Visual Field Patterns of Pseudo-optic Discs in Chorioretinal Coloboma

Purpose@#We report three cases of asymptomatic pseudo-optic discs in chorioretinal colobomas highlighted on visual fields patterns.Case summary: (Case 1) A 36-year-old man was found to have a pseudo-optic disc below the optic nerve with a relatively intact neurosensory retina over the lesion. There were no obvious abnormalities on the visual field test, so he underwent no treatment and was followed up every 6 months. (Case 2) A 37-year-old woman diagnosed with glaucoma had abrupt convergence of the neurosensory retinal layers on the boundary of the pseudo-optic disc and a focal retinal nerve fiber layer defect in the inferior sector. An antiglaucoma eyedrop was used to manage the superior hemifield defect, and no significant progression was observed in the structural and functional tests during the 5-year follow-up. (Case 3) A 57-year-old man had a pseudo-optic disc with diffuse retinal nerve fiber layer atrophy in both the superior and inferior sectors. The pseudo-optic disc had protruded into the vitreous cavity. Antiglaucoma eyedrops were used to manage both the superior and inferior hemifield defects, and no significant progression was observed using the structural and functional tests during the 6-year follow-up period. @*Conclusions@#Various visual field results may occur with pseudo-optic discs in chorioretinal colobomas depending on the status of residual retinal tissues and underlying glaucoma. Further evaluations and management options should be considered according to the patient’s condition.

Analysis of Macular Layer Thickness Measured Using Spectral Domain Optical Coherence Tomography in Korean Subjects

PURPOSE: To analyze macular layer thickness using spectral domain optical coherence tomography (SD-OCT) in normal subjects. METHODS: One hundred normal eyes were enrolled in this study. Macular thickness was measured via enhanced depth imaging using Heidelberg Spectralis(R) OCT, using calipers within the program. RESULTS: Central subfield thickness was 11.35 +/- 2.11 microm in the retinal nerve fiber layer, 13.33 +/- 4.16 microm in the ganglion cell layer, 19.38 +/- 3.20 microm in the inner plexiform layer, 18.23 +/- 4.66 microm in the inner nuclear layer, 23.27+/- 6.83 microm in the outer plexiform layer, 91.97 +/- 9.59 microm in the outer nuclear layer, 16.68 +/- 1.83 microm in the retinal pigment epithelium layer, 179.82 +/- 29.99 microm in the inner retinal layer, and 88.32 +/- 2.81 microm in the photoreceptors layer. No significant differences were observed in the spherical equivalent according to age. Despite no significant differences being present, the macular central subfield thickness was thinner in women than in men. CONCLUSIONS: In the present study, differences in macular layer thickness were found according to age and gender which should be considered when macular diseases are evaluated.

The Effect of Fluorescein Angiography on Renal Function in Patients with Diabetic Retinopathy

PURPOSE: This study was designed to compare the change of renal function before and after fluorescein angiography in patients with diabetic retinopathy. METHODS: This study included 80 patients diagnosed with diabetic retinopathy who did not receive dialysis from April 2004 to December 2014. Based on retrospective analysis of a blood test performed within one week before and after fluorescein angiography, the changes of blood urea nitrogen (BUN), serum creatinine (Scr), and estimated glomerular filtration rate (eGFR) were measured. Additionally, the effect of fluorescein angiography on renal function was estimated according to chronic kidney disease (CKD) stage. RESULTS: The average BUN/SCr before and after fluorescein angiography was not statistically significantly different before and after fluorescein angiography. The average eGFR before and after fluorescein angiography increased from 62.62 ± 31.59 to 66.46 ± 31.22 (p = 0.006). Regarding changes in renal functions according to CKD stage, based on the average eGFR in CKD stages 5, 4, 2, and 1, no significant differences were observed in renal functions before and after fluorescein angiography, whereas eGFR was significantly increased after fluorescein angiography at CKD stage 3 (p = 0.042). CONCLUSIONS: In patients with diabetic retinopathy, BUN/Scr and eGFR were not significantly different before or after fluorescein angiography. Moreover, the deterioration of renal function was not observed at any CKD stage. Therefore, fluorescein angiography is a relatively safe diagnostic examination in patients with diabetic retinopathy who did not receive dialysis due to the low-risk of renal function deterioration.

