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Purpose: To investigate chorioretinal vascular changes in the non-surgical eyes of patients who underwent vitreoretinal surgery under general anesthesia using optical coherence tomography angiography (OCTA).Methods: Data from 40 patients who underwent retinal surgery were retrospectively analyzed. Ophthalmologic examinations (including OCTA) were performed in the morning before and after surgery. The presence of intraoperative hypotension (IOH; mean arterial pressure 0.05). The duration of anesthesia and average size of the choriocapillaris void (p < 0.05, r = -0.32), and the intraoperative mean arterial pressure (MAP) fluctuation and DCP, showed statistically significant negative linear correlations (p < 0.05, r = -0.38). The choriocapillaris void size and intraoperative MAP fluctuation also displayed a significant negative correlation (p < 0.05, r = -0.37), while the average size signal void showed a weak positive linear correlation (p < 0.01, r = 0.41; and p < 0.01, r = 0.44, respectively).Conclusions: This is the first study to assess the effects of general anesthesia on chorioretinal vessels using OCTA. The Vessel density of the DCP was significantly increased in the non-surgical eye after total vitrectomy under general anesthesia. Furthermore, we found a correlation between MAP fluctuation and choriocapillaris void features. More studies are needed to confirm and expand on these observations.

Purpose To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). Methods The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. Results The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p l 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p g 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p g 0.05). Conclusions Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

Rationale: Cases of bilateral acute angle closure have been reported after use of various drugs. Patient concerns: A 52-year-old woman visited the emergency room and complained of acute bilateral ocular pain and decreased vision accompanied by headache, nausea, and vomiting. One day before, she had started a herbal medicine containing Ma-huang for weight loss. On examinations, myopic shift, edematous cornea, increased intraocular pressure, shallow anterior chamber, and thickened choroid on both eyes were observed. Diagnoses: Angle closure glaucoma induced by drug (Ma-huang). Interventions: To promptly quit the offending drug and apply ocular hypotensives and cycloplegics. Outcomes: Her symptoms and signs were relieved after antiglaucoma medications and no significant recurrence has been occurred. Lessons: Physicians prescribing weight loss medications containing Ma-huang must be aware of the potentially sight-threatening adverse effect of bilateral acute angle closure.

Purpose. To describe a method to overcome the nonavailability of a long needle 9-0 polypropylene suture for sutured scleral fixation of the posterior chamber intraocular lens (PC-IOL) using a single fisherman’s knot (SFK).Methods. First, a 10-0 polypropylene suture was passed from the sclera to the ciliary sulcus using a long needle. A 9-0 suture was tied to the unpassed portion of the 10-0 suture with an SFK. We pulled the 10-0 suture to pass the SFK through the sclera, and then we cut the knot and removed the 10-0 suture. IOL fixation with 9-0 sutures used the conventional techniques used for sutured scleral-fixated IOL. Preoperative and postoperative visual acuity, corneal astigmatism, and endothelial cell count and intraoperative/postoperative complications were evaluated.Results. An SFK joining the two sutures was passed through the sclera without breakage or slippage. A total of 35 eyes from 35 patients who underwent sutured scleral fixation of the IOL. An intraoperative complication (minor intraocular hemorrhage) was recorded in four cases. Knot exposure, IOL dislocation, subluxation, and retinal detachment were not observed.Conclusions. The SFK offers the opportunity to use 9-0 sutures for the long-term safety and may not require the surgeon to learn any new technique.

Purpose To investigate the effect of optic disc center displacement on retinal nerve fiber layer (RNFL) measurement determined by spectral domain optical coherence tomography (SD-OCT). Methods The optic disc center was manipulated at 1-pixel intervals in horizontal, vertical, and diagonal directions. According to the manipulated optic disc center location, the RNFL thickness data were resampled: (1) at a 3.46-mm diameter circle; and (2) between a 2.5-mm diameter circle and 5.4-mm square. Error was calculated between the original and resampled RNFL measurements. The tolerable error threshold of the optic disc center displacement was determined by considering test-retest variability of SD-OCT. The unreliable zone was defined as an area with 10% or more variability. Results The maximum tolerable error thresholds of optic disc center displacement on the RNFL thickness map were distributed from 0.042 to 0.09 mm in 8 directions. The threshold shape was vertically elongated. Clinically important unreliable zones were located: (1) at superior and inferior region in the vertical displacement; (2) at inferotemporal region in the horizontal displacement, and (3) at superotemporal or inferotemporal region in the diagonal displacement. The unreliable zone pattern and threshold limit varied according to the direction of optic disc displacement. Conclusions Optic disc center displacement had a considerable impact on whole RNFL thickness measurements. Understanding the effect of optic disc center displacement could contribute to reliable RNFL measurements.

