Postural Effect on Intraocular Pressure in Gas-Filled Eyes after Vitrectomy

PURPOSE: To assess the influence of body position on intraocular pressure (IOP) in patients who underwent vitrectomy and intraocular gas tamponade. METHODS: Patients who did not undergo any surgery were defined as Group 1. The remaining patients were divided into 3 groups according to the surgery performed (Group 2; cataract surgery, Group 3; vitrectomy and cataract surgery, Group 4; vitrectomy with intraocular gas tamponade and cataract surgery). IOP was measured by a non-contact tonometer, Goldmann applanation tonometer, and Tono-Pen in the sitting, supine, and prone positions. RESULTS: The difference of IOP measured in the sitting position among the 4 groups was not significant. IOP was significantly elevated by 2.04 mm Hg on average when the posture was changed from sitting to supine or prone in all 4 groups. The IOP discrepancy between supine and sitting positions was significantly greater in group 4 by 3.61 mm Hg than the other groups (p = 0.003, ANOVA test). The IOP difference between the prone and sitting position was also significantly higher in group 4 by 3.82 mm Hg than the other groups (p = 0.001, ANOVA test). CONCLUSIONS: The patients with vitrectomized gas tamponade eyes had a mean IOP increase of 3.82 mm Hg when the position was changed from sitting to prone. When performing vitrectomy and intraocular gas tamponade on patients in the prone position, an IOP elevation should be monitored thoroughly.

Surgical Outcomes for Lens Fragments Dropped into the Vitreous Cavity during Cataract Surgery

PURPOSE: To assess the clinical features and outcomes of patients referred for management of dropped lens fragments during cataract surgery. METHODS: The medical records of 22 eyes from 22 patients who were referred to our hospital to undergo pars plana vitrectomy (PPV) for management of dropped lens fragments after phacoemulsification surgery at private clinics were reviewed. Data including patient demographics, preoperative and postoperative visual acuity, factors associated with dropped lens fragment, and postoperative complications were recorded. The factors were compared between 2 patient groups: postoperative Snellen acuity of 0.5 or better and acuity less than 0.5. The statistical significances of differences in factors between the 2 groups were calculated. RESULTS: The mean interval between cataract surgery and PPV was 2.6 +/- 3.7 days. At the final examination, the mean postoperative acuity was 0.57 +/- 0.20, and 16 eyes (72.7%) had a visual outcome of 0.5 or better. After excluding 7 eyes with other pre-existing ocular co-morbidities, 14 eyes (93.0%) achieved a final visual acuity of 0.5 or better. Multivariate analysis showed that the predictor for visual outcomes of 0.5 or better was absence of preoperative eye disease (p = 0.007). Complications after PPV included 2 (9.0%) cases of cystoid macular edema and 1 (4.5%) case of retinal detachment. CONCLUSIONS: Prompt referral and surgical management within 1 week for dropped lens fragments during cataract surgery may achieve a better visual outcome in cases with no pre-existing eye disease.

Impact of Intravitreal Bevacizumab Injection on Life Quality in Patients with Branch Retinal Vein Occlusion

PURPOSE: To evaluate the impact of intravitreal bevacizumab injection on visual function and vision-related quality of life (VR-QOL) in patients with branch retinal vein occlusion (BRVO) using the Korean version of the National Eye Institute Visual Function Questionnaire 25 (K-NEI-VFQ-25). METHODS: This study included 32 normal control subjects and 32 patients with BRVO. The Korean version of NEI-VFQ-25 was answered by the patients with BRVO before and 3 months after intravitreal bevacizumab injection, as well as by normal control subjects. Clinical data were collected, including central macular thickness (CMT), total macular volume (TMV) (using time-domain optical coherence tomography [OCT]), and best corrected visual acuity (BCVA). RESULTS: Visual acuity, CMT, and TMV significantly improved 3 months after intravitreal bevacizumab injections. No bevacizumab-related systemic or ocular adverse effects following intravitreal drug injections were observed. Significant improvement in the VFQ-25 composite score was observed in patients with BRVO. Subscale scores, including general vision, near activities, distance activities, social functioning, mental health, role difficulties, dependency, and peripheral vision, improved after injection. However, subscale scores regarding general health, ocular pain, driving, and color vision did not improve significantly. CONCLUSIONS: Intravitreal bevacizumab injection appears to be an effective treatment for visual function, as well as VR-QOL in macular edema secondary to BRVO. However, improvement of driving function and color vision appears to require a longer recovery time than visual function.

Combined Therapy of Intravitreal Bevacizumab and Posterior Subtenon Triamcinolone Injection in Macular Edema with Branch Retinal Vein Occlusion

PURPOSE: To compare the clinical outcomes of intravitreal bevacizumab with and without posterior subtenon triamcinolone acetonide injections for macular edema with branch retinal vein occlusion. METHODS: Intravitreal bevacizumab injection (single group) or intravitreal bevacizumab injection with posterior subtenon triamcinolone acetonide injection (combined group) were performed in 30 eyes each, and intravitreal bevacizumab injection was given once a month in both groups until macular edema was in the normal range. A best corrected visual acuity and central macular thickness were measured pre- and post-injection. RESULTS: The required number of injections to achieve improved macular edema in the normal range was 2.8 +/- 0.5 times in the single group and 2.0 +/- 0.6 times in the combined group. Six months after injection, average central macular thickness decreased to 185.3 +/- 63.5 microm in the single group and to 260.0 +/- 74.6 microm in the combined group. The best corrected visual acuity (log MAR) improved from 0.71 +/- 0.63 to 0.35 +/- 0.44 in the single group and from 0.67 +/- 0.42 to 0.08 +/- 0.11 in the combined group. The number of cases in which the central macular thickness increased again within 6 months after the injections was 19 eyes in the single group and 6 eyes in the combined group. CONCLUSIONS: In macular edema with branch retinal vein occlusion, early rapid recovery of visual acuity and decrease of central macular thickness were observed due to the synergistic effect of bevacizumab and triamcinolone acetonide in combined therapy, and the recurrence frequency of macular edema was reduced by the long-term effect instilled by the long half-life of triamcinolone acetonide.

