Comparison of Surgical Outcomes between Conventional Sutured Scleral Fixation and Flanged Intrascleral Intraocular Lens Fixation

Purpose@#We compared the surgical outcomes and complications of conventional, sutured scleral fixation and flanged intrascleral intraocular lens (IOL) fixation. @*Methods@#We retrospectively analyzed the medical records of patients who underwent conventional, sutured scleral fixation or flanged intrascleral IOL fixation and who were then observed for more than 6 months. The best-corrected visual acuity (BCVA), operation time, spherical equivalent (SEQ), astigmatism, and postoperative complications were recorded up to 6 months after surgery. @*Results@#Of sixty-nine enrolled eyes, 39 underwent conventional, sutured scleral fixation (“sutured” group) and 30 flanged intrascleral IOL fixation (“sutureless” group). The operation time was significantly shorter in the sutureless group than in the sutured group (56.3 ± 11.8 vs. 77.7 ± 17.9 minutes, p < 0.001). In both groups, the BCVA and SEQ improved significantly at all visits after surgery compared to the baseline values p < 0.05). There was no between-group difference in BCVA, SEQ, astigmatism, or complications. @*Conclusions@#Compared to conventional, sutured scleral fixation, flanged intrascleral IOL fixation afforded equivalent improvements in visual acuity but with a shorter surgical duration. Therefore, flanged intrascleral IOL fixation is a useful alternative to conventional, sutured scleral fixation.

Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Age-related Clinical Analysis of Bacterial Keratitis in Daejeon and Chungcheong Provinces: a Multicenter Study

Purpose@#The purpose of this study was to investigate the age-related clinical features, risk factors, and prognoses of bacterial keratitis in Daejeon and Chungcheong provinces and the patterns and trends of fluoroquinolone antibiotic susceptibility. @*Methods@#Medical records of 433 patients (433 eyes) who visited one of the five university hospitals in Daejeon and Chungcheong provinces and were diagnosed as culture-positive bacterial keratitis between January 2000 to December 2018 were reviewed retrospectively. The patients were divided into younger and older groups based on an age of 60 years. Predisposing factors, prognostic factors, treatment method, causative organisms, and susceptibility to fluoroquinolone were analyzed. @*Results@#Two hundred seventy three males (63.0%) and 160 females (37.0%) were included. The most common risk factors in the younger group were contact lens wear (27.5%) and trauma and foreign body (27.0%). The most common risk factors in the older group were trauma and foreign body (30.5%). Staphylococcus species was the most common causative Gram-positive bacteria, regardless of age, and Pseudomonas species was the most common among Gram-negative bacteria. The older group tended to have more severe keratitis required more surgical treatment and had a worse visual outcome than the younger group (p 0.05). @*Conclusions@#Bacterial keratitis in Daejeon and Chungcheong provinces indicated more severe clinical aspects and worse prognoses in older patients showing similar results from previous studies. Caution regarding trauma and foreign bodies and managing previous ocular disease is necessary for all age groups. Education regarding adequate contact lens care and hygiene is required for younger (<60 years) patients.

Clinical Features and Risk Factors of Herpes Zoster Ophthalmicus

PURPOSE: To evaluate the clinical characteristics and risk factors of severe manifestation of herpes zoster ophthalmicus. METHODS: We conducted a retrospective analysis using medical records from 106 patients diagnosed with herpes zoster ophthalmicus from January 2012 to June 2015. Patients were classified according to the type and frequency of ophthalmologic manifestations. Patients with conjunctivitis, punctate keratitis, and pseudodendritic keratitis were classified into the mild group, whereas patients with deep stromal keratitis, endothelitis, scleritis, glaucoma, and extraocular muscle paralysis were classified into the severe group. The age, sex, severity, location of skin lesions, delayed time to treatment, the presence of Hutchinson's sign, and associated systemic diseases were compared between the groups. In addition, we investigated changes in vision, intraocular pressure, treatment duration, recurrence and the prevalence of postherpetic neuralgia. RESULTS: The incidence of conjunctivitis (47.2%), punctate keratitis (42.5%), pseudodendritic keratitis (12.2%), deep stromal keratitis (12.2%), endothelitis (15.1%), scleritis (18.9%), glaucoma (14.2%), and extraocular muscle (EOM) paralysis (4.7%) were observed in these patients. The group with mild disease included 70 cases with conjunctivitis, punctate keratitis and pseudodendritic keratitis. The severe group included 36 cases with deep stromal keratitis, endothelitis, scleritis, glaucoma and EOM palsy. Disease most often occurred in the distribution of the first branch of the trigeminal nerve, with no differences in the age or sex of patients in both groups. Severe manifestations were more common when a greater extent of the skin was involved, when Hutchinson's sign was present, or when treatment was significantly delayed. There were no significant differences between the two groups in recurrence or the presence of postherpetic neuralgia. CONCLUSION: Long-term treatment for herpes zoster opthalmicus is more likely to be required if severe manifestation of disease exists, such as widespread skin involvement, Hutchinson's sign, or a delay to the initiation of antiviral treatment. More active observation and treatment are required in such cases.

