PURPOSE: To report a case of secondary pigmentary glaucoma after implantable contact lens (ICL) implantation successfully treated with trabeculectomy without ICL removal. CASE SUMMARY: A 29-year-old woman presented with refractory intraocular pressure (IOP) increase in both eyes. IOP was 22 mm Hg in the right eye and 39 mm Hg in the left eye. The patient received posterior chamber phakic intraocular lens implantation in both eyes 22 months prior. Slit lamp examination revealed patent iridotomy sites in both eyes. Gonioscopy revealed open angles with 4-degree pigment deposits on the trabecular meshwork in both eyes. Ultrasound biomicroscopy examination confirmed contact between ICL and the posterior surface of the iris. In spite of well tolerated medical therapy and selective laser trabeculoplasty, IOP was 46 mm Hg in her left eye. Trabeculectomy was performed in her left eye without ICL removal. At 6 months postoperative, IOP measured 6 mm Hg without any anti-glaucoma medication and bleb was maintained in good condition in the left eye. CONCLUSIONS: The results from this case study indicate that ICL implantation can lead to secondary pigmentary glaucoma and trabeculectomy without ICL removal may help to decrease the IOP.
Blister ; Eye ; Female ; Glaucoma, Open-Angle ; Gonioscopy ; Humans ; Intraocular Pressure ; Iris ; Lenses, Intraocular ; Microscopy, Acoustic ; Phakic Intraocular Lenses ; Trabecular Meshwork ; Trabeculectomy

PURPOSE: The present study reviewed the surgical outcomes of conjunctival flap advancement with pterygial tissue excision in primary and recurrent pterygium. METHODS: In a retrospective survey of 169 eyes of 169 patients who underwent pterygial tissue excision and conjunctival flap advancement surgery, after a three-month follow-up minimum, history of pterygium surgery, surgical outcomes, recurrence rates, and complications were evaluated. RESULTS: The study included 74 male and 95 female patients. The mean age was 56 +/- 11.93 years (range: 31-81 years). One hundred and forty eyes were considered as primary pterygium without history of surgery and 29 eyes were considered as recurrent pterygium. In the cases of primary pterygium, 139 eyes were treated after the surgery without recurrence (success rate: 99.2%) and one recurred case was localized to the sclera. Among the 29 eyes with recurrent pterygium, 26 eyes were treated without recurrence (success rate: 89.7%) and 3 recurred cases were localized to the sclera. There were no significant complications related to the surgical procedures. CONCLUSIONS: Conjunctival flap advancement surgery with pterygial tissue excision was an effective method in primary and recurrent pterygium treatment and showed low recurrence and minimal complications.
Eye ; Female ; Follow-Up Studies ; Humans ; Male ; Pterygium ; Recurrence ; Retrospective Studies ; Sclera

PURPOSE: The present study reviews the clinical features of orbital cellulitis in childhood for early diagnosis and proper treatment. METHODS: The authors performed a retrospective study by computed tomography (CT) on children under 14 years of age diagnosed with orbital cellulitis and admitted to Pusan National University Hospital from 2003 to 2010. RESULTS: In total, 27 patients were identified (range 4 months to 14 years). Periorbital swelling was the most common initiating symptom, followed by fever and conjunctival injection. Paranasal sinus disease was the most common predisposing factor. Preseptal cellulitis was the most common finding, followed by subperiosteal abscess, orbital cellulitis, and orbital abscess. All patients underwent a blood culture; none were positive. Intravenous antibiotics therapy was performed empirically and was effective in all cases. No patients suffered from permanent complications except recurrence. CONCLUSIONS: Orbital cellulitis in children presents with periorbital swelling, fever, conjunctival injection in association with sinusitis, and upper respiratory infection (URI). A CT study is a reliable diagnostic option for the early detection and localization in the pediatric orbital cellulitis. Early empirical antibiotic therapy is mandatory for successful treatment.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Child ; Early Diagnosis ; Fever ; Humans ; Orbit ; Orbital Cellulitis ; Paranasal Sinus Diseases ; Retrospective Studies ; Sinusitis

PURPOSE: To present a surgical result of Yokoyama procedure in myopic strabismus fixus. CASE SUMMARY: A 51-year-old female patient presented with progressive esotropia and diplopia. According to the Krimsky test, the patient showed 70 prism diopter esotropia and 30 prism diopter hypotropia in her left eye. The axial length was 34.97 mm in the right eye and 33.71 mm in the left eye. The patient was diagnosed with myopic strabismus fixus. The authors performed the Yokoyama procedure on her left eye. Surgical examination revealed each medial rectus muscle was recessed. Half of the muscle bellies of the superior and lateral rectus muscles were sutured together without muscle splitting 15 mm posterior from their insertion. At 1 year postoperatively, the patient showed 30 prism diopter esotropia and 20 prism diopter hypotropia in her right eye by alternative prism cover test. The authors performed the same procedure on her right eye. At 2 months after the second surgery, the patient showed orthotropia in the primary position and gaze limitation was improved. CONCLUSIONS: The Yokoyama procedure can be an effective method for improving deviation and ocular motility in esotropia caused by high myopia.
Diplopia ; Esotropia ; Eye ; Female ; Humans ; Muscles ; Myopia ; Strabismus

