Clinical Outcomes and Indications of In-Office Sutureless Dried Gamma Ray-Sterilized Human Amniotic Membrane Transplantation With Bandage Contact Lenses in Various Ocular Surface Disorders.

PURPOSE: The purpose of this study was to investigate the efficacy and indications of using dried gamma ray-sterilized amniotic membrane (AM) transplantation with bandage contact lenses for the in-office sutureless treatment of various ocular surface diseases. METHODS: This study retrospectively included 56 eyes of 52 patients with various ocular surface diseases treated with sutureless dehydrated AM-assisted therapeutic contact lenses. The patients were followed up and assessed 1, 2, and 4 weeks after the treatment, and the therapeutic contact lenses were removed after 1 or 2 weeks. The size of the corneal lesion and the degree of pain experienced by each patient before and after the procedure were measured. Corneal re-epithelization rate and clinical aspects related to re-epithelialization were evaluated. RESULTS: Complete corneal re-epithelialization of the epithelial defect was observed in 40 eyes. The complete re-epithelialization rates of persistent epithelial defect caused by infectious ulcers, neurotrophic ulcers, ulcers due to burn, toxic keratopathy, previous penetrating keratoplasty or other corneal surgeries, and severe dry eye disease were 69.2%, 80.0%, 77.8%, 100%, 75.0%, and 100%, respectively. Five patients with uncontrolled infectious ulcers, neurotrophic ulcer, bullous keratopathy, and ulcers associated with rheumatic disease did not show significant improvement. Patient pain scores significantly decreased after the procedure. CONCLUSIONS: Dehydrated AM transplantation with a bandage contact lens is minimally invasive and easily applicable through in-office procedures. This approach is expected to be more actively applied in various ocular surface disorders, not only in severe corneal diseases but also in relatively mild corneal surface diseases.

Corneal epithelial remodeling induced by combined small incision lenticule extraction and accelerated corneal collagen crosslinking for myopia

PURPOSE: To evaluate the changes of the corneal epithelial thickness (ET) profile induced by combined small incision lenticule extraction and accelerated corneal collagen crosslinking (SMILE-xtra) for myopia compared with the standard small incision lenticule extraction (SMILE). SETTING: Nuri Eye Hospital, 61, Dunsan-ro, Seo-gu, Daejeon, 35233, Korea. DESIGN: Retrospective cross-sectional study. METHODS: Thirty-one myopic eye undergoing SMILE-xtra and control group of 36 myopic eyes undergoing SMILE were retrospectively analyzed. Spectral-domain optical coherence tomography (CIRRUS™ HD-OCT 5000, ZEISS, Dublin, CA) was used to measure corneal ET of 17 zones within the central 7-mm zone at preoperative, postoperative 1 month, 3 months and 6 months. Postoperative ET alterations were analyzed for correlation with treatment parameters. RESULTS: There was no difference in preoperative mean age, postoperative MRSE, visual acuity, and ablation depth between the two groups, and there was a significant difference in preoperative central corneal thickness. Both groups showed the greatest increase in corneal ET in the paracentral area on the inferotemporal area, respectively, for 6 months. The preoperative MRSE and the ablation depth showed significant correlation with the postoperative epithelial thickening in mid-peripheral sectors in both groups, and significant negative correlations in paracentral sectors only in SMILE-xtra group. CONCLUSIONS: It is significant as the first study to compare corneal epithelial remodeling between SMILE and SMILE with accelerated corneal collagen crosslinking. The SMILE-xtra with the relatively large corneal ablation did not show a significant difference in the pattern of corneal epithelial remodeling compared to the SMILE group.

Evaluation of angle-to-angle and spur-to-spur using swept source optical coherence tomography in different refractive error.

