Inverted flap technique versus internal limiting membrane insertion for macular hole in eyes with extremely high myopia.

BACKGROUND: To compare the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique and ILM insertion for macular hole (MH) without retinal detachment in eyes with extremely high myopia. METHODS: In this retrospective study, we analyzed 22 eyes with an axial length ≥ 30.0 mm that had underwent MH surgery between April 2015 and August 2021. The surgical procedures involved either an inverted ILM flap or ILM insertion. The outcomes were compared between the two techniques. Closure of the MH was confirmed by optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) was measured before and after surgery. Associated complications were documented. RESULTS: The median of axial length was 30.64 mm (range, 30.0-34.42). The MH closed in 100% (22/22) eyes and did not recur with a median follow-up of 12.5 months. For the inverted ILM flap technique, the median BCVA improved significantly from 0.80 logarithm of the minimum angle of resolution (logMAR) (range, 0.40-2.00) before surgery to 0.70 logMAR (range, 0.09-1.52) after surgery (p = 0.002). In addition, the median of final BCVA was better for the inverted ILM flap than ILM insertion (0.7 logMAR V.S. 1.00 logMAR; p = 0.016). CONCLUSIONS: In eyes with extremely high myopia, despite comparable effects on MH closure for both ILM insertion and the inverted ILM flap, the later technique achieved significantly better visual outcomes.

Treatment of persistent flap closure with fluid gas exchange after inverted internal limiting membrane flap technique for idiopathic macular hole.

We evaluated the results of fluid-gas exchange (FGE) for long-term flap closure of idiopathic macular holes (MH) using the inverted internal limiting (ILM) flap technique. We retrospectively included eyes showing flap closure without complete MH closure and connection of separate macular tissue 1 month postoperatively after the inverted ILM flap technique was detected by ocular coherence tomography at follow-up. Eyes remained flap closure at 2 months after surgery further underwent in-office FGE with 16% C3F8. Of the 153 eyes using the inverted ILM flap technique for idiopathic MH between June 2015 and November 2018, 10 eyes (6.99%) remained flap closure at 1 month postoperatively. Among 10 eyes, 5 eyes (50%) showed flap closure at 2 months postoperatively further underwent FGE for complete MH closure, while the remaining 5 eyes (50%) progressed directly to normal macular structures at 2 months postoperatively. Improvement in vision of all flap closure from baseline was significant (P = .015), with a mean baseline vision of 1.19 [Snellen equivalent (SE), 20/307] ±â€…0.52 logMAR and the mean final vision of 0.63 (SE, 20/85) ±â€…0.38 logMAR. The group that underwent FGE showed better final vision of 0.45 (SE, 20/75) ±â€…0.23 logMAR than the group that did not undergo FGE (0.81 [SE, 20/128] ±â€…0.44 logMAR). All eyes achieved complete MH closure, including the eyes that underwent FGE in a mean period of 5.60 months (range 3-10 months) after the inverted ILM flap technique. Eyes that underwent FGE achieved a higher rate of foveal restoration [complete external limiting membrane 80%; complete ellipsoid zone (EZ) 60%] than those that did not receive FGE (complete external limiting membrane: 40%; complete EZ: 10%). Eyes with persistent flap closure for more than 2 months postoperatively that underwent FGE showed accelerated complete MH closure, better final vision, and foveal restoration.

Combination Treatment of Intense Pulsed Light Therapy and Meibomian Gland Expression for Evaporative Dry Eye.