Endogenous endophthalmitis is an intraocular infection that results from hematogenous spread of organisms from a distant source of infection. Facial cellulitis is rarely reported as a focus of infection. We report a case of 51-year-old unconscious woman presenting with fever, facial swelling, and decreased visual acuity secondary to facial cellulitis, endogenous endophthalmitis and end-stage renal disease(ESRD). Generally systemic antibiotics in endophthalmitis have low efficacy because of the blood-ocular barrier. The management of endophthalmitis begins with intravitreal antibiotic injections and if the response is not favorable to do a vitrectomy. Twelve hours after the intravitreal antibiotic injection, vitrectomy was considered because of worsening of the vitreal cloudiness. However, the patient's general medical condition precluded vitrectomy. We experienced successful treatment with intravitreal antibiotic injection and continuous intravenous antibiotic administration because of the breakdown of the blood-ocular barrier due to ocular inflammation, especially in the setting of systemic vascular and fluid homeostatic changes.

PURPOSE: The aim of study was to investigate the relationship between depression and age-related macular degeneration (AMD) in Korea treated with intravitreal ranibizumab. METHODS: This was a cross-sectional study. This study included 107 patients diagnosed with AMD treated with intravitreal ranibizumab. All patients answered the Korean version of the Geriatric Depression Scale (GDS-K), and the prevalence of depression was evaluated. The patients from 1 center were classified into groups with and without depression according to GDS-K. Visual acuity (VA), duration, bilaterality, history of previous treatment for AMD, and comorbidities were assessed and compared between groups. The correlations between GDS-K and other variables were investigated. RESULTS: The prevalence of depression was 26.2% with AMD treated with intravitreal ranibizumab in this study. In subanalysis, the 23 depressed patients (33.3%) were older (P = 0.022) than the nondepressed. Positive correlations were observed between GDS-K and age, VA of injected eye, VA of better eye, duration of AMD, and the number of previous treatments for AMD. CONCLUSIONS: This is the first study evaluating the relationship between depression and AMD in Koreans treated with intravitreal ranibizumab. The prevalence of depression in AMD is substantial and similar to those in previous reports. Interventions to diagnose and treat depression in AMD patients are necessary.

The primary goal of surgery for macular holes is to induce visual improvement via the reappositioning of the detached or thickened rim of the neurosensory retina to the retinal pigment epithelium. The macular hole is sealed by formation of a glial plug, which reattaches the rim of the neurosensory retina around the edges of the hole.1-3 In order to improve the success rate of surgery, it is necessary to provide stimulus to the glial cells, a template for migration, and a scaffold for proliferation.4 Several adjuvants have been introduced in the hopes of improving the outcomes associated with macular hole surgery,5-8 but the effects remain somewhat controversial.9-11 Laser photocoagulation at the center of the macular hole, one of the adjuvant therapies for the treatment of macular holes, was introduced by Del Priore.12 The theoretical basis of this procedure is that the retinal pigment epithelium will produce cytokines after completion of laser photocoagulation which will promote the formation of a glial plug to close the macular hole.13-15 Several consecutive series have previously demonstrated that laser photocoagulation, when performed as an adjuvant therapy, is able to promote the closure of primary or recurrent macular holes and, as a result, improve visual outcomes.13,14,16-18 The above results suggest that laser photocoagulation might constitute a useful adjuvant therapy for the treatment of idiopathic macular holes. However, this benefit has not been confirmed in a controlled clinical trial. In this randomized clinical trial, we attempted to evaluate the effectiveness of laser photocoagulation as an adjuvant therapy in the surgical treatment of macular holes with diameters larger than 400 µm.

목적: 유리체강 내 약물주입술에 사용되는 다양한 약물이 각막내피세포에 미치는 영향을 알아보고자 하였다. 대상과 방법: 2016년 2월부터 2016년 10월까지 본원 안과에서 유리체강 내 주사 치료를 받은 환자 113명 118안(나이관련황반변성 61 안, 당뇨황반부종 40안, 망막정맥폐쇄에 동반된 황반부종 16안, 포도막염 1안)을 대상으로 주사 전후...

목적: 투명각막절개를 통한 백내장 초음파수정체유화술에서 절개위치에 따른 수술에 의해 유발된 후면각막난시의 변화와 전체각막난시에 미치는 영향에 대해 알아보았다. 대상과 방법: 단일 술자에 의해 투명각막절개를 통해 시행된 초음파수정체유화술을 받은 환자 81명(84안)을 대상으로 연구하였다. 절개방향은 상측 혹은 이측에서 시행하였으며 자동각막굴절계 상에서...

