment than ranibizumab. Because there was no significant difference in visual acuity improvement in serous pigment detachment for both treatments, it might be necessary to further study the relationship between visual acuity and serous pigment detachment improvement.

Intraocular lymphoma in Korea: the Consortium for Improving Survival of Lymphoma (CISL) study

BACKGROUND: Intraocular lymphoma (IOL) is a rare malignant lymphoma that most closely resembles a diffuse large B-cell lymphoma, and it is a subtype of primary central nervous system lymphoma (PCNSL). IOL is located inside the eye in the retina, uvea, and/or optic nerve. We retrospectively analyzed IOL patient data to identify treatment patterns and survival rates in Korea. METHODS: Cytological confirmation for a diagnosis of IOL was performed for all patients. The clinical data collected from medical records included Ann Arbor stage, International Prognostic Index, performance status, date of diagnosis, treatment modality and response, date of relapse, and date of last follow-up. RESULTS: Twenty patients who were diagnosed with IOL, between December 2007 and June 2014 at multiple centers in Korea, were included in the analysis. Four patients were diagnosed with IOL alone, not involving the CNS. Two patients with isolated IOL later developed PCNSL. Nine patients developed CNS lesions before the onset of ocular lymphoma. Five patients had simultaneous onset in the eye and CNS. Twelve patients were treated by intravitreal injection of methotrexate for IOL. The median progression-free survival (PFS) for patients was 19.7 months (95% CI, 8.7-30.7 mo). The estimated 3-year overall survival (OS) for all patients was 75.1%. CONCLUSION: Treatment for IOL patients included radiotherapy and intraocular chemotherapy. IOL patients showed favorable PFS and OS. These patients would require long-term follow-up to identify relapse and adverse effects of radiotherapy or intraocular chemotherapy.

The Short-term Efficacy of Subthreshold Micropulse Yellow (577-nm) Laser Photocoagulation for Diabetic Macular Edema

PURPOSE: This pilot study aimed to evaluate the efficacy and safety of subthreshold micropulse yellow (577-nm) laser photocoagulation (SMYLP) in the treatment of diabetic macular edema (DME). METHODS: We reviewed 14 eyes of 12 patients with DME who underwent SMYLP with a 15% duty cycle at an energy level immediately below that of the test burn. The laser exposure time was 20 ms and the spot diameter was 100 microm. Laser pulses were administered in a confluent, repetitive manner with a 3 x 3 pattern mode. RESULTS: The mean follow-up time was 7.9 ± 1.6 months. The baseline-corrected visual acuity was 0.51 ± 0.42 logarithm of the minimum angle of resolution (logMAR), which was improved to 0.40 ± 0.35 logMAR (p = 0.025) at the final follow-up. The central macular thickness at baseline was 385.0 ± 111.0 microm; this value changed to 327.0 ± 87.7 microm (p = 0.055) at the final follow-up. CONCLUSIONS: SMYLP showed short-term efficacy in the treatment of DME and did not result in retinal damage. However, prospective, comparative studies are needed to better evaluate the efficacy and safety of this treatment.

Predictive Findings of Visual Outcome in Spectral Domain Optical Coherence Tomography after Ranibizumab Treatment in Age-related Macular Degeneration

PURPOSE: To investigate which spectral domain optical coherence tomography (SD-OCT) findings predict visual outcome after anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (NV-AMD). METHODS: We reviewed the medical records of patients with treatment-naive NV-AMD who underwent three or more consecutive anti-VEGF injections. The patients were divided into three groups according to their changes of visual acuity (VA); improved (group I), static (group S), or worsened (group W). We assessed the incidences and values of all available SD-OCT findings of these groups, compared these findings between the three groups and compared the initial values with the post-treatment values. RESULTS: Better initial VA and longer external limiting membrane (ELM) length were associated with less change in VA after anti-VEGF treatment. The initial VA was mildly correlated with initial photoreceptor inner and outer segment junction (IS/OS) length and initial ELM length. The final VA was also mildly correlated with the final IS/OS length and the final ELM length. VA was significantly changed after anti-VEGF treatment in groups W and I. With regard to incidence, disruption of the IS/OS (IS/OS-D), disruption of the ELM (ELM-D) and ELM length differed significantly between the three groups, particularly ELM-D. The incidences of IS/OS-D and ELM-D in group I were significantly lower than those in groups S and W, and those in group S were also lower than those in group W. The ELM length in group I was significantly longer than it was in groups S and W, and the ELM length in group S was longer than that for group W. However, these three findings did not change after the anti-VEGF treatment. CONCLUSIONS: Initial IS/OS-D, ELM length and particularly ELM-D can be useful predictors of the visual outcome after anti-VEGF treatment in NV-AMD patients.

The Clinical Characteristics of Thyroid Orbitopathy in Thyroid Dysfunction Pediatric Patients

PURPOSE: To investigate the clinical characteristics and treatment methods for pediatric thyroid-associated orbitopathy in pediatric patients with thyroid disorders. METHODS: To determine the prevalence and clinical characteristics of pediatric thyroid-associated orbitopathy, we retrospectively analyzed the medical records of 34 patients admitted to the Pediatrics Department of our institution between September 2010 and September 2012. The patients had been diagnosed with autoimmune thyroid disorder and were admitted for treatment of thyroid-associated orbitopathy. RESULTS: In the 24.1 months of follow-up observation, 14 patients were diagnosed with Graves' disease (41.2%) and 20 patients with Hashimoto's thyroiditis (58.8%). Of the 34 patients, 15 (44.1%) developed eye symptoms. Among the eye symptoms, lid swelling was the most prevalent in 41.2% of patients, followed by eyelid retraction in 23.5%, lid lag in 17.6%, conjunctival injection in 14.7%, proptosis in 8.8%, and extraocular muscle hypertrophy in 17.6%. Severe impairment of visual acuity, visual field, and ocular motility were not observed in our study. Although eyelid surgery was performed in 3 cases, most patients were treated conservatively. CONCLUSIONS: Pediatric thyroid-associated orbitopathy was frequently observed in patients with Graves' disease and Hashimoto's thyroiditis. Compared to adults, children showed milder disease manifestation and progression, and the disease could be managed with conservative treatment.

A Case of Acute Anterior Uveitis Associated with HLA-B27 Positivity after Intravitreal Injection of Bevacizumab

PURPOSE: Intravitreal injection of bevacizumab (Avastin(R)) can lead to several intraocular complications including endophthalmitis, hemorrhage and inflammation. We present one case of acute anterior uveitis with hypopyon in an HLA-B27(+) patient following intravitreal injection of bevacizumab. CASE SUMMARY: A 40-year-old male with known central retinal vein occlusion presented with redness and decreased visual acuity in the left eye. Symptoms had developed 4 days earlier after the sixth intravitreal injection of bevacizumab in that eye. The patient had a marked anterior chamber reaction with hypopyon and posterior synechiae. Nine days after onset, similar symptoms in the left eye occurred in the uninjected right eye. Through examination and clinical manifestations, we diagnosed acute anterior uveitis associated with HLA-B27 positivity. The patient was treated with 1% prednisolone acetate, 0.5% moxifloxacin and 1% atropine in both eyes and all symptoms had resolved after 6 weeks.

The Changes in Tear Film and Corneal Sensation after Refractive LASIK Surgery for Presbyopia

PURPOSE: To evaluate the changes in break-up time (BUT) and corneal sensitivity following LASIK surgery for refractive error correction with presbyopia in patients older than 45 years. METHODS: The authors of the present study measured the BUT and corneal sensitivity of 92 eyes that received LASIK surgery for correcting refractive error with presbyopia. The eyes were divided into groups according to gender and preoperative refractive error before surgery and 1, 3, 6 and 12 months after LASIK. RESULTS: The mean age of patients was 52.01 +/- 5.51 years, and the male to female eye distribution was 31:61. The value of BUT before surgery and 1, 3, 6, and 12 months postoperative was 5.31 +/- 2.03 sec, 4.47 +/- 1.67 sec, 4.04 +/- 1.58 sec, 4.53 +/- 1.51 sec, and 4.87 +/- 1.46 sec, respectively; corneal sensitivity was 56.35 +/- 5.94 mm, 40.07 +/- 14.21 mm, 46.42 +/- 10.41 mm, 50.75 +/- 8.04 mm, and 52.92 +/- 7.51 mm, respectively. BUT was not significantly different relative to refractive error and was significantly shorter in the female group than the male group at 1 month postoperative. Corneal sensation of myopia at 12 months postoperative was statistically higher than at other time points; however, there was no difference between genders. BUT and corneal sensitivity at 12 months postoperative recovered to 91.6% and 93.9% of the preoperative value, respectively. CONCLUSIONS: BUT and corneal sensitivity after LASIK for presbyopia were decreased until 12 months postoperative and recovered slowly, but did not return to preoperative levels.

A Clinical Study of Pediatric Orbital Wall Fracture

PURPOSE: We sought to evaluate the clinical aspects associated with a preoperative and postoperative state in cases of blow-out fracture. METHODS: We retrospectively assessed the cause, location, type, and ocular motility restriction in 25 eyes of 25 pediatric patients with blow-out fracture, which were repaired by orbital reconstruction between January 2001 and June 2004. RESULTS: The mean age of patients was 14.96 years, the most common cause of fracture was assault (13 cases, 52%); there were 15 case (60%) of inferior wall fracture, 14 cases (45%) of comminuted type fracture, and 11 cases (35.4%) of trapdoor type fracture. The mean time to intervention was 14 days (range, 3 to 56 days). Ocular motility restriction improved most in the early postoperative period, and then decreased gradually. At last follow-up, the majority of patients had improved. Their diplopia improved almost completely, except in one patient who had late orbital reconstruction. CONCLUSIONS: Most cases of blow-out fracture were resolved with orbital reconstruction. Even when performed late, orbital reconstruction is helpful in improving the symptoms associated with blow-out fracture.