Retinal changes among pre-eclamptic patients in University of Benin Teaching Hospital, Benin, Nigeria

Background: Preeclampsia is one of the hypertensive disorders in pregnancy that contributes significantly to maternal and fetal morbidity and mortality, with the impact felt more in developing countries. It is characterized by endothelial dysfunction and vasospasm of vessels which can be observed by an ocular fundal examination. The aim of this study was to determine the ocular fundus findings of women with preeclampsia. Methods: This was a cross-sectional study, carried out at the University of Benin Teaching Hospital involving a total of 220 pregnant women. The women were divided into two groups of 110 pregnant women (A&B).Their Age and Gestational age was cross-matched and retinopathy graded according to Keith and Wagner classification. Group A was made up of Preeclamptic women and Group B was made up of healthy pregnant women. Visual acuity was measured using Snellens' chart, and the fundus was examined with direct ophthalmoscope. Results: This showed that the retinal changes observed in the preeclamptic women were associated with their age (P = 0.009), gestational age (P = 0.044), blood pressure (P = 0.001), Proteinuria (P = 0.001), Severity of the disease (P = 0.001), visual acuity (P = 0.035) as well as with the visual symptoms (P = 0.001) but not statistically significant with the gravida (P = 0.799). Conclusion: Our study highlights the importance of timely ophthalmoscopy which helps to assess severity of disease (pre-eclampsia) which affects the decision of induction of delivery to predict and prevent possible complications which in turn immensely helps in judicious management of disease. Also, the study revealed that preeclamptic women who are multigravida are more likely to have retinopathy than primigravid

Retinal Toxicity Following the Injection Ganciclovir into Silicone Oil-filled Eye to Treat Acute Retinal Necrosis

PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.

Retinal Ganglion Cell Layer Thicknesses and Visual Functions in Patients with Bilateral Temporal Optic Atrophy

PURPOSE: To investigate correlations between macular retinal ganglion cell (RGC) layer thickness and best-corrected visual acuity (BCVA) and visual field parameters in patients with bilateral temporal optic atrophy.METHODS: Thirty eyes of 15 patients with bilateral temporal optic atrophy and 30 eyes of 15 normal subjects that were age- and sex-matched were included in the study. We measured the thicknesses of the RGC layers of posterior poles using optical coherence tomography volume scanning. The RGC layer was divided into nine zones based on the Early Treatment of Diabetic Retinopathy Study baseline. Possible correlations of the RGC layer with the BCVA and visual field parameters were determined.RESULTS: The RGC layer thickness was significantly thinner in all patients compared to those in the control group (p = 0.001). The RGC layer thicknesses in the inner superior, inner temporal, inner inferior, and inner nasal areas were significantly correlated with the BCVA (r = −0.650, r = −0.626, r = −0.616, and r = −0.636, respectively; p = 0.000). The RGC layer thicknesses in the outer superior, outer temporal, outer inferior, and outer nasal areas were significantly correlated with the mean deviation of the visual field test (r = 0.470, r = 0.349, r = 0.496, and r = 0.469, respectively; p < 0.05).CONCLUSIONS: In patients with bilateral temporal optic atrophy, the RGC layer thickness in the medial region was correlated with the BCVA, and the RGC layer thickness in the lateral region was correlated with the mean deviation of the visual field test.

Comparison of Visual Acuity and Retinal Thickness According to Membranectomy in Idiopathic Epiretinal Membrane

PURPOSE: To compare the visual acuity and retinal thickness in patients with an idiopathic epiretinal membrane (ERM) after vitrectomy and membranectomy using two different methods.METHODS: This retrospective observational study included 77 eyes (32 eyes in the diamond-dusted membrane scraper [DDMS] group, and 45 eyes in the intraocular forceps [IOF] group) of 77 patients with idiopathic ERM who underwent pars plana vitrectomy and membranectomy. The main outcome measures were best-corrected visual acuity (BCVA, logMAR) and mean retinal thickness.RESULTS: In the IOF group, the BCVA at postoperative 1 week was significantly lower than at baseline and had improved at 12 weeks after surgery. In the DDMS group, the BCVA at postoperative 1 week showed no significant difference at baseline and had improved at 4 weeks after surgery. The central macular thickness at postoperative 6 months was significantly lower than at baseline (all, p < 0.001); there was no significant difference between the two groups (p = 0.400). The postoperative macular thickness of the DDMS group was significantly lower than that of the IOF group in the inner inferior and outer inferior areas at postoperative 12 weeks and 4 weeks (p = 0.046 and p = 0.039, respectively). Five eyes of the DDMS group and 15 eyes of the IOF group developed cystoid macular edema, 14 eyes of that improved without treatment.CONCLUSIONS: In patients with ERM, the use of DDMS or IOF for vitrectomy and membranectomy both resulted in improved visual acuity and decreased mean retinal thicknesses.

