Validation and Reliability of the Cataract-related Visual Function Questionnaire (CVFQ)

Purpose@#To evaluate the reliability and validity of the Cataract-related Visual Function Questionnaire (CVFQ). @*Methods@#A prospective cross-sectional study of 141 cataract patients was conducted from March 2022 to June 2022. The questionnaire was created based on a literature review and advice from an expert panel. This study determined its construct validity, criterion validity, internal consistency, and test-retest reliability. @*Results@#The CVFQ consists of 15 items distributed among five categories: overall visual quality, overall visual function, distance vision, near vision, and glare. In the exploratory factor analysis of validity, the first three principal components explained 77.8% of the variance. The p-values in the Spearman correlation test comparing the pre- and postoperative total CVFQ score and best-corrected visual acuity (BCVA) were 0.006 and 0.004, respectively. In the reliability analysis, Cronbach’s alpha was > 0.9 for internal consistency and the p-values of each subcategory were all significant in the analysis of test-retest reliability. @*Conclusions@#Our results indicate that the CVFQ is useful for measuring the visual quality and visual function of cataract patients in Korea.

Persistent Epithelial Defects Caused by Limbal Deficiency for Various Causes

Purpose@#We report the process of treating persistent corneal epithelial defects due to limbal deficiency in a patient who underwent surgery for ptosis, recurrent pterygium, and senile cataract for 3 weeks.Case summary: A 65‐year‐old male patient underwent cataract surgery 4 months ago and visited this hospital with persistent inflammation of the left cornea that started 2 months ago. The patient underwent blepharoplasty and pterygium surgery at the same time 3 weeks before cataract surgery. At the first visit, severe conjunctival injection and an oval‐shaped corneal epithelial defect with a size of 3 × 5 mm in the center of the cornea were seen. As the result of the eyelid eversion test, fibrotic scar tissue due to the non‐absorbable suture used during the upper eyelid blepharoplasty was observed and surgically removed. The corneal epithelial defect site became smaller, but the atrophy of the corneal stroma was sustained, and the amniotic membrane was tripled and permanent amniotic membrane transplantation was performed. Corneal epithelial defects have improved with postoperative best‐corrected visual acuity of 0.15. @*Conclusions@#Sufficient recovery period between serial multiple surgeries is required to reduce the occurrence of complications like persistent epithelial defects.

Long-term Outcome and Predictors of Silicone Tube Intubation for Patients with Nasolacrimal Duct Obstruction

Purpose@#To evaluate the long-term outcome and prognostic factors according to the degree of obstruction after silicone tube intubation in patients with nasolacrimal duct obstruction (NLDO). @*Methods@#From March 2016 to July 2020, the medical records of 145 eyes of 107 patients with NLDO who underwent silicone tube intubation and had been followed for more than 6 months were analyzed retrospectively. The preoperative lacrimal irrigation and degree of obstruction were classified into three groups, and the surgery outcome was also evaluated. Successful surgery was defined as a case in which the epiphora improved, the height of the tear meniscus decreased, and there was no reflux in the postoperative lacrimal irrigation. Risk factors for recurrence were analyzed using a Cox proportional hazards model and Kaplan-Meier survival analysis. @*Results@#Surgery was successful in 99 eyes (68.3%), while recurrence occurred in 46 eyes (31.7%) after silicone tube removal. The average follow-up period was 23.09 months. The recurrence rate was 30.4%, 29.3%, and 50.0% for functional, partial, and total NLDO, respectively, and did not differ significantly (p = 0.300). The risk of recurrence was higher at older age (adjusted hazard ratio [aHR] = 1.079, p < 0.001) and with a history of facial palsy (aHR = 4.031, p = 0.019), and was lower in the functional NLDO group than in the total NLDO group (aHR = 0.368, p = 0.040). In the Kaplan–Meier survival analysis, the total NLDO group differed significantly from the functional NLDO group (log-rank, p = 0.011). @*Conclusions@#Age, a history of facial palsy, and the degree of preoperative obstruction were associated with the prediction of recurrence after silicone tube intubation in patients with NLDO.