Dry eye disease (DED) is most commonly caused by evaporative subtypes and mainly induced by meibomian gland dysfunction (MGD). Intense pulsed light (IPL) combined with meibomian gland expression (MGX) is a noninvasive treatment for improvement of ocular discomfort symptoms and MGD. In this prospective study between November 2020 and May 2022, the patients with MGD and abnormal meibomian expressibility that met the criteria of both ocular surface disease index (OSDI) ≥ 13 scores and standardized patient evaluation of eye dryness (SPEED) ≥ 8 scores were enrolled in Kaohsiung Veteran General Hospital. Three separate treatment sessions of IPL therapy combined with MGX were administered to the lower lids, with an interval of 28 days. Further tear film assessment included lipid layer thickness (LLT), tear meniscus height (TMH), noninvasive tear break-up time (NIBUT), and meibomian gland loss (MGL) either before or after first and third IPL therapy combined with MGX. In addition, lissamine green staining and pain scores were also recorded. We totally enrolled 37 patients of 74 eyes. Men accounted for 18.92% (7/37). The mean age was 54.51 ± 11.72 years. The mean OSDI scores were 58.12 ± 22, while the SPEED scores were 17.03 ± 5.98. The mean Schirmer's test was 3.66 ± 2.43 mm. After three sessions of IPL treatment with MGX, the OSDI, SPEED, LLT, TMH, MGL, MGXS, and pain scores were significantly improved. For the MGX scores (MGXS) ≤ 20 group, lissamine green scores showed nearly significant improvements. For the MGXS > 20 group, TMH revealed statistical improvement. Noninvasive IPL therapy with MGX statistically improved not only dry eye symptoms, but also tear film assessments, including LLT, TMH, and MGL.

Treating refractory corneal hydrops in a male patient with vernal keratoconjunctivitis and mental retardation: a case report.

BACKGROUND: Keratoconus is the most common noninflammatory bilateral corneal ectasia. Vernal keratoconjunctivitis (VKC) and eye rubbing may be associated with keratoconus in children and young adults. Timely management of advanced keratoconus is important to improve visual quality. In addition, it is challenging to carry out VKC treatment with an intent to avoid the occurrence of punctate epithelial keratitis, ulceration, or corneal neovascularization on corneal grafts. CASE PRESENTATION: We report the case of an 18-year-old male patient with a long-term history of mental retardation due to megalencephaly presenting with acute onset of corneal hydrops with prominent bulging and refractory steroid-induced glaucoma of the right eye. The topography of the right eye was unavailable due to advanced ectasia, and that of the left eye revealed central steepening with inferior-superior dioptric asymmetry. According to the clinical findings, the patient was diagnosed with keratoconus. Because of progressive corneal opacity and neovascularization, the patient underwent penetrating keratoplasty (PK) with combination of interrupted and intrastromal running suturing after receiving a preoperative subconjunctival injection of bevacizumab in his right eye, followed by lower eyelid correction. After surgery, the patient was treated with 0.1% tacrolimus dermatological ointment, 0.1% cyclosporine eye drops, artificial tears, and 0.5% loteprednol for keratoplasty and VKC. Repeated education on avoiding eye rubbing was offered to the patient. Two years after PK treatment, his best-corrected visual acuity of the right eye successfully improved from hand motion at 10 cm preoperatively to 6/20 postoperatively. CONCLUSIONS: Large-diameter PK with intrastromal suturing technique for advanced keratoconus could achieve better visual outcomes and avoid suture-related complications. In addition, tacrolimus dermatological ointment rather than tacrolimus topical eye drops or ointment showed satisfactory efficacy when combined with topical cyclosporine and steroid that no significant VKC reactivation were noted after PK.

Treatment outcomes of acute poptoperative infectious endophthalmitis.

BACKGROUND: Acute postoperative endophthalmitis is one of the most severe complications of modern ophthalmic procedures including cataract surgeries, vitrectomy and intravitreal injection (IVI). We evaluated the treatment outcomes of acute postoperative infectious endophthalmitis. METHODS: In this retrospective study, we collected data from 82 patients with acute infectious endophthalmitis within 6 weeks after intraocular surgeries, including cataract surgeries, vitreoretinal surgeries, and IVI, from January 2010 to December 2019. We analyzed the pre-treatment, treatment-related and post-treatment factors that affected visual outcomes. RESULTS: The mean age was 67.65 ± 9.52 years, the proportion of male patients was 56.1%. The mean baseline vision was 1.92 (Snellen Equivalent SE], counting finger [CF]) ± 0.54 logarithm of the minimum angle of resolution (log MAR) and the mean final vision was 0.71 (SE, 39/200) ± 0.80 logMAR. Visual improvement was significant (P < 0.001). The pre-treatment factors affecting final visual outcomes were diabetes, hemodialysis, baseline vision, signs of vitreous opacity, and different surgeries before endophthalmitis; the treatment-related factors affecting visual outcomes were the choice factors between IVI of antibiotics alone and vitrectomy combined with IVI of antibiotics, and the injection numbers of antibiotics; post-treatment factors affecting visual outcomes were complications such as retinal detachment (RD), glaucoma and macular pucker. Furthermore, prior cataract surgery was associated with a better mean final vision of 0.57 (SE, 54/200) ± 0.67 logMAR while prior vitrectomy resulted in the worst mean final vision of 1.38 (SE, 21/500) ± 0.75 logMAR. CONCLUSIONS: The important factors that affected the final visual prognosis, included diabetes, hemodialysis, baseline vision, severity of vitritis, treatment strategies and complications. The treatment outcomes revealed better final vision in prior cataract surgery than vitrectomy.

