Symmetry of Peripapillary-Optical Coherence Tomography Angiography Parameters between Dominant and Non-dominant Eyes in Normal Eyes

Purpose@#To assess whether optical coherence tomography (OCT) measurements and peripapillary microvascular parameters measured via optical coherence tomography angiography (OCTA) were similar between the dominant and non-dominant eyes of normal subjects. @*Methods@#We retrospectively analyzed spectral domain OCT and OCTA data on healthy Koreans. The “hole-in-the-card” technique was used to determine ocular dominance. The perfusion density (PD) and flux index (FI) of the peripapillary 4.5 × 4.5-mm area were measured via OCTA. Central macular, peripapillary retinal nerve fiber layer, and macular ganglion cell-inner plexiform layer thicknesses were measured with the aid of spectral-domain OCT. The OCT and OCTA data of dominant and non-dominant eyes were compared. @*Results@#A total of 84 eyes of 42 healthy subjects were analyzed. The average age was 27.3 ± 5.63 years. Twenty-eight subjects (66.7%) were right eye-dominant and 14 (33.3%) left eye-dominant. None of the central macular (260.00 ± 14.16 μm, 258.71 ± 15.18 μm, p = 0.183), macular ganglion cell-inner plexiform layer (82.02 ± 5.07 μm, 82.43 ± 5.60 μm, p = 0.460), or peripapillary retinal nerve fiber layer thickness (99.36 ± 9.27 μm, 97.90 ± 9.46 μm, p = 0.091) differed between the eyes; neither did any OCTA-assessed microvascular parameter. @*Conclusions@#No OCT or OCTA parameter differed between dominant and non-dominant eyes. No parameter identified ocular dominance.

Symmetry of Optical Coherence Tomography Angiography Parameters between Dominant and Non-dominant Eyes in Healthy Koreans

Purpose@#To assess the symmetry of microvascular parameters measured via optical coherence tomography angiography (OCTA) between the dominant and non-dominant eyes of normal Korean subjects. @*Methods@#We retrospectively analyzed data on 120 eyes of 60 healthy Koreans. The ‘hole-in-the-card’ technique was used to determine ocular dominance. Central macular, peripapillary retinal nerve fiber layer thickness, and macular ganglion cell-inner plexiform layer thickness, were measured via spectral domain OCT. Vessel and perfusion density and the area of the foveal avascular zone (FAZ) were measured via OCTA. We used the paired t-test to compare all between-eye parameters. We calculated areas under receiver operating characteristic curves to determine diagnostic utility. @*Results@#The average participant age was 27.4 ± 2.01 years. Forty-one subjects (68.3%) were right eye-dominant and 19 (31.7%) left eye-dominant. None of the central macular, macular GC-IPL, or peripapillary RNFL thickness differed between the eyes; neither did any OCTA-assessed microvascular parameter (vessel or perfusion density or the FAZ area). @*Conclusions@#No OCT or OCTA parameter differed between dominant and non-dominant eyes. No parameter identified ocular dominance.

Interocular Symmetry of Optical Coherence Tomography Angiography Parameters in Normal Eyes of Korean Adults

PURPOSE: To evaluate the interocular symmetry of microvascular parameters measured by optical coherence tomography angiography (OCTA) in normal eyes of Korean adults. METHODS: We retrospectively reviewed the retinal microvascular structure of 91 healthy Korean subjects (182 eyes). We used OCTA to measure the area of the foveal avascular zone (FAZ), vessel density (VD), and perfusion density (PD) in both eyes. Intraclass correlation coefficients (ICCs), coefficients of variation (CVs), and Pearson correlation coefficients were calculated to evaluate the extent of agreement and correlations between binocular OCTA measurements. RESULTS: Both eyes had similar microvascular characteristics: FAZ area (right eye: 0.31 ± 0.11 mm², left eye: 0.30 ± 0.10 mm², p = 0.98), FAZ perimeter (right eye: 2.35 ± 0.45 mm, left eye: 2.36 ± 0.39 mm, p = 0.86). VD 1-mm center (right eye: 9.42 ± 2.75, left eye: 9.14 ± 2.96, p = 0.163), full area (right eye: 19.94 ± 1.65, left eye: 19.72 ± 1.76, p = 0.285), and PD 1-mm center (right eye: 0.16 ± 0.05, left eye: 0.16 ± 0.05, p = 0.151), full area (right eye: 0.36 ± 0.03, left eye: 0.36 ± 0.04, p = 0.716). All ICC values were above 0.8 and all CVs below 10%. CONCLUSIONS: The microvascular structure, as represented by the VD, PD, and FAZ area measured via OCTA, was bilaterally symmetric in normal eyes of Korean adults.

