Clinical Manifestations and Prognosis in Patients with Infectious Endophthalmitis after Ahmed Glaucoma Valve Implant Surgery

Purpose@#We studied the clinical features and assessed the treatment outcomes of infectious endophthalmitis subsequent to Ahmed glaucoma valve (AGV) implant surgery. @*Methods@#We performed a retrospective review of the medical records of patients who underwent AGV implant surgery between January 1, 2010 and May 31, 2022. Clinical course, microbiological lab results, and the treatment data of patients who developed infectious endophthalmitis were analyzed. @*Results@#Of 310 eyes that underwent AGV implant surgery, 9 (2.90%) developed endophthalmitis. The average time interval between AGV implant surgery and the diagnosis of endophthalmitis was 3.59 years. As initial treatment, all affected eyes received injections of intravitreal antibiotics, while four underwent primary pars plana vitrectomy. The implanted valve was removed in seven instances. Microorganisms were found in cultures from four cases. Two patients achieved a final best-corrected visual acuity (BCVA) above 20/200, while the other five had a final BCVA of hand motion or worse. @*Conclusions@#AGV implant-related endophthalmitis is uncommon and often results in poor visual outcomes, with unpredictable onset. Consequently, it is crucial to educate patients undergoing AGV implant surgery during regular follow-ups. Immediate evaluation and treatment are necessary for patients exhibiting symptoms after surgery.

Changes in Macular Thickness and Microvasculature in Koreans with Early Parkinson’s Disease

Purpose@#To investigate the thickness of the nerve fiber layer-ganglion cell inner plexiform layer (NFL-GCIPL) complex and microvascular macular changes in Korean patients with early Parkinson’s disease using optical coherence tomography (OCT) and OCT angiography (OCTA). @*Methods@#Forty-three eyes of 22 patients with early Parkinson’s disease were included. A control group of 20 patients (40 eyes) was also recruited. The thickness of the NFL-GCIPL macular complex was measured using OCT, and the densities of the superficial and deep macular retinal vessels were evaluated via OCTA in all subjects. @*Results@#The NFL-GCIPL thicknesses of the superior, inferior, temporal, and nasal sectors were 94.70 ± 9.35, 93.32 ± 9.16, 90.18 ± 6.32, and 93.11 ± 8.75 μm in the control group and 92.05 ± 4.96, 91.32 ± 7.48, 84.74 ± 6.82, and 91.32 ± 7.47 μm in the Parkinson’s disease group, respectively; all thicknesses were significantly greater in the control group. The superficial and deep retinal vessel densities did not differ between the two groups. @*Conclusions@#Neurodegenerative macular changes are more obvious than microvascular changes in patients with early Parkinson’s disease. Such neurodegenerative changes should be further evaluated in future cohort studies.

Interactive Direct Interhospital Transfer Network System for Acute Stroke in South Korea

Background@#and PurposeInterhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. @*Methods@#In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH (“door”) to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. @*Results@#The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38–114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0–22.0 min) and 137.5 min (IQR, 125.3–149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). @*Conclusions@#The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.

The Utility of Peripheral Vitrectomy Featuring Scleral Indentation during Scleral Fixation of Intraocular Lenses

Purpose@#We evaluated the utility of peripheral vitrectomy featuring scleral indentation; we compared a group who underwent peripheral vitrectomy to a control group for whom vitrectomy was combined with scleral fixation of intraocular lenses (IOLs) in patients exhibiting IOL dislocations. @*Methods@#From January 2018 to December 2020, 20 eyes of patients evidencing IOL dislocations that underwent total vitrectomy, IOL removal, and IOL scleral fixation were evaluated; peripheral vitrectomy with scleral indentation was performed in 10 patients. All operations were performed by the same surgeon. We excluded patients with follow-up periods less than 6 months, those with a history of retinal and/or glaucoma surgery, and patients with retinal abnormalities or glaucoma that might significantly compromise visual acuity. The postoperative best-corrected visual acuity, intraocular pressure, astigmatism changes, and complications were retrieved from the medical records. @*Results@#Six months after surgery, the best corrected visual acuity was 0.95 (the Snellen measure) in the group who underwent peripheral vitrectomy featuring scleral indentation, and 0.60 in the control group (p = 0.029). The total astigmatism values were 0.48 diopter in the former and 2.80 diopter in the latter group; the difference was significant (p < 0.001). @*Conclusions@#In patients with IOL dislocations who underwent vitrectomy combined with IOL scleral fixation, improvements in visual acuity were further enhanced when peripheral vitrectomy was combined with scleral indentation. Complete removal of the peripheral vitreous may stabilize IOL positioning by the remnant vitreous.

