Associated factors and treatment outcome of presumed noninfectious endophthalmitis occurring after intravitreal triamcinolone acetonide injection.

BACKGROUND: To investigate the associated factors and treatment outcomes in patients with presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide (IVTA) injection. METHODS: Among 219 consecutive cases of 186 patients who had undergone IVTA injection for macular diseases, presumed noninfectious endophthalmitis was diagnosed if the patient showed severe inflammation in the anterior chamber and vitreous cavity within 7 days after injection but no organism was isolated on microbiological examination. Clinical features and previously performed surgical procedures were evaluated to assess their association with presumed noninfectious endophthalmitis using logistic regression. After surgical or medical treatment for endophthalmitis, the visual outcome was evaluated in all patients. RESULTS: Noninfectious endophthalmitis developed in six of 219 eyes (2.7 %). Previous vitrectomy, history of IVTA injection, and pseudophakia were significantly associated with the occurrence of presumed noninfectious endophthalmitis after IVTA injection (p = 0.049, 0.034, and 0.009, respectively). Internal limiting membrane (ILM) peeling during vitrectomy also showed statistically significant association (odds ratio = 13.6, p = 0.017). Five of six patients (83.3 %) regained pre-injection vision. CONCLUSION: In addition to previous vitrectomy, history of IVTA injection, internal limiting membrane (ILM) peeling, and pseudophakia may render the eye vulnerable to presumed noninfectious endophthalmitis following IVTA injection. Visual outcome shows generally good prognosis after treatment.

Peripapillary staphyloma: clinical features and visual outcome in 19 cases.

OBJECTIVE: To investigate the clinical features and visual outcome of patients with peripapillary staphyloma. METHODS: The medical records of patients diagnosed as having peripapillary staphyloma at Seoul National University Children's Hospital, Seoul, Korea, between January 1, 1991, and December 31, 2003, were reviewed. Visual acuity and associated ocular and systemic abnormalities were recorded. RESULTS: Nineteen patients (21 eyes) with peripapillary staphyloma were included in the study. The mean age at initial examination was 21 months, and 42% (8/19) of the patients were girls. Two patients (11%) had bilateral peripapillary staphylomas. Only 2 eyes had visual acuity better than 20/200 at the last examination, and 7 eyes had severe myopia of more than -6 diopters. After occlusion therapy, 1 patient achieved a visual improvement from light perception to 20/30. Congenital cataract and persistent pupillary membrane were present in 2 eyes each at initial examination. Complications observed during the follow-up period included acquired total cataract in 2 eyes and retinal detachment in 3 eyes. Scleral encircling buckling was performed in 1 eye with retinal detachment, and subsequently the retina was reattached. Only 2 patients had accompanying systemic abnormalities. CONCLUSIONS: Rarely, patients with peripapillary staphyloma can achieve significant visual improvement by occlusion therapy, although visual outcome is generally poor. Because associated ocular disease and refractive errors are not infrequent, complete ophthalmic examinations and regular follow-up are necessary.

Optic disc rim area to retinal nerve fiber layer thickness correlation: comparison of diabetic and normal tension glaucoma eyes.

PURPOSE: To compare the correlation between optic disc rim area and retinal nerve fiber layer thickness (rim-RNFL correlation) in diabetic eyes with non-progressive RNFL defects and normal tension glaucoma (NTG) eyes. METHODS: Seventy-three eyes of 73 patients with preperimetric or early NTG and 25 eyes of 25 type II diabetes patients with a non-progressive RNFL defect for ≥5 years were enrolled in this retrospective cohort study. Rim areas and RNFL thicknesses were measured by Heidelberg retina tomography (HRT II) and by optical coherence tomography (Cirrus OCT), in global and 12 clock-hour parameters. Diabetic eyes were evaluated whether they were above the 95 % prediction interval (PI) for the rim-RNFL correlation of NTG. RESULTS: A significant linear rim-RNFL correlation was observed in NTG eyes globally and at all clock-hours, except in the 4 and 9 o'clock areas, (0.08 < r (2) < 0.56, P < 0.05). Eighty-four percent of the diabetic eyes were above the 95 % PI of the rim-RNFL correlation of NTG in ≥2 clock-hours, as compared with 36 % of the eyes in the global parameter. CONCLUSIONS: The eyes of diabetic patients with non-progressive RNFL were well-differentiated from NTG eyes by the rim-RNFL correlation.

Comparison of features on SD-OCT between acute central serous chorioretinopathy and exudative age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To compare the spectral-domain optical coherence tomography (SD-OCT) features of acute central serous chorioretinopathy (CSC) versus exudative age-related macular degeneration (AMD) and explore disease-specific features of each disease. PATIENTS AND METHODS: SD-OCT images obtained at the time of diagnosis in 39 eyes with acute CSC (symptom onset < 2 months) and 52 eyes with exudative AMD were compared. Multiple regression analysis was performed to identify disease-specific features. The relationship between anatomical findings and visual function was also assessed. RESULTS: There were significant morphologic differences on SD-OCT between the two diseases, including the presence and height of retinal fluid and morphologic changes of retinal pigment epithelium (RPE). Multiple regression analysis revealed that a reflective band with posterior shadowing was a disease-specific finding indicating exudative AMD; however, other SD-OCT findings were attributed to differences in age of onset between the two diseases. Visual acuity was correlated with subretinal fluid in CSC, whereas pigment epithelial detachment, intraretinal fluid, and diverse RPE morphologic abnormalities were associated with visual decline in exudative AMD. CONCLUSION: A reflective band with posterior shadowing is a disease-specific feature of exudative AMD that may be useful for the differential diagnosis. High-resolution SD-OCT images of the retinal layers identified distinguishing pathologic features of the outer retina between the two diseases. The OCT features associated with visual function were different between the two diseases.

Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections.

PURPOSE: To investigate the clinical manifestations and visual prognosis of retinal artery occlusion resulting from cosmetic facial filler injections. DESIGN: Retrospective, noncomparative case series. METHODS: Setting. Institutional. Study Population. Twelve consecutive patients with retinal artery occlusion caused by cosmetic facial filler injections. Main Outcome Measures. Filler materials, injection sites, best-corrected visual acuities, fundus fluorescein angiography and optical coherence tomography findings, and associated ocular and systemic manifestations. RESULTS: Seven, 2, and 3 patients had ophthalmic, central retinal, and branch retinal artery occlusions, respectively. Injected materials included autologous fat (7 cases), hyaluronic acid (4 cases), and collagen (1 case), and injection sites were the glabellar region (7 cases), nasolabial fold (4 cases), or both (1 case). Injected autologous fat was associated with worse final best-corrected visual acuity than the other materials. All patients with ophthalmic artery occlusion had ocular pain and no improvement in best-corrected visual acuity. Optical coherence tomography revealed thinner and less vascular choroids in eyes with ophthalmic artery occlusion than in adjacent normal eyes. Concomitant brain infarction developed in 2 cases each of central retinal artery occlusion and ophthalmic artery occlusion. Phthisis developed in 1 case of ophthalmic artery occlusion. CONCLUSIONS: Cosmetic filler injections into the glabellar region or nasolabial fold can cause retinal artery occlusion. Iatrogenic ophthalmic artery occlusion is associated with painful blindness, a thin choroid, brain infarction, and poor visual outcomes, particularly when autologous fat is used. Ophthalmic examination and systematic brain magnetic resonance imaging should be performed in patients with ocular pain after such injections.