Non-glaucomatous Retinal Nerve Fiber Layer Defect Associated with Paravascular Inner Retinal Defect

PURPOSE: To report a case of non-glaucomatous retinal nerve fiber layer (RNFL) defect associated with paravascular inner retinal defect (PIRD) in a patient with idiopathic epiretinal membrane (ERM).CASE SUMMARY: A 70-year-old male who was diagnosed with ERM in his right eye and pseudoexfoliative glaucoma in his left eye visited our clinic. His intraocular pressure was 14 mmHg in both eyes while using topical hypotensive medications in both eyes. His right eye showed no glaucomatous change of the optic disc head, and also no glaucomatous visual field defect on standard automated perimetry. Red-free fundus photography and swept-source optical coherence tomography showed an ERM and wedge-shaped RNFL defect starting from the PIRD, not the optic disc head. He was diagnosed with non-glaucomatous RNFL defect in the right eye and was told to stop using topical hypotensive medication for the right eye. After 2 years of discontinuing the medication, the IOP was within the normal range, the RNFL defect showed no progression, and the visual field remained stationary.CONCLUSIONS: A non-glaucomatous RNFL defect can develop in association with PIRD in patients with idiopathic ERM. Examinations for PIRD as well as evaluation of the optic disc head are therefore necessary in patients with ERM and RNFL defect.

Bromfenac as Adjunctive Treatment with Intravitreal Bevacizumab in Branch Retinal Vein Occlusion of Macular Edema

PURPOSE: To evaluate the effectiveness of 0.1% topical bromfenac as an adjunctive treatment with intravitreal bevacizumab (IVB) injection for branch retinal vein occlusion (BRVO) patients.METHODS: We retrospectively evaluated 68 eyes of 68 patients with macular edema (ME) secondary to BRVO who were treated with IVB injection and followed up for at least 12 months. Of the 68 eyes, 38 were treated with IVB combined with 0.1% topical bromfenac and 30 were treated with IVB alone. IVB reinjection was performed in cases of recurrence. The primary outcome measurement was the number of IVB injections. Changes in the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) during the 12-month follow-up were compared.RESULTS: There was no significant difference in the BCVA or CFT between the two groups at the initial and final examinations. However, the number of IVB injections was significantly lower in the 0.1% bromfenac-treated eyes (p < 0.01) than in the control eyes (4.1 ± 0.7 vs. 5.0 ± 0.6 times).CONCLUSIONS: Compared to IVB monotherapy, topical bromfenac as an adjunctive treatment with IVB injection of eyes with ME secondary to BRVO did not affect visual outcomes, but it reduced the number of IVB injections.

Intraocular Pressure: Intravitreal Preservative-free Triamcinolone Injection in Diabetic Macular Edema and Branch Retinal Vein Occlusion

PURPOSE: To compare the intraocular pressure (IOP) in diabetic macular edema (DME) patients and macular edema associated with branch retinal vein occlusion (BRVO) patients after intravitreal preservative-free Triamcinolone injection.METHODS: This study included 36 patients diagnosed with DME and 44 patients diagnosed with BRVO with macular edema. Both groups were treated with intravitreal preservative-free Triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection, and we compared the IOPs of the two groups determined before injection and at 1, 2, 3, and 6 months after injection. We also compared the IOP elevation ratios and durations, and central foveal thickness (CFT) changes using optical coherence tomography.RESULTS: In both groups, there was no statistical significance in the IOP before injection and at 1, 2, 3, and 6 months after injection. However, the IOP elevation ratio in the DME patients (38.9%) was significantly higher than that in the BRVO patients (15.9%) (p = 0.02). The duration of IOP elevation in the DME patients (1.14 ± 1.85 months) was significantly longer than that in the BRVO patients (0.30 ± 1.20 months) (p = 0.03). When the IOP was not controlled, we used IOP-lowering agents, and two patients in the DME were treated with glaucoma surgery. There was no statistical significance in the CFT before injection and at 1, 2, or 3 months after injection between the two groups (p = 0.72, p = 0.26, p = 0.66, p = 0.34, respectively). However, the CFT after 6 months was 328 ± 103 µm in the DME group and 434 ± 189 µm in the BRVO; this difference was significant (p < 0.01).CONCLUSIONS: Intravitreal injection of preservative-free Triamcinolone was effective in the treatment of both DME patients and macular edema patients associated with BRVO. Furthermore, Triamcinolone was more safely injected in macular edema associated with BRVO patients than in DME patients.