Primary Intraocular T-cell Lymphoma

PURPOSE: Intraocular lymphoma can be divided into primary and secondary usually involving B-cell lymphoma. Intraocular T-cell lymphoma is mostly secondary lymphoma while primary intraocular T-cell lymphoma is extremely rare. We report a case of primary T-cell lymphoma. CASE SUMMARY: A 62-year-old male without any systemic disease presented with a floater in the right eye. A fundus examination showed multiple whitish retinal infiltrations in the right eye. Intraocular lymphoma was suspected, and systemic examination was performed, but all results were normal. During steroid treatment, previous lesions were enlarged, new lesions developed, and a diagnosis of primary T-cell lymphoma was made by diagnostic vitrectomy. Consecutive intravitreal injections of methotrexate were performed. After eight injections, the vitreous and retinal lesions improved but we decided to terminate the injections due to corneal epitheliopathy. The corneal epitheliopathy was recovered and the patient is currently undergoing periodic follow-ups without progression of the lesion. CONCLUSIONS: Although intraocular T-cell lymphoma is a rare condition, this primary T-cell type should be considered when an intraocular lymphoma lesion is suspected.

Effect of Serous Retinal Detachment on the Measurement of Axial Length in Central Serous Chorioretinopathy

PURPOSE: To evaluate the changes of axial length (AXL) in eyes with unilateral idiopathic central serous chorioretinopathy (CSC) after resolution of serous retinal detachment. METHODS: A total of 31 patients diagnosed with idiopathic unilateral CSC were included in this study. The changes of AXL according to serous retinal detachment were examined. The keratometric value and AXL were measured using partial coherence interferometry. Serous retinal detachment and central macular thickness (CMT) were measured by spectral domain optical coherence tomography. RESULTS: The mean age of the 31 CSC patients, including 19 males, was 42.7 years. The AXL was significantly increased from 23.41 to 23.58 mm after resolution of serous retinal detachment (p < 0.001). The CMT was significantly decreased from 413.4 to 226.8 µm after resolution of serous retinal detachment (p < 0.001). The differences in AXL correlated with CMT differences and subretinal fluid height (r = −0.616, p < 0.001 and r = −0.637, p < 0.001, respectively), and the best-corrected visual acuity was significantly different after resolution of serous retinal detachment (p < 0.001). CONCLUSIONS: In unilateral idiopathic CSC with serous retinal detachment, a shortened AXL in the acute phase was restored after resolution of serous retinal detachment.

Comparison of Effects and Complications between Conventional Trabeculectomy and Trabeculectomy with a Collagen Matrix Insertion

PURPOSE: To compare the surgical outcomes between trabeculectomy with a collagen matrix (Ologen®) insertion and conventional trabeculectomy. METHODS: An ophthalmic examination, including tonometry and a slit lamp examination, was performed 1 week, 2 weeks, 1 month, 2 months, 4 months, 6 months, and 12 months postoperatively in glaucoma patients who underwent a trabeculectomy using Ologen® (experimental group) or a conventional trabeculectomy (control group). Clinical features including success rate and complications were compared between the two groups. RESULTS: In 21 eyes of the experimental group and 42 eyes of the control group, the success rates were 76% and 69%, respectively (p = 0.554). Needling with subconjunctival 5-fluorouracil injection or laser suture lysis of the scleral flap was required in three eyes (14.3%) in the experimental group and 18 eyes (42.9%) in the control group (p = 0.023). The types of complications differed, although the total number of complications did not differ between the two groups (23.8% vs. 19.0%, respectively; p = 0.745). The most common complication in the experimental group was an encapsulated bleb, which occurred in three eyes (14.3%), whereas an avascular bleb occurred in three eyes (7.1%) in the control group. CONCLUSIONS: The success rate of trabeculectomy with Ologen® was comparable to that of conventional trabeculectomy. However, postoperative interventions were less commonly required after trabeculectomy with Ologen®, and the complications differed between the groups. When choosing the surgical method and examining the postoperative condition, these differences should be considered.