Traumatic displacement of laser in situ keratomileusis flaps: an integrated clinical case presentation.

BACKGROUND: Traumatic dislocation of laser-assisted in situ keratomileusis (LASIK) corneal flaps is an uncommon postoperative complication that could occur any time after LASIK, and could be visually devastating. We evaluated the visual outcomes, corneal sensation, tear function, and dry eye questionnaire results of patients with traumatic dislocation of LASIK flaps, including one LASIK flap amputation. METHODS: This is a retrospective case series. Seven patients who were diagnosed with traumatic displacement of the LASIK flap and underwent flap replacement surgery between August 2014 and January 2019 were included.Patient's visual acuity, refraction, corneal sensitivity, non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), and ocular surface disease index (OSDI) results were evaluated. RESULTS: The patients' mean age was 35.86 ± 5.84 years, and 42.9 % (3/7) were male. The mean duration from LASIK to trauma was 8.86 ± 2.48 years.The mean preoperative and postoperative six-month corrected distance visual acuity (CDVA) were 0.55 ± 0.34 and 0.02 ± 0.03, respectively. The mean spherical equivalent and astigmatism at six months postoperatively was - 1.0 ± 0.95 D and - 0.5 ± 0.25 D, respectively. The corneal flap was clear and well-positioned at the final follow-up (mean: 28.57 ± 6.9 months). 85.71 % (6/7) of the patients showed worse corneal sensation in the injured eye. Interocular OSDI discrepancy was less in those whose last visit was more than 30 months after the trauma. CONCLUSIONS: Postoperative CDVAat six months was improved, and the refractive data also showed some improvement. The corneal nerve and tear function recovery peaked before 30 months, while the OSDI continued to show a strong trend of improvement beyond 30 months.

Surgical outcomes of the removal of posterior segment metallic intraocular foreign bodies.

BACKGROUND: Posterior segment metallic intraocular foreign bodies (IOFBs) are a leading cause of visual morbidity and blindness, especially among young and middle-aged working populations. Here, we aimed to evaluate the surgical outcomes of the removal of such IOFBs that result from injuries. METHODS: In this retrospective study, 39 patients injured by metallic posterior segment IOFBs and who underwent primary repair procedures, vitrectomies, and IOFBs removal with or without procedures for traumatic cataract removal, scleral buckling and intraoperative tamponade application from January, 2008 to January, 2019. We analyzed the preoperative, intraoperative and postoperative related factors that affect the final visual outcomes. RESULTS: The mean age of the 39 patients was 40.51 ± 12.48 years with the male being predominent (100%).The mean preoperative vision measured 1.50 [Snellen Equivalent (SE), 20/645] ± 1.12 logMAR with the mean final vision measuring 0.93 (SE, 20/172) ± 1.09 logMAR. The related factors that were determined to affect the final visual outcomes included preoperative vision (P = 0.025), IOFB-related macula injuries (P = 0.001) and the development of postoperative complications (P = 0.005) especially retinal detachment (P = 0.002) with the mean final vision measuring 2.12 (SE, counting finger to hand motion) ±1.23 logMAR. Concerning the preoperative signs, the patients with preoperative endophthalmitis also obtained poor mean final vision measuring 1.30 (SE,20/400) ± 1.40 logMAR. CONCLUSION: IOFB-related macula injuries and postoperative retinal detachment were important related factors of poor final visual prognoses in cases involving posterior segment metallic IOFBs. Removing IOFB as early as possible may prevent preoperative endophthalmitis which could lead poor final visions even without significance.

