Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment.

PURPOSE: The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age. RESULTS: This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003). CONCLUSIONS: Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

Comparison of scleral buckling and vitrectomy using wide angle viewing system for rhegmatogenous retinal detachment in patients older than 35 years.

BACKGROUND: To compare scleral buckling (SB) and pars plana vitrectomy (PPV) using a wide angle viewing system (WAVS) for uncomplicated phakic rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated phakic RRD were retrospectively reviewed. Eyes with pseudophakic or attached fovea were excluded. Patients treated with SB were classified as group B, and PPV using WAVS as group V. Primary success rate, visual acuity (VA), macular complications, and sustained subretinal fluid (SRF) were compared between groups. RESULTS: Seventy-two eyes were included in group B and 57 eyes in group V. Group B had better preoperative VA (1.38 ± 0.87 vs 1.84 ± 0.97 in LogMAR, P = 0.010), but worse final VA (0.51 ± 0.48 vs 0.30 ± 0.23, P = 0.012) than group V. The primary success rate of 94.7 % in group V was higher than 77.8 % in group B (P = 0.010). Final success rate was 100 % in both groups. There was no significant difference in macular complications between groups (P = 0.087). Sustained SRF was found in 22 eyes in group B (38.6 %), while only two eyes in group V exhibited sustained SRF (2.8 %, P < 0.001). CONCLUSIONS: Pars plana vitrectomy using WAVS was more efficacious than SB for treating uncomplicated phakic RRD.

Clinical features of infectious endophthalmitis in South Korea: a five-year multicenter study.

BACKGROUND: To investigate clinical features of infectious endophthalmitis over five years in a South Korean population. METHODS: Medical records of consecutive patients diagnosed with infectious endophthalmitis at eight institutions located in Gyeongsangnam-do and Pusan city between January 1, 2004 and July 31, 2010 were reviewed. RESULTS: A total of 197 patients were diagnosed and treated. An average of 30.0 infectious endophthalmitis per year was developed. The annual incidence rate of postoperative endophthalmitis during 2006~2009 was 0.037%. The ratios of male to female and right to left were 50.2%: 49.8 % and 54.8%: 43.2%, respectively. Eighth decade and spring were the peak age (36.6%) and season (32.0%) to develop the infectious endophthalmitis. The most common past history in systemic disease was hypertension (40.4%), followed by diabetes (23.4%). Cataract operation (60.4%) was the most common cause, among which most of them was uneventful phacoemulsification (95.9%). Corneal laceration (51.6%) and liver abscess (42.9%) were the most common causes of traumatic and endogenous endophthalmitis, respectively. The percentages of patients with initial and final visual acuity less than counting fingers were 62.6% and 35.2%, respectively. Treatment with vitrectomy with or without intravitreal antibiotics injection was administered to 72.6% of patients, while 17.3% received intravitreal antibiotics only. CONCLUSIONS: Our study revealed that the development of infectious endophthalmitis was related with seasonal variation and increased during our study period. Pars plana vitrectomy was preferred for the treatment of infectious endophthalmitis in South Korea.

Analysis of the ganglion cell layer and photoreceptor layer using optical coherence tomography after idiopathic epiretinal membrane surgery.

