Outcomes after Cataract Surgery in High Myopes with Axial Length Differences of ≥2 mm

Purpose@#To evaluate the visual outcome after cataract operations in high myopia patients, whose axial length differences are longer than 2 mm. @*Methods@#A retrospective study was conducted on patients who had received phacoemulsification cataract surgery from January 2014 to June 2020. The patients whose axial lengths and inter-eye axial lengths exceeded 26 and 2 mm, respectively, were selected. Demographic data, axial lengths, central subfield macular thickness, retinal nerve fiber layer, and best-corrected visual acuities (BCVAs) before and at 6 months postoperatively were collected. The factors related to visual outcome were analyzed using univariate, multivariate linear regression. @*Results@#Twelve patients had an inter-eye axial length difference longer than 2 mm. The average axial lengths of longer and shorter eyes were 29.17 ± 1.94 and 26.66 ± 2.51 mm, respectively (p = 0.02, Mann-Whitney U-test). The BCVAs (logarithm of minimal angle of resolution, logMAR) of the longer and shorter eyes before the surgery were 1.09 ± 0.62 and 0.19 ± 0.16, respectively (p = 0.03, Mann-Whitney U-test). The BCVAs (logMAR) of the longer and shorter eyes 6 months after surgery were 0.19 ± 0.16 and 0.08 ± 0.10, respectively (p = 0.11, Mann-Whitney U-test). In univariate linear regression analysis, the BCVAs 6 months after the surgery showed better preoperative BCVAs (p < 0.001) and a thinner central subfield macular thickness (p = 0.001). In multivariate linear regression analysis, the BCVA at 6 months after the surgery showed significant improvement compared with preoperative BCVA values (p < 0.001). @*Conclusions@#High myopia patients whose axial length differences exceeded 2 mm showed improved VA after cataract surgery.

Outcomes after Cataract Surgery in High Myopes with Axial Length Differences of ≥2 mm

Purpose@#To evaluate the visual outcome after cataract operations in high myopia patients, whose axial length differences are longer than 2 mm. @*Methods@#A retrospective study was conducted on patients who had received phacoemulsification cataract surgery from January 2014 to June 2020. The patients whose axial lengths and inter-eye axial lengths exceeded 26 and 2 mm, respectively, were selected. Demographic data, axial lengths, central subfield macular thickness, retinal nerve fiber layer, and best-corrected visual acuities (BCVAs) before and at 6 months postoperatively were collected. The factors related to visual outcome were analyzed using univariate, multivariate linear regression. @*Results@#Twelve patients had an inter-eye axial length difference longer than 2 mm. The average axial lengths of longer and shorter eyes were 29.17 ± 1.94 and 26.66 ± 2.51 mm, respectively (p = 0.02, Mann-Whitney U-test). The BCVAs (logarithm of minimal angle of resolution, logMAR) of the longer and shorter eyes before the surgery were 1.09 ± 0.62 and 0.19 ± 0.16, respectively (p = 0.03, Mann-Whitney U-test). The BCVAs (logMAR) of the longer and shorter eyes 6 months after surgery were 0.19 ± 0.16 and 0.08 ± 0.10, respectively (p = 0.11, Mann-Whitney U-test). In univariate linear regression analysis, the BCVAs 6 months after the surgery showed better preoperative BCVAs (p < 0.001) and a thinner central subfield macular thickness (p = 0.001). In multivariate linear regression analysis, the BCVA at 6 months after the surgery showed significant improvement compared with preoperative BCVA values (p < 0.001). @*Conclusions@#High myopia patients whose axial length differences exceeded 2 mm showed improved VA after cataract surgery.

Age-related Changes of Macular Ganglion Cell-inner Plexiform Layer Thickness in Korean Elderly Subjects

Purpose@#We sought to establish normative ranges of the ganglion cell-inner plexiform layer (GCIPL) thickness using spectral-domain optical coherence tomography in Korean elderly individuals and to identify factors that influence GCIPL thickness. @*Methods@# We conducted a retrospective, observational study of 114 healthy subjects (75 years old or older) who underwent comprehensive ophthalmic examinations at a single institution. GCIPL thickness was measured with the Cirrus spectral-domain optical coherence tomography system and automatic segmentation. Subjects were divided into two age groups: those younger than 80 years and those 80 years or older, respectively. A cross-sectional analysis was adopted to evaluate associations of GCIPL thickness with sex, age, intraocular pressure, optic disc rim area, axial length, spherical equivalent (SE) refractive errors, astigmatism, and body mass index. @*Results@#The average and minimum GCIPL thicknesses were 80.3 ± 5.6 µm and 76.3 ± 5.9 µm, respectively. The GCIPL thickness was significantly lower in the older group than in the younger group in the inferior, inferonasal, and inferotemporal segments (all p < 0.01). A thinner average GCIPL thickness was strongly associated with increasing age (β = -2.87, p = 0.021) and thinner circumpapillary retinal nerve fiber layer thickness (β = 2.87, p < 0.001) in all segments. @*Conclusions@#GCIPL thickness decreased with age globally and in all segments, even after 75 years of age. Thinner GCIPL was associated with older age and thinner circumpapillary retinal nerve fiber layer. Age-related changes should be considered when using GCIPL thickness to assess glaucoma and other optic neuropathies characterized by retinal ganglion cell loss.

