Relationships Between Choroidal Characteristics and Disease Activity in Acute Central Serous Chorioretinopathy

Purpose@#To investigate choroidal characteristics during active and resolved (presence and absence of subretinal fluid, respectively) central serous chorioretinopathy (CSC), and to clarify their relationships with disease activity. @*Methods@#The choroidal characteristics of 33 CSC and 35 age-matched control eyes were analyzed using optical coherence tomography (OCT). The CSC group included eyes with subretinal fluid at baseline. Horizontal OCT images passing through the macula, and data for age, sex, visual acuity, and refractive error, were acquired. The subretinal fluid height and subfoveal choroidal thickness were measured. The total choroidal area (TCA), luminal choroidal area (LCA), and stromal choroidal area (SCA) were measured using ImageJ software. The choroidal vascularity index (CVI) was defined as the ratio of LCA to TCA. The measurements were repeated after 5.6 months following complete absorption of the subretinal fluid. The choroidal characteristics were compared between the active and resolved phases. @*Results@#The CSC group had significantly greater choroidal thickness, TCA, LCA, and CVI values compared to the control group. The choroidal thickness, TCA, LCA, and SCA were significantly reduced after resolution compared to active CSC. However., the decrease in SCA was greater than that in LCA, which led to a significant increase in CVI (68.6 ± 3.2 vs. 71.6 ± 3.0, p < 0.001) after CSC resolution. @*Conclusions@#CVI measurements may allow estimation of CSC disease activity. TCA, LCA, SCA, and CVI changes may indicate whether the disease is active or resolved, and thus guide CSC treatment.

Comparison of Surgical Outcomes between Conventional Sutured Scleral Fixation and Flanged Intrascleral Intraocular Lens Fixation

Purpose@#We compared the surgical outcomes and complications of conventional, sutured scleral fixation and flanged intrascleral intraocular lens (IOL) fixation. @*Methods@#We retrospectively analyzed the medical records of patients who underwent conventional, sutured scleral fixation or flanged intrascleral IOL fixation and who were then observed for more than 6 months. The best-corrected visual acuity (BCVA), operation time, spherical equivalent (SEQ), astigmatism, and postoperative complications were recorded up to 6 months after surgery. @*Results@#Of sixty-nine enrolled eyes, 39 underwent conventional, sutured scleral fixation (“sutured” group) and 30 flanged intrascleral IOL fixation (“sutureless” group). The operation time was significantly shorter in the sutureless group than in the sutured group (56.3 ± 11.8 vs. 77.7 ± 17.9 minutes, p < 0.001). In both groups, the BCVA and SEQ improved significantly at all visits after surgery compared to the baseline values p < 0.05). There was no between-group difference in BCVA, SEQ, astigmatism, or complications. @*Conclusions@#Compared to conventional, sutured scleral fixation, flanged intrascleral IOL fixation afforded equivalent improvements in visual acuity but with a shorter surgical duration. Therefore, flanged intrascleral IOL fixation is a useful alternative to conventional, sutured scleral fixation.

Variability of Preoperative Angle of Deviation Measured on the Day of Surgery in Intermittent Exotropia

PURPOSE: To evaluate the characteristics and surgical outcomes of children with intermittent exotropia whose preoperative angle of deviation changed on the day of surgery. METHODS: The medical records of 323 children with intermittent exotropia who underwent lateral rectus recession in both eyes were reviewed. The records were classified according to the difference of 8 prism diopters (PD) or more between the largest angle of deviation measured within 3 months prior to the operation and that on the day of surgery into the increased, same, or decreased groups. The frequency, characteristics, and surgical outcomes of each group were analyzed. The surgical amount was determined based on the largest angle of deviation measured at distance within 3 months before surgery. RESULTS: The angle of deviation at distance on the day of surgery was increased in 5 patients (1.5%) and decreased in 6 (1.9%). The near angle was increased in 19 (5.9%) and decreased in 22 (6.8%) patients. The groups in which distant deviation was changed had a greater distant angle and more patients with anisometropia. The group in which near deviation decreased was older than the same group and 81.8% of the patients were school-aged. In the group with changes in either distant or near deviation, the angle on the day of surgery changed toward decreasing disparity of near-distant deviation. On the last follow-up, the rate of overcorrection of 10 PD or more was 13.6% in the decreased near deviation group, which was significantly high (p = 0.039). CONCLUSIONS: The angle of deviation on the day of surgery could be different compared to the largest preoperative angle in some patients with intermittent exotropia. In patients with decreased near deviation, the rate of postoperative overcorrection might be high.

Two Cases with Positive Ice Tests Mimicking Ocular Myasthenia Gravis

PURPOSE: To report two patients with positive ice tests who had diplopia and blepharoptosis caused by something other than ocular myasthenia gravis. CASE SUMMARY: A 35-year-old female presented with a one-week history of inability to adduct the left eye and left blepharoptosis. Although the ice test was positive, serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Brain angiography showed an aneurysm of the left posterior communicating artery, leading to the diagnosis of left pupil-sparing oculomotor nerve palsy. A 25-year-old female presented with an 8-month history of intermittent horizontal diplopia and blepharoptosis in the right eye. The ice test was positive, however serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Anti-nuclear antibody was positive (titer 1:160). CONCLUSIONS: The ice test is a useful screening test for myasthenia gravis. However, a series of differential diagnoses including blepharoptosis and ocular motility disorder should be considered because these conditions also show a positive result in the ice test.