Myopia Progression of Full Correction and Undercorrection with Myopic Anisometropia

PURPOSE: To investigate the change of refractive error between the full-correction and under-correction treatment groups of myopic anisometropic patients. METHODS: This study included 36 patients who had no amblyopia with myopic anisometropia > 3.00 diopters (D) and less than 6.00 D using the cycloplegic refraction test. The patients were divided into two groups involving the full-correction of both eyes (group 1) or full-correction on the less myopic eye and under-correction with −0.50 D of the more myopic eye (group 2). We monitored refractive changes every 6 months for 24 months. RESULTS: At the first visit, the mean refractive error of the less myopic eye was −0.68 ± 0.54 D and that of the more myopic eye was −4.22 ± 0.77 D in group 1. The mean refractive error of the less myopic eye was −0.75 ± 0.58 D and that of the more myopic eye was −4.36 ± 0.73 D in group 2. There was no significant difference between the groups (p = 0.713 and p = 0.585, respectively). At 24 months, the mean refractive errors of group 1 were −1.27 ± 0.54 D and −4.88 ± 0.81 D, respectively, and that of group 2 were 1.38 ± 0.54 D and −5.59 ± 1.01 D, respectively. The mean refractive error of the less myopic eyes showed no significant difference between both groups (p = 0.555), but that of the more myopic eyes was significantly different (p = 0.027). Between both groups, the degree of anisometropia at 24 months was 3.61 ± 0.60 in group 1 and 4.20 ± 0.86 in group 2. Group 2 showed a significant difference and more severe anisometropic changes (p = 0.022). CONCLUSIONS: Full correction of myopic anisometropia without amblyopia is a better method for reducing the progression of anisometropia.

Analysis of Tear Meniscus Change after Strabismus Surgery Using Optical Coherence Tomography

PURPOSE: In this study, the changes in ocular surface parameters and tear meniscus after strabismus surgery when treated with or without artificial tears were evaluated using optical coherence tomography (OCT). METHODS: The present study included 30 patients who received bilateral lateral rectus recession surgery for exotropia. The patients instilled artificial tear eye drops only in the left eye. Before and 2, 4, 8, and 12 weeks after surgery, tear film break-up time (BUT), Schirmer's test, corneal staining test, tear meniscus height and area were measured using OCT and compared in both eyes. Before and 8 weeks after surgery, conjunctival compression cytology test was performed. RESULTS: The mean patient age was 8.7 years. After 8 weeks, BUT and corneal staining scores were 12.3 ± 1.5 seconds and 1.3 ± 0.4 in patients treated with artificial tears and 9.5 ± 1.0 seconds and 2.0 ± 0.7 in patients not treated with artificial tears (both p < 0.000). Four weeks after surgery, tear meniscus height and area using OCT were 290.2 ± 42.3 µm and 566.7 ± 48.2 pixels in patients treated with artificial tears and 246 ± 45.5 µm and 504.0 ± 29.7 pixels in patients not treated with artificial tears (p = 0.045 and p = 0.019, respectively). Goblet cell count was significantly different between the eyes 8 weeks after surgery (p = 0.033). CONCLUSIONS: Instability of tear meniscus can be detected after strabismus surgery using BUT, Schirmer's test, corneal staining test, tear meniscus height and area, and OCT. After surgery, artificial tears help treat dry eye symptoms by corneo-conjunctival wound healing mechanism and increasing tear meniscus stability.

Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

PURPOSE: To investigate the outcomes of quantitative lens nuclear opalescence change after pars plana vitrectomy and intravitreal gas injection in patients with idiopathic epiretinal membrane and macular hole. METHODS: All patients were divided into two group according to the kinds of injected gases, either Group 1 (fluid/air exchange) or Group 2 (20% SF₆ gas injection). Lens nuclear opalescence according to the classification of Lens Opacities Classification System (LOCS) III, mean nuclear density and maximal nuclear density of Pentacam® scheimpflug image changed by image J, besides refractive errors were evaluated before surgery and 1, 2, 4, 6, and 12 months after surgery. RESULTS: Out of 40 eyes of 40 patients included in the analysis, 21 received only fluid/air exchange (Group 1) and 19 received 20% SF₆ gas injection (Group 2). There were significant changes in lens nuclear opalescence between the study and control (unaffected) eyes. In both groups, the study eyes experienced significant progression of cataract compared with the control eyes, in terms of mean nuclear density, maximal nuclear density and LOCS III. In comparison according to the kinds of injected gases, there was a significant difference in mean nuclear density after 4 months, maximal nuclear density after 2 months and 4 months, LOCS after 2 months and 4 months, and refractive error after 1, 2, 4, and 6 months between both groups (p = 0.003). CONCLUSIONS: After vitrectomy and intravitreal gas injection, changes in postoperative lens nuclear opalescence of the study eyes progressed more rapidly compared with the control eyes. This study identified that lens nuclear opalescence of Group 2 progressed rapidly, but after 12 months there was no significant difference of lens opacity between the kinds of injected gases.