Evaluation of the Protective Effect of an Ophthalmic Viscosurgical Device on the Ocular Surface in Dry Eye Patients during Cataract Surgery

PURPOSE: To evaluate the protective effect of applying an ophthalmic viscosurgical device (OVD) to the ocular surface during cataract surgery and its ability to prevent dry eye syndrome. METHODS: Twenty-four patients aged 50 to 75 years who underwent cataract surgery at Seoul National University Bundang Hospital and agreed to participate in the study were included and divided into two groups: a study group who underwent cataract surgery after application of an OVD to the ocular surface, and a control group who underwent cataract surgery without application of an OVD. DisCoVisc was used as the OVD in the study group, while other factors including surgical techniques and administration of anesthetic agents were performed in both groups in the same manner. Indicators of dry eye syndrome including ocular staining score, tear break-up time, and tear osmolality were analyzed. Ocular surface disease index and a visual analog scale were analyzed for dry eye symptoms, and the amount of balanced salt solution used during surface irrigation and operation time were also analyzed. RESULTS: Significant improvement in the tear break-up time, corneal ocular staining score, and ocular surface disease index score in the study group compared with the control group one week after operation (by the Mann-Whitney test). Use of OVD was associated with longer operating time. CONCLUSIONS: OVD applied to the ocular surface during cataract surgery had a protective effect on the ocular surface one week after surgery.

Two Cases of Serous Retinal Detachment Following Vitrectomy in Patients with Proliferative Diabetic Retinopathy

PURPOSE: In the present study, 2 cases of serous retinal detachment in patients diagnosed with proliferative diabetic retinopathy after pars plana vitrectomy are reported. CASE SUMMARY: (Case 1) A 38-year-old female diagnosed with high-risk proliferative diabetic retinopathy underwent pars plana vitrectomy and cataract surgery due to intravitreal hemorrhage. One day after the operation, fundus photograph and optical coherence tomography (OCT) revealed serous retinal detachment. After ensuring that no retinal hole was present based on fundus examination, the patient was diagnosed with serous retinal detachment and antimicrobial and steroid eye drops were applied. After 1 week, subretinal fluid disappeared. (Case 2) A 63-year-old male diagnosed with proliferative diabetic retinopathy underwent pars plana vitrectomy due to right vitreous hemorrhage. On postoperative day 1, focal subretinal fluid under the macula was observed using OCT. Intravitreal triamcinolone injection was performed during surgery and steroid eye drops were applied. Subretinal fluid collection was absorbed 5 days postoperatively. CONCLUSIONS: Two cases of serous retinal detachment that occurred postoperatively in patients with diabetic retinopathy are reported. Serous retinal detachment was resolved after several days without specific management.

Evaluation of Visual Outcome after Cataract Surgery in Patients Aged 85 Years or Older

PURPOSE: To compare the visual outcome after cataract surgery in patients 85 years of age or older with those in other age groups. METHODS: This retrospective study included 313 eyes of 204 patients who underwent cataract surgery from April 2014 to March 2015 at Kangwon National University Hospital and were followed up or 3 months or longer. The patients were divided into groups A (86 eyes of 53 patients between 55 and 69 years of age), B (85 eyes of 53 patients between 70 and 84 years of age), and C (143 eyes of 98 patients 85 years of age or older), and the medical records of the patients were reviewed and analyzed. RESULTS: The postoperative best-corrected visual acuity (BCVA) improved in 95% of group A patients, 87% of group B, and 81% of group C. When compared with the log MAR BCVA before and after surgery, the visual acuity after cataract surgery was improved effectively from 0.40 to 0.06 in group A, from 0.50 to 0.16 in group B, and from 0.75 to 0.31 in group C (p < 0.001). In group C, preoperative and postoperative BCVAs were significantly worse than in other groups (p < 0.001 and < 0.001, respectively) and the ratio of patients with vision improvement and patients with BCVA of 20/40 or better was significantly lower than in the other groups (p = 0.009 and < 0.001, respectively). CONCLUSIONS: The ratio of visual acuity improvement was decreased among the patients over 85 years of age. Pre and postoperative visual acuities in group C were observed worse than in other groups. Additionally, the postoperative visual acuity was low. However, average visual acuity improved in 81% of patients. Therefore, cataract surgery should be strongly recommended for very old patients.

