Characteristics of Unexposed Proliferative Diabetic Retinopathy: An Optical Coherence Tomography Angiography Study

Purpose@#To compare optical coherence tomography angiography (OCTA) findings between severe non-proliferative diabetic retinopathy (NPDR) and unexposed proliferative diabetic retinopathy (PDR), and identify predictive factors. @*Methods@#Patients newly diagnosed with severe NPDR or unexposed PDR between January 2018 and December 2021 were reviewed retrospectively. Unexposed PDR was diagnosed using fluorescein fundus angiography, because new vessels could not be observed in the poster pole or clearly distinguished in the retinal periphery on wide fundus photography. Clinical features at the time of diagnosis, and OCTA measurements (mean vascular density, superficial capillary plexus (SCP) foveal avascular zone (FAZ) area, and mean retinal thickness), were compared between the two groups. Factors that could predict unexposed PDR were investigated using multivariate analysis with a generalized estimating equation. @*Results@#A total of 61 severe NPDR and 23 unexposed PDR eyes were included. The unexposed PDR had significantly larger SCP-FAZ areas (p = 0.031) and lower total and parafoveal mean inner retinal thicknesses (p = 0.014 and p 0.05). Multivariate analysis showed that SCP-FAZ area and parafoveal mean inner retinal thickness were significant predictors of unexposed PDR (p = 0.027 and p = 0.001, respectively). @*Conclusions@#In severe NPDR patients, unexposed PDR may be considered a differential diagnosis when the SCP-FAZ area is large or the parafoveal mean inner retinal thickness is small.

Anterior Ocular Biometrics Using Placido-scanning-slit System, Rotating Scheimpflug Tomography, and Swept-source Optical Coherence Tomography

Purpose@#To compare anterior biometry measurements using placido-scanning-slit topography, rotating Scheimpflug tomography, and swept-source optical coherence tomography. @*Methods@#A retrospective review consisted of 80 eyes of 49 participants who underwent anterior chamber depth (ACD), central corneal thickness (CCT), and keratometry examination on the same day. We used placido-scanning-slit topography (ORBscan II), rotating Scheimpflug tomography (Pentacam HR), and swept-source optical coherence tomography (CASIA SS1000). The intraclass correlation coefficients and Bland-Altman plots were used to evaluate the agreement and differences between measurements. @*Results@#The mean ACD values were 2.88 ± 0.43, 2.82 ± 0.50, and 2.68 ± 0.44 mm; and the mean CCT values were 536.96 ± 31.19, 543.79 ± 31.04, and 561.41 ± 32.60 μm; and the mean keratometry (Km) were 43.81 ± 1.69, 43.81 ± 1.77, and 44.65 ± 1.95 diopters; as measured by CASIA SS-1000, Pentacam HR, and ORBscan II, respectively. Among the three devices, ACD was deepest to shallowest in the order of CASIA SS-1000, Pentacam HR, and ORBscan II (p < 0.05). The CCT was thickest to thinnest in the order of ORBscan II, Pentacam HR, and CASIA SS-1000 (p < 0.05). No significant differences in Km values were examined between CASIA SS-1000 and Pentacam HR, whereas ORBscan II overestimated Km with a statistically significant difference compared to the other two devices. @*Conclusions@#High level of agreement was found between CASIA SS-1000 and Pentacam HR for anterior parameters, including ACD, CCT, and Km, suggesting interchangeability. However, ORBscan II measurements differed considerably with the measurements obtained from the other two devices; therefore, it should not be used interchangeably. However, further studies with repeatability test should be considered in order to elucidate the reliability of each device.

Autologous Retinal Flap Transplantation of a Refractory Giant Macular Hole with Retinal Detachment

Purpose@#A giant macular hole with retinal detachment occurred in a patient who had undergone several surgical treatments for retinal detachment, macular hole, and complicated cataracts. Here we report a case of successful retinal attachment and macular hole closure for this patient after autologous retinal flap transplantation.Case summary: Recently, an 18-year-old female presented with a newly developed visual field disturbance in her left eye. She had been on medication for severe atopic dermatitis in the past and seven years ago underwent scleral buckling, pars plana vitrectomy, and complicated cataract surgery due to rhegmatogenous retinal detachment of the left eye. Five years ago, extensive internal limiting membrane peeling, intravitreal gas tamponade, and aftercataract removal were performed due to the development of a macular hole with retinal detachment of the left eye. Thereafter, although the retina was reattached, closure of the macular hole was not successful. Recently, a giant macular hole with a retinal detachment was detected in this patient accompanied by symptoms of visual disturbance. Autologous retinal flap transplantation and intravitreal silicone oil tamponade were performed. Two months after the operation, she underwent silicone oil removal. Successful closure of the macular hole and retinal reattachment were confirmed. @*Conclusions@#In a patient with a refractory giant macular hole with retinal detachment, the closure of the hole and retinal reattachment were successfully achieved after retinal flap transplantation, without viscoelastics or perfluorocarbon liquid.

