To report a case of cytomegalovirus (CMV) retinitis after intravitreal injection of triamcinolone acetonide (IVTA). A 77-year-old woman with macular edema due to central retinal vein occlusion (CRVO) developed peripheral retinitis 4 months after IVTA. A diagnostic anterior chamber paracentesis was performed to obtain DNA for a polymerase chain reaction (PCR) test for viral retinitis. The PCR test was positive for CMV DNA. Other tests for infective uveitis and immune competence were negative. Four months after presentation, gancyclovir was intravitreously injected a total of 5 times, and the retinitis resolved completely. CMV retinitis is a rare complication of local immunosuppression with IVTA. It can be managed with timely injection of intravitreal gancyclovir until recovery from local immunosuppression.
Aged ; Antiviral Agents/therapeutic use ; Cytomegalovirus/genetics ; Cytomegalovirus Retinitis/diagnosis/drug therapy/*etiology ; DNA, Viral/analysis ; Female ; Ganciclovir/therapeutic use ; Humans ; Immunosuppressive Agents/*adverse effects ; Injections ; Macular Edema/drug therapy/etiology ; Polymerase Chain Reaction ; Retinal Vein Occlusion/complications/*drug therapy ; Triamcinolone Acetonide/*adverse effects ; Vitreous Body

Here, we report early treatment outcomes of gene therapy for early onset retinitis pigmentosa (RP) (Leber congenital amaurosis) associated with biallelic RPE65 mutation in a 30-year-old female patient. Initially, her visual acuity (VA) was 20/200, and her visual field (VF) was severely constricted to the center in the left eye. Her electroretinography showed nearly extinct signals. Full-field stimulus threshold test (FST) revealed diminished dark-adapted light sensitivity. Voretigene neparvovec-rzyl (VN) is the first in vivo viral gene therapy agent to be approved. At 3 months after subretinal injection of VN in the left eye, VA, VF, and FST showed sustained improvement. She did not exhibit any signs of adverse effects from the treatment. Gene therapy for RP proved to be an effective and safe treatment in an advanced case of RPE65-associatied early onset RP.

PURPOSE: Compression of the optic nerve by a dolichoectatic internal carotid artery is known to cause of visual field defects. We experienced a case of optic nerve compression by a normal-appearing internal carotid artery. METHODS: A 22-year-old man presented with left eye visual field defect without obvious cause and magnetic resonance imaging revealed compression of the left optic nerve by ipsilateral internal carotid artery. RESULTS: At eight-month follow-up, there was no improvement in visual field defect or optic disc change. CONCLUSIONS: In an unexplained optic neuropathy, T1-weighted MRI is needed to evaluate the relationship between the optic nerve and internal carotid artery.
Carotid Artery, Internal* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Optic Nerve Diseases ; Optic Nerve* ; Visual Fields* ; Young Adult

PURPOSE: To determine the influence of clinical features and Indocyanine green (ICG) angiographic features on the visual outcome of patients with myopic sub-foveal choroidal neovascularization (CNV) who received photodynamic therapy (PDT). METHODS: Thirty-six consecutive patients (39 eyes) with myopic CNV who were followed up for more than one year after PDT were enrolled in this study. Clinical features included age, gender, refractive error, great linear dimension, and subretinal hemorrhage. ICG features included the lesion size, lacquer cracks, hypofluorescence surrounding the CNV (dark rim), peripapillary atrophy size, and visible prominent choroidal veins under the macula. Linear regression analysis was performed using the change in visual acuity (delta logMAR) as the dependent variable and the above factors as independent variables. RESULTS: At one-year follow-up after PDT, a younger age (p=0.002) and the presence of a dark rim (p=0.002) were significantly correlated with an improvement of visual acuity (decrement in logMAR) after PDT. Other factors had no significant influence on changes in visual acuity. CONCLUSIONS: Younger patients and patients with a dark rim on ICG angiography had a higher chance of visual improvement after PDT in myopic CNV.
Visual Acuity ; Retrospective Studies ; Prognosis ; *Photochemotherapy ; Myopia/*complications/pathology ; Middle Aged ; Male ; Indocyanine Green/*diagnostic use ; Humans ; Fundus Oculi ; Fovea Centralis/*pathology ; Follow-Up Studies ; Fluorescein Angiography/*methods ; Female ; Coloring Agents/*diagnostic use ; Choroidal Neovascularization/complications/drug therapy/*pathology ; Aged ; Adult