A Retrospective Study of Choroidal Thickness in Children with Unilateral High Myopia

PURPOSE: To compare the choroidal thickness of unaffected and affected eyes in children with unilateral high myopia when measured using enhanced depth imaging and to analyze the relationship among choroidal thickness and axial length, spherical equivalent and best corrected visual acuity (BCVA). METHODS: Twenty children with high unilateral high myopia who received optical coherence tomography from December 2012 to May 2014 were retrospectively analyzed. Choroidal thickness was measured with a caliper at 500 microm apart from fovea superiorly and inferiorly, 2,500 microm apart nasally and at 2,500 microm apart temporally at 500 microm intervals. For statistical analyses, paired t-test was used for choroidal thickness and linear regression analysis for the relationship among choroidal thickness and axial length, spherical equivalent and BCVA. RESULTS: The patients were 10.4 +/- 3.5 years of age and the average BCVA of myopic eye was 0.38 +/- 0.2. Mean spherical equivalent was -9.8 +/- 1.9D. The choroidal thickness was significantly thinner in the myopic eye (102.5 +/- 16.9 microm) than the fellow eye (282.9 +/- 14.0 microm). The thickest choroid in the myopic eye was the temporal and the thinnest was the nasal area (p = 0.008). Choroidal thickness was significantly associated with axial length and spherical equivalent but not BCVA. CONCLUSIONS: Highly myopic eyes tend to have thinner choroidal thickness than the fellow eyes and choroidal thickness tends to be thicker temporally. Therefore, several anatomical changes in unilateral highly myopic children may exist.

Successful Treatment of Infectious Scleritis by Pseudomonas aeruginosa with Autologous Perichondrium Graft of Conchal Cartilage

Infectious scleritis by Pseudomonas aeruginosa is a well-known vision-threatening disease. In particular, scleral trauma following pterygium surgery may increase the risk of sclera inflammation. Surgical debridement and repair is necessary in patients who do not respond to medical treatments, such as topical and intravenous antibiotics. We reports herein the effectiveness of an autologous perichondrium conchal cartilage graft for infectious scleritis caused by Pseudomonas aeruginosa. This procedure was performed on four eyes of four patients with infectious scleritis who had previously undergone pterygium surgery at Gyeongsang National University Hospital (GNUH), Jinju, Korea from December 2011 to May 2012. Pseudomonas aeruginosa was identified in cultures of necrotic scleral lesion before surgery. The conchal cartilage perichondrium graft was transplanted, and a conjunctival flap was created on the scleral lesion. The autologous perichondrium conchal cartilage graft was successful and visual outcome was stable in all patients, with no reports of graft failure or infection recurrence. In conclusion, autologous perichondrium conchal cartilage graft may be effective in surgical management of Pseudomonal infectious scleritis when non-surgical medical treatment is ineffective. Further studies in larger, diverse populations are warranted to establish the effectiveness of the procedure.

Clinical Manifestations of Ocular Syphilis Combined with Neurosyphilis

PURPOSE: To report the manifestation of ocular syphilis combined with neurosyphilis in patients who present with uveitis clinically and are diagnosed initially by an ophthalmologist. METHODS: This study is a retrospective, clinical investigation of seven male patients with ocular syphilis from a single tertiary center between 2009 and 2012. RESULTS: The average age of the patients at onset was 44.4 years (range, 33-71 years). Posterior segment involvement was found in all patients. Two patients had papillitis. In serologic testing, all patients had positive responses to Venereal Disease Research Laboratory (VDRL), fluorescent treponemal antibody-absorption test (FTA-ABS) and Treponema pallidum hemagglutination (TPHA). In fluorescein angiography (FAG), retinal vascular and disc leakage was the most common finding. Cerebrospinal fluid (CSF) analysis was performed for six patients and demonstrated positive CSF FTA-ABS and CSF TPHA tests in all patients. CSF VDRL was reactive in 2 patients (33.3%). CONCLUSIONS: All patients with ocular syphilis were diagnosed with neurosyphilis based on the analysis of CSF with FTA-ABS and TPHA. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis.

The Change of Anterior Chamber Parameters with Pentacam(R) after Intravitreal Injection