PURPOSE: To measure angle-to-angle (ATA) and spur-to-spur (STS) distances along six meridians using swept-source optical coherence tomography (SS-OCT) and compare with horizontal white-to-white (WTW) distance in different refractive error. METHODS: Overall, 126 eyes were assessed with the Anterion SS-OCT (Heidelberg Engineering, Heidelberg, Germany). ATA and STS distances were obtained using SS-OCT at 0, 30, 60, 90, 120, and 150 degrees. WTW was measured at 0 degree with built-in infrared camera. One way ANOVA test, pearson correlation coefficient, and stepwise multivariate regression analysis were used to compare ATA and STS distances with age, anterior chamber depth (ACD), axial length (AL), and simulated keratometric values (Sim K) in different refractive error groups. RESULTS: The mean MRSE refraction was +0.05 ± 0.23 D in the emmetropic group (41 eyes), -3.42 ± 3.04 D in the myopic group (44 eyes), and +1.33 ± 0.64 D in the hyperopic group (31 eyes). There was no statistical difference in the WTW of the emmetropic (11.62 ± 0.44 mm), myopic (11.79 ± 0.46 mm), and hyperopic groups (11.80 ± 0.49 mm) using one-way ANOVA (p = 0.007). ATA and STS were vertically oval in all groups. The correlation between ATA, STS and age, ACD, AL, and K values showed different significance for each meridian according to the refractive error. ATA increased as the horizontal WTW, ACD, and AL increased and Sim K decreased. STS shows relatively smaller explanatory power than ATA in the stepwise multivariate regression analysis. CONCLUSIONS: This study is the first to analyze the relationship between ATA and STS compared to WTW by different refractive error. The difference between the horizontally oval WTW and vertically oval anterior chamber can be large, especially in myopia. ATA showed a greater positive correlation than STS with AL and ACD.

Anterior segment characteristics in normal and keratoconus eyes evaluated with a new type of swept-source optical coherence tomography.

PURPOSE: This study aimed to evaluate and compare the discriminating ability of corneal elevation maps generated using a swept-source optical coherence tomography (SS-OCT) (SS-OCT ANTERION, Heidelberg Engineering, Heidelberg, Germany), which was estimated with different reference surfaces, to distinguish normal corneas from those with keratoconus and keratoconus suspect. METHODS: A total of 126 eyes of patients, which comprised 43, 37, and 46 keratoconus, keratoconus suspects, and normal controls, respectively, were included in this study. The anterior and posterior elevations at the thinnest point under the best-fit sphere (BFS) and toric-ellipsoid (BFT), respectively, and other corneal parameters were measured using the SS-OCT. In addition, the receiver operating characteristic (ROC) curve analysis and cut-off value were calculated to evaluate the diagnostic ability of the corneal elevation values in differentiating keratoconus and keratoconus suspects from normal eyes. RESULTS: The mean total keratometric and corneal elevation values were significantly higher in the keratoconus group than in the other groups. Pachymetric parameters exhibited the lowest values for keratoconus. In addition, ROC curve analyses showed a high accuracy of the thinnest point anterior and posterior BFT for both keratoconus and keratoconus suspects and normal controls (area under the ROC were 0.969 and 0.961, respectively). Furthermore, the optimal cut-off point of the posterior elevation at the thinnest point under BFT was 16.44 µm (sensitivity and specificity of 86% and 98%, respectively) for differentiating keratoconus from normal and keratoconus suspect eyes. CONCLUSIONS: The elevation map using the BFS and BFT references measured with the anterior segment SS-OCT is considered an effective indicator for keratoconus diagnosis. Therefore, the anterior segment SS-OCT can effectively differentiate keratoconus from suspected keratoconus and normal corneas by measuring parameters such as posterior and anterior elevations, pachymetry, and keratometry.

Corneal Endothelial Cell Changes After Femtosecond Laser-Assisted Cataract Surgery in Diabetic and Nondiabetic Patients.

OBJECTIVE: To compare corneal endothelial cell changes after femtosecond laser-assisted cataract surgery (FLACS) in diabetic and nondiabetic patients. METHODS: This retrospective study included patients with cataract who underwent FLACS performed by a single surgeon between August 2018 and November 2020. Changes in corneal endothelial cell density (ECD), hexagonality, coefficient of variation in cell size (CV), and central corneal thickness (CCT) at baseline and at the 1-month and 3-month postoperative follow-ups were investigated by dividing the patients into diabetic and nondiabetic groups. RESULTS: We included 75 patients (60% men, mean age: 57.7±11.4 years, range: 27-80 years) in the analysis: 31 diabetic patients (64% men, mean age: 58.7±11.9 years, range: 27-79 years) and 44 nondiabetic patients (56% men, mean age: 57.1±11.3 years, range: 34-80 years). No differences were observed between the two groups as regards preoperative and intraoperative parameters, the mean postoperative ECD, hexagonality, and CV. At 1 month postoperatively, the CCT was significantly greater in the diabetic group (P=0.034); however, at 3 months, there was no significant difference between the two groups (P=0.927). CONCLUSIONS: Changes in postoperative corneal endothelial cells were comparable between patients with and without diabetes after FLACS. Femtosecond laser-assisted cataract surgery seems to cause less damage to the corneal endothelium in diabetic patients because it uses less phacoemulsification energy.