Peripapillary Retinoschisis in Non-Glaucomatous Eyes

PURPOSE: To investigate the characteristics of non-glaucomatous eyes with peripapillary retinoschisis. METHODS: Six non-glaucomatous eyes with peripapillary retinoschisis were enrolled. Age, sex, refractive error, intraocular pressure, location and changes of peripapillary retinoschisis, and the presence of accompanied abnormalities were assessed. To determine possible abnormalities of the optic nerve head and macula, fundus photographs and cross-sectional images of the optic nerve head and macula obtained by optical coherence tomography were inspected. RESULTS: Three males and 3 females were enrolled. Age of the subjects ranged from 11 to 59 years (median, 45 years). Refractive error ranged from -6.25 to +1.00 diopter (median, -0.50 diopter). Peripapillary retinoschisis was located in the superior quadrant in four eyes, in the nasal quadrant in one eye, and in the inferior quadrant in one eye, respectively. No additional abnormalities were found in fundus photographs or in the cross-sectional images of the optic nerve head and macula that were obtained by optical coherence tomography. Longitudinal follow-up was available for two eyes and spontaneous resolution of peripapillary retinoschisis was observed in these eyes 6 and 9 months later, respectively. CONCLUSIONS: Peripapillary retinoschisis was observed in non-glaucomatous eyes. This finding was observed in subjects of various ranges of age and refractive error, and in both sexes, without any other accompanying abnormalities.

Multiple Evanescent White-Dot Syndrome in a 14-Year-Old Girl

PURPOSE: To report a case of multiple evanescent white-dot syndrome (MEWDS) in a 14-year-old female. CASE SUMMARY: A 14-year-old female presented with decreased visual acuity. Review of systems was unremarkable except for a recent upper respiratory infection prior to her symptoms. On examination, her visual acuity was 20/20 in the right eye and 20/200 in the left eye. Relative afferent pupillary defect was observed. Examination of the left fundus revealed optic disc edema and multiple white dots in the posterior pole. Humphrey visual field test showed enlargement of the blind spot in the left eye. Fluorescein angiography revealed hyperfluorescence and late leakage of the white dots. Indocyanine green angiography showed enlarged late hypofluorescence of the white dots. MEWDS was diagnosed and the patient was followed up with serial examinations. At a follow-up examination 2 weeks later, visual acuity in the left eye improved to 20/70. The majority of white dots on fundus had disappeared and the enlarged scotoma in the left eye recovered to normal size on Humphrey visual field test. At a follow-up examination 3 months later, visual acuity in the left eye improved to 20/30 and residual white dots had further disappeared. CONCLUSIONS: Cases of MEWDS have been reported in patients as old as 67 years; however, MEWDS is a rare disease and most patients are young females. The authors describe the youngest case to date in Korea of MEWDS in 14-year-old female with typical clinical course.

Result of Visual Evoked Potential, Electroretinography and Electrooculography in Normal Subjects Using MonPack 3 System

PURPOSE: We present the results of visual evoked potential (VEP), electroretinography (ERG), and electrooculography (EOG) in normal subjects using the Mon-pack 3 system (Metrovision). METHODS: VEP, ERG, and EOG were obtained in 92 normal eyes. The measurements followed the International Society for Clinical Electrophysiology of Vision (ISCEV) standardization protocol. In VEP, the standard electrode was placed on the forehead and the active electrode was attached on the occiput. In ERG, a 20-minute dark adaptation was performed after mydriasis, and an ERG-jet electrode was used. EOG was measured by attaching an electrode to each medial canthal skin. Each latent period and electric potential was measured with average, standard deviation, median, and 95% confidencenterval (95% CI). RESULTS: The mean P100 latency in pattern VEP was 104.36 ms, and P100 latency in flash VEP was 116.71 ms. For the maximal ERG response, the implicit times of a and b waves were 22.65 ms and 44.58 ms, respectively and the amplitude of a and b waves were 274.09 microv and 489.52 microv, respectively. For the ERG cone response, the implicit time of a and b waves were 18.21 ms and 33.40 ms, respectively, and the amplitude of a and b waves were 35.87 microv and 104.42 microv, respectively. The mean ERG oscillitatory potential was 285.53 microv. The average EOG Arden ratio was 2.54. CONCLUSIONS: VEP, ERG, and EOG results from normal subjects using the Mon-pack 3 system can be applied to the diagnosis of retina and optic nerve disease and basic research.