Postoperative Refractive Errors after Posterior Capsulectomy during Combined Vitrectomy and Cataract Surgery

PURPOSE: To evaluate the difference between the predicted and actual postoperative refractions after combined vitrectomy and cataract surgeries with a posterior capsulectomy. METHODS: We performed a retrospective study of 33 eyes of 33 patients who underwent combined vitrectomy and cataract surgeries in our hospital between March 2013 and May 2014. The patients were divided into 2 groups: those who underwent a posterior capsulectomy (group A) and those who underwent combined vitrectomy and cataract surgeries (group B). The actual refractive errors were analyzed 3 months after surgery using spherical equivalent. We compared the results between the predicted and actual refractive errors in the two groups. RESULTS: Group A consisted of 25 eyes of 25 patients and group B of 8 eyes of 8 patients. In group A, the average difference between predicted and actual postoperative refractive errors was -0.16 +/- 0.38 D (p = 0.083). The predicted refraction was -0.33 +/- 0.46 D and actual refraction was -0.49 +/- 0.55 D in group A. There was no statistically significant difference between the predicted refraction and actual refractive errors in group A (p = 0.083). In group B, the average difference between predicted and actual postoperative refractive errors was 0.27 +/- 0.29 D (p = 0.078). Additionally, the predicted refraction was -0.49 +/- 0.77 D and actual refraction was -0.22 +/- 0.59 D. The difference between the predicted refraction and actual refractive errors in group B was not statistically significant (p = 0.078). CONCLUSIONS: When a posterior capsulectomy is performed during combined vitrectomy and cataract surgery, no significant difference in refractive errors between the predicted refraction and actual refractive errors was observed 3 months after surgery. Compared with combined vitrectomy and cataract surgeries only, a small amount of myopic refractive change tended to occur 3 months after surgery.

Correlation between Intraocular Pressure and Bottle Heights during Vitrectomy

PURPOSE: To determine the correlation between intraocular pressure (IOP) and the bottle heights during vitrectomy using TONO-PEN(R)XL applanation tonometer and Icare(R) PRO rebound tonometer. METHODS: Twenty-four eyes of 24 patients who underwent 23-gauge sutureless vitrectomy were evaluated. After complete vitrectomy, the IOP was gradually increased by lifting the irrigation bottle height from the trocar insertion site by 40 cm, 45 cm, 50 cm, and 55 cm. The distance between the floor and patient's eye was consistent in all cases (105.5 cm). Before the removal of 23-gauge microcannulas, IOP was measured five times using each of the two methods, Tono-Pen(R)XL and Icare(R) PRO. RESULTS: The mean IOPs were 8.25 +/- 0.35 mm Hg for TONO-PEN(R)XL and 8.96 +/- 0.32 mm Hg for Icare(R) PRO at 40 cm bottle height. As the bottle height increased, the differences in IOP was also increased, 10.71 +/- 0.37 mm Hg at 45 cm, 14.18 +/- 0.39 mm Hg at 50 cm and 17.93 +/- 0.40 mm Hg at 55 cm for TONO-PEN(R)XL and 11.48 +/- 0.31 mm Hg at 45 cm, 14.64 +/- 0.31 mm Hg at 50 cm and 18.13 +/- 0.38 mm Hg at 55 cm for Icare(R) PRO. In TONO-PEN(R)XL, the linear equation was Y = 0.65 X - 18.108 (R2 = 0.794, p = 0.000) and the quadratic equation was Y = 0.013 X2 - 0.569 X + 10.446 (R2 = 0.801, p = 0.000). In Icare(R) PRO, the linear equation was Y = 0.614 X - 15.842 (R2 = 0.820, p = 0.000) and the quadratic equation was Y = 0.010 X2 - 0.306 X + 5.688 (R2 = 0.825, p = 0.000). The results show correlation of the quadratic equation was stronger than the linear equation in both tonometers. CONCLUSIONS: The differences of IOP were positively correlated with bottle heights in the form of a curve during vitrectomy. Therefore, the patients who are susceptible to retina or optic nerve damage during vitrectomy should be closely monitored.