PURPOSE: To investigate the correlation of visual acuity with the ganglion cell layer and the photoreceptor layer using spectral-domain optical coherence tomography after surgery for idiopathic epiretinal membrane (ERM). METHODS: The medical records of 58 eyes were reviewed retrospectively to collect data on visual acuity (VA), ganglion cell complex thickness (GT) and photoreceptor reflectivity (PR) at baseline, 3 months, and 6 months after surgery. The GT was adjusted to compensate for tractional thickening by calculating the proportional thickness to the macular thickness (MT). The PR was adjusted to compensate for the shadowing effects from the inner retina, which was achieved by calculating the ratio to the retinal pigment epithelium reflectivity (RR). The relative GT (RGT = GT/MT) and relative PR (RPR = PR/RR) were analyzed to determine their correlation with visual acuity. RESULTS: The GT was segmented correctly in 13 eyes at baseline, and in all eyes after surgery. The RGT and RPR were significantly lower than the normal eye. Thinner RGT correlated with poorer VA at 3 months (R = -0.352, p = 0.007) and 6 months (R = -0.324, p = 0.013), but the RPR had correlation with visual acuity only at 6 months (R = -0.377, p = 0.004). The area under the receiver operating characteristic curve was significant for VA ≥ 20/30 in both the RGT and RPR, and this significance was present for visual acuity ≥ 0/25 only in the RGT. CONCLUSIONS: The postoperative ganglion cell layer was found to be correlated to postoperative VA more consistently than the photoreceptor layer after ERM surgery. The outer retinal damage was a determining factor in the poor VA group.

Effects of fluoroquinolone eye solutions without preservatives on human corneal epithelial cells in vitro.

AIMS: To evaluate the biologic effects of fluoroquinolone eye solutions without preservatives on cultured human corneal epithelial cells in vitro. METHODS: We studied the effect of diverse generations of topical fluoroquinolones such as ofloxacin 0.3%, levofloxacin 0.5%, tosufloxacin 0.3%, moxifloxacin 0.5% and gatifloxacin 0.3% on cultured human corneal epithelial cells. MTT-based calorimetric assay, lactate dehydrogenase leakage (LDH) assay and scratch wound test were performed. Corneal epithelial cell morphologies were examined by performing inverted light microscopy and transmission electron microscopy. RESULTS: In all topical fluoroquinolones, the metabolic activity of the corneal epithelial cells decreased in a time-dependent fashion and the LDH titer increased with longer exposure times. Especially, the LDH titers significantly increased after exposure to moxifloxacin 0.5% and gatifloxacin 0.3% compared with controls. The migration rates of the corneal epithelial cells were faster in ofloxacin 0.3% or levofloxacin 0.5% than other fluoroquinolones. Severe cellular morphological damage was observed after exposure to moxifloxacin 0.5% and gatifloxacin 0.3%. CONCLUSIONS: As moxifloxacin 0.5% and gatifloxacin 0.3% induced the toxic effect to the corneal epithelial cells, compared with other fluoroquinolones, the 4th fluoroquinolone eye solutions should be carefully used in case of the corneal epithelium is damaged by long duration of treatment or overdosage.

Intravitreal pharmacokinetics after posterior subtenon triamcinolone acetonide injection in vitrectomized rabbit eyes.

PURPOSE: To investigate the intraocular pharmacokinetics of triamcinolone acetonide (TA) injected into the posterior subtenon of vitrectomized rabbit eyes. METHODS: Vitrectomy was performed on the right eyes of 35 rabbits. Triamcinolone acetonide (40 mg/mL) was injected into the posterior subtenon space of both eyes. Five rabbits each were killed at days 1, 3, 7, 14, 28, 56, and 84. Both eyes were enucleated. The vitreous was isolated, and TA concentration was measured. RESULTS: In vitrectomized eyes, the intravitreal concentrations of TA were 1763, 822.9, 321.5, 113.3, 35.5, 14.4, and 6.7 ng/mL, respectively, at the time points indicated above; the concentrations in nonvitrectomized eyes were 397.8, 360.4, 154.4, 48.5, 30.7, 15.2, and 8.0 ng/mL, respectively. Triamcinolone acetonide concentrations were significantly higher in the vitrectomized eyes at days 1, 3, 7, and 14. The terminal half-life of intravitreal TA was 23.3 days in the vitrectomized eyes and 28.9 days in the nonvitrectomized eyes. CONCLUSION: Intravitreal absorption and excretion of TA in the posterior subtenon space are increased after vitrectomy. Although the terminal half-life of TA was shorter, higher early concentration and similar effective duration were achieved in the vitrectomized eyes.

The effect of a systemic angiotensin receptor blocker on vascular endothelial growth factor in the vitreous of patients with proliferative diabetic retinopathy.

