Massive Retinal Gliosis Mistaken as a Malignant Intraocular Tumor in Phthisis Bulbi.

Massive retinal gliosis (MRG) is a rare condition of non-neoplastic glial proliferation, which forms massive lesions that fill the eye. MRG is commonly associated with phthisis bulbi (a non-functional eye), congenital anomalies, or malformations. Herein, we report a case of massive retinal gliosis associated with a traumatic phthisis bulbi, which was initially mistaken as a malignant intraocular tumor and confirmed only after an eye enucleation. A 70-year-old woman presented with a protruding ocular mass in her left eye which had slowly grown for a year. She had phthisis bulbi in her left eye due to trauma during her childhood. An orbital CT revealed an intraocular mass lesion with calcifications, raising the possibility of retinoblastoma or other malignant intraocular tumors. Enucleation of the left eye globe was performed. Histopathologic examination revealed exuberant proliferation of the glial cells, metaplastic bone formation, hyalinized vessels, and hyperplasia of the retinal pigment epithelium, confirming the diagnosis of MRG. Although rare, the possibility of MRG should be considered as a differential diagnosis when encountering an intraocular mass lesion, as it can be misdiagnosed as a malignant tumor.

Orbital abscess due to infection of a non-absorbable porous orbital implant after orbital wall fracture repair : An uncommon and delayed occurred case.

We report a rare case of a patient who developed an orbital abscess several years after successful orbital medial wall fracture repair. A 37-year-old female patient who underwent orbital fracture repair with a titanium Medpor® orbital implant two years prior visited the clinic for pain, conjunctival injection, discharge, and lid swelling of the right eye. Orbital CT revealed severe orbital cellulitis and sinusitis. After administering antibiotics, the sinusitis was successfully resolved. However, the orbital inflammation around the implant did not improve, forming an orbital abscess. Abscess drainage and implant removal were performed. The removed implant was infected at the center, exhibiting a yellowish abscess-like discoloration. The patient improved rapidly and recovered without complications. In rare cases, orbital cellulitis and orbital abscesses develop even after a considerable period of time after orbital fracture repair using a non-absorbable porous orbital implant. In such cases, delayed orbital implant infection should be suspected as the cause, and an imaging study should be performed. If the patient does not respond to antibiotic treatment, it may be necessary to remove the infected implant with immediate drainage.

Structure-Function Relationship and Vision-Related Quality of Life in Glaucoma Secondary to Anterior Uveitis: Comparison with Open Angle Glaucoma.

PURPOSE: The aim of this study is to investigate the structure-function characteristics and vision-related quality of life (VR-QoL) in uveitic glaucoma (UG) compared with open-angle glaucoma (OAG). METHOD: The study included 69 patients with UG and 138 patients with primary open angle glaucoma, normal-tension glaucoma. A 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was used to evaluate the patients' VR-QoL. The retinal nerve fiber layer thickness (RNFLT) was measured using optical coherence tomography, and the integrated visual field (IVF) was determined using the best location method. RESULTS: There were no significant differences in the binocular IVF and mean deviation (MD) of the affected eye between the OAG and UG group, whereas the average RNFLT was significant thinner in the OAG group (p = 0.008). The patients with UG showed a significantly lower composite score and five subscales of the VFQ-25, compared with those with OAG (p < 0.05, for all, general linear model). Multivariate linear regression analyses showed that the composite score showed the strongest associations with the whole IVF (ß = 1.240, p < 0.001) in the OAG group, whereas in the UG group, a significant association was seen only with the inferior VF of the affected eye (ß = 0.596, p = 0.038). CONCLUSIONS: The eyes with UG exhibited distinctive structure-function characteristics and worse VR-QoL that differentiated them from OAG eyes.

The association between myocardial infarction and intravitreal bevacizumab injection.