A Case Report of Primary Vitrectomy in Multiple Bilateral Retinal Capillary Hemangiomas Accompanying Epiretinal Membrane

PURPOSE: To report the clinical result of pars plana vitrectomy (PPV) as the primary treatment in a patient with multiple bilateral retinal capillary hemangiomas (RCH) accompanying epiretinal membrane (ERM). CASE SUMMARY: A 17-year-old female patient visited our clinic for decreased bilateral vision 4 days in duration. At the first visit, the vision in her right eye was 20/25 and, 20/100 in her left eye. Bilateral multiple retinal capillary hemangiomas were observed at the peripheral retina in both eyes on fundus examination, fluorescein angiography (FAG) and optical coherence tomography (OCT). ERM and associated macular edema (ME) were noted in her left eye. For her left eye, focal laser photocoagulation (PC) was performed 6 times. ME was decreased and her vision improved to 20/25. However, 3 months after the initial visit, her vision decreased to 20/400 accompanied with exacerbated ERM and ME. Therefore, PPV was performed in her left eye. ERM and associated ME were decreased and her vision improved to 20/25 after 18 months. PPV was performed in the right eye immediately after her vision worsened (best corrected visual acuity, BCVA 20/40) and ERM occurred. After 15 months later, vision in her right eye improved to 20/20 and ERM was also decreased.

Comparison of Therapeutic Effect Between Half-Energy Photodynamic Therapy and Intravitreal Bevacizumab Injection in Chronic Central Serous Chorioretinopathy for 12 Months

PURPOSE: In this study we compared the effectiveness between half energy photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection for chronic central serous chorioretinopathy (CSC). METHODS: Forty-five eyes of 42 patients diagnosed as chronic CSC from March 2008 to April 2011 were treated with half energy PDT or IVB injection. The subjects were chosen for a retrospective study and analysis was performed on changes in best corrected visual acuity and existence of subretinal fluid, recurrence rate and changes in central macular thickness. RESULTS: Similar improvement of visual acuity was observed in both treatment groups 1 month after treatment and no meaningful difference was found in each stage for both groups (p = 0.001, p = 0.0012, respectively). However, 6 to 12 months after the treatment, the half energy PDT group showed more improvement in visual acuity compared to the IVB injection group (p = 0.019, p = 0.043, respectively). Nineteen out of 21 cases showed full recovery of subretinal fluid in the half energy PDT group with an average treatment period of 1.3 +/- 0.8 months and 7 out of 24 cases showed full recovery in the IVB injection group with an average treatment period of 3.2 +/- 2.8 months. There was a single case of recurrence in the half energy PDT group and 4 in the IVB injection group. The half energy PDT group showed a meaningful decline in central macular thickness at 1, 3, and 6 months after treatment (p = 0.001, p = 0.005, p = 0.007, respectively) compared to the IVB injection group and showed numerous cases with decline in central macular thickness below the 2 standard deviation from normal values (p = 0.002). CONCLUSIONS: Both half energy PDT and IVB injection were effective for the treatment of chronic central serous chorioretinopathy. However, the half energy PDT group comparatively showed better anatomical and functional outcomes. The thinning of central macular thickness below normal value was also observed, thus careful choice of treatment is necessary for patients with chronic central serous chorioretinopathy.

Complication Incidence of Day Surgeries with 23 Gauge Vitrectomy

PURPOSE: To evaluate the complication incidence of 23-gauge pars plana vitrectomy day surgery. METHODS: A retrospective review was conducted on 79 eyes that underwent 23-gauge pars plana vitrectomy day surgery from September 2009 to September 2010. The main outcome measures included changes in best corrected visual acuity (BCVA), intraocular pressure (IOP), and presence of postoperative complications after the day surgery. RESULTS: The mean preoperative log MAR BCVA improved from 1.32 +/- 0.96 to 0.40 +/- 0.41 at 3 months after surgery (p 0.05). At the end of surgery, suture placement was required for sclerotomy site leakage in 4 eyes (5.1%). There were 10 eyes (12.7%) with postoperative complications, including 7 eyes with increased IOP (8.9%), hypotony in 2 eyes (2.6%) and vitreous hemorrhage in 1 eye (1.3%), with no case requiring reoperation. CONCLUSIONS: The patients who underwent 23-gauge pars plana vitrectomy day surgery achieved visual improvement without serious complications postoperatively.