Refractive prediction of four different intraocular lens calculation formulas compared between new swept source optical coherence tomography and partial coherence interferometry.

PURPOSE: To compare the biometry and prediction of postoperative refractive outcomes of four different formulae (Haigis, SRK/T, Holladay1, Barrett Universal II) obtained by swept-source optical coherence tomography (SS-OCT) biometers and partial coherence interferometry (PCI; IOLMaster ver 5.4). METHODS: We compared the biometric values of SS-OCT (ANTERION, Heidelberg Engineering Inc., Heidelberg, Germany) and PCI (IOLMaster, Carl Zeiss Meditec, Jena, Germany). Predictive errors calculated using four different formulae (Haigis, SRKT, Holladay1, Barrett Universal II) were compared at 1 month after cataract surgery. RESULTS: The mean preoperative axial length (AL) showed no statistically significant difference between SS-OCT and PCI (SS-OCT: 23.78 ± 0.12 mm and PCI: 23.77 ± 0.12 mm). The mean anterior chamber depth (ACD) was 3.30 ± 0.04 mm for SS-OCT and 3.23 ± 0.04 mm for PCI, which was significantly different between the two techniques. The mean corneal curvature also differed significantly between the two techniques. The difference in mean arithmetic prediction error was significant in the Haigis, SRKT, and Holladay1 formulae. The difference in mean absolute prediction error was significant in all four formulae. CONCLUSIONS: SS-OCT and PCI demonstrated good agreement on biometric measurements; however, there were significant differences in some biometric values. These differences in some ocular biometrics can cause a difference in refractive error after cataract surgery. New type SS-OCT was not superior to the IOL power prediction calculated by PCI.

Visual Performance and Optical Quality after Implantation of a New Generation Monofocal Intraocular Lens.

PURPOSE: To evaluate the performance of two intraocular lenses (IOLs). The new monofocal IOL using a higher-order aspheric optic (Tecnis Eyhance ICB00) was compared to a standard monofocal IOL (Tecnis monofocal ZCB00) of the identical platform and material. METHODS: The medical records of the patients who had undergone cataract surgery with implantation of either the ZCB00 or the ICB00 in the dominant eye from March 2020 to August 2020 and with available data from the 3-month visit were reviewed. Subjects with ocular comorbidities or corneal astigmatism greater than 1.00 diopters were excluded. The uncorrected near, intermediate, distance visual acuity and corrected distance visual acuity were the main outcome measures. Optical quality parameters measured using an optical quality analysis system, clinical records including age, sex, laterality, ocular dominance, and information related to refractory errors was also collected. Parameters related to the refractory errors were all uniformly based on the Barrett Universal II formula. RESULTS: Of the 197 recruited patients, 111 and 86 were implanted with the ICB00 and ZCB00, respectively. No statistically significant differences in baseline parameters were observed between the two groups. While no statistically significant differences in distance visual acuity or optical quality were found between the two groups, compared to the ZCB00 group, the ICB00 group showed significantly higher intermediate visual acuity (p < 0.001) and near visual acuity (p < 0.05) 3 months postoperatively. CONCLUSIONS: ICB00 provided superior intermediate vision and comparable distance performance and photic phenomena compared to a standard monofocal IOL.

Relationship between the partial blink rate and ocular surface parameters.

PURPOSE: To elucidate the relationship between partial blink rate (PBR) and ocular surface parameters. METHODS: We conducted a retrospective cross-sectional study of the patients who visited the Kim's Eye Hospital between March 2020 and July 2020. Blinking dynamics, tear film lipid layer thickness (LLT), non-invasive tear film break- up time (NITBUT), tear meniscus height (TMH), and meibomian gland (MG) dropout rate were assessed using the IDRA® Ocular surface analyzer (SBM SISTEMI, Inc., Torino, Italy) (IDRA). Dry eye symptoms were quantified by the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores. RESULTS: A total of 47 non-Sjögren dry eye patients (47 right eyes, mean age = 56.8 ± 14.5 [20-75] years, 66% female) were enrolled. Among the ocular surface parameters, PBR had strong correlations with MG dropout rate (r = 0.811; p < 0.01) and moderate correlations with SPEED scores (r = 0.596; p < 0.01). MG dropout rate and age had moderate correlations with SPEED scores (r = 0.416; p = 0.04 and r = 0.322; p = 0.03, respectively). Comparisons by sex revealed no significant difference in characteristics, except for the TMH value. The TMH of female patients (0.17 ± 0.07) was significantly higher than that of males (0.14 ± 0.04; p = 0.04). LLT showed no significant correlation with the other variables. CONCLUSION: PBR and MG dropout rates measured with IDRA were significantly correlated to dry eye symptoms.