Anterior Segment Changes after Laser Iridotomy for the Treatment and Prevention of Angle-closure Glaucoma

PURPOSE: To evaluate the changes and characteristics of the anterior segment of the eye after laser peripheral iridotomy (LPI) conducted on patients with acute angle closure crisis (AACC) for both therapeutic purposes and prophylactic purposes in the fellow eye. METHODS: Anterior segments were examined by topography, laser interferometry, anterior segment optical coherence tomography, anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), angle opening distance (AOD), central corneal thickness (CCT), and axial length as compared to prior procedures in 20 eyes with glaucoma (treatment group) and 20 contralateral eyes (prophylactic group) in 20 patients diagnosed with AACC. RESULTS: Before laser treatment, there were no significant differences in pre-LPI ACV, ACA, AOD and axial length, although differences in the CCT and ACD existed between the groups. Compared to prior laser treatment at 1 and 3 months after laser treatment, the ACV, ACA, AOD 500, and AOD 750 increased in both groups. When both groups were compared 1 month after their laser treatments, the AOD 750 was increased in the treatment group. There were no significant differences between two groups 3 months post LPI. CONCLUSIONS: Other than changes in the ACD and CCT, no significant differences were observed in the anterior segment characteristics in AACC affected and contralateral eyes prior to LPI. After LPI, the treatment group showed greater changes in their anterior segments; however, the open angle was maintained at 1 month post treatment.

Influence of Preoperative Corneal Endothelial Status on Postoperative Corneal Endothelium Density after Cataract Surgery

PURPOSE: To analyze the influence of preoperative corneal endothelial status on postoperative corneal endothelium density after cataract surgery. METHODS: We evaluated 228 eyes of 158 patients who underwent cataract surgery. Corneal endothelial status and central corneal thickness were measured before surgery and 1 day, 1 month, 3 months and 6 months after surgery. Patients were classified by preoperative endothelial cell density (three groups) and their coefficients of variation and hexagonality (two groups). Clinical parameters, including corneal endothelial cell losses, visual acuity, intraocular pressure, spherical equivalent refraction and central corneal thickness were measured to compare the intergroup indices. RESULTS: There were no significant differences in corneal endothelial cell losses at 1 day, 1 month, 3 months and 6 months after surgery in any of the groups based on corneal endothelial cell density. There were increases in corneal thickness at 1 day and 1 month after surgery that were significantly higher in the low-endothelial cell density group than the 2,000-2,500 cells/mm² cell density group (p < 0.05), but there were no differences after the 3-month time point. There were no significant differences in clinical parameters for the coefficient of variation and hexagonality groups until 6 months after surgery. CONCLUSIONS: We observed reversible corneal edema in the low endothelial group; however, there were no significant intergroup differences in corneal endothelial cell loss due to preoperative corneal endothelial status. Our results suggest that cataract surgery is relatively safe for patients with morphologically abnormal corneal endothelium and/or low endothelial density; the safety is primarily due to improved equipment and surgery techniques.

Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification

PURPOSE: To compare the clinical outcomes during phacoemulsification when using recently improved longitudinal (Stellaris(R), Bausch & Lomb, Rochester, NY, USA) and torsional (Infiniti Ozil(R), Alcon, Fort Worth, TX, USA) ultrasound. METHODS: The present study included 74 eyes of 59 patients undergoing cataract surgery. Operated eyes with mild cataract (nuclear sclerosis grade 1 and 2), moderate cataract (nuclear sclerosis grade 3) and hard cataract (nuclear sclerosis grade 4 and 5) were compared in terms of the total phacoemulsification (phaco) time, average phaco power, total phaco energy and amount of fluid used during cataract surgery between the 2 modalities. Endothelial cell density, corneal edema, central corneal thickness (CCT), surgically induced astigmatism (SIA) and best-corrected visual acuity (BCVA) were also evaluated preoperatively and up to 3 month postoperatively. RESULTS: In mild cataracts, the operative parameters and corneal changes were similar between the 2 modalities. In moderate cataracts, the total phaco time was significantly higher in the torsional group than the longitudinal group, but the average phaco power, total phaco energy, and amount of fluid were not significantly different. In patients with hard cataract, the torsional group showed higher total phaco time (27.50 +/- 17.77 sec vs. 97.08 +/- 12.67 sec), average phaco power, total phaco energy, persistent corneal edema at 1 week postoperatively and more endothelial cell loss at 3 month postoperatively (16.33 +/- 15.50% vs. 38.71 +/- 26.49%). Postoperative CCT, SIA and BCVA were not significantly different in hard cataracts between the 2 modalities. CONCLUSIONS: In mild and moderate cataracts, the efficiency of phaco and corneal changes were similar between the 2 modalities. However, recently improved longitudinal phaco showed superior efficiency for hard cataracts and induced less endothelial cell loss than torsional phaco.

Comparison of Clinical Outcomes between Torsional and Longitudinal Phacoemulsification

PURPOSE: To compare the clinical outcomes during phacoemulsification when using recently improved longitudinal (Stellaris(R), Bausch & Lomb, Rochester, NY, USA) and torsional (Infiniti Ozil(R), Alcon, Fort Worth, TX, USA) ultrasound. METHODS: The present study included 74 eyes of 59 patients undergoing cataract surgery. Operated eyes with mild cataract (nuclear sclerosis grade 1 and 2), moderate cataract (nuclear sclerosis grade 3) and hard cataract (nuclear sclerosis grade 4 and 5) were compared in terms of the total phacoemulsification (phaco) time, average phaco power, total phaco energy and amount of fluid used during cataract surgery between the 2 modalities. Endothelial cell density, corneal edema, central corneal thickness (CCT), surgically induced astigmatism (SIA) and best-corrected visual acuity (BCVA) were also evaluated preoperatively and up to 3 month postoperatively. RESULTS: In mild cataracts, the operative parameters and corneal changes were similar between the 2 modalities. In moderate cataracts, the total phaco time was significantly higher in the torsional group than the longitudinal group, but the average phaco power, total phaco energy, and amount of fluid were not significantly different. In patients with hard cataract, the torsional group showed higher total phaco time (27.50 +/- 17.77 sec vs. 97.08 +/- 12.67 sec), average phaco power, total phaco energy, persistent corneal edema at 1 week postoperatively and more endothelial cell loss at 3 month postoperatively (16.33 +/- 15.50% vs. 38.71 +/- 26.49%). Postoperative CCT, SIA and BCVA were not significantly different in hard cataracts between the 2 modalities. CONCLUSIONS: In mild and moderate cataracts, the efficiency of phaco and corneal changes were similar between the 2 modalities. However, recently improved longitudinal phaco showed superior efficiency for hard cataracts and induced less endothelial cell loss than torsional phaco.

Retinal Hemorrhage Associated with Perinatal Distress in Newborns

PURPOSE: To describe the ophthalmoscopic features and natural history in a case series of eyes that developed intraocular hemorrhages associated with perinatal distress and to evaluate their clinical courses. METHODS: A retrospective chart review of 289 neonates with a medical history of perinatal distress was conducted. Among these 289 patients (578 eyes), 29 eyes of 17 neonates were found to have had retinal hemorrhages or vitreous hemorrhages (VH). A comprehensive chart review, including details of fundoscopic findings and perinatal history, was conducted. RESULTS: Intraocular hemorrhage was present in 5.5% of the patients. Most hemorrhages (82.7%) were intraretinal. In our population, 17% (n = 5) of hemorrhages resolved within two weeks, but 31% (n = 9) did not resolve even after four weeks. Most hemorrhages spontaneously resolved without any specific sequelae; however, one infant's dense unilateral VH persisted up to three months after birth. When the patient was seen again at 3.5 years of age, she had developed axial myopia and severe amblyopia of the involved eye. CONCLUSIONS: In asphyxiated newborns, the possibility of intraocular hemorrhages should be considered. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Therefore, ophthalmic examination should be considered in neonates with perinatal distress, and close observation is necessary for hemorrhages that do not resolve in this amblyogenic age group.