Hierarchical Cluster Analysis of Peripapillary Retinal Nerve Fiber Layer Damage and Macular Ganglion Cell Loss in Open Angle Glaucoma

Development of a Post-vitrectomy Injection of N-methyl-N-nitrosourea as a Localized Retinal Degeneration Rabbit Model

Since genetic models for retinal degeneration (RD) in animals larger than rodents have not been firmly established to date, we sought in the present study to develop a new rabbit model of drug-induced RD. First, intravitreal injection of N-methyl-N-nitrosourea (MNU) without vitrectomy in rabbits was performed with different doses. One month after injection, morphological changes in the retinas were identified with ultra-wide-field color fundus photography (FP) and fundus autofluorescence (AF) imaging as well as spectral-domain optical coherence tomography (OCT). Notably, the degree of RD was not consistently correlated with MNU dose. Then, to check the effects of vitrectomy on MNU-induced RD, the intravitreal injection of MNU after vitrectomy in rabbits was also performed with different doses. In OCT, while there were no significant changes in the retinas for injections up to 0.1 mg (i.e., sham, 0.05 mg, and 0.1 mg), outer retinal atrophy and retinal atrophy of the whole layer were observed with MNU injections of 0.3 mg and 0.5 mg, respectively. With this outcome, 0.2 mg MNU was chosen to be injected into rabbit eyes (n=10) at two weeks after vitrectomy for further study. Six weeks after injection, morphological identification with FP, AF, OCT, and histology clearly showed localized outer RD - clearly bordered non-degenerated and degenerated outer retinal area - in all rabbits. We suggest our post-vitrectomy MNU-induced RD rabbit model could be used as an interim animal model for visual prosthetics before the transition to larger animal models.

Location of Retinal Nerve Fiber Layer Defects in Open-angle Glaucoma and Associated Factors

PURPOSE: To investigate the location of retinal nerve fiber layer defects (RNFLDs) in open-angle glaucoma and the differences in systemic and ocular factors between superotemporal and inferotemporal RNFLDs. METHODS: We performed a retrospective review of the 2008 to 2012 data from the Korea National Health and Nutrition Examination Survey. Subjects aged ≥19 years with an evaluable fundus photograph of at least one eye were enrolled, and open-angle glaucoma was diagnosed according to modified International Society of Geographical and Epidemiological Ophthalmology criteria. In subjects with open-angle glaucoma, locations of RNFLDs were evaluated, and systemic and ocular factors were compared between the bilateral superotemporal RNFLD group and bilateral inferotemporal RNFLD group. RESULTS: A total of 534 subjects had open-angle glaucoma with RNFLDs. The unilateral inferotemporal region (25.8%) was the most common location for RNFLDs, followed by the unilateral superotemporal region (24.4%). Multivariate analysis revealed that hypertension was more significantly associated (p = 0.048) with the bilateral superotemporal RNFLD group than with the bilateral inferotemporal RNFLD group. CONCLUSIONS: Superotemporal RNFLDs are more related to hypertension than are inferotemporal RNFLDs.

Additive Role of Optical Coherence Tomography Angiography Vessel Density Measurements in Glaucoma Diagnoses

