PURPOSE: The authors of the present study report a case of bilateral simultaneous acute angle closure glaucoma following sildenafil citrate-aided sexual intercourse. CASE SUMMARY: A 63-year-old man visited the emergency department with sudden onset of bilateral ocular pain and blurred vision. The patient had taken 50 mg sildenafil citrate followed by sexual intercourse. His visual acuity on presentation was 0.3 in the right eye and 0.5 in the left eye. Intraocular pressure (IOP) was 54 mm Hg and 46 mm Hg in the right and left eye, respectively. Anterior chamber depths were shallow and angles were closed on gonioscopy in both eyes. The patient was treated with ocular hypotensive medication and subsequently managed with bilateral YAG laser peripheral iridotomies. During the 13 months of follow-up, there was no recurrent angle closure attack and IOPs were well-controlled. CONCLUSIONS: The mechanism of bilateral angle closure glaucoma caused by sildenafil citrate is not proven. Those who are predisposed towards developing angle-closure glaucoma may be at risk when having sexual intercourse aided by sildenafil citrate.
Anterior Chamber ; Citric Acid ; Coitus ; Emergencies ; Eye ; Follow-Up Studies ; Glaucoma, Angle-Closure ; Gonioscopy ; Humans ; Intraocular Pressure ; Lasers, Solid-State ; Middle Aged ; Piperazines ; Purines ; Sulfones ; Vision, Ocular ; Visual Acuity ; Sildenafil Citrate

Purpose: We corrected the axial lengths of the macular and peripapillary significance maps using software embedded in a commercial spectral domain optical coherence tomography (SD-OCT) package. We evaluated the accuracy of glaucoma diagnosis in patients with high myopia, and the clinical implications. Methods: Seventy eyes of 70 highly myopic patients with or without normal-tension glaucoma were retrospectively reviewed. The sensitivities and specificities of the color-coded significance maps were calculated using 1% (red) or 5% (yellow) as the abnormality criteria, and the values compared before and after axial length corrections performed using embedded SD-OCT software. Results: At the 1% level of the normative database, we found no significant difference in specificity or sensitivity. At the 5% level, the increase in specificity was significant only for the inferotemporal sectors of the macular significance map. The specificity of the inferotemporal sector of the inner scan circle increased from 61.9 to 78.6% (p = 0.016) and that of the outer scan circle from 69 to 83.8% (p = 0.031). The specificities of the entire chart, the superior sector of the superior/inferior chart, and the 12-clockwise map increased significantly from 54.8 to 78.6% (p = 0.002), 59.5 to 76.2% (p = 0.039), and 59.5 to 76.2% (p = 0.002) respectively. Conclusions Clinicians should note that axial length correction of significance maps reduces the false-positive glaucoma diagnostic rates in highly myopic eyes. Correction of significance maps using embedded software may thus aid clinicians in the diagnosis of glaucoma in high myopic eyes.

PURPOSE: To compare axial length, anterior chamber depth, and keratometric measurements of an optical low-coherence reflectometry device with those of other ocular biometry devices and evaluate the accuracy of predicting postoperative refraction. METHODS: A total of 32 eyes in 32 patients who received cataract surgery were included in the present study. The axial length, anterior chamber depth, and keratometry were measured by optical low-coherence reflectometry (Lenstar LS900(R)), partial coherence interferometry (IOL master(R)), and ultrasound. The SRK/T formula was used to calculate IOL power, and predictive error that subtracts predictive refraction from postoperative refraction was compared among ocular biometry devices. RESULTS: Axial length, anterior chamber depth, and keratometry had a strong correlation and demonstrated no statistically significant differences between Lenstar LS900(R) and other devices. The Bland-Altman plots showed a high degree of agreement between Lenstar LS900(R) and other devices. The mean absolute prediction errors in Lenstar LS900(R) and IOL master(R) were not significantly different. CONCLUSIONS: The ocular biometric measurements and prediction of postoperative refraction using Lenstar LS900(R) were as accurate as IOL master(R) and ultrasound.
Anterior Chamber ; Biometry ; Cataract ; Eye ; Humans ; Interferometry

PURPOSE: To compare the clinical results of single-piece hydrophilic acrylic intraocular lenses (IOL) (Akreos AdaptTM, B&L) with those of three-piece hydrophobic acrylic IOL (Sensar(R), AMO) after cataract surgery. METHODS: This study was a prospective case-control study in which Akreos lenses were implanted for the experimental group and Sensar lenses were implanted for the control group. All surgical procedures were performed by the same surgeon. Best corrected visual acuity (BCVA), change of anterior chamber depth, degree of posterior capsule opacification (PCO), higher-order aberration, and contrast sensitivity (CS) were examined. Measurements were performed by masked examiners prior to the surgery and at 1 week, 1 month, 3 months, and 6 months, postoperatively. RESULTS: There were no statistically significant differences in BCVA, CS or PCO between the two groups. The Refractive error was -0.17+/-0.67D in the experimental group and -0.02+/-0.41D in the control group at 6 months, postoperatively. During the first postoperative month, forward movement of both IOLs was detected. Afterward, both IOLs moved backwards until 6 months. Fourth-order spherical aberrations were significantly higher in the Akreos group (p<0.05) at 1 month, 3 months, and 6 months, postoperatively. CONCLUSIONS: The clinical results for Akreos IOL and Sensar IOL were similar in most aspects.
Anterior Chamber ; Capsule Opacification ; Case-Control Studies ; Cataract* ; Contrast Sensitivity ; Lenses, Intraocular ; Masks ; Prospective Studies ; Refractive Errors ; Visual Acuity