To evaluate the risk of myocardial infarction (MI) after receiving intravitreal bevacizumab (IVB) injection. We retrospectively reviewed the charts of patients who had received IVB injection in 2016, and grouped them according to whether they received the injection for age-related macular degeneration (AMD), diabetes-related complications, or retinal vein occlusion (RVO). We then investigated the prevalence of MI within 2 months after IVB injection and analyzed the possible association of IVB with MI. During 2016, 724 patients were enrolled and received a total of 1870 IVB injections. Seven patients were diagnosed with MI within 2 months after receiving an IVB injection. Of 274 patients with AMD, 2 were diagnosed with MI; of 311 patients with diabetes-related complications, 3 were diagnosed with MI; and of 139 patients with RVO, 2 were diagnosed with MI (P = 0.785). All MIs occurred between 3 days and 3 weeks after IVB injection (mean = 14.00 ±â€Š6.45 days). The MIs after receiving IVB were associated with previous history of MI or cerebrovascular infarction in multivariate logistic regression analysis (P = 0.005). There was no significant difference in MI prevalence after IVB injection according to the reason for receiving the injection. However, care should be taken when administering IVB injections, especially to patients with risk factors such as history of MI or cerebrovascular infarction.

Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy.

To evaluate the prevalence and risk factors of neovascular glaucoma (NVG) after vitrectomy in patients with vitreous hemorrhage associated with proliferative diabetic retinopathy (PDR). This retrospective, noncomparative, observational study included 127 eyes of 127 patients with PDR who received vitrectomy with a follow-up period of at least 6 months. The prevalence of NVG and associated risk factors were assessed including sex, age, previous panretinal photocoagulation, baseline intraocular pressure, combined phacovitrectomy, and pretreatment with intravitreal bevacizumab (IVB) before vitrectomy for the treatment of vitreous hemorrhage. NVG developed in 15 (11.8%) of 127 patients. Of the 15 eyes with NVG, 11 cases (73.3%) postoperatively developed NVG within 6 months. Postoperative NVG was associated with preoperative IVB treatment (odds ratio, 4.43; P = 0.019). The prevalence of NVG after vitrectomy was 11.8%, and an associated risk factor for NVG was preoperative IVB for the treatment of vitreous hemorrhage.

Effect of trapping vascular endothelial growth factor-A in a murine model of dry eye with inflammatory neovascularization.

AIM: To evaluate whether trapping vascular endothelial growth factor A (VEGF-A) would suppress angiogenesis and inflammation in dry eye corneas in a murine corneal suture model. METHODS: We established two groups of animals, one with non-dry eyes and the other with induced dry eyes. In both groups, a corneal suture model was used to induce inflammation and neovascularization. Each of two groups was again divided into three subgroups according to the treatment; subgroup I (aflibercept), subgroup II (dexamethasone) and subgroup III (phosphate buffered saline, PBS). Corneas were harvested and immunohistochemical staining was performed to compare the extents of neovascularization and CD11b+ cell infiltration. Real-time polymerase chain reaction was performed to quantify the expression of inflammatory cytokines and VEGF-A in the corneas. RESULTS: Trapping VEGF-A with aflibercept resulted in significantly decreased angiogenesis and inflammation compared with the dexamethasone and PBS treatments in the dry eye corneas (all P<0.05), but with no such effects in non-dry eyes. The anti-inflammatory and anti-angiogenic effects of VEGF-A trapping were stronger than those of dexamethasone in both dry eye and non-dry eye corneas (all P<0.05). The levels of RNA expression of VEGF-A, TNF-alpha, and IL-6 in the aflibercept subgroup were significantly decreased compared with those in the PBS subgroup in the dry eye group. CONCLUSION: Compared with non-dry eye corneas, dry eye corneas have greater amounts of inflammation and neovascularization and also have a more robust response to anti-inflammatory and anti-angiogenic agents after ocular surface surgery. Trapping VEGF-A is effective in decreasing both angiogenesis and inflammation in dry eye corneas after ocular surface surgery.

Ganglion Cell-Inner Plexiform Layer, Peripapillary Retinal Nerve Fiber Layer, and Macular Thickness in Eyes with Myopic ß-Zone Parapapillary Atrophy.

Purpose. To assess the correlations of myopic ß-zone parapapillary atrophy (ß-PPA) with the optic nerve head (ONH) and retina. Methods. We selected 27 myopic patients who showed prominent ß-PPA in one eye and no ß-PPA in the other eye. We studied their macula, macular ganglion cell-inner plexiform layer (mGCIPL), peripapillary retinal nerve fiber layer (pRNFL) thickness, and ONH parameters using optical coherence tomography. Results. The average of five out of six sectors and minimum values of mGCIPL thicknesses in eyes with prominent ß-PPA discs were significantly less than those of the control eyes. The results of clock-hour sector analyses showed significant differences for pRNFL thickness in one sector. In the ONH analyses, no significant difference was observed between myopic ß-PPA and control eyes. The macular thickness of the ß-PPA eyes was thinner than control eyes in all sectors. There was a significant difference between the two groups in three sectors (the inner superior macula, inner temporal macula, and inner inferior macula) but there was no significant difference in the other sectors, including the fovea. Conclusions. The myopic ß-PPA eyes showed thinner mGCIPL, parafovea, and partial pRNFL layers compared with myopic eyes without ß-PPA.

