A 24 year-old Malay lady presented with high grade fever, myalgia, generalized rashes, severe headache and was positive for dengue serology test. Her lowest platelet count was 45 × 10(9) cells/L. She complained of sudden onset of painlessness, profound loss of vision bilaterally 7 days after the onset of fever. On examination, her right eye best corrected vision was 6/30 and left eye was 6/120. Her anterior segment examination was unremarkable. Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid. Systemic examination revealed normal findings except for residual petechial rashes. She was managed conservatively. Her vision improved tremendously after 2 months. The retinal hemorrhages and foveal elevation showed sign of resolving. Ocular manifestations following dengue fever is rare. However, bilateral visual loss can occur if both fovea are involved.
Dengue ; complications ; diagnosis ; Female ; Fovea Centralis ; pathology ; Humans ; Macula Lutea ; pathology ; Retinitis ; diagnosis ; etiology ; Vision Tests ; Young Adult

PURPOSE: This study was designed to assess and compare the thicknesses of the fovea and the retinal nerve fiber layer in normal children and children with amblyopia. METHODS: Optical Coherence Tomography (OCT) was performed on 26 children (52 eyes total) with unilateral amblyopia that was due to anisometropia or strabismus. OCT was also performed on 42 normal children (84 eyes), for a total of 136 eyes. Retinal thickness measurements were taken from the fovea, and the retinal nerve fiber layer thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. RESULTS: The average age of the normal children was 8.5 years, and the average age of the children with amblyopia was 8.0 years. The average thickness of the fovea was 157.4 micrometer in normal eyes and was 158.8 micrometer in amblyopic eyes. The difference between the two groups was not statistically significant (p=0.551). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the normal children and the children with amblyopia were also not statistically significant (p=0.751, 0.228, 0.696 and 0.228, respectively). However, for the children with anisometropic amblyopia and the children with strabismic amblyopia, the average thicknesses of the fovea were 146.5 micrometer and 173.1 micrometer, respectively, and the retinal nerve fiber layer thicknesses were measured to be 112.9 micrometer and 92.8 micrometer, respectively, and these were statistically significant differences (p=0.046, 0.034, respectively). CONCLUSIONS: Normal thicknesses of the fovea and the retinal nerve fiber layers were established, and there were no differences in the fovea and the retinal nerve fiber layer thickness found between normal children and children with amblyopia.
Tomography, Optical Coherence ; Severity of Illness Index ; Retrospective Studies ; Retinal Ganglion Cells/*pathology ; Nerve Fibers/*pathology ; Male ; Humans ; Fovea Centralis/*pathology ; Female ; Child, Preschool ; Child ; Amblyopia/*pathology ; Adolescent

PURPOSE: To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD). METHODS: We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT. RESULTS: The mean duration of macular detachment was 15.5 +/- 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 +/- 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017). CONCLUSIONS: Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.
Adolescent ; Adult ; Female ; Fovea Centralis/*pathology/*surgery ; Humans ; Macula Lutea/pathology/surgery ; Male ; Middle Aged ; *Recovery of Function ; Retinal Detachment/*pathology/*surgery ; Retrospective Studies ; *Tomography, Optical Coherence ; Young Adult

PURPOSE: To investigate changes in the thickness of the fovea and peripapillary RNFL associated with myopia. METHODS: Sixty-five Korean adults (for a total of 130 eyes) between 23 and 26 years of age were selected as test subjects. Thirty-eight test subjects were male, and 27 were female. Subjects with glaucoma or other identified ocular diseases were excluded. Patients whose manifest refraction measurement values ranged between 0 to -2D were classified as group one (emmetropia and low myopia), those between -2 to -5D were classified as group two (moderate myopia), and those more than -5D were classified as group three (high myopia). Using the OCT, the thickness of the fovea and peripapillary RNFL were measured for every subject. RESULTS: The thicknesses of the fovea for each of three groups were 142.16+/-8.99 micrometer in group one (45 eyes), 153.58+/-17.63 micrometer in group two (43 eyes) and 158.86+/-11.93 micrometer in group three (28 eyes). The data showed significant differences in fovea thickness between the groups. The average thicknesses of the peripapillary RNFL for each of three groups were 113.29+/-10.80 micrometer in group one, 103.85+/-14.48 micrometer in group two and 100.74+/-9.15 micrometer in group three. A statistically significant difference was found between group one and the other groups (p<0.05). CONCLUSIONS: As the level of myopia increased, the thickness of the fovea also increased, while the thickness of the peripapillary RNFL decreased. Therefore, when interpreting OCT results in the clinic, careful consideration should be given to various changes associated with myopia.
Tomography, Optical Coherence ; Severity of Illness Index ; Refraction, Ocular ; Prognosis ; Nerve Fibers/*pathology ; Myopia/*pathology ; Male ; Humans ; Fovea Centralis/*pathology ; Follow-Up Studies ; Female ; Adult