PURPOSE: To compare high-sensitivity C-reactive protein (hsCRP) levels and lipid profiles between Korean normal tension glaucoma (NTG) patients and healthy controls. METHODS: This cross-sectional study included 38 Korean patients with NTG and 38 age- and sex-matched healthy control subjects. We excluded the patients with cardiovascular risk factors and other systemic diseases that might affect CRP levels and lipid profiles. Each patient underwent a Humphrey visual field examination and blood sampling for hsCRP and lipid profile analyses. Subsequently, the NTG patients were classified into two groups based on their untreated intraocular pressure (IOP) level: low NTG (LNTG) with IOP< or =13 mmHg (13 subjects) and high NTG (HNTG) with relatively high IOP (>13 and < or =21 mmHg, 25 subjects). The hsCRP levels and lipid profiles were compared between NTG patients and healthy controls, and between LNTG, HNTG, and healthy controls. RESULTS: There were no significant differences in hsCRP and lipid profiles between either the NTG patients and healthy controls, or between the LNTG, HNTG, and controls (p>0.05) after exclusion of Korean patients with cardiovascular risk factors. There was no significant association between hsCRP and visual field indices (p>0.05). CONCLUSIONS: High-sensitivity C-reactive protein-related vascular inflammatory conditions may not be directly associated with the development of NTG, regardless of the untreated IOP level.
Adolescent ; Adult ; Aged ; *Asian Continental Ancestry Group ; C-Reactive Protein/*metabolism ; Cross-Sectional Studies ; Female ; Humans ; Lipids/*blood ; Low Tension Glaucoma/*blood ; Male ; Middle Aged ; Young Adult

PURPOSE: To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO). METHODS: Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients. RESULTS: Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05). CONCLUSIONS: The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.
Compensation and Redress ; Eye ; Glaucoma ; Humans ; Nerve Fibers ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Risk Factors ; Scanning Laser Polarimetry ; Visual Fields

PURPOSE: To compare mini-mental state examination (MMSE) score between glaucoma group and normal control group and to evaluate the correlation between MMSE score and spectral domain-optical coherence tomography (SD-OCT) values in both groups. METHODS: This prospective study includes thirty glaucoma patients (eleven primary open angle glaucoma and nineteen normal tension glaucoma) and thirty normal controls. Retinal nerve fiber layer (RNFL) and Ganglion cell-inner plexiform layer (GC-IPL) thickness were measured with SD-OCT, and the average values of both eyes were used. The cognitive function was evaluated with MMSE by a single examiner. RESULTS: The mean MMSE scores of glaucoma group and normal group were 26.07 ± 2.95, and 27.00 ± 1.68 respectively (p = 0.137). MMSE score of less than 24 only showed in glaucoma group. MMSE score and RNFL thickness showed statistically no signifance in correlation (R² = 0.236; p = 0.070), however, MMSE score and GC-IPL showed statistically significant correlation (R² = 0.256; p = 0.048). CONCLUSIONS: Glaucoma patients tend to show low cognitive function even though the correlation between glaucoma patient and low cognitive function was not statistically significant. Therefore, the aspect of cognitive depression should be concerned, when facing glaucoma patients.
Cognition* ; Depression ; Ganglion Cysts ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Nerve Fibers ; Prospective Studies ; Retinaldehyde

PURPOSE: To compare the level of accuracy of intraocular pressure (IOP) measurements of a rebound tonometer (RT) Icare(R), and non-contact tonometer (NCT), using Goldmann Applanation tonometer (GAT) as a reference to evaluate the influence of central corneal thickness (CCT) on IOP readings in the Korean population. METHODS: In a prospective study of 273 eyes, IOP was measured with RT, GAT, and NCT and compared to CCT measurements. Patients were assigned to one of 3 groups based on IOP measurements of GAT and 1 of 2 groups based on CCT. The comparison of the IOP values of RT, GAT, and NCT was performed between the IOP and CCT groups, and the differences among tonometers were evaluated. RESULTS: The RT showed statistically significant correlation with the GAT compared to the NCT. The CCT was related to RT measurements. The RT values compared to the GAT was underestimated in thin corneas and overestimated in thick corneas. CONCLUSIONS: There was a significant correlation between the RT and the GAT measurements compared with the NCT. However, RT is influenced by CCT and correlates less with GAT in low IOP ranges, suggesting that corneal thickness should be taken into consideration during such measurements.
Cornea ; Eye ; Humans ; Intraocular Pressure ; Peptides ; Prospective Studies ; Reading

PURPOSE: To evaluate the effect of intravitreal injection on the corneal endothelium according to the injected drug. METHODS: The present study included 118 eyes of 113 patients who received intravitreal injection. Before each injection and 1 month after the injection, specular microscopy was performed to evaluate the corneal endothelial changes and central corneal thickness. We classified the patients according to the injected drug (bevacizumab 21 eyes, ranibizumab 20 eyes, aflibercept 47 eyes, dexamathasone implant 30 eyes), phakic or pseudophakic eyes, single or multiple injections and analyzed them retrospectively. RESULTS: The mean corneal endothelial cell density was 2,693.2 ± 298.2 cells/mm² before injection and 2,686.8 ± 288.7 cells/mm² 1 month after injection, and there was no statistically significant difference (p = 0.731). According to the kind of drug, the mean corneal endothelial cell density and central corneal thickness were not significantly different before and 1 month after injection in any of the 4 groups. CONCLUSIONS: There were no significant changes in corneal endothelium before and 1 month after intravitreal injection of the various drugs.
Endothelial Cells ; Endothelium, Corneal* ; Humans ; Intravitreal Injections* ; Microscopy ; Ranibizumab ; Retrospective Studies

A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature 38.7℃, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.