Thickness of the Macula, Retinal Nerve Fiber Layer, and Ganglion Cell-inner Plexiform Layer in the Macular Hole: The Repeatability Study of Spectral-domain Optical Coherence Tomography

PURPOSE: We measured the thicknesses of the ganglion cell and inner plexiform layer (GCIPL), the macula, and the retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography in patients with idiopathic macula holes to analyze the repeatability of these measurements and compare them with those of the fellow eye. METHODS: We evaluated 85 patients who visited our retinal clinic. The patients were divided into two groups according to their macular hole size: group A had a size of <400 µm, while group B had a size of ≥400 µm. Repeatability was determined by comparing the thicknesses of the GCIPL, macula, and RNFL with those of the normal fellow eye. RESULTS: The average central macular thickness in patients with macular holes was significantly thicker than that in the normal fellow eye (343.8 ± 78.6 vs. 252.6 ± 62.3 µm, p < 0.001). The average thickness of the GCIPL in patients with macular holes was significantly thinner than that in the normal fellow eye (56.1 ± 23.4 vs. 77.1 ± 12.8 µm, p < 0.001). There was no significant difference in the average RNFL thickness between eyes with macular holes and fellow eyes (92.4 ± 10.0 vs. 95.5 ± 10.7 µm, p = 0.070). There were also no significant differences in the thicknesses of the GCIPL and RNFL among the two groups (p = 0.786 and p = 0.516). The intraclass correlation coefficients for the macula and RNFL were 0.994 and 0.974, respectively, in patients with macular holes, while that for the GCIPL was 0.700. CONCLUSIONS: Macular contour change with macular hole results in low repeatability and a tendency of thinner measurement regarding GCIPL thickness determined via spectral-domain optical coherence tomography. The impact of changes in the macular shape caused by macular holes should be taken into consideration when measuring the GCIPL thickness in patients with various eye diseases such as glaucoma and in those with neuro-ophthalmic disorders.

Parry-Romberg Syndrome Associated with Hypothyroidism

PURPOSE: We report a case of Parry-Romberg syndrome associated with right enophthalmos, hypotropia, up-gaze limitation, en coup the sabre, morphea, and hypothyroidism. CASE SUMMARY: A 41-year-old woman presented with slowly progressive right enophthalmos that started 5 years previous. With a Hertel exophthalmometer, the right eye measured 10 mm, and the left eye 13 mm. Right enophthalmos and atrophy of subcutaneous tissues of right side orbit were observed. Axial scan of computerized tomography shows atrophy of right side orbital subcutaneous tissues without bony abnormality. At primary gaze, 4 prism diopter hypotropia was observed in the right eye. Up-gaze was limited in both eyes. Visual acuity was 1.0 in both eyes. No specific sign was found in her anterior segment. The patient had experienced right side alopecia 20 years prior and had undergone biopsy, which proved morphea. Linear en coup de sabre morphea was found on the right forehead and scalp. Hypothyroidism due to Hashimoto's thyroiditis was diagnosed based on a blood test, which also showed positive antinuclear antibody. Thus, the patient was diagnosed with Parry-Romberg syndrome associated with hypothyroidism. CONCLUSIONS: Clinicians need to consider the rare disease Parry-Romberg syndrome when a patient with ophthalmologic symptoms such as enopthlamos or eye movement disorders is accompanied by dermatologic symptoms such as linear en coup de sabre morphea or alopecia.