PURPOSE: This study compared the glaucoma diagnostic abilities of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). In addition, the possibility of enhancing diagnostic capability by combining the two modalities was investigated. METHODS: A total of 131 healthy eyes and 113 glaucomatous eyes were imaged by both OCT and OCTA. In OCT, glaucoma was defined as when the color of the superior or inferior quadrant of the peripapillary retinal nerve fiber layer thickness map was yellow (borderline, <5%) or red (outside normal limits, <1%). In OCTA, glaucoma was determined using the cut-off value of the superior or inferior peripapillary vessel density, calculated after receiver operating characteristic curve analysis. Sensitivity and specificity were determined by OCT alone, by OCTA alone, or by OCT and OCTA combined. RESULTS: The sensitivity of OCT (86.7%) was better than that of OCTA (74.3%), whereas the specificity of OCTA (87.0%) was better than that of OCT (67.9%). When these two modalities were combined, both sensitivity and specificity were enhanced (90.3% and 92.4%, respectively). Among the 131 eyes, 32 were misdiagnosed as glaucomatous by OCT but accurately diagnosed as normal by OCTA. These eyes were myopic, with a longer axial length and a thinner and temporally displaced peak of peripapillary retinal nerve fiber layer thickness, causing the false positive result in OCT. CONCLUSIONS: When OCTA was combined with OCT, the specificity of glaucoma diagnoses were enhanced. OCTA may compensate for the shortcomings of OCT in the diagnosis of glaucoma.

Effects of Orbital Decompression on Lamina Cribrosa Depth in Patients with Graves' Orbitopathy

PURPOSE: We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography. METHODS: Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups—a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan—and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated. RESULTS: At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01). CONCLUSIONS: The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.

Influence of Epiretinal Membranes on the Retinal Nerve Fiber Layer Thickness Measured by Spectral Domain Optical Coherence Tomography in Glaucoma

PURPOSE: We investigated changes in the thickness of the peripapillary retinal nerve fiber layer (RNFL) following the onset of an epiretinal membrane (ERM) in glaucoma patients. METHODS: Among regularly monitored glaucoma patients, patients with a newly diagnosed ERM were consecutively enrolled. Before and after the onset of ERM, the RNFL thickness was measured using spectral domain optical coherence tomography, and a visual field examination was performed using a Humphrey field analyzer. Changes in RNFL thickness parameters and global indices of the visual field analyzer were assessed. RESULTS: In a total of 28 eyes from 28 patients, the average RNFL thickness increased by a mean of 4.0 ± 7.4 µm (p = 0.009) after ERM onset. There was an increase in the superior, nasal, and temporal quadrant RNFL thicknesses, and the change in the temporal RNFL thickness was significant (14.4 ± 21.2 µm, p < 0.001). However, the inferior RNFL thickness decreased by −0.6 ± 7.5 µm (p = 0.116). In the visual field examination, the mean deviation decreased significantly by −0.8 ± 1.7 dB (p = 0.038), from −14.6 to −15.4 dB. CONCLUSIONS: A significant increase in average RNFL thickness was detected following ERM onset in glaucoma patients, although there was deterioration of the mean deviation in the visual field. When ERM occurs in glaucoma patients, clinicians should be aware that RNFL thickness measurements obtained with a spectral domain optical coherence tomography may underestimate the status of glaucomatous optic neuropathy.

Symptomatic Retinal Artery Occlusion after Angioplasty and Stenting of the Carotid Artery: Incidence and Related Risk Factors

OBJECTIVE: Retinal artery occlusion (RAO) is rarely seen as a complication in patients undergoing carotid artery stenting (CAS); hence, its characteristics have not been documented in detail. This study aimed to investigate the incidence of this complication and the related risk factors, focusing on differences in ophthalmic artery (OA) supply (whether by the external or internal carotid artery [ECA or ICA]) prior to CAS procedures. MATERIALS AND METHODS: We retrospectively examined 342 patients who underwent CAS for severe and/or symptomatic carotid artery stenosis between January 2009 and December 2017. Cumulative medical records and radiologic data were assessed. RAO was confirmed by photography and fluorescent angiography of the fundus, which were performed by an ophthalmologist. In all patients, distal filter systems of various types were applied as cerebral protection devices (CPDs) during procedures. Univariate and multivariate analyses were conducted to identify the risk factors for RAO after CAS. RESULTS: Symptomatic RAO was observed in six patients (1.8%), of which five (6.8%) were ECA-dominant group members (n = 74). In a binary logistic regression analysis, OA supply by the ECA (odds ratio [OR], 9.705; 95% confidence interval [CI], 1.519–62.017; p = 0.016) and older age (OR, 1.159; 95% CI, 1.005–1.336; p = 0.041) were identified as significant risk factors in patients with RAO after CAS. ECA-supplied OA was also associated with the severity of ipsilateral ICA stenosis (p = 0.001) and ulcerative plaque (p = 0.021). CONCLUSION: In procedures performed using ICA distal filtering CPD systems, RAO as a complication of CAS (performed for severe stenosis) showed a relationship to ECA-supplied OA. For older patients, simultaneous use of ICA-ECA CPDs might help prevent such complications.

