Spontaneous Resolution of Cataract-related Acute Vitreomacular Traction Syndrome

Purpose@#To report a case of spontaneous resolution of vitreomacular traction (VMT) syndrome after cataract surgery.Case summary: A 70-year-old woman underwent lens emulsification and intraocular lens implantation for a right-eye cataract.Preoperative optical coherence tomography (OCT) showed vitreomacular adhesion (VMA). At that time, the decimal visual acuityof the right eye was 0.63 and the best-corrected visual acuity (BCVA) was 0.8. At one day after cataract surgery, OCT showedVMT, with disruption of the ellipsoid zone and outer limiting membrane. The BCVA of the right eye was 0.32, which was worsethan before surgery. At two weeks after cataract surgery, OCT revealed spontaneous resolution of the VMT, whereas the VMApersisted. At four months after cataract surgery, the BCVA of the right eye was 0.8. @*Conclusions@#In cases of VMT after cataract surgery, there is a possibility of spontaneous resolution without VMA separation.Therefore, careful observation in the early stages should be considered before surgical treatment.

A Case of Resolved Massive Suprachoroidal Hemorrhage after Sclerotomy in Penetrating Keratoplasty Patient

PURPOSE: To report the resolution of a massive suprachoroidal hemorrhage after penetrating keratoplasty by sclerotomy. CASE SUMMARY: A 64-year-old man with a corneal opacity in the left eye underwent penetrating keratoplasty. On the first postoperative day, a massive suprachoroidal hemorrhage was detected. After two surgical drainage procedures, the suprachoroidal hemorrhage subsided and the graft survived. His visual acuity was 20/240 two months post-operation. CONCLUSIONS: We report a patient with massive suprachoroidal hemorrhage after penetrating keratoplasty that was improved by surgical drainage procedures.

Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy

BACKGROUND: Some patients with type 2 diabetes mellitus (T2DM) do not develop diabetic kidney disease (DKD) despite the presence of advanced diabetic retinopathy (DR). We aimed to investigate the presence of DKD and its risk factors in patients with T2DM and advanced DR. METHODS: We conducted a cross-sectional study in 317 patients with T2DM and advanced DR. The phenotypes of DKD were divided into three groups according to the urine albumin/creatinine ratio (uACR, mg/g) and estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): no DKD (uACR <30 and eGFR ≥60), non-severe DKD (uACR ≥30 or eGFR <60), and severe DKD (uACR ≥30 and eGFR <60). Mean systolic and diastolic blood pressure, mean glycosylated hemoglobin (HbA1c) level, and HbA1c variability (standard deviation [SD] of serial HbA1c values or HbA1c-SD) were calculated for the preceding 2 years. RESULTS: The prevalence of no DKD, non-severe DKD, and severe DKD was 37.2% (n=118), 37.0% (n=117), and 25.8% (n=82), respectively. HbA1c-SD and the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio correlated positively with uACR and negatively with eGFR. Multiple linear regression analyses showed that the HbA1c-SD and TG/HDL-C ratio were significantly related with eGFR. Multiple logistic regression analyses after adjusting for several risk factors showed that HbA1c-SD and the TG/HDL-C ratio were significant risk factors for severe DKD. CONCLUSION: The prevalence of DKD was about 60% in patients with T2DM and advanced DR. HbA1c variability and TG/HDL-C ratio may affect the development and progression of DKD in these patients.