The Change in Corneal Endothelial Cell Density after Pars Plana Vitrectomy

PURPOSE: To assess the effect of pars plana vitrectomy and gas tamponade on corneal endothelial cell density. METHODS: The corneal endothelial cell density in 145 eyes that underwent pars plana vitrectomy was examined with a noncontact specular microscope 3 months pre- and post-operation. The subjects were divided as follows: Group 1 (32 eyes) underwent pars plana vitrectomy, group 2 (26 eyes) underwent pars plana vitrectomy combined with gas tamponade, group 3 (34 eyes) underwent pars plana vitrectomy combined with phacoemulsification and group 4 (48 eyes) underwent pars plana vitrectomy combined with phacoemulsification and gas tamponade. The changes in corneal endothelial cell density between groups was compared. RESULTS: The mean endothelial cell loss was more significant in group 2 than in group 1 (p = 0.012), and there was no difference between groups 3 and 4 (p = 0.063). However, after excluding 6 eyes that had blood in the center of the corneal endothelium as a result of being in the prone position following gas tamponade, the mean endothelial cell loss in group 2 was not less than in group 1. In eyes with blood in the corneal endothelium, endothelial cell loss significantly increased (p < 0.001). CONCLUSIONS: The results of this study suggest that ophthalmic surgeons should attempt to carefully control bleeding and sufficiently irrigate the vitreous during pars plana vitrectomy combined with gas tamponade.

A Case of Metastasis of the Malignant Melanoma from Untreated Choroidal Melanoma

A 47 year old man gave a history of progressive deterioration of vision in his right eye of more than 8 years duration, which culminated in total blindness. Since 1981 by several ophthalmologists, he had been diagnosed as retinal deta chment, a case of cysticercosis, or choroidal melanoma of the right eye. On admission, ultrasonogram and CT scan for the globe showed choroidal tu mor which entirely filled the vitreous cavity. Cytology for ascites disclosed malignant melanoma cells. Death from metastatic disease occurred four weeks after admission. The diffrentiation between primary and metastatic melanoma may be difficult. The followings are the noted help points: metastatic tumors are typically multiopIe and flat in the uveal tract: multiple tumor emboli are observed in choroid, ciliary body or retinal vessels: associated nevus cells at the base of tumor are lacking: and epitheloid cell types are consistently present. This case might be, morphologically and by his history, originated from a primary choroidal melanoma(epitheloid type).

A Case of Metastasis of the Malignant Melanoma from Untreated Choroidal Melanoma

A 47 year old man gave a history of progressive deterioration of vision in his right eye of more than 8 years duration, which culminated in total blindness. Since 1981 by several ophthalmologists, he had been diagnosed as retinal deta chment, a case of cysticercosis, or choroidal melanoma of the right eye. On admission, ultrasonogram and CT scan for the globe showed choroidal tu mor which entirely filled the vitreous cavity. Cytology for ascites disclosed malignant melanoma cells. Death from metastatic disease occurred four weeks after admission. The diffrentiation between primary and metastatic melanoma may be difficult. The followings are the noted help points: metastatic tumors are typically multiopIe and flat in the uveal tract: multiple tumor emboli are observed in choroid, ciliary body or retinal vessels: associated nevus cells at the base of tumor are lacking: and epitheloid cell types are consistently present. This case might be, morphologically and by his history, originated from a primary choroidal melanoma(epitheloid type).

A Case of Anterior Lenticonus in Alport's Syndrome

Alport's syndrome, first described by Alport in 1927, is a clinical entity which consists of lens abnormalities, hereditary hemorrhagic nephritis and nerve deafness. Anterior lenticonus is a rare structual anomaly of lens in which there is a conicalor spherical protrusion of the anterior lens surface into the anterior chamber as a characteristic finding of Alport's syndrome. The authers experienced a case of Alport's syndrome in a 22-year-old man associated with bilateral anterior and posterior lenticonus, hematuria, proteinuria, renal failur earld nerve deafness(complete form).

Study on Color Discrimination for the Subjects of Congenital Color Deficiency

A total of 75 subjects were examined using Hahn's color vision test and Hahn's Double 15-Hue test. Among the 75 subjects, 62 subjects detected by screening test among 2700 high school students had defective color vision but good visual acuity and no retinal diseases. The other 13 subjects were detected in out-patient ophthalmic clinic. Results of examination in classifying the types and estimating the extent of color defects were obtained. 1. In the total 75 persons examined, extent of the color defects were as follows; mild ............ 6 cases, moderate.........31 cases, strong...........38 cases. 2. The classification of types of congenital color defects were as follows; Protan .........2 cases, Deutan ........25 cases, Unclassified...48 cases. Lack of advanced study on color discrimination for congenital color deficiency resulted in existing job discrimination against a color defective person by restricting his/her job opportunity. Therefore this kind of research has very important meanings and should be continued.