Retinal Hemorrhage Associated with Perinatal Distress in Newborns

PURPOSE: To describe the ophthalmoscopic features and natural history in a case series of eyes that developed intraocular hemorrhages associated with perinatal distress and to evaluate their clinical courses. METHODS: A retrospective chart review of 289 neonates with a medical history of perinatal distress was conducted. Among these 289 patients (578 eyes), 29 eyes of 17 neonates were found to have had retinal hemorrhages or vitreous hemorrhages (VH). A comprehensive chart review, including details of fundoscopic findings and perinatal history, was conducted. RESULTS: Intraocular hemorrhage was present in 5.5% of the patients. Most hemorrhages (82.7%) were intraretinal. In our population, 17% (n = 5) of hemorrhages resolved within two weeks, but 31% (n = 9) did not resolve even after four weeks. Most hemorrhages spontaneously resolved without any specific sequelae; however, one infant's dense unilateral VH persisted up to three months after birth. When the patient was seen again at 3.5 years of age, she had developed axial myopia and severe amblyopia of the involved eye. CONCLUSIONS: In asphyxiated newborns, the possibility of intraocular hemorrhages should be considered. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Therefore, ophthalmic examination should be considered in neonates with perinatal distress, and close observation is necessary for hemorrhages that do not resolve in this amblyogenic age group.

Incidental Abnormal Ocular Findings of Neonates in Ophthalmic Examinations

PURPOSE: To investigate incidental abnormal ocular findings that may cause visual impairment in neonates. METHODS: The medical records of patients requested for screening for retinopathy of prematurity (ROP) at our hospital's pediatrics department between March 2005 and July 2009 were retrospectively reviewed. Patients were classified into premature and mature neonates according to gestational age (under 37 weeks). RESULTS: A total of 2,090 eyes from 1,045 patients were comprised of 1,514 eyes of 757 premature neonates and 576 eyes of 288 mature neonates. Among 154 eyes of 78 patients (10.17%) who were diagnosed with ROP, 34 eyes of 18 patients had laser treatment. Seven eyes of 5 patients in the premature neonate group (0.46%), and 38 eyes of 23 patients in the mature neonate group (6.57%) were found to have abnormal ocular findings, excluding incidental ROP. Twenty-six eyes of 16 patients were found to have a retinal hemorrhage, and the majority had a birth history of perinatal distress, including birth asphyxia, meconium aspiration, and transient tachypnea of the newborn. Other findings included congenital cataracts, corneal opacity, macular coloboma, persistent hyperplastic primary vitreous, and abnormal fundus. CONCLUSIONS: The incidence of ocular abnormalities in neonates that cause visual impairment is low, but theses may threaten a child's life. Early detection and prompt treatment of ocular disorders in children are important in order to avoid permanent, lifelong visual impairment. Therefore, ophthalmic examinations are essential, even in normal neonates, for early detection of ocular disorders.

Delayed-Onset Expulsive Suprachoroidal Hemorrhage Due to a Trauma after Removal of Penetrating Keratoplasty Suture

PURPOSE: To report a case of delayed-onset expulsive suprachoroidal hemorrhage due to trauma after removal of a penetrating keratoplasty suture. CASE SUMMARY: A 66-year-old man had penetrating keratoplasty for bullous keratopathy performed in his left eye. After 1 year, the continuous suture was removed for adjustment of astigmatism. Four days after removal of the suture, the patient struck his left eye with the back of his hand, although at the time of injury he had no specific symptoms. Two days later, the patient noticed abrupt pain, decreased visual acuity, and massive hemorrhage in his left eye. Examination revealed an inferior wound dehiscence of approximately 8 clock hours (2 thru 10 o'clock) with prolapsed intraocular contents such as the uvea and retina. The patient underwent cornea graft resuturing with resection of ocular contents, which could not be repositioned. Although bleeding was controlled after the operation, vision was lost in his left eye. After two months, according to decrement of intraocular hematoma, the patient had a phthisis bulbi with low intraocular pressure in his left eye. CONCLUSIONS: Persistent low intraocular pressure due to wound leakage through the graft-host junction likely resulted in delayed onset of expulsive suprachoroidal hemorrhage. The risk of traumatic corneal graft rupture after penetrating keratoplasty is significant and is associated with a poor visual outcome and eyeball viability. Therefore, patients should be cautioned. In addition, the importance of eye examination after trauma should be emphasized.

