PREVALENCE AND RISK FACTORS OF AGE-RELATED MACULAR DEGENERATION FEATURES AMONG PILOTS.

PURPOSE: To investigate the prevalence and risk factors of age-related macular degeneration features among pilots of Republic of Korea Air Force. METHODS: This retrospective, cross-sectional study was performed with a total of 2781 Republic of Korea Air Force pilots who underwent regular medical examinations between 2020 and 2021. Age-related macular degeneration features were determined and graded by fundus photographs. Risk factors were identified with logistic regression analysis in odds ratio (OR) and 95% confidence interval (CI). RESULTS: The prevalence was 12.9% in the Republic of Korea Air Force pilots and 35.2% in those older than 50 years. Pilots with age-related macular degeneration features were positively associated with age (OR: 1.082, CI: 1.067-1.096, P < 0.001), male sex (OR: 0.229, CI: 0.056-0.939, P = 0.041), smoking (OR: 1.027, CI: 1.008-1.047, P = 0.006), flight time (OR: 1.004, CI: 1.003-1.005, P < 0.001), total cholesterol (OR: 1.004, CI: 1.000-1.007, P = 0.033), and low-density lipoprotein (OR: 1.005, CI: 1.001-1.008, P = 0.011). Aircraft type was also identified as a risk factor (OR: 0.617, CI: 0.460-0.827 for carrier, OR: 0.572, CI: 0.348-0.940 for helicopter, P = 0.002), with fighter pilots having a higher risk than carrier and helicopter pilots. The results were similar for pilots older than 50 years. CONCLUSION: The prevalence of age-related macular degeneration features in Republic of Korea Air Force pilots was higher than in other general populations studied. Identified risk factors such as flight time and aircraft type suggest potential occupational risk of age-related macular degeneration in aviators.

New onset of acute uveitis following COVID-19 vaccination.

PURPOSE: This study reported 11 cases of new-onset acute uveitis following coronavirus disease 2019 (COVID-19) vaccination. METHODS: This retrospective observational case study included 11 eyes of 11 patients with acute uveitis after the COVID-19 vaccination. We only included patients with new-onset uveitis. The medical records of the patients from January 2021 to January 2022 were reviewed. RESULTS: The mean age of the participants was 51.81 years, and all patients demonstrated anterior chamber reaction with keratic precipitates in the affected eye. The mean duration between vaccination and uveitis was 8.27 days. Seven patients developed uveitis after receiving the second dose of vaccination, and four developed uveitis after receiving the third dose of vaccination. Five patients showed posterior synechiae, and three patients showed hypopyon. After treatment with topical 1% prednisolone acetate eye drops and systemic prednisolone, inflammation was adequately controlled and quickly resolved. CONCLUSIONS: COVID-19 vaccination with messenger RNA and viral vector vaccines may cause acute anterior uveitis. Although initially severe, uveitis responded well to steroid therapy with no visual impairment.

Menopausal hormone therapy and the risk of cataracts in postmenopausal women in South Korea.

PURPOSE: Postmenopausal women have a higher prevalence of cataracts than men of a similar age. This study aimed to evaluate the effects of menopausal hormone therapy (MHT) on lens opacities in postmenopausal women. METHODS: This retrospective cohort study analysed population-based health insurance data in South Korea collected from 2002 to 2019. To determine the risk factors associated with cataract, postmenopausal women (N = 2,506,271) were grouped according to post-MHT use. The treatment group was further divided into the following subgroups: tibolone, combined oestrogen plus progestin by manufacturer, oral oestrogen, combined oestrogen plus progestin by physician and topical oestrogen groups. The main outcome measure was the prevalence of cataracts. RESULTS: The control group comprised 463,151 postmenopausal women who had never used MHT after menopause, while the treatment group included 228,033 postmenopausal women who had used MHT continuously for at least 6 months. The treatment group had a higher incidence of cataracts than the control group based on Cox proportional hazards ratio analysis. Low socioeconomic status and high parity were identified as risk factors for cataracts, and reduced risk of cataracts was associated with living in rural areas and drinking alcohol. CONCLUSIONS: Women undergoing post-MHT, including tibolone, had a higher incidence of cataracts. Cataract development should be a concern when examining postmenopausal patients using MHT.

