The Effect of Intraocular Pressure-lowering Eye Drops on Myopic RetinoschisisPatients

Purpose@#To investigate the influence of intraocular pressure (IOP)-lowering eye drops on myopic retinoschisis. @*Methods@#We investigated myopic retinoschisis patients with high myopia (defined as a myopic refractive error more than -8.0 dioptersor an axial length longer than 26.5 mm), who were suspected of having glaucomatous optic neuropathy, using IOP-loweringeye drops between April 2014 and December 2018. We retrospectively analyzed the changes in optical coherence tomographyfindings after 6 months using IOP-lowering eye drops. The progression of retinoschisis was assessed by analyzing retinalvolume changes. A decrease in the total retina volume and a decrease in volume more than 10% in one section out of five withoutmore than a 10% volume increase in any other section was defined as resolution of myopic retinoschisis. The opposite casewas defined as an aggravation. @*Results@#We analyzed 17 eyes of 15 patients with high myopia. Six of 17 eyes (35.3%) showed a resolution of myopic retinoschisisat 6 months after using IOP-lowering eye drops. Of the 17 eyes, two (11.8%) experienced progression of myopicretinoschisis. Seven out of 14 eyes (50.0%) who were followed-up over 1 year showed resolution of myopic retinoschisis, andtwo eyes (14.3%) experienced progression of myopic retinoschisis. There was no macular hole development or posterior vitreousdetachment during the follow-up period in the seven eyes, and there was no significant correlation between the absolute valueof the initial IOP, axial length, IOP change, and degree of improvement of myopic retinoschisis. @*Conclusions@#The use of IOP-lowering eye drops on highly myopic eyes with retinoschisis showed a significant improvement ofmyopic retinoschisis, when compared to previous studies. These findings suggest the possibility of IOP-lowering eye drops delayingor improving the natural course of myopic retinoschisis.

Long-term Outcomes of and Recurrence Risk Factors Associated withPhotodynamic Therapy to Treat Central Serous Chorioretinopathy

Purpose@#We sought risk factors for the development of persistent or recurrent central serous chorioretinopathy (CSC) in patientsunder long-term follow-up (>1 year) after photodynamic therapy (PDT). @*Methods@#We retrospectively reviewed the medical records of patients who received PDT to treat CSC from January 2005 toFebruary 2016. CSC was considered persistent if subretinal fluid (SRF) was evident for longer than 3 months or if additionaltreatment was required before 3 months. Also, CSC was regarded as recurrent when SRF re-appeared after initial completeresorption. @*Results@#We enrolled 73 patients (77 eyes). The mean follow-up period was 48.9 ± 31.3 months (12 to 144 months). The persistentgroup consisted of 10 eyes (13%) and the recurrent group 17 eyes (22%). The mean time to recurrence was 39.8 ± 23.3months, ranging from 3 to 91 months. Fifty patients (52 eyes) were enrolled in the treatment-naive group. The persistent groupconsisted of four eyes (8%) and the recurrent group 10 eyes (19%). The mean time to recurrence was 48.4 ± 30.0 months. Onchi-squared analysis of recurrence risk factors in all patients, the odds ratio for eyes with a history of both focal laser and anti-vascular endothelial growth factor treatments prior to PDT was 2.94 (p = 0.031). @*Conclusions@#CSC patients with histories of other treatment are likely to exhibit persistent or recurrent disease after PDT.

Cataract Change after Vitrectomy and Gas Injection in Patients with Epiretinal Membrane and Macular Hole

PURPOSE: To investigate the outcomes of quantitative lens nuclear opalescence change after pars plana vitrectomy and intravitreal gas injection in patients with idiopathic epiretinal membrane and macular hole. METHODS: All patients were divided into two group according to the kinds of injected gases, either Group 1 (fluid/air exchange) or Group 2 (20% SF₆ gas injection). Lens nuclear opalescence according to the classification of Lens Opacities Classification System (LOCS) III, mean nuclear density and maximal nuclear density of Pentacam® scheimpflug image changed by image J, besides refractive errors were evaluated before surgery and 1, 2, 4, 6, and 12 months after surgery. RESULTS: Out of 40 eyes of 40 patients included in the analysis, 21 received only fluid/air exchange (Group 1) and 19 received 20% SF₆ gas injection (Group 2). There were significant changes in lens nuclear opalescence between the study and control (unaffected) eyes. In both groups, the study eyes experienced significant progression of cataract compared with the control eyes, in terms of mean nuclear density, maximal nuclear density and LOCS III. In comparison according to the kinds of injected gases, there was a significant difference in mean nuclear density after 4 months, maximal nuclear density after 2 months and 4 months, LOCS after 2 months and 4 months, and refractive error after 1, 2, 4, and 6 months between both groups (p = 0.003). CONCLUSIONS: After vitrectomy and intravitreal gas injection, changes in postoperative lens nuclear opalescence of the study eyes progressed more rapidly compared with the control eyes. This study identified that lens nuclear opalescence of Group 2 progressed rapidly, but after 12 months there was no significant difference of lens opacity between the kinds of injected gases.