Combined Clear Corneal Phacoemulsification and Vitrectomy Versus Two-Step Surgery in Korean Patients With Idiopathic Epiretinal Membrane

PURPOSE: To evaluate the surgical outcomes on the combined procedures of phacoemulsification, intraocular lens (IOL) implantation, and vitrectomy, and to compare clinical results with sequential surgery results in Korean patients with idiopathic epiretinal membrane. METHODS: The present retrospective study included 20 eyes of 19 patients with idiopathic epiretinal membrane who underwent combined phacoemulsification, IOL implantation, and pars plana vitrectomy (combined surgery), and 18 eyes of 18 patients who underwent phacoemulsification and IOL implantation subsequent to vitrectomy (sequential surgery). Postoperative clinical results and intra- and postoperative complications were compared between the 2 groups. RESULTS: Postoperative best corrected visual acuity (BCVA) (logMAR) was 0.41 +/- 0.42 in the combined group, and 0.35 +/- 0.37 in the sequential group. There was no significant difference in BCVA between the 2 groups (p = 0.675). The mean refractive prediction error was -0.46 +/- 0.88 diopters (D) in the combined group, and -0.06 +/- 0.68 D in the sequential group, showing no statistically significant difference between the 2 groups (p = 0.147). The present study showed no major differences between the 2 groups in complications such as intraoperative mild corneal edema, postoperative ocular hypertension, and lens capsular opacity. CONCLUSIONS: Combined phacoemulsification, IOL implantation, and pars plana vitrectomy as well as the two-step procedure are safe and effective for treating patients with idiopathic epiretinal membrane.

Hypertensive Retinopathy and Associated Target Organ Damage in Korean Hypertensive Patients

PURPOSE: To report the relationship between hypertensive retinopathy and associated target organ damage in Korean hypertensive patients. METHODS: A total of 519 hypertensive patients were divided into hypertension retinopathy grades I through IV based on fundus examination. According to the grade of each hypertensive retinopathy, the frequency of target organ damage (cardiovascular disease, chronic kidney disease, and retinal vessel occlusion) and the association with hypertension retinopathy were evaluated. RESULTS: There were 211 patients (40.7%) without hypertensive retinopathy, 226 patients (43.5%) with hypertensive retinopathy grade I, 71 patients (13.7%) with grade II, seven patients (1.3%) with grade III and four patients (0.8%) with grade IV. The numbers of patients with cardiovascular disease were 103 (45.6%) in grade I, 57 (80.3%) in grade II, 3 (42.9%) in grade III, two (50.0%) in grade IV, and 70 (37.4%) in the non-hypertensive retinopathy group. According to four grades, the numbers of patients with cerebrovascular disease were three (1.3%), two (2.8%), zero (0%), and one (25.0%), respectively, with two (0.9%) in the non-hypertensive retinopathy patients. The respective numbers of patients with chronic kidney according to grades I through IV were 14 (6.2%), ten (14.0%), two (28.6%), and four (100.0%), as well as ten (4.7%) in the non-hypertensive retinopathy patients. The respective numbers of patients with retinal vessel occlusion were one (0.4%), two (2.8%), one (14.3%), and one (25.0%), with zero (0%) in the non-hypertensive retinopathy patients. CONCLUSIONS: The significance of hypertensive retinopathy should not be overlooked in Korean hypertensive patients due to an association with various target organ damage.

The Efficacy of Ranibizumab for Choroidal Neovascularization in Age-related Macular Degeneration

PURPOSE: To report 1-year clinical changes in visual acuity (VA) after intravitreal ranibizumab therapy for choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), and to determine differences in treatment effects according to the CNV subtype. METHODS: Forty six patients (46 eyes) with subfoveal CNV were treated with intravitreal ranibizumab (0.5 mg) injections as needed. Visual acuity, fluorescein angiography, and macular OCT were examined after 12 months. The patients were divided into two groups: Classic CNV and occult CNV. The VA of the two groups was compared 12 months after the initial injections. RESULTS: The average VA and mean central retinal thickness (CRT) before ranibizumab treatment was 1.011+/-0.408 logMAR and 335.3 microm, respectively, and the VA and mean CRT 12 months after the initial injections was 0.928+/-0.357 logMAR and 246.2 microm, respectively (p=0.042, p<0.001). Out of 46 eyes, 13 eyes (28.3%) had a VA that improved by more than 0.1 logMAR, 33 eyes (71.7%) had VA that changed less than 0.1 logMAR, and 40 eyes (86.6%) had a VA that changed by less than 0.3 logMAR. The VA improved to 0.084 logMAR in classic CNV (18 eyes) and to 0.081 logMAR in occult CNV (28 eyes) after 12 months, though the difference between groups was not significant (p=0.910). CONCLUSIONS: Intravitreal injection of ranibizumab is an effective treatment for patients with subfoveal CNV secondary to AMD to improve or stabilize VA, and the effect of treatment on VA is not significantly different according to the CNV subtype.

