Changes in the Visual Field Test after Descemet Stripping Automated Endothelial Keratoplasty in Advanced Glaucoma.

Background: To evaluate changes in the visual field (VF) after Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with advanced glaucoma and previous trabeculectomy. Methods: Changes in VF, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications were analyzed before and after DSAEK in 19 eyes. The VFs were evaluated using the 10-2 program of the Humphrey Field Analyzer (HFA) and/or Goldmann perimetry (GP). Results: In nine eyes, the MD improved from -22.24 ± 6.5 dB to -18.36 ± 5.1 dB in HFA. In five out of nine eyes, postoperative MD improved >1 dB compared to preoperative MD. In GP testing, 10 out of 15 eyes showed an improvement, that is, greater than 20° in VF enlargement by the isopter of I-4e and/or new detection of a smaller or darker isopter. Overall, improvement in VF with the HFA and/or GP test was observed in 12/19 (63.2%) eyes after DSAEK. Postoperative BCVA improved by more than two lines in logMAR VA in 18 of 19 (94.7%) eyes. There were no significant differences between the preoperative and postoperative IOP and the number of glaucoma medications. Conclusions: DSAEK may produce subjective improvement in the visual field as well as improved visual acuity, even in advanced glaucomatous eyes.

Case of bilateral Mooren's ulcers following filtering surgery using EX-PRESS glaucoma filtering devices.

PURPOSE: To report our findings in a case of bilateral Mooren's ulcer that developed after filtering surgeries using the EX-PRESS glaucoma filtering device (EX-PRESS surgery). PATIENTS AND METHODS: A 71-year-old Japanese man with primary open angle glaucoma underwent EX-PRESS surgery first in his left eye and 1 month later in his right eye. He developed Mooren's ulcer in his right eye at 7 months and in his left eye at 10 months after the initial EX-PRESS surgery. Systemic examinations showed no collagen vascular disease, and he did not have a history of bacterial or viral infections. He was not allergic to metallic materials. Before the EX-PRESS surgery, he had underdone cataract surgery combined with trabeculotomy in both eyes, and a reoperation of trabeculotomy in his left eye. He had not developed Mooren's ulcer after these surgeries. The Mooren's ulcer after the EX-PRESS surgery was treated with oral prednisolone (30 mg tapering) in combination with topical 0.1% betamethasone sodium. The ulcers were responsive and healed well in three months. CONCLUSIONS: The EX-PRESS devices were most likely the cause of the Mooren's ulcers considering that they were located close to the site of EX-PRESS insertion and no peripheral corneal ulcer developed after prior intraocular surgeries.

Incidence of late-onset ocular hypertension following uncomplicated pars plana vitrectomy in pseudophakic eyes.

PURPOSE: To determine the incidence of late-onset ocular hypertension following uncomplicated vitrectomy in pseudophakic eyes with an open angle. DESIGN: A retrospective observational case series. METHODS: Seven hundred and sixty-seven eyes of 767 patients that underwent vitrectomy combined with cataract surgery in 1 eye were studied. There were 383 men and 384 women. The indications for vitrectomy were: 308 eyes with rhegmatogenous retinal detachment, 202 eyes with epiretinal membrane, 169 eyes with macular hole, 44 eyes with vitreous hemorrhage, 16 eyes with subretinal hemorrhage, 15 eyes with vitreomacular traction syndrome, 12 eyes with vitreous opacity, and 1 eye with retinoschisis. Of these, 176 eyes underwent vitrectomy alone because of previous cataract surgery. Late-onset ocular hypertension was defined as an intraocular pressure (IOP) >21 mm Hg that developed more than 2 months postoperatively in at least 2 postoperative visits. An increase in the IOP >4 mm Hg over the preoperative IOP was necessary. Eyes with ocular hypertension, glaucoma (suspect), or a possibility of IOP elevation were excluded. RESULTS: The mean age was 63 ± 11 years. The mean follow-up duration after vitrectomy was 47.8 ± 25.3 months. Thirty-two eyes (4.2%) developed late-onset ocular hypertension. The mean age was 60 ± 10 years. The mean interval between vitrectomy and development of ocular hypertension was 31.1 ± 26.0 months. There were no significant differences in the incidence of late-onset ocular hypertension and the vitreoretinal disease for vitrectomy, sex, or gauge of instruments for vitrectomy. CONCLUSION: Long-term IOP monitoring is necessary after vitrectomy.

The clinical characteristics of fungal keratitis in eyes after Descemet's stripping and automated endothelial keratoplasty.