PURPOSE: Renin-angiotensin system (RAS) is reportedly associated with the vitreous level of vascular endothelial growth factor (VEGF) in proliferative diabetic retinopathy (PDR). This study was conducted to investigate the effect of systemic angiotensin receptor blocker (ARB) on vitreous VEGF in PDR. METHOD: Patients who underwent a vitrectomy due to PDR were divided into two groups: patients who were taking ARB to control hypertension (Group A) and normotensive patients (Group B). Patients having epiretinal membrane or macular hole without diabetes or hypertension were included in the control group (Group C). We assessed the best-corrected visual acuity (BCVA) and VEGF levels of the vitreous fluid and the serum using enzyme-linked immunosorbent assay. RESULTS: Nineteen eyes were in Group A, 27 eyes in Group B, and 30 eyes in Group C. The mean levels of vitreous VEGF were 487.5 pg/ml in Group A and 553.0 pg/ml in Group B. In Group C, the vitreous VEGF was below the detection limit in 29 of the 30 eyes. The mean serum VEGF levels were 384.8 pg/ml, 384.6 pg/ml, and 388.1 pg/ml, respectively. The ratio of vitreous VEGF to serum was 4.0 in Group A and 2.97 in Group B. There were no differences in vitreous and serum VEGF levels between two groups. The median BCVA of Groups A and B significantly improved from 1.55 and 1.10 at baseline to 0.55 and 0.30 respectively at 6 months (logarithm of minimal angle resolution, p < 0.005). No differences were found in visual acuity. CONCLUSION: Systemic ARB did not show beneficial effects with respect to the vitreous level of VEGF or functional outcomes after vitrectomy in patients with PDR.

A case of presumed acute retinal necrosis after intraocular foreign body injury.

The aim of this study was to report a case of acute retinal necrosis (ARN) after intraocular foreign body removal. A 32-year-old male presented with visual loss in the left eye. He was hit by an iron fragment while he was hammering. An intraocular foreign body was found with corneal laceration and traumatic cataract. On the day he was injured, primary closure of the laceration, lensectomy, and vitrectomy were performed, and the foreign body was removed. The day after the operation, there was no sign of retinal detachment or retinitis. Two days after the operation, retinal necrosis and accompanying vitreous inflammation were noted in the far periphery. On day 3, the necrosis spread circumferentially and inflammation became more distinct. ARN was presumed and intravenous acyclovir was administered. The necrotic areas were reduced 2 days later, and were resolved in 1 month. The final visual acuity in his left eye was 20/20 after implantation of an intraocular lens. This case is the first report of ARN after penetrating injury and an intraocular foreign body. ARN may develop after open-globe injury.

Bell's phenomenon during screening examination for retinopathy of prematurity.

PURPOSE: Bell's phenomenon (BP), which may disturb screening examinations for retinopathy of prematurity (ROP), is known to present infrequently in premature babies. Stress associated with the examinations can influence expression of BP. The authors of the present study evaluated BP during examinations for ROP. METHODS: The present study included 102 eyes of 51 premature babies. Expression of BP was assessed at 3 steps of the examination in the following order: after insertion of a speculum, after illumination of an indirect ophthalmoscope and after scleral depression. The relationship between the expression of BP and the gestational age at the examination was analyzed in each step of the examination. RESULTS: The frequency of BP after the speculum insertion and the illumination was 77% to 92% in infants 32 weeks of age or younger, and decreased significantly to 16% to 57% in infants 42 weeks of age or older (p < 0.005). BP after the scleral depression had no significant association with the gestational age. Frequency of BP increased significantly as the steps of the examination proceeded (p < 0.01). CONCLUSIONS: BP was frequent in premature infants during ROP examination in spite of neurological immaturity. The examiner should take BP into consideration, which frequently occurs in younger infants.

Effect of intravitreal triamcinolone injection during vitrectomy for idiopathic epiretinal membrane.