Short-term Efficacy of Intravitreal Ranibizumab for Myopic Choroidal Neovascularization

PURPOSE: To evaluate the effects of intravitreal ranibizumab in myopic choroidal neovascularization (CNV). METHODS: Patients who underwent intravitreal ranibizumab injection for myopic CNV, and were followed up more than 6 months, and their records were retrospectively investigated. The best corrected visual acuity, central macular thickness, and leak in fluorescein angiography were compared at baseline, and at 1, 3, and 6 months after injection. RESULTS: Twenty-one eyes of 18 patients were evaluated. The mean best corrected visual acuity (logMAR) was 1.23+/-0.65, 0.96+/- 0.40, 0.95+/-0.67, and 0.83+/-0.58 at baseline, 1, 3, and 6 months, respectively (p<0.001, p=0.006, p=0.001). The mean central macular thickness was 233.42+/-65.55 microm, 204.14+/-65.29 micrometer, and 157.76+/-71.45 microm at baseline, 3, and 6 months, respectively (p<0.001). In fluorescein angiography at 6 months after injection, regression was observed in 12 eyes, and fibrosis in 9 eyes. CONCLUSIONS: Intravitreal ranibizumab injection for myopic CNV in Korean patients appeared to be effective, resulting in regression of lesion and improvement of visual acuity.

Bilateral Adrenal Gland Lymphoma Masquerading as Vogt-Koyanagi-Harada Syndrome

PURPOSE: To report a case of bilateral adrenal gland lymphoma mimicking symptoms of Vogt-Koyanagi-Harada syndrome. CASE SUMMARY: A 57-year-old woman complained of decreased visual acuity and metamorphopsia in both eyes. She had no prior medical history, but had experienced headaches in the past week. Fundus examination revealed multiple serous retinal detachment. Fluorescein angiography of the fundus revealed multiple pinpoint leaks in early stages and subretinal dye pooling in the retinal detachment area in late stages. The most likely diagnosis was therefore Vogt-Koyanagi-Harada syndrome. Two days later, mild fever developed and a systemic evaluation was performed. Computed tomography of chest and abdomen showed bilateral adrenal gland T-cell lymphoma. Through prompt combination chemotherapy, the patient's systemic condition recovered, and her fundus recovered with improved visual acuity. CONCLUSIONS: We experienced a rare case of bilateral adrenal lymphoma which masqueraded as Vogt-Koyanagi-Harada syndrome. When there are systemic symptoms such as mild fever and headaches, systemic evaluation should be done so as not to miss more serious systemic pathology.

Primary Silicone Oil Tamponade with Vitrectomy in Macular Hole Retinal Detachment of Highly Myopic Eyes

PURPOSE: To determine the results of pars plana vitrectomy and silicone oil tamponade to treat retinal detachment caused by macular holes in highly myopic eyes. METHODS: Eighteen highly myopic patients with spontaneous retinal detachment due to macular holes underwent vitrectomy and primary silicone oil tamponade. Preoperative statuses and postoperative results were reviewed. All patients had high myopia with axial lengths longer than 28 mm or had definite staphyloma. The average follow-up period was 24 months. RESULTS: Successful retinal attachment of the retina was achieved in 17 eyes, though 1 eye had redetached. Of the 17 eyes, 13 eyes achieved anatomical macular hole closure and 7 eyes showed improved visual acuity. CONCLUSIONS: Vitrectomy and silicone oil tamponade for retinal detachment due to macular holes in highly myopic eyes produce good anatomical and functional results.