Correction to: Indirect choroidal neovascularization secondary to a posterior-segment intraocular foreign body - case report.

An amendment to this paper has been published and can be accessed via the original article.

Indirect choroidal neovascularization secondary to a posterior-segment intraocular foreign body - case report.

BACKGROUND: We reported a rare case of indirect choroidal neovascularization (CNV) secondary to a posterior-segment intraocular foreign body (IOFB) that was not located in the area of direct injury but in the fovea. After intravitreal injections (IVIs) of aflibercept, the choroidal neovascularization (CNV) lesion disappeared and vision improved. CASE PRESENTATION: A 26-year-old male patient suffered from a fast-shot metallic IOFB in his right eye. He underwent primary corneal repair, pars plana vitrectomy, IOFB removal and an IVI of antibiotics in the right eye. Two weeks later, cataract surgery was performed on the right eye for traumatic cataract after an episode of acute phacolytic glaucoma. The best-corrected visual acuity (BCVA) of the right eye improved to 20/20 5 months after the first surgery. However, the vision of the right eye worsened suddenly with metamorphopsia 1 year after the first surgery. Color fundus images showed a whitish lesion with faint retinal hemorrhage and surrounding sensory elevation. Fluorescein angiography (FA) revealed a lesion with early- and late-phase severe leakage. Optical coherence tomography (OCT) demonstrated a CNV lesion with surrounding subretinal fluid. The patient received an IVI of aflibercept every 8 weeks for 3 times. Finally, the BCVA of the right eye improved to 20/25. CONCLUSIONS: For rare cases of fovea-spared injury by a metallic IOFB, it is still necessary to pay close attention to the foveal microstructure to avoid possible CNV formation. Treatment with IVIs of anti-VEGF, aflibercept, as early as possible could provide good visual outcomes.

Surgical outcomes of centripetal non-fovea-sparing internal limiting membrane peeling for myopic foveoschisis with and without foveal detachment: a follow-up of at least 3 years.

BACKGROUND: We evaluated the surgical outcomes of vitrectomy with non-fovea-sparing internal limiting membrane (ILM) peeling for myopic foveoschisis with a follow-up of at least 3 years. METHODS: In this retrospective study, 32 consecutive eyes with high myopia with or without foveal detachment underwent vitrectomy and centripetal, non-fovea-sparing ILM peeling with gas tamponade for myopic foveoschisis. Outcome measures were visual acuity (VA) and optical coherence tomography findings. RESULTS: Mean axial length was 29.39±1.92 mm; mean follow-up was 42.66 (±8.29) months. Foveoschisis and foveal detachment completely resolved in all eyes postoperatively. Mean central foveal thickness (CFT) improved significantly from 631.88±191.72 to 232.65±69.67 µm, and mean best-corrected visual acuity improved significantly from 0.90 (Snellen equivalent (SE), 20/160)±0.43 logarithm of minimum angle of resolution (logMAR) to 0.43 (SE, 20/54)±0.29 logMAR (both p<0.001; two-tailed, paired t-test). Eyes with foveal detachment (n=10) at baseline had thicker preoperative CFT (737.8±239.83 vs 583.73±147.78 µm; p=0.033) but thinner postoperative CFT (188.20±31.52 vs 252.86±73.29 µm; p=0.012). Eyes without foveal detachment at baseline had significantly better postoperative VA (0.33 (SE, 20/43)±0.18 vs 0.65 (SE, 20/86)±0.37 logMAR; p=0.002). No macular hole or other complications occurred during follow-up. CONCLUSION: Centripetal, non-fovea-sparing ILM peeling with gas tamponade may achieve myopic foveoschisis resolution and vision improvement without macular hole formation during at least 3-year follow-up.

Gradual spontaneous resolution of corneal bloodstaining after anterior chamber irrigation for rebleeding secondary to traumatic hyphema.