PURPOSE: To evaluate the changes of anterior chamber parameters and intraocular pressure (IOP) with Pentacam(R) after intravitreal injection. METHODS: A total of 76 eyes of 76 patients received an intravitreal injection of either triamcinolone acetonide (TA) or bevacizumab. Twelve patients were treated with an intravitreal injection of TA 0.1 ml, 16 patients were treated with an intravitreal injection of TA 0.05 ml, while the remaining 48 patients received a bevacizumab 0.05 ml injection. All patients underwent anterior chamber depth, anterior chamber angle, and anterior chamber volume evaluation with Pentacam(R) before and 5 minutes after injection. Additionally, IOP measurements were taken 5 minutes before and 5 minutes, 30 minutes, 1 hour and 1 day after injection. RESULTS: Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving TA 0.1 ml were 0.4 +/- 0.11 mm, 10.2 +/- 4.1degrees, 33.7 +/- 5.9 mm3 and 18.8 +/- 12.1 mm Hg, respectively. Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving TA 0.05 ml were -0.01 +/- 0.05 mm, 2.4 +/- 3.2degrees, 5.8 +/- 9.5 mm3 and 4.8 +/- 7.4 mm Hg, respectively. Anterior chamber depth, anterior chamber angle, anterior chamber volume, and IOP changes in patients receiving bevacizumab were 0.28 +/- 0.99 mm, 0.8 +/- 4.0degrees, 7.1 +/- 9.6 mm3 and 5.4 +/- 6.3 mm Hg, respectively. There was a significant difference between TA 0.1 ml and 0.05 ml. However, there was no significant difference between TA 0.05 ml and bevacizumab 0.05 ml. CONCLUSIONS: Because of similar anterior chamber parameters changes after 0.05 ml intravitreal injection with TA or bevacizumab, early period IOP increases due to intravitreal volume expansion. Intravitreal 0.05 ml injections do not require any other procedures for controlling IOP 30 minutes after injection.

A Case of Chronic Dacryocystitis Caused by Achromobacter Xylosoxidans

PURPOSE: To report a case of chronic dacryocystitis caused by Achromobacter xylosoxidans. CASE SUMMARY: A 73-year-old female was referred to our clinic for management of chronic dacryosyctitis from which she did not to recover despite empirical therapy. A. xylosoxidans was isolated from purulent discharge. Based on the results of susceptibility testing, therapy was changed to fortified ceftazidime eye-drop 6 times a day and intravenous tazocin 4.5 g/20 ml (piperacillin 2 g/tazobactam 0.25 g) 3 times a day. All symptoms were resolved after treatment with sensitive antibiotics and external dacryocystorhinostomy. CONCLUSIONS: To our knowledge, this is the first report of A. xylosoxidans dacryocystitis. A. xylosoxidans are rare but potential pathogens which cause dacryocystitis. The cultures and sensitivity test were collected and processed to detect the presence of unusual pathogens in a case with persistent infection despite conventional treatment.

A Case of Fungal Keratitis Caused by Drechslera Species

PURPOSE: To report a case of fungal keratitis caused by Drechslera species. CASE SUMMARY: A 77-year-old man visited our clinic complaining of left ocular pain and decrease of visual acuity for 1 week On slit-lamp examination, epithelial defect and stromal infiltration on the corneal center with numerous inflammatory cells in the anterior chamber were found. There was no improvement after routine antibiotic treatment. A corneal biopsy and culture were performed on the corneal lesion. The KOH smear study reported hyphae, thus the patient was treated with 0.25% amphotericin B, 0.2% fluconazole and 5% natamycin eye drops. A clinical improvement was observed on the corneal lesion and Drechslera species was identified by the culture study. CONCLUSIONS: The authors report an experience of fungal keratitis caused by Drechslera species.

Effects of Mitomycin C on Eyelash-Regrowth in Epilated Rats

PURPOSE: The aim of the present study was to determine the effects of mitomycin C (MMC) on eyelash regrowth in rats. METHODS: Ten rats were subjected to bilateral eyelid epilation. One drop of 0.04% MMC solution and one drop of normal saline was then administered to the right and left eyelid, respectively. Three months post-epliation, the number of regrown eyelashes was counted, and a section of tissue from each eyelid was examined under light- and electron microscopies. RESULTS: The number of regrown long eyelashes was 1.0 +/- 0.81 on the right, and 12.5 +/- 1.08 on the left. The rate of regrowth was 7.35 +/- 5.55% on the right and 98.45 +/- 3.27% on the left. Histological examination revealed no significant differences between the right and left eyelids, except for the absence of any hair shafts in the follicles on the right. However, electron microscopy revealed mitochondrial damage in the follicles of the right eyelid. These changes were not observed in tissue from the left eyelid. CONCLUSIONS: The application of 0.04% MMC inhibited the regrowth of normal eyelashes in rats following simple epilation. These results suggest that MMC may be a novel therapy for replacing invasive surgery in trichiasis with no malpositioning.

A Case of Low Grade Malignant Fibrous Histiocytoma in Lateral Canthus

PURPOSE: To report a case of malignant fibrous histiocytoma of the lateral canthal area that was diagnosed clinically as a benign epidermal inclusion cyst. CASE SUMMARY: A 49 year-old man presented with a cutaneous mass involving the lateral canthal area. A 0.7-cm cystic lesion was freely movable and non-inflamed. After excisional biopsy, the results of immunohistochemical staining led to a final diagnosis of low-grade malignant fibrous histiocytoma. The specimen from excisional biopsy had margins positive for malignancy; the patient underwent a second procedure for complete resection, and that specimen had tumor-free margins. CONCLUSIONS: Fibrous histiocytoma is a rare disease but may occur in the eyelid. Therefore, when an eyelid tumor progresses rapidly, malignant fibrous histiocytoma should be considered as a diagnosis.