Occlusion of Multiple Branches of the Ophthalmic Artery after Injection of Triamcinolone into the Nasal Septum

Purpose@#We report a case of visual loss caused by occlusion of multiple branches of the ophthalmic artery after triamcinolone injection into the nasal septum.Case summary: A 62-year-old male was referred to our ophthalmology clinic because of marked loss of vision in the right eye immediately after triamcinolone injection into the nasal septum. His corrected visual acuity was hand motion in the right eye and the intraocular pressure was 20 mmHg. His pupil was mid-dilated, fixed, and did not respond to light. Fundus examination revealed multiple, white steroidal emboli in the terminal retinal artery and capillaries. Fundus photography revealed macular edema, ischemic retinal whitening, and a cherry-red spot in the posterior pole of the retina. Optical coherence tomography (OCT) revealed inner-layer whitening and swelling and OCT-angiography revealed reduced numbers of terminal capillaries and a low vascular density. Anterior chamber paracentesis and ocular massage were immediately performed. Wide fluorescein angiography revealed diffuse choroidal hypofluorescence in the early phase and fluorescein leakage around the posterior pole in the late phase. Visual acuity improved to 1.0, but retinal whitening was still evident below the macula on fundus examination 3 months after symptom onset. @*Conclusions@#Multiple branches of the ophthalmic artery may become occluded after an intranasal, septal triamcinolone injection. The condition improves with immediate management.

Clinical Features of Patients with Opacification of Hydrophilic Acrylic Intraocular Lens in Neovascular Glaucoma

Purpose@#To report the clinical features of patients with opacification of hydrophilic acrylic intraocular lens (IOL) after cataract surgery in neovascular glaucoma. @*Methods@#This retrospective case series included 11 eyes of 10 patients with IOL opacification and neovascular glaucoma (NVG) between January 2006 and December 2010. We included and analyzed cases with opacification of hydrophilic acrylic IOL. An IOL exchange was performed in three cases, and the explanted IOLs were examined grossly and evaluated by light microscopy. Sagittal sections of the optics of the IOLs were evaluated by Von Kossa staining, scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX). @*Results@#All 11 eyes of 10 patients were implanted with hydrophilic acrylic IOLs. In addition, there were no cases of hydrophobic acrylic IOL opacification. Nine patients of the 10 patients had diabetic retinopathy and one patient had central retinal artery occlusion. The mean period of IOL opacification after IOL implantation was 19.45 ± 8.52 months and the mean period of IOL opacification after the occurrence of NVG was 14.37 ± 8.51 months. The deposits of the explanted IOLs were shown to consist of calcium by von Kossa staining. The explanted IOLs showed fine whitish irregular granular deposits on the entire anterior surface of the optics by SEM and the presence of calcium deposition was confirmed by EDX analysis. @*Conclusions@#Care is required when using hydrophilic acrylic IOLs in patients with risk of neovascular glaucoma, such as those with diabetic retinopathy or central retinal artery occlusion.

Surgical Results of Scleral Buckling without Subretinal Fluid Drainage in Patients with Primary Rhegmatogenous Retinal Detachment

Purpose@#To assess the clinical outcomes of scleral buckling (SB) without subretinal fluid drainage (SRFD) on primary rhegmatogenous retinal detachment (RRD). @*Methods@#The medical records of patients with RRD treated via SB without SRFD from March 2009 to Feb 2018 were retrospectively reviewed. Cases with histories of previous intraocular surgery (except cataract removal) were excluded. The primary and final surgical success rates were the main outcome measures. Pre- and post-operative visual acuity and intraocular pressure (IOP), factors that might affect the surgical success rate, secondary operative procedures, re-operation rates, and complications were analyzed. @*Results@#A total of 66 eyes of 66 patients were included. The mean patient age was 38.9 ± 18.6 years and the mean symptom duration 19.23 ± 25.14 days. The retinae were reattached after single surgeries on 57 eyes (success rate 86.36%); the final success rate was 100% after a second operation (when necessary). Of the nine eyes requiring additional surgery, seven required vitrectomy and two vitrectomy combined with buckle revision. The mean preoperative logMAR visual acuity of 0.578 ± 0.647 improved to 0.518 ± 0.512 at 1 month after surgery (p < 0.001) and to 0.262 ± 0.372 at the last follow-up visit (p < 0.001). The postoperative IOP was higher than the preoperative IOP at 3 months (p = 0.024). @*Conclusions@#Scleral buckling without SRFD used to treat primary RRD afforded a high reattachment rate (compared to those of previous reports employing vitrectomy or scleral buckling with SRFD). Given the possible complications of SRFD, our method may be a safe and feasible surgical option, affording good results with few complications in patients with primary RRD.