Comparison of the Incidence of Nd:YAG Laser Capsulotomy Based on the Type of Intraocular Lens.

Background and Objectives: Posterior capsular opacification (PCO) is the most common long-term complication of successful cataract surgery and can cause visual impairment. We aimed to investigate the effects of intraocular lens (IOL) characteristics on PCO by comparing the incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy for different types of intraocular lenses. Materials and Methods: A retrospective analysis was performed on 2866 eyes that underwent cataract surgery between January 2010 and December 2017, with at least 5 years of follow-up. The IOLs used for surgery were the hydrophobic lenses SN60WF (Alcon, Fort Worth, TX, USA), ZCB00 (Johnson & Johnson Vision, Santa Ana, CA, USA), and MX60 (Bausch & Lomb, Rochester, NY, USA), and the hydrophilic lens MI60 (Bausch & Lomb, Rochester, NY, USA). We analyzed the incidence of Nd:YAG laser capsulotomy according to the type of IOL used. Results: The incidence of Nd:YAG laser capsulotomy was significantly higher with MI60 lenses (31.70%, 175/552 eyes) compared to SN60WF (7.90%, 113/1431 eyes), ZCB00 (10.06%, 64/636 eyes), and MX60 (10.57%, 13/123 eyes; p < 0.001) lenses. The incidence of Nd:YAG laser capsulotomy was significantly lower with the hydrophobic IOLs (8.68%, 190/2190 eyes) than with the hydrophilic IOL (31.70%, 175/552 eyes; p < 0.001). Over time, the rate of increase in the cumulative number of Nd:YAG laser capsulotomy cases was the highest with MI60. The cumulative rate of Nd:YAG laser capsulotomy during the first 3 years was 4.90% with SN60WF (70/1431 eyes), 6.76% with ZCB00 (43/636 eyes), 8.94% with MX60 (11/123 eyes), and 26.10% with MI60 (144/552 eyes) lenses. Conclusions: The incidence of PCO is influenced by the material of the IOLs. The hydrophilic IOL was associated with a higher rate of Nd:YAG laser capsulotomy than the hydrophobic IOLs, with a shorter time to Nd:YAG laser capsulotomy.

EFFECTS OF GLYCEMIC VARIABILITY ON THE PROGRESSION OF DIABETIC RETINOPATHY AMONG PATIENTS WITH TYPE 2 DIABETES.

PURPOSE: To evaluate the effects of glycemic variability on the progression of diabetic retinopathy (DR) among individuals with Type 2 diabetes and to test the hypothesis that consistent glycemic control delays the progression of DR. METHODS: This retrospective study included 1,125 participants with a follow-up period of more than 5 years and more than 20 glucose laboratory test results. The hazard ratio of ≥3 steps of progression on the Early Treatment Diabetic Retinopathy Study person scale and progression to proliferative DR were assessed. RESULTS: An increase in the HbA1c SD was associated with a higher risk of ≥3 step progression (P < 0.001) and progression to proliferative DR (P < 0.001). Not only mean HbA1c, but also HbA1c SD was associated with a lower risk of ≥3 steps of progression (P < 0.001), and progression to proliferative DR (P < 0.001). CONCLUSION: Achievable and consistent glycemic control may contribute to the delay in DR progression. CLINICAL TRIAL REGISTRATION NUMBER: Institutional review board of Inje University (No. 202003014).

TOPOGRAPHIC CHANGES IN CHOROIDAL THICKNESS IN AGE-RELATED MACULAR DEGENERATION DURING THE DEVELOPMENT OF ACTIVE CHOROIDAL NEOVASCULARIZATION.