Clinical Features of Infectious Keratitis in West Coast Area of Chungcheongnam-do, Korea

PURPOSE: To evaluate the clinical features of infectious keratitis in the western coastal area of Chungcheongnam-do, Korea. METHODS: We performed bacterial and fungal cultures in patients with findings of infectious keratitis. Any correlations between the culture results and the patients' place of residence, occupation, types of ocular trauma, contact lens wear, previous ocular disease, duration of treatment for complete recovery, time between the onset of symptom and beginning of treatment were evaluated. In addition, we assessed the antibiotic susceptibilities of the cultured organisms. RESULTS: We detected 34 (58.62%) among 58 cultures performed in 55 patients that were positive for organisms; 24 for Gram-positive bacteria, 17 for Gram-negative bacteria, 3 for fungi and 9 for polymicrobial infections. Coagulase-negative staphylococci (CNS) was the most frequent infection. The culture positivity rate was significantly higher (P=0.047) in patients with history of previous ocular disease but no correlations were detected with place of residence, type of ocular trauma or the timing of culture. The average treatment period was 33.95+/-30.59 days, which extended as the lesion size increased (P=0.003). CONCLUSIONS: Pseudomonas species are considered to be the most frequent cause of infectious keratitis in Korea. However, in our study, CNS were the most frequent culture-positive organisms and visual prognosis was poorer in the culture-positive group.

A Case of Candida Parapsilosis Keratitis With Atypical Presentation

PURPOSE: To report a case of Candida parapsilosis keratitis with atypical presentation demonstrated by subepithelial white dot deposits without peripheral inflammatory reaction. CASE SUMMARY: A 45-year-old woman with Stevens-Johnson syndrome had used topical corticosteroid and bandage contact lens due to recurrent epithelial defect and keratitis. Multiple subepithelial white dot deposits were revealed on the central corneal area without surrounding inflammation. The corneal lesion was improved after epithelial debridement with topical antibiotics and steroid eyedrops. A few months later, however, the corneal lesion recurred. Smear cytology was performed, and yeast-formed fungi and pseudohyphae were found. C. parapsilosis was identified in the culture study. Therefore, the topical steroid was withdrawn and 0.15% topical Amphotericin was applied. The corneal lesion improved and corneal opacity did not progress. CONCLUSIONS: The case reported in this study is C. parapsilosis keratitis with multiple subepithelial white dot deposits without typical presentations of fungal kertitis. Although no typical infectious indication was evident, infection should be suspected in patients who show abnormal corneal lesion under immunosuppressive treatment.

Metastatic Esophageal Squamous Cell Carcinoma to the Orbit and Periorbit Masquerading as Periorbital Abscess

A 61-year-old man with no history of malignancy presented with a rapidly expanding left periorbital mass, first noticed one month prior to presentation. The mass was firm, and a pus-like discharge drained spontaneously from the center of the lesion. A biopsy was performed, and histopathology confirmed squamous cell carcinoma. Systemic evaluation revealed that the patient had a primary esophageal squamous cell carcinoma with multiple metastases. The prognosis of orbital metastasis is generally poor, and this patient expired after one month of conservative treatment.

The Clinical Characteristics of Facial Herpes Zoster in Korean Patients

PURPOSE: To investigate the clinical characteristics of Korean patients with facial herpes zoster. METHODS: The present study enrolled patients with facial involvement among the patients with herpes zoster. The percentage of involved branches of the trigeminal nerve, types and frequency of ocular complications, and changes in visual acuity depending on systemic treatment were analyzed. RESULTS: A total of 146 patients (15.9%) out of 916 patients with herpes zoster were diagnosed with facial herpes zoster. The ophthalmic branch was the most frequently involved (55.5%), and coinfection with the ophthalmic and maxillary branch was also common (31.5%). Ocular complications developed in 82 eyes (56.2%) and were most common in the group of coinfection with the ophthalmic and maxillary branch (Fisher's exact test, p=0.003). Conjunctivitis (72.0%) was the most commonly observed ocular complication, while punctate keratitis and endothelitis were also frequent. After treatment with a systemic antiviral agent, visual acuity was significantly improved (paired t test, p=0.001). CONCLUSIONS: A higher incidence of ophthalmic complications was observed in facial herpes zoster patients with a wider area of involvement, including the ophthalmic branch. There was significant improvement of visual acuity and ocular complications after systemic treatment. Therefore, systemic antiviral treatment should be considered when a broad herpes zoster skin lesion is observed.

