PURPOSE: To evaluate the effect of adjunctive subtenon injection of triamcinolone acetonide (TA) in gas-filled eyes after vitrectomy for complicated proliferative diabetic retinopathy (PDR). METHODS: This nonrandomized comparative study included 27 patients (27 eyes) who underwent pars plana vitrectomy and gas tamponade for treatment of PDR with tractional or combined tractional-rhegmatogenous retinal detachment and who received subtenon injection of TA (40 mg) at the end of surgery. The study group was compared with the control group (29 eyes), which was matched with the study group for preoperative and intraoperative parameters, but underwent pars plana vitrectomy and gas tamponade without a subtenon injection of TA. RESULTS: Retinal reattachments without reoperation were achieved in 25 eyes (92.6%) and 26 eyes (89.7%) at 6 months (p = 1.000) in the study and control groups, respectively. The study group and the control group did not differ significantly in the frequency of postoperative proliferative vitreoretinopathy, retinal redetachment rate, reoperation rate, macular pucker formation, postoperative vitreous hemorrhage, gain in visual acuity, intraocular pressure, and intraocular inflammation (p > 0.05). CONCLUSIONS: The clinical results of pars plana vitrectomy for complicated PDR are not improved significantly by an adjunctive subtenon TA injection in gas-filled eyes.
Diabetic Retinopathy/complications/*therapy ; Female ; Gases ; Glucocorticoids/administration & dosage ; Humans ; Injections ; Male ; Middle Aged ; Tenon Capsule ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Vitrectomy/*methods ; Vitreoretinopathy, Proliferative/etiology/*therapy

PURPOSE: To investigate the morphologic changes in the outer retina of patients with cone dystrophy, using spectral-domain optical coherence tomography (SD-OCT). METHODS: The medical records of 15 cone dystrophy patients examined from January 2007 to January 2012 were reviewed retrospectively. All patients underwent ophthalmic evaluation including best-corrected visual acuity (BCVA), color vision testing, fundus examination, full-field standard electroretinography (ERG), multifocal (mf) ERG, and SD-OCT. Qualitative and quantitative SD-OCT data and ERG responses were analyzed and compared among the patient categories and the normal control group. RESULTS: There were 4 major categories of SD-OCT findings, based on the status of the ellipsoid portion of the photoreceptor inner segment (ISe), outer segment (OS) contact cylinder, and retinal pigment epithelium (RPE) layer. Category 0 showed no structural abnormalities. Category 1 showed foveal ISe loss and obscurity of the border between the ISe band and the external limiting membrane (ELM). Category 2 showed foveal thinning and focal foveal ISe disruption with an intact ELM. Category 3 showed foveal thickening and perifoveal disruption of the ISe layer. Category 1 to 3 showed OS contact cylinder layer absence and RPE thickening. The patients in category 0 tended to be younger (mean, 10.0 years) than those in categories 1 to 3 (mean, 17.6 years), although this difference was not statistically significant. Category 1 to 3 patients exhibited statistically significant thinning of the central retina and outer nuclear layer and thickening of the RPE layer relative to the category 0 and normal control group. There was a significant correlation between the central foveal thickness and BCVA in the patients with cone dystrophy. ERG and mfERG responses did not differ significantly among the different cone dystrophy categories. CONCLUSIONS: The morphologic features of cone dystrophy as revealed by SD-OCT, could be categorized as either normal or 1 of 3 different types of outer retinal changes. The presence of normal retinal structures in young cone dystrophy patients with functional impairment (category 0) indicates that electrophysiologic studies are superior to current imaging modalities for the early diagnosis of cone dystrophy. The characteristic SD-OCT findings in cone dystrophy patients may aid in differential diagnosis and be useful for future research on the pathology of cone dystrophy.
Adolescent ; Adult ; Child ; Child, Preschool ; Electroretinography ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Male ; Middle Aged ; Ophthalmoscopy ; Reproducibility of Results ; Retinal Cone Photoreceptor Cells/*pathology ; Retinal Dystrophies/*pathology/physiopathology ; Retrospective Studies ; Tomography, Optical Coherence/*methods ; Visual Acuity ; Young Adult

