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Purpose: To describe successful treatment of cytomegalovirus immune recovery retinitis, with similarity to acute retinal necrosis, in patients with acquired immunodeficiency syndrome (AIDS) in the immune recovery stage.Case summary: A 37-year-old man, diagnosed with AIDS 5 years prior, visited our clinic with a chief complaint of visual disturbance in his right eye for 1 week. Slit lamp examination revealed severe inflammation; a light gray retinal lesion with a clear border was present in the inferotemporal area of the peripheral retina. Antiviral (ganciclovir) and oral steroid treatments were initiated. Blood test results indicated that the CD4+ T-cell count was 222/μL. Polymerase chain reaction analysis of anterior puncture findings showed a positive result for cytomegalovirus. Clinical findings were suggestive of acute retinal necrosis, but the patient's condition and examination were also suggestive of cytomegalovirus retinitis in the immune recovery stage. One month after treatment, retinal detachment was observed; surgery was performed. There was no recurrence for 3 years after the second operation and the patient remained in stable condition.Conclusions: In the immune recovery stage, non-specific cytomegalovirus retinitis accompanied by inflammation may exhibit fundus findings similar to acute retinal necrosis. We report a rare case of cytomegalovirus immune recovery retinitis where normal vision was restored via systemic drug treatment and surgery.

Purpose: To evaluate the results of treatment according to the method of intravitreal injection of bevacizumab for macular edema due to branch retinal vein occlusion (BRVO). Methods: The clinical records of macular edema patients were analyzed retrospectively for a total of 62 eyes of 62 patients who were injected with bevacizumab into the vitreous as the first treatment for BRVO. Best-corrected visual acuity (BCVA), the findings of spectral-domain optical coherence tomography before and after injection, and prognosis-related factors were evaluated for 21 eyes that received the initial three monthly loading treatments and the 41 eyes that did not. Results: Significant improvement in BCVA was observed in the group having received the initial three injections compared with the group who did not receive the injections at 3, 6, and 12 months (p = 0.025, p = 0.019, and p = 0.008, respectively). The central macular thickness (CMT) showed greater improvement in the initial three injections group than the group without at 6 months (p = 0.034). Multivariate regression showed that the duration from the onset, the three loadings, BCVA, disorganization of the retinal inner layer (DRIL), and choroidal thickness were predictors related to visual gain (p = 0.044, p = 0.047, p = 0.004, p = 0.045, and p = 0.034, respectively). Age, three loadings, BCVA, and DRIL were predictors related to final visual acuity (p = 0.045, p = 0.046, p = 0.002, and p = 0.034, respectively). Duration from the onset, CMT, and choroidal thickness were predictors related to CMT improvement (p = 0.042, p = 0.009, and p = 0.015, respectively). Conclusions: In macular edema of BRVO, the initial three monthly intravitreal injections of bevacizumab provided superior treatment outcomes regarding short-term functional and anatomical improvements and long-term functional improvement, compared with methods that did not treat with the initial three monthly injections.

Purpose: To report a case of endophthalmitis and retinal detachment after injury caused by an animal inoculation needle. Case summary: A 39-year-old man received an injury to his left eye with an animal inoculation needle while vaccinating a pig came to the hospital due to decreased visual acuity. At initial presentation, the best-corrected visual acuity in the left eye was “counting fingers,” and slit lamp examination revealed corneal lacerations, anterior capsule rupture, and traumatic cataract. Ultrasonography showed no specific findings in the vitreous and retina. Primary corneal suture, phacoemulsification, anterior vitrectomy due to rupture of the posterior capsule and vitreous prolapse, intraocular lens implantation, and intravitreal antibiotic injection were performed. On day 1 postoperatively, vitrectomy, anterior chamber irrigation, intravitreal antibiotic injection, and silicone oil injection were performed as signs of endophthalmitis, such as hypopyon and retinal tear, and focal retinal detachment were observed during surgery. Silicone oil removal was performed 7 months after the operation and the best-corrected visual acuity was 0.6. There has been no recurrence during follow-up. Conclusions: This is the first report in Korea of ocular injury caused by an animal inoculation needle. If the fundus is not observed in such injuries, there is a possibility of endophthalmitis and retinal detachment and early vitrectomy should be considered.