Complication Incidence of Day Surgeries with 23 Gauge Vitrectomy

PURPOSE: To evaluate the complication incidence of 23-gauge pars plana vitrectomy day surgery. METHODS: A retrospective review was conducted on 79 eyes that underwent 23-gauge pars plana vitrectomy day surgery from September 2009 to September 2010. The main outcome measures included changes in best corrected visual acuity (BCVA), intraocular pressure (IOP), and presence of postoperative complications after the day surgery. RESULTS: The mean preoperative log MAR BCVA improved from 1.32 +/- 0.96 to 0.40 +/- 0.41 at 3 months after surgery (p 0.05). At the end of surgery, suture placement was required for sclerotomy site leakage in 4 eyes (5.1%). There were 10 eyes (12.7%) with postoperative complications, including 7 eyes with increased IOP (8.9%), hypotony in 2 eyes (2.6%) and vitreous hemorrhage in 1 eye (1.3%), with no case requiring reoperation. CONCLUSIONS: The patients who underwent 23-gauge pars plana vitrectomy day surgery achieved visual improvement without serious complications postoperatively.

Visual Acuity and Astigmatism after Simultaneous Surgery for Upper and Lower Eyelid Epiblepharon in Children

PURPOSE: To study the changes in vision and astigmatism in epiblepharon patients undergoing simultaneous surgery for both upper and lower eyelid epiblepharon. METHODS: The study subjects consisted of 40 eyes of 20 patients who underwent surgery for both upper and lower eyelid epiblepharon from March 2007 to December 2008. The patients were divided into groups depending on the degree of corneal erosion. Uncorrected and best corrected vision, refractive error and the degree of corneal erosion were measured before and three months after the surgery. RESULTS: The mean patient age was 7.40 years, and all but three patients showed postoperative grade 0 corneal erosion. Mean uncorrected logMAR visual acuity was 0.44 preoperatively and 0.25 three months after the operation. The mean best corrected logMAR visual acuity was 0.13 preoperatively and 0.04 three months after the operation (p = 0.02, 0.01). Mean astigmatism showed a significant decrease from 1.46 preoperatively to 1.19 three months after surgery (p = 0.03). CONCLUSIONS: After simultaneous surgery for upper and lower eyelid epiblepharon in children, uncorrected and best corrected visual acuity and corneal erosion were all improved. The astigmatism was largely with-the-rule, both before and after surgery.

Effect of Adenotonsillectomy on Symptoms and Growth in Children with Sleep Disordered Breathing : Long-Term Results / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic upper airway obstruction attributable to adenotonsillar hypertrophy is the most common cause of sleep disordered breathing (SDB) in children. The objective of this study was to evaluate the long-term effects of adenotonsillectomy on the degree of SDB and growth in children with SDB. SUBJECTS AND METHOD: Forty-three children (mean age, 6.1+/-2.4 years) clinically diagnosed as SDB were enrolled, and they were scheduled for adenotonsillectomy (T&A ) based on their response to the validated, 22-item sleep related breathing disorder (SRBD) scale and a physical examination that showed adenotonsillar hypertrophy. Weight, height, and BMI (body mass index) were evaluated before and three years after T&A. RESULTS: SRBD scales decreased significantly after T&A(p<0.001). Their Z scores (standard deviation scores) for weight, height, and BMI of 43 children were significantly higher three years after T&A compared with before T&A (p<0.01). CONCLUSION: Children with SDB who underwent adenotonsillectomy showed significant long-term increases in weight, height, and BMI as well as a significant long-term improvement in quality of the sleep.