PURPOSE To determine the risk factors for and relationship between diabetic retinopathy (DR) and diabetic nephropathy (DN), including microalbuminuria and overt nephropathy, in a population-based study of diabetes mellitus (DM) patients in Korea. METHODS This was a population-based, cross-sectional study. From the fifth (2011, 2012) Korea National Health and Nutrition Examination Survey (KNHANES), 971 participants with type 2 DM were included. The prevalence of DR and DN was determined. Multivariate logistic regression was performed to determine risk factors, including DR, associated with DN in the Korean population. RESULTS In DM patients, we observed a prevalence of 20.0% for any DR and 3.8% for proliferative diabetic retinopathy (PDR). Microalbuminuria prevalence was 19.3% and overt nephropathy prevalence was 5.5%. The risk factors of microalbuminuria were presence of hypertension; higher systolic blood pressure, serum hemoglobin A1c (HbA1c), and serum blood urea nitrogen level; as well as the presence of PDR. The risk factors of overt nephropathy were long duration of DM; high levels of HbA1c, systolic blood pressure, total cholesterol, and serum creatinine; as well as the presence of DR CONCLUSIONS: Proliferative diabetic retinopathy is associated with microalbuminuria and DR is associated with overt nephropathy in Korean DM patients. Our findings suggest that when an ophthalmologist finds the presence of DR or PDR, timely evaluation of the patient's renal status should be recommended.

Purpose: To examine the relationship between the refractive astigmatism by automated refractometry and the corneal astigmatism by a dual Scheimpflug analyzer in pseudophakic eyes. Methods: Prospectively, 75 patients (100 eyes) were enrolled in the present study. Refractive astigmatism was obtained by automated refraction. Corneal astigmatism was obtained using automated keratometry (ARK-530A) and dual Scheimpflug scanning analysis (Galilei G4). All refractive values were converted to the power vector components J0 and J45 for comparison and regression analysis of refractive versus corneal astigmatism. Bland-Altman plots were created to estimate the agreement between measurements. Results: The average astigmatism from each measurement was -1.11 ± 1.44 D (refractive astigmatism from automated refraction), -0.77 ± 1.06 D (corneal astigmatism from automated keratometry), -0.93 ± 1.02 D (simulated K from Galilei G4), and -1.11 ± 1.48 D (total corneal power from Galilei G4). Refractive J0 and keratometric J0 were significantly correlated (r = 0.557, p ≤ 0.001), as well as the corresponding J45 values (r = 0.655, p = 0.025). Refractive astigmatism and total corneal power components were also significantly correlated (J0: r = 0.618, p ≤ 0.001; J45: r = 0.608, p = 0.04). In the Bland-Altman plots, keratometric J0 and total corneal power J0 showed the best agreement. Conclusions: The accuracy of measurements for corneal refraction and astigmatism in pseudophakic eyes is higher using the dual Scheimpflug analyzer, especially for total corneal power. This value of astigmatism can take into account the refractive astigmatism of pseudophakic eyes and can be used in evaluating postoperative corneal astigmatism. J Korean Ophthalmol Soc 2016;57(3):361-368

목적: 급성망막괴사의 치료를 위해 항바이러스제 정맥 투여 후 급성 신손상이 발생한 환자에서 정맥투여 중단 후 유리체강 내 ganciclovir 단독 주입술로 호전된 환자 1예를 보고하고자 한다. 증례요약: 46세 여자가 10일 전 시작된 우안 충혈, 시력저하로 내원하였다. 초진 당시 교정시력 우안 안전수지, 좌안 1.0이었으며, 안저 검사상 우안은 다발성 주변부 망막동맥폐쇄, 시신경부종, 주변부 망막의 백색 괴사성 침윤 등이 관찰되었다. 우안 급성망막괴사 진단하에 acyclovir 정맥투여를 시작하였다. 주사치료 2일째 혈액검사에서 혈청 크레아티닌 수치가 상승되었고 사구체 여과율은 감소하여 acyclovir에 의한 급성 신손상으로 보고 정맥주사를 중지하였다. 정맥주사 중지 직후부터 유리체강 내 ganciclovir 주입술을 시행하였으며, 중지 5일 후 혈청 크레아티닌은 정상범위로 회복되었고, 발병 4달째 나안 시력 우안 0.2로 유지되었으며, 진행 및 재발소견은 관찰되지 않았다. 결론: 유리체강 내 ganciclovir 단독 주사치료가 신장 기능이 좋지 않은 환자의 급성망막괴사 치료에 있어 효과적인 대체 치료법이 될 수 있을 것으로 생각된다.