Ocular surface analysis: A comparison between the LipiView® II and IDRA®.

PURPOSE: To compare the lipid layer thickness (LLT), meibomian gland (MG) dropouts, and blinking pattern determined by the analysis of images acquired from the LipiView® II (LVII) and the IDRA® Ocular surface analyzer. METHODS: A cross-sectional single-visit observational study was conducted. The LLT (minimum, maximum, and average), percentages of MG dropouts, and partial blink rates (PBR) were taken from both eyes of 47 participants using LVII and IDRA. Both devices were used to image the inferior eyelid of each participant in a random order. RESULTS: Forty-seven participants (mean age 56.77 ± 14.47 (21-79) years, 66% female) completed the study. There was no significant difference in LLT between the two devices. A significant difference in percentages of MG dropouts was obtained between the LVII (36.51 ± 17.53) and the IDRA (45.36 ± 21.87), p = 0.003). There was also a significant difference in PBR between the LVII (0.51 ± 0.37) and the IDRA (0.23 ± 0.27), p < 0.001). CONCLUSION: No significant difference in LLT was obtained between LVII and IDRA. IDRA had a significantly lesser percentage of MG dropout and a higher PBR compared to LVII. These results indicate that these devices should not be used interchangeably for the evaluation of MG dropouts and PBR.

Comparison study of the axial length measured using the new swept-source optical coherence tomography ANTERION and the partial coherence interferometry IOL Master.

PURPOSE: To compare a biometer using swept-source optical coherence tomography (SS-OCT) with a partial coherence interferometry (PCI)-based biometer in measurements of two ocular biometry parameters, i.e., the axial length and anterior cornea curvature. METHODS: We compared the two biometers SS-OCT (ANTERION, Heidelberg Engineering Inc., Heidelberg, Germany) and PCI (IOL Master, Carl Zeiss Meditec, Jena, Germany) in terms of the axial length (AL) and corneal curvature (K) measurements of 175 eyes. Paired t-tests were used to compare the two biometers. Agreement between the biometers was evaluated using the Bland-Altman method. RESULTS: The mean age was 36.0 ± 25.6 years (range: 5 to 85 years). The mean axial length was 24.42 ± 0.13 mm for SS-OCT and 24.45 ± 0.14 mm for PCI. The mean corneal curvature was significantly different between the two biometry in flat K (K1) but not in steep K (K2). The limit of agreement was -0.15 to 0.21 in the axial length, -1.18 to 0.83 in K1, and -1.06 to 0.95 in K2. All above ocular biometric measurements between SS-OCT and PCI correlated significantly (Pearson's correlation, p<0.001). CONCLUSIONS: The axial length measured using SS-OCT is useful in clinical practice. It shows a good correlation and agreement with that measured using PCI. However, the axial length and corneal curvature measured using SS-OCT cannot be used interchangeably with that measured using PCI in clinical practice.

Combined Phototherapeutic Keratectomy and Peripheral Anterior Stromal Puncture for the Treatment of Recurrent Corneal Erosion Syndrome.

PURPOSE: To investigate the efficacy of the combined phototherapeutic keratectomy (PTK) and peripheral anterior stromal puncture (ASP) compared with that of PTK alone in patients with recurrent corneal erosion syndrome (RCES). METHODS: The medical records of 25 patients (25 eyes) who underwent combined treatment of PTK and peripheral ASP for RCES from March 2016 to May 2017 were retrospectively reviewed. Twenty-three patients (23 eyes) treated with PTK alone from March 2015 to February 2016 served as a control group. All surgeries were performed by a single surgeon. This retrospective clinical study comprised 48 patients (48 eyes) who were followed up for more than 18 months. Clinical records of age, sex, laterality, etiology of RCES, and history of recurrence after treatment were evaluated. RESULTS: Twenty-five eyes were treated with combined PTK and ASP, and 23 eyes were treated with PTK only. The mean follow-up period was 19.63 ± 2.97 and 19.75 ± 6.83 months, respectively. There were no differences in baseline parameters between the groups. In the combined treatment group, one patient experienced recurrence 6 months after the surgery. In the single treatment group, five patients showed recurrence at 4, 7, 8, 11, and 13 months after the surgery, respectively. Compared to the single treatment group, the combined treatment group showed significantly lower recurrence rate (p < 0.05). All recurred patients required no additional treatment except temporary therapeutic contact lenses and topical lubricants. CONCLUSIONS: Our findings suggest that combined treatment of PTK and peripheral ASP is effective in alleviation of symptoms and prevention of recurrence in refractory RCES compared with treatment using PTK alone.