Corneal bloodstaining, which is brown or dark yellow in color, is induced by hemoglobin deposition, and its breakdown products extend into the corneal stroma. In this article, we report a rare case of corneal bloodstaining induced by total hyphema after rebleeding for traumatic hyphema. The patient underwent irrigation of the anterior chamber (AC) and cataract surgery of the right eye after trauma. After oral and topical treatment the imprint of corneal bloodstaining faded, and it nearly disappeared after the procedures. Corneal bloodstaining is undoubtedly a vision-threatening complication of total hyphema after ocular trauma, surgical intervention, and even rebleeding. Removal of the total hyphema as soon as possible decreases the severity of corneal bloodstaining, shortens the course of spontaneous healing, and thus improves vision.

Intraoperative severe suprachoroidal air as a complication of 23-gauge vitrectomy combined with air-fluid exchange.

We reported a rare case of sudden onset of severe but reversible suprachoroidal air that occurred at the moment of air-fluid exchange in 23-gauge vitrectomy. A 31-year-old male patient presented with a large break at 10-11 o'clock and high bullous, nearly total retinal detachment. He underwent first surgery with silicon oil injection at the end of the surgery. He was arranged to have a second surgery for silicon oil removal through pars plana vitrectomy which was performed smoothly at first. While switching to another mode of air-fluid exchange to clean the residual emulsified oil droplets, surgical view disappeared completely and was suddenly replaced with severe and total suprachoroidal air, which fortunately resolved within 3 days without any other severe complications.

Removal of silicone oil droplets adhering to the posterior surface of an intraocular lens (IOL).

PURPOSE: We report a rare case of silicone oil droplets adhering to the posterior surface of an intraocular lens (IOL) after removal of silicone oil for a patient with retinal reattachment, who had a history of pseudophakic rhegmatogenous retinal detachment. CASE REPORT: A 45-year-old male with a history of cataract surgeries of both eyes developed pseudophakic retinal detachment in his left eye. He received surgeries of scleral buckle and standard 3-port pars plana vitrectomy with silicon oil tamponade. With retinal attachment for 7 months, he underwent removal of silicone oil in the left eye. However, a big silicone oil droplet was found on the posterior surface of the IOL with complaints of distorted micropsia and poor vision, a month later. Pars plana vitrectomy using a 20-gauge vitreous cutter, which was supposed to have a higher cleaning capability compared with a smaller size device, was performed to aspirate the main part of the big oil droplet. The residual dispersed smaller droplets at the center of the visual axis were swept peripherally using a 27-gauge bending tip cannula. Fortunately, the patient regained his vision of 20/20 without distortion and micropsia in his left eye. CONCLUSION: This was a rare case where silicone oil droplets were found adhering to the posterior surface of an IOL after removing silicone oil a month later. We used a 20-gauge vitrectomy system to remove large oil droplets and swept smaller ones off the visual axis to improve the vision and visual quality.

Traumatic corneal flap displacement after laser in situ keratomileusis (LASIK).

BACKGROUND: Laser in situ keratomileusis (LASIK) is the most common and popular procedure performed for the correction of refractive errors in the last two decades. We report a case of traumatic flap displacement with flap folding which occurred 3 years after LASIK was performed. Previous literature suggests that vision prognosis would be closely related to proper and prompt management of traumatic flap displacement with flap folding 3 years after LASIK. CASE PRESENTATION: A 23-year-old female presented to our hospital who had undergone uneventful LASIK in both eyes 3 years prior. Unfortunately, she had suffered a blunt trauma in her right eye in a car accident. A late onset of corneal flap displacement was found with upper and lower portion of the flap being folded inside the corneal bed. Surgical intervention for debridement with subsequent reposition of corneal flap was performed as soon as possible in the operating room. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. Two days after the operation, the displaced corneal flap was found to be well attached smoothly on the corneal bed without folds. The best-corrected visual acuity was 6/6 with refraction of -0.75 D to 1.0 D ×175° in her right eye 1 month later. LITERATURE REVIEW: We reviewed a total of 19 published cases of late-onset traumatic flap dislocations or displacements after LASIK with complete data from 2000 to 2014. CONCLUSION: Traumatic displacement of corneal flaps after LASIK may occur after blunt injury with specific direction of force to the flap margin, especially tangential one. According to the previous literature, late-onset traumatic flap displacement may happen at any time after LASIK and be caused by various types of injuries. Fortunately, good visual function could mostly be restored with immediate and proper management.

