Visual Prognosis and Foveal Reattachment After Reattachment Surgery in Macula-off Retinal Detachment

PURPOSE: To evaluate the visual prognosis and time course of the foveal reattachment according to operation methods and preoperative factors using optical coherence tomography (OCT) after successful reattachment surgery in cases of macula-off rhegmatogenous retinal detachment. METHODS: From Jan 2006 to Aug 2008, 47 patients who underwent retinal reattachment surgery for macula-off retinal detachment who were followed up for more than 12 months were enrolled in this study. Thirty patients underwent vitrectomy, and 17 patients underwent a scleral buckle procedure. Ophthalmological examinations, including best-corrected visual acuity, slit-lamp examination, fundus examination, and OCT, were performed before surgery and at 1, 1.5, 3, 6, and 12 months after surgery. RESULTS: The foveal reattachment time was shorter after vitrectomy than after the buckle procedure (p<0.05). Postoperative visual acuity was better when the height of the detached fovea, as viewed by OCT, was shorter, although foveal reattachment time was not related to visual prognosis. CONCLUSIONS: OCT may help to predict visual outcome and to assess macular changes in patients with macula-off retinal detachment after successful reattachment surgery.

The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy

The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.

Early Results of Femtosecond Laser-Assisted Mushroom-Shaped Wound-Configurized Keratoplasty

PURPOSE: To report the results of femtosecond laser-assisted 'mushroom-shaped wound-configurized keratoplasty' in 6 patients based on the results of experimental models in rabbits' and enucleated porcine eyes. METHODS: Mushroom-shaped donor corneal grafts were designed and transplanted in 3 rabbit eyes and 10 enucleated porcine eyes. The histologic findings were observed and wound burst pressure compared between penetrating keratoplasty (PKP) and mushroom-shaped keratoplasty. The 'mushroom-shaped wound-configurized keratoplasty' was subsequently performed in 6 eyes of 6 patients. RESULTS: In all eyes of the rabbits, histologic findings showed stable wound structure. In the porcine models, mushroom-shaped keratoplasty showed a better resistance to IOP than PKP after complete suture. Patients who underwent the surgery showed an improvement of over 2 lines in Snellen visual acuity after the operation. The mean follow-up period was approximately 11 months. Complete suture removal was performed within 6 months and accurate and stable wound structure was identified. CONCLUSIONS: Wound-configurized keratoplasty with femtosecond laser and mechanical dissection' has shown several advantages in the lamellar structure of the wound. Stable wound structure, less astigmatism, rapid suture removal and visual rehabilitation was achieved.