Photocoagulation Up to Ora Serrata in Diabetic Vitrectomy to Prevent Recurrent Vitreous Hemorrhage

Purpose@#To evaluate the role of performing photocoagulation up to ora serrata during vitrectomy in preventing recurrent vitreous hemorrhage (VH) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). @*Methods@#This retrospective, nonrandomized study included 60 eyes from 60 patients who had undergone PPV for VH due to PDR. These patients were divided into two groups: group 1, those who underwent photocoagulation up to ora serrata using the scleral indentation technique during surgery; and group 2, those who did not undergo scleral indentation when photocoagulation and underwent photocoagulation up to vortex veins. Their hospital records were analyzed to investigate the recurrence rate of VH, the time until recurrence of VH after surgery, logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) measured before surgery and at 1, 2, and 3 years after surgery, and the occurrence of complications such as neovascular glaucoma (NVG) during follow-up. @*Results@#Group 1 exhibited lower recurrence rate of VH (2 of 30 [6.7%] vs. 10 of 30 [33.3%], p = 0.01) and lower occurrence of postoperative NVG (2 of 30 [6.7%] vs. 8 of 30 [26.7%], p = 0.038) compared with group 2. There were no statistically significant differences in logMAR BCVA measured at 1, 2, and 3 years between the two groups (at 1 year: 0.54 ± 0.43 vs. 0.54 ± 0.44, p = 0.954; at 2 years: 0.48 ± 0.47 vs. 0.55 ± 0.64, p = 0.235; at 3 years: 0.51 ± 0.50 vs. 0.61 ± 0.77, p = 0.200). Logistic regression analysis showed that among several factors that could affect recurrence rate of VH, only range of photocoagulation performed was a statistically significant factor (odds ratio, 0.119; 95% confidence interval, 0.022–0.659; p = 0.015). @*Conclusions@#Photocoagulation treatment over a wider range with scleral indentation could be a beneficial adjunct procedure for preventing postoperative recurrent VH following diabetic vitrectomy.

Assessment of Scleral Contour Changes in High Myopia by Optical Coherence Tomography

Purpose@#This study aimed to establish and validate optical coherence tomography (OCT) based diagnostic criteria of high myopia. @*Methods@#This was a cross-sectional study including 100 eyes of high myopia with axial length larger than 26.5 mm and 100 control eyes, which were examined by spectral-domain OCT. Vertical and horizontal OCT of 9 mm scanning across fovea were analyzed. OCT characteristics including mirror artifact, scleral sink due to steep inclination of posterior sclera, scleral visibility, abnormality of outer retinal layer, foveoschisis, and dome-shaped macula were assessed in each group. @*Results@#The mean axial length was 28.65 ± 2.07 mm (range, 26.51–34.59 mm) in high myopia group and 23.79 ± 0.99 mm (range, 21.26–25.94 mm) in control group. Among the OCT characteristics noted at high frequency in the eyes with high myopia, three criteria achieving high sensitivity and specificity were determined: scleral sink over 500 μm, scleral visibility over 100 μm, and dome-shaped macula. Under conditions of presence of any of three criteria in either horizontal or vertical OCT scanning, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value for high myopia were found to be 95.0%, 98.0%, 98.0%, and 95.1%, respectively. In a new set of OCT images from 50 eyes with high myopia and 50 eyes of nonhigh myopia cases, the OCT-based criteria also proved similar level of diagnostic validity. @*Conclusions@#The OCT-based criteria, which directly addressed posterior scleral contour changes, may lead to an intuitive and accurate diagnosis of high myopia. Also, the criteria may contribute to early detection and monitoring of eyes that cannot be defined as high myopia but can progress. OCT may be useful for monitoring high myopia patients as OCT can detect myopia-associated retinal pathologies as well as scleral contour changes.

Early Retinal Hemorrhage Absorption Rate and Long Term Clinical Outcomes in Branch Retinal Vein Occlusion

Purpose@#We report the relationship between early retinal hemorrhage absorption rate (RHAR) and long-term clinical outcomes associated with branch retinal vein occlusion (BRVO). @*Methods@#This retrospective study included 66 eyes with BRVO. We used a grid as a quantitative measurement unit for measuring the amount of hemorrhage, and calculated the RHAR by measuring variance between sums of the grids. We investigated the relationship of best corrected visual acuity (BCVA), central foveal thickness (CFT), and other long term clinical outcomes with RHAR. @*Results@#The RHAR in BRVO patients measured 16.46 ± 21.48 ∑grid/time (month). Improvement of BCVA (logMAR) was 0.28 ± 0.28 at 12 months, showing statistical significance with the RHAR (p < 0.01). We divided RHAR into two groups by 7.5 ∑ grid/month; slow and fast RHAR groups. Improvement of BCVA (logMAR) was 0.16 ± 0.23 in the slow RHAR group, and 0.38 ± 0.28 in the fast RHAR group, with statistical significance (p = 0.01). Regression of CFT was 133.12 ± 142.93 μm in the slow RHAR group, and 236.62 ± 131.55 μm in the fast RHAR group, with statistical significance (p < 0.01). @*Conclusions@#RHAR may be a prognostic factor during follow-up in BRVO patients.