Two Cases of Unusual Presentation of Postoperative Endophthalmitis Caused by Streptococcus dysgalactiae Subspecies Equisimilis

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.

Clinical Features and Treatment Outcomes in Patients with Infectious Scleritis

PURPOSE: To investigate risk factors, clinical features, pathogenic organisms, and outcomes in patients with infectious scleritis. METHODS: This study was a retrospective review of 20 patients with infectious scleritis who were admitted from January 2011 to December 2018 in a single tertiary hospital, with at least 3 months of follow-up. We analyzed age, risk factors, clinical manifestations, pathogenic organisms, treatment, and outcomes of infectious scleritis. RESULTS: The mean patient age was 69.2 ± 8.4 years and the mean duration of hospitalization was 11.3 ± 5.8 days. Furthermore, the mean duration of symptoms before presentation was 16.8 ± 13.9 days; patients were followed for a mean duration of 23.3 ± 25.4 months. All patients had prior pterygium surgery. Eighteen patients (90%) were culture-positive and Pseudomonas aeruginosa (P. aeruginosa) was identified in 12 eyes. In the acute stages, adjuvant surgical intervention was performed for 18 patients (90%) for these patients, the mean duration of hospitalization before surgery was 4.1 ± 4.4 days. CONCLUSIONS: The most common risk factor and pathogenic organism for infectious scleritis were prior pterygium surgery and P. aeruginosa, respectively. Identification of specific causative organisms and corresponding antibiotic treatment with adjuvant surgical intervention may improve visual prognosis in patients with infectious scleritis.

Reversible Cerebral Vasoconstriction Syndrome Presenting with Bilateral Occipital Hemorrhage after the Subcutaneous Injection of Synthetic Gonadotropin Releasing Hormone

Reversible cerebral vasoconstriction syndrome (RCVS) is a heterogeneous group of cerebrovascular disease. The pathophysiology of RCVS is unknown, but a disturbance in cerebral vascular tone is one of hypothesis. Long-term use of Gonadotropin-releasing hormone (GnRH) agonists can induce a pseudomenopausal state in which estrogen production are suppressed. It might lead to reduced arterial relaxation by estrogen withdrawal. We report a case of RCVS after the injection of synthetic analogue of GnRH.

Embolic Infarction with Hypercoagulability Caused by Subclavian Pseudoaneurysm

Traumatic subclavian artery injury is a rare complication of clavicular fracture. An arterial injury can present as a pseudoaneurysm, which can cause a hypercoagulable state, thrombus formation, deep vein thrombosis, and distal embolism. We report a case of subclavian artery pseudoaneurysm that presented as embolic stroke in a 81-year-old man at 2015 1 month after clavicular fracture.

Short-term Clinical Outcomes after Transscleral Fixation Using the Intrascleral Pocket Technique: A Retrospective Cohort Study Analysis

PURPOSE: To compare the two transscleral fixation (TSF) techniques of intrascleral pocket and conventional scleral flap with conjunctival division techniques in terms of short-term clinical effects. METHODS: This retrospective cohort study included all consecutive patients with aphakia in Gyeongsang National University Hospital in Jinju, Korea, who underwent TSF between January 2012 and December 2014. The medical records of all patients were retrospectively reviewed, and the endothelial cell count (ECC), refraction, best-corrected visual acuity (BCVA), intraocular pressure, slit lamp, and fundus examination results before and 1 day and 6 months after surgery were recorded. The postoperative complications and visual outcomes were also recorded. RESULTS: The intrascleral pocket and conventional-flap groups did not differ significantly in terms of demographics, presurgical BCVA, or ECC. However, the intrascleral pocket group had a significantly lower BCVA at 1 day and 6 months after surgery compared to the conventional-flap group. The two groups did not differ in terms of ECC 6 months after surgery. The intrascleral pocket group had no postoperative complications, but five patients in the conventional-flap group complained of irritation. In both groups, the intraocular lens was well positioned without tilting or subluxation, and astigmatism was significantly reduced at 1 day and 6 months after surgery. CONCLUSIONS: The intrascleral pocket technique of TSF does not involve conjunctival dissection and is a successful method of sulcus fixation. It stably corrects the intraocular lens and is easy to perform, which helps to reduce operation time. It also reliably yields rapid visual acuity recovery without complications.

