The Spontaneous Resolution of Idiopathic Macular Hole Diagnosed with OCT

PURPOSE: To report two cases of spontaneous resolution of macular hole stage 1 and 2, that were objectively diagnosed with OCT(optical coherence tomography). METHODS: Case 1-A 64-year-old woman without systemic disease visited Kong Eye Center complaining of decreasing visual acuity for 1 month. We diagnosed her case as macular hole stage 1, checked her regularly and detected spontaneous resolution of the macular hole after 6 months. We examined her using OCT before and after spontaneous resolution. Case 2-A 66-year-old man without systemic disease visited Kong Eye Center complaining of decreasing visual acuity for several months. We diagnosed his case as macular hole stage 2 and decided to perform an operation 3 weeks later. On admission, we detected spontaneous resolution of the macular hole. We examined him using OCT before and after spontaneous resolution. RESULTS: We could confirm the spontaneous resolution of stage 1 and 2 macular hole using OCT objectively. CONCLUSIONS: OCT is a useful tool in the diagnosis of macular hole and in the evaluation of various natural course of macular hole.

The Clinical Manifestations and Treatments of Parafoveal Telangiectasis

PURPOSE: To investigate the clinical manifestations and treatments of parafoveal telangiectasis. METHODS: Twenty-two eyes of fifteen patients diagnosed as parafoveal telangiectasis were selected who had visited Kong Eye Center from September 1999 to August 2003 complaining of decreasing visual acuity. Visual acuity was checked and fluorescein angiography and optical coherence tomography were done. Authors treated six eyes of six patients experienced decreasing visual acuity due to macular edema with argon laser photocoagulation and one eye of one patient accompanying with choroidal neovascularization with photodynamic therapy. RESULTS: Among fifteen patients, group 1 cases were eight (1B eight) and group 2 cases were seven by classification of Gass and Blodi. Visual acuity improved in two eyes of six eyes and maintained in four eyes of six eyes and optical coherence tomography showed decrease of macular edema in six eyes of six patients all after argon laser photocoagulation. Visual acuity improved and optical coherence tomography showed decrease of macular edema in one eye of one patient after photodynamic therapy. CONCLUSIONS: Group 1 cases were more than group 2 cases. Argon laser photocoagulation can be effectively used to treat decreasing visual acuity due to macular edema in parafoveal telangiectasis patients. Photodynamic therapy seems to be effective in parafoveal telangiectasis accompanied with choroidal neovascularization but we think that additional studies with more cases are needed.

The Relations of Cataract Progressed Postoperatively and Viscoelastic Substance or Mitomycin C used in Trabeculectomy

Viscoelastic substance or Mitomycin C(MMC)is not necessarily used in trabeculectomy. Hence, the authors investigated the rate of cataract development or progression after trabeculectomy related with using of the viscoelastic substance or MMC. The authors evaluated 119 eyes undergoing trabeculectomy and divided these eyes into 4 groups :group 1, 2, 3, and 4. In group 1, viscoelastic substance or MMC was not used(27 eyes). In group 2, only viscoelastic substance was used(35 eyes). In group 3, only MMC was used(15 eyes). In group 4, both viscoelastic substance and MMC were used(42 eyes). The cataract development or progression was examined with slit-lamp biomicroscope at postoperative 6 months and defined as the decrease of visual acuity more than 2 lines. The rate of cataract development or progression at postoperative 6 months was 18%in group 1, 14%in group 2, 40%in group 3, and 19%in group 4.The use of MMC without viscoelastic substance in trabeculectomy influenced cataract development or progression extremely. In conclusion, the results of this study suggest that the viscoelastic substance may reduce the rate of cataract development or progression after trabeculectomy in which MMC is used besides.

A Case of Leigh's Disease Accompanied by Limitation of Bilateral Ocular Movement

PURPOSE: Leigh's disease is a mainly autosomal recessive inherited progressive disorder, with onset in the first 2 years of life, and has ocular signs such as nystagmus, gaze palsy, nuclear ophthalmoplegia and various neurologic signs. This disease finally results in death due to respiratory difficulty after repeated fever, dehydration, poor oral intake, lethargy, and convulsion. Leigh's disease is one of central nervous diseases considered in case infants or children who have paralytic esotropia or rapidly progressive limitation of ocular movement. METHODS: Authors experienced a case of 35-month-old male who had had 15 of right esotrophia and limitation of ocular movement in abduction for 1 month. At first visit, we diagnosed as a right 6th nerve palsy. However, the patient showed rapidly progressive limitation of ocular movement in all direction except in adduction and esotropia in both eyes. RESULTS: The patient presented ocular signs earlier than other neurologic symptoms and signs. He was consulted to the department of pediatric neurology and radiology, and diagnosed as Leigh's disease.

The Effect of Viscoelastic Substance for Trabeculectomy

The viscoelastic substance has been used popularly in trabeculectomy. Hence, the authors compared the safety and postoperative influence in viscoelastic substance use group with non-use group in trabeculectomy. The authors evaluated 20 eyes of 10 open-angle glaucomatous patients undergoing trabeculectomy who had had no systemic disease, no ocular trauma history, and over 21 mmHg intraocular pressure though over 2 eye drops and over one time p.o. medications a day. One eye of these patients used viscoelastic substance(Viscoat(r), Alcon, U.S.A.)and the other did not. The authors measured intraocular pressure and anterior chamber depth at postoperative 1 day, 3 days, and 7 days and measured corneal endothelial cell numbers at preoperative and postoperative 1 month and examined complications such as anterior chamber hemorrhage, anterior chamber inflammation and cataract progression. Viscoelastic substance did not influence intraocular pressure, anterior chamber formation and corneal endothelial cell damage postoperatively in trabeculectomy(p>0.5). But as complications, intraoperative iris prolapse in two eyes, postoperative anterior chamber hemorrhage in a eye, and postoperative cataract progression in a eye developed and anterior chamber inflammation was also worse in the non-viscoelastic substance use group. Conclusively, the viscoelastic substance would reduce intraocular tissue damage, make intraoperative bleeding control easy and prevent anterior chamber collapse immediately after operation in trabeculectomy. Because only open angle glaucoma was studied in the present research, further study was applied to acute angle closure glaucoma, neovascular glaucoma which is apt to bleed, and glaucoma with cataract or uveitis in which intraoperative intraocular damage is minimized.