Early Retinal Hemorrhage Absorption Rate and Long Term Clinical Outcomes in Branch Retinal Vein Occlusion

Purpose@#We report the relationship between early retinal hemorrhage absorption rate (RHAR) and long-term clinical outcomes associated with branch retinal vein occlusion (BRVO). @*Methods@#This retrospective study included 66 eyes with BRVO. We used a grid as a quantitative measurement unit for measuring the amount of hemorrhage, and calculated the RHAR by measuring variance between sums of the grids. We investigated the relationship of best corrected visual acuity (BCVA), central foveal thickness (CFT), and other long term clinical outcomes with RHAR. @*Results@#The RHAR in BRVO patients measured 16.46 ± 21.48 ∑grid/time (month). Improvement of BCVA (logMAR) was 0.28 ± 0.28 at 12 months, showing statistical significance with the RHAR (p < 0.01). We divided RHAR into two groups by 7.5 ∑ grid/month; slow and fast RHAR groups. Improvement of BCVA (logMAR) was 0.16 ± 0.23 in the slow RHAR group, and 0.38 ± 0.28 in the fast RHAR group, with statistical significance (p = 0.01). Regression of CFT was 133.12 ± 142.93 μm in the slow RHAR group, and 236.62 ± 131.55 μm in the fast RHAR group, with statistical significance (p < 0.01). @*Conclusions@#RHAR may be a prognostic factor during follow-up in BRVO patients.

Comparison of Clinical Results between 2.2 mm and 2.8 mm Incision Cataract Surgery Using Ellips Ultrasound

PURPOSE: Introduction of phacoemulsification and development of foldable artificial lens has facilitated smaller incisions, even micro-coaxial incisions. However, there have been several studies showing that micro-coaxial incision has no benefit compared with the conventional small incision method. Cases where Ellips ultrasound was used have not yet been reported. Therefore, we compared the postoperative results between 2.2-mm and 2.8-mm incision groups using Ellips ultrasound. METHODS: Among 49 eyes receiving cataract surgery from March, 2012 to August, 2012, 27 eyes in the 2.2-mm group and 22 eyes in the 2.8-mm group were examined to obtain cumulated dissipated energy (CDE), use of balanced salt solution (BSS), best-corrected visual acuity (BCVA), corneal endothelial cell count (ECC), corneal thickness at center and incision site, and keratometric astigmatism before and after surgery. RESULTS: There were no statistically significant differences between the 2.2-mm and 2.8-mm groups in CDE (2.5 +/- 2.0 vs. 2.5 +/- 2.3) and use of BSS (188 +/- 127 vs. 138 +/- 43 mL) during the surgery, BCVA (-0.45 +/- 0.62 vs. -0.55 +/- 0.79 log MAR), ECC (-178 +/- 210 vs. -99 +/- 114 cells/mm2), corneal thickness at center (23 +/- 23 vs. 27 +/- 23 microm) and incision site (24 +/- 19 vs. 27 +/- 19 microm) and keratometric astigmatism before and after the surgery. CONCLUSIONS: A 2.2-mm micro-coaxial incision using Ellips ultrasound showed no statistically significant differences in BCVA, ECC, corneal thickness at center and incision site, and keratometric astigmatism compared with 2.8-mm small incision.

The Effect of One Myopic Eye on Visual Field Testing

PURPOSE: To investigate the effect of lens-corrected myopia on Humphrey Matrix and Humphrey Field Analyser (HFA). METHODS: A total of 59 lens-corrected myopic eyes of 59 normal volunteers underwent Humphrey Field Analyser and Humphrey Matrix (FDP) testing. Spherical equivalent divided into 3 groups: -3 < or = D < 0, -6 < or = D < -3, D < -6. HFA and FDP sensitivity for mean deviation (MD) and pattern standard deviation (PSD), as well as axial length and astigmatism, were compared between these 3 groups. RESULTS: The MD of the fields as determined by the HFA decreased significantly as the refractive errors increased, despite correction. However, there were no significant differences in MD or PSD of FDP, or in the PSD of HFA. There were no significant differences in axial length or astigmatism as calculated by MD and PSD for HFA and FDP. CONCLUSIONS: The spherical equivalent showed that lens correction alters the MD for HFA but not for FDP.

A Case of Corneal Perforation and IOL Prolapsed in Serratia Marcescens Endophthalmitis after Cataract Surgery

PURPOSE: To report a case of Serratia marcescens endophthalmitis following phacoemulsification and posterior chamber intraocular lens implantation. CASE SUMMARY: A 64-year-old male with a history of diabetes, hypertension, cardiovascular disease was referred with right ocular pain and reduced vision 1 day after cataract surgery. On admission, hypopyon on anterior chamber by slit lamp examination and anterior vitreous was hazy according to ultrasonography. We immediately performed intravitreal antibiotics injection and microbiological analysis of anterior chamber and vitreous samples was performed. On day 3, persistent cornea stormal infiltration and cornea perforation were visible and the organism was identified as S. marcescens. Despite appropriate antibiotic treatment the eye continued to deteriorate. CONCLUSIONS: S. marcescens endophthalmitis was diagnosed and treated immediately, but rapid progression and outcome were unsatisfactory.