A case report of fulminant endophthalmitis caused by Streptococcus dysgalactiae in a patient with traumatic corneal laceration.

BACKGROUND: To report a case of enucleation caused by Streptococcus dysgalactiae endophthalmitis after traumatic corneal laceration. CASE PRESENTATION: A 69-year-old man with history of retinal detachment treated with vitrectomy and subsequent cataract surgery presented with traumatic corneal laceration while cutting grass. Appropriate repair of corneal laceration and intravitreal antibiotics (vancomycin, ceftazidime) injection was performed. S. dysgalactiae which was sensitive to the conventional antibiotics (Ampicillin, Ceftriaxone, Levofloxacin, etc.) detected by aqueous culture. One day following primary closure, the patient developed a complete hypopyon and vitreous membranes. Despite vigorous systemic and intravitreal antibiotics administration with vitrectomy, endophthalmitis was not controlled and patient's ocular pain was increased. The vitreous culture was also positive for S. dysgalactiae. Finally, total enucleation was performed 9 days after trauma due to fulminant endophthalmitis with severe scleritis. CONCLUSION: Progression of traumatic endophthalmitis associated with S. dysgalactiae can be fulminant. Sufficient warning to patient about enucleation and intensive care is needed in the case of this infection.

Lenticular fungal infection caused by Aspergillus in a patient with traumatic corneal laceration: a case report.

BACKGROUND: To report a case of lenticular infection caused by Aspergillus, which was diagnosed 13 weeks after traumatic corneal laceration. CASE PRESENTATION: A 60-year-old woman presented with traumatic corneal laceration including anterior lens capsule rupture and traumatic cataract after being hit with a chestnut in the right eye. There were multiple injuries due to tiny thorns of the chestnut, including the conjunctiva, sclera, cornea, and anterior lens capsule. But no visible foreign body was detected by slit-lamp examination. Topical corticosteroid was prescribed to resolve the conjunctival inflammation induced by the thorns of chestnut, which could have caused persistent irritation. As conjunctival injection and edema being decreased during outpatient clinical follow-up, embedded conjunctival foreign body was detected and surgically removed (1st surgery). Approximately 10 weeks after the trauma, severe inflammation of the anterior segment accompanied with hypopyon developed suddenly and at the same time embedded scleral foreign body was revealed. After removal of scleral foreign body (2nd surgery), unspecified mold species was cultured from the scleral foreign body in SDA (Sabouraud dextrose agar) plate. Suspicious corneal foreign body was removed as 3rd surgery and phacoemulsification of traumatic cataract was planned as 4th surgery. Aspergillus was finally detected from removed anterior capsule and fibrotic membrane during the operation. Fungal infection resolved successfully after administration of topical (1% voriconazole and 5% natamycin) and systemic (fluconazole) antifungal agents and phacoemulsification of traumatic cataract. CONCLUSION: Chestnut thorns can damage multiple ocular tissues simultaneously. Lens capsular rupture could result in fungal inoculation and lead to delayed lenticular fungal infection with complicated cataract formation. In cases of ocular trauma due to organic substances such as thorns and branches, the possibility of fungal infection should be considered.

Changes of tear film lipid layer thickness by 3% diquafosol ophthalmic solutions in patients with dry eye syndrome.

AIM: To evaluate the quantitatively changes in lipid layer thickness (LLT) when 3% diquafosol eye drop is used for dry eye patients using the tear film interferometer. METHODS: A total 124 participants (32 males, 92 females; mean age, 28.9y) diagnosed with dry eye disease (DED) received topical instillation of 4 ophthalmic solutions in one eye: diquafosol, normal saline, 0.1% sodium hyaluronate and 0.3% gatifloxacin, in a masked manner. LLT was measured using an interferometer at baseline and 20min after the instillation of each ophthalmic solutions. RESULTS: Changes of LLT after instillation (nm, mean± standard error) were as follows: 12.6±2.0 for diquafosol (P<0.001), 1.2±2.2 for normal saline (P=0.301), 1.5±2.0 for hyaluronate (P=0.495), and 0.5±3.2 for gatifloxacin (P=0.884). CONCLUSION: Topical instillation of diquafosol increases tear film LLT in DED patients. Diquafosol 3% eye drop might be effective treatment option of evaporative DED with meibomian gland dysfunction.