PURPOSE: To investigate the effect of intravitreal triamcinolone injections as an adjuvant of vitrectomy for idiopathic epiretinal membrane. METHODS: This study included 58 eyes of 58 patients who were diagnosed as having idiopathic epiretinal membrane and who underwent vitrectomy and membrane peeling. They were divided into 2 groups: 27 eyes in the injected group that received triamcinolone injection during the surgical procedure and 31 eyes in the control group that did not receive injection. The best-corrected visual acuity, foveal thickness, and complications were compared between the two groups. RESULTS: Average visual acuity of the injected group improved from 0.70 logarithm of the minimal angle of resolution (logMAR) (Snellen equivalent, 20/100; range, 20/25-20/200) at baseline to 0.59 logMAR (20/80; range, 20/40-20/200) at 1 month and 0.55 logMAR (20/70; range, 20/30-20/200) at 3 months. Foveal thickness reduced from 456.9 µm (range, 307-740 µm) to 387.9 µm (range, 238-584 µm) at 1 month and 336.4 µm (range, 225-529 µm) at 3 months, respectively. In the control group, average visual acuity improved from 0.63 logMAR (20/80; range, 20/40-20/300) to 0.48 logMAR (20/60; range, 20/25-20/125) and 0.43 logMAR (20/50; range, 20/25-20/160) at 1 month and 3 months, respectively. Foveal thickness reduced from 467.1 µm (range, 328-621 µm) to 376.1 µm (range, 271-429 µm) and 375.1 µm (range, 236-475 µm) at 1 month and 3 months, respectively. There were no significant differences in the visual acuity, foveal thickness, and any complications between the two groups during follow-up. CONCLUSION: Intravitreal injection of triamcinolone combined with vitrectomy for idiopathic epiretinal membrane did not affect postoperative foveal thickness and functional recovery.

Intravitreal triamcinolone acetonide for rebound phenomenon after high-dose intravenous steroid treatment in Vogt-Koyanagi-Harada disease.

The authors report two cases of rebound phenomenon treated with intravitreal triamcinolone acetonide in Vogt-Koyanagi-Harada (VKH) disease. Patients in the acute phase of VKH disease were treated with high-dose intravenous (IV) methylprednisolone (1 g/day) for 3 days. Serous retinal detachment decreased and visual acuity improved during IV steroid treatment. After switching to oral steroid treatment, choroiditis and visual acuity worsened. An injection of triamcinolone acetonide (4 mg) into the vitreous resulted in gradual resolution of subretinal fluid and improvement of visual acuity. Systemic steroids were tapered to discontinuation without a relapse of inflammation. Adjuvant intravitreal triamcinolone is useful in the management of the rebound phenomenon in VKH disease.

Photoreceptor layer assessed in tissue layer image using spectral-domain optical coherence tomography after surgical closure of macular hole.

PURPOSE: To investigate changes in the photoreceptor layer in tissue layer images using spectral-domain optical coherence tomography after macular hole surgery. METHODS: Visual acuity and spectral-domain optical coherence tomography scans were obtained in 24 eyes with surgically closed macular holes prospectively at 1, 2, 4, and 6 months after surgery. The scanned data were processed to generate tissue layer images of the photoreceptor layer, namely, photoreceptor layer map. Hyporeflective area and reflectivity at the fovea were analyzed to find a correlation with visual acuity. RESULTS: Mean visual acuity improved from 48.1 letters preoperatively to 62.5 letters at 1 month and to 73.8 letters at 6 months. Hyporeflective area in the photoreceptor layer map corresponded to attenuated signals from the junction of the inner and outer segments of the photoreceptors. Hyporeflective area decreased from 1.54 mm at 1 month to 0.60 mm at 6 months. Foveal reflectivity increased from 0.77 to 0.85. Visual acuity correlated with the hyporeflective area (r = 0.43-0.63) and foveal reflectivity (r = 0.35-0.61). CONCLUSION: After macular hole closure, attenuated signal from the junction of the inner and outer segments of the photoreceptors representing disorganization of the photoreceptor layer was shown in the photoreceptor layer map as a hyporeflective area, which correlated with the postoperative visual acuity. Hyporeflectivity decreased gradually with concurrent improvement in visual acuity.