PURPOSE: To compare the efficacy of the transconjunctival releasable suture technique for pars plana vitrectomy using 23-gauge (23G) instruments versus the conventional 20-gauge (20G) technique. METHODS: A retrospective and interventional case series was consecutively performed for 199 eyes of the 192 patients that were a part of this study. Clinical data were reviewed retrospectively regarding the operation time, preoperative and postoperative intraocular pressure, visual acuity and astigmatism for 54 consecutive patients who received a 23G releasable suture vitrectomy and for 98 consecutive patients who received a 20G conventional vitrectomy during the period between April 2007 and September 2010. RESULTS: Mean operation time based on the operation record was 88.5 +/- 20.1 minutes in the 23G releasable suture vitrectomy group and 102.1 +/- 23.1 minutes in the 20G conventional vitrectomy group, respectively (p = 0.01). The last best-corrected visual acuity (BCVA) was significantly better than the preoperative BCVA in both patient groups (p = 0.01, p = 0.01). The 23G releasable suture group showed less surgically induced astigmatism than the 20G conventional vitrectomy group. Vitreous bleeding was observed to be in 6 eyes (5.9%) in the 23G group, and in 8 eyes (8.2%) in the 20G group. In addition, ocular hypertension was noted to be in 3 eyes (3.0%) in the 23G group, and 6 eyes (6.1%) in the 20G group. No serious complications such as postoperative hypotony or endophthalmitis were observed in either group. CONCLUSIONS: The 23G releasable suture technique is as effective as the 20G conventional technique and offers several advantages.
Adult ; Aged ; Equipment Design ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Suture Techniques/*instrumentation ; *Sutures ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods ; Vitreous Hemorrhage/physiopathology/*surgery

PURPOSE: To evaluate changes over time of the anterior capsule opening size after phacoemulsification, based on haptic number and composition of three acrylic intraocular lenses (IOLs). METHODS: Fifty-five patients (70 eyes) were included. All underwent phacoemulsification followed by implantation of either an acrylic IOL with two-haptic (one-piece, 26 eyes; three-piece, 22 eyes), or four-haptic (one-piece, 22 eyes). The area of the anterior capsule opening size was measured one week postoperatively (baseline) and at three months. RESULTS: There was a significant reduction in the area of the anterior capsule opening from one week as compared to three months postoperatively in all groups (p < 0.001). However, there was no significant difference in the reduction in the anterior capsule opening between the IOLs (p = 0.36). CONCLUSIONS: The number and material of the haptic of the three acrylic IOLs did not influence the degree of anterior capsule opening shrinkage.
*Acrylic Resins ; Aged ; Cataract Extraction/*methods ; Female ; Follow-Up Studies ; Humans ; Lens Capsule, Crystalline/*physiopathology ; *Lenses, Intraocular ; Male ; *Polymethyl Methacrylate ; Postoperative Period ; Prosthesis Design ; Retrospective Studies ; *Silicone Elastomers

PURPOSE: To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis. METHODS: A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation. RESULTS: The pre- and postoperative MRD1 averaged 1.1 +/- 0.8 mm and 2.8 +/- 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery. CONCLUSIONS: Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis.
Aged ; Aged, 80 and over ; Blepharoplasty/*methods ; Blepharoptosis/*surgery ; Dissection/*methods ; Eyelids/*surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/surgery ; Orbit/*surgery ; Retrospective Studies ; *Sutures ; Treatment Outcome

Livedoid vasculopathy (LV) is characterized by a long history of ulceration of the feet and legs and histopathology indicating a thrombotic process. We report a case of acute central retinal artery occlusion in a 32-year-old woman who had LV. She showed no discernible laboratory abnormalities such as antiphospholipid antibodies and no history of cerebrovascular accidents. Attempted intra-arterial thrombolysis showed no effect in restoring retinal arterial perfusion or vision. The central retinal artery occlusion accompanied by LV in this case could be regarded as a variant form of Sneddon's syndrome, which is characterized by livedo reticularis and cerebrovascular accidents.
Acute Disease ; Adult ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Retinal Artery Occlusion/diagnosis/*etiology/physiopathology ; Sneddon Syndrome/*complications/diagnosis ; *Visual Acuity

A 50-year-old man had undergone lumbar vertebral surgery and was confined to bed in the supine position for three months. When he sat up from the prolonged supine position, he showed clinical signs of orthostatic hypotension and reported decreased vision in both eyes. He also had underlying anemia. Ophthalmologic findings suggested bilateral anterior ischemic optic neuropathy (ION) as the cause of the visual loss. Although there are numerous reports of ION in the setting of hemodynamic compromise, such as systemic hypotension, cases of ION-associated orthostatic hypotension are very rare.
Acute Disease ; Blindness/diagnosis/*etiology/physiopathology ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Hypotension, Orthostatic/*complications/physiopathology ; Male ; Middle Aged ; Visual Acuity