Acute Transient Myopic Shift in a Patient With Fever of Unknown Origin: A Case Report

PURPOSE: To report a case of acute transient myopic shift in a patient with fever of unknown origin. CASE SUMMARY: A 31-year-old woman without a history of any ophthalmic problems presented with a sudden onset of bilateral blurred vision. She was admitted with the diagnosis of fever of unknown origin (FUO). Ophthalmic examination revealed a visual acuity of 0.06 in the right eye and 0.1 in the left eye. A myopic shift of 3.12 diopters (D) and 2.25D was noted in the right and left eyes, respectively. Retinal folds and choroidal thickening accompanied the myopic shift. On the third day after onset, visual acuity had decreased even more. Myopic shift increased to 4.87D in the right eye and 4.50D in the left eye. At the same time, the depth of the anterior chamber maximally decreased and the thickness of the lens was maximally increased. One week later, the myopic shift was normalized to emmetropia. The depth of the anterior chamber and the thickness of the lens also normalized as the fever subsided.

Comparison of Corneal Thickness and Anterior Chamber Depth Measured With Orbscan, Pentacam, and Ultrasound Pachymetry

PURPOSE:We compared the measurements of corneal thickness and anterior chamber depth (ACD) using three different methods Orbscan, Pentacam and ultrasound pachymetry. METHODS: In healthy volunteers, central corneal thickness was measured with Orbscan, Pentacam and ultrasound pachymetry. Estimation of peripheral corneal thickness and ACD were done by Orbscan and Pentacam. All results were compared statistically. RESULTS: The mean central corneal thickness of 64 eyes measured by Orbscan, Pentacam and ultrasound pachymetry were 509.1+/-61.0 microm, 539.2+/-51.7 microm and 527.4+/-48.3 microm, respectively. There were statistically significant differences in the results among the three methods (repeated-measures analysis of variance (ANOVA), p0.90, p<0.05). The temporal and nasal peripheral corneal thicknesses were thinner in the Pentacam than in the Orbscan (paired t-test, p<0.05). The superior and inferior corneal thickness and ACD were not significantly different. CONCLUSIONS: The results of the three instruments have significant correlations with each other, so all methods are clinically useful.

An Incidental Finding of Pseudoexfoliation in Patient With Ophthalmic Artery Occlusion

PURPOSE: To report a case of pseudoexfoliation in the unaffected eye in a patient with ophthalmic artery occlusion. CASE SUMMARY: A 49-year-old female presented with sudden vision loss in her right eye. On the initial examination, best corrected visual acuity was 20/500 in the right eye, and 20/20 in the left eye. Intraocular pressure in both eyes was 17 mmHg. Fundus examination showed retinal edema and a cotton wool spot in the right eye. There was a filling delay of choroidal and retinal vessels in the fluorescein angiography. On the slit lamp examination, there was pseudoexfoliation material around the pupil margin and lens capsule in the unaffected eye but no evidence of glaucoma. At the six-month follow-up, best corrected visual acuity in the right eye improved to 20/30 and a retinal nerve fiber layer defect was found at the spot of the previous cotton wool spot. On the visual field examination, visual defects corresponded with a retinal nerve fiber layer defect. CONCLUSIONS: Pseudoexfoliation may be related to a systemic vascular disorder.

Two Cases of Tsutsugamushi Disease with Ocular Disease and Eschars on the Lower Eyelid

PURPOSE: To report two cases of tsutsugamushi disease, showing ocular manifestations with eschars on the lower eyelids. METHODS: Two patients who have tsutsugamushi disease with ocular manifestations were examined by standard ophthalmic procedures. Eschars were observed in both patients on the medial canthal lower lid. Conjunctival injection and episcleral vessel dilations were also observed in both patients. One patient had limbal vasculitis with pannus. RESULTS: It is possible that eschars, which are the pathognomonic sign in tsutsugamushi disease, can occur on the eyelid, as well as on the axilla, perineum, abdomen, and extremities, which have been commonly observed sites. Ocular manifestations, including conjunctival injection, episcleral vessel dilation, or limbitis may be observed. These conditions may respond well to treatment with 0.1% Fluorometholone.