A Case of Macular Hole After Nd:YAG Laser Capsulotomy

PURPOSE: To report a case of a macular hole resulting from accidental Nd:YAG laser capsulotomy for cataract, which was treated by vitrectomy. CASE SUMMARY: A 70-year-old man had decreased visual acuity one day after Nd:YAG laser capsulotomy. By fundus exam, vitreous and macular hemorrhages were observed. After 11 days, intravitreal gas injection was performed, and 3 months later, a macular hole has developed. Pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade were performed, and anatomical occlusion was achieved and maintained for 6 months postoperatively. However, final visual acuity improvement was limited up to 0.08. CONCLUSIONS: We experienced an unusual case of macular hole formation from Nd:YAG capsulotomy. Vitrectomy was performed but visual acuity improvement remained limited.

Photodynamic Therapy for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

PURPOSE: To investigate the effects of repeated photodynamic therapy (PDT) for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD) in Korean patients. METHODS: Clinical data of patients who were treated with repeated (3 times or more) PDT for subfoveal choroidal neovascularization secondary to AMD and followed up for more than 6 months were collected from 17 hospitals around the country. Visual outcomes at 12 and 24 months, follow-up were compared between subtypes of choroidal neovascularization. The factors related to final visual prognosis and PDT-related adverse effects were evaluated. RESULTS: 244 patients (244 eyes) were recruited (male: 60%, age: 67.7+/-9.1 years). The portion of patients with predominantly classic, minimally classic, and occult without classic choroidal neovascularization was 57%, 13%, and 24%, respectively and that of patients with visual improvements or less than moderate visual loss at 24 months follow-up were 28%, 38%, 30% and 47%, 56%, and 65%, respectively. Baseline visual acuity and age were significantly related to the final visual prognosis (p<0.05). PDT-related adverse events developed in 15 (6.1%) patients, but most were mild and transient. CONCLUSIONS: Repeated PDT for subfoveal choroidal neovascularization secondary to AMD has effects comparable to those of previous prospective, controlled trials without any significant safety concerns in Korea.

The Effect of Anti-TNF-alpha on Refractory Uveitis

PURPOSE: To investigate the effects of Anti-TNF-alpha (infliximab, Remicade(R), Shering-Plough) on refractory uveitis. METHODS: A retrospective observational survey was conducted on 12 eyes of 10 patients with refractory uveitis. These patients had no response to immunosuppresants or systemic steroid therapy and were intolerable due to drug toxicity. After an intravenous injection of Anti-TNF-alpha, best corrected visulal acuity was measured. Improvement in inflammation was then observed at the first, third and last month of follow-up. RESULTS: Patients were observed for a mean period of 15 months. They received anti-TNF-alpha intravenously, ranging from one to eleven infusions. After infusion with Anti-TNF-alpha, remission of intraocular inflammation was evident in all patients within 9.7 days. Best corrected visual acuity also improved at the first, third, and last month of follow-up. Two patients were infected by tuberculosis and mumps respectively. CONCLUSIONS: There was an effect on refractory uveitis with anti-TNF-alpha therapy. Many participants may also require further evaluation after treatment.