PURPOSE: Recent reports suggest the association of human papilloma virus (HPV) with retinoblastoma. This study was performed to elucidate whether HPV infection is related to retinoblastoma among Koreans. METHODS: A total of 54 cases diagnosed with retinoblastoma were enrolled from Seoul National University Children's Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center. Presence of human papilloma viral DNA was detected by in situ hybridization in formalin-fixed paraffin-embedded retinoblastoma tissues using both probes against high- and low risk HPV types. RESULTS: The mean age at diagnosis was 22.0 months (range, 1.1 to 98.0 months), and the mean age at enucleation was 27.8 months (range, 1.5 to 112.7 months) among the 54 patients with retinoblastoma. HPV was not detected in any of the retinoblastoma samples using either high risk or low risk HPV probes. CONCLUSIONS: Our study, being the first study in the Korean population, proposes that HPV infection may have no causal relationship with retinoblastoma in Koreans.
Child, Preschool ; DNA, Viral/*analysis ; Eye Infections, Viral/complications/diagnosis/*epidemiology ; Female ; Humans ; In Situ Hybridization ; Incidence ; Infant ; Male ; Papillomaviridae/*genetics ; Papillomavirus Infections/complications/diagnosis/*epidemiology ; Prevalence ; Prognosis ; Republic of Korea/epidemiology ; Retinal Neoplasms/complications/pathology/*virology ; Retinoblastoma/pathology/*virology

PURPOSE: To compare the success rates, complications, and visual outcomes between silicone Ahmed glaucoma valve (AGV) implantation with 96 mm2 (FP8) or 184 mm2 (FP7) surface areas. METHODS: This study is a retrospective review of the records from 132 adult patients (134 eyes) that underwent silicone AGV implant surgery. Among them, the outcomes of 24 eyes from 24 patients with refractory glaucoma who underwent FP8 AGV implantation were compared with 76 eyes from 76 patients who underwent FP7 AGV implantation. Preoperative and postoperative data, including intraocular pressure (IOP), visual acuity, number of medications, and complications were compared between the 2 groups. RESULTS: There were no significant differences in baseline characteristics between the 2 groups (p > 0.05). The postoperative visual acuity of the patients in the FP8 group was better than that of the patients in the FP7 group in some early postoperative periods (p < 0.05); however, after 10 postoperative months, visual acuity was not significantly different through the 3-year follow-up period (p > 0.05). Postoperative IOP was not significantly different between the 2 groups (p > 0.05) except for IOP on postoperative day 1 (11.42 mmHg for the FP7 group and 7.42 mmHg for the FP8 group; p = 0.031). There was no statistical difference in success rates, final IOP, number of medications, or complication rates between the 2 groups (p > 0.05). CONCLUSIONS: The FP7 and FP8 AGV implants showed no difference in terms of vision preservation, IOP reduction, and number of glaucoma medications required.
Adult ; Female ; Glaucoma/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Humans ; Intraocular Pressure/*physiology ; Male ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; *Silicone Elastomers ; Tonometry, Ocular ; Treatment Outcome ; Visual Acuity

PURPOSE: To identify the unique pathologic findings of retinal angiomatous proliferation (RAP) in optical coherence tomography (OCT). METHODS: Retrospectively, 29 eyes of 25 patients with age-related macular degeneration and complicated RAP were analyzed. All 29 eyes had choroidal neovascularization (CNV) in the area of pigment epithelial detachment (PED) or adjacent to it, which was visible with fluorescein angiography or indocyanine green angiography. Cross-sectional images were obtained by OCT scanning through the CNV lesions. RESULTS: Six distinctive findings of OCT included drusen (100%), inner retinal cyst (80%), outer retinal cyst (68%), fibrovascular PED (84%), serous retinal detachment (40%), and PED (68%). CONCLUSIONS: Through analysis of OCT findings, we revealed six different types of lesions distinctive of RAP which may provide helpful diagnostic information for subsequent treatment and predicting the prognosis of RAP.
Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Macular Degeneration/*complications/diagnosis ; Male ; Middle Aged ; Reproducibility of Results ; Retina/*pathology ; Retinal Neovascularization/*diagnosis/etiology ; Retrospective Studies ; Severity of Illness Index ; Tomography, Optical Coherence/*methods