Successful treatment of central retinal artery occlusion using hyperbaric oxygen therapy.

Central retinal artery occlusion (CRAO) is considered an ophthalmologic emergency. The prognosis of this disease is very poor. Currently, there is no generally effective therapy available to treat CRAO. Hyperbaric oxygen therapy (HBOT) can increase the volume of oxygen delivered to the ischemic retinal tissue until spontaneous or assisted reperfusion occurs. We report the case of a patient who experienced sudden visual loss due to CRAO that was treated with HBOT. The patient was an 81-year-old woman who presented with CRAO in her right eye (OD). She exhibited "hand motion" visual acuity before treatment. She underwent three sessions of HBOT at a pressure of 2.8 atmospheres absolute, performed over 3 days. After 4 days in hospital, her visual acuity improved to 0.4 (OD) for far vision and 0.5 (OD) for near vision. Her vision was stable without the supply of oxygen; therefore, she was discharged.

Macular infarction associated with reactive arthritis.

A 53-year-old woman visited the Department of Rheumatology with a chief complaint of a 3-day history of fever and chills and also presented with pain occurring in both knees at the time of outpatient visit. Based on rheumatologic and hematological lab studies, ultrasonography, and a needle aspiration biopsy of the articular cavity, the patient was diagnosed with reactive arthritis. On hospitalization day 3, consultation with the Department of Ophthalmology was requested regarding decreased visual acuity lasting for 3 days. Upon ophthalmologic examination, the corrected visual acuity was 0.1 in the right eye and 0.05 in the left eye. Upon slit lamp microscopy, there were no abnormal findings in the anterior segment. Upon fundus examination, however, there were yellow-white lesions in the macular area of both eyes. Fluorescein angiography was performed to assess the macular lesions, and the findings were suggestive of macular infarction in both eyes. Due to a lack of other underlying disease, a past surgical history, and a past history of drug administration, the patient was diagnosed with macular infarction in both eyes associated with reactive arthritis. To date, there have been no other such cases reported. In a patient with reactive arthritis, we experienced a case of macular infarction in both eyes, which occurred without association with a past history of specific drug use or underlying disease. Herein, we report our case, with a review of the literature.

Clinical progress in impending central retinal vein occlusion.

PURPOSE: Impending central retinal vein occlusion is associated with mild or no loss of vision; however, its progress and vision prognosis have not been clearly defined until now. Therefore, we studied the progress and prognoses in patients with impending central retinal vein occlusion. METHODS: For this study, we selected ten subjects who had been diagnosed with impending central retinal vein occlusion, and we retrospectively reviewed their progress and prognoses. RESULTS: The average age of the subjects was 31.0 years (18 to 48 years). Eight patients were male and two were female. The average observational period was 5.5 months. Six out of ten subjects were found to have no underlying systemic disease, four subjects had underlying disease. All ten patients were affected unilaterally. When initially tested, the affected eyes showed an average vision of LogMar 0.30. The final vision test revealed an average of LogMar 0.04, which indicates good progress and prognosis. In one patient, retinal hemorrhage and macular edema progressively worsened after the diagnosis, and the patient was treated with radial optic neurotomy. CONCLUSIONS: The cases of impending central retinal vein occlusion that we observed seemed to primarily affect young patients with generally good prognoses. However, in some cases, the degrees of obstruction and hemorrhage increased as time progressed. This suggests that impending central retinal vein occlusion could develop into the prodromal phase of an acute attack.

Refractive change caused silicone oil adhesion to the intraocular lens following Nd:YAG posterior capsulotomy.

A 32-year-old female who had undergone the silicone oil removal procedure presented with visual disturbance in her left eye. Several months previous, she had cataract surgery in a private clinic, and a month later she had a Nd:YAG laser procedure for posterior capsulotomy. The slit-lamp examination revealed silicone oil droplets that had adhered to the intraocular lens where the posterior capsulotomy was performed. She had experienced high myopia as a manifestation of the resulting refractive changes. We replaced the previous intraocular lens with a new acrylic intraocular lens with resulting improvement to her vision. Here we report the case of a female patient with a history of silicone oil removal surgery where the resulting silicone bubbles had not been removed thoroughly and remained in the vitreous cavity. These bubbles subsequently adhered to the intraocular lens following YAG laser posterior capsulotomy, resulting in refractive changes. We recommend that implanting a silicone intraocular lens in anyone with a history of the silicone oil removal procedure or who has a possible history of silicone oil use should be avoided.

Valsalva retinopathy associated with an oratorical contest.

A 17-year-old man presented to us with a chief complaint of decreased visual acuity accompanied by central scotoma. There was nothing unusual in his medical history other than a recent oratorical contest. At the time of initial diagnosis, the corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye. No significant findings were apparent on ophthalmic evaluation. On fundoscopy, there was a dumbbell-shaped macular bleed with a well-defined margin in the left eye. The clinical course was closely monitored along with drug therapy. Four weeks post presentation, the pre-retinal hemorrhage had nearly resolved. On fluorescein angiography, no significant findings were observed. In the left eye, the corrected visual acuity had improved to 20/25. Valsalva retinopathy is a pathology that occurs when a sudden increase in intra-thoracic pressure or abdominal pressure occurs in an otherwise healthy person. Here we report a case of Valsalva retinopathy occurring following an oratorical contest along with a review of the relevant literature.

Conjunctival expansion using a subtenon's silicone implant in New Zealand white rabbits.

PURPOSE: In the field of ophthalmology, the conjunctival autograft is a useful therapeutic material in many cases, but the small size of the autograft is a disadvantage. Therefore, we evaluated the feasibility of taking an expanded sample of conjunctival tissue using a subtenon's silicone implant. MATERIALS AND METHODS: We included a total of nine rabbits; eight rabbits were operative cases, and one was a control. A portion of conjunctival tissue from the control rabbit, which did not undergo surgery, was dissected and examined to determine whether it was histologically different from the experimental group. The surgical procedure was performed on eight rabbits via a subtenon's insertion of a silicone sponge in the left superior-temporal portion; after surgery, we dropped antibiotics into the eyes. We sacrificed a pair of rabbits every three days (on days 3, 6, 9, and 12) after surgery, removed the expanded conjunctival tissues with the silicone sponge implants, and measured their sizes. RESULTS: The mean size of the expanded conjunctival tissues was 194.4 mm2. On the third day, we were able to harvest a 223.56 mm2 section of conjunctival tissue, which was the most expanded sample of tissue in the study. On the twelfth day, we removed a 160.38 mm2 section of conjunctival tissue, which was the least expanded sample of tissue. Statistically, there were no significant differences in the mean dimensions of the expanded conjunctival tissues for each time period. Microscopic examinations showed no histological differences between the expanded conjunctival tissues and the normal conjunctival tissues. CONCLUSION: The results reveal that this procedure is a useful method to expand the conjunctiva for grafting and transplantation.