Influence of Sodium Hyaluronate Concentration on Corneal Aberrations in Soft Contact Lens Wearers

PURPOSE: This study aimed to evaluate the influence of varying concentrations of sodium hyaluronate (SH) eye drops on corneal aberrations in normal individuals wearing silicone hydrogel contact lenses. METHODS: Normal individuals wearing silicone hydrogel contact lenses were enrolled in this study. Subjects were classified into two groups depending on the concentration of the preservative-free SH used (group 1, 0.1% SH; group 2, 0.3% SH). All subjects were asked to blink five times after instillation of the SH eye drop and before the Galilei measurements. Corneal aberrations were measured over the contact lenses before and after SH eye drop instillation. Visual acuity (VA) over the contact lenses was also measured both before instillation of the SH eye drop and after the subjects completed the five blinks. RESULTS: There was no change in VA after SH instillation in group 1; however, group 2′s VA significantly deteriorated after SH instillation. Changes in VA after SH instillation compared to baseline were significantly higher in group 2 than in group 1. Similarly, the increase in corneal aberrations after SH instillation was significant in group 2 but not significant in group 1. Among the significantly increased corneal aberration parameters, defocus was the main type in group 2. Changes in corneal aberrations after SH instillation compared to baseline were significantly higher in group 2 than in group 1. CONCLUSIONS: A 0.3%-concentration of SH increases corneal aberration and decreases VA in soft contact lens wearers. Defocus is the main type of aberration that increased in the 0.3% SH instillation group.

The Effect of Intraoperative Exophthalmometric Values on Enophthalmos Correction in Inferior Orbital Wall Reconstruction

PURPOSE: To measure the enophthalmos corrective effect after inferior orbital wall reconstruction, we compared preoperative and intraoperative exophthalmometric values with postoperative exophthalmometric values. METHODS: From January 2014 to April 2016, 60 eyes of 60 patients who underwent surgery for inferior orbital wall fracture were included. In Group 1, the exophthalmometric value was measured before surgery, during the operation, and 6 months after surgery using the Naugle exophthalmometer. In Group 2, the value was measured before surgery and 6 months after surgery using the Hertel exophthalmometer. The thickness of implants was determined by preoperative exophthalmometric values and overcorrection of 0.5 mm was performed in Group 1 patients with relatively large fractures. RESULTS: The mean age of the patients was 32.4 years in Group 1 and 34.3 years in Group 2. The mean duration between injury and surgery was 4.2 weeks in Group 1 and 2.3 weeks in Group 2. There was no statistically significant difference between preoperative exophthalmometric values in Group 1 (−1.78 ± 0.31 mm) and Group 2 (−1.81 ± 0.26 mm), but postoperative exophthalmometric values between Group 1 (−0.25 ± 0.78 mm) and Group 2 (−0.53 ± 0.46 mm) were statistically different (p = 0.034). CONCLUSIONS: The exophthalmometric values and wall fracture size are important factors for determining implant thickness of inferior orbital wall reconstruction. Intraoperative measurement of exophthalmometric values should be considered in inferior orbital wall reconstruction for enophthalmos correction.

A Case of Acute Macular Neuroretinopathy in a Young Male

PURPOSE: We report a rare case of unilateral acute macular neuroretinoapthy in a young male. CASE SUMMARY: A 35-year-old male presented with a 2-day history of paracentral scotoma. He had suffered for 2 days from a flu-like illness, and his best corrected visual acuity was 20/20 OD and 20/20 OS. Pupillary reflex was normal and no relative afferent pupillary defects were not found. Ocular movement test was normal and pain on ocular movement was not noticed. Ophthalmoscopic examination of the left eye revealed multiple exudates lining the nasal macula toward the fovea. A Humphrey visual field study identified small paracentral scotoma. Spectral domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Heidelberg, Germany) of the lesions showed a hyper-reflective lesion located in the outer plexiform layer and inflammatory cell infiltration. Fluorescent angiography was normal in the macula but showed late leak at the disc. The multifocal electroretinogram (mfERG) showed decreased foveal P1 amplitude in the left eye. The patient was diagnosed with acute macular neuroretinopathy and was treated with 60 mg of prednisolone. His subjective symptoms were improved, the paracentral scotoma disappeared, and the lesions appeared different upon SD-OCT; specifically, the hyper-reflective lesion disappeared and the outer plexiform layer showed thinning. CONCLUSIONS: Acute macular neuroretinopathy is a rare disease, and we report a case using SD-OCT and mfERG.