Serum 25-hydroxyvitamin D level is associated with myopia in the Korea national health and nutrition examination survey.

The aim of this article was to assess the associations of serum 25-hydroxyvitamin D [25(OH)D] and daily sun exposure time with myopia in Korean adults.This study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) of Korean adults in 2010-2012; multiple logistic regression analyses were performed to examine the associations of serum 25(OH)D levels and daily sun exposure time with myopia, defined as spherical equivalent ≤-0.5D, after adjustment for age, sex, household income, body mass index (BMI), exercise, intraocular pressure (IOP), and education level. Also, multiple linear regression analyses were performed to examine the relationship between serum 25(OH)D levels with spherical equivalent after adjustment for daily sun exposure time in addition to the confounding factors above.Between the nonmyopic and myopic groups, spherical equivalent, age, IOP, BMI, waist circumference, education level, household income, and area of residence differed significantly (all P < 0.05). Compared with subjects with daily sun exposure time <2 hour, subjects with sun exposure time ≥2 to <5 hour, and those with sun exposure time ≥5 hour had significantly less myopia (P < 0.001). In addition, compared with subjects were categorized into quartiles of serum 25(OH)D, the higher quartiles had gradually lower prevalences of myopia after adjustment for confounding factors (P < 0.001). In multiple linear regression analyses, spherical equivalent was significantly associated with serum 25(OH)D concentration after adjustment for confounding factors (P = 0.002).Low serum 25(OH)D levels and shorter daily sun exposure time may be independently associated with a high prevalence of myopia in Korean adults. These data suggest a direct role for vitamin D in the development of myopia.

Characteristics of Retinal Nerve Fiber Layer Defect in Nonglaucomatous Eyes With Type II Diabetes.

PURPOSE: To investigate the characteristics of retinal nerve fiber layer (RNFL) defects associated with type II diabetes. METHODS: Forty nonglaucomatous eyes with type II diabetes and 54 eyes with early open angle glaucoma that exhibited a localized RNFL defect and 42 eyes from age- and sex-matched nondiabetic, nonglaucomatous controls were imaged with red-free fundus photography and optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec). The area under the receiver operating characteristic curves of eyes with diabetes was compared with that of eyes with glaucoma. When an RNFL defect on fundus photographs was identified in the quadrant, clock-hour, temporal-superior-nasal-inferior-temporal (TSNIT), deviation, and thickness maps, it was considered a true detection. RESULTS: In eyes with diabetes, the RNFL defects were located more frequently in the superior hemisphere than they were in those with glaucoma (P < 0.001). The angular locations of RNFL defects in eyes with diabetes (56.1 ± 12.7°) were significantly farther from the fovea compared with those in glaucoma (44.3 ± 17.3°; P < 0.001); in addition, the width of RNFL defects in diabetes (5.1 ± 2.3°) was significantly narrower than those in glaucoma (20.8 ± 12.3°; P < 0.001). The best parameter discriminating RNFL defects in diabetes from those in glaucoma was width of RNFL defect (0.955), followed by rim area (0.844), and average RNFL (0.791). The thickness map showed a sensitivity (70%) and specificity (69.1%), superior to those of all other maps in eyes with diabetes. CONCLUSIONS: The narrow width and identification of RNFL defect in thickness map obtained with Cirrus HD-OCT seems to be an effective tool for detecting RNFL defects in diabetes.

Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model.