The Relationships between Anterior Chamber Parameters and Obesity

No abstract available.

Learning Curve for Strabismus Surgery

PURPOSE: In the present study, we evaluated the learning curve of strabismus surgery performed by a single surgeon. METHODS: We reviewed the data of 62 patients with exodeviation who underwent strabismus surgery and were followed up for at least 3 months between March 2011 and November 2014. Patients were divided into 3 groups classified chronologically and the success rate in each group was investigated. Additionally, the results of exotropia surgery were analyzed using cumulative sum (CUSUM) analysis. We compared 5 m distal angle deviation preoperatively and 3 months after strabismus surgery. RESULTS: The overall surgical success rate of 62 patients was 72.6% (45/62). Success rates were 70% (14/20) in the first group, 71.4% (15/21) in the second group and 76.2% (16/21) in the third group. CUSUM analysis indicated that a surgeon's performance begins to improve at attempt number 11 and cumulative failure chart suggested the surgeon had achieved acceptable level of performance after 44 surgeries. CONCLUSIONS: A novice strabismus surgeon showed performance improvement after 11 cases and achieved acceptable level of performance after 44 strabismus surgeries. Although additional statistical data using more cases is needed, we suggest surgeons should perform at least 50 strabismus surgeries to ensure a high success rate.

Pathophysiology of Transient Corneal Edema and Pseudophakic Cystoid Macular Edema

No abstract available.

Pathophysiology of Transient Corneal Edema and Pseudophakic Cystoid Macular Edema

No abstract available.

Long-standing Asymptomatic Intralenticular Foreign Body

No abstract available.

Lumbar Intradural Neurocysticercosis: A Case Report

Cysticercosis is the most common parasitic disease affecting the central nervous system. Spinal involvement is rare in neurocysticercosis, and isolated spinal involvement without evidence of cranial involvement is even rarer. We report an unusual case of neurocysticercosis with isolated spinal involvement. A 59 year-old male presented with radiating pain in the left leg. He complained of aggravating weakness and numbness in the left leg since his previous visit one month ago. Magnetic resonance imaging (MRI) revealed multiple peripheral wall-enhanced intradural cystic masses from L1 to L5. The patient underwent a total laminectomy of L4. Dissection revealed abnormal cystic masses compressing the nerve roots. The cyst was punctured, spilling clear mucoid fluid into the surgical field. The exposed cysticerci, white and mucoid, was easily removed. Patient received course of steroids and oral albendazole. The patient experienced symptomatic improvement without further neurologic deficits except for mild sensory impairment. Clinicians should include spinal neurocysticercosis in differential diagnosis of radiculopathies. Although isolated spinal neurocysticercosis is rare, it can be satisfactorily managed with surgery and medication.

Prediction of Chronic Subdural Hematoma in Minor Head Trauma Patients / 대한신경손상학회지

OBJECTIVE: Chronic subdural hematoma (CSDH) is relatively common in neurosurgical field. However not all patients develop CSDH after minor head trauma. In this study, we evaluate the risk factors of post-traumatic CSDH. METHODS: Two-hundred and seventy-seven patients were enrolled and analyzed in this study from January 2012 to December 2013. Of those, 20 participants had minor head trauma developed CSDH afterward. We also included 257 patients with minor head trauma who did not develop CSDH during the same follow-up period as the control group. We investigated the risk factors related to the development of CSDH after minor head trauma. RESULTS: Old age (p=0.014), preexisting diabetes mellitus (p=0.010), hypertension (p=0.026), history of cerebral infarction (p=0.035), antiplatelet agents (p=0.000), acute subdural hematoma in the convexity (p=0.000), encephalomalacia (p=0.029), and long distance between skull and brain parenchyma (p=0.000) were significantly correlated with the development of CSDH after trauma. Multivariate analysis revealed that only the maximum distance between the skull and the cerebral parenchyma was the independent risk factor for the occurrence of CSDH (hazard ratio 2.55, p=0.000). CONCLUSION: We should consider the possibility of developing CSDH in the post-traumatic patients with the identified risk factors.