Ocular Side Effects Induced by 0.25% Alcaftadine Ophthalmic Solution

PURPOSE: To report a case series of patients experiencing side effects of 0.25% alcaftadine eye drops and to analyze the possible reasons for the side effects. CASE SUMMARY: Medical records of 90 patients who had a history of alcaftadine eye drop use were retrospectively analyzed. Eight out of the 90 patients (8.9%) showed ocular side effects that required discontinuation of the alcaftadine eye drops. All eight cases of alcaftadine side effects showed palpebral and bulbar conjunctival injection, watery discharge, and lid swelling. During additional history collection, all patients with alcaftadine side effects confessed of overuse (more than twice/day) of the eye drops. Anticipation for fast symptom relief was the main reason for the alcaftadine overuse. In all side effect cases, patients were asked to stop alcaftadine eye drops and use preservative-free artificial tears and steroid eye drops. After discontinuation of 0.25% alcaftadine eye drops, regression of palpebral and bulbar conjunctival injection and lid swelling was observed. CONCLUSIONS: Overuse of 0.25% alcaftadine eye drops can induce ocular surface toxicity possibly due to toxicity of drug itself. The possible side effects of overuse of 0.25% alcaftadine eye drops should be fully explained to all patients before use.

The Change of Lacrimal Gland Volume in Korean Patients with Thyroid-associated Ophthalmopathy

PURPOSE: To describe the change of lacrimal gland volumes in Korean patients with thyroid-associated ophthalmopathy (TAO) via computed tomography (CT). METHODS: A retrospective review of CT images from 217 TAO patients and 135 control subjects was performed. The TAO patients were diagnosed between May 2005 and May 2014 and had a CT performed on initial presentation (330 orbital CT scans). These images were compared with 270 orbital CT scans from the control group, obtained between May 2013 and May 2014. An open source DICOM viewer was used to calculate the volume of the lacrimal gland. RESULTS: The mean volume of the lacrimal gland in TAO patients was 0.816 cm³ in the right orbit (standard deviation [SD], 0.048) and 0.811 cm3 in the left orbit (SD, 0.051), with no significant difference between right and left (p = 0.192). However, significant differences were observed between TAO patients and healthy individuals (p < 0.001). There was no significant difference between mean lacrimal gland volumes of males (0.812 cm³; SD, 0.037) and females (0.816 cm³; SD, 0.029) (p = 0.513). There was a negative correlation between gland volume and age in TAO patients (Pearson r = -0.479, p = 0.00). The subjective tearing (right: r = 0.244, p = 0.018; left: r = 0.226, p = 0.024), corneal superficial punctate keratopathy (right: r = 0.192, p = 0.040; left: r = 0.206, p = 0.036), and exophthalmometry (right: r = 0.182, p = 0.032; left: r = 0.180, p = 0.046) correlated with lacrimal gland volume. CONCLUSIONS: This study is the first to use CT images to calculate the lacrimal gland volume of Korean TAO patients. In TAO patients, the lacrimal gland volume was notably increased compared to control subjects. The lacrimal gland volume decreased with age, but there was no difference between gender and no difference between left and right. The lacrimal gland volume correlated with subjective tearing, corneal superficial punctate keratopathy and exophthalmometry.

A Case of Bilateral Maculopathy Caused by High-Voltage-Induced Spark Injury

PURPOSE: To report a case of maculopathy after exposure to a high-voltage spark. CASE SUMMARY: A 40-year-old male patient visited our clinic complaining of visual disturbance in both eyes 1 day after exposure to a high voltage arc discharge. His best corrected visual acuity was 4/20 in both eyes. On fundus examination, a yellowish retinal scar was observed at the foveal area. The spectral domain optical coherence tomography (SD-OCT) showed inner segment/outer segment line disruption. The best corrected visual acuity was 4/20 in both eyes and SD-OCT showed a remaining inner segment/outer segment line disruption after 3 years. CONCLUSIONS: Maculopathy can result from exposure to a high voltage arc discharge exposure.

A Case of Raoultella planticola Endophthalmitis after Cataract Surgery

PURPOSE: To report the first case of the Raoultella planticola endophthalmitis after the phacoemulsification and posterior chamber multi-focused intraocular lens (IOL) implantation. CASE SUMMARY: A healthy 49-year-old male visited our clinic with a sudden visual disturbance and ocular pain 2 days after phacoemulsification and multi-focused IOL implantation in his right eye. On initial ophthalmic examination, severe corneal edema and hypopyon were observed. The retina could not be visualized due to vitreous opacity and anterior chamber inflammation. Therefore, the patient immediately underwent pars plana vitrectomy. Vancomycin hydrogen chloride (HCl) 0.3 mg/0.1 mL was injected into the anterior part and vancomycin HCl 1.0 mg/0.1 mL and ceftazidime 2.0 mg/0.1 mL were injected into the intravitreal part. The culture test of aqueous humor and vitreous body fluid revealed Raoultella planticola, thus, systemic antibiotic (ceftazidime) and antibiotic eye drops (vancomycin and ceftazidime) were administered. After 4 months of follow-up, best-corrected visual acuity improved to 20/20 in the affected eye after surgery. CONCLUSIONS: In the present case, we found that endophthalmitis due to Raoultella planticola can be successfully treated. We suggest that atypical bacteria should be considered in the differential diagnosis of endophthalmitis after cataract surgery.