AIM: To compare the effects of the surgical insult of cataract surgery on corneal inflammatory infiltration, neovascularization (NV) and lymphangiogenesis (LY) between the dry eye and non-dry eye in murine cataract surgery models. METHODS: We established two groups of animals, one with normal eyes (non-dry eye) and the second with induced dry eyes. In both groups, we used surgical insults to mimic human cataract surgery, which consisted of lens extraction, corneal incision and suture. After harvesting of corneas on the 9(th) postoperative day and immunohistochemical staining, we compared NV, LY and CD11b+ cell infiltration in the corneas. RESULTS: Dry eye group had significantly more inflammatory infiltration (21.75%±7.17% vs 3.65%±1.49%; P=0.049). The dry eye group showed significantly more NV (48.21%±4.02% vs 26.24%±6.01%; P=0.016) and greater levels of LY (9.27%±0.48% vs 4.84%±1.15%; P=0.007). In corneas on which no surgery was performed, there was no induction of NV in both the dry and non-dry group, but dry eye group demonstrated more CD11b+ cells infiltration than the non-dry eye group (0.360%±0.160% vs 0.023%±0.006%; P=0.068). Dry eye group showed more NV than non-dry eye group in both topical PBS application and subconjunctival PBS injection (P=0.020 and 0.000, respectively). CONCLUSION: In a murine cataract surgery model, preexisting dry eye can induce more postoperative NV, LY, and inflammation in corneal tissue.

Refractive errors in high myopic eyes after phacovitrectomy for macular hole.

AIM: To examine the refractive prediction error in high myopic eyes after phacovitrectomy. METHODS: This retrospective comparative case series included 91 eyes (18 high myopic eyes and 73 non-high myopic eyes) of 91 patients who underwent successful phacovitrectomy (phacoemulsification, intraocular lens implantation, and pars plana vitrectomy). The high myopic eyes were defined as the eye with more than 26.0 mm of axial length. The postoperative prediction error of mean error and mean absolute error were evaluated at 4mo postoperatively. Axial length and keratometry measurement were performed preoperatively and 4mo postoperatively using the IOL Master. RESULTS: The refractive outcome after phacovitrectomy showed significantly greater myopic shift in the high myopic eyes [-1.08±0.87 diopters (D)] than that in the non-high myopic eyes (-0.43±0.63 D, P=0.004). Axial length and keratometric value in the high myopic eyes were significantly increased (P=0.043, 0.037 respectively), whereas those in the non-high myopic group were not significantly increased (P=0.135, 0.347 respectively). The change of the axial length in the myopic eye (0.46±0.28 mm) was greater than that in the non-high myopic eye (0.11 ± 0.34 mm; P<0.001). CONCLUSION: High myopic eyes showed more myopic shift than non-high myopic eyes after phacovitrectomy. The cause of myopic shift in high myopic eyes seems to be attributed to actual elongation of the axial length in high myopia.

Serum D-dimer levels to evaluate the risk for arterial thromboembolism after intravitreal injection of bevacizumab and ranibizumab.

PURPOSE: There are concerns about arterial thromboembolic event after intravitreal injection of bevacizumab or ranibizumab. Motivated by the fact that D-dimer was a sensitive biomarker for thromboembolism, we evaluated serum D-dimer levels in patients with age-related macular degeneration (AMD) after intravitreal injection of bevacizumab and ranibizumab. METHODS: In this prospective, nonrandomized, uncontrolled study, 122 patients (122 eyes) with AMD were enrolled. Sixty-two eyes received intravitreal injections of bevacizumab and 60 eyes received intravitreal injections of ranibizumab monthly for 3 months. Serum D-dimer levels were measured in patients before intravitreal injection and 1 day, 1 week, 1 month, and 3 months thereafter. RESULTS: Serum D-dimer levels were not significantly altered following injection of either bevacizumab or ranibizumab. Subgroup analysis for patients at risk for thromboembolic events revealed that serum D-dimer levels showed no significant change after injection of ranibizumab. However, D-dimer levels significantly increased at 1 day (P=0.041) and 1 week (P=0.022) after injection of bevacizumab. CONCLUSIONS: Serum D-dimer levels were not changed after injection with either bevacizumab or ranibizumab. In subgroup analysis, bevacizumab injection in patients at risk of thromboembolism increased serum D-dimer levels.

Prevalence and risk factors for age-related macular degeneration: Korean National Health and Nutrition Examination Survey 2008-2011.

