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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.

Purpose To investigate the relationship between topical glaucoma medications and meibomian gland dysfunction (MGD) in early middle-aged patients with glaucoma. Methods In this cross-sectional study, 50 patients with glaucoma younger than 50 years who had used topical glaucoma medications for more than 6 months and 40 normal controls of similar age were included. Patients in each group were graded for MGD (0-4) using slit-lamp microscopy. Tear film breakup time (BUT), ocular surface staining, and Marx line scores were also evaluated. Differences between both groups were analyzed statistically. Results The prevalence of MGD was 82% in the group using topical glaucoma medications and 52.5% in the control group. The average period of topical glaucoma medication use was 27.4 months. There were significant differences in the breakup time and Marx line score according to the presence of MGD. Although the duration of topical glaucoma medication use and the severity of MGD did not show a significant correlation, the degree of MGD and the Marx line score were significantly correlated. Conclusions Glaucoma eye drops may be one factor affecting the eyelid changes associated with MGD. The Marx line score may be used as an index to evaluate MGD in patients with glaucoma.

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.

To analyze the incidence of and risk factors for newly developed or increased macular hemorrhage after intravitreal ranibizumab injection (IVR) for neovascular age-related macular degeneration (AMD).We performed a retrospective chart review of 220 subjects (220 eyes) from 5 hospitals who received IVRs for neovascular AMD between 1 June 2009 and 30 June 2010. Systemic conditions (age, sex, presence of diabetes, hypertension, cardiovascular disease, smoking, and use of anticoagulation agent) and presence of hemorrhage at the initial exam were evaluated. The primary study outcome was the incidence of newly developed or increased macular hemorrhage during the 1-month postinjection period.The incidence of newly developed or increased macular hemorrhage including vitreous hemorrhage was 8% (18/220). Presence of diabetes was found to be a risk factor for macular hemorrhage [odds ratios (OR): 2.16, 95% confidence intervals (CI): 1.07-8.13]. When subjects had both diabetes and hypertension, the risk of macular hemorrhage after injection increased 4.8-fold (OR: 4.84, CI: 1.24-18.85).The systemic condition of subjects was found to be an important risk factor for newly developed or increased macular hemorrhage after IVR for neovascular AMD. More consideration should be given to the status of diabetes and hypertension in subjects who receive ranibizumab for neovascular AMD.

To obtain a de novo map of outer photoreceptor layer (OPRL) thickness using a semiautomatic segmentation method for commercial spectral-domain optical coherence tomography (SD-OCT) and analyze the features of the resulting OPRL map in normal eyes and eyes with various inactive macular diseases. Forty normal eyes and 50 eyes with various inactive macular diseases such as resolved central serous chorioretinopathy (20 eyes), surgically-repaired macular hole (10 eyes), epiretinal membrane (10 eyes), and reattached rhegmatogenous retinal detachment (10 eyes) were screened. All subjects underwent a 12 radial scan protocol in SD-OCT. The segmentation lines defining the OPRL were modified using built-in software. The diseased eyes were subdivided into two groups (good vision, or intermediate to poor vision) based on a visual acuity better or worse than 20/40. The map of the OPRL thickness was obtained automatically by the embedded software and was presented as the Early Treatment Diabetic Retinopathy Study (ETDRS) style. The mean OPRL thickness in normal eyes in all subfields was 40.37 ± 4.35 μm. The central subfield area showed the greatest mean OPRL thickness in normal eyes. The mean OPRL thickness of diseased eyes with good vision in the central subfield was greater than that of eyes with intermediate to poor vision. The OPRL thickness map showed various patterns according to the type of macular diseases. We suggest that our semiautomated segmentation method using a 12 radial scan protocol is simple, fast, and suitable for producing a reliable OPRL map with ETDRS. This quantitative data could be useful in clinical practice or research of various macular diseases.

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 To characterize retinal changes in areas of commotio retinae using spectral-domain optical coherence tomography. METHODS In this retrospective observational case series, we included 14 eyes of 14 patients who had experienced blunt ocular trauma and underwent spectral-domain optical coherence tomography and fundus photography evaluation on the same day. The retinal thickness and volume of eyes with commotio retinae were compared with those of eyes without it. Normal untraumatized fellow eyes served as control. Fundus images obtained by spectral-domain optical coherence tomography were compared with fundus photographs. The retinal tissue reflectivities indicated by the images were compared across each lesion. RESULTS There were 7 eyes with commotio retinae involving the macula and 7 eyes without it. Macular thickness and volume were not different between eyes with and without commotio retinae involving the macula. Photoreceptor outer segment reflectivity corresponding to the area of retinal opacity was increased with characteristic features and recovered with the disappearance of retinal opacity over time. CONCLUSION Lesions exhibiting retinal opacity characteristic of commotio retinae corresponded to hyperreflective outer segment lesions without the increase in retinal thickness on spectral-domain optical coherence tomography.