Bilateral Optic Disc Edema Associated with Hypocalcemia

PURPOSE: To report a case of bilateral optic disc edema associated with hypocalcemia. CASE SUMMARY: A 48-year-old woman visited our ophthalmology department with decreased vision and disturbance of the visual field in the right eye, which began 2 days prior to presentation. The patient history indicated she had undergone total thyroidectomy 3 months prior and was given an oral calcium preparation. She had no eye pain, headache, tinnitus or diplopia. Her best corrected visual acuity of both eyes was 1.0, and color vision was normal in both eyes although a mild relative afferent pupillary defect was present in the right eye. Severe bilateral optic disc edema was present in the right eye. A Humphrey visual field test revealed an enlarged blind spot and peripheral nasal step scotoma in the right eye. The Cerebrospinal fluid (CSF) opening pressure was within the normal range and there were no abnormal findings regarding CSF. Additionally, there were no remarkable findings on brain magnetic resonance imaging nor neurologic tests. Her serum calcium was 5.9 mg/dL (normal range: total calcium 8.7-10.6 mg/dL), and an intravenous calcium supplement was started. Visual disturbance and optic disc edema improved 2 days after replacement and the optic disc edema completely dissolved 2 months later. CONCLUSIONS: Hypocalcemia may cause bilateral optic disc edema and can be recovered through adequate calcium supplementation, and it is necessary to prevent and promptly detect this rare complication.

The Effect of Machine Aging on the Measurements of Optical Coherency Tomography

PURPOSE: To evaluate the effect of instrument aging on optical coherence tomography (OCT) measurements. METHODS: Single eyes of 60 healthy participants (60 eyes) aged 20-30 years were examined twice using a 5-year-old OCT instrument and a new OCT instrument (Carl Zeiss Meditec, Dublin, CA, USA). The measurements and changes in signal strength were investigated using both instruments. RESULTS: The signal strengths of the new and aged instruments were 8.6 ± 0.8 and 5.0 ± 1.0, respectively, which was a statistically significant difference (p < 0.001). In addition, the central macular thicknesses (CMT) of the new and aged instruments were 201.1 ± 16.1 µm and 210.3 ± 16.0 µm, respectively. The thickness was significantly greater using the aged instrument (p < 0.001). Repeated measurements within the same eye were compared, and the difference in CMT was 3.2 using the new instrument and 10.5 using the aged instrument (p < 0.05). The intraclass correlation coefficient (ICC) was compared to evaluate the reproducibility of each instrument. The ICC values of nine areas of Early Treatment Diabetic Retinopathy Study in the aged instrument were 0.371-0.872, indicating low reproducibility. However, the new instrument showed high reproducibility with values of 0.806-0.947. CONCLUSIONS: Higher signal strength and lower CMT were observed using the new instrument compared to the aged instrument. Additionally, there were no differences in signal strength errors between the instruments. However, the error in CMT measured using the new instrument was significantly smaller compared to that using the aged instrument. Therefore, the effect of instrument aging should be accounted for in analyses of OCT measurements.

Comparison of Partial Interferometry and Ultrasound A-scan for Axial Length Measurement in Retinal Vein Occlusions

PURPOSE: To evaluate the significance of axial length, which is a known risk factor of retinal vein occlusion, we measured the axial lengthby using contact A-scan sonography and partial interferometry and compared the two values. METHODS: This study included 19 patients complaining of visual symptoms and who were diagnosed with unilateral retinal vein occlusion (RVO) with macular edema (ME). Affected eyes were classified as the study group, and healthy fellow eyes were classified as the control group. We measured the central macular thickness (CMT) and axial length (AL) of the affected and fellow eyes and compared them. CMT was measured by optical coherence tomography (Stratus OCT, Carl Zeiss, Jena, Germany), and AL was measured by interferometry (IOL Master®, Carl Zeiss, Jena, Germany). RESULTS: In RVO patients, CMT was significantly different between affected eyes (485.7 ± 111.3 µm) and fellow eyes (197.8 ± 29.7 µm; p < 0.001). Axial length measured by A-scan sonography was 23.06 ± 0.86 mm in the affected eyes and 23.28 ± 0.93 mm in the healthy eyes, which was statistically different (p < 0.001). However, using partial interferometry, the AL was 23.35 ± 0.87 mm in the affected eyes and 23.38 ± 0.95 mm in the healthy eyes. No significant difference was found. CONCLUSIONS: We confirmed that short AL, which was once thought to be a risk factor of RVO, results from the properties of the instruments used for measurement. Moreover, we verified that partial interferometry is more accurate for measurement of AL than A-scan sonography when retinal vein occlusion is associated with ME.