Lipogranulomatous Inflammation and Ptosis Developing after Vitrectomy Using a Silicone Oil Tamponade

Purpose@#We report a rare case of injected silicone oil migration into the upper eyelid, accompanied by lipogranulomatous inflammation and ptosis, after vitrectomy using a silicone oil tamponade.Case summary: An 83-year-old female presented to our clinic with left upper eyelid swelling and ptosis 2 months in duration. Five months prior, she had undergone 23-gauge pars plana vitrectomy combined with Ahmed valve implantation to treat neovascular glaucoma. Four months prior, only about half the original volume of intraocular silicone oil remained, and a second oil injection was thus administered after removal of the remaining original oil. We found a mass in front of the left orbital septum; this was associated with gradual progression of the left upper eyelid swelling and ptosis. We resected the mass via a left upper eyelid skin incision 2 months after presentation. Histological examination of the excised tissue revealed necrotic fat consistent with lipogranulomatous inflammation. One week after excision, the ptosis disappeared. At the 4-month follow-up, the left upper eyelid was normal with no sign of recurrence. @*Conclusions@#To the best of our knowledge, this is the first report in South Korea of lipogranulomatous inflammation and ptosis induced by migration of injected silicone oil into the upper eyelid. Clinicians should be aware that swelling of the upper eyelid and a substantial decrease in the silicone oil level in the vitreous cavity, reflecting silicone oil leakage, maybe one of complications of vitrectomy.

Surgical Results of Scleral Buckling without Subretinal Fluid Drainage in Patients with Primary Rhegmatogenous Retinal Detachment

Purpose@#To assess the clinical outcomes of scleral buckling (SB) without subretinal fluid drainage (SRFD) on primary rhegmatogenous retinal detachment (RRD). @*Methods@#The medical records of patients with RRD treated via SB without SRFD from March 2009 to Feb 2018 were retrospectively reviewed. Cases with histories of previous intraocular surgery (except cataract removal) were excluded. The primary and final surgical success rates were the main outcome measures. Pre- and post-operative visual acuity and intraocular pressure (IOP), factors that might affect the surgical success rate, secondary operative procedures, re-operation rates, and complications were analyzed. @*Results@#A total of 66 eyes of 66 patients were included. The mean patient age was 38.9 ± 18.6 years and the mean symptom duration 19.23 ± 25.14 days. The retinae were reattached after single surgeries on 57 eyes (success rate 86.36%); the final success rate was 100% after a second operation (when necessary). Of the nine eyes requiring additional surgery, seven required vitrectomy and two vitrectomy combined with buckle revision. The mean preoperative logMAR visual acuity of 0.578 ± 0.647 improved to 0.518 ± 0.512 at 1 month after surgery (p < 0.001) and to 0.262 ± 0.372 at the last follow-up visit (p < 0.001). The postoperative IOP was higher than the preoperative IOP at 3 months (p = 0.024). @*Conclusions@#Scleral buckling without SRFD used to treat primary RRD afforded a high reattachment rate (compared to those of previous reports employing vitrectomy or scleral buckling with SRFD). Given the possible complications of SRFD, our method may be a safe and feasible surgical option, affording good results with few complications in patients with primary RRD.