PURPOSE: To report a case of retinopathy in a patient with chronically resistant idiopathic thrombocytopenic purpura (ITP) associated with a poor prognosis. CASE SUMMARY: A 52-year-old female presented with a complaint of decreased visual acuity, which was 0.63 in both eyes. The patient had received a splenectomy, was receiving systemic treatment for chronic ITP, and had a history of diabetes mellitus and hypertension. Multiple retinal and subretinal hemorrhages and Roth spots were found on fundus examination. Fluorescein angiography revealed microaneurysms and hemorrhages in all four quadrants of the retina. The patient's platelet count was 38,000/µL. The patient was diagnosed with non-proliferative diabetic retinopathy and ITP-associated retinopathy, and underwent panretinal photocoagulation. Sudden visual loss was noted 4 months later, at which time the patient's visual acuity was 0.1 in both eyes, and her platelet count was 7,000/µL. For 2 years, the patient's platelet count was not controlled, and remained between 12,000–19,000/µL despite active medical treatment. Macular edema did not improve with intravitreal triamcinolone, dexamethasone, and bevacizumab. Retinal hemorrhages were not absorbed and visual acuity decreased to light perception in the right eye and counting fingers in the left eye. CONCLUSIONS: ITP-associated retinopathy was associated with a poor prognosis when the systemic disease was not controlled.
Bevacizumab ; Dexamethasone ; Diabetes Mellitus ; Diabetic Retinopathy ; Female ; Fingers ; Fluorescein Angiography ; Hemorrhage ; Humans ; Hypertension ; Light Coagulation ; Macular Edema ; Middle Aged ; Platelet Count ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic ; Retina ; Retinal Hemorrhage ; Retinaldehyde ; Splenectomy ; Triamcinolone ; Visual Acuity

PURPOSE: Dexamethasone intramuscular injection and oral prednisolone have been known to be effective in the treatment of croup. The aim of this study was to determine whether nebulized budesonide leads to clinically important improvement in respiratory symptoms within four hours for child with mild to moderate croup. METHODS: Patients with croup visited to the department of Pediatrics, Han Il General Hospital from March 1995 to June 1996 were enrolled in this study. Patients were eligible if their age was between six months and six years, their total croup score was higher than 2 after breathing humidified air for at least 15 minutes. 28 patients were treated with 2mg (8ml) of nebulized budesonide and 8 patients with 8ml of normal saline as control group over the 30 minutes. Croup score, heart rate and respiratory rate were then assessed hourly for up to four hours. Side effects were also observed. RESULTS: 1) The croup score was improved from 3.6+/-0.8 to 1.9+/-0.9 at 4 hours after the nebulized budesonide treatment. 2) No significant differences in changes in heart rate were observed until 4 hours after both the nebulized budesonide group and control group. 3) Significant decrease in respiratory rate was observed at 4 hours after the nebulized budesonide group. 4) No specific side effects were noted during and 4 hours after the nebulized budesonide treatment. CONCLUSIONS: We concluded that nebulized budesonide leads to a prompt and important clinical improvement in children with mild to moderate croup without any specific side effects.
Budesonide* ; Child ; Croup* ; Dexamethasone ; Heart Rate ; Hospitals, General ; Humans ; Injections, Intramuscular ; Pediatrics ; Prednisolone ; Respiration ; Respiratory Rate

PURPOSE: To compare lens-save and simultaneous phacoemulsification with intraocular lens implantation in primary vitrectomy for phakic rhegmatogenous retinal detachment (RRD). METHODS: A retrospective comparative analysis of 54 consecutive eyes from 54 phakic RRD patients who underwent vitrectomy with a minimum of 12 months of follow-up was performed. The patients were divided into the vitrectomy group and the combined group (patients who underwent vitrectomy with concurrent cataract surgery). The main outcome measures were the best corrected visual acuity (BCVA), anatomical success rate, complications and cataract status according to LOCSIII grading. RESULTS: Baseline characteristics were similar in both groups, except for age and cataract status. The mean age was 46.9 year in the vitrectomy group (n = 20) and 60.5 years in the combined group (n = 34) (p < 0.001). The postoperative BCVA (log MAR) improved from 1.27 and 1.30 at baseline to 0.45 and 0.28 at 12 months (p < 0.05), respectively, which was not a significant difference between the 2 groups. In the vitrectomy group, cataract status was changed from 1.8 at baseline to 2.5 at 12 months (p = 0.001). Two patients (11.1%) had an additional cataract surgery performed. The primary anatomical success rate was 90.0% in the vitrectomy group and 94.1% in the combined group. CONCLUSIONS: The vitrectomy group and combined group had similar results in the repair of phakic RRD. Although postoperative cataract progression was noted, lens should be saved in vitrectomy for young patients, as significant cataract is uncommon.
Cataract ; Eye ; Follow-Up Studies ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Outcome Assessment (Health Care) ; Phacoemulsification ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Visual Acuity ; Vitrectomy