Purpose: The authors report a case of bilateral simultaneous central retinal vein occlusion caused by Waldenstrom’s macroglobulinemia. Case summary: A 65-year-old man presented to our department complaining of decreased visual acuity for the duration of about 6 months. On his initial visit, best-corrected visual acuity was 0.02 in the right eye and 0.06 in the left eye. Based on the findings of a funduscopic examination, the patient had bilateral diffuse retinal hemorrhages, dilated tortuous veins, and macular edema. He had experienced recurrent spontaneous epistaxis 6 months previously and had undergone treatments such as intravitreal bevacizumab injection and intravitreal dexamethasone implantation at another hospital. Laboratory tests at that hospital showed anemia and hyperproteinemia, for which he was referred to our hemato-oncology department. Bone marrow biopsy was consistent with Waldenstrom’s macroglobulinemia/lymphoplasmacytoid lymphoma, and he was treated with systemic chemotherapy. One year after the systemic chemotherapy, his best-corrected visual acuity was 0.15 in the right eye and 0.6 in the left eye. Funduscopy showed decreased bilateral retinal hemorrhages and macular edema. Conclusions: When simultaneous bilateral central retinal vein occlusion occurs in a patient with no other underlying disease such as hypertension or diabetes, it might be a sign of serum hyperviscosity, and there should be a very high level of suspicion for presence or progression of systemic disease. If such a disease is properly and timely diagnosed, effective early systemic evaluation and therapy can be administered, and it is important to have initial general treatment as well as ophthalmic treatment. J Korean Ophthalmol Soc 2016;57(6):1012-1017

목적: 시야검사상 반시야결손을 나타내는 녹내장 환자에서 스펙트럼영역 빛간섭단층촬영(spectral-domain optical coherence tomography, SD-OCT)으로 측정한 정상 반시야의 시신경유두주위 망막신경섬유층(circumpapillary retinal nerve fiber layer, cRNFL) 및 황반부신경절세포층(macular...

목적: 정상 소아에서 스펙트럼영역 빛간섭단층촬영(spectral domain optical coherence tomography)을 이용하여 망막신경섬유층 부피를 측정하고 망막신경섬유층 두께와의 상관관계를 알아보고자 하였다. 대상과 방법: 2012년 2월부터 11월까지 4세에서 15세 사이의 정상 소아 79안을 대상으로 스펙트럼영역 빛간섭단층촬영을...

To the Editor: We read the article by Ascaso entitled, “Spontaneous Resolution of Central Serous Chorioretinopathy in a Patient with Congenital Retinal Macrovessel” published in Volume 124 of Circulation with great interest.1 In our opinion, the images provided in the article do not seem to show what we can see in typical central serous chorioretinopathy (CSCR). In the images provided, the leakage seen on fundus fluorescein angiography definitely appears to be originating from an anastomotic site at the congenital retinal macrovessels (CRMs). The retinal vessels are visible below the leakage point, which …

Loa loa is unique among the human filariae in that adult worms are occasionally visible during subconjunctival migration. A 29-yr-old African female student, living in Korea for the past 5 yr without ever visiting her home country, presented with acute eyelid swelling and a sensation of motion on the left eyeball. Her symptoms started one day earlier and became worse over time. Examination revealed a threadlike worm beneath the left upper bulbar conjunctiva with mild eyelid swelling as well as painless swelling of the right forearm. Upon exposure to slit-lamp illumination, a sudden movement of the worm toward the fornix was noted. After surgical extraction, parasitologic analysis confirmed the worm to be a female adult Loa loa with the vulva at the extreme anterior end. On blood smear, the microfilariae had characteristic features of Loa loa, including sheath and body nuclei up to the tip of the tail. The patient also showed eosinophilia (37%) measuring 4,100/microL. She took ivermectin (200 microg/kg) as a single dose and suffered from a mild fever and chills for one day. This patient, to the best of our knowledge, is the first case of subconjunctival loiasis with Calabar swelling in Korea.

목적: 비접촉경면현미경, 이중샤임플러그전안부 사진기 및 초음파 각막두께측정계를 이용하여 중심각막두께의 측정치를 비교하고자 하였다. 대상과 방법: 정상인 70명 70안을 대상으로 비접촉경면현미경, 이중샤임플러그전안부 사진기 그리고 초음파 각막두께측정계로 측정한 중심각막두께를 비교하고 상관관계를 알아보았다. 결과: 비접촉경면현미경, 이중샤임플러그전안부 사진기...