Intraocular toxicity and pharmacokinetics of candesartan in a rabbit model.

PURPOSE: To investigate the intravitreal toxicity and pharmacokinetics of candesartan, a selective type 1 angiotensin II receptor blocker, in rabbit eyes. METHODS: For the toxicity study, 15 white rabbits were divided into three groups (five rabbits each). Different candesartan doses, namely 0.5, 1, and 2 mg in 0.1 mL, were injected into the vitreous of the right eye in each of the five rabbits. The vehicle solution was injected into the left eye as a control. ERG was recorded at 1, 3, and 7 days after injection. Retinal histology was examined by light microscope and transmission electron microscope. For pharmacokinetics analysis, one eye of each of the 30 rabbits received an intravitreal injection of candesartan (1 mg/0.1 mL). The concentration of candesartan in the vitreous was measured by a liquid chromatograph-triple quadrupole mass spectrometer at 12, 24, 36, 48, 60, and 72 hours after injection. RESULTS: No significant difference in ERG was found between the study and the control eyes of the 0.5-mg group. The dark-adapted b-wave amplitudes decreased significantly at -10-dB intensities of stimulation in the 1-mg group. The b-wave amplitudes were significant at all intensities in the 2-mg group. Histologic studies revealed normal retinal morphology and structures in all eyes. The half-life of candesartan was 6.8 hours in the rabbit eyes. CONCLUSIONS: Intravitreal injection of 0.5 mg candesartan would be safe in the rabbit eyes. The half-life of candesartan was short in the vitreous, and modification of the delivery method would be required to extend the action duration for clinical applications.

The effect of the YK lens in keratoconus.

PURPOSE: To report the clinical results of the use of the YK contact lens (Lucid Co., Seoul, Korea) for keratoconus. METHODS: One hundred and twenty nine keratoconic eyes were fitted with a YK lens which has one base curve and three peripheral curves. A light feather touch fluorescein pattern was obtained based on topographic indices. Visual acuity, comfort, mean wearing time, and ocular tissue changes were evaluated. Mean follow up was 17.5 +/- 13.8 months (range 6-75). RESULTS: One hundred and twenty six (97.6%) eyes tolerated the contact lenses. A total of 94.5% of the eyes achieved a visual acuity of 20/40 or better (average 0.79 +/- 0.21), and flatter base curve radius (BCR) was related to better visual acuity. One hundred and seventeen (90.7%) eyes reported that the lenses were comfortable. Mean wearing time was 12.1 h per day (range 4-18). Changes in keratometric values were not significant between baseline and final follow-up visit. CONCLUSIONS: The YK lens can provide successful visual outcome, with comfort, and no significant influence on the progression of keratoconus.

Results of vitrectomy for breakthrough vitreous hemorrhage associated with age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: The purpose of this study was to evaluate the results of vitrectomy in patients with vitreous hemorrhage associated with age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS: A retrospective review was conducted of consecutive cases of patients undergoing pars plana vitrectomy for nonclearing vitreous hemorrhage associated with neovascular AMD or PCV. RESULTS: Twenty-four eyes of 23 patients were included. The mean length of time from the onset of vitreous hemorrhage to operation was 4.3 months. Twelve eyes had AMD, and 12 eyes of 11 patients had PCV. Additional treatments for active choroidal neovascularization or PCV were required in 12 eyes during follow-up. The mean visual acuity improved significantly from a logarithm of the minimum angle of resolution of 2.79 +/- 0.85 before operation to 1.61 +/- 0.98 at 2 months after operation (P < 0.001). Visual acuity was >or=20/200 in 9 eyes (37.5%) at 2 months after operation; 1 eye was in the AMD group, and the other eyes were in the PCV group. Improvement was more frequently observed in the PCV group (P = 0.005). CONCLUSION: In this series, the functional outcomes of vitrectomy for vitreous hemorrhage associated with AMD were inferior to outcomes of the PCV group. Vitrectomy is beneficial for improving visual function in select cases of breakthrough vitreous hemorrhage.