PURPOSE: To compare the therapeutic efficacy of vitrectomy plus intravitreal antibiotic injection (vitrectomy group) with intravitreal antibiotic injection alone (antibiotic group) for eyes with acute endophthalmitis developed after cataract surgery with visual acuity of hand motion or better. METHODS: In this retrospective chart review, we compared the visual acuities of 10 eyes of a vitrectomy group and 17 eyes of an antibiotic group. RESULTS: We found no significant differences between the two groups in terms of age, comorbidities (diabetes, hypertension), time of symptom onset, time of diagnosis, type of systemic antibiotic prescribed, or positive culture rate. Mean baseline best-corrected visual acuity (BCVA) was similar in the two groups (2.17 vs. 1.96 logMAR; p = 0.60). Both groups exhibited significant improvements in mean BCVA after 2 months: from 2.17 to 0.81 logMAR in the vitrectomy group (p = 0.01) and from 1.96 to 0.76 logMAR in the antibiotic group (p = 0.002), but the final BCVA did not differ significantly between the two groups (0.81 vs. 0.76 logMAR, p = 0.75). CONCLUSIONS: Both vitrectomy combined with intravitreal antibiotic injection and intravitreal antibiotic injection alone significantly improved visual acuity; the final BCVA did not differ between the two groups. Intravitreal antibiotic injection alone may be an effective first-line treatment for endophthalmitis in patients with initial visual acuity of hand motion or better.
Cataract ; Comorbidity ; Diagnosis ; Endophthalmitis ; Hand ; Humans ; Retrospective Studies ; Visual Acuity ; Vitrectomy

PURPOSE: To report a case of rapid progression of the epiretinal membrane following intravitreal aflibercept injection in a patient with exudative age-related macular degeneration. CASE SUMMARY: An 82-year-old female presented with a complaint of decreased visual acuity in her left eye for 1 month. The initial best-corrected visual acuity was 0.2 in the left eye. Fundus examination and optical coherence tomography revealed soft drusen with retinal hemorrhage of the macula and a transparent epiretinal membrane in the left eye. Fluorescein angiography and indocyanine green angiography showed retinal angiomatous proliferation (RAP) of the left eye, so intravitreal aflibercept injection was performed. One month after the first injection, intraretinal cystic macular edema decreased, while transparency of the epiretinal membrane decreased and reflectivity and thickness of the membrane increased. After two additional injections of aflibercept, RAP showed improvement, whereas the epiretinal membrane progressed. Visual acuity of the left eye decreased to 0.1 and vitrectomy of the membrane was performed. CONCLUSIONS: Careful observation for potentially rapid progression of epiretinal membrane is needed after intravitreal aflibercept injection in the management of exudate age-related macular degeneration accompanied by epiretinal membrane.
Aged, 80 and over ; Angiography ; Epiretinal Membrane ; Exudates and Transudates ; Female ; Fluorescein Angiography ; Humans ; Indocyanine Green ; Macular Degeneration ; Macular Edema ; Membranes ; Retinal Hemorrhage ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

Purpose: To evaluate the one-year efficacy of intravitreal aflibercept injection in polypoidal choroidal vasculopathy (PCV) with best-corrected visual acuity (BCVA) of 20 / 40 or better. Methods: This was a multicenter retrospective study. The medical records of patients diagnosed with treatment-naïve PCV were retrospectively reviewed. Patients with an initial BCVA of 20 / 40 or better and who had undergone intravitreal aflibercept injection were included. Patients were treated with three consecutive monthly injections, followed by pro re nata regimen according to the clinician’s discretion at variable interval visits. The proportions of eyes for which BCVA was maintained (≤ 0.2 logarithm of the minimum angle of resolution change) or improved at 12 months were evaluated. The changes of BCVA, central subfield macular thickness (CSMT), pigment epithelial detachment, and subretinal fluid also were assessed. Results: A total of 86 eyes were included. The mean number of injections for 12 months of treatment was 5.4 ± 1.7. BCVA was maintained or improved in 94.2% (81 / 86) of cases. Mean BCVA (logarithm of the minimum angle of resolution) had changed from the baseline (0.23 ± 0.09) at 3 months (0.21 ± 0.14), 6 months (0.24 ± 0.22), and 12 months (0.20 ± 0.18), but with no statistical significance. CSMT had improved significantly from the baseline (336.1 ± 97.3 μm) at 3 months (223.6 ± 47.22 μm), 6 months (239.6 ± 64.2 μm), and 12 months (223.8 ± 47.9 μm). Pigment epithelial detachment was observed in 93% of cases at the baseline, 72.1% at 3 months, and 69.8% at 12 months, showing a significant decrease at all observation points. Subretinal fluid was observed in 91.9% of cases at the baseline, 20.9% at 3 months, and 29.1% at 12 months, showing a significant decrease at all observation points. Conclusions In cases of PCV with good visual acuity, intravitreal aflibercept injections decreased CSMT and were effective in maintaining visual acuity.