Metastatic endophthalmitis combined with subretinal abscess in a patient with diabetes mellitus--a case report.

BACKGROUND: Endogenous endophthalmitis, extra-hepatic metastasis from liver abscess with diabetes mellitus, could lead to a devastating outcome without a prompt and appropriate management. We report a case of metastatic endophthalmitis combined with subretinal abscess with successful visual outcome after treatment. CASE PRESENTATION: A 56-year-old male patient with diabetes mellitus under poor control presented to our emergency room with fever, sore throat, cough and poor appetite for 2 weeks. Abdominal computed tomography showed a 2.2 × 2.0 cm liver abscess. During hospitalization, sudden onset of blurred vision with floaters in his left eye was noted. Meanwhile, Brain computed tomography demonstrated subdural abscess in right parietal area. With obvious vitritis, a localized subretinal abscess was also found over temporal arcade with size about four disc areas under indirect ophthalmoscopy. A pars plana vitrectomy with intravitreal injection of ceftazidime (2 mg/0.1 ml) and amikacin (0.4 mg/0.1 ml) was performed without retinectomy. The margin of the subretinal abscess became firm and the central area resolved after the operation. Finally, his vision improved to 6/6 after cataract surgery. CONCLUSIONS: Subretinal abscess is an extremely rare presentation of metastatic endophthalmitis. It is difficult to develop appropriate treatment guidelines of endophthalmitis complicated with subretinal abscess. Our experience in this case demonstrated if the size of the subretinal abscess is smaller than four disc areas, pars plana vitrectomy with intravitreal injection of antibiotics without retinectomy could be considered to avoid further retinal detachment.

Bilateral macular infarction as an ocular manifestation of systemic lupus erythematosus (SLE).

We report a rare case of bilateral macular infarction as an ocular presenting sign of systemic lupus erythematosus (SLE). A 29-year-old woman presented to our ophthalmologic clinic with a 1-week history of progressive visual loss in her left eye after she had visited a rheumatologic clinic where SLE was diagnosed. At examination, best-corrected visual acuity (BCVA) of the right eye was 6/6, and for the left was counting fingers. Fundus examination revealed perivascular hard exudates along some branches of vessels in both eyes. After pulse therapy, her BCVA in the right eye declined to 6/30 and in the left improved to 3/60. She was administered sub-Tenon's injections of triamcinolone acetonide 50 mg/week in both eyes for 3 weeks. Her BCVA improved to 3/6 in her right eye and remained at 3/60 in her left eye. Macular infarction is an uncommon but most severe complication of SLE. Early and regular exam of the fundus in patients with SLE is necessary to avoid progression of severe ocular complications.

Prevalence and associated risk factors of myopic maculopathy in elderly Chinese: the Shihpai eye study.

PURPOSE: To assess the prevalence and associated risk factors of myopic maculopathy in an elderly Chinese population in Taiwan. METHODS: Population-based, cross-sectional study. A total of 1361 Chinese aged 65 years or older residing in Shihpai, Taipei, Taiwan, underwent a detailed ophthalmic examination. Of the 1361 participants, 1058 subjects had at least one gradable fundus photograph and were recruited for analysis. High myopia was defined as spherical equivalent of less than -6.0 diopter (D) in the phakic eyes or axial length greater than 26.5 mm in pseudophakic or aphakic eyes. Myopic maculopathy was defined as the appearance of lacquer cracks, focal area of deep choroidal atrophy and macular choroidal neovascularization, or geographic atrophy in the presence of high myopia. RESULTS: The prevalence of high myopia was 4.2% (44/1058). Signs of myopic maculopathy were present in 32 (72.7%) of the 44 high myopics, representing a prevalence of 3.0% (95% confidence interval, 2.0%-4.0%). Subjects with high myopia with myopic maculopathy had higher systolic blood pressure than those without maculopathy (146.4 ± 16.2 mm Hg vs. 127.0 ± 15.9 mm Hg, P = 0.001), and the difference persisted (P = 0.018) after adjustment for age, sex, smoking, body mass index, diastolic blood pressure, educational levels, alcohol drinking, and histories of diabetes or taking anti-hypertension medication. Of the 65 high myopic eyes, eyes with maculopathy had a greater myopic degree (-12.8 ± 5.1 D vs. -7.6 ± 1.5 D, P = 0.001) and poorer corrected visual acuity (logMAR 0.72 ± 0.6 vs. 0.27 ± 0.2, P = 0.001) than those without. CONCLUSIONS: The prevalence of high myopia and myopic maculopathy in this elderly Chinese population group was high. Of the major risk factors examined, high systolic blood pressure may be associated with myopic maculopathy.