Purpose: To evaluate the clinical stability and outcomes of 3-piece intraocular lens (IOL) transscleral fixation surgery using a modified injector. Methods: We have modified and used the Sapphire unfolder injector system (Allergan, USA). This involved, cutting a slit longitudinally at the terminal part of the injector so that a thread could pass through it freely. After a conjunctival peritomy created at 2 and 8 o’clock, a long curved needle with double-armed 10-0 polypropylene is passed through the exposed sclera. Two pieces of suture are withdrawn through the 2.8 mm corneal incision and 1 suture (from 8 o’clock) is passed through the opening of the cartridge and then tied to the leading haptic. Next, the IOL was implanted with the cartridge and then inserted through the corneal incision site. The other suture (from 2 o’clock) is tied to the haptic on the opposite side and inserted. Results: The study included 20 eyes of 20 patients with a mean age of 62.8 years at the initial visit. There were no complications, such as vitreous hemorrhage, retinal detachment, glaucoma, corneal edema, or iris injury. While the knot fixed to the leading haptic of IOL passed by the cartridge, there was no change of position. During the follow-up period, IOL dislocation did not occur and the corrected visual acuity and corneal astigmatism improved significantly. Conclusions: This technique is an effective procedure for minimizing entangled thread and corneal astigmatism. J Korean Ophthalmol Soc 2015;56(3):345-350

목적: Galilei G6(R)와 IOL master(R)를 이용하여 백내장 안에서 측정한 생체계측값 및 백내장 수술 후 굴절률 예측의 정확성을 비교하고자 하였다. 대상과 방법: 백내장 수술을 시행 받은 50명 50안을 대상으로 Galilei G6(R), IOL master(R)를 이용하여 수술 전 안축장, 전방깊이, 각막굴 절력을 측정하였다. 인공수정체의 도수결정은 SRK/T 공식을 이용했으며, 백내장 수술 4-6주 후 자동굴절검사계로 측정한 굴절값에서 예상 굴절력을 뺀 차이의 절대값을 이용해서 평균절대오차를 비교하였다. 결과: Galilei G6(R)와 IOL master(R)에서 측정된 안축장의 평균은 각각 23.36 ± 0.80 mm, 23.36 ± 0.90 mm였으며 통계적으로 유의한 차이가 없었다(p=0.321). Galilei G6(R)와 IOL master(R)에서 측정된 전방깊이는 각각 3.22 ± 0.35 mm, 3.11 ± 0.46 mm (p＜0.001), 구면대응각막굴절률은 각각 44.29 ± 1.40D, 44.39 ± 1.41D (p=0.028)로 전방깊이, 구면대응각막굴절률 모두 유의한 차이를 보였다. IOL master(R)와 비교한 Galilei G6(R)에서의 절대값 예측오차의 평균은 통계적으로 유의한 차이가 없었다(p=0.423). 결론: Galilei G6(R)와 IOL master(R)를 이용한 안구생체계측 측정치 중 안축장 길이는 유사한 결과값을 보였으나 전방깊이 및 각막굴절력은 유의한 차이를 보였다. 또한 백내장 수술 후 굴절력 예측의 정확도는 두 측정방법 간 차이가 없었다.

Objective To evaluate the clinical outcomes of macular laser photocoagulation after the intravitreal injection of 4 mg of triamcinolone acetonide (IVTA) for diffuse diabetic macular edema (DME). Methods Eighty-six eyes of 74 patients with diffuse DME were randomized into 2 groups. The laser group eyes (n = 48) were subjected to a macular grid laser photocoagulation 3 weeks after IVTA. The control group eyes (n = 38) underwent only IVTA. Both groups were compared with regard to the changes in visual acuity and central macular thickness at 3 weeks, 3 months, and 6 months after IVTA. Results The mean central macular thickness before, 3 weeks after, and 3 and 6 months after IVTA were 538, 250, 295, and 301 μm in the laser group vs 510, 227, 302, and 437 μm in the control group, respectively. The logMAR visual acuities were not significantly different between the 2 groups at baseline and at 3 weeks after IVTA but were significantly better in the laser group at 3 ( P = .02) and 6 months ( P Conclusions Macular laser coagulation effectively maintains improved visual acuity after IVTA for diffuse DME and is believed to reduce recurrent DME after IVTA.

PURPOSE To evaluate the effects of laser photocoagulation on reopened macular holes. METHODS This study involved 9 eyes from 9 patients who underwent laser photocoagulation coupled with fluid-gas exchange for reopened macular holes. The photocoagulation was performed at the center of the macular hole. Closure of the reopened hole was categorized by optical coherence tomography (OCT) according to the presence (type 1 closure) or absence (type 2 closure) of continuity in the foveal tissue. Best corrected visual acuity (BCVA), closure types, and complications were assessed. RESULTS Upon final examination, all macular holes were found to have closed. Six eyes were classified as type 1 closure, and three were classified as type 2 closure. The mean BCVAs, before and after laser photocoagulation, were 0.11 and 0.31, respectively (P

Purpose: To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy. Methods: Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups. Results: The average RNFL thickness had increased by 0.84 µm two months after and decreased by 0.4 µm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 µm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 µm (p = 0.11) at six months in the PASCAL group. Conclusions: PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.