PURPOSE: To investigate the factors that affect final vision following photodynamic therapy (PDT) for idiopathic subfoveal choroidal neovascularization (CNV). METHODS: A retrospective review of 16 patients whose eyes were diagnosed as idiopathic subfoveal CNV and were followed up for a minimum of 9 months. Statistical analysis was performed to investigate relationships between sex, age, size of the lesion, and initial vision compared to final vision. RESULTS: In the PDT group (10 eyes), the mean age of the patients was 34 years, mean size of the lesion was 1300 micrometer, mean initial vision was 20/60, and 7 of the 10 patients (70%) showed more than a two-line improvement in vision. Factors affecting final vision were sex (p=0.049), initial vision (p=0.0455), and size of the lesion (p=0.006). In the observation group (6 eyes), the mean age of the patients was 39 years, mean size of the lesion was 575 micrometer, mean initial vision was 20/32, and 5 of the 6 patients (83%) showed more than a two-line improvement in vision. CONCLUSIONS: The prognosis of idiopathic CNV was favorable as was reported in other studies. In the PDT group, statistically significant factors affecting final vision were initial vision, size of the lesion, and sex. However, since the number of patients sampled was insufficient and the average size of the lesions in the female patients was smaller, the size of the lesion seems to be the most important factor.
Visual Acuity ; Treatment Outcome ; Retrospective Studies ; *Photochemotherapy ; Middle Aged ; Male ; Humans ; Fundus Oculi ; Fovea Centralis ; Follow-Up Studies ; Fluorescein Angiography ; Female ; Choroidal Neovascularization/*drug therapy/pathology/physiopathology ; Adult

The visual results of laser photocoagulation for subfoveal choroidal neovascular membrane (CNVM) has not always been satisfactory. The surgical removal of the neovascular membrane may be another treatment option. To investigate the prognosis and risk factors of this surgery, we analyzed the results of surgical removal of subfoveal CNVM (23 eyes), subfoveal hemorrhage with CNVM (6 eyes), and subfoveal hemorrhage alone (6 eyes). The mean follow-up period was 17.7 months (range 2 to 47 months). The mean preoperative membrane size was 0.89 disc diameter and the mean postoperative retinal pigment epithelial (RPE) defect size was 1.33 disc diameter. Visual improvement was observed in 13 out of the 23 eyes (56.5%) with sufoveal CNVM, four out of the six eyes (66.6%) with subretinal hemorrhage and CNVM, and five out of the six eyes (83.3%) with subretinal hemorrhage only. The visual outcome of subfoveal CNVM surgery was related to the presence of a subfoveal RPE defect (p = 0.005) rather than to the size of the RPE defect. No recurrence of neovascular membrane was observed during the follow up period. In conclusion, surgical removal may be a good alternative treatment for subfoveal CNVM.
Choroidal Neovascularization/surgery* ; Choroidal Neovascularization/diagnosis ; Choroidal Neovascularization/complications ; Comparative Study ; Female ; Fluorescein Angiography ; Fovea Centralis/surgery ; Fovea Centralis/pathology ; Fundus Oculi ; Human ; Laser Coagulation* ; Male ; Middle Age ; Pigment Epithelium of Eye/pathology ; Prognosis ; Retinal Hemorrhage/surgery ; Retinal Hemorrhage/diagnosis ; Retinal Hemorrhage/complications ; Retrospective Studies ; Risk Factors ; Visual Acuity

PURPOSE: To compare the foveal thickness (FT) parameters measured by Stratus optical coherence tomography (OCT) and Spectralis OCT in various retinal diseases and to construct conversion formulas between the two types of OCT devices. METHODS: We examined 366 consecutive patients (475 eyes) with retinal diseases and 13 normal controls (13 eyes). The patients were categorized into eight retinal disease groups. The mean amount and distribution of foveal thickness differences (FTD) measured by Stratus and Spectralis OCT were determined, and conversion formulas were constructed for Stratus OCT FT from Spectralis OCT FT for each retinal disease group. RESULTS: Among retinal diseases, the mean FTD was significantly larger in exudative age-related macular degeneration (AMD) patients (mean +/- SD, 94.0 +/- 55.0 microm) compared to normal subjects (66.2 +/- 11.7 microm; p < 0.0001). The proportion of eyes with a mean FTD outside 1.96 standard deviations of normal subject FTD was greatest in the exudative AMD (50.0%) group and smallest in the macular hole (18.2%) group. The predicted FTs obtained through the conversion formulas showed lower variance than the actual FTD values, especially in the exudative AMD group. The prediction line for exudative AMD deviated most from that of normal subjects. CONCLUSIONS: FTD shows diverse values and variances among various retinal diseases, especially in exudative AMD, which indicates that Stratus OCT FT cannot be predicted from Spectralis OCT FT by FTD value alone. We constructed statistically significant conversion formulas, which provided more reliable methods to predict Stratus OCT-measured FT from Spectralis OCT measurements for different retinal disease groups.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Fovea Centralis/*pathology ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retinal Diseases/*pathology ; Retrospective Studies ; *Tomography, Optical Coherence ; Young Adult