PURPOSE: To evaluate topographic changes in choroidal thickness during development of choroidal neovascularization (CNV) in treatment-naive age-related macular degeneration (AMD) and to test the value of such changes as a predictive tool of CNV development. METHODS: This retrospective cohort included 86 eyes that developed CNV from intermediate AMD, 43 eyes with intermediate AMD, and 36 eyes without AMD. Patients with intermediate AMD underwent spectral domain optical coherence tomography using enhanced depth imaging mode every 6 months until CNV was detected. Choroidal neovascularization was localized to one of the subfields of Early Treatment of Diabetic Retinopathy Study grid on fluorescein angiography. Average choroidal thickness of each subfield was calculated. RESULTS: Choroidal thickness of the subfield where CNV developed at first clinical detection significantly increased compared with that 6 months before (P = 0.000 for central, P = 0.001 for superior parafoveal, P = 0.002 for temporal parafoveal, P = 0.002 for inferior parafoveal, and P = 0.001 for nasal parafoveal subfield). In eight patients who visited unexpectedly 3 months before CNV development in central subfield, choroidal thickness of central subfield increased significantly compared with that 6 months before CNV development (P = 0.001). CONCLUSION: Choroidal neovascularization development accompanied choroidal thickening of the corresponding subfield. Regular measurement of choroidal thickness may assist in prediction of CNV.

Comparison of electroretinographic measurements between tabletop and handheld stimulators in healthy subjects.

PURPOSE: To compare full-field electroretinography (ffERG) parameters obtained from handheld and tabletop electroretinography (ERG) devices in normal subjects. METHODS: Twenty volunteers underwent ffERG using a tabletop and handheld stimulator. The responses obtained from the right eyes were compared. The coefficient of variation and intraclass correlation coefficient (ICC) were derived to assess inter- and intra-individual reliability. RESULTS: The b-wave in the rod response, a- and b-waves in the maximal combined response, a-wave in the cone response, and the 30-Hz flicker response showed significantly greater amplitudes when recorded with the tabletop stimulator than with the handheld stimulator. The implicit time of response (ITR) in the 30-Hz flicker response was longer when recorded with the handheld stimulator than when recorded with the tabletop stimulator. With regard to amplitude, the ICC indicated moderate-to-high reliability in the measurement of the b-wave in the rod response, and a- and b-waves in the maximal combined response. With regard to ITR, measurement of the b-wave in the rod response and a-wave in the maximal combined response showed moderate-to-high reliability. CONCLUSION: Despite the significantly lower ERG amplitude measurements recorded by the handheld stimulator, there were no significant differences in variability between the two stimulators.

Rapid progression of cataract to mature stage after intravitreal dexamethasone implant injection: a case report.

BACKGROUND: This study aims to report a case of rapid progression of cataract to mature stage after intravitreal dexamethasone implantation for macular edema due to branch retinal vein occlusion. CASE PRESENTATION: A 59-year-old Korean male with complaints of sudden metamorphopsia and reduced visual acuity for three days in the left eye was referred to our clinic. Ophthalmological investigations included fundus photography, fluorescein angiography, and optical coherence tomography. In the left eye, branch retinal vein occlusion with macular edema was observed. We performed intravitreal dexamethasone implantation in the left eye three times within a period of one year. One week after the third intravitreal dexamethasone implantation, grade 1 posterior subcapsular opacity and raised intraocular pressure were observed in the left eye. Three weeks later, mature cataract was observed in the left eye. We performed cataract surgery along with intravitreal ranibizumab injection in the left eye. The procedure was uneventful, and the visual acuity improved postoperatively. CONCLUSIONS: Posterior subcapsular cataract developed due to intravitreal dexamethasone implantation can progress rapidly to mature stage. Therefore, short-term follow-up examinations may be necessary for early diagnosis and treatment of this complication.

Uveitis after COVID-19 Vaccination.

This report describes a case of acute uveitis following COVID-19 vaccination. A 21-year-old patient was referred to our department for decreased visual acuity and injection of the left eye. Two days prior, the patient received her second dose of the severe acute respiratory syndrome coronavirus 2 vaccine (BNT162b2, Pfizer-BioNTech). On ocular examination, her left eye's best-corrected visual acuity was 20/250, and its intraocular pressure was 16 mm Hg on a noncontact tonometer. Hypopyon, 4+ cells, and flares were observed in the anterior chamber. The patient was diagnosed with acute uveitis. She received topical dexamethasone (0.1%) hourly and systemic prednisone (50 mg/day). After 7 days, her inflammatory symptoms were mostly resolved. COVID-19 vaccination can cause acute anterior uveitis, which is responsive to steroids.