Prevalence and associated risk factors of age-related macular degeneration in an elderly Chinese population in Taiwan: the Shihpai Eye Study.

PURPOSE: To assess the prevalence and associated risk factors of age-related macular degeneration (AMD) in an elderly Chinese population in Taiwan. METHODS: The Shihpai Eye Study was a survey of vision and ocular disease in an elderly Chinese population 65 years of age or older residing in Shihpai, Taipei, Taiwan. Of 2045 elderly residents randomly sampled from the household registration databank, 1361 (66.6%) underwent a detailed ophthalmic examination that included fundus color slides by fundus camera after pupil dilatation. Photographs were graded according to the Wisconsin Age-Related Maculopathy Grading System. RESULTS: Fundus photographs were available for 1105 (54.0% in the eligible, 81.2% in the ocular examined) participants. The 47 (4.3%) participants who had ungradable fundus images were older and had more lens opacity. Of the 1058 gradable photographs, the prevalence of early AMD was 9.2% (95% confidence interval [CI], 7.8-10.8); of late AMD, 1.9% (95% CI, 1.3-2.7); of soft drusen, 42.2% (95% CI, 39.7-44.8); of soft indistinct drusen, 4.1% (95% CI, 3.1-5.2); and of any pigmentary change, 8.6% (95% CI, 7.2-10.2). Age was the most significant factor associated with both early and late AMD. The prevalence of early AMD rose from 5.0% in the 65- to 69-year age group to 24.4% in those 80 years of age and older; and for late AMD, from 1.0% to 9.0%. Those who currently drank alcohol had a lower rate of early AMD than did the nondrinker (adjusted odd ratio 0.32, 95% CI: 0.11-0.93, P = 0.037). CONCLUSIONS: AMD is a common eye disease in the elderly Chinese people in Taiwan. The adjusted prevalence rate of exudative AMD is comparable to that in the Chinese people in the Multiethnic Study of Atherosclerosis (MESA) in the United States but is higher than in the Chinese people in the Beijing study in China. Further studies are needed to clarify the incidence and associated risk factors.

Corneal injury by anti-misting agent in swim goggles: a case report.

PURPOSE: To report a case of corneal injury by swim goggle anti-misting agent. METHODS: Case report. RESULTS: A 47-year-old man presented with ocular injury caused by swim goggle anti-misting agent. Two weeks previously, the patient felt sudden ocular pain and grit after pool water flooded his goggles while swimming. Before the patient's swim, a copious amount of anti-misting agent was sprayed inside his goggles. On examination, severe corneal epithelial defect and stroma edema of the right eye were noted. Best-corrected visual acuity (BCVA) was 20/40. Right eye corneal thickness was 625 microm. Topical corticosteroids, antibiotic eye drops, and oral tetracycline were started. After 1 week of treatment, the epithelial defect of his right cornea improved slightly. Stromal edema decreased mildly. Epithelial defect persisted at 1 month follow-up. Right eye BCVA remained 20/40. Three months after treatment, the right eye epithelial defect healed completely. Mild diffuse superficial stromal opacity was noted. BCVA improved to 20/20. At 1-year follow-up, right eye corneal thickness was 547 microm, which was thinner than the left eye. Right eye corneal endothelial cell density measured approximately 1500 cells/mm2, which was less than the left eye at 2300 cells/mm2. The faint, diffuse stromal opacity disappeared; however, white subepithelial plaques were noted in the cornea centers. After 1 month of treatment with topical corticosteroids, the plaques subsided completely. The corneas remained clear at 2-year follow-up. CONCLUSION: Anti-misting agent can cause severe corneal injuries, including persistent epithelial defects, stromal edema and opacity, endothelial cell loss, and subepithelial plaque.