Lipogranulomatous Inflammation and Ptosis Developing after Vitrectomy Using a Silicone Oil Tamponade

Purpose@#We report a rare case of injected silicone oil migration into the upper eyelid, accompanied by lipogranulomatous inflammation and ptosis, after vitrectomy using a silicone oil tamponade.Case summary: An 83-year-old female presented to our clinic with left upper eyelid swelling and ptosis 2 months in duration. Five months prior, she had undergone 23-gauge pars plana vitrectomy combined with Ahmed valve implantation to treat neovascular glaucoma. Four months prior, only about half the original volume of intraocular silicone oil remained, and a second oil injection was thus administered after removal of the remaining original oil. We found a mass in front of the left orbital septum; this was associated with gradual progression of the left upper eyelid swelling and ptosis. We resected the mass via a left upper eyelid skin incision 2 months after presentation. Histological examination of the excised tissue revealed necrotic fat consistent with lipogranulomatous inflammation. One week after excision, the ptosis disappeared. At the 4-month follow-up, the left upper eyelid was normal with no sign of recurrence. @*Conclusions@#To the best of our knowledge, this is the first report in South Korea of lipogranulomatous inflammation and ptosis induced by migration of injected silicone oil into the upper eyelid. Clinicians should be aware that swelling of the upper eyelid and a substantial decrease in the silicone oil level in the vitreous cavity, reflecting silicone oil leakage, maybe one of complications of vitrectomy.

Long Term Incidence Rate of Glaucoma after Pars Plana Vitrectomy

PURPOSE: To evaluate the incidence rate of postoperative glaucoma after pars plana vitrectomy (PPV) and to compare incidence rate of glaucoma between phakic and pseudophakic eyes. METHODS: Retrospective chart review of patients who underwent PPV between January 2007 and May 2014. The outcome measure was the presence or absence of postoperative glaucoma, defined as definitive loss of neuro-retinal rim defect on fundus exam or showing glaucomatous change on a visual field test that warranted maintenance of ocular hypotensive therapy. RESULTS: There were 333 patients average age 57.09 +/- 13.43 included this study. Patients were followed for an average of 56.23 +/- 10.85 months. There was no significant difference in mean intra ocular pressure (IOP) between the vitretomized eyes with unoperative eyes, except in mean IOP at one day postoperatively (p = 0.012). In unoperative eyes, 10 of 315 (3.1%) were newly diagnosed as postoperative glaucoma. For the vitrectomized eyes, 69 of the 351 (19.6%) were newly diagnosed as postoperative glaucoma. There was a significant difference in incidence rate of glaucoma between the two groups (p < 0.001, chi-square test). There was a significantly higher IOP in glaucoma eyes compared with normal eyes (p < 0.001, Repeated Measures Analysis of variance [RM-ANOVA]). A possible risk factor for the development of glaucoma after PPV was cataract surgery (p = 0.0497, chi-square test). CONCLUSIONS: The incidence of glaucoma in patients with PPV is higher than in normal eyes. The incidence seems to increase particularly in those who have a pesudophakic eye. Patients who underwent PPV, especially in the pseudophakic state, need to have their IOP monitored carefully and managed properly by an ophthalmologist.

Clinical Features and Compliance in Patients with Cosmetic Contact Lens-Related Complications

PURPOSE: To investigate the clinical features and compliance of cosmetic contact lens (CL)-related complications compared with soft CL-related complications. METHODS: We performed a retrospective chart review of 97 patients (194 eyes) regarded as having CL-related complications at the outpatient clinic. The portion of complications, gender, age, and chief complaints at the initial visit were analyzed, as was compliance to cosmetic and soft CL-related guidelines for use. RESULTS: A total of 97 patients (49 patients with cosmetic CL-related complications and 43 patients with soft CL-related complications) were evaluated. The mean age of the subjects using cosmetic CL was 19.8 years (14-31 years), and all the patients were female. The chief complaints at the initial visit included ocular pain, injection, blurred vision, dryness, itching and foreign body sensation. The main complications included corneal erosion, sterile corneal infiltrate, allergic disease, neovascularization, corneal ulcer and dry eye syndrome. No statistical difference was found regarding chief complaints or complications. The proportion of patients lost to follow-up was 47% in cosmetic CL-related and 20% in soft CL-related complications, a significant difference (p = 0.015). CONCLUSIONS: Because young females are the most common CL patients and do not always fully comply with the guidelines for use, ophthalmologists need to warn these patients about the risk of serious complications.