Longitudinal Changes in Retinal Nerve Fiber Layer Thickness after Intravitreal Anti-vascular Endothelial Growth Factor Therapy

PURPOSE: To determine the effects of intravitreal anti-vascular endothelial growth factor (VEGF) on thickness of the retinal nerve fiber layer (RNFL) in patients with age-related macular degeneration. METHODS: Twenty eyes of 20 patients diagnosed with age-related macular degeneration who underwent intravitreal anti-VEGF injection were studied. Postinjection RNFL thickness was measured using optical coherence tomography. Average thickness, four-quadrant RNFL thicknesses, and intraocular pressure (IOP) in affected eyes were measured before and 6 and 12 months after anti-VEGF injection for comparison. RNFL thickness and IOP in affected and normal fellow eyes were also compared. Given that macular lesions can affect RNFL thickness, the changes in thickness were evaluated by dividing the 12 clock-hour RNFL into the pathologic areas adjacent to the lesion and the non-pathologic area. RESULTS: The mean clock-hour segment in the pathologic area was 4.8 hours. A significantly thicker RNFL was exhibited in temporal quadrants and pathologic areas (p = 0.043 and 0.048, respectively) in affected eyes before injection compared to the baseline RNFL thickness in normal eyes. No significant differences were found in RNFL thickness or IOP between affected and normal eyes after injection. The changes over time in the temporal and pathologic areas were statistically significant at 6 and 12 months after injection compared to baseline data (p < 0.05). No significant differences were displayed in RNFL thickness in the other three quadrants or in non-pathologic areas in either affected or normal eyes. Sequential changes in RNFL thickness in affected eyes were not significant. CONCLUSIONS: Repeat intravitreal anti-VEGF treatment did not have a significant effect on RNFL thickness. RNFL thickness significantly decreased with time in the pathologic areas and in the temporal segment adjacent to exudative macular lesions. The reduction in RNFL thickness was most likely associated with changes in the macular lesion rather than with anti-VEGF injection.

Oil Droplet Cataract: Cause of Decreased Vision of Unknown Etiology

PURPOSE: To report cases of oil droplet cataract, one cause of decreased vision of unknown etiology. METHODS: We performed a retrospective chart review analysis of patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity and diagnosed with oil droplet cataract. Clinical features including history, result of ophthalmologic examinations, and clinical course were evaluated. RESULTS: Among the patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity, 6 patients were diagnosed with oil droplet cataract. The patients ranged from 38 to 63 years of age and their best corrected visual acuities at their first visits were between 0.1 and 0.7. Ophthalmologic examinations including neuro-ophthalmologic tests were normal except for changes in lens nucleus and peculiar fundus reflexes were observed using retinoscopy in all patients. Five eyes of 4 patients underwent cataract surgery and all 5 eyes achieved the best corrected visual acuity of 1.0 or higher. CONCLUSIONS: Oil droplet cataract is a cause of decreased visual acuity of unknown etiology that can be missed. The disease abnormalities are difficult to observe because only subtle changes in lens nucleus are apparent on slit lamp examination; however characteristic fundus reflexes can be identified using retinoscopy. Ophthalmologists should thoroughly understand the oil droplet cataract and diagnose it in the early stages to avoid misdiagnosis and unnecessary costs.

A Case of Pseudomonas aeruginosa Infection after Scleral Buckling for Retinal Detachment

PURPOSE: To report a case of Pseudomonas aeruginosa infection after scleral buckling for retinal detachment. CASE SUMMARY: A 68-year-old male presented with a 2-day history of pain in the right eye. The patient had a history of scleral buckling for retinal detachment 10 years earlier and excisional biopsy for conjunctival mass 1 month previously. Biopsy revealed chronic inflammation and granulation tissue formation. Slit-lamp examinations revealed superior conjunctival injection, edema and exposed suture knot. Fundus examination revealed exudative retinal detachment and choroidal detachment. The conjunctival lesion did not improve although the patient was treated with moxifloxacin. After 4 days, bacterial and fungal cultures were performed because the conjunctiva presented with purulent discharge 4 days after treatment. The scleral buckle and suture knot were removed. The cultures revealed growth of Pseudomonas aeruginosa. According to antibiotic sensitivity test results, the authors treated the patient with ceftazidime. The conjunctival lesion, choroidal detachment and exudative retinal detachment were improved. CONCLUSIONS: In patients with conjunctival injection, edema, purulent discharge and ocular pain after scleral buckling, presence of infection should be suspected. If scleral buckle infection is suspected, bacterial culture, antibiotics treatment and scleral buckle removal should be considered.

