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PURPOSE To evaluate changes in the peripapillary retinal nerve fiber layer (RNFL) thicknesses using spectral-domain optical coherence tomography (SD-OCT) in hydroxychloroquine (HCQ) users. METHODS The medical records of HCQ users were retrospectively reviewed. In these HCQ users, an automated perimetry, fundus autofluorescence photography, and SD-OCT with peripapillary RNFL thickness measurements were performed. The peripapillary RNFL thicknesses were compared between the HCQ users and the control groups. The relationships between the RNFL thicknesses and the duration or cumulative dosage of HCQ use were analyzed. RESULTS This study included 77 HCQ users and 20 normal controls. The mean duration of HCQ usage was 63.6 ± 38.4 months, and the cumulative dose of HCQ was 528.1 ± 3.44 g. Six patients developed HCQ retinopathy. Global and six sectoral RNFL thicknesses of the HCQ users did not significantly decrease compared to those of the normal controls. No significant correlation was found between the RNFL thickness and the duration of use or cumulative dose. The eyes of those with HCQ retinopathy had temporal peripapillary RNFL thicknesses significantly greater than that of normal controls. CONCLUSIONS The peripapillary RNFL thicknesses did not change in the HCQ users and did not correlate with the duration of HCQ use or cumulative doses of HCQ. RNFL thickness is not a useful biomarker for the early detection of HCQ retinal toxicity.

Purpose To determine the necessity of rehabilitative surgical procedures for no implant anophthalmic sockets, and predictive factors of corrective operations after secondary orbital implantation. Material and methods Nineteen unilateral anophthalmic patients without orbital implant were included. The distance of eyebrow, upper eyelid margin, and lower eyelid margin from the horizontal medial canthal line (BM, UM, and LM, respectively) was measured using photographs. The anophthalmic orbit anatomy was compared with that of the healthy side using CT scans. Results Five (26.3%) patients showed satisfactory results with the secondary implantation alone. Fourteen (74%) patients needed additional surgeries for ptosis, shallow inferior fornix, enophthalmos, or lower eyelid malposition. Separated superior muscle complex and prominent intermuscular septum connecting the levator and the lateral rectus muscles were noticeable in CT scans. Predictive factors for ptosis surgery included longer BM ( p = 0.04), shorter distance from the superior orbital wall to the upper margin of the prosthesis ( p p = 0.04). Conclusion Most patients needed multiple operations after secondary implantation for rehabilitation. Additional ptosis operation may be required for patients with a high brow on the anophthalmic side, a vertically long prosthesis, and an impinged prosthesis against the superior orbital wall.

This study aimed to evaluate the frequency and clinical characteristics of hydroxychloroquine (HCQ) retinopathy in Korean patients with rheumatologic diseases. We retrospectively reviewed medical records of 310 patients taking HCQ. Ophthalmic examinations included spectral-domain optical coherence tomography (SD-OCT), automated visual field test, and fundus autofluorescence. The severity of retinopathy was categorized as early, moderate, or severe, and the location was categorized as parafoveal, pericentral, or mixed pattern. Among 310 patients, 9 patients (2.9%) were diagnosed as HCQ retinopathy. Among the patients with HCQ use ≥ 5 years (n = 174), the frequency was 5.2%. Only 1 (11.1%) of the 9 patients was symptomatic. The mean daily dose per kilogram of real body weight of the 9 patients was 5.6 mg, and only 3 had used 6.5 mg or more. Four of the 9 patients had severe HCQ retinopathy. Six of the 9 patients showed pericentral or mixed pattern of retinal damage. Consequently, the frequency of HCQ retinopathy in Korean patients was not low, especially when administered at a high cumulative dose and for a long duration. Screening of HCQ retinopathy by the recommended guidelines that include SD-OCT seems useful and should be done to detect retinal damage earlier in patients with chronic exposure to HCQ., Graphical Abstract