The choroid is the connective tissue-containing vascular layer between the retina and the sclera that provides oxygen and nourishment to the outer retina. It is associated with the pathophysiology of many diseases affecting the retina, such as age-related macular degeneration, polypoidal choroidal vasculopathy, central serous chorioretinopathy, and high myopia-related chorioretinal atrophies [1]. Because choroidal change has a major role in the development and progression of these diseases, choroidal thickness, which reflects choroidal change, provides useful information to clinicians. Adequate measurement of choroidal thickness using spectral domain optical coherence tomography (SD-OCT) is possible by introduction of an enhanced depth imaging technique and by averaging several B-scan signals from the same position [2,3]. Using a long-wavelength light source is another approach to visualize the posterior choroid and sclera [1,4]. Recent studies in a healthy population report a range of choroidal thickness from 270 to 350 µm. A negative correlation between choroidal thickness and age was previously reported [1-3,5]. Choroidal thinning is prominent in highly myopic eyes, and refractive error affects choroidal thickness [6]. Previous studies of normal choroidal thickness profiles utilized Heidelberg Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany), Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA), or high-penetration OCT with long-wavelength (prototype). Moreover, normal choroidal thickness was usually reported in Western populations [2-5]. 3D OCT-1000 (Topcon, Tokyo, Japan) is another commercially available SD-OCT that supports 'choroid mode' optimized for choroidal and scleral imaging. However, the choroidal visualization ability of 3D OCT-1000 has not been reported. We therefore investigated the choroidal thickness profile based on location using 3D OCT-1000 in healthy Korean individuals and its correlations with age and refractive error.

Since the report from the Early Treatment Diabetic Retinopathy Study, macular laser photocoagulation has been widely accepted as the treatment of choice for clinically significant macular edema (CSME). However, intractable diabetic macular edema (DME) is a well-known limitation of this treatment [1-3]. A recent large clinical trial showed favorable results after laser photocoagulation for DME, but 12% of the eyes in the trial still had worsening of 10 or more letters at the three-year follow-up [4]. Although intravitreal injection of triamcinolone acetonide (IVTA) is a potent treatment method, it has some limitations. Many investigators have reported excellent short-term outcomes, but the effect of IVTA is usually only maintained for a period of several months; as a result, frequent repeat injections may be necessary [5-7]. In addition, DME refractory to IVTA is also an issue. Therefore, IVTA, which is expected to decrease central macular thickness (CMT) over a short period of time, has been employed for the reinforcement of laser photocoagulation, which is more effective for treating DME with CMT less than 400 µm [8,9]. In a randomized, multicenter clinical trial, the Diabetic Retinopathy Clinical Research (DRCR) Network showed that IVTA plus prompt laser therapy seems to be more effective in pseudophakic eyes than laser therapy alone [10]. In a recent randomized clinical trial of eyes with DME, IVTA plus laser therapy resulted in a marked improvement in vision (by 10 letters or more) compared with laser therapy only. Gillies et al. [11] found that IVTA can be a useful adjunct to laser treatment in the management of DME. We previously reported a six-month result from a prospective comparative clinical trial showing that macular grid photocoagulation subsequent to IVTA is more effective than IVTA monotherapy [8]. Eyes treated with the combination therapy showed better logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at three- and six-month follow-up visits. The maintenance of reduced central macular thickness was noted after six months of follow-up. However, these results were not replicated in a subsequent study, although a similar trend was noted [12]. Therefore, it is expected that a longer follow-up period will confirm the validity of combination therapy. The purpose of this study was to assess the three-year outcomes of laser photocoagulation following IVTA in the treatment of DME.

