Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens.

INTRODUCTION: The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). METHODS: This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. RESULTS: There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). CONCLUSIONS: In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.

Multifocal Electroretinography Changes over 12 Months after Resolution of Central Serous Chorioretinopathy: Prospective Observational Study.

INTRODUCTION: This prospective observational study aimed to evaluate the changes in retinal function after the anatomical resolution of central serous chorioretinopathy by multifocal electroretinography. METHODS: Thirty-two eyes of 32 patients with unilaterally resolved central serous chorioretinopathy were prospectively studied. Serial multifocal electroretinography examinations were performed at the initial visit for active central serous chorioretinopathy, the time of anatomical resolution (resolved central serous chorioretinopathy), and 3, 6, and 12 months after resolution. The peak amplitudes of the first kernel responses were analysed and compared with those in 27 age-matched normal controls. RESULTS: Compared with controls, the N1 amplitudes of rings 1-4 and P1 amplitudes of rings 1-3 showed statistically significant reductions at 12 months after the resolution of central serous chorioretinopathy (p < 0.05). The multifocal electroretinography amplitude substantially increased at the time of resolution and gradually improved until 3 months after the resolution of central serous chorioretinopathy. CONCLUSION: Serial examinations with multifocal electroretinography showed that retinal responses increased mostly after the resolution of central serous chorioretinopathy, and this improvement slowly progressed until 3 months; however, the multifocal electroretinography amplitudes remained statistically reduced 12 months after the anatomical resolution of central serous chorioretinopathy, indicating the residual functional deficits detected by multifocal electroretinography.

Evaluation of Acute Central Serous Chorioretinopathy Using Enhanced Depth Imaging Optical Coherence Tomography and Multifocal Electroretinography.

INTRODUCTION: The aim of the study was to evaluate functional and structural abnormalities in patients with acute central serous chorioretinopathy (CSC) with multifocal electroretinography (mfERG) and enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: This prospective observational study included 57 patients with unilateral CSC. Both eyes underwent mfERG and EDI-OCT. Peak amplitudes and implicit times of the first kernel responses were analyzed and compared with those of 25 age-matched normal controls. Correlational analyses were performed between the mfERG results and EDI-OCT parameters. RESULTS: Compared with the normal controls, the amplitude and implicit time on mfERG were significantly impaired in the area with serous retinal detachment (SRD) and the area beyond the SRD. Eyes with a greater reduction in SRD had a less impaired mfERG response in fellow eyes than those whose retinal detachments were not spontaneously decreased by >90% after 3 months. Correlational analysis revealed that the subfoveal choroidal thickness was negatively correlated with the mfERG parameters. CONCLUSIONS: The findings of this study indicate diffuse functional impairment in acute CSC involving both eyes and areas beyond the SRD. The retinal response of the unaffected eye was associated with regression of SRD. Functional retinal abnormality was found to correlate with pathological changes in the choroid.

Analysis of treatment response about low-dose (0.01%) atropine eye-drops in myopic children.

INTRODUCTION: Myopia usually commences during primary school and progresses until the mean age of 16 years. Topical low-dose (0.01%) atropine eye-drop appears to be safe and efficacious for myopia control in children. However, in some cases, a higher concentration of atropine is required in some cases because low-dose atropine treatment is not effective. METHODS: This is a retrospective study among young myopic children between 5 and 15 years with myopia progression > 0.50 D/year. We selected patients treated with low-dose atropine (0.01%) eye-drops for 12 months and conducted a comparative analysis of the group with good responder and poor responder. Patients were classified as good responders if spherical equivalent refractive error (SE) progression was ⩽ 0.50 D after 12 months of treatment and poor responders if SE progression > 0.50 D. The prognostic factors before and after treatment were analyzed in two groups. RESULTS: A total of 68 eyes were included. Low-dose (0.01%) atropine eye-drops have a good treatment response in 54% of patients. In the good responder group (n = 37), the mean rate of myopia progression after 12 months of treatment (0.36 ± 0.17 D) was significantly slower compared with the baseline progression (p < 0.001). Good responders have smaller changes in axial length (AL) elongation and SE than poor responders (p < 0.001). The only adverse event was temporary near vision difficulty (10%), photophobia (10%), and mild pupil dilation (30%). DISCUSSION: The AL elongation is an important indicator for monitoring the treatment response. Children with a family history of myopia at a young age may not respond well to low-dose (0.01%) atropine eye-drops. In these cases, increasing the concentration of atropine eye-drops should be considered.

Choroidal Thickness Changes after Orthokeratology Lens Wearing in Young Adults with Myopia.

INTRODUCTION: Recently in South Korea, there are increasing number of young adults undergoing orthokeratology treatment for myopia control. They prefer orthokeratology treatment more than wearing spectacles or having a refractive surgery for several reasons. However, there is little research on the effect of orthokeratology treatment on choroids. OBJECTIVE: The aim of this study was to analyze the change in choroidal thickness (CT) in the horizontal axis in young myopic adults after orthokeratology treatment. METHODS: This was a retrospective research among young myopic patients (-1.0 to -5.0 diopters) aged 19-29 years (n = 36; 23.6 ± 2.5 years). We selected patients who were treated with orthokeratology for 12 months. CT values of the horizontal axis near the fovea before and after orthokeratology treatment were analyzed using optical coherence tomography. The value was measured at the beginning of treatment and at 3, 6, and 12 months after orthokeratology treatment. Three regional areas of choroid on the horizontal plane including fovea were analyzed. RESULT AND CONCLUSIONS: In the beginning of orthokeratology treatment, CT of the horizontal axis was 248.9 ± 45.7 µm in the temporal region, 259.9 ± 55.3 µm in the macular region, and 219.2 ± 46.4 µm in the nasal region. Three months after orthokeratology treatment, thickness values of choroids in the 3 divided areas increased significantly (p < 0.05). Mean CT at 6 or 12 months after orthokeratology treatment was greater than before ortho--keratology treatment. CT increased after 3 months of orthokeratology treatment in each regional area. In young myopic adults, CT in nasal area was thinner than that in foveal or temporal area before treatment. CT recovered to near baseline when it was observed for more than 6 months after orthokeratology treatment.