Previous epidemiological studies have demonstrated that the lower serum concentration of vitamin D was associated with elevated risk of open-angle glaucoma (OAG). However, few studies have examined the association between aqueous humor vitamin D concentrations and OAG. Hence, we investigated the relationship between 25-hydroxyvitamin D (25(OH)D) concentrations in aqueous humor and OAG. We measured 25(OH)D concentrations in aqueous humor and serum of 126 patients who underwent cataract surgery. 36 were patients with OAG and 90 were control patients. The 25(OH)D concentrations were measured using Elecsys Vitamin D Total Kits with the Cobas e602 module (Roche Diagnostics, Mannheim, Germany), an electrochemiluminescence assay. Multiple linear regression analysis was performed to investigate factors associated with serum and aqueous humor 25(OH)D concentrations. Patients with OAG had significantly lower 25(OH)D concentrations in aqueous humor than control patients. Serum 25(OH)D concentrations were higher in patients with OAG than in the control, but this was not statistically significant. 25(OH)D concentrations in aqueous humor of patients with OAG were significantly associated with axial length but not with glaucoma severity, which was determined by the retinal nerve fiber layer thickness or mean deviation. Vitamin D concentrations in aqueous humor of patients with OAG were significantly lower than those in patients without OAG.

Purpose: This study investigated the 1-year outcomes of a treat-and-extend regimen of ranibizumab for exudative age-related macular degeneration and examined the clinical results when drug treatment was changed within the same period. Methods: This retrospective analysis included 32 eyes first diagnosed with wet age-related macular degeneration and treated for more than 1 year with a treat-and-extend regimen of ranibizumab, as well as 24 eyes treated by changing from ranibizumab to aflibercept within the same period. The injection number, maximum injection interval, change in central retinal thickness, and best-corrected visual acuity were assessed in all eyes. Results: In 32 eyes that received a treat-and-extend regimen of ranibizumab, the mean best-corrected visual acuity improved from 59.46 ± 15.13 to 68.00 ± 12.48 at 12 months (p < 0.0001). The mean central retinal thickness decreased from 409 ± 141 μm to 273 ± 89 μm at 12 months (p < 0.0001). The average number of injections per year was 7.2 ± 0.85. One complication related to the 12 months of injections was a tear in the retinal pigment epithelium; no systemic complications were observed. Of 24 eyes that underwent a change in medication, the rate of maintenance or improvement in initial visual acuity was 83% (10 eyes). The central retinal thickness was initially 371.58 ± 109.96 μm, but improved to 290.33 ± 58.66 μm in 12 eyes that received three injections of aflibercept. Conclusions: At 1 year, good outcomes were obtained using treat-and-extend ranibizumab for exudative age-related macular degeneration. When the treatment was changed to aflibercept within the same period, vision was often maintained and short-term anatomical improvement was evident.

Purpose We present a newly developed approach to secondary intraocular lens (IOL) implantation, which uses an artificial bag with optic capture (i.e., ABC technique) in patients with IOL dislocation. Methods This is a retrospective, noncomparative, and interventional case series which reveals the results of secondary IOL implantation using an artificial bag with optic capture in four cases of IOL dislocation. All patients underwent the above-mentioned surgery and were followed up for at least 6 months. Results The best corrected visual acuity of patients ranged from 20/30 to 20/20. IOL of all patients showed no tilting or decentration with normal intraocular pressure. Conclusion We believe that this method produces satisfactory results and will be especially beneficial to retinal surgeons for the management of patients with IOL dislocation.

In this case series, we assessed a new technique, the intrascleral pocket procedure of transscleral fixation (TF) of the intraocular lens (IOL) in post-vitrectomized eyes. We performed the transscleral fixation of IOL in four aphakic patients who underwent pars plana vitrectomy. Two points 180° apart were marked at the limbus. A 2-mm-sized intrascleral pocket was created by lamellar dissection using a crescent blade without conjunctival dissection. A 2.8-mm clear corneal incision (CCI) was made using a keratome. Prolene sutures were exteriorized through the CCI pocket and a three-piece foldable acrylic IOL was injected via CCI and the ends of the haptics were exteriorized through the CCI. The prolene sutures for each haptic in the intrascleral pocket bed were then tied and knots were buried under scleral flaps. No patient had complaints such as conjunctival irritation, and visual acuity was almost identical to preoperative best-corrected visual acuity at day 1 postoperatively. IOLs were well placed without tilting or subluxation. They had no wound dehiscence or endophthalmitis postoperatively. The intrascleral pocket procedure of TF without the need for conjunctival dissection is a successful method for sulcus fixation in post-vitrectomized eyes predisposed to developing glaucoma.