To investigate the error rate of automated choroidal segmentation and the effect of frame averaging on error rate.A horizontal B scan at the fovea was performed in patients having various retinochoroidal disorders using swept-source optical coherence tomography (OCT) with frame-averaging technique. Scanned images were classified into four morphological groups: normal from fellow eyes (NF ), normal from pathologic eyes (NP ), retinal abnormality (R) and retinochoroidal abnormality (RC) group. Choroidal segmentation was automatically performed using built-in software of a swept-source OCT device, and the error rate of choroidal segmentation was analysed.Qualified images for all four averaging types with different number of averaged frames were acquired in 89 eyes of 77 patients. Images of 12, 20, 24 and 33 eyes were classified as NF , NP , R and RC group, respectively. The choroidal segmentation error was detected in 1-2 images (8.3-16.7%) in the NF group, 3-6 images (15.0-30.0%) in the NP group, 4-8 images (16.7-33.3%) in the R group and 17-19 images (51.5-57.6%) in the RC group. The error rate was significantly higher in RC group than other groups (p 0.05). Increasing the number of frames for averaging showed no significant effect on the error rate in all groups (p 0.05).Automated choroidal segmentation showed a high error rate in images with choroidal abnormalities, and the averaging effect could not reduce the error rate significantly. Thus, further technological improvement is needed to increase the accuracy of the automated choroidal segmentation.

To examine the choroidal thickness in patients with indirect traumatic optic neuropathy (TON) Methods: Patients with unilateral traumatic optic neuropathy over a period of 4 years were included in this study. Horizontal and vertical enhanced-depth imaging (EDI) from spectral-domain optical coherence tomography (SD-OCT) scans of the fovea were obtained in patients with unilateral TON within 2 weeks of injury. The main outcome measure was the choroidal thickness at nine locations. The choroidal thickness was compared between affected and unaffected eyes in the TON group, and the mean difference in the choroidal thickness in both eyes was compared between TON and control groups.A total of 16 patients and 20 control subjects were included. The choroidal thickness at horizontal, vertical and average subfoveal, inner temporal, and outer inferior locations was significantly thicker (13-23%) in affected eyes than in unaffected fellow eyes (p = 0.042, 0.046, 0.024, 0.013, 0.018, and 0.027, respectively). The mean difference value between choroidal thickness measurements in both eyes was significantly larger in the TON group than in the control group at the horizontal, vertical and average subfoveal, inner temporal, inner nasal, inner superior, inner inferior, and outer superior locations (p = 0.001, 0.011,0.001, 0.001, 0.033, 0.014, 0.011, and 0.014, respectively). The choroidal thickness at subfoveal locations showed no statistical difference between TON and control eyes (p 0.05).Eyes affected by TON showed a regionally thicker choroid than unaffected fellow eye. This thick choroid might be due to impaired blood circulation and vascular remodeling of the optic nerve head and choroid. These results help to better understand the pathophysiology of TON.

Purpose To compare the efficacy and rotational stability after implantation of two types of toric implantable collamer lenses (Toric ICL™(TICL);V4 and V4c, STAAR Surgical Co.) Study design Retrospective case series. Methods This retrospective study evaluated total 48 eyes of 48 patients who underwent the implantation with V4 and V4c TICL with a central hole; A twenty-four eyes of 24 patients with V4 TICL and 24 eyes of 24 patients with V4c TICL with a central hole. Visual acuity, manifest refraction, and intraocular pressure were evaluated before and after surgery. Rotational stability (disparity between the intended axis and achieved axis) was assessed in both groups using digital anterior segment photographs, and vector analysis was also performed. Results Uncorrected visual acuity improved in both groups without significant difference (P = .111). There were no statistical differences between two groups in postoperative SE and cylindrical errors (P = .067 and .384, respectively). The mean value of rotation was 4.17±3.31° and 3.39±2.36° in the V4 and V4c TICL groups, respectively without significant difference (P = .364). Vector analysis of astigmatic correction showed no significant diffrence between two groups. Conclusion V4 and V4c TICL have similar efficacy with regard to visual acuity and refractive outcomes and rotational stability.