Combined Cataract Extraction and Vitrectomy for Macula-sparing Retinal Detachment: Visual Outcomes and Complications

PURPOSE: To evaluate the visual outcome of combined phacoemulsification, intraocular lens implantation, and vitrectomy for macula-sparing rhegmatogenous retinal detachment. METHODS: The results of combined vitrectomy with cataract extraction were retrospectively analyzed in patients with preexisting cataracts and new-onset rhegmatogenous retinal detachment. To qualify, patients must also have had macular sparing in a region 6,000 microm in diameter on optical coherence tomography. The anatomical success rate, visual outcomes, and postoperative complications relating to visual acuity were evaluated. RESULTS: In 56 patients followed postoperatively for more than 12 months, the initial and final surgical success rate was 96.4% and 100%, respectively. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 0.05 and decreased to 0.11 postoperatively (p < 0.001). Of the 56 patients, 20 (35.7%) had worse visual acuity postoperatively, compared with preoperatively (0.06 vs. 0.27, p < 0.001); these cases were comprised of six patients with epiretinal membranes, 12 patients with a posterior capsule opacity, and two patients with cystoid macular edema. In the remaining 36 patients, there were no significant differences in visual acuity preoperatively and postoperatively (0.04 vs. 0.03, p = 0.324). CONCLUSIONS: In patients with cataracts who develop macula-sparing rhegmatogenous retinal detachment and whose visual prognosis is excellent assuming the retina can be reattached successfully, combined phacoemulsification, intraocular lens implantation, and vitrectomy might be an effective treatment. However, the visual prognosis is significantly affected by postoperative complications such as an epiretinal membranes, posterior capsule opacity, and cystoid macular edema. Therefore, further studies should examine methods to prevent these postoperative complications.

The Optical Coherence Tomography Findings of Optic Tract Syndrome

PURPOSE: To report a case of optic tract syndrome in which optical coherence tomography (OCT) demonstrated the specific findings of the retinal nerve fiber layer (RNFL). CASE SUMMARY: A 32-year-old male patient visited the hospital with right side visual field defect in both eyes that occurred immediately after a traffic accident 8 months prior. The visual acuity of both eyes was normal, and a relative afferent papillary defect was evident in the right eye. In addition, suspicious band atrophy of the right optic disc and thinning of the superior and inferior arcuate bundle were observed in the left eye. On visual field examination, homonymous hemianopia was present. Optic tract syndrome was suspected, although there was no abnormality of the visual tract on MRI. On fast RNFL thickness 3.4 scan, a thinning of RNFL in the nasal and temporal segments in the right eye and superior and inferior segments in the left eye were observed. Based on the findings, optic tract syndrome was diagnosed in the left eye. CONCLUSIONS: We report specific OCT findings which can be useful when making a diagnosis of optic tract syndrome.

Acute Bilateral Visual Loss Related to Orthostatic Hypotension

A 50-year-old man had undergone lumbar vertebral surgery and was confined to bed in the supine position for three months. When he sat up from the prolonged supine position, he showed clinical signs of orthostatic hypotension and reported decreased vision in both eyes. He also had underlying anemia. Ophthalmologic findings suggested bilateral anterior ischemic optic neuropathy (ION) as the cause of the visual loss. Although there are numerous reports of ION in the setting of hemodynamic compromise, such as systemic hypotension, cases of ION-associated orthostatic hypotension are very rare.

