Selective Laser Trabeculoplasty for Medically Uncontrolled Pseudoexfoliation Glaucoma in Korean Patients

Purpose@#This study investigated the efficacy and safety of selective laser trabeculoplasty (SLT) in Korean patients with medically uncontrolled pseudoexfoliation glaucoma (PEXG). @*Methods@#This retrospective observational study enrolled 43 medically uncontrolled PEXG patients who underwent a 360° SLT and were followed up for at least 12 months after SLT. The intraocular pressure (IOP) before and after SLT at 1 week, 1, 3, 6, and 12 months was evaluated. Treatment success was defined as an IOP reduction of ≥20% from the baseline and an IOP equal to lower than 22 mmHg without additional anti-glaucomatous intervention. Additionally, every follow-up medical record was reviewed to assess any possible side effects of SLT. @*Results@#Based on the Kaplan-Meier survival analysis, the treatment success rate at 12 months after SLT was 41.9% (18 eyes). For the success group at the 12 months follow-up, SLT showed a mean IOP reduction of 10.3 ± 5.0 mmHg (from 25.6 ± 4.4 to 15.2 ± 2.9 mmHg; 39.3%, p < 0.05). Among the 25 eyes that were considered as the treatment failure group, 14 eyes underwent glaucoma filtering surgeries, four eyes received additional SLT, and further intervention and follow-up was refused for seven eyes. During the overall follow-up period, there were no significant adverse events. @*Conclusions@#SLT is a partially effective and safe procedure for lowering IOP in Korean patients with medically refractory PEXG. Therefore, it can be considered as one of the alternative treatment modalities in patients who are at high risk for conventional filtering surgery.

Effect of Anti-glaucoma Agents on Myopic Retinoschisis

Purpose@#To evaluate the effect of intraocular pressure (IOP)-lowering medications on myopic retinoschisis. @*Methods@#The medical records of 33 patients (36 eyes) with myopic retinoschisis associated with pathologic myopia were reviewed retrospectively. The patients were divided into two groups: the study group comprising patients undergoing treatment with anti-glaucoma medications for suspected glaucoma; the control group comprising patients who did not use any IOP lowering medications. The changes in retinoschisis in the two groups were compared using the Spectralis domain optical coherence tomography thickness map protocol. @*Results@#The study group included 18 eyes (17 patients), and the control group included 18 eyes (16 patients). There were no significant differences between the 6-month and 12-month improvement or aggravation rates of the two groups (p = 0.513 and 0.137, respectively). However, after 18 months, the aggravation rate of retinoschisis was significantly lower in the study group (p = 0.003). The improvement / aggravation rate was 58.33% / 16.67% in the study group and 0% / 57.14% in the control group. @*Conclusions@#The use of IOP-lowering medications for more than a year may be useful for the management of retinoschisis associated with pathologic myopia.

Effect of Anti-glaucoma Agents on Myopic Retinoschisis

Purpose@#To evaluate the effect of intraocular pressure (IOP)-lowering medications on myopic retinoschisis. @*Methods@#The medical records of 33 patients (36 eyes) with myopic retinoschisis associated with pathologic myopia were reviewed retrospectively. The patients were divided into two groups: the study group comprising patients undergoing treatment with anti-glaucoma medications for suspected glaucoma; the control group comprising patients who did not use any IOP lowering medications. The changes in retinoschisis in the two groups were compared using the Spectralis domain optical coherence tomography thickness map protocol. @*Results@#The study group included 18 eyes (17 patients), and the control group included 18 eyes (16 patients). There were no significant differences between the 6-month and 12-month improvement or aggravation rates of the two groups (p = 0.513 and 0.137, respectively). However, after 18 months, the aggravation rate of retinoschisis was significantly lower in the study group (p = 0.003). The improvement / aggravation rate was 58.33% / 16.67% in the study group and 0% / 57.14% in the control group. @*Conclusions@#The use of IOP-lowering medications for more than a year may be useful for the management of retinoschisis associated with pathologic myopia.