Ganglion Cell Analysis in an Optic Tract Syndrome Patient Previously Diagnosed with Glaucoma

PURPOSE: To report the results of ganglion cell analysis in a patient with optic tract syndrome who was previously diagnosed with glaucoma. CASE SUMMARY: A 32-year-old male, who had been diagnosed with glaucoma 12 years ago, but had not visited an ophthalmology clinic since then, came to our clinic for evaluation of his glaucoma. Both eyes showed an increased cup-to-disc ratio and temporal pallor of the disc. Retinal nerve fiber layer (RNFL) optical coherence tomography showed thinning of the superior, inferior, and temporal peripapillary RNFL in both eyes. On ganglion cell analysis (GCA), ganglion cell layer thinning in the nasal region of the right eye and in the temporal region of the left eye was observed. The visual field test showed right incongruous homonymous hemianopsia. After the atrophic change of the left optic tract was confirmed by orbit magnetic resonance imaging, he was diagnosed with left optic tract syndrome. CONCLUSIONS: We report the results of GCA in a case of optic tract syndrome, previously diagnosed as glaucoma. GCA can be useful when diagnosing optic tract syndrome.

A Case of Cytomegalovirus Retinitis Following Intravitreal Dexamethasone Implant in an Immunocompetent Patient with Uveitis

PURPOSE: We report a case of cytomegalovirus (CMV) retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient diagnosed with non-infectious uveitis. CASE SUMMARY: A 60-year-old woman was referred to our hospital for recurrent anterior uveitis. Fundus examination and fluorescein angiography showed dense vitritis, but no definite retinal infiltration. After laboratory examinations, the patient was diagnosed with non-infectious panuveitis. Uveitis was much improved after the patient started taking oral steroid medication. However, the patient complained of systemic side effects from the oral steroids. Medication was stopped, and an intravitreal dexamethasone implant was fitted to address worsening inflammation. Two months later, perivascular retinal infiltration developed and vitritis recurred. Viral retinitis was suspected, and the patient underwent diagnostic vitrectomy adjunctive with intravitreal ganciclovir injection. Polymerase chain reaction of vitreous fluid confirmed the diagnosis of CMV retinitis. The patient has remained inflammation-free for more than 20 months after vitrectomy, single ganciclovir injection, and 2 months of oral valganciclovir medication. CONCLUSIONS: This is a case report of CMV retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient without any risk factors or previous history of immunosuppression. Potential risk factors for CMV retinitis should be evaluated and careful follow-up should be performed when intravitreal dexamethasone injections are unavoidable for the treatment of non-infectious uveitis.

Clinical Changes after Switching from Ranibizumab/Aflibercept to Bevacizumab in Exudative Age-related Macular Degeneration

PURPOSE: This study was performed to investigate the changes in clinical findings after switching from ranibizumab or aflibercept to bevacizumab due to the limited number of insured injections in patients with exudative age-related macular degeneration (ARMD). METHODS: The study population consisted of patients who had undergone intravitreal injection of ranibizumab or aflibercept for ≥ 6 months and were then treated with bevacizumab for ≥ 6 consecutive months for exudative ARMD. We evaluated best-corrected visual acuity, central subfield macular thickness, disease activity, and the number of injections for one year at the time of switching the drugs. RESULTS: Forty patients (26 men and 14 women) were included in the analysis. The mean age was 71.9 (56-89) years old, with typical ARMD in 23 eyes, polypoidal choroidal vasculopathy in 15 eyes, and retinal angiomatous proliferation in two eyes. The number of injections for 6 months increased from 2.3 to 2.9 after switching the drugs (p < 0.001). Visual acuity was not significantly different between 6 months before and at the time of switching (LogMAR 0.55 ± 0.34 and 0.52 ± 0.27, respectively) (p = 0.300), but decreased significantly to 0.57 ± 0.34 at 6 months after switching (p = 0.018). There were no significant differences in central subfield macular thickness or disease activity. CONCLUSIONS: Bevacizumab required more injections to achieve similar anatomical outcomes in patients with exudative ARMD treated with ranibizumab or aflibercept, and visual acuity decreased despite anatomical stability.