Atypical Cogan's Syndrome with Choroidal Effusion: A Case Report.

Cogan's syndrome is a rare form of autoimmune vasculitis that manifests with ocular and audiovestibular symptoms. The clinical presentations of Cogan's syndrome can be classified as typical and atypical, and the auditory symptoms are classically similar to those seen in cases of Meniere's syndrome. Without treatment, Cogan's syndrome could become severe, resulting in sensorineural hearing loss in over 50% of patients. This report describes a rare case of uncontrolled intraocular pressure and choroidal effusion in a patient with atypical Cogan's syndrome. A 51-year-old woman was referred to our clinic on account of bilateral distortion of visual acuity and ocular pain following admission to the internal medicine department for bilateral hearing loss, acute renal failure, and fever. Upon ocular examination, we observed bilateral 2-3+ cells in the anterior chamber and closed-angle glaucoma, and choroidal effusion in the right eye. The intraocular pressure could not be controlled with topical and systemic medications, and a bilateral valve implant surgery was performed subsequently. Two weeks later, after systemic corticosteroid therapy, the choroidal effusion resolved. Cogan's syndrome can provoke angle-closure glaucoma with choroidal effusion in patients with a short axial length and shallow anterior chamber.

Choroidal Effusion following Intravitreal Brolucizumab Injection: A Case Report.

This report describes a case of choroidal effusion after intravitreal brolucizumab injection for wet age-related macular degeneration (AMD). A 71-year-old Korean man with a history of wet AMD visited our clinic. On examination, the best-corrected distance visual acuity (BCVA) was 20/200 in the right eye. Fundus photography and optical coherence tomography showed wet AMD in the right eye. The patient showed no improvement while undergoing treatment with anti-vascular endothelial growth factor therapy (aflibercept, 6 times; ranibizumab, 5 times; and bevacizumab 3 times). We administered intravitreal brolucizumab injections in the right eye of the patient. After first brolucizumab injection, the BCVA improved from 20/200 to 20/63 in the right eye. Two months after the intravitreal brolucizumab injection, recurrence of wet AMD and deterioration of the BCVA to 20/200 was observed on the right eye. The patient underwent a second intravitreal brolucizumab injection in the right eye in the same manner. Three days after the second brolucizumab injection, choroidal effusion was observed in the right eye. The choroidal effusion resolved completely 12 days after the injection, without any additional treatment. Intravitreal brolucizumab injection may provoke choroidal effusion. Although it may resolve promptly, short-term follow-up fundus examinations may be necessary for the early diagnosis and treatment of this complication.

Hyperacute iris neovascularization following cataract surgery.

RATIONALE: We describe a case of acute neovascularization of the iris after uneventful cataract surgery. PATIENT CONCERNS: A 78-year-old man visited our clinic for cataract surgery and glaucoma management. DIAGNOSES: The patient underwent bilateral laser iridotomy 4 years ago. On ocular examination, the best-corrected visual acuity was no light perception in the right eye and 20/100 in the left eye. We observed pseudophakic bullous keratopathy in the right eye and cataracts and hemicentral retinal vein occlusion (CRVO) in the left eye. INTERVENTIONS: The patient underwent cataract surgery in the left eye without complications. OUTCOMES: The day after surgery we observed 360° of neovascularization in the iris and aggravated hemi-CRVO with macular edema. Therefore, we administered intravitreal bevacizumab in the left eye, after which the iris neovascularization and macular edema improved. LESSONS: Cataract surgery can rapidly aggravate hemi-CRVO and cause iris neovascularization, which is responsive to bevacizumab.

Menopause and the Risk of Developing Age-Related Macular Degeneration in Korean Women.