The objective of this study was to determine the effect of vitamin C supplementation on reducing the size of corneal opacity resulting from infectious keratitis. The study included 82 patients (82 affected eyes), admitted for infectious keratitis from January 2009 to August 2013, who were followed for more than 3 months. Patients were divided into control, oral vitamin C (3 g/d), and intravenous vitamin C (20 g/d) groups during hospitalization. Corneal opacity sizes were measured using anterior segment photographs and Image J program (version 1.27; National Institutes of Health, Jinju, South Korea) at admission, discharge, and final follow-up. The corneal opacity size used for analysis was the measured opacity size divided by the size of the whole cornea. The corneal opacity size decreased by 0.03 ± 0.10 in the oral vitamin C group, 0.07 ± 0.22 in the intravenous vitamin C group, and 0.02 ± 0.15 in the control group. Intravenous vitamin C reduced the corneal opacity size more than oral vitamin C (P = 0.043). Intravenous vitamin C produced greater reduction in corneal opacity size in younger patients (P = 0.015) and those with a hypopyon (P = 0.036). Systemic vitamin C supplementation reduced the size of corneal opacity resulting from infectious keratitis. Intravenous vitamin C was more beneficial than oral supplementation, especially in younger patients and those with hypopyon.

Seong-Jae Kim,1,2 Yong-Wun Cho,1 Seong-Wook Seo,1,2 Sun-Joo Kim,2,3 Ji-Myong Yoo1,21Department of Ophthalmology, 2Gyeongsang Institute of Health Science, 3Department of Laboratory Medicine, Gyeongsang National University, College of Medicine, Jinju, KoreaPurpose: To report the predisposing risk factors, clinical presentation, management, and therapeutic outcomes of fungal keratitis caused by Acremonium.Methods: This is a retrospective study of cases with Acremonium fungal keratitis that presented to our tertiary referral center between January 2006 and August 2012. Patient demographic and clinical details were determined and reported.Results: Five cases of fungal keratitis from Acremonium species were identified in five patients (three males, two females). The mean age of the patients was of 73.4±5.46 years, with a mean follow-up time of 124±72 days. All patients had a history of corneal trauma with vegetable matter. Four cases were unresponsive to initial treatment (0.2% fluconazole, 0.15% amphotericin B) and required topical 5% natamycin, and, in two out of five cases, topical 1% voriconazole.Conclusion: The most common risk factors for Acremonium fungal keratitis was ocular trauma. When a corneal lesion is found to be unresponsive to the initial treatment, we should consider adding or substituting topical natamycin or voriconazole for treatment.Keywords: Acremonium, fungal keratitis, natamycin, prognosis, voriconazole

Purpose To compare the two transscleral fixation (TSF) techniques of intrascleral pocket and conventional scleral flap with conjunctival division techniques in terms of short-term clinical effects. Methods This retrospective cohort study included all consecutive patients with aphakia in Gyeongsang National University Hospital in Jinju, Korea, who underwent TSF between January 2012 and December 2014. The medical records of all patients were retrospectively reviewed, and the endothelial cell count (ECC), refraction, best-corrected visual acuity (BCVA), intraocular pressure, slit lamp, and fundus examination results before and 1 day and 6 months after surgery were recorded. The postoperative complications and visual outcomes were also recorded. Results The intrascleral pocket and conventional-flap groups did not differ significantly in terms of demographics, presurgical BCVA, or ECC. However, the intrascleral pocket group had a significantly lower BCVA at 1 day and 6 months after surgery compared to the conventional-flap group. The two groups did not differ in terms of ECC 6 months after surgery. The intrascleral pocket group had no postoperative complications, but five patients in the conventional-flap group complained of irritation. In both groups, the intraocular lens was well positioned without tilting or subluxation, and astigmatism was significantly reduced at 1 day and 6 months after surgery. Conclusions The intrascleral pocket technique of TSF does not involve conjunctival dissection and is a successful method of sulcus fixation. It stably corrects the intraocular lens and is easy to perform, which helps to reduce operation time. It also reliably yields rapid visual acuity recovery without complications.