Predicting Factor of Visual Outcome in Unilateral Idiopathic Cataract Surgery in Patients Aged 3 to 10 Years.

PURPOSE: To report the surgical results of unilateral pediatric cataracts from uncertain causes in relatively older children and to identify factors related to better visual outcomes. METHODS: We retrospectively evaluated the medical records of 39 patients who underwent surgery between the ages of 3 and 10 years for unilateral pediatric cataracts of no known cause. All patients underwent primary intraocular lens implantation and postoperative amblyopia treatment. A postoperative final visual acuity better than 20 / 30 was considered to be a good visual outcome. RESULTS: The mean age of patients was 6.0 ± 1.8 years at the time of surgery. The mean preoperative visual acuity was 1.07 ± 0.71 logarithm of the minimum angle of resolution (range, 0.15 to 3.00), while the mean final postoperative visual acuity was 0.47 ± 0.54 logarithm of the minimum angle of resolution (range, 0.00 to 2.00). Of 39 patients, 18 (46.2%) achieved a good visual outcome. Only the preoperative visual acuity maintained a significant association with a good visual outcome according to our multivariate analysis (p = 0.040). A preoperative visual acuity of 20 / 100 or better was found to increase the chance of achieving a good visual outcome by 13.79-fold (95% confidence interval, 1.13 to 167.58). CONCLUSIONS: The visual outcome of unilateral pediatric cataract surgery for cataracts with no specific cause identified in patients after three years of age could be satisfactory, especially with a preoperative visual acuity of 20 / 100 or better.

Macular hole formation after pars plana vitrectomy for the treatment of Valsalva retinopathy: a case report.

We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.

Morphological change of inner retinal layer on spectral-domain optical coherence tomography following macular hole surgery.

BACKGROUND/AIMS: To investigate the morphological changes of the inner retinal layer by spectral-domain optical coherence tomography (OCT) after idiopathic full-thickness macular hole (MH) surgery. METHODS: In a retrospective study, the authors evaluated 52 eyes of 49 patients with MH closed following vitrectomy. All patients were followed postoperatively for more than 6 months. Cross-sectional and retinal surface images were obtained using Cirrus high-definition OCT before and after surgery. In 24 of the 52 eyes, fundus autofluorescence (FAF) was analyzed. RESULTS: The incidence of dissociated optic nerve fiber layer (DONFL) increased gradually over time after surgery. 57.7% had defects of only the retinal nerve fiber layer (RNFL) and 30.8% had defects in the inner plexiform layer at 6 months after surgery. Postoperative best-corrected visual acuity did not differ significantly based on the depth of the DONFL (p = 0.299). There were no changes in FAF in the area with DONFL. CONCLUSIONS: DONFL is characterized by progressive defects that are not limited to RNFL thickness. The healing process after vitrectomy for MH is not limited in the RNFL affecting deeper structural changes. Further investigations are required to evaluate the pathophysiological mechanism of inner retinal change after MH surgery.

Traumatic chorioretinal folds treated with intra-vitreal triamcinolone injection.

A 34-year-old male visited the hospital due to decreased visual acuity in the left eye following an injury from a car accident. In the left eye, best-corrected visual acuity (BCVA) was hand motion and intraocular pressure (IOP) was 8 mmHg. Choroidal vasodilation and chorioretinal folds were observed by spectral domain-optical coherence tomography (SD-OCT). Topical and systemic steroid treatments did not improve the chorioretinal folds. Twelve months after the injury, intra-vitreal triamcinolone (4 mg/0.1 ml) was injected. Six months after intra-vitreal triamcinolone injection, BCVA in the left eye had improved to 20/100. Fundus examination showed improvement in retinal vascular tortuosity and SD-OCT revealed improvements in choroidal vasodilation and chorioretinal folds. Intra-vitreal triamcinolone injection (IVTI) was effective against traumatic chorioretinal folds with no recurrence based on objective observation by fundus photography and SD-OCT.