Previous studies have shown that menopausal hormone therapy in postmenopausal women results in a higher prevalence of age-related macular degeneration. This study aimed to evaluate the effects of menopause and patient factors on the development of age-related macular degeneration in Korean women. Data between 2011 and 2014 were collected from the Korean National Health Insurance database. In this retrospective cohort study, 97,651 participants were premenopausal and 33,598 were menopausal. Participants were divided into menopausal and premenopausal groups to analyze the risk factors associated with the development of age-related macular degeneration. The prevalence of age-related macular degeneration was compared between the two groups. Other patient factors were also analyzed. Using a 1:1 propensity score matching method and adjusting for variables, the incidence of age-related macular degeneration was not significantly different between the two groups. Age and diabetes mellitus were associated with an increased risk of developing age-related macular degeneration, regardless of menopause. Menopause was not a risk factor for age-related macular degeneration. These findings may help physicians identify women with diabetes who are at a greater risk of developing age-related macular degeneration.

Impact of the Coronavirus Disease 2019 Pandemic on the Ophthalmology Department.

We aimed to evaluate the effects of the coronavirus disease (COVID-19) pandemic on the Ophthalmology Department. This study was based on data collected between January 2019 and November 2021. We divided patients scheduled for eye care during pre-COVID-19 (January-December 2019), early COVID-19 (January-December 2020), and late COVID-19 (January-November 2021) periods. Changes in the outpatient cancellation rate in each department were analyzed and compared in the pre-, early, and late periods. The basic information of cancellation and reason for not visiting the clinic were also analyzed. Overall, 121,042 patients were scheduled to visit the Sanggye Paik Hospital Ophthalmology Department. The overall cancellation rate was 19.13% during pre-COVID-19, 24.13% during early COVID-19, and 17.34% during late COVID-19. The reasons for not visiting the clinic included hospital, patient, and contact factors; hospitalization in other departments and hospitals; and death. The Strabismus/Pediatric Ophthalmology Department showed the highest cancellation rate of 24.21% over three years. There were no significant differences in the causes of hospital visits by period. The COVID-19 pandemic has caused an overall decrease in the number of ophthalmic outpatients. However, after about a year, the number of outpatients in these departments recovered to the level before the COVID-19 outbreak.

Visually Disturbing Vitreous Floaters following Neodymium-Doped Yttrium Aluminum Garnet Capsulotomy: A Single-Center Case Series.

This study aimed to report the risk factors and treatment outcomes of visually disturbing vitreous opacities after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. This was a retrospective observational case series study that included 6 patients who underwent vitrectomy for vitreous opacities after Nd:YAG laser capsulotomy. The patients' medical records from January 2017 to June 2020 were reviewed. Seven eyes of 6 patients who underwent pars plana vitrectomy for visually disturbing vitreous opacities were included in this study. The mean duration between Nd:YAG capsulotomy and vitrectomy was 8.57 ± 1.27 months. The posterior capsule opacification was proliferative with a pearl form in all patients. Visual acuity improved significantly after vitrectomy. Nd:YAG laser causes visually disturbing vitreous opacities. Vitrectomy was an effective treatment for these opacities.

Microbial Contamination of Preservative-Free Artificial Tears Based on Instillation Techniques.

Preservative-free artificial tears eliminate the side effects of preservatives but are prone to microbial contamination. This study evaluates the incidence of microbial contaminations in single-use vials of preservative-free 0.1% hyaluronate artificial tears. Based on what touched the vial tip during its first use, 60 unit-dose vials (0.5 mL) were divided into groups A (no touch, n = 20), B (fingertip, n = 20), and C (lid margin, n = 20). The vials were recapped after the first use, and the residual solution was cultured 24 h later. The solution from 20 aseptically opened and unused vials was also cultured (group D). Microbial contamination rates were compared between the groups using the Fisher's exact test. Groups B and C contained 45% (9/20) and 10% (2/20) contaminations while groups A and D contained undetected microbial growth. The culture positivity rates were significantly different between groups A and B (p = 0.001) and groups B and C (p = 0.013) but not between groups A and C (p = 0.487). We demonstrate a significantly higher risk of contamination when fingertips touch the vial mouth. Therefore, users should avoid the vial tip touching the fingers or eyelid during instillation to prevent contamination of the eye drops.

