A Case of Ophthalmic Artery Occlusion Following Subcutaneous Injection of Epinephrine Mixed with Lidocaine into the Supratrochlear Area

No abstract available.

Scleral Buckling Using a Non-contact Wide-Angle Viewing System with a 25-Gauge Chandelier Endoilluminator

PURPOSE: To report the outcome of scleral buckling using a non-contact wide-angle viewing system with a 25-gauge chandelier endoilluminator. METHODS: Retrospective analyses of medical records were performed for 17 eyes of 16 patients with primary rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy who had undergone conventional scleral buckling with cryoretinopexy using the combination of a non-contact wide-angle viewing system and chandelier endoillumination. RESULTS: The patients were eight males and five females with a mean age of 26.8 ± 10.2 (range, 11 to 47) years. The mean follow-up period was 7.3 ± 3.1 months. Baseline best-corrected visual acuity was 0.23 ± 0.28 logarithm of the minimum angle of resolution units. Best-corrected visual acuity at the final visit showed improvement (0.20 ± 0.25 logarithm of the minimum angle of resolution units), but the improvement was not statistically significant (p = 0.722). As a surgery-related complication, there was vitreous loss at the end of surgery in one eye. As a postoperative complication, increased intraocular pressure (four cases) and herpes simplex epithelial keratitis (one case) were controlled postoperatively with eye drops. One case of persistent RRD after primary surgery needed additional vitrectomy, and the retina was postoperatively attached. CONCLUSIONS: Scleral buckling with chandelier illumination as a surgical technique for RRD has the advantages of relieving the surgeon's neck pain from prolonged use of the indirect ophthalmoscope and sharing the surgical procedure with another surgical team member. In addition, fine retinal breaks that are hard to identify using an indirect ophthalmoscope can be easily found under the microscope by direct endoillumination.

Results of the 2015 Questionnaire Survey of the Korean Retina Society: Current Trends in the Treatment of Vitreoretinal Diseases

PURPOSE: To report the results of the 2015 questionnaire survey of current trends and practice patterns in the treatment of vitreoretinal diseases, which was conducted by the Korean Retina Society (KRS). METHODS: In October 2015, members of the KRS participated in a survey of current trends and practice patterns in the treatment of vitreoretinal diseases. This survey was comprised of 68 multiple choice and dichotomy questions. RESULTS: One hundred eleven (41%) members participated in this survey. Most respondents (42%) had begun their vitreoretinal subspecialty ≤7 years previously, 32% had practiced for 8-15 years, and 26% for 16 years or more. The preferred primary treatment for newly diagnosed wet-type age-related macular degeneration was ranibizumab or aflibercept, and most clinicians (68%) favored a pro re nata regimen. Seventy percent of respondents treated injection-related endophthalmitis using a combination of immediate vitrectomy and intravitreal antibiotic injection. Bevacizumab was the most commonly (78-87%) preferred first-line therapy for macular edema (ME) secondary to central retinal vein occlusion or branch retinal vein occlusion. When ME did not respond to anti-vascular endothelial growth factor treatment, most respondents (91%) switched patients to dexamethasone implant or triamcinolone acetonide. Eighty-four percent of the respondents performed scleral buckling during retinal detachment surgery in fewer than 40% of cases. Also, most respondents (96%) prescribed an antibiotic eye drop after, or before and after intravitreal drug injection. CONCLUSIONS: This survey reflected the recent trends and practice patterns in the treatment of vitreoretinal diseases in Korea.

Ocular Inflammation Associated with Systemic Infection / 한양의대학술지

Systemic infections that are caused by various types of pathogenic organisms can be spread to the eyes as well as to other solid organs. Bacteria, parasites, and viruses can invade the eyes via the bloodstream. Despite advances in the diagnosis and treatment of systemic infections, many patients still suffer from endogenous ocular infections; this is particularly due to an increase in the number of immunosuppressed patients such as those with human immunodeficiency virus infection, those who have had organ transplantations, and those being administered systemic chemotherapeutic and immunomodulating agents, which may increase the chance of ocular involvement. In this review, we clinically evaluated posterior segment manifestations in the eye caused by hematogenous penetration of systemic infections. We focused on the conditions that ophthalmologists encounter most often and that require cooperation with other medical specialists. Posterior segment manifestations and clinical characteristics of cytomegalovirus retinitis, endogenous endophthalmitis, toxoplasmosis, toxocariasis, and ocular syphilis are included in this brief review.

Prevalence and Risk Factors of Early-Stage Age-Related Macular Degeneration in Patients Examined at a Health Promotion Center in Korea

We evaluated the prevalence and risk factors for early age-related macular degeneration (AMD) in Koreans 50 yr of age or older who were examined at a single health promotion center. We retrospectively reviewed the records of 10,449 subjects who visited the center over a 6-month period. Fundus photography was performed on all subjects, and systematic risk factor analysis was conducted using a structured questionnaire. All patients (n = 322) were initially diagnosed with drusen or early AMD using fundoscopy; the control group (n = 10,127) were those yielding normal fundoscopy findings. The age- and gender-adjusted prevalence of early AMD was 3.08%. Advanced age, male gender, smoking status, hyperlipidemia, working outdoors, and residence in rural areas were all significantly associated with an increased risk for development of early AMD. Higher-level ingestion of fruit or herbal medication and an increased amount of exercise were associated with a lower risk of early AMD development. In our Korean cohort, consisting principally of relatively healthy, middle-class urban adults, the prevalence of early AMD was 3.08% that is similar to that reported in earlier epidemiological studies. Several modifiable risk factors such as smoking and hyperlipidemia are associated with the prevalence of early AMD in our cohort.