Association of Alcohol Consumption with the Risk of Ocular Trauma

This study was conducted to evaluate the influence of alcohol consumption on the risk of ocular trauma. We retrospectively reviewed the medical records of 1,024 patients who visited emergency department and received ophthalmologic examination from January 1 to December 31, 2009. The patients were divided into 2 groups: those with ocular trauma (n = 494) and those without (n = 530); the influence of alcohol consumption was compared between these 2 groups. In the ocular trauma group, the association of the causes and types of ocular trauma with alcohol consumption was evaluated. One of 530 patients of no trauma group and 117 (23.7%) of 494 patients of trauma group were related with alcohol intake, and the difference was statistically significant (P < 0.001). Concerning the causes, physical assault was significantly more common in alcohol-associated injury (P < 0.001). Regarding the types of injury, orbital wall fracture and hyphema showed a significant association with alcohol consumption (P < 0.001). Older age and nighttime injury were significantly related to the increased risk of alcohol-associated ocular trauma (P = 0.018 and < 0.001, respectively). In conclusion, alcohol consumption significantly increases the risk of ocular trauma.

Clinical Manifestation and Predisposing Factors of Infectious Keratitis Following Penetrating Keratoplasty in Korean Patients

PURPOSE: To report the clinical manifestation, predisposing factors, microbiological profiles and treatment outcome of infectious keratitis following penetrating keratoplasty (PK). METHODS: Medical records of the post-PK patients later diagnosed with culture-positive keratitis, between January 2003 and June 2008 at our hospital were retrospectively reviewed. RESULTS: Among 228 eyes of 226 patients who previously had PK, 18 eyes (7.89%) of 16 patients developed microbial keratitis. Fifteen patients had a bacterial infection, of which a Streprococcus species was the most common causative microorganism (6 eyes, 33.3%). Three eyes had fungal infection; one case was co-infected with bacteria. Six eyes (33.3%) presented with a suture-related problem, and sixteen eyes (88.9%) had been using topical glaucoma medications. The suture-related problem and use of glaucoma medication were significantly associated with the development of infectious keratitis (p=0.040 and 0.013, respectively). Remission was achieved in all cases within the mean duration of 2.47 months after treatment initiation. However, visual improvement was not achieved in 11 eyes (68.7%) due to graft opacity. CONCLUSIONS: Early identification of predisposing factors and appropriate management at an early stage may prevent the occurrence of graft infection and improve graft survival.

Presumed Metastasis of Breast Cancer to the Abducens Nucleus Presenting as Gaze Palsy

A 51-year-old woman with breast cancer presented with progressive diplopia. Neuro-ophthalmologic examination revealed right gaze palsy and peripheral facial nerve palsy. Brain magnetic resonance imaging (MRI) was normal. However, two months later a repeat brain MRI revealed an enhancing round nodular mass at the right facial colliculus of the lower pons, at the location of the abducens nucleus. Localized metastasis to the abducens nucleus can cause gaze palsy in a patient with breast cancer.

A Case of Functional Bitemporal Hemianopia Respecting the Vertical Meridian

PURPOSE: To report a case of functional bilateral hemianopia which was not associated with any organic causes. CASE SUMMARY: A 35-year-old female patient presented with bilateral disturbance of visual acuity and visual field, which had begun 8 months prior. Goldmann perimetry showed bitemporal hemianopsia respecting the vertical meridian. Pupillary response was normal, and the anterior segment, fundus, and optic nerve were also normal bilaterally. However, the tangent screen test and Humphrey visual field test showed a widening of hemianopia not respecting the vertical meridian, and the crossing of isopters at 1 m and 2 m with the tangent screen test. In addition, multifocal electroretinogram and multifocal visual evoked potential did not reveal any abnormal findings corresponding to the bitemporal hemianopia. Brain magnetic resonance imaging showed no abnormal findings in the orbit and brain. CONCLUSIONS: Bitemporal hemianopsia can be developed functionally, although it may be rare. Repetition of various visual field tests and use of multifocal electrophysiologic studies can be helpful in the differential diagnosis.

Clinical Aspect of Low Vision Patients due to Macular Degeneration

PURPOSE: To investigate the clinical features of low vision patients due to macular degeneration and to evaluate the efficacy of low vision aids in patients with the disease. METHODS: Out of 283 patients who visited the vision clinic of Seoul National University Hospitalfrom March 2004 to January 2007, the number of patients with macular degeneration was 38. Their medical records were reviewed retrospectively. RESULTS: The study group consisted of 23 male and 15 female patients. The average age was 69.7+/-11.2 years and 34 patients (89.5%) were over 50 years of age. From the visits to the low vision clinic, results showed thenear vision improved in 63%, distant vision in 5.3%, and both in 7.9% of the patients. With the help of low vision aids, near visual acuity of 0.4 or better was achieved in 80% of the patients. Low vision aids were prescribed for near vision in 30 patients and for distant vision in 2 patients. CONCLUSIONS: Near vision can improve in most macular degeneration patients with the use of proper low vision aids. Consistent education and training could promote successful use of the devices.