Bilateral Ophthalmic Artery Occlusion in Rhino-Orbito-Cerebral Mucormycosis

PURPOSE: To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. METHODS: Reviewed clinical charts, photographs, and fluorescein angiography RESULTS: An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. CONCLUSIONS: Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.

Bilateral Ophthalmic Artery Occlusion in Rhino-Orbito-Cerebral Mucormycosis

PURPOSE: To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. METHODS: Reviewed clinical charts, photographs, and fluorescein angiography RESULTS: An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. CONCLUSIONS: Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.

Clinical Manifestation in Rhino-Orbito-Cerebral Mucormycosis

PURPOSE: To report upon several cases of rhino-orbito-cerebral mucormycosis with variable clinical manifestations including ocular symptoms. METHODS: We documented three patients with rhino-orbital-cerebral mucormycosis and uncontrolled diabetes. RESULTS: The patients presented variable ophthalmic symptoms including blepharoptosis, ophthalmoplegia, visual disturbance, visual field defect and ocular pain. Despite administration of an antifungal agent within two days, all of the patients died. CONCLUSIONS: We reported the cases of three patients with rhino-orbito-cerebral mucormycosis presenting ophthalmic symptoms with a literature review. Variable initial symptoms were emphasized in making diagnosis of rhino-orbito-cerebral mucormycosis.

Factors Influencing Optic Disc and Retinal Nerve Fiber Layer Parameters Measured by Optical Coherence Tomography

PURPOSE: To determine the factors influence retinal nerve fiber layer (RNFL) and optic nerve head (ONH) parameters measured by Stratus optical coherence tomography (OCT). METHODS: Topographic RNFL thickness and optic disc parameters of 129 healthy Korean subjects of aged 14 to 87 were measured using the fast retinal nerve fiber layer thickness and fast optic disk algorithms of Stratus OCT. One eye of each subject was randomly selected for statistical analysis. Using multiple linear regression, the effect of optic disc area, age, refractive error, and zone beta on each parameter was analyzed. RESULTS: Large discs had large horizontal integrated rim width (HIRW), cup area, rim area, C/D area ratio, and vertical C/D ratio. The thickness of average, superior, inferior, and nasal quadrant RNFL increased significantly with an increase in optic disc area. Average and superior quadrant RNFL thickness, and HIRW decreased with age. Refractive error showed a correlation with the vertical integrated rim area, horizontal C/D ratio, and temporal quadrant RNFL thickness. Gender and zone beta had no statistically significant influence on ONH and RNFL parameters. CONCLUSIONS: This study shows that optic disc size affects most RNFL thickness and ONH parameters. Because of the relationships revealed in this study, optic disc area in addition to age should be considered when the Stratus OCT RNFL thickness and ONH parameters are interpreted.

Discrimination between Normal and Early Stage of Glaucomatous Eyes Using the Stratus Optical Coherence Tomography

PURPOSE: To evaluate the diagnostic ability of Stratus optical coherence tomography (OCT) parameters to distinguish normal eyes from those with early glaucomatous visual field defects. METHODS: One eye each of 52 normal-tension glaucoma patients with early visual field defects (mean deviation, -3.98+/-1.30dB; range, -0.01 to -5.86dB) and 88 age-matched normal subjects were enrolled. The Peripapillary retinal nerve fiber layer (RNFL) and optic nerve head regions were scanned using the Stratus OCT. Areas under the receiver operating characteristic curve (AROC) and the sensitivity and specificity for various OCT parameters were used to assess the performance of OCT. RESULTS: The AROC for the C/D area ratio was 0.865. Other high AROC values included the vertical C/D ratio (0.848), the average RNFL thickness (0.813), and the RNFL thickness in the inferior quadrant (0.791). A stepwise discriminant analysis found that a combination of the C/D area ratio and RNFL thickness in the inferior quadrant could correctly identify 86.4% of the normals and 80.8% of the glaucoma patients (AROC=0.893). CONCLUSIONS: In our sample of patients with early visual field defects, Stratus OCT parameters showed moderate discriminating abilities. Combining the C/D area ratio and RNFL thickness in the inferior quadrant by discriminant analysis improved the diagnostic ability to detect glaucoma.

Optic Nerve Head Appearance in Chronic Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma

PURPOSE: To evaluate the morphologic characteristics of the optic nerve head in chronic primary angle-closure glaucoma (CPACG) and primary open-angle glaucoma (POAG). METHODS: The study included 77 normal subjects, 82 patients with CPACG, and 120 patients with POAG. Age and refraction in the POAG and normal control groups were matched to those of the CPACG group. Using color optic disc photographs, the presence or absence of qualitative signs for differentiating between normal and glaucoma eyes were recorded. RESULTS: A rim notch was observed in 9 eyes (11.0%) in the CPACG group and in 27 eyes (22.5%) in the POAG group (P=0.04). Disc hemorrhage was found in 4 eyes (3.3%) in the POAG group and was not found in the CPACG group (P=0.15). Neither groups varied significantly in frequency of rim shape alteration (alteration of ISN'T rule), thinnest rim width outside the temporal sector, baring of the circumlinear vessel, bayonetting of vessel, nasalization of vessel, abnormally large peripapillary atrophy, abnormal form of peripapillary atrophy, or zone beta. CONCLUSIONS: Compared with the CPACG group, rim notches and disc hemorrhages were found more often in the POAG group. These results suggest that CPACG and POAG have at least partially different pathogenesis.