목적: 드루젠 발견에 있어서 기존의 안저사진과 retromode로 촬영한 주사레이저검안경(scanning laser ophthalmoscope) 영상을 비교하고자 한다. 대상과 방법: 단안의 삼출성 나이관련황반변성으로 진단된 10명의 반대안 10안과 드루젠 소견만 보이는 20명 20안을 대상으로 안저사진과 retromode를 이용한 주사레이저검안경(F-10, Nidek, Gamagori, Japan) 영상을 촬영하였다. 각각 동일한 범위 내에서 드루젠을 발견하여 개수를 비교하였다. 결과: 삼출성 나이관련황반변성안의 반대안에서는 안저사진상 평균 63.1 ± 81.9개, retromode 영상상 평균 141.3 ± 124.1개의 드루젠이 발견되었다( p=0.005). 드루젠 소견만 보였던 대상안에서는 안저사진상 평균 57.0 ± 43.9개, retromode 영상상 평균 112.2 ± 82.0개의 드루젠이 발견되었다( p=0.000). 매체혼탁으로 안저사진상 드루젠이 잘 보이지 않았던 경우에도 retromode 영상에서는 잘 보였다. 결론: 드루젠 관찰에 있어서 retromode를 이용한 주사레이저검안경 검사는 안저사진보다 더 예민한 영상을 제공하는 것으로 생각된다.

Purpose: To evaluate the repeatability of macular thickness and total macular volume measurements made using spectral domain optical coherence tomography (OCT) in normal subjects and subjects with macular disease. Methods: Among a total of 108 subjects, there were 50 normal subjucts, 20 patients with diabetic macular edema, 10 patients with retinal vein occlusion, 15 patients with age-related macular degeneration, and 13 subjects with other conditions. Two serial macular measurements were obtained from each subject by a single experienced examiner using spectral domain OCT. The repeatability of the measurements was evaluated by comparing two consecutive foveal and perifoveal thickness measurements and total macular volume measurements. The intraclass correlation coefficient was also calculated to evaluate the repeatability of measurements made in normal and macular disease subjects. Result: Spectral domain OCT measurements of macular thickness and macular volume were found to be consistent. Measurements of normal subjects were the most consistent, followed by measurements of patients with age-related macular degeneration, retinal vein occlusion, and diabetic macular edema. Conclusions: Although measurements made using spectral domain OCT were repeatable across all subjects, they were more consistent in normal subjects than in patients with macular disease. The differences in repeatability should be considered in the context of diseased pathologic anatomy. Physicians should remain cautious when using these measurements for clinical evaluation.

A principal pathogenic mechanism in diabetic retinopathy (DR) is the compromise of the blood-retinal barrier (BRB), leading to retinal edema. Subsequent increases in retinal volume and retinal thickness are relevant quantitative parameters for BRB damage [1]. Traditional methods for evaluating macular thickening, including slit lamp biomicroscopy and stereo fundus photography, are relatively insensitive to small alterations in retinal thickness [2]. Although fluorescein angiography is highly sensitive for the qualitative detection of fluid leakage, the technique provides no quantitative measure of either BRB alteration or retinal thickening [3]. Optical coherence tomography (OCT), a non-invasive imaging technology that can generate micrometer resolution cross-sectional imaging of intraocular structures in a few minutes, allows for a quantitative measurement of alterations in retinal thickness with good reproducibility [4-6]. Given the increasing diabetic population, a cost-effective and reliable screening program for DR is essential [7-10]. However, interobserver agreement is merely fair for DR grading using fundus photography [11, 12]. Interobserver agreement is even worse for proliferative diabetic retinopathy (PDR), for which diagnostic accuracy is even more important [13]. In this study, we employed easy-to-use and -reproduce OCT to compare the retinal thicknesses of the macula and the peripapillary zone in order to determine the relationship between retinal thickness and DR severity. We also evaluated the validity of baseline retinal thickness for predicting disease progression in DR patients. In particular, we studied which retinal location was best for evaluating the severity of DR and for predicting possible disease progression.

Purpose: To report the frequency, severity and various types of artifacts associated with spectral-domain optical coherence tomography (SD-OCT) based on macular pathologies. Methods: Data was collected retrospectively from 116 eyes of 116 subjects. SD-OCT (3D-1000, Topcon Corp., Japan) imaging was performed in 40 healthy eyes, 45 eyes with intraretinal pathology (IRP) and 31 eyes with subretinal pathology (SRP). The scan protocol was 126 mm radial scan. The frequency and types of artifacts were investigated in each scan and were analyzed based on macular disease. Additionally, the effect of artifacts on the measurement of macular thickness was studied. Results: Errors occurred in 77 eyes (66.38%). Inner retinal boundary misidentification (IRBM) was the most common error (25.86%), with the frequencies of other types of artifacts being 10.34% for off-center fixation, 15.52% for degraded image and 8.6% for outer retinal boundary misidentification (ORBM). The overall error rate of SD-OCT in the retinal pathology group was much higher than that in the normal group. Macular thickness was underestimated in the IRP group because the outer retinal boundary of the IRP group tended to be misidentified toward the inner retina (p