Comparision between Simultaneous Intracameral and Intravitreal Injection and Intravitreal Injection of Bevacizumab in Neovascular Glaucoma

PURPOSE: To compare the clinical efficacy of simultaneous intracameral and intravitreal injection and intravitreal single injection of bevacizumab in patients with neovascular glaucoma (NVG). METHODS: The medical records of 43 eyes of 43 patients, who had treated with simultaneous intracameral and intravitreal injection (Group I) or intravitreal single injection (Group II) of bevacizumab 1.25 mg from January 2010 to December 2012, were retrospectively reviewed. The best corrected visual acuity (BCVA), intraocular pressure (IOP), regression time of new vessel in the iris (NVI) and anterior chamber angle (NVA), progression of peripheral anterior synechiae (PAS), and corneal parameters were measured preoperatively and one day, three days, 1 week, 1 month, and 3 months postoperatively. RESULTS: There was significant changes of IOP between the two groups at 1, 3 days postoperatively (p = 0.001, p < 0.001). The regression time of NVI and NVA in Group I was significantly faster than Group II (p = 0.026, p = 0.033). In the phakic eyes, regression time of NVI and NVA was significantly longer than aphakic and pseudophakic eyes in group II (p = 0.006, p = 0.005). Also, in the phakic NVG patients, the formation of PAS in Group I was significantly less than in Group II for the postoperative three months (p = 0.020). CONCLUSIONS: Simultaneous intravitreal and intracameral injection of bevacizumab seem to be more effective for the early lowering of IOP and regression of NVI and NVA, and inhibiting further PAS formation in NVG patients, especially in the phakic eyes. Therefore, simultaneous intracameral and intravitreal injection of bevacizumab may be considered as an adjunct to management of NVG in the phakic eyes.

Retinitis Pigmentosa Complicated by Vitreous Hemorrhage in a Young Patient: A Case Report

PURPOSE: To report a case of a young male patient with retinitis pigmentosa (RP) accompanied by vitritis and neovascularization of the optic disk in both eyes who underwent unilateral vitrectomy for the treatment of vitreous hemorrhage in the right eye. CASE SUMMARY: An 8-year-old boy visited our clinic with a complaint of night blindness. Both eyes showed inflammatory cells in the anterior vitreous and neovascularization of the optic disk confirmed by fluorescein angiography. Extensive vitreous hemorrhage developed in his right eye and he underwent unilateral vitrectomy. His final visual acuity was 0.6 in both eyes. CONCLUSIONS: Vitreous hemorrhage may be related to chronic inflammation in the vitreous and is a very rare RP complication. Vitrectomy can be an effective treatment option for RP complicated by vitreous hemorrhage.

Cyclocryotherapy and Intravitreal Gas Tamponade of a Chronic Cyclodialysis Cleft: Case Report

PURPOSE: To report a case of chronic hypotony maculopathy caused by traumatic cyclodialysis cleft and treated with 20% sulfur hexafluoride (SF6) gas tamponade with cyclocryotherapy. CASE SUMMARY: A 39-year-old woman with a history of blunt trauma developed a unilateral chronic ocular hypotony in her left eye. She was treated with topical atropine sulphate 1% for 2 months. Three years later, she was referred to our clinic for evaluation and treatment of persistent hypotony. The intraocular pressure (IOP) was 4 mm Hg and the best corrected visual acuity was 0.4. B-scan echography revealed a choroidal effusion and fundus examination showed choroidal detachment and macular folds. Gonioscopy examination revealed cyclodialysis cleft from the direction of 7 o'clock to 11 o'clock. A single bubble of SF6 20% (0.4 cc) was injected into the vitreous cavity and transconjunctival cyclocryotherapy was performed under retrobulbar anesthesia. Six months later, the IOP was 12 mm Hg and the best corrected visual acuity was 1.0. B-scan echograpy and fundus examination showed the disappearance of the choroidal effusion. CONCLUSIONS: Gas tamponade with cyclocryotherapy may be useful in cases of cyclodialysis cleft that failed to respond to medical therapy.

Two Cases of Ocular Complications Caused by Phendimetrazine

PURPOSE: The authors of the present study report treatment experience of acute myopia and branch retinal vein occlusion associated with phendimetrazine, a drug used for weight reduction. CASE SUMMARY: Case 1: A 32-year-old woman, previously devoid of ocular problems, visited our hospital with bilateral visual disturbance after taking phendimetrazine for weight reduction. Ciliochoroidal effusion and anterior shifting of the lens-iris diaphragm were observed, which resulted in a shallow anterior chamber, myopic shifting and an increase in intraocular pressure due to angle closure. The symptoms were relieved by discontinuing the use of phendimetrazine and administration of intraocular pressure-lowering agents. Case 2: A 26-year-old woman, previously devoid of ocular problems, visited our hospital with left superior visual field disturbance after taking phendimetrazine for weight reduction. The examinations revealed papilledema, disc hemorrhage and tortuous vascular changes in her left eye. Fluorescein angiography was performed, and retinal vein occlusion was diagnosed. The patient discontinued weight reduction agents and recovered while under observation. CONCLUSIONS: Phendimetrazine, used for weight reduction, can cause acute myopia via prostaglandin synthesis and retinal venous occlusion due to vascular constriction.