Glaucoma Progression Detection by Retinal Nerve Fiber Layer Measurement Using Scanning Laser Polarimetry: Event and Trend Analysis

PURPOSE: To evaluate the use of scanning laser polarimetry (SLP, GDx VCC) to measure the retinal nerve fiber layer (RNFL) thickness in order to evaluate the progression of glaucoma. METHODS: Test-retest measurement variability was determined in 47 glaucomatous eyes. One eye each from 152 glaucomatous patients with at least 4 years of follow-up was enrolled. Visual field (VF) loss progression was determined by both event analysis (EA, Humphrey guided progression analysis) and trend analysis (TA, linear regression analysis of the visual field index). SLP progression was defined as a reduction of RNFL exceeding the predetermined repeatability coefficient in three consecutive exams, as compared to the baseline measure (EA). The slope of RNFL thickness change over time was determined by linear regression analysis (TA). RESULTS: Twenty-two eyes (14.5%) progressed according to the VF EA, 16 (10.5%) by VF TA, 37 (24.3%) by SLP EA and 19 (12.5%) by SLP TA. Agreement between VF and SLP progression was poor in both EA and TA (VF EA vs. SLP EA, k = 0.110; VF TA vs. SLP TA, k = 0.129). The mean (+/-standard deviation) progression rate of RNFL thickness as measured by SLP TA did not significantly differ between VF EA progressors and non-progressors (-0.224 +/- 0.148 microm/yr vs. -0.218 +/- 0.151 microm/yr, p = 0.874). SLP TA and EA showed similar levels of sensitivity when VF progression was considered as the reference standard. CONCLUSIONS: RNFL thickness as measurement by SLP was shown to be capable of detecting glaucoma progression. Both EA and TA of SLP showed poor agreement with VF outcomes in detecting glaucoma progression.

Macular Gradient Measurement in Myopic Posterior Staphyloma Using Optical Coherence Tomography

PURPOSE: To evaluate clinical characteristics and the macular gradient in myopic posterior staphyloma with time domain (TD) optical coherence tomography (OCT). METHODS: Sixty-four staphyloma eyes of 40 patients were examined. Macular gradient (tangent theta) and the location of staphyloma were assessed with OCT imaging. The macular gradient was measured at points 1 mm and 2 mm distant from the fovea. The relationships of the macular gradient with age, axial length, and spherical equivalent were analyzed. RESULTS: In 8 eyes (12.5%), the bottoms of the staphylomas were in the fovea, and there was no macular gradient. However, in the other 56 eyes (87.5%), the bottoms of the staphylomas were not in the foveal area, and macular gradients existed. Staphylomas were commonly located in the infero-nasal retinal area. The mean macular gradient (tangent theta) was 0.26 +/- 0.08 at 1 mm distance from the fovea and 0.28 +/- 0.10 at 2 mm. No significant relationships were observed between macular gradient and axial length, patient age, or spherical equivalent. CONCLUSIONS: TD OCT reveals staphyloma location. If the location is outside of the fovea, a macular gradient exists and can be measured by OCT. Axial length measurement error may occur in eyes with poor visual fixation and steep macular gradients.

Long-term Clinical Outcomes of Femtosecond LASER-Assisted Descemet's Stripping Endothelial Keratoplasty

PURPOSE: To evaluate the long-term clinical outcomes of femtosecond LASER-assisted Descemet's stripping endothelial keratoplasty (DSEK). METHODS: The clinical results of endothelial keratopathy from 11 consecutive patients who were followed up for at least 12 months after femtosecond LASER-assisted DSEK were retrospectively analyzed. The best corrected visual acuities (BCVA), manifest refractions, intraocular pressures, and perioperative complications were evaluated preoperatively and up to 24 months after the femtosecond LASER-assisted DSEK. RESULTS: The average follow-up period was 18 months. Postoperative visual acuity had significantly improved from 1.26 (logMAR) to 0.80 (logMAR) at 3 months (p < 0.05) and this change was maintained during postoperative follow-up. All eyes underwent successful transplantation and the donor discs were well-attached. The mean endothelial cell density continued to decrease during the follow-up period. The donor-recipient stromal interface was the area where varying degree of haziness and birefringent particles were found. CONCLUSIONS: The femtosecond LASER-assisted DSEK was effective in creating an endothelial donor disc which resulted in rapid visual recovery and low surgically-induced astigmatism. However, the operation caused rapid decrease in endothelial cell density which requires continuing further consideration by the physician.

Characterization of Peripapillary Atrophy Using Spectral Domain Optical Coherence Tomography

PURPOSE: To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT). METHODS: SD-OCT imaging of the optic disc was performed on healthy eyes, eyes suspected of having glaucoma, and eyes diagnosed with glaucoma. From the peripheral beta-zone, the retinal nerve fiber layer (RNFL), the junction of the inner and outer segments (IS/OS) of the photoreceptor layer, and the Bruch's membrane/retinal pigment epithelium complex layer (BRL) were visualized. RESULTS: Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA beta-zone of all eyes, and no eye showed an IS/OS complex in the beta-zone. The BRL was absent in the beta-zone of two eyes. The BRL was incomplete or showed posterior bowing in the beta-zone of five eyes. CONCLUSIONS: The common findings in the PPA beta-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the beta-zone areas.