Comparison of Double Maddox Rod Test and Bagolini Striated Lens Test for Superior Oblique Palsy

PURPOSE: We compared the results of the double Maddox rod test (DMRT), which is commonly performed in clinics as a subjective torsion test for superior oblique muscle palsy, with those of the Bagolini striated lenses test (BSLT) in a least dissociating condition to predict the cyclofusional capacity. METHODS: Twenty-five patients with acquired superior oblique muscle palsy were tested for degree of subjective torsion with DMRT and BSLT in primary position and down-gaze in Daegu Catholic University Hospital from May 2014 to March 2015. DMRT was performed in a dark room and BSLT in a lighted room. RESULTS: Mean extorsional degree in primary position was 3.40 ± 2.58° on DMRT and 1.88 ± 2.92° on BSLT, a significant difference (p = 0.000). In down-gaze, mean extorsional degree was 4.16 ± 2.90° with DMRT and 2.40 ± 2.90° with BSLT (p < 0.001). CONCLUSIONS: The subjective torsional measurement with BSLT was significantly smaller than with DMRT, and the cyclofusional capacity in patients with acquired superior oblique palsy was 1.5° in primary position and 1.8° in down-gaze. BSLT is helpful in addition to DMRT and fundus photograph for the evaluation of cyclotropia in patients with superior oblique muscle palsy, and this test may yield clinically important information for predicting the cyclofusional capacity of patients with superior oblique muscle palsy.

A Case of Bilateral Trochlear Nerve Palsy Following Cisternography

PURPOSE: To report a case of bilateral trochlear nerve palsy following cisternography. CASE SUMMARY: A 43-year-old male with intermittent watery rhinorrhea persisting for 3 months visited the neurosurgery department of our institute. His past medical history included removal of a pituitary adenoma 22 years prior to presentation. Cerebrospinal fluid leakage was suspected and cisternography was performed. The patient was referred to our ophthalmology department for diplopia 3 days after the cisternography. An alternate prism cover test showed 5 prism diopter (PD) right hypertrophia in the primary position, and underaction of bilateral superior oblique muscles and overaction of the left inferior oblique muscle. A positive Bielschowsky test with the head tilted to either side was observed and excyclotorsion was 9degrees on the double Maddox rod test. The patient was diagnosed with bilateral trochlear nerve palsy. After 2 years of follow-up, diplopia persisted and recession of the bilateral inferior oblique muscles was performed. After the surgery, diplopia disappeared, the fundus photography showed no excyclotorsion, and the double Maddox rod test indicated 3degrees of excyclotorsion. CONCLUSIONS: Cisternography should be carefully performed due to the possibility of bilateral trochlear nerve palsy, an extremely rare but possible occurrence following the procedure.

A Case of Spontaneous Closure of Macular Hole in a Previously Vitrectomized Eye

PURPOSE: To report a case of spontaneous closure of a macular hole in a previously vitrectomized eye. CASE SUMMARY: A 71-year-old female had undergone vitrectomy on the left eye due to a secondary epiretinal membrane with vitreous opacity caused by vasculitis. After the procedure, while the patient was still on medication for the recurrent inflammation of the anterior and posterior segment of the vitreous, a macular hole was found after fundus examinations. Visual acuity of her left eye was 0.125 and ocular coherence tomography (OCT) confirmed a full thickness macular hole with a perifoveal cyst. We recommended vitrectomy, internal limiting membrane peeling, and intravitreal gas injection, but the patient refused further intervention due to her poor general condition. After 2 weeks, resolution of the perifoveal cyst with the macular hole was observed. After 13 weeks, OCT revealed the complete closure of the macular hole with normal foveal depression and the patient regained 0.4 visual acuity. CONCLUSIONS: Spontaneous closure of macular hole is a rare phenomenon in vitrectomized eyes, but a small macular hole with inflammation may close spontaneously without additional intervention. Therefore, observation should be considered rather than hasty surgical intervention. Apparently, the spontaneous closure of a macular hole is due to degenerative processes such as development of macular edema and natural recovery.