Pigment Dispersion Syndrome and Reverse Pupillary Block after Implantable Collamer Lens with Central Hole Implantation

PURPOSE: To report a case of pigment dispersion syndrome and reverse pupillary block secondary to the implantation of implantable collamer lens (ICL) with a central hole (AQUA ICL®) that was treated with ICL removal and laser peripheral iridotomy (LPI). CASE SUMMARY: A 29-year-old woman with myopia in both eyes underwent implantation of AQUA ICL®. Four weeks postoperatively, the intraocular pressure (IOP) increased to 34 mm Hg and the patient showed pigment dispersion syndrome in both eyes. Since the IOP did not reduce with the maximum tolerable medical therapy, the ICLs were removed 8 weeks after implantation. The pigment dispersion subsided and IOP reduced shortly after ICL removal. However, 4 weeks after removal of ICL, posterior iris bowing and reverse pupillary block occurred in the right eye and the IOP increased to 46 mm Hg. LPI was performed in the right eye, and the reverse pupillary block was dissolved after a reduction in pigment dispersion. The IOP subsequently normalized to 13 mm Hg. Two weeks later, prophylactic LPI was performed in the left eye. Four weeks after prophylactic LPI, selective laser trabeculoplasty was performed on both eyes. As a result, the IOP was 11 mm Hg in the right eye and 12 mm Hg in the left eye after 4 weeks of treatment with topical IOP-lowering medications. CONCLUSIONS: The present case indicates that implantation of ICL with a central hole can lead to early postoperative pigment dispersion syndrome. When this condition persists and is accompanied by reverse pupillary block after ICL removal, LPI can be partially effective.

A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

Resolution of Recalcitrant Uveitic Optic Disc Edema Following Administration of Methotrexate: Two Case Reports

A 13-year-old male and a 15-year-old female presented with optic disc edema associated with chronic recurrent uveitis. While the ocular inflammation responded to high doses of oral prednisolone, the disc edema showed little improvement. After oral administration of methotrexate, the disc edema and ocular inflammation were resolved, and the dose of oral corticosteroid could be reduced.

Visual Prognosis of Leber's Hereditary Optic Neuropathy with T14484C Mitochondrial DNA Mutation in Koreans

PURPOSE: In order to evaluate the clinical features and visual prognosis of Leber's hereditary optic neuropathy (LHON) associated with T14484C mitochondrial DNA (mtDNA) mutation in Korean patients. METHODS: To evaluate the clinical feature of Korean LHON patients with T14484C mtDNA mutation, a retrospective chart review was performed on 14 patients who visited our clinic with the chief complaint of decreased visual acuity. RESULTS: All of the 14 patients experienced a significant decrease in visual acuity during the follow-up period. Eight of these patients (57%) showed an improvement in visual acuity of 20/50 or better in one or both eyes, and the remaining six patients (43%) showed visual acuities of 20/200 or worse in both eyes at the final follow-up. When the symptoms aggravated, ten patients (71%) showed central scotoma or cecocentral scotoma. Eleven of 12 patients (92%) who had undergone the Ishihara color vision test showed dyschromatopsia in the aggravated stage. Four patients had dyschromatopsia and three patients had central scotoma in both eyes even after visual recovery. There were no statistically significant differences in the age of onset or the nadir of visual acuity between the good visual recovery group and the non-recovery group (p > 0.05). CONCLUSIONS: Korean LHON patients with the T14484C mutation showed relatively good visual prognosis similar to those of the Caucasian or Japanese patients but with remaining dyschromatopsia or central scotoma after visual recovery.

A Case of Acquired Dacryocystocele Treated by Lacrimal Silicone Intubation

PURPOSE: To report a case of an acquired dacryocystocele successfully treated with bicanalicular silicone intubation and to review relating literature. CASE SUMMARY: A 17-year-old girl visited our clinic with tearing of both eyes since birth and a mass on the right medial canthal area for 2 years. A firm, non-tender mass with a well-demarcated border was palpated in the subcutaneous level just inferior to the right medial canthal ligament. Lacrimal irrigation via the lower punctums showed reflux through the opposite punctums without nasal passage in both of her eyes. Computed tomographic scan showed a widening of the right lacrimal sac fossa and bony nasolacrimal canal and a 16 x 18 mm sized cyst-like mass in the right lacrimal sac. The patient was diagnosed with right acquired dacryocystocele associated with bilateral congenital nasolacrimal duct obstructions. After opening of the obstructed common canaliculus using a fine lacrimal probe, silicone intubation was performed. The tearing symptom improved and the mass disappeared during the subsequent follow-up period of 1 year. CONCLUSIONS: When only accompanied by distal nasolacrimal duct obstruction, acquired dacryocystocele can be inferred to be associated with congenital nasolacrimal duct obstruction. Subsequently, bicanalicular silicone intubation can be considered as a treatment of choice.