Assessment for Macular Thickness after Uncomplicated Phacoemulsification Using Optical Coherence Tomography.

PURPOSE: Macular edema including cystoid macular edema is one of the main causes of unfavorable visual outcomes after cataract surgery. The macular thickness and the occurrence of macular edema after uncomplicated cataract surgery was evaluated using optical coherence tomography (OCT) in this study. METHODS: Macular map images were taken by OCT before surgery and at 1 week, 1 month, and 2 months postsurgery. The subjects were classified into two groups (group 1, patients with no macular edema; group 2, patients with macular edema). Group 2 was defined as increase in central macular thickness (CMT) by 30% compared with that before surgery. The risk factors for macular edema were evaluated. Group 2 was divided into two subgroups: subclinical macular edema (group 2A) and cystoid macular edema (group 2B) and they were assessed in terms of the clinical course of best-corrected visual acuity and CMT. RESULTS: A total of 376 patients were enrolled in this study, of which 36 (9.57%, group 2) showed macular edema measured by OCT after the surgery. Univariate analysis for group 1 and 2 revealed that intracameral injection of epinephrine during phacoemulsification was associated with the development of macular edema. In group 2, five patients (1.33%) developed cystoid macular edema. Statistically significant differences in the clinical course of CMT were observed at 2 months (201.2 ± 23.1, 250.0 ± 29.8, and 371.0 ± 160.3 in group 1, group 2A, and group 2B, respectively; p < 0.001) and 1 month postoperatively (198.5 ± 23.6, 237.8 ± 40.9, and 314.0 ± 104.5 in group 1, group 2A, and group 2B, respectively; p < 0.001). Group 2B required additional treatment and eventually achieved best-corrected visual acuity of >0.2 with CMT in the normal range. CONCLUSIONS: The intracameral injection of epinephrine may cause macular edema after uncomplicated cataract surgery. Examination of CMT using OCT is recommended for the early detection of macular edema.

Genetic Characteristics and Phenotype of Korean Patients with Stickler Syndrome: A Korean Multicenter Analysis Report No. 1.

Stickler syndrome is an inherited connective tissue disorder of collagen. There are relatively few reports of East Asian patients, and no large-scale studies have been conducted in Korean patients yet. In this study, we retrospectively analyzed the genetic characteristics and clinical features of Korean Stickler syndrome patients. Among 37 genetically confirmed Stickler syndrome patients, 21 types of gene variants were identified, of which 12 were novel variants. A total of 30 people had variants in the COL2A1 gene and 7 had variants in the COL11A1 gene. Among the types of pathogenic variants, missense variants were found in 11, nonsense variants in 8, and splice site variants in 7. Splicing variants were frequently associated with retinal detachment (71%) followed by missense variants. This is the first large-scale study of Koreans with Stickler syndrome, which will expand the spectrum of genetic variations of Stickler syndrome.

Comparison of outcomes of scleral fixation with and without pars plana vitrectomy for the treatment of dislocated intraocular lens.

PURPOSE: To investigate the surgical outcomes of scleral fixation with either pars plana vitrectomy (ppV) or anterior vitrectomy (AV) for the treatment of dislocated intraocular lens (IOL). METHODS: By retrospective review of electronic medical records, patients with in-the-bag spontaneous IOL dislocation who underwent IOL exchange with scleral fixation were included and grouped according to the vitrectomy method: ppV (group 1) and AV (group 2). Post-operative surgical outcomes including visual acuity (log MAR), spherical equivalent, and surgically induced astigmatism (SIA) and complications were investigated and analyzed. RESULTS: After 6 months, post-operative measurements showed an average visual acuity of 0.16 ± 0.20, spherical equivalent of -1.48 ± 1.53D (diopters), and refractive shift of -0.19 ± 0.44D in group 1 (n = 19). There was no statistically significant difference between the measurements of group 1 and group 2 (n = 20) (0.10 ± 0.12, -2.00 ± 1.71D, -0.39 ± 0.57D, respectively) (p = 0.51, p = 0.29, p = 0.16, respectively). When analyzed by the algebraic and vector methods, group 1 did show a higher magnitude of surgically induced astigmatisms (1.61 ± 1.50D, 2.10 ± 1.03D, respectively) than did group 2 (0.49 ± 1.02D, 1.31 ± 0.83D respectively) (both p's = 0.01). There was no significant difference in the incidence of complications except for vitreoretinal complications, which were higher in group 2 (25%), compared with group 1 (0%) (p = 0.047). CONCLUSIONS: Both ppV and AV are appropriate options in patients who need IOL exchange with scleral fixation based on visual outcomes, refractive shifts, and complication rates. In terms of managing astigmatism, the AV procedure may be the better option.

Clinical Features in Children with Posterior Polymorphous Corneal Dystrophy.