The purpose of this study was to describe the clinical characteristics of fungal keratitis caused by Candida albicans in an eye after Descemet stripping automated endothelial keratoplasty (DSAEK). A 72-year-old male with a history of three trabeculectomies, cataract surgery, and two DSAEK procedures developed a corneal ulcer in his right eye two years after his last DSAEK. Fungal keratitis was most likely related to the immunosuppressive conditions that occurred due to the previous operations, the continuous use of steroid eye drops, and the use of disposable soft contact lenses. A smear and culture from the ulcer detected Candida albicans. Slit-lamp examination showed the characteristic feature was the presence of interface infiltrates located between the host and the graft cornea and in the enlarged area around the ulcer. Two weeks after intense antimycotic treatments with voriconazole, miconazole, and natamycin, perforation of the cornea occurred and further therapeutic penetrating keratoplasty was required. Histological analysis revealed an accumulation of infiltrated cells and fibrotic tissue. The poor prognosis for fungal keratitis that occurs in eyes after undergoing DSAEK may be related to the rapid expansion of inflammatory cells through the interface between the host and the graft. In eyes that develop fungal keratitis after DSAEK, special attention should be paid to the possibility that perforation could occur in these patients.

Successful resolution of endophytic optic disk hemangioma by photodynamic therapy.

PURPOSE: To report the successful resolution of an endophytic optic disk hemangioma (ODH) by photodynamic therapy. METHODS: Case report. RESULTS: A 48-year-old man presented with endophytic ODH in his right eye. His best-corrected visual acuity was 1.2 in the right eye, but there was a serous retinal detachment with exudations extending from the tumor. Two intravitreal injections of bevacizumab were given with an interval of 6 months; however, the size of the ODH continued to increase and the best-corrected visual acuity decreased from 1.2 to 0.2. One year after the last injection of bevacizumab, 2 sessions of photodynamic therapy were performed with an interval of 4 months. The follow-up examination 2 years after the second photodynamic therapy showed that the ODH was reduced in size and its activity was low. The best-corrected visual acuity remained at 0.3. CONCLUSION: The findings indicate that photodynamic therapy can be an effective therapy for eyes with an ODH.

Difference in morning and evening choroidal thickness in Japanese subjects with no chorioretinal disease.

BACKGROUND AND OBJECTIVE: To determine whether the choroidal thickness varies significantly according to the time of measurement in Japanese subjects without chorioretinal diseases. PATIENTS AND METHODS: Twelve eyes of 12 subjects were examined with enhanced depth imaging spectral-domain optical coherence tomography. The choroidal thickness was measured in the mornings (9:00 to 9:30 AM) and evenings (7:30 to 8:00 PM) at three locations: the fovea, 1.5 mm temporal to the fovea, and 1.5 mm nasal to the fovea. RESULTS: The mean age of the subjects was 62.6 ± 14.5 years. For the morning measurements, the mean choroidal thickness was 308.5 ± 74.4 µm at the fovea, 276.2 ± 84.6 µm temporally, and 239.3 ± 98.4 µm nasally. For the evening measurements, the mean choroidal thickness was 328.8 ± 85.6 µm at the fovea, 284.8 ± 91.6 µm temporally, and 248.9 ± 101.5 µm nasally. The mean subfoveal (P < .0001) and nasal (P = .03) choroidal thicknesses were significantly thicker in the evenings than in the mornings. There was no significant difference in the mean temporal choroidal thickness (P = .08). CONCLUSION: The choroidal thickness varies according to the time of measurement.

Triamcinolone acetonide-assisted peeling of the internal limiting membrane.

PURPOSE: We report on a new technique to peel the internal limiting membrane (ILM) using triamcinolone acetonide (TA) to facilitate visualization during surgery. DESIGN: Interventional case series. METHODS: In four eyes of four patients with macular hole, TA was used during vitrectomy to visualize the hyaloid. After the posterior hyaloid was surgically separated from the optic nerve head and posterior retina, TA suspension was injected over the posterior pole. Intraocular forceps was used to peel the ILM in a circumferential manner around the macular hole. RESULTS: Numerous particles of TA were dispersed over the posterior retina as white specks. Once the ILM was peeled, the peeled area was clearly visualized as an area lacking the white specks. In all patients, the macular holes closed. No adverse reactions were observed during the 3-month follow-up period. CONCLUSIONS: TA-assisted ILM peeling is an effective and safe technique for macular hole surgery.

Intracorneal hematoma with descemet membrane detachment after viscocanalostomy.

PURPOSE: To describe a case of intracorneal hematoma with Descemet membrane detachment after viscocanalostomy. DESIGN: Interventional case report. METHODS: A 63-year-old with uncontrolled primary open-angle glaucoma underwent viscocanalostomy. During the introduction of hyaluronate 2.3% under the superficial flap, a limited lysis of Descemet membrane was observed. RESULT: Slit-lamp biomicroscopy showed an intracorneal hematoma with Descemet membrane detachment 1 day after viscocanalostomy. The creation of an intentional break of Descemet membrane and descemetopexy using sulfur hexafluoride gas were performed. The cornea regained transparency after surgery. CONCLUSIONS: Intracorneal hematoma with Descemet membrane detachment is a possible complication of viscocanalostomy.