Purpose To describe the clinical characteristics of spontaneous reattachment of rhegmatogenous retinal detachment (SRRRD). Design Retrospective observational case series. Participants Fifteen patients who were diagnosed with SRRRD. Methods The medical records of 15 patients were reviewed. Spontaneous reattachment of rhegmatogenous retinal detachment was confirmed via serial observation in 4 of the eyes, and the remaining eyes represented patients in whom the condition was presumed to develop. Main Outcome Measures Clinical features and association. Results This study involved 6 male patients and 9 female patients with a mean age of 48.0 years. The mean refractive errors in the involved and contralateral eyes were –5.0 and –5.3 diopters, respectively. All 15 eyes evidenced diffuse retinal pigmentary alterations within a sharply demarcated and convex margin. The lesions were located in the inferior retina in 10 of the 15 eyes, limited to 6 clock hours or fewer (66.7%). Although subretinal gliotic bands were detected within the lesion in 11 patients (73.3%), epiretinal proliferation was evident in only 2 patients (13.3%). Retinal changes associated with rhegmatogenous retinal detachment were noted in the fellow eyes of 7 patients (46.7%). Conclusions Spontaneous reattachment of rhegmatogenous retinal detachment should be included in differential diagnoses of patients with diffuse retinal pigmentary alterations within a sharply demarcated convex margin in unilateral eyes. Small retinal breaks observed in nonvitrectomized eyes may be associated with the occurrence of SRRRD.

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 describe the results of photodynamic therapy (PDT) and/or focal laser photocoagulation in the treatment of serous retinal detachments secondary to lupus choroidopathy. Methods The medical records of three patients with serous detachments secondary to lupus choroidopathy who were treated with PDT and/or focal laser photocoagulation were reviewed. Concomitant systemic medical therapy as well as visual acuity and optical coherence tomography (OCT) outcomes were recorded. Results All patients received systemic immunosuppressive therapy and had control of their extraocular manifestations prior to PDT and/or laser photocoagulation. One patient received only focal laser photocoagulation and had complete resolution of the subretinal fluid on OCT. The two other patients received a combination of PDT and focal laser treatment. One had improvement in vision and resolution of subretinal fluid on OCT. The second patient, who had longstanding lupus choroidopathy and associated subretinal fluid and macular edema, had only a significant decrease in fluid on OCT but no vision improvement. Conclusion In conjunction with control of systemic disease, PDT and/or focal laser photocoagulation can be successful in resolving subretinal fluid secondary to lupus choroidopathy.

To identify the clinical features, treatment outcomes, and prognostic factors of endogenous endophthalmitis in multiple tertiary referral centers of South Korea over a 6-year period.The authors conducted a retrospective review of medical records of 57 eyes of 43 patients diagnosed with endogenous endophthalmitis from January 2005 to December 2011, which was referred to tertiary referral centers.Fifty-seven cases of 43 patients were followed for a mean of 18.7 months (range, 0.5-50 months). The common underlying diseases were diabetes mellitus (46.5%) and liver cirrhosis (20.93%). Liver abscess (39.5%) was the most common infection source. Among prognostic factors, the initial visual acuity was associated with favorable visual outcome significantly (P0.001). Endogeneous endophthalmitis with gram-negative bacteria had worse visual outcomes than gram-positive bacteria or fungus (P = 0.014).Similar to the findings of previous East Asian studies, this study showed that Klebsiella pneumoniae was the most common causative organism of endogenous endophthalmitis and liver abscess was the most common infection focus. Although endogenous endophthalmitis is generally associated with poor visual acuity outcomes, the prognosis depends mainly on the initial visual acuity and the pathogen.

Purpose To measure the maximum angle of ocular versions using photographs of the 9 cardinal positions and a modified limbus test. Design An evaluation of diagnostic technology; a prospective observational study. Participants We enrolled 104 healthy subjects, 20 to 40 years of age. Methods Photographs were obtained in the 9 cardinal positions of gaze and the images were processed using Photoshop. The images were analyzed using the Image J program to measure the angle of version. The maximum angle of the 9 cardinal positions was quantified using a modified limbus test. Main Outcome Measures We measured the maximum angle of ocular versions in the 9 cardinal positions of gaze. We also compared the results for males and females. Results The mean angles of maximum version were adduction 47.4°, abduction 46.4°, elevation 31.8°, depression 47.8°, elevation in adduction 39.7°, elevation in abduction 40.7°, depression in adduction 52.7°, and depression in abduction 49.2°. The mean angle of maximum elevation was significantly smaller than that of depression ( P 0.001). There were no correlations between the angle of maximum version and age, spherical equivalents, or axial length. The angle of maximum version for males was significantly greater than that for females, except for inferior gaze. Conclusions A modified limbus test using photographs of the 9 cardinal positions is an objective and reproducible tool for quantifying ocular movement. Considering its simplicity, ease of use, and low cost, it has clear applications in clinical practice.