LASIK of Customized Microkeratomy by Selection of Microkeratome Heads

PURPOSE: To compare the intraoperative and postoperative complication rates and visual outcomes with M2 130 head (thick flap group) and M2 110 head (thin flap group). METHODS: One-hundred-ninety-five eyes of 104 patients who underwent LASIK with the Moria M2 microkeratome and Allegretto-wave laser were reviewed retrospectively. Selection of M2 heads was based on preoperative pachymetry and estimated ablation depth. Intraoperative and postoperative flap-related complications, mean postoperative uncorrected visual acuity (UCVA), and mean spherical equivalent (MSE) were evaluated and compared. RESULTS: Mean follow-up was 8.1 months. The number of eyes, preoperative MSE and mean corneal thickness of M2 130 were 115, -4.04+/-1.63diopter (D) and 549.40+/-39.16 micrometer, and 85, -6.61+/-3.43D and 525.16+/-24.53 micrometer, respectively, in the 110 head group. Mean UCVA and MSE at postoperative 1 week, 3 months and 6 months were 1.00+/-0.18, -0.26+/-0.49D; 1.07+/-0.68, -0.40+/-0.51D; and 1.01+/-0.22, -0.51+/-0.50D, respectively, in the 130 head group, and 0.90+/-0.23, -0.46+/-1.02D; 0.91+/-0.23, -0.67+/-0.79D; 0.85+/-0.46, -0.75+/-0.88D, respectively, in the 110 head group. There were no significant differences in intraoperative and postoperative flap-related complication rates between the two groups (p=0.316). There were no statistically significant differences in postoperative mean UCVA or MSE between the two groups (p>0.05), except for MSE at the third and sixth postoperative months (p=0.005, 0.013). CONCLUSIONS: Proper selection of M2 heads by preoperative pachymetry allowed for an adequate residual stroma bed with good visual outcome. Utilizing one single microkeratome and switching between two heads was advantageous and cost-effective.

Glaucomatous Optic Nerve Damage in the Fellow Eyes of Acute Angle-Closure Glaucoma

PURPOSE: To determine whether glaucomatous optic nerve damage occurs in the fellow eyes of patients with unilateral acute primary angle-closure glaucoma. METHODS: This study included both eyes of 75 subjects with unilateral acute primary angle-closure glaucoma in one eye, and 92 eyes of age- and refraction-matched normal controls. The presence or absence of qualitative signs for differentiating between normal and glaucoma eyes, vertical cup to disc ratio, and extent of zone beta were recorded. All subjects underwent examination with a Humphrey Field Analyser. RESULTS: Twelve fellow eyes (16%), 28 attacked eyes (37.3%), and no eyes in the control group had a vertical cup to disc ratio of 0.7 or greater (p<0.05). Thinnest rim width outside the temporal sector, rim shape alteration (alteration of ISN'T rule), baring of circumlinear vessel, and abnormal form of peripapillary atrophy were detected more frequently in fellow eyes than in normal controls (P<0.05). After excluding the attacked eyes with vertical cup to disc ratios of 0.69 or less and their fellow eyes, interocular correlation of mean deviation (r=0.31), corrected pattern standard deviation (r=0.32), extent of zone beta (r=0.57), and vertical cup to disc ratio (r=0.38) for attacked and fellow eyes were significant (p<0.05). CONCLUSIONS: Some of the fellow eyes of patients with unilateral acute primary angle-closure glaucoma had glaucomatous optic nerve damage, particularly the fellow eyes with a large cup to disc ratio.

The Factors Related with Epithelial Healing after Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the factors that contribute to protraction of epithelial damage after vitrectomy for proliferative diabetic retinopathy (PDR). METHODS: We retrospectively studied factors that may be related to protraction of epithelial damage and recovery time after epithelial damage in 76 eyes of 66 patients who underwent vitrectomy for PDR in our hospital between August 2003 and August 2004. The 76 eyes in this study were divided into two groups: 17 eyes (22.4 %) with epithelial damage persisting for more than 14 days after vitrectomy (protracted group) and 59 eyes (77.6 %) without epithelial damage or signs of epithelial damage that disappeared in less than 13 days after vitrectomy (non-protracted group). We compared factors that may be related to protraction of epithelial damage and recovery time from epithelial damage between the two groups. RESULTS: The average recovery time from epithelial damage was 45.7+/-26.6 days in the protracted group and 2.6+/-2.4 days in the non-protracted group. Intraoperative epithelial debridement significantly delayed epithelial healing in the protracted group (P<0.05). The level of BUN, insulin use, and epithelial defect during surgery were correlated with the duration of epithelial damage (P<0.05). CONCLUSIONS: Our results show that protracted recovery from epithelial damage after vitrectomy for PDR is correlated with impaired renal function, the method of treatment, and epithelial debridement. Therefore, particular attention should be paid to corneal epithelial damage in patients with these factors.

Photodynamic Therapy with Verteporfin for Anterior Segment Neovascularization in Neovascualr Galucoma

PURPOSE: To evaluate photodynamic therapy (PDT) with verteporfin for iris and angle neovascularization in eyes with neovascular glaucoma. METHODS: We treat a patient who had neovascular glaucoma with iris and angle neovacularization and showed reduction of intraocular pressure (IOP) and the obliteration of neovascularization after PDT. PDT was performed following the treatment parameters used in age-related macular degeneration. The laser was directed at the anterior chamber angle and iris surface using a Goldmann three-mirror contact lens. Follow-up examination was performed 1, 2, 3, 5, 7, and 8 weeks after PDT, and included visual acuity, IOP, and iris fluorescein angiography (7 weeks after PDT). RESULTS: Two months after PDT, we observed a reduction of IOP and the improvement of iris fluorescein leakage. IOP diminished considerably after 1 week, and showed subsequent tendency toward stabilization without additional antiglaucoma medicine. CONCLUSIONS: Photodynamic therapy can be used safely and effectively in the early phase of neovascular glaucoma to achieve the obliteration of iris and angle neovascularization and induce IOP reduction.