Purpose: To report a rare case of relapsed inflammatory choroidal neovascularization (CNV) in a young female patient after intravitreal bevacizumab (IVB) treatment for subfoveal CNV secondary to punctate inner choroidopathy (PIC). Case summary: A 25-year-old myopic female presented with PIC complicated by subfoveal CNV in the right eye. Her lesion initially responded to three monthly 1.25 mg IVB injections, but the lesion recurred two months after the final injection, and the size of the lesion was larger than that observed before treatment. Further treatment with systemic steroids and IVB resulted in successful anatomic and visual improvement. Conclusions: This report presents a rare case of relapsed inflammatory CNV in a young female patient after IVB treatment for subfoveal CNV secondary to PIC. Systemic steroid and IVB were performed after relapse, which successfully improved and maintained vision for longer than 18 months. J Korean Ophthalmol Soc 2016;57(3):513-517

Purpose: To compare the choroidal thickness of unaffected and affected eyes in children with unilateral high myopia when measured using enhanced depth imaging and to analyze the relationship among choroidal thickness and axial length, spherical equivalent and best corrected visual acuity (BCVA). Methods: Twenty children with high unilateral high myopia who received optical coherence tomography from December 2012 to May 2014 were retrospectively analyzed. Choroidal thickness was measured with a caliper at 500 μm apart from fovea superiorly and inferiorly, 2,500 μm apart nasally and at 2,500 μm apart temporally at 500 μm intervals. For statistical analyses, paired t-test was used for choroidal thickness and linear regression analysis for the relationship among choroidal thickness and axial length, spherical equivalent and BCVA. Results: The patients were 10.4 ± 3.5 years of age and the average BCVA of myopic eye was 0.38 ± 0.2. Mean spherical equivalent was -9.8 ± 1.9D. The choroidal thickness was significantly thinner in the myopic eye (102.5 ± 16.9 μm) than the fellow eye (282.9 ± 14.0 μm). The thickest choroid in the myopic eye was the temporal and the thinnest was the nasal area (p = 0.008). Choroidal thickness was significantly associated with axial length and spherical equivalent but not BCVA. Conclusions: Highly myopic eyes tend to have thinner choroidal thickness than the fellow eyes and choroidal thickness tends to be thicker temporally. Therefore, several anatomical changes in unilateral highly myopic children may exist. J Korean Ophthalmol Soc 2015;56(10):1624-1629

Purpose: We report a case of visual loss after the injection of poly-L-lactic acid filler into the right forehead area for cosmetic purposes. Case summary: A 46-year-old female patient visited our clinic due to sudden visual disturbance and dysesthesia on the right forehead and cheek. Her best corrected visual acuity was no light perception in the right eye and 20/20 in the left eye. Visual acuity in her right eye was not corrected. An afferent papillary defect in the right eye and paralysis of oculomotor muscles were observed. Fundus exam revealed a pale optic nerve and turbid retina on the posterior pole. The retinal vessels were narrowed. A papule 1 cm to the lateral margin of the right eyebrow due to the needle injection was found and no other visible skin abnormalities were observed. She had a cosmetic poly-L-lactic acid filler injection into the right forehead area immediately before the visual disturbance occurred. Fluorescent angiography showed occlusion of the right retinal artery and blood flow defects on the retina and choroid were present. The patient was followed up for 6 months and visual acuity and dysesthesia in her right forehead and cheek did not improve. Conclusions: Several cases of visual loss have occurred after injection of filler on the glabella and forehead for cosmetic purposes. However, most of the complications were observed after the use of hyaluronic fillers and not due to poly-L-lactic acid filler. This is the first case report of visual loss caused by poly-L-lactic acid filler in South Korea in a normal patient. Hence, consideration of complications when using this type of fillers is important. J Korean Ophthalmol Soc 2014;55(8):1253-1256