Clinical Manifestations and Outcomes of Treatment in Cytomegalovirus Endotheliitis

PURPOSE: To elucidate the clinical manifestations of cytomegalovirus (CMV) endotheliitis, and evaluate the outcomes of treatment in CMV endotheliitis. METHODS: We reviewed the medical records of 7 patients (8 eyes) who were diagnosed with CMV endotheliitis via a polymerase chain reaction (PCR) of aqueous humor and were treated with ganciclovir. RESULTS: Eight eyes of 7 patients were followed for a mean of 17.8 months. One patient had bilateral corneal endotheliitis. All eyes had coin-shaped keratoprecipitates and mild anterior chamber inflammation (1+~2+). All eyes had an absence of anterior segment inflammation 3 weeks after ganciclovir treatment. Following treatment, the mean visual acuity improved significantly from 0.60 ± 0.40 (log MAR) at baseline to 0.18 ± 0.18 (log MAR) at last follow-up. The mean intraocular pressure (IOP) decreased significantly from 30 mm Hg at baseline to 12 mm Hg at last visit. Two eyes had a recurrence of corneal endotheliitis, where one underwent penetrating keratoplasty and the other was treated with intravitreal ganciclovir injection. CONCLUSIONS: Patients with increased IOP and coin-shaped keratoprecipitates are suspected to have CMV endotheliitis, and PCR of aqueous humor is needed to diagnose CMV endotheliitis. More than 6 weeks of ganciclovir treatment might be effective for CMV endotheliitis and may help prevent recurrence.

Clinical Manifestations and Outcomes of Treatment in Cytomegalovirus Endotheliitis

PURPOSE: To elucidate the clinical manifestations of cytomegalovirus (CMV) endotheliitis, and evaluate the outcomes of treatment in CMV endotheliitis. METHODS: We reviewed the medical records of 7 patients (8 eyes) who were diagnosed with CMV endotheliitis via a polymerase chain reaction (PCR) of aqueous humor and were treated with ganciclovir. RESULTS: Eight eyes of 7 patients were followed for a mean of 17.8 months. One patient had bilateral corneal endotheliitis. All eyes had coin-shaped keratoprecipitates and mild anterior chamber inflammation (1+~2+). All eyes had an absence of anterior segment inflammation 3 weeks after ganciclovir treatment. Following treatment, the mean visual acuity improved significantly from 0.60 ± 0.40 (log MAR) at baseline to 0.18 ± 0.18 (log MAR) at last follow-up. The mean intraocular pressure (IOP) decreased significantly from 30 mm Hg at baseline to 12 mm Hg at last visit. Two eyes had a recurrence of corneal endotheliitis, where one underwent penetrating keratoplasty and the other was treated with intravitreal ganciclovir injection. CONCLUSIONS: Patients with increased IOP and coin-shaped keratoprecipitates are suspected to have CMV endotheliitis, and PCR of aqueous humor is needed to diagnose CMV endotheliitis. More than 6 weeks of ganciclovir treatment might be effective for CMV endotheliitis and may help prevent recurrence.

Difference of Self-identity Levels between Strabismus Patients and Normal Controls

PURPOSE: To evaluate differences in self-identity in patients diagnosed with strabismus, patients who underwent strabismus surgery, and healthy control individuals. METHODS: Self-identity testing was done during a military service physical examination. There were three subject groups: subjects with strabismus (group 1), subjects who had undergone corrective strabismus surgery (group 2), and subjects free of strabismus (group 3). The self-identity test was comprised of six sub-sections (subjectivity, self-acceptance, future confidence, goal orientation, initiative, and familiarity). Statistical significance of the sub-sections was compared across the three groups. Correlations in age at the time of surgery and across the six sub-sections were investigated in group 2. RESULTS: A total of 351 subjects were enrolled in the study; 96 subjects were in group 1, 108 subjects were in group 2, and 147 subjects were in group 3. Significant differences were evident in subjectivity, self-acceptance, initiative and familiarity between groups 1 and 3. No significant differences were found between groups 2 and 3. In group 2, statistical significance was evident between age at surgery and initiative and familiarity (r = −0.333, p < 0.001; r = −0.433, p < 0.001, respectively). CONCLUSIONS: Self-identity is greater in non-strabismus subjects than strabismus subjects. Correction of strabismus may increase self-identity levels.