Schwannomas rarely present as intraocular tumors and are often misdiagnosed as malignant melanoma. We describe a choroidal schwannoma confirmed by sclerouvectomy. A 30-year-old woman presented with a large nonpigmented intraocular mass of the choroid in the right eye and underwent surgical excision by sclerouvectomy. Histologically, the tumor was composed of a mixture of cellular solid components (Antoni A) and loose myxoid components (Antoni B). The tumor was eventually diagnosed as a schwannoma. Currently available ancillary studies are still of little value in definitively differentiating schwannomas from other choroidal tumors. In the case of atypical findings for a malignant melanoma, a benign neoplasm should be included in the differential diagnosis. This patient avoided enucleation by first having the mass excised. We are unaware of previous reports in which a choroidal schwannoma was diagnosed by surgical excision.
Adult ; Choroid/*pathology ; Choroid Neoplasms/*diagnosis/surgery ; Diagnosis, Differential ; Eye Enucleation/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma/*diagnosis/surgery

PURPOSE: To investigate various imaging techniques for the diagnosis of primary uveal melanomas in Korean patients. METHODS: We retrospectively reviewed the medical records of 35 eyes in 35 patients (22 males, 13 females) diagnosed with uveal melanomas between September 2004 and December 2006. The findings of fundus photographs, ultrasonography, CT scan, MRI, and PET scan were documented. RESULTS: A/B scan ultrasonography showed typical findings of uveal melanomas in 74.3% (26 eyes) of the patients. On CT scan, the mass appeared as a homogenous hyperdense lesion, and on MRI, the typical signal of hyperintensity on the T1-weighted image and hypointensity on the T2-weighted image was seen in 89.3% (25 eyes), with contrast enhancement in only 46.4% (13 eyes) of the patients. A PET scan revealed positive tumor uptake in 22.7% (5 eyes) of the patients. CONCLUSIONS: Although ultrasonography is the most useful and accurate method for the diagnosis of uveal melanoma, it provides more atypical cases in Korean patients than Caucasian patients. CT scans and MRI can be used for a differential diagnosis, but the diagnostic efficacy of PET scans is low.
Diagnosis, Differential ; Eye ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Melanoma ; Positron-Emission Tomography ; Retrospective Studies ; Uveal Neoplasms

Purpose: To describe a case of acute retinal necrosis with clinical features of orbital inflammation.Case summary: A 33-year-old female presented with right eye injection, chemosis, and pain. At the first visit, the uncorrectedvisual acuity and intraocular pressure of her right eye were 20/20 and 20 mmHg, respectively. Slit-lamp examination showed inflammatorycell 2+ in the anterior chamber of the right eye; an evaluation of the peripheral retina was not conducted. The nextday, computed tomography (CT) was performed due to aggravation of the orbital inflammation. High-dose intravenous methylprednisoloneinjection was initiated on the finding of posterior scleritis with orbital inflammation on CT scans; peripheral retinalnecrosis and obstructive vasculitis were also noted. Clinically determined to be acute retinal necrosis, the patient began systemicantiviral therapy. A diagnostic anterior chamber paracentesis was positive for herpes simplex virus type 2 by polymerasechain reaction. The patient was treated with intravenous acyclovir and intravitreal injections of foscarnet, as well as barrier lasertherapy. After two weeks of treatment, the patient was discharged with oral valacyclovir. During the three months of follow-up,the visual acuity of the right eye was hand motion, due to chronic optic disc swelling with chronic macular edema and maculardegeneration. Neither eye showed retinal lesion progression. Conclusions Rarely, acute retinal necrosis is accompanied by clinical manifestations of orbital inflammation. Therefore, if patientshave uveitis with orbital inflammation, it is important to consider the possibility of acute retinal necrosis and to examine theperipheral retina carefully.