PURPOSE: To describe clinical features in children diagnosed with posterior polymorphous corneal dystrophy (PPCD) in their first or second decade of life. METHODS: A retrospective study was performed with the medical records of seven unrelated Korean pediatric patients who were diagnosed with PPCD and were followed up for a minimum of 3 years. Thorough ocular examinations were performed, including best-corrected visual acuity, intraocular pressure, refractive and keratometric measurements, slit-lamp biomicroscopy, and specular microscopy at all visits. RESULTS: Slit-lamp examinations revealed vesicular lesions in one patient and horizontally parallel band-like endothelial lesions in six patients. Unilateral corneal involvement was displayed in 4 patients, yielding 10 eyes with deep corneal features characteristic of PPCD. Other corneal, iris, or fundus pathologic findings were not detected in all cases. Among four children who were examined in their visual development (approximately under 8 years of age), two cases demonstrated unilateral amblyopia at initial examination and exhibited improved visual acuity after refractive correction and occlusion therapy. Astigmatism more than 1.5D, which is generally considered amblyogenic, was found in 8 among 10 PPCD-affected eyes. A final visual acuity of more than 20/32 was achieved with appropriate refractive correction in all PPCD-affected eyes. There was a negative correlation between the corneal astigmatism and the mean endothelial cell density (ECD) (r = -0.655, P = .011). Initial specular microscopic examinations revealed reduced ECD (1733.0 ± 543.9 cells/mm) composed of enlarged cells (average cell area, 624.8 ± 182.1 µm/cell) in PPCD-affected eyes, compared with those in PPCD-unaffected eyes from our study subjects (P < .001 and P = .005, respectively). A statistically significant percent loss in ECD from initial to 3 years was noted in the PPCD-affected eyes (P = .03). CONCLUSIONS: The awareness and treatment of refractive error are important, especially in children with early-onset PPCD during the reversible period of amblyopia. Long-term monitoring of corneal endothelium is required in pediatric patients with early-onset PPCD based on a significant endothelial loss over 3 years in PPCD-affected eyes.

Necrotizing herpetic retinopathy in an immune-compromised pediatric patient with minimal signs of inflammation: case report.

BACKGROUND: To report a case of necrotizing herpetic retinopathy(NHR) in an immuno-compromised pediatric patient. CASE PRESENTATION: An 11-year-old boy presented with a minimal ocular foreign-body sensation and peripheral visual-field defect, as well as mild upper respiratory symptoms. He had undergone the Fontan operation for a ventricular septal defect and single ventricle during infancy, and had been taking oral steroids for 1 year immediately prior to his presentation to treat protein-losing enteropathy. Initially, a case of either cytomegalovirus (CMV) retinitis or acute retinal necrosis (ARN) was suspected, and an intravenous course of ganciclovir and acyclovir was therefore initiated. During treatment, varicella-zoster virus (VZV) was detected in the anterior chamber, and ARN was confirmed when both serum and aqueous humor were found by polymerase chain reaction (PCR) to be positive for VZV DNA. A peripheral retinal break and detachment developed after medical treatment, and a vitrectomy was performed. CONCLUSIONS: Typically, ARN is found in both healthy individuals and subclinically immuno-compromised patients of any age. CMV retinitis is somewhat more typical for immuno-compromised patients. Herein, we report a case of NHR in a pediatric patient with poor general condition and showing minimal signs of inflammation.

Disc Torsion and Vertical Disc Tilt Are Related to Subfoveal Scleral Thickness in Open-Angle Glaucoma Patients With Myopia.

PURPOSE: To find out the characteristics of optic disc morphology in glaucomatous eyes and to evaluate related ocular factors, including the scleral thickness measured from swept-source optical coherence tomography (OCT). METHODS: We compared disc torsion and tilt between 180 normal controls and 180 patients with open-angle glaucoma, matched according to age and axial length based on propensity scores. In a subset of 63 glaucoma and matched control eyes with high myopia, swept-source OCT images of the optic nerve head obtained. The disc ovality and torsion degree were measured from disc photographs, and tilt degree was measured from cross-sectional images of the optic nerve head using swept-source OCT. Scleral thickness was measured from swept-source OCT images at the subfoveal point and 1000 µm away superiorly, inferiorly, temporally, and nasally from the subfoveal point. RESULTS: The degree of disc tilt and torsion was significantly different between glaucoma (9.3 ± 6.3° and 28.2 ± 19.8°, respectively) and control eyes (6.2 ± 4.1° and 14.1 ± 8.0°, respectively) with similar axial length. The thickness of the inferior sclera and the superior-inferior difference were significantly different between control and glaucomatous eyes with high myopia (P < 0.001 and P = 0.031). The thickness of the inferior sclera and the superior-inferior difference were significantly related to the disc tilt (P = 0.034 for inferior sclera and P < 0.001 for superior-inferior difference) and torsion (P < 0.001 and P < 0.001, respectively) in glaucomatous eyes with high myopia. CONCLUSIONS: Disc tilt and torsion were prominent features of glaucomatous eyes when compared to normal controls with similar axial length and were significantly related to the thickness of the inferior sclera in glaucomatous eyes with myopia.