Bilateral Occipital Lobe Infarction Presenting as Bilateral Inferior Altitudinal Defects

PURPOSE: Horizontal visual field defects are generally caused by lesions before the optic chiasm, but we report a case with bilateral inferior altitudinal defects secondary to bilateral occipital lobe infarction. CASE SUMMARY: A 57-year-old male with a history of diabetes and hypertension presented with a month of blurring in the inferior visual field. His corrected visual acuity was 1.0 in the right eye and 0.63 in the left eye, and the intraocular pressure was normal in each eye. Pupillary response, ocular movement, and color vision tests were normal in both eyes. There was no specific finding of the optic disc and macula on fundus examination. Visual field examination revealed an inferior congruous homonymous hemianopia with horizontal meridian sparing and a left incongruous homonymous quadrantanopia. Optical coherence tomography for peripapillary retinal nerve fiber layer thickness revealed a mild decrease in the inferior disc of both eyes. Brain magnetic resonance imaging confirmed the presence of an acute infarction confined with upper medial calcarine fissures of bilateral occipital lobe and the right splenium of the corpus callosum, which were consistent with inferior altitudinal hemianopia and left superior incongruous quadrantanopia, respectively. Brain magnetic resonance angiography showed multiple stenosis of bilateral posterior cerebral arteries. CONCLUSIONS: The altitudinal visual field defects could be caused by the occipital lesion medial to the calcarine fissure, and unusual visual defects could be due to a combination of multiple lesions.

Clinical Characteristics of Intraocular Foreign Bodies According to Entrance Location: Corneal vs. Non-Corneal

PURPOSE: To investigate differences in the clinical features of post-traumatic intraocular foreign bodies (IOFBs) according to their entrance locations, specifically, those penetrating the cornea and those not penetrating the cornea. METHODS: A retrospective chart review was performed of patients with an IOFB from January 2011 to July 2016. The patients were divided into two groups: those in whom the IOFB entered through the cornea (“corneal entrance” group) and those in whom the IOFB did not penetrate the cornea (“non-corneal entrance” group), and compared. Damage to the anterior and posterior capsule, retinal tear, and retinal detachment were analyzed, and differences in surgical techniques including the IOFB extraction route and intraocular lens implantation were recorded. RESULTS: A total of 43 eyes (43 patients) were included, with 33 (76.7%) in the corneal entrance group and 10 (23.3%) in the non-corneal group. The posterior capsule was preserved in 24.2% (eight) of eyes in the corneal group and 80% (eight) of eyes in the non-corneal group. The corneal group had significantly more posterior capsule ruptures but dramatically fewer retinal tears (39.4%) than the non-corneal group (80% retinal tears). CONCLUSIONS: The location of IOFB entrance is a predictable factor of lens capsule and retinal injuries.

Long-term Clinical Outcome of Vitrectomy for the Treatment of Optic Disc Pit Maculopathy

PURPOSE: To evaluate the long-term outcomes of optic disc pit maculopathy after vitrectomy. METHODS: We evaluated retrospectively the medical records of eight patients with macular retinal detachment or retinoschisis who underwent vitrectomy due to optic disc pit maculopathy. The best-corrected visual acuity and optical coherence tomography findings were analyzed after surgery. RESULTS: Eight eyes of eight patients (two male and six female) were enrolled. The mean best-corrected visual acuity was 0.76 log MAR, the mean age was 42.8, and the mean follow-up period was 56 months (range: 8–120 months). At baseline, retinoschisis was observed in all eight eyes. Six eyes had serous retinal detachment of the macula. Vitrectomy for a complete posterior vitreous detachment was performed. Additional internal limiting membrane peeling and tamponade were performed in six and four eyes, respectively. After surgery, serous retinal detachment was gone in all eyes (100%) at a mean of 22.8 months (range: 18 days–60 months). Three of eight eyes (37.5%) showed the disappearance of retinoschisis at a mean of 6.8 months (range: 1.7–21 months), but the remaining patients still had retinoschisis at the final visit. Ocular complications were full-thickness macular hole and iatrogenic retinal detachment in each case. The final corrected visual acuity improved to 0.29 logMAR. CONCLUSIONS: Vitrectomy is an effective treatment for patients with optic disc pit maculopathy. It achieved anatomical and visual improvements over a long period of time. However, retinoschisis due to inner retinal fluid remained in many patients.