Intravitreal Injection of Triamcinolone Acetonide on Refractory Uveitis

PURPOSE: To investigate the effect of intravitreal injection of triamcinolone acetonide (4 mg) on refractory uveitis with cystoid macular edema (CME). METHODS: A retrospective observation survey was conducted on 21 eyes of 15 patients with refractory uveitis that had no response to immunosuppresants or systemic steroid therapy. Seven eyes were injected with triamcinolone acetonide intravitreally only, and fourteen eyes were injected during pars plana vitrectomy. At 3 and 12 months after triamcinolone acetonide injection, best corrected visual acuity and thickness of macula were measured by OCT. RESULTS: The average pre-treatment best corrected visual acuity was 0.18+/-0.08, and the average macular thickness was 534+/-132 micrometer. At 3 months after injection, the results for the same parameters were 0.45+/-0.18, 345+/-125 micrometer respectively. At 12 months after injection, they were 0.30+/-0.09, 498+/-133 micrometer respectively. Thus, best corrected visual acuity had improved and macular thickness had decreased at 3 months post-injection for the groups with intravitreal injection of triamcinolone acetonide and intravitreal injection during pars plana vitrectomy. However, these changes in best corrected visual acuity and macular thickness were not observed 12 months after injection. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide had a temporary effect on refractory uveitis with cystoid macular edema (CME). However, a study that includes more participants will be necessary for conclusive evaluation.

Efficacy of Screening with Topical Steroids before Intravitreal Triamcinolone Injection

PURPOSE: To evaluate the efficacy of screening of high risk groups with topical steroids due to increased ocular pressure by intravitreal triamocinolone injection (IVTA). METHODS: We selected 96 eyes that had undergone IVTA between January 2003 and December 2004. The screening method used was as follows; We administered 4 drops daily of prednisolone (1%) eye drops for 3weeks and included patients with an intraocular pressure increase of less than 5 mmHg for the procedure. Two groups consisting of the post-screening IVTA group (group A) and non-screening group (group B) were classified, and intraocular pressure was measured using a Goldman applanation tonometer at 1 week, 1 month, 2 months, 3 months and 6 months after the procedure. RESULTS: One patient in group A (3.1%) required glaucoma medication compared with 10 patients in group B (17.9%), and one of these group B patients required surgical intervention. Chi-square analysis showed a statistically significant reduction in glaucoma medication use in group A compared with group B (P<0.05). Group B had a higher percentage of patients with an increase of intraocular pressure over 5 mmHg compared with values before the procedure, particularly in the second and third months after the procedure. CONCLUSIONS: IVTA after screening resulted in less use of glaucoma medication and a reduced rate of increase in intraocular pressure. Complications due to increased intraocular pressure by IVTA can be minimized by screening high risk groups.

Analysis of Systemic Risk Factors in Idiopathic Macular Hole

PURPOSE: We studied the association between systemic risk factors and idiopathic macular hole. In addition, we analyzed the mechanism by which systemic risk factors affect the development and progression of macular hole. METHODS: Seventy patients with idiopathic macular holes were compared with 30 sex- and age- matched controls. The vascular viscosity profiles, and coagulation, biochemical and hormone factors were evaluated as systemic risk factors. RESULTS: The levels of fibrinogen and blood estrogen were significantly higher in the idiopathic macular hole group than in the control group. Also the fibrinogen level increased with the progression of macular hole. But there was no significant difference between the two groups with respect to the remaining factors. CONCLUSIONS: These results support the possibility that fibroproliferative factors from platelet increase in patients with idiopathic macular hole, and that fibrinogen is the parameter that increases among the fibroproliferative factors. This study also suggests that blood estrogen is important in the development of macular hole.

Two years results of surgery for idiopathic macular hole

PURPOSE: To evaluate preoperative and intraoperative factors affecting the clinical results and determine the effectiveness of the internal limiting membrane in surgery for long standing idiopathic macular holes (stage 2, 3, 4). METHODS: The data were reviewed from a retrospective study on 95 consecutive eyes with idiopathic macular holes undergoing vitrectomy, fluid gas exchange. Forty six of the 95 eyes underwent internal limiting membrane removal surgery additionally. Postoperative follow up was for 2 years. Wilcoxon matched pairs test, Wilcoxon rank test and multiple regression analysis were performed by using SPSS program. RESULTS: The surgery was anatomically successful in 74 of the 95 eyes (77.8%) and 30 of the eyes (31.5%) showed functional success. Preoperative visual acuity and internal limiting membrane removal were important factors affecting postoperative visual outcome in 2 years follow up of the vitrectomy for idiopathic macular holes. Preoperative factors such as age, sex, duration of visual complaints, stage were not found any association with postoperative visual acuity. CONCLUSIONS: Preoperative visual acuity and internal limiting membrane removal were good prognostic factors in idiopathic macular hole surgery. Functional success group showed constant improvement of visual acuity in postoperative 2 years.