To evaluate the diagnostic accuracy of Topcon 3D spectral-domain optical coherence tomography (SD-OCT) for measuring the macular inner retinal layers and the circumpapillary retinal nerve fiber layer (cpRNFL) in order to detect preperimetric glaucoma. Two hundred four eyes, including 64 healthy eyes, 68 eyes with preperimetric glaucoma, and 72 eyes with early glaucoma were analyzed. Patients had a comprehensive ocular examination including visual field testing and SD-OCT imaging (3D OCT-2000; Topcon Corporation, Tokyo, Japan) in the macular and peripapillary regions. OCT macular scans were segmented into the macular nerve fiber layer (mNFL), ganglion cell layer with the inner plexiform layer (GCIP), and ganglion cell complex (GCC) (composed of the mNFL and GCIP). Ability to discriminate preperimetric glaucoma was assessed using the area under the receiver operating curve for all macular parameters and the cpRNFL. The median visual field MD was −0.78 ± 1.19 dB for the healthy group, −1.02 ± 1.29 dB for the preperimetric glaucoma group, and −3.08 ± 1.61 dB for the early glaucoma group. There were significant differences between the preperimetric and healthy groups for GCIP and GCC and for almost all cpRNFL thickness parameters (P

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...

Aims The involvement of cytokines in the aqueous humour is important in the development and progression of diabetic macular oedema (DMO) and macular oedema (MO) due to branch retinal vein occlusion (BRVO-MO). In this study, the concentrations of cytokines in the aqueous humour of eyes with DMO and BRVO-MO were measured and compared. Methods Prospective, observational case series. Aqueous samples were obtained from 18 eyes with DMO (DMO group), 12 eyes with BRVO-MO (BRVO-MO group), and 16 normal eyes (control group). The aqueous levels of cytokines, including interleukin (IL)-2, IL-5, IL-6, IL-8, IL-12p70, IL-13, monocytochemotactic protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), platelet-derived growth factor-AA (PDGF)-AA, transforming growth factor-α (TGF-α), interferon-γ (IFN-γ), epidermal growth factor, fibroblast growth factor 2 (FGF2) and vascular endothelial growth factor (VEGF), were measured. Results The aqueous levels of IL-8, MCP-1, PDGF-AA and VEGF were higher, and IL-13 was lower in the DMO group compared with the control group. The aqueous levels of IL-8 and VEGF were higher in the BRVO-MO group than in the control group. Compared with the IL-6 and MCP-1 levels in the BRVO-MO group, those levels were significantly higher in the DMO group. Correlation analyses revealed that IL-8 was positively and IFN-γ was negatively correlated with the severity of MO in the DMO group. In the BRVO-MO group, IL-8 and was positively correlated with severity of MO and retinal ischaemia. Conclusions DMO and BRVO-MO may differ in terms of pathogenesis because the cytokine concentrations in the aqueous humour differ. The results suggest that the inflammatory reaction may be more activated in DMO than in BRVO-MO, and ischaemic insult may play a central role in the development of BRVO-MO.

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

Lacrimal gland choristoma manifesting in the ciliary body is quite rare. We report a case of lacrimal gland choristoma manifesting in the ciliary body, coupled with orbital cellulites, in an infant.A 10-month-old female infant with swelling and tenderness of the right upper eyelid.The results of ophthalmic examinations of the patient were consistent with orbital cellulitis. During the funduscopic examination, a fleshy mass was incidentally detected at the superotemporal portion of the ciliary body in the right eye. A local resection of the lesion was carried out. The results of a pathologic examination showed lacrimal gland choristoma of the ciliary body that was accompanied by an epithelia-lined cyst. The patient has had no hypotonia or enlargement of the lesion for 1 year after surgery.Lacrimal gland choristoma should be included in the differential diagnosis of a ciliary body mass in pediatric patients.

To report a novel method for measuring the degree of inferior oblique muscle overaction and to investigate the correlation with other factors.Cross-sectional diagnostic study.One hundred and forty-two eyes (120 patients) were enrolled in this study. Subjects underwent a full orthoptic examination and photographs were obtained in the cardinal positions of gaze. The images were processed using Photoshop and analyzed using the ImageJ program to measure the degree of inferior oblique muscle overaction. Reproducibility or interobserver variability was assessed by Bland-Altman plots and by calculation of the intraclass correlation coefficient (ICC). The correlation between the degree of inferior oblique muscle overaction and the associated factors was estimated with linear regression analysis.The mean angle of inferior oblique muscle overaction was 17.8 ± 10.1 degrees (range, 1.8-54.1 degrees). The 95% limit of agreement of interobserver variability for the degree of inferior oblique muscle overaction was ±1.76 degrees, and ICC was 0.98. The angle of inferior oblique muscle overaction showed significant correlation with the clinical grading scale (R = 0.549, P.001) and with hypertropia in the adducted position (R = 0.300, P = .001). The mean angles of inferior oblique muscle overaction classified into grades 1, 2, 3, and 4 according to the clinical grading scale were 10.5 ± 9.1 degrees, 16.8 ± 7.8 degrees, 24.3 ± 8.8 degrees, and 40.0 ± 12.2 degrees, respectively (P.001).We describe a new method for measuring the degree of inferior oblique muscle overaction using photographs of the cardinal positions. It has the potential to be a diagnostic tool that measures inferior oblique muscle overaction with minimal observer dependency.

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.