Retinopathy of prematury (ROP) is a major cause of blindness that affects premature infants. With advances in neonatology, ROP is likely to emerge as a more significant problem of vision loss in children in developing countries. With the recent advances in basic science research, our understanding of the pathophysiology of ROP has rapidly evolved. Clinical trials along with natural history of the disease have lead to updated screening and treatment guidelines. For successful control of ROP, timely and accurate screening is very important because early treatment leads to favorable outcomes. New treatment modalities are being explored with pharmacologic agents targeting the modulation of angiogenesis. The improved surgical intervention offers the potential for preservation of vision for eyes of ROP-related retinal detachment. The body of information germane to caring for ROP from infancy to adulthood continues to grow up. Improved surveillance and treatment programmes are likely to be most effective in reducing blindness caused by ROP in developing countries.

Purpose: To investigate the short-term effects of panretinal photocoagulation (PRP) combined with an intravitreal injection of Avastin ® (bevacizumab) as an adjuvant to high-risk proliferative diabetic retinopathy (PDR). Methods: The data was collected retrospectively from the eyes of high-risk PDR patients, which were divided into two groups. One eye was treated with only PRP (PRP only group) and the fellow eye of same patient was treated with both PRP and intravitreal bevacizumab injection (Adjuvant group). Best corrected visual acuity (BCVA), IOP (intraocular pressure), and new vessel (NV) size in fluorescein angiography were recorded immediately and at the six-week followup visit. Adverse events associated with intravitreal injection were investigated. Results: Of 12 patients with high-risk PDR, five were male and seven were female. There were no statistically significant BCVA or IOP changes after treatment in either group (p=0.916, 0.888). The reduction of NV size was found in both groups, but NV size in the adjuvant group showed a greater decrease than that of the PRP only group (p=0.038). Three patients had adverse events after intravitreal injection. Two patients had mild anterior uveitis and one patient had a serious complication of branched retinal artery obstruction (BRAO). Conclusions: Intravitreal bevacizumab injection with PRP resulted in marked regression of neovascularization compared with PRP alone. One serious side effect, BRAO, was noted in this study. Further studies are needed to determine the effect of repeated intravitreal bevacizumab injections and the proper number of bevacizumab injections as an adjuvant.

Purpose: Septal deviation has few subjective symptoms. However, a difficulty remains in doing DCR (dacryocystorhinostomy) in these patients. We investigate the clinical course of DCR in patients with a septal deviation. Methods: Acquired nasolacrimal duct-obstructed patients who had undergone DCR with septal deviation from 2003 to 2006 in our hospital were retrospectively analyzed. We measured the septal distance using paranasal computed tomography taken preoperatively and compared the sex and age of patients, the kinds of operations, outcome of surgery, and ocular and nasal complications in our analysis. Results: Twenty-two eyes of 22 patients with a mean age of 55.3 years (range 29～74) were analyzed (4 males, 18 females). Mean septal distance was 4.84 mm (range 2.18～6.99 mm). Nineteen eyes had endonasal DCR, and three had external DCR. Two had DCR combined with septoplasty. Three had septoplasty as a secondary operation, Nasal complication was synechiae in 9 eyes. DCR success was seen in 15 eyes, and DCR failure in 7 eyes. Septal distance was not correlated with DCR success but was correlated with nasal complication (Mann-Whitney test, p=0.003) Conclusions: In the case of DCR with septal deviation, the surgical technique used will need to minimize the mucosal injury and ensure appropriate nasal correction to prevent future complications.

Purpose To characterize cross-sectional images of idiopathic polypoidal choroidal vasculopathy (PCV). Methods A cross-sectional and retrospective study was performed involving 28 eyes with PCV and 112 eyes with exudative age-related macular degeneration. The frequency and dimensions of the retinal pigment epithelial detachment (RPED) with attenuation of internal reflectivity on optical coherence tomographic (OCT) examination were compared in both diseases. Results OCT showed the RPED with attenuation of internal reflectivity corresponding to the polypoidal structure in the indocyanine green angiogram in 75% of eyes with PCV, which was significantly more frequent than in eyes with exudative age-related macular degeneration (3.6%). In lesions suspicious of exudative age-related macular degeneration or PCV, the RPED with attenuation of internal reflectivity on OCT images strongly supported PCV diagnosis with a sensitivity of 84% and a specificity of 94%. The base diameter (p=0.010) and base diameter times height (p=0.028) of RPED were smaller in PCV than in exudative age-related macular degeneration. Conclusions An RPED with attenuation of internal reflectivity in OCT examination is a highly sensitive and specific finding which characterizes PCV. Recognition of this RPED appearance, as well as the evaluation of its size, aids in the diagnosis of PCV.