A Case of Thiamine (Vitamin B1)-Deficient Optic Neuropathy Associated with Wernicke's Encephalopathy

PURPOSE: To report a case of subacute optic neuropathy caused by thiamine (vitamin B1) deficiency. CASE SUMMARY: A 44-year-old woman was referred to the ophthalmology department due to decreased vision which began 10 days prior to presentation. The patient history indicated that she had undergone chemotherapy for ovarian cancer and she had been dependent on total parenteral nutrition for 3 weeks due to nausea and vomiting. Her best corrected vision of the right and the left eyes were 0.15 and 0.2, respectively. Color vision was severely impaired in both eyes without retrobulbar pain. There was marginal blurring on the temporal side of the optic discs of both eyes. The optic nerves were unremarkable on orbital and brain magnetic resonance imaging (MRI). There was high signal intensities in both the mammillary body and periaqueductal gray matter on T2-weighted imaging. In addition, the patient exhibited ataxia along with short-term memory loss. She was diagnosed with Wernicke's encephalopathy. Thiamine was administrated based on the diagnosis, and after 2 days of administration, the patient's vision and neurologic symptoms began to improve. Two weeks later, the patient recovered her vision. CONCLUSIONS: Thiamine deficiency may cause optic neuropathy and can be recovered with early thiamine supplementation. This condition could occur due to deficient oral thiamine administration. We should keep this point in mind and try to prevent or diagnose early.

Central Retinal Vein Occlusion Occurrence in an Eales Disease Patient

PURPOSE: To report the occurrence of central vein occlusion in an Eales disease patient. CASE SUMMARY: A 23-year-old man presented with decreased left eye visual acuity and was diagnosed with bilateral Eales disease after ophthalmic evaluations. The patient received laser photocoagulation and visual acuity in his left eye improved 1 month after treatment. He was followed up regularly for 3 years and had no specific eye problems. Subsequently, the patient visited our clinic because of visual disturbance in his right eye. The patient's visual acuity was 0.6 in his right eye, and 1.0 in his left eye. On right eye fundus examination, there were multiple flame shape hemorrhages and retinal vascular tortuosity was observed. Arteriovenous transit time was extended on fluorescein angiography. Therefore, the patient was diagnosed with central retinal vein occlusion and underwent an internal medical examination to reveal a possible systemic cause of the central retinal vein occlusion; however, there were no systemic problems. Macular edema was observed on optical coherence tomography and the patient received an intravitreal bevacizumab injection. Six months after treatment, the right eye visual acuity and macular edema improved. CONCLUSIONS: Reports of branched retinal vein occlusion on the peripheral retina are common in Eales disease patients. However, the authors experienced and report a case of central retinal vein occlusion occurring in Eales disease.

The Recurrent Submacular Hemorrhage after Removal of Sub-Internal Limiting Membrane Hemorrhage with Retinal Arterial Macroaneurysm

PURPOSE: To report a case of a recurrent macular hemorrhage that developed after surgical removal of the internal limiting membrane (ILM) for subintimal hemorrhage due to retinal macroaneurysm. CASE SUMMARY: A 75-year-old female was admitted to the hospital complaining of decreased vision in the left eye which had started 3 weeks previously. The best corrected visual acuity (BCVA) of the right and left eye was 0.7 and 0.03, respectively. The intraocular pressure (IOP) of the right and left eye was 10 mm Hg and 12 mm Hg, respectively. On the fundus examination, macular preretinal and subretinal hemorrhage was observed and a diagnosis of retinal arterial macroaneurym of the inferonasal major artery was made. Vitrectomy was performed. After indocyanine green dye staining, the sub-ILM hemorrhage was treated with removal of the ILM. At postoperative day 3, the annular chorioretinal folds were observed due to the hypotony (4 mm Hg). However, the absence of leakage was confirmed through the sclerotomy site. At postoperative day 8, recurrent submacular hemorrhage occurred and the hemorrhage was observed to have spread after intravitreal C3F8 gas injection and when the patient was placed in the prone position. At postoperative 4 months, the hemorrhage that had invaded the macular area was completely resolved. The BCVA was 0.3, respectively. CONCLUSIONS: When removing a sub-ILM hemorrhage due to retinal macroaneurysm, recurrent hemorrhage can occur especially in a patient with ocular hypotony, as in the present case report. Physicians should be aware of this possibility and the proper treatment the condition requires.