Evaluation of differentially expressed genes identified in keratoconus.

PURPOSE: To identify the differentially expressed genes (DEGs) in the human keratocytes in keratoconus. METHODS: Total RNA extracted from cultured corneal stromal fibroblasts from normal and keratoconic corneas were used for the synthesis of cDNA. DEGs were screened by an annealing control primer(TM)-based PCR method using GeneFishing() DEG kits. The differentially expressed bands were sequenced and analyzed. The genes identified were further evaluated by reverse transcriptase PCR and quantitative real-time PCR. RESULTS: Overexpression of bone morphogenetic protein 4 (BMP4), cofilin 1 (CFL1), and JAW1-related protein (MRVI1) and underexpression of actin, alpha 2 (ACTA2), gene rich cluster, and C 10 gene (GRCC10), tissue inhibitor of metalloproteinase 3 (TIMP3), tissue inhibitor of metalloproteinase 1 (TIMP1), and somatostatin receptor 1 (SSTR1) were verified, and these results were confirmed by reverse transcriptase PCR and quantitative real-time PCR. CONCLUSIONS: Eight genes were identified to be differentially expressed in keratoconus and related with apoptosis, the cytoskeleton, wound healing, and nerve fibers. The genes identified may be involved in the mechanism underlying stromal thinning; thus, they could be important and deserve further investigation.

Edema of the photoreceptor layer in Vogt-Koyanagi-Harada disease observed using high-resolution optical coherence tomography.

PURPOSE: To evaluate the characteristics of fluid accumulation in the uveitic stage of Vogt-Koyanagi-Harada (VKH) disease using high resolution optical coherence tomography (OCT3). METHODS: Twenty-eight eyes in 14 patients with VKH disease were reviewed retrospectively. These 28 eyes were divided into 19 eyes with intraretinal fluid (C group) and 9 eyes without intraretinal fluid (N group). Changes in visual acuity and fluid accumulation observed using OCT were compared between the two groups. RESULTS: Visual acuity at the time of presentation was significantly worse in the C group than in the N group (p=0.005). The photoreceptor layer appeared to be double-layered due to a cystoid space in the C group. Layered structures and strands found in the cystoid space. Expanding sponge-form edema led to the development of a cystoid space in the photoreceptor layer. Intraretinal fluid resolved earlier than subretinal fluid. There were no observed differences in visual acuity between the two groups after four days of treatment. CONCLUSIONS: Accumulation of intraretinal fluid was related to poor initial visual acuity, but not to final visual acuity. High resolution OCT findings indicate that edema of the photoreceptor layer participates in the development of a cystoid space.

Effect of fat embolism with triolein emulsion on blood-retinal barrier.

BACKGROUND: Triolein emulsion is under investigation for supplemental use to open the blood-brain barrier during chemotherapy. The effects of triolein emulsion on the blood-retinal barrier (BRB) were investigated. METHODS: Fat emboli were induced in 20 cats by injecting triolein emulsion through the carotid artery. At 30 min, 4, 12 and 48 h after embolization, electroretinography (ERG) and fluorescein angiography (FA) were performed. The eyeballs were enucleated for transmission electron-microscopic study. RESULTS: FA revealed multiple leaking points at 30 min, and prominent diffuse leakage at 4 h when scotopic b-waves showed significant differences between the study and control eyes. Multiple focal disruptions of the blood vessels by fat vacuoles were found with electron microscopic study. ERG improved at 12 and 48 h, and the BRB appeared to be recovered on FA and electron microscopic studies after 48 h. CONCLUSION: An experimental embolism with triolein emulsion disrupted the blood retinal barrier. Delayed maximal change was observed, and it could be implicated in the latent interval of clinical fat embolism syndrome.