PURPOSE: To evaluate the clinical course of visual acuity and foveal thickness in the idiopathic epiretinal membrane (ERM) after a vitrectomy with the use of triamcinolone. METHODS: We retrospectively reviewed the records of 30 patients (30 eyes) with ERM that were treated by vitrectomy from 2004 to 2008. Visual acuity and foveal thickness from optical coherence tomography imaging was obtained preoperatively and at every postoperative follow-up visit. RESULTS: Visual acuity improved by two or more lines of vision in 30%, 50%, 60%, and 70%, and stayed the same within +/-1 line in 47%, 50%, 40%, and 30% at one month, three months, five months, and seven months after surgery. Twenty-three percents of the subjects deteriorated by two or more lines of vision within one month after surgery. None of the subjects had reduced vision three months after surgery. Foveal thickness decreased significantly after surgery. The mean thickness was 409.7+/-107.9 microm before surgery and 288.6+/-66.1 microm seven months after surgery. Parameters which were significantly correlated with the final visual acuity included preoperative visual acuity (0.683), preoperative foveal thickness (0.544), and final foveal thickness (0.643) (p<0.005). CONCLUSIONS: Foveal thickness and visual acuity improved until seven months after the vitrectomy in patients with idiopathic ERM. Preoperative visual acuity, foveal thickness, and final foveal thickness had a significant correlation with the final visual acuity.
Aged ; Epiretinal Membrane/pathology/*surgery ; Female ; Follow-Up Studies ; Fovea Centralis/*pathology ; Humans ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

PURPOSE: To compare the efficacy of posterior sub-Tenon's capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). MATERIALS AND METHODS: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. RESULTS: The ETDRS scores at baseline were 25.2 +/- 13.6 (mean +/- SD) letters in the PSTI + MP group, whereas 21.7 +/- 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 +/- 15.9, 34.7 +/- 16.6 and 30.9 +/- 19.0 letters in the PSTI + MP group whereas by 30.9 +/- 15.4, 30.1 +/- 17.9 and 31.5 +/- 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p < 0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 +/- 148.3, 309.1 +/- 131.3, 319.3 +/- 93.3, 340.4 +/- 123.5micrometer (mean +/- SD) in the PSTI + MP group vs. 369.1 +/- 123.1, 241.4 +/- 52.3, 277.5 +/- 137.4, 290.2 +/- 127.9micrometer in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the PSTI + MP group, and at both 1 month (p < 0.001) and 3 months (p = 0.016) for the IVTA group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). In contrast to the PSTI + MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group. CONCLUSION: PSTI + MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.
Adult ; Aged ; Anti-Inflammatory Agents/administration & dosage ; Diabetic Retinopathy/*drug therapy/physiopathology/*surgery ; Female ; Fovea Centralis/pathology ; Humans ; *Laser Coagulation ; Macular Edema/complications/*drug therapy/physiopathology/*surgery ; Male ; Middle Aged ; Prospective Studies ; Triamcinolone/*administration & dosage ; Visual Acuity ; Vitreous Body

PURPOSE: To evaluate the visual outcomes of retinoblastoma in the posterior pole (RBPP) treated with chemotherapy plus local treatments and to address the prognostic factors that influence such outcomes. METHODS: The medical records of patients with RBPP diagnosed at the Department of Pediatric Ophthalmology, Seoul National University Children's Hospital between August 1987 and September 2007 were reviewed retrospectively. Only those patients treated via primary chemotherapy plus local treatments were included. The presence of foveal involvement and tumors in the posterior pole before and after treatment, the type of regression pattern and the best corrected visual acuity (BCVA) of each patient were evaluated. RESULTS: A total of 13 eyes in 12 patients were included. The mean final BCVA for treated RBPP was 20/210 (range, hand motion to 20/16). However, eight eyes (61.5%) had an acuity of 20/200 or better and seven eyes (53.8%) had an acuity of 20/50 or better. The mean final BCVA was significantly better in cases with negative foveal involvement; however, four eyes (37.5%) with positive foveal involvement had an acuity of 20/200 or better. Tumors area in the posterior pole and the type of regression pattern were not significantly related to final BCVA. CONCLUSIONS: Over one half of the studied RBPP patients had working vision. Although the eyes had RBPP with positive foveal involvement, about one-third of the patients had working vision. Vision preservation should be considered when deciding on RBPP treatment.
Antibiotics, Antineoplastic/administration & dosage ; Antineoplastic Agents/administration & dosage ; Antineoplastic Agents, Alkylating/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Cisplatin/administration & dosage ; Cyclophosphamide/administration & dosage ; Doxorubicin/administration & dosage ; Etoposide/administration & dosage ; Eyeglasses ; Female ; Follow-Up Studies ; Fovea Centralis/pathology ; Humans ; Infant ; Male ; Prognosis ; Retinal Neoplasms/*drug therapy/pathology/*physiopathology ; Retinoblastoma/*drug therapy/pathology/*physiopathology ; Retrospective Studies ; Treatment Outcome ; Visual Acuity