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.

Full-thickness Sclerotomy for Uveal Effusion Syndrome

To report the surgical outcome of full-thickness sclerotomy in five cases of uveal effusion syndrome (UES). Full-thickness sclerotomy without sclerectomy was performed on five eyes of four patients with UES with or without nanophthalmos. In four of the eyes, exudative retinal detachment associated with UES resolved after the sclerotomy. The subretinal fluid in one eye, which had a normal axial length, was relieved after undergoing three sclerotomy procedures. Full-thickness sclerotomy without vortex vein decompression or sclerectomy is an effective surgical option for the management of significant UES.

Retinopathy of Prematurity in Infants Born before 25 Weeks Gestation in a Korean Single Neonatal Intensive Care Unit: Incidence, Natural History and Risk Factors

As younger preterm infants are able to survive, more extremely preterm infants are at risk of developing retinopathy of prematurity (ROP). To investigate the incidence, progression and risk factors of ROP in extremely preterm infants in Korea, the medical records of infants born before 25 weeks gestation were retrospectively reviewed. The criteria for laser treatment agreed with type 1 ROP as defined by the Early Treatment for Retinopathy of Prematurity study. Of the 121 infants included in the analysis, 119 (98.4%) infants developed any stage ROP, including 78 infants (64.5%) with type 1 ROP. The mean postmenstrual age (PMA) at the onset of any ROP and type 1 ROP were 33.5 and 36.1 weeks, respectively. All but one infant developed type 1 ROP after 31 weeks PMA. Univariate analysis showed that duration of total parenteral nutrition and onset of any ROP (PMA) were associated with the development of type 1 ROP. In conclusion, this study shows high incidence of ROP in extremely preterm infants and suggests that, although current screening protocols are feasible for most preterm infants born before 25 weeks gestation, earlier screening before 31 weeks PMA may be necessary in infants with an unstable clinical course.

Repeatability of Intraocular Pressure Patterns in Glaucomatous Patients

PURPOSE: To investigate the repeatability of 24-hour intraocular pressure (IOP) patterns in glaucomatous patients. METHODS: The author reviewed bilateral IOP data of 18 glaucoma patients who were admitted for 2 days. IOP data were collected in both eyes every 2 hours using Goldmann applanation tonometry during a 48-hour admission except at 02:00 o'clock (13 patients) and 04:00 o'clock (5 patients). The intraclass correlation coefficient was used to analyze the agreement of IOP patterns between the first and the second 24 hours. RESULTS: IOP reached its peak between 04:00 o'clock and 06:00 o'clock in both eyes and on both days. On evaluation, the IOP data excluding the results of 02:00 o'clock and 04:00 o'clock, agreement of IOP values of 18 patients was good to excellent at 06:00, 18:00, 20:00, and 24:00 o'clock in both eyes. Agreement of IOP values at 08:00 and 12:00 o'clock was good in the right eye and the left eye, respectively. The agreement of IOP values of 13 patients who underwent IOP assessment at 04:00 o'clock and not at 02:00 o'clock, was good to excellent only at 04:00 and 06:00 o'clock in both eyes. Otherwise, agreement was poor or not significant except at 18:00 and 22:00 o'clock which showed good agreement in the right eye and the left eye, respectively. CONCLUSIONS: Presumable, a circadian IOP pattern exists, because in the present study, IOP reached its peak in the early morning on both days. However, to stipulate IOP patterns were repeatable appears to be difficult since there were numerous time points with poor agreement.

Ultrawide-field Fluorescein Angiography for Evaluation of Diabetic Retinopathy

PURPOSE: To investigate the advantages of ultrawide-field fluorescein angiography (FA) over the standard fundus examination in the evaluation of diabetic retinopathy (DR). METHODS: Ultrawide-field FAs were obtained in 118 eyes of 59 diabetic patients; 11 eyes with no DR, 71 eyes with nonproliferative diabetic retinopathy (NPDR), and 36 eyes with proliferative diabetic retinopathy (PDR), diagnosed by the standard method. The presence of peripheral abnormal lesions beyond the standard seven fields was examined. RESULTS: Ultrawide-field FA images demonstrated peripheral microaneurysms in six (54.5%) of 11 eyes with no DR and all eyes with moderate to severe NPDR and PDR. Peripheral retinal neovascularizations were detected in three (4.2%) of 71 eyes with NPDR and in 13 (36.1%) of 36 eyes with PDR. Peripheral vascular nonperfusion and vascular leakage were found in two-thirds of eyes with severe NPDR and PDR. CONCLUSIONS: Ultrawide-field FA demonstrates peripheral lesions beyond standard fields, which can allow early detection and a close evaluation of DR.