Effect of Growth Factors on Hearing Restoration in Deafened Animal Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss is caused by ototoxic drugs, radiation therapy, noise exposure and trauma, etc. They make irreversible changes in cochlear hair cells and degeneration of spiral ganglion neurons. It is known that neurotrophins and other growth factors have an important role in protectingcochlear hair cells and spiral ganglion neurons. We designed this study to analyze the effect of neurotrophins and growth factors delivered to the inner ear of deafened guinea pig. MATERIALS AND METHOD: Healthy 15 guinea pigs with normal Preyer's reflex were chosen, and were made deaf by infusion of kanamycin and ethacrynic acid. Myringotomy was done to both ears, normal saline injected into the left ear, and BDNF (brainderived neurotrophic factor), GDNF (glial cell derived neurotrophic factor), NT-3 (neurotrophin-3), IGF (insulin-like growth factor), EGF (epidermal growth factor), FGF (fibroblast growth factor) were injected in the right ear. RESULTS: Statistically significant hearing gain was obtained up to 35.00+/-13.78 dB in the group 1 (BDNF, GDNF, NT-3 treated group), and up to 34.0+/-5.47 dB in the group 2 (IGF treated group). However, no statistically significant hearing gain was observed in the group 3 (EGF, FGF treated group). CONCLUSION: We observed statistically important improvement of hearing threshold in the BDNF, GDNF, NT-3 treated group and IGF treated group.

A Combination of 23-gauge and 20-gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To describe the clinical experience and safety profile of a combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy (TSV) METHODS: Thirty-seven eyes of thirty-seven consecutive patients who underwent 23-gauge combined with 20-gauge transconjunctival vitrectomy surgery by a single surgeon from August 2006 through December 2006 were reviewed retrospectively for surgical indications, wound problems, and postoperative complications. RESULTS: Thirty-seven eyes, including eyes with proliferative diabetic retinopathy (n=24), macular hole (n=3), epiretinal membrane (n=3), vitreous hemorrhage due to branch retinal vein occlusion and choroidal neovascular membrane (n=3), vitreous opacity secondary to uveitis (n=1), rhegmatogenous retinal detachment (n=1), and vitreoretinal traction syndrome (n=1), underwent operation. Seven eyes at 23-gauge sclerotomy sites and 15 eyes at 20-gauge sclerotomy sites had subconjunctival hemorrhage. Three eyes required sutures at 20-gauge sclerotomy sites intraoperatively due to wound leakage. One wound hemorrhage occurred at a 23-guage sclerotomy site. Vitreous hemorrhage (4 eyes), hyphema (2 eyes), and vitreous hemorrhage with hyphema (1 eye) occurred postoperatively. Postoperative hypotony, retinal detachment, and other complications did not occur. CONCLUSIONS: A combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy which was created by modifying transconjunctival sutureless vitrectomy systems published previously guarded against sclerotomy wounds and a variety of vitreoretinal surgical indications.

Retinal Capillary Hemangioma Treated with Verteporfin Photodynamic Therapy and Intravitreal Triamcinolone Acetonide

PURPOSE: To report a case of retinal capillary hemangioma treated with verteporfin photodynamic therapy combined with intravitreal triamcinolone acetonide. METHODS: A 15-year-old female presented with metamorphopsia in the left eye for 7 days. Examination showed peripheral endophytic retinal capillary hemangioma, macular edema, and a best-corrected visual acuity of 20/50. The hemangioma and macular edema were treated with verteporfin photodynamic therapy and intravitreal triamcinolone acetonide. RESULTS: After 5 months of follow-up, involution of the hemangioma, reduction of macular edema, decrease of the feeder and draining vessel diameter, and improvement of best-corrected visual acuity to 20/25 was seen. CONCLUSIONS: This verteporfin photodynamic therapy combined with intravitreal triamcinolone acetonide appeared to cause involution of the hemangioma with reduction in macular edema and improvement in visual acuity.

A Case of Macular Edema after Rosiglitazone Use

PURPOSE: To report a case of macular edema after the use of the oral hypoglycemic agent rosiglitazone. METHODS: A 43-year-old man, who had diabetic mellitus and was on oral rosiglitazone therapy, complained of a visual disturbance in his left eye. After fundus examination and optical coherence tomography, macular edema was observed, therefore rosiglitazone therapy was discontinued. RESULTS: After 2 weeks, his visual acuity improved, and macular edema decreased in the left eye on optical coherence tomography. CONCLUSIONS: Rosiglitazone use should be considered as one of the potential causes of macular edema.