PURPOSE: To evaluate the prevalence of and risk factors for age-related macular degeneration (AMD) in a representative Korean population. MATERIALS AND METHODS: A nationwide population-based cross-sectional study was conducted among the civilian, noninstitutionalized Korean population aged 40 and older (mean age, 55.7 years; 95% confidence interval [CI], 55.4-56.0). A total of 16,109 older (≥40 years of age) subjects participated in the Korean National Health and Nutrition Survey 2008-2011. All participants underwent standardized interviews and comprehensive ophthalmic examinations. Using physiologic mydriasis, a 45° digital fundus photograph was taken of both eyes of each participant. All fundus photographs were graded according to an international classification and grading system. Main outcome measures consisted of prevalence of early- and late-AMD. RESULTS: Of the 16,109 subjects, fundus photographs were gradable for 14,352 (89.1%). The prevalence of early- and late-AMD in the Korean population was 6.0 and 0.6%, respectively. The prevalence of early-AMD increased from 1.5% in those aged 40-49 years to 16.2% in those aged ≥70 years. After adjusting for confounders, the prevalence of early-AMD increased with increasing age (odds ratio [OR], 1.08; CI, 1.06-1.09). For late-AMD, old age (OR, 1.09; CI, 1.04-1.14), male gender (OR, 2.45; CI, 1.11-5.37), high systolic blood pressure (OR, 1.03; CI, 1.00-1.06) and high fasting glucose level (OR, 0.97; CI, 0.94-0.99) were significant risk factors. Smoking was not associated with either early- or late-AMD in this Korean population. CONCLUSIONS: The present study provides the first population-based data on the prevalence of and risk factors for AMD in a representative Korean population. The prevalences of early- and late-AMD in this population were 6.0 and 0.6%, respectively. The prevalence of AMD in Koreans is higher than for those in other Asian countries and similar to that of Caucasians in Western countries.

Low serum 25-hydroxyvitamin D is associated with myopia in Korean adolescents.

PURPOSE: To assess the relationship between serum level of 25-hydroxyvitamin D (25(OH)D) and refractive error in Korean adolescents. METHODS: A total of 2038 adolescent aged 13 to 18 years, who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011 underwent refractive examination using an autorefractor. Serum 25(OH)D concentration and other potential risk factors were examined. Multivariate regression analysis was performed to investigate the association between serum 25(OH)D and spherical equivalent (SE). RESULTS: Among the participants, 80.1% had myopia (-0.5 diopters [D] or more myopic) and 8.9% had high myopia (-6.0 D or more myopia). Age, total energy/Ca intake, area of residence, parental income, and smoking experience were significantly different among groups according to SE (All, P < 0.05). The age-adjusted distribution of SE according to serum 25(OH)D concentration showed a positive relationship (r = 0.067, P = 0.012). The myopia group had a significant positive relationship between SE and serum 25(OH)D tertile concentration (P = 0.020), whereas the nonmyopia group did not have any significant relationship (P = 0.599). In multiple linear regression analyses, SE was significantly associated with low serum 25(OH)D concentration after adjustment for area of residence, parental income, total energy intake, dietary Ca intake, milk consumption, and smoking experience (P = 0.047). The prevalence of high myopia was significantly associated with the lowest tertile of serum 25(OH)D concentration after adjustment for the confounding factors (P = 0.017). CONCLUSIONS: Low serum 25(OH)D concentration was associated with myopia prevalence in Korean adolescents. This relationship was particularly notable in adolescents with high myopia.

Treatment of intractable orbital implant exposure with a large conjunctival defect by secondary insertion of the implant after preceding dermis fat graft.

AIM: To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repeated graft necrosis. METHODS: A retrospective chart review of four patients who had extensive orbital implant exposures with large conjunctival defects and had past histories of repeated autologous or preserved dermis graft failures was done. As a first-stage operation, the problematic pre-existing orbital implants were removed and autologous dermis fat grafts alone were performed on the defect area. Four months later, new orbital implants were secondarily inserted after confirmation of graft survival. The size of the conjunctival defects and state of the extraocular muscles were checked preoperatively. Success of the operations and complications were investigated. RESULTS: The mean size of the conjuctival defects was 17.3mm×16.0mm, and the mean time from the initial diagnosis of orbital implant exposure to implant removal and autologous dermis fat graft was 20.8 months. After implant removal and autologous dermis fat graft, no graft necrosis was observed in any patients. Also, implant exposure or fornix shortening was not observed in any patients after new orbital implant insertion. CONCLUSION: The secondary insertion of a new orbital implant after pre-existing implant removal and preceding dermis fat graft is thought to be an another selective management of intractable orbital implant exposure in which dermis fat grafts persistently fail.