Raloxifene induced keratopathy: A case report.

Purpose: We report a case of corneal verticillata in a patient who had been taking raloxifene for a prolonged period. To our knowledge, this is the first case report of an ocular side effect of raloxifene. Observations: A 69-year-old female patient presented to our clinic for her routine eye check-up. On slit-lamp examination, whorl-like subepithelial deposits were observed in the bilateral corneas. She was diagnosed with corneal verticillata (vortex keratopathy) caused by raloxifene. A follow-up evaluation was conducted after discontinuation of the drug; however, the corneal opacity did not improve. Conclusions and importance: Patients with corneal verticillata should be asked regarding any intake of raloxifene for osteoporosis, as it may cause corneal verticillata.

Scheimpflug Topography Oriented Adequate Repositioning of a Misaligned Free Flap after Laser in situ Keratomileusis.

This report describes a case of Scheimpflug topography oriented adequate repositioning of a misaligned thick free flap after laser in situ keratomileusis (LASIK). A 24-year-old patient consulted for irregular astigmatism and disoriented free right eye flap. The patient previously underwent binocular LASIK at a private clinic. During the right eye surgery, the flap was repositioned after laser ablation due to the free flap. The free flap was not repositioned to its original configuration due to insufficient preoperative corneal marking. On examination, the uncorrected visual acuity was 0.4, and refractive power was +2.00 Dsph with -4.25 Dcyl axis 66 in the right eye. Scheimpflug topography revealed irregular right eye astigmatism. The sagittal curvature of topography showed a 40° counterclockwise misalignment of the steep axis of the cornea. The free flap was repositioned by 40° clockwise rotation. After this, the refractive corneal power improved to -1.00 Dsph with -1.00 Dcyl Axis 19 in the right eye. The uncorrected and best-corrected visual acuity improved to 20/30 and 20/25 (x - 0.25Dsph -1.25 Dcyl A20), respectively. This is the first report on free flap repositioning using Scheimpflug topography. As proper flap positioning was compromised because of the free LASIK flap with no preoperative corneal marking, the flap was effectively repositioned using Scheimpflug topography.

Comparison of Meibomian Gland Imaging Findings and Lipid Layer Thickness between Primary Sjögren Syndrome and Non-Sjögren Syndrome Dry Eyes.

Purpose: To compare meibomian gland (MG) imaging findings and lipid layer thickness (LLT) between patients with primary Sjögren syndrome (SS) dry eyes (DE) and non-SS DE.Methods: A total of 60 patients-30 with SS DE and 30 with non-SS DE were evaluated. Infrared image findings of MGs and LLT were assessed using the LipiView II interferometer.Results: The maximum LLT was significantly lower in the SS DE group. SS DE exhibited significantly higher MG dropout compared to the non-SS DE. Average and maximal LLT showed significant negative correlations with MG dropout in both groups (p<0.05). Conjunctival staining scores showed significant correlations with average and maximum LLT and MG dropout values in the SS DE group (p<0.05).Conclusion: These findings suggest that the new interferometer will be useful in understanding the pathophysiology of SS DE.

Intravitreal Voriconazole for Treatment of Bilateral Endogenous Candida Chorioretinitis.

This report describes a patient with bilateral endogenous candida chorioretinitis. The patient had a 2-day history of bilateral blurred vision. Fundus photography revealed multiple chorioretinal infiltrations in both eyes and a parafoveal hemorrhage in the left eye. After 2 days, fundus examination showed an increased number of infiltrations and hemorrhages in both eyes and worsening vitreous inflammation. A large infiltrative intraretinal lesion and a retinal hemorrhage of the left eye were discovered on optical coherence tomography. Candida albicans was diagnosed from blood culture. The bilateral candida chorioretinitis had not responded to systemic or topical antifungal medication. The chorioretinitis was refractory to intravitreal amphotericin B as well. Intravitreal voriconazole injection in both eyes and intravitreal bevacizumab injection in the left eye were performed thereafter. The chorioretinal infiltrations and hemorrhages decreased in both eyes. Intravitreal voriconazole injection was effective in the treatment of intractable candida chorioretinitis.