Combined Anti-VEGF and C3F8 Injection for Large Submacular Hemorrhage Secondary to Age-Related Macular Degeneration

PURPOSE: To evaluate the effect of intravitreal expansile gas (C3F8) with anti-VEGF injection for the treatment of large submacular hemorrhage (SMH) secondary to age-related macular degeneration (ARMD). METHODS: In this report, 18 eyes of 18 patients with large SMH secondary to ARMD were treated with a simultaneous injection of 0.3 cc C3F8 and 0.05 ml anti-VEGF intravitrealy. RESULTS: The mean age was 64.89 +/- 5.68 years and the mean size of SMH was 4.44 +/- 1.25 disc diameters (DD). The minimum follow-up period was 12 months (range: 12-17 months). Mean preoperative best corrected visual acuity (BCVA) was 1.72 +/- 0.56 log MAR which improved significantly to 1.01 +/- 0.68 log MAR at 12 months (p = 0.002). SMH displacement occurred in all eyes. BCVA improved 2 or more lines in 11 eyes (61.1%) and deteriorated in 1 eye (5.6%). CONCLUSIONS: In this report, intravitreal injection of an expansible gas (C3F8) with anti-VEGF produced successful results in anatomical displacement of SMH and early visual improvement.

Effect of Experimental Scleral Shortening on Axial Length of the Rabbit Eye

PURPOSE: To evaluate the change of axial length (AL), intraocular pressure (IOP), and corneal astigmatism after scleral shortening with scleral invagination in the rabbit eye. METHODS: The authors performed scleral shortening (3 mm) with scleral invagination in two groups of 6 eyes each: 180 degrees (group 1) and 360 degrees (group 2). RESULTS: Average AL shortening was more prominent in group 2 (0.5 +/- 0.17 mm) than in group 1 (0.37 +/- 0.29 mm), but the difference was not statistically significant. IOP increased immediately after the procedure and was maintained at a high level through 2 months postoperatively. Induced corneal astigmatism was more prominent in group 1 than in group 2. The difference was statistically significant in group 1 (p< 0.05) but not in group 2. CONCLUSIONS: In the scleral shortening with scleral invagination procedure, a large amount of scleral invagination resulted in more shortening of axial length, but there was more corneal astigmatism in 180-degree invagination of the sclera than in 360-degree. Further research is required to determine the effect of the extent of scleral invagination on the change of these values.

Late Postoperative Opacification of the Foldable Hydrophilic Acrylic Intraocular Lens, ACRL-160

PURPOSE: To report pathological, histochemical, ultrastructural, and spectrographic analysis of explanted hydrophilic acrylic intraocular lenses obtained from patients who had visual disturbances caused by postoperative opacification of the IOL. METHODS: Forty-three hydrophilic IOLs (ACRL-160, Ophthalmed Inc.) were explanted from 39 patients with decreased visual acuity because of opacification of the IOL itself. All explanted IOLs were examined grossly and by light microscopy. Full-thickness sagittal sections of the optics of the randomly selected 10 IOLs were stained with the von kossa method (special stains for calcium). One of these sectioned IOLs was not stained, and submitted for scanning electron microscopy and energy dispersive X-ray spectroscopy. RESULTS: Microscopic analysis revealed multiple fine, granular deposits within the lens optics and haptics, and these deposits were stained positively with the von Kossa method. They were varible in size, and unevenly distributed in the optics on the scanning electron microscopy, and energy dispersive X-ray spectroscopy of the internal substance of IOL demonstrated the presence of calcium within the deposits. CONCLUSIONS: We evaluated 43 explanted opacified ACRL-160 lenses, and have demonstrated that the opacification was caused by the presence of granular deposits within the IOL. The deposits have the component of calcium.

A Case of Type 2 Waardenburg Syndrome with Open angle Glaucoma

Waardenburg syndrome is a very rare auditory-pigment syndrome with autosomal dominant inheritance. In his first report in 1951, Waardenburg characterized this syndrome as dystopia canthorum, a high broad nasal bridge, synophrys[confluent eyebrows], heterochromia iridid, a white forelock or early graying, and sensory neural deafness. We observed a case of Type 2 Waardenburg syndrome with openangle glaucoma and, therefore report with literature review.

Two Cases of Endogenous Endophthalmitis

Bacterial endophthalmitis remains an uncommon, but devastating complication of ocular surgery, trauma, and systemic infection. Most cases develop from an exegenous source and are introduced at the time of ocular surgery or penetrating trauma to the eye. Hematogenous spread of bacterial infection to the eye may also result in bacterial endophthalmitis. But, endogenous endophthalmitis caused by gram-negative bacteria in debilitated or immunocompromised patients and drug abusers has become well recognized in recent years. We report cases of endogenous Klebsiella pneumoniae endophthalmitis associatied with sepsis in a poor controlled diabetic patient and Streptocpccus pyogenes endophthalamitis associated with transurethral laser-induced prostatectomy of benign prostatic hypertrophy in a pneumonia patient.

Contamination of Acanthamoeba in Contact Lens Care System

Recently, the number of reports of Acanthamoeba keratitis has been increased apparently as a consequence of association with use of contact lenses, contaminated contact lens care system and high concern of ophthalmologist to Acanthamoeba keratitis. But, there were few epidemiologic studies of contamination of contact lens care system by Acanthamoeba and there was no report in Korea. We carried out a survey to demonstrate the contamination of contact lens care system by Acanthamoeba and bacteria and analysed the results according to the types of contact lenses and methods of disinfection. We examined the contact lens care system of 185 asymptomatic contact lens wearer for the contamination of Acanthamoeba and bacteria. The result showed a significant contamination of Acanthamoeba and bacteria. Twenty eight(15%) were contaminated with Acanthamoeba, eighteen(10%) were mixed with bacterial contamination and seventy four(40%) were contaminated with bacteria. There was no significant difference with sex and the result showed a lot of cocontamination with bacteria and amoeba and chemical disinfection showed a high Acanthamoeba contamination rate. Based on data from this and previous studies, the most of contact lens care system of contact lens wearer was contaminated with bacteria, amoeba and other microorganism. So, ophthalmologists should be concerned about Acanthamoeba contamination of contact lens care system.

Clinical Results of the Q-Switched Nd-YAG Laser Iridotomy

In order to evaluate the effect of Q-switched YAG laser iridotomy to the intraocular pressure, we performed the Q-switched Nd-YAG laser iridotomy in 39 eyes of 28 patients with angle closure glaucoma. Postoperative difference of the intraocular pressure was 27.5 +/- 27.0mmHg and the intraocular pressure was reduced. After 2 months, 12 eyes had needed one kind of anti-glaucomatous medication, 7 eyes had needed no medication, 6 eyes had needed two medications and 1 eye had needed three medications. Postoperative complications were iris bleeding(10 eyes), transient pressure rising(9 eyes), focal corneal opacities(2 eyes) and closure of iridotomy(2 eyes). These result shows that laser iridotomy should be considered in the management of angle closure glaucoma.