Comparison of Scleral Buckling and Vitrectomy Using Wide Angle Viewing System for Rhegmatogenous Retinal Detachment.

Purpose: To compare the surgical results of pars plana vitrectomy (PPV) and scleral buckling (SB) using the same vitreoretinal viewing system for rhegmatogenous retinal detachment (RRD) Methods: The study was a retrospective analysis of the medical records of 52 eyes (52 patients) with uncomplicated RRD located in superior quadrants. Eyes with pseudophakia or complications were not included. Thirty-one eyes underwent PPV using a wide-angle viewing system (WAVS) and 21 eyes received SB using the same WAVS combined with a chandelier endoilluminator. The primary anatomical success rate was the main outcome, defined as the proportion of eyes with successful reattachment of the retina. Results: The primary anatomical success rate was 90.5% in the SB group and 90.3% in the PPV group. Both groups achieved 100% of the final success rate. Although no significant difference was observed between the two groups, temporary intraocular pressure elevation and post-operative cataract formation were more frequent in the PPV group. In patients under the age of 55, post-operative cataract formation was significantly less common in the SB group. (P = .045) Conclusions: Under the same vitreoretinal visualization techniques, both SB and PPV had similar anatomical success rates. Chandelier­assistance WAVS may increase the popularity of SB to treat primary RRD, allowing many patients to receive the benefits of SB surgery.

Effectiveness of Scleral Buckling with a Wide-Field Surgical Microscope and Chandelier Illumination in Retinal Detachment Repair.

PURPOSE: To assess treatment efficacy of scleral buckling surgery with wide-field surgical microscope and 27-gauge (G) chandelier illumination for rhegmatogenous retinal detachment (RRD). METHODS: This study is a retrospective chart review of 29 eyes in 29 patients with RRD who underwent scleral buckling surgery with a wide-field surgical microscope and 27-G chandelier illumination fiber inserted into the sclera at the pars plana. Results are expressed as mean ± standard deviation. Data were analyzed using the paired sample t test. Statistical significance was considered if p value was less than 0.05. RESULTS: The mean age of patients was 43.5 ± 3.5 years, and the mean follow-up time was 10.4 ± 2.5 months. Retinal reattachment was achieved in 27 of 29 eyes at initial surgery. The mean best corrected visual acuity improved from 0.38 ± 0.29 (logMAR) preoperatively to 0.19 ± 0.21 at 6 months after surgery. Two eyes underwent vitrectomy with silicone oil tamponade because of development of proliferative vitreoretinopathy. There was no complication such as choroidal hemorrhage, hypotony, or vitreous herniation at the end of surgery. CONCLUSION: Scleral buckling with a wide-field surgical microscope and 27-G chandelier illumination has the advantage of offering exact identification of retinal tears and determination of the adequacy of buckle height and position in retinal detachment surgery compared to conventional scleral buckling surgery.

Orbital Frontal Nerve Schwannoma-Distinctive Radiological Features.

PURPOSE: To review the radiological findings of frontal nerve schwannoma of the orbit and determine distinguishing imaging features. DESIGN: Retrospective interventional case series. METHODS: Setting: Single tertiary institution. PERIOD: September 1996 to December 2016. PATIENT POPULATION: Thirteen patients with orbital frontal nerve schwannoma. INTERVENTION: Patients underwent surgical excision following preoperative imaging. MAIN OUTCOME MEASURES: Imaging characteristics on computed tomography (CT) and magnetic resonance imaging (MRI). RESULTS: There were 13 patients with histopathologically proven schwannoma of the frontal nerve. Mean age was 44.4 years and 61.5% were male. The majority (84.6%) of frontal nerve schwannomas extended between the supraorbital notch and superior orbital fissure. The most common shape seen in our patients with frontal nerve schwannoma was a multilobulated "beaded" appearance (46.2%), followed by a dumbbell (30.8%), oval (15.4%), and fusiform (7.7%) shape. On CT imaging, all patients had bony remodeling. Target sign, fascicular sign, and cystic degeneration were seen in 76.9%, 35.8%, and 46.2% of patients, respectively. On radiological-pathologic correlation, the zone of tightly packed cellular solid portion (Antoni A pattern) corresponded to the hypointense area on T2-weighted MRI and the hyperintense area on gadolinium-enhanced T1-weighted MRI. CONCLUSION: Frontal nerve schwannoma should be considered as a differential diagnosis for any superior orbital mass. Our study describes several radiological findings that would point toward its diagnosis, including its multilobulated beaded or dumbbell shape, as well as additional signs such as the target sign, fascicular sign, and cystic degeneration.