Background To evaluate the observed prevalence and the optic nerve head (ONH) characteristics of normal tension glaucoma (NTG)-suspect eyes in branch retinal vein occulusion (BRVO) eyes in Korean population. Methods This was a retrospective observational study. We investigated 445 BRVO eyes that were diagnosed in the retina clinic of Samsung Medical Center between March 2005 and December 2011. The observed prevalence of NTG-suspect in BRVO eyes was evaluated compared to the previous population based study. In addition, NTG-suspect cases in BRVO were divided into three groups based on the characteristics of optic disc morphology. Results In 445 BRVO eyes, 30 eyes were excluded from the present study. In 415 BRVO eyes, 4.3% (18 eyes) (95% confident interval [CI], 2.4–6.3%) were diagnosed with suspect glaucoma and this is not significantly different from the result in the general Korean population (P = 0.09). We classified the NTG-suspect eyes into three groups such as disc rim notching and thinning type (Group 1; 55.6%), optic cup-sited hemorrhage type (Group 2; 16.7%) and disc rim thinning and pallor type (Group 3; 27.8%). NTG-suspect in the fellow eye were only found in group 1 (80%) and group 2 (67%), but not in group 3 (P = 0.01). Conclusions BRVO and glaucoma seem to have no common vascular pathogenesis in consideration of the prevalence of NTG-suspect in BRVO eyes compared to general Korean population.

Purpose: To evaluate the reflection rate of the first eye in order to minimize the real refractive error in the second eye in bilateral consecutive cataract surgeries. Methods: A retrospective analysis was performed with 248 patients who underwent bilateral sequential uncomplicated phacoemulsification and posterior chamber intraocular lens implantation. Predicted spherical equivalent was compared with postoperative spherical equivalent, and the range of real refractive error was analyzed by calculating the reflection rate of the first eye. Results: When the difference between predicted spherical equivalent and postoperative spherical equivalent was greater than 0.5 D as calculated with the formula of Sanders-Retzlaff-Kraff Theoretical (SRK)-T and SRK II, application of 50-60%, 40-50% of the difference of the first eye was high probability to reduce the second-eye real refractive error (75%, 100%). Conclusions: Application of 40-60% of the real refractive error in the first-eye can minimize the real refractive error in the second-eye in bilateral sequential cataract surgeries. J Korean Ophthalmol Soc 2016;57(3):399-404

Purpose: To report a case of steroid-induced glaucoma in a child who was treated with systemic steroids for a long period due to graft-versus-host disease. Case summary: A 10-year-old male was referred to our ophthalmologic clinic for examination of papilledema due to persistent headache and nausea. He was diagnosed as aplastic anemia 8 years prior and took approximately 4,000 mg of oral prednisolone for 8 years from April 2007 to April 2015 for treatment of lung graft-versus-host disease after hematopoietic stem cell transplantation. His best corrected visual acuity was 0.8 (decimal) in the right eye, 0.5 in the left eye and intraocular pressure (IOP) measured using a Goldmann applanation tonometer was 42 mm Hg in the right eye and 43 mm Hg in the left eye. His cup-to-disc ratio was 0.8 in the right eye and 0.7 in the left eye. Additionally, superior and inferior neuroretinal rim thinning was present in both eyes. Despite using IOP-lowering agents, IOP was not controlled. However, after trabeculectomy with mitomycin C in both eyes, IOP became normalized. Conclusions: In cases of pediatric patients treated with systemic steroids for a long period of time, regular observation is necessary to prevent IOP elevation and steroid-induced glaucoma. J Korean Ophthalmol Soc 2016;57(3):518-523

Purpose: To report a case of nonparaneoplastic autoimmune retinopathy diagnosed using serum anti-retinal autoantibodies. Case summary: A 60-year-old female complained of progressive visual loss in both eyes over 3 months. Her best corrected visual acuity was hand motion in the right eye, 0.9 (decimal) in the left eye, and no definite abnormal findings were identified on fundus examinations. Automated visual field test revealed severely depressed visual fields in both eyes. Standard full-field electroretinogram (ERG) revealed nearly extinguished scotopic b-waves and spectral-domain optical coherence tomography (SD-OCT) showed subtle obscuration and interruption of the inner segment/outer segment (IS/OS) junction of the photoreceptors. Using Western blotting with human retinal proteins and the patient’s serum, we diagnosed nonparaneoplastic autoimmune retinopathy and performed posterior subtenon steroid injection in the right eye, systemic corticosteroids, and oral mycophenolate mofetil. Full-field ERG after treatment showed slightly increased amplitude but there was no subjective visual improvement. OCT after treatment did not reveal significant changes in the photoreceptor layer. Conclusions: This is the first reported case of nonparaneoplastic autoimmune retinopathy in Korea diagnosed using Western blotting with anti-retinal autoantibodies. Autoimmune retinopathy should be considered in patients with visual field and ERG impairment without definite fundus abnormalities. J Korean Ophthalmol Soc 2015;56(7):1134-1140