Purpose: To investigate the tomographic structural changes in the retinal layers after internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM). Methods: Sixty-nine eyes treated with vitrectomy and ILM peeling for idiopathic ERM were analyzed. Parafoveal retinal thickness was measured at baseline and 6 months after surgery. Results: Total retinal thickness decreased significantly in the nasal and temporal subfields after surgery (p < 0.001), whereas the inner nuclear layer and outer nuclear layer showed nasal thickening (all, p < 0.001). The postoperative temporalasal subfield thickness ratio of each layer was significantly lower than that of fellow eyes. Eyes with larger ILM peeling showed a significantly lower temporalasal subfield thickness ratio (p = 0.033) than those with smaller sizes. Conclusions The retinal thickness of each layer showed anatomical changes from ILM peeling and ERM removal. Nasal parafoveal thickening and temporal thinning occurred in the inner retinal architecture, which might be affected by ILM peeling size.

Purpose: To examine the refractive errors, retinal manifestations, and genotype in tuberous sclerosis complex (TSC) patients in a Korean population. Materials and Methods: A total of 98 patients with TSC were enrolled in Severance Hospital for a retrospective cohort study. The number of retinal astrocytic hamartoma and retinal achromic patch within a patient, as well as the size, bilaterality, and morphological type were studied. In addition, the refractive status of patients and the comorbidity of intellectual disability and epilepsy were also examined. Results: Retinal astrocytic hamartoma was found in 37 patients, and bilateral invasion was observed in 20 patients (54%). TSC1 mutation was associated with myopia (p=0.01), while TSC2 mutation was associated with emmetropia (p=0.01). Retinal astrocytic hamartoma was categorized into three morphological types and examined as follows: type I (87%), type II (35%), and type III (14%). Single invasion of retinal astrocytic hamartoma was identified in 32% of the patients, and multiple invasions in 68%. The TSC1/ TSC2 detection rate was 91% (41/45). Among them, TSC1 variant was detected in 23 patients (54%), whereas TSC2 variant was detected in 18 patients (40%). The results showed that TSC2 mutations are correlated with a higher rate of retinal astrocytic hamartoma involvement (all p<0.05), and multiple and bilateral involvement of retinal hamartomas (all p<0.05). However, the size of retinal astrocytic hamartomas, comorbidity of epilepsy, or intellectual disability did not show correlation with the genetic variant. Conclusion TSC1 variant patients were more myopic, while TSC2 variant patients showed association with more extensive involvement of retinal astrocytic hamartoma.

BACKGROUND: This is the studies about "If the soldiers expose in the paraquat, how much have it influenced on themselves who participated in the Vietnam War and their second generation?" and this is also researched about the factors that "How differents do the symptoms according to their health conditions and a class of diseases?". First of all, We divided them into 3 groups as exposure duration and exposure degree of the paraquat and We gave marks against each steps, too. (< point 10: low group, point 11-19: middle group, > point 20: high group). We've focused in "Does the high score really involves with their descendants who suffers from paraquat?" as direct damages men during from June 1965 to February 1971 (72 persons) and their descendants (266 persons) who are in the Pusan veterans hospital and outpatients. METHODS: It is completed by direct interview, telephone interview, army records, army history, and medical records with them. We've tried to minify sample bias as analyzing their information. We could contact only a few people among living in Pusan or Kyongnam province. Generally, someone including persons who couldn't get a damaging proofs from paraquat hardly joined us and the others strongly rejected the interview for this research. RESULTS: Among the 72 participating soldiers in the Vietnam war, average age of patient is 53 years old (the youngest: 46 years old, the oldest: 64 years old), average of exposure score is 16 point (minimum: 1.9 point, maximum: 31.9 point), average of pregnant frequency is 5.2 persons, and average degree of smoking is 14.382 single cigarette (minimum: 4 single cigarette, maximum: 60 single cigarette). The second generation is suffering from abortion, skin disorder, still birth, congenital anomalies, weakness, visual disturbance, peripheral neuropathy in frequency. CONCLUSION: There's no relation between exposure score of paraquat and diseases of the descendants.
Bias (Epidemiology) ; Busan ; Gyeongsangnam-do ; Hospitals, Veterans ; Humans ; Interviews as Topic ; Male ; Medical Records ; Middle Aged ; Military Personnel ; Outpatients ; Paraquat* ; Parturition ; Peripheral Nervous System Diseases ; Skin ; Smoke ; Smoking ; Tobacco Products ; Vietnam*