Clinical results of LASIK: Comparison by the Different Corneal Flap Diameters

PURPOSE: To evaluate clinical results of LASIK according to the different corneal flap diameters. METHODS: LASIK was performed in 31 myopic eyes by using a 8.0 mm stop ring and a 8.25 mm applicator (group 1) or in 31 eyes by using a 8.5 mm stop ring and a 8.75 mm applicator (group 2). We measured the preoperative and postoperative uncorrected visual acuity, corrected visual acuity, corneal flap diameter, refraction, intraocular pressure, corneal thickness and corneal topography. Mean follow-up time of group 1 was 8.09+/-1.92 months and that of group2 was 8.36+/-2.31 months. RESULTS: The mean corneal flap diameter of group 1 was 8.33+/-0.39 mm and that of group 2 was 8.87+/-0.44 mm (P<0.05). The flap thickness of group 2 was also larger (P<0.05). There was no significant difference in the spherical equivalent between the two groups at postoperative 1day and 1week. After 2 months, the mean spherical equivalent of group 1 and group 2 was -0.32+/-0.67 D and -0.01+/-0.65 D respectively (P<0.05). After 6 months, the mean spherical equivalent of group 1 and group 2 was -0.69+/-0.64 D and -0.34+/-0.71 D (P<0.05). There was no significant difference in the mean corneal astigmatic power of 3 mm zone, postoperative intraocular pressure, corneal thickness or uncorrected visual acuity between two groups. CONCLUSIONS: The diameter of corneal flap was measured larger intraoperatively than we had expected. The larger corneal flap group resulted in the postoperative refraction of near emmetropia.

Nine-Year Results of Excimer Laser Photorefractive Keratectomy for Myopia

PURPOSE: To evaluate the long term stability, complications, and causative factors in eyes that had photorefractive keratectomy (PRK) for myopia. METHODS: We investigated the results of photorefractive keratectomy (PRK) on 72 consecutive myopic eyes (45 patients) with follow-up of 9 years by using Eximed UV 200LA laser (Summit technology, USA). The patients were divided into two groups according to preoperative myopia : group 1 with diopters between -3.25 D and -6.50 D, group 2 with diopters above -6.50 D. During the follow-up period, 1, 2, 3, 5, 7 and 9 years, refractive error, uncorrected and best corrected visual acuity and corneal opacity were examined. Preoperative myopia ranged from -3.25 D to -9.12 diopters (D), with astigmatism of less than 1.50 D. The excimer laser was set to a maximum correction of -6.50 D at a 5.0mm diameter ablation zone. Patients with more than -6.50 Dmm of myopia had double-pass PRK with two different ablation zone sizes (5.0 and 4.5 mm). The data were analyzed using paird T-test and Regression analysis. RESULTS: Mean refractive error 9 years after PRK was -2.10+/-0.99 D. It was -1.67+/-0.71 D in moderately myopic eyes (less than 6.50 D) and -2.60+/-1.04 D in highly myopic eyes (more than 7.0 D). The Myopic regression rate markedly decreased after 2years in moderate myopic group but after 3 years in highly myopic group (P<0.01). The most possible causative factor for myopic regression were pre-PRK refraction (P<0.01) and its relative risk was 4.21: At 9 years, 92.3% eyes achieved uncorrected visual acuity of 0.5 or better group1, and 78.7% in group2. Moderate corneal haze was present in 2eyes in group 2. CONCLUSION: According to these results, we thought that eximer PRK was effective for